bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of mometasone furoate for nasal polyps
Authors: Yu Hai-jiang , Han Lin , Wang Wei-feng , Yang Lin-hong , Nie Yu-fei 
Published: July 2019

Abstract

Background:
This study aims to systematically explore the efficacy and safety of mometasone furoate (MTF) for patients with nasal polyps (NP).

Methods:
We will search MEDLINE, Cochrane Library, PubMed, Springer, Web of Science, Ovid, Wangfang and Chinese Biomedical Literature Database from their inception to April 30, 2019 without language restrictions. All randomized controlled trials (RCTs) of MTF for the treatment of NP will be considered for inclusion. RevMan 5.3 software will be used for data synthesis, subgroup analysis, sensitivity analysis, as well as the meta-analysis.

Results:
Primary outcomes include change in symptom scores (as measured by any symptom scores), and polyp size (as assessed by any Polyp size scores or tools). Secondary outcomes consist of polyp recurrence, change in nasal air flow, quality of life outcomes (as measured by any quality of life scales, such as Short Form Health Survey is a 36-item), and adverse events.

Conclusion:
This study will provide evidence for judging whether MTF is an effective and safe treatment for NP or not.

PROSPERO registration number:
PROSPERO CRD42019134037.
Nonspecific dizziness as an unusual presentation of neurocysticercosis
Authors: Li Huiying , Sun Jing , Nan Guangxian 
Published: July 2019

Abstract

Rationale:
Neurocysticercosis (NCC) can cause lesions across the central nervous system, leading to varying clinical manifestations. While the presentation of nonspecific symptom is rare, they are easy to ignore. The present report documents a case of NCC that manifested as persistent dizziness.

Patient concerns:
A Chinese woman visited the hospital on account of dizziness, the severity of which had increased gradually over the month prior.

Diagnoses:
Head computed tomography and magnetic resonance imaging (MRI) revealed hydrocephalus. Cervical MRI revealed an abnormal object in the spinal canal at the junction of the medulla oblongata and C1, which blocked the circulation cerebrospinal fluid circulation and caused the enlargement of the ventricles.

Intervention:
The patient underwent surgical treatment. The abnormal object was removed, and a diagnosis of NCC was considered by pathological examination.

Outcome:
The patient's dizziness resolved after surgical treatment, and no other symptoms appeared thereafter.

Lesson:
Clinicians should not ignore nonspecific clinical symptoms, as they may indicate hydrocephalus.
A suprasellar bronchogenic cyst
Authors: Bian Bingyang , Yu Miao , Liu Shanshan , Li Shu , Wei Ying , Zhang Bei 
Published: July 2019

Abstract

Rationale:
Bronchogenic cysts are mainly benign, congenital abnormalities, originating from the remnants of the primitive foregut. However, intracranial bronchogenic cysts have been rarely observed. Hence, better understanding of the suprasellar bronchogenic cysts is of great significance to properly perform perioperative management.

Patient's concerns:
A 62-year-old Chinese female was admitted to our hospital due to impairment of memory and asthenia.

Diagnosis:
Magnetic resonance imaging (MRI) confirmed presence of cystic lesion in the suprasellar region. The patient underwent craniotomy with resection of the cystic mass. The histopathological examinations confirmed diagnosis of bronchogenic cyst as well.

Interventions:
The cystic lesion was removed without complications. No drugs during follow-up were recommended.

Outcomes:
After discharge, the patient was advised to undergo MRI for 6 months to 1 year. No evidence of recurrence was found in the first postoperative review.

Lessons:
Bronchogenic cysts should be considered in differential diagnosis of cystic mass detected in the suprasellar region on MRI. Once the disease is considered, surgical resection is recommended to obtain pathological diagnosis, alleviate clinical symptoms, and prevent complications.
Spinal epidural hematoma occurring at a distance from the transforaminal epidural injection site
Authors: Kim Sang-In , Lee Dong-Hyun , Kim Sun-Hee , Cho Yong-Hyun 
Published: July 2019

Abstract

Rationale:
Transforaminal epidural steroid injection (TFESI) is a conservative method to treat back pain due to radiculopathy. However, epidural hematoma can occur after the procedure by various mechanisms, which can cause serious complications.

Patient concerns:
An 82-year-old man with spinal stenosis was treated with TFESI in the right intervertebral foramen at the L2-L3 level. The next morning, he experienced severe back pain and diffuse motor deficit.

Diagnosis:
Emergency magnetic resonance imaging revealed fluid collection in the posterior epidural space at the T11-L1 level with central-canal stenosis.

Interventions:
Emergency hematoma evacuation was performed to remove the epidural hematoma.

Outcomes:
After the surgery, the back pain disappeared.

Lessons:
Epidural hematoma may occur due to causes other than direct needle injury after TFESI. Therefore, careful observation of the patient is necessary after the procedure.
Five-year Impact of a Commercial Accountable Care Organization on Health Care Spending, Utilization, and Quality of Care
Authors: Zhang Hui , Cowling David W. , Graham Joanne M. , Taylor Erik 
Published: July 2019

Background:
Accountable Care Organizations (ACOs) have proliferated after the passage of the Affordable Care Act in 2010. Few longitudinal ACO studies with continuous enrollees exist and most are short term.

Objective:
The objective of this study was to evaluate the long-term impact of a commercial ACO on health care spending, utilization, and quality outcomes among continuously enrolled members.

Research Design:
Retrospective cohort study design and propensity-weighted difference-in-differences approach were applied to examine performance changes in 2 ACO cohorts relative to 1 non-ACO cohort during the commercial ACO implementation in 2010–2014.

Subjects:
A total of 40,483 continuously enrolled members of a commercial health maintenance organization from 2008 to 2014.

Measures:
Cost, use, and quality metrics for various type of services in outpatient and inpatient settings.

Results:
The ACO cohorts had (1) increased inpatient and outpatient total spending in the first 2 years of ACO operation, but insignificant differential changes for the latter 3 years; (2) decreased outpatient spending in the latter 2 years through reduced primary care visits and lowered spending on specialists, testing, and imaging; (3) no differential changes in inpatient hospital spending, utilization, and quality measures for most of the 5 years; (4) favorable results for several quality measures in preventive and diabetes care domains in at least one of the 5 years.

Conclusions:
The commercial ACO improved outpatient process quality measures modestly and slowed outpatient spending growth by the fourth year of operation, but had a negligible impact on inpatient hospital cost, use, and quality measures.
Update on treatment options for blast-induced hearing loss
Authors: Mizutari Kunio 
Published: July 2019

Purpose of review
The incidence of blast injuries has increased, and the ear is the highest risk organ. Ear injury induced by blast exposure is important in both military and civilian conditions. The permanent hearing loss caused by blast exposure is associated with a decline in the quality of life. In this review, I describe recent therapeutic strategies for each of the ear pathologies caused by blast exposure.

Recent findings
For tympanic membrane perforation after blast exposure, basic fibroblast growth factor (bFGF) has been used as a less invasive treatment to repair the tympanic membrane. The closure rates of tympanic membrane perforations treated with bFGF were reported to be comparable to those following conventional tympanoplasty.
For sensorineural hearing loss after blast exposure, treatment with neurotrophic factors, such as nerve growth factor (NGF) or neurotrophin-3, antioxidants, and Atoh1 induction have recently been applied, and some of them were considered for clinical application.

Summary
Recent advances of therapeutics for blast-induced hearing loss, based on their pathologies, have been outlined. There are several promising therapeutic approaches for both middle and inner ear disorders after blast exposure; however, further research is needed to establish new treatments for blast-induced hearing dysfunction.
Spleen and Liver Stiffness to Detect Esophageal Varices in Children with Biliary Atresia
Authors: Sintusek Palittiya , Siriporn Nipaporn , Punpanich Dollapas , Chongsrisawat Voranush , Poovorawan Yong 
Published: July 2019

ABSTRACTObjectives:The aim of the study was to determine the accuracy of noninvasive parameters, such as liver (LS) and spleen stiffness (SS) to detect esophageal varices (EV) in children with biliary atresia (BA).Methods:Children with BA between 2000 and 2015 were recruited. All underwent esophagogastroduodenoscopy and transient elastography. Demographic data, laboratory investigations, alanine transferase‐to‐platelet ratio index (APRI), and Varices Prediction Rule (VPR) score were collected.Results:A total of 51 children (mean age 10.63 years, standard deviation (SD) = 6.08 years; 53% boys) were enrolled. There were differences in onset and outcome of portoenterostomy, spleen palpablility, platelet count, albumin, LS, SS, and VPR between the varice and varice‐free groups (P < 0.05). In the varice group, the median LS was 18.12 (interquartile ratio, IQR 13.15–19.12) and the median SS was 46.85 (IQR 25.95–54.55) kPa. In the varice‐free group, the median LS was 7.85 (IQR 5.88–16.75) and the median SS was 16.54 (IQR 11.75–21.75) kPa. Both LS and SS were higher in the varice than the varice‐free group (P < 0001). The area under the receiver operating characteristic curve of LS, SS, spleen palpability, platelet count, APRI, and VPR were 0.734, 0.870, 0.817, 0.810, 0.751, and 0.794, respectively. Using a cut‐off value of 12.5 kPa for LS, the sensitivity and specificity were 80 and 70%, respectively. Using a cut‐off value of 28.9 kPa for SS, the sensitivity and specificity were 75 and 87%, respectively. Combination of LS and SS to diagnose varices increased the specificity to 93%.Conclusions:SS as a single marker had the best diagnostic value to predict esophageal varices in children with BA. The combination of SS and LS furthermore, increased the diagnostic yield.
Toward Optimal Communication About HPV Vaccination for Preteens and Their Parents: Evaluation of an Online Training for Pediatric and Family Medicine Health Care Providers
Authors: Cates Joan R. , Diehl Sandra J. , Fuemmeler Bernard F. , North Stephen W. , Chung Richard J. , Hill Jill Forcina , Coyne-Beasley Tamera 
Published: July 2019

Objective:
Health care provider recommendation is a key determinant of human papillomavirus (HPV) vaccination. We developed an online training program for providers that addressed vaccine guidelines, hesitancy to strongly recommend the vaccine, and reluctance to discuss HPV infection as a sexually transmitted infection.

Design:
Single-group evaluation with 3 waves. Providers completed a 29-item electronic survey with closed and open-ended response options after course completion.

Setting:
Pediatric and family medicine practices in North Carolina.

Participants:
Prescribing clinicians (MD, DO, family nurse practitioner, physician assistant) who serve preteens aged 11 to 12 years. In wave 3, we expanded our communities to include nursing and medical staff.

Intervention:
An asynchronous online course to promote preteen HPV vaccination. Topics included HPV epidemiology, vaccine recommendations from the Advisory Committee on Immunization Practices (ACIP), preteen-provider-parent communication, topics about hesitancy to seek vaccination, subjects related to sexual health, and practice-level strategies to increase vaccination rates. The course, approved for 12 CME and CNE credits, was live for 4 weeks and available on-demand for 3 additional months.

Main Outcome Measures:
Provider-reported change in vaccine communication, perceptions of course content in improving practice, and satisfaction with materials.

Results:
A total of 113 providers from 25 practices enrolled in the course and 69 (61%) completed an evaluation. Providers spent an average of 6.3 hours on the course and rated the CDC (Centers for Disease Control and Prevention)-ACIP Web site and multiple resources on hesitancy and communication about sexually transmitted infection vaccines most highly of all materials across the 3 waves. Almost all (96%) agreed the course will improve their practice. About half of all participants said they were either “much more likely” (28%) or “more likely” (19%) to recommend the vaccine after course participation.

Conclusions:
An online format offers a highly adaptable and acceptable educational tool that promotes interpersonal communication and practice-related changes known to improve providers' vaccine uptake by their patients.
Cigarette Use Among American Indians and Alaska Natives in Metropolitan Areas, Rural Areas, and Tribal Lands
Authors: Cunningham James K. , Ritchey Jamie , Solomon Teshia A. , Cordova Felina M. 
Published: July 2019

Context:
Cigarette use among the US general population is significantly lower in metropolitan areas than in rural areas.

Objective:
To assess whether cigarette use among American Indians and Alaska Natives (AI/AN) is lower in metropolitan areas than in rural areas and tribal lands (which are predominantly rural).

Design:
Data came from the National Survey on Drug Use and Health (2012-2016). Regressions with adjustments for demographics were performed to assess whether cigarette use differed in association with type of place.

Settings:
The AI/AN in tribal lands (n = 1569), nontribal large metropolitan (1+ million people) areas (n = 582), nontribal small metropolitan (<1 million) areas (n = 1035), and nontribal rural areas (n = 1043).

Main Outcome Measures:
Cigarette abstinence, current smoking, daily use, number of cigarettes used, and days of use—all in the past month. Nicotine dependence was also examined.

Results:
Metropolitan (large or small) areas versus rural areas: no statistically significant differences in cigarette use were found. Metropolitan (large or small) areas versus tribal lands: days of cigarette use and daily use were significantly lower in tribal lands. Tribal lands were also lower than small metropolitan areas regarding number of cigarettes used and nicotine dependence. Rural areas versus tribal lands: cigarette measures were consistently lower in tribal lands. For example, the prevalence of current smokers, daily users and nicotine dependence, respectively, was 37.9%, 25.9%, and 16.3% in rural areas and 27.4%, 13.6%, and 8.9% in tribal lands.

Conclusions:
Differences in cigarette use between AI/AN in nontribal rural and metropolitan areas were not indicated. Instead, the place differences found were lower cigarette use in tribal lands than in nontribal rural areas and, to some extent, metropolitan areas. These findings can help inform policy makers working to develop context-sensitive anticommercial tobacco efforts for AI/AN.
Using Resident and Faculty Focus Groups to Obtain Stakeholder Input during the ACGME Self-study
Authors: Huggins Kathryn M. , Sprewell Angelina R. , Elmore Dominique C. , Shepherd Meagan W. , LeGrow Tracy L. , Frazier Marie D. , Flesher Susan L. 
Published: July 2019

Introduction:
The Accreditation Council for Graduate Medical Education describes steps to guide programs regarding self-study. The process relies heavily on obtaining stakeholder input to validate findings. Focus groups have been noted to provide input and data not elicited using other methods. Our objective was to show the value of focus groups in obtaining a clear picture of stakeholder priorities as they relate to program aims, opportunities, threats, areas for improvement, and sustainability of improvements.

Methods:
We conducted a series of focus groups in 2017–2018 at a pediatric residency program with residents and core faculty members. The first session for each group elicited input regarding program aims, opportunities, and threats. The second session focused on evaluating program progress over the past 10 years and identifying strengths and needed areas for improvement. We documented responses obtained during the focus groups and used inductive content analysis methods to identify major themes. We repeated the focus groups every 6 months.

Results:
We identified 8 program aims and pinpointed opportunities and threats. Areas for improvement were selected and then presented back to the stakeholders who confirmed their appropriateness. Repetition of the focus groups every 6 months facilitated ongoing measurement of progress and promoted the development of multiple plan, do, study, act cycles for areas of improvement.

Conclusions:
Focus groups are an effective way to initiate the self-study process, examine the program aims, opportunities, and threats, and formulate a detailed improvement plan. They are also useful as part of continual evaluation during a dynamic change process.
Sensory Recovery of the Breast following Innervated and Noninnervated DIEP Flap Breast Reconstruction
Authors: Beugels Jop , Cornelissen Anouk J. M. , van Kuijk Sander M. J. , Lataster Arno , Heuts Esther M. , Piatkowski Andrzej , Spiegel Aldona J. , van der Hulst René R. W. J. , Tuinder Stefania M. H. 
Published: July 2019

Background:
The sensory recovery of the breast remains an undervalued aspect of autologous breast reconstruction. The aim of this study was to evaluate the effect of nerve coaptation on the sensory recovery of the breast following DIEP flap breast reconstruction and to assess the associations of length of follow-up and timing of the reconstruction.

Methods:
A prospective comparative study was conducted of all patients who underwent either innervated or noninnervated DIEP flap breast reconstruction and returned for follow-up between September of 2015 and July of 2017. Nerve coaptation was performed to the anterior cutaneous branch of the third intercostal nerve. Semmes-Weinstein monofilaments were used for sensory testing of the native skin and flap skin.

Results:
A total of 48 innervated DIEP flaps in 36 patients and 61 noninnervated DIEP flaps in 45 patients were tested at different follow-up time points. Nerve coaptation was significantly associated with lower monofilament values in all areas of the reconstructed breast (adjusted difference, −1.2; p < 0.001), which indicated that sensory recovery of the breast was significantly better in innervated compared with noninnervated DIEP flaps. For every month of follow-up, the mean monofilament value decreased by 0.083 in innervated flaps (p < 0.001) and 0.012 in noninnervated flaps (p < 0.001). Nerve coaptation significantly improved sensation in both immediate and delayed reconstructions.

Conclusions:
This study demonstrated that nerve coaptation in DIEP flap breast reconstruction is associated with a significantly better sensory recovery in all areas of the reconstructed breast compared with noninnervated flaps. The length of follow-up was significantly associated with the sensory recovery.
The Use of Emotional Artificial Intelligence in Plastic Surgery
Authors: Levites Heather A. , Thomas Analise B. , Levites Jim B. , Zenn Michael R. 
Published: July 2019

Background:
The use of social media to discuss topics related to and within plastic surgery has become widespread in recent years; however, it remains unclear how to use this abundance of largely untapped data to propagate educational research in the field of plastic surgery. In this prospective, observational study, the authors aimed to delineate which plastic surgery–related topics evoked a significant emotional response within the study population and to assess the utility of motivational artificial intelligence within the field of plastic surgery.

Methods:
Over a 4-month period (January to April of 2018), Cognovi Lab’s artificial intelligence technology was used to search and analyze emotional reactions to several commonly hashtagged words. This innovative software uses several key metrics to describe its findings, including awareness, engagement, and motivation.

Results:
Of the search terms examined, “nose job” had the most awareness during the study period, and the topic that most engaged consumers emotionally was “liposuction.” Interestingly, “liposuction” ranked only fifth in terms of awareness. Consumers showed the strongest positive motivation toward the subjects of “plastic surgery” and “cosmetic surgery,” and the lowest motivation toward the topic of “tummy tucks.”

Conclusions:
This analysis by Cognovi Labs is the first quantitative effort to use the plethora of data on social media to interpret patient motivations and subsequent behavior. Moving forward, artificial intelligence technology will make it possible to predict which plastic surgery products, procedures, and practices will be successful. The findings presented in this article describe the unique viewpoint and power that this technology can deliver.
Dynamic FET PET Imaging of a “Butterfly” IDH-Wildtype Anaplastic Astrocytoma
Authors: Galldiks Norbert , Brunn Anna , Fink Gereon R. , Langen Karl-Josef 
Published: July 2019

Abstract
A variety of neoplastic and nonneoplastic conditions involve the corpus callosum, which may result in a “butterfly” appearance on conventional MRI. Typically, that pattern shows a bilateral and heterogeneous contrast enhancement of the lesion, occasionally with central nonenhancing areas indicating intralesional necrosis. In contrast, anaplastic gliomas may show only minimal or even a lack of contrast enhancement on MRI. We here report neuroimaging findings in a 69-year-old man with a “butterfly” pattern on dynamic FET [O-(2-[18F]-fluoroethyl)-l-tyrosine] PET and the diagnosis of an anaplastic astrocytoma (WHO grade III; IDH-1/−2 wildtype, no 1p/19q co-deletion) but without typical MRI contrast enhancement.
Uptake of Pineal Gland Visible on 18F-DOPA PET/CT With Last Generation of SiPM PET/CT
Authors: Decazes Pierre , Hapdey Sébastien , Humbert Olivier , Marie-Cardine Aude , Vera Pierre 
Published: July 2019

Abstract
A 17-year-old girl underwent an 18F-DOPA brain PET/CT on a new high-resolution digital SiPM PET/CT (Vision600 Siemens) to explore a suspicion of recurrence of a pilocytic astrocytoma. This study showed a local recurrence, but a second intense focal uptake was visible above, more intense than striata. On fused MRI, this was the pineal gland considered as physiological. This physiological uptake, due to a pineal DOPA decarboxylase activity, has also been observed with this PET system in other patients with 18F-DOPA to explore movement disorders. New high-resolution PET can show uptake of small structures by being less dependent to partial volume effect.