bluuebunny/crossref_metadata_2025_split huggingface dataset:
Word Identification With Temporally Interleaved Competing Sounds by Younger and Older Adult Listeners
Authors: Helfer Karen S. , Poissant Sarah F. , Merchant Gabrielle R. 
Published: September 2019

Objectives:
The purpose of this experiment was to contribute to our understanding of the nature of age-related changes in competing speech perception using a temporally interleaved task.

Design:
Younger and older adults (n = 16/group) participated in this study. The target was a five-word sentence. The masker was one of the following: another five-word sentence; five brief samples of modulated noise; or five brief samples of environmental sounds. The stimuli were presented in a temporally interleaved manner, where the target and masker alternated in time, always beginning with the target. Word order was manipulated in the target (and in the masker during trials with interleaved words) to compare performance when the five words in each stream did versus did not create a syntactically correct sentence. Talker voice consistency also was examined by contrasting performance when each word in the target was spoken by the same talker or by different talkers; a similar manipulation was used for the masker when it consisted of words. Participants were instructed to repeat back the target words and ignore the intervening words or sounds. Participants also completed a subset of tests from the NIH Cognitive Toolbox.

Results:
Performance on this interleaved task was significantly associated with listener age and with a metric of cognitive flexibility, but it was not related to the degree of high-frequency hearing loss. Younger adults’ performance on this task was better than that of older adults, especially for words located toward the end of the sentence. Both groups of participants were able to take advantage of correct word order in the target, and both were negatively affected, to a modest extent, when the masker words were in correct syntactic order. The two groups did not differ in how phonetic similarity between target and masker words influenced performance, and interleaved environmental sounds or noise had only a minimal effect for all listeners. The most robust difference between listener groups was found for the use of voice consistency: older adults, as compared with younger adults, were less able to take advantage of a consistent target talker within a trial.

Conclusions:
Younger adults outperformed older adults when masker words were interleaved with target words. Results suggest that this difference was unlikely to be related to energetic masking and/or peripheral hearing loss. Rather, age-related changes in cognitive flexibility and problems encoding voice information appeared to underlie group differences. These results support the contention that, in real-life competing speech situations that produce both energetic and informational masking, older adults’ problems are due to both peripheral and nonperipheral changes.
Deep Learning in Automated Region Proposal and Diagnosis of Chronic Otitis Media Based on Computed Tomography
Authors: Wang Yan-Mei , Li Yike , Cheng Yu-Shu , He Zi-Yu , Yang Juan-Mei , Xu Jiang-Hong , Chi Zhang-Cai , Chi Fang-Lu , Ren Dong-Dong 
Published: September 2019

Objectives:
The purpose of this study was to develop a deep-learning framework for the diagnosis of chronic otitis media (COM) based on temporal bone computed tomography (CT) scans.

Design:
A total of 562 COM patients with 672 temporal bone CT scans of both ears were included. The final dataset consisted of 1147 ears, and each of them was assigned with a ground truth label from one of the 3 conditions: normal, chronic suppurative otitis media, and cholesteatoma. A random selection of 85% dataset (n = 975) was used for training and validation. The framework contained two deep-learning networks with distinct functions: a region proposal network for extracting regions of interest from 2-dimensional CT slices; and a classification network for diagnosis of COM based on the extracted regions. The performance of this framework was evaluated on the remaining 15% dataset (n = 172) and compared with that of 6 clinical experts who read the same CT images only. The panel included 2 otologists, 3 otolaryngologists, and 1 radiologist.

Results:
The area under the receiver operating characteristic curve of the artificial intelligence model in classifying COM versus normal was 0.92, with sensitivity (83.3%) and specificity (91.4%) exceeding the averages of clinical experts (81.1% and 88.8%, respectively). In a 3-class classification task, this network had higher overall accuracy (76.7% versus 73.8%), higher recall rates in identifying chronic suppurative otitis media (75% versus 70%) and cholesteatoma (76% versus 53%) cases, and superior consistency in duplicated cases (100% versus 81%) compared with clinical experts.

Conclusions:
This article presented a deep-learning framework that automatically extracted the region of interest from two-dimensional temporal bone CT slices and made diagnosis of COM. The performance of this model was comparable and, in some cases, superior to that of clinical experts. These results implied a promising prospect for clinical application of artificial intelligence in the diagnosis of COM based on CT images.
Association Between Saccule and Semicircular Canal Impairments and Cognitive Performance Among Vestibular Patients
Authors: Pineault Kevin , Pearson Deryck , Wei Eric , Kamil Rebecca , Klatt Brooke , Agrawal Yuri 
Published: September 2019

Objectives:
Growing evidence suggests that vestibular function impacts higher-order cognitive ability such as visuospatial processing and executive functioning. Despite evidence demonstrating vestibular functional impairment impacting cognitive performance, it is unknown whether cognitive ability is differentially affected according to the type of vestibular impairment (semicircular canal [SCC] versus saccule) among patients with diagnosed vestibular disease.

Design:
Fifty-four patients who presented to an academic neurotologic clinic were recruited into the study. All patients received a specific vestibular diagnosis. Forty-one patients had saccule function measured with the cervical vestibular-evoked myogenic potential, and 43 had SCC function measured using caloric irrigation. Cognitive tests were administered to assess cognitive performance among patients. One hundred twenty-five matched controls were recruited from the Baltimore Longitudinal Study of Aging to compare cognitive performance in patients relative to age-matched healthy controls.

Results:
Using multivariate linear regression analyses, patients with bilaterally absent cervical vestibular-evoked myogenic potential responses (i.e., bilateral saccular impairments) were found to take longer in completing the Trail-Making test (β = 25.7 sec, 95% confidence interval = 0.3 to 51.6) and to make significantly more errors on the Benton Visual Retention test part-C (β = 4.5 errors, 95% confidence interval [CI] = 1.2 to 7.8). Patients with bilateral SCC impairment were found to make significantly more errors on the Benton Visual Retention test part-C (β = 9.8 errors, 95% CI = 0.2 to 19.4). From case–control analysis, for each SD difference in Trail-Making test part-B time, there was a corresponding 142% increase in odds of having vestibular impairment (odds ratio = 2.42, 95% CI = 1.44 to 4.07).

Conclusions:
These data suggest that bilateral saccule and SCC vestibular impairments may significantly affect various domains of cognitive performance. Notably, the cognitive performance in patients in this study was significantly poorer relative to age-matched healthy adults. Cognitive assessment may be considered in patients with saccule and SCC impairments, and cognitive deficits in vestibular patients may represent an important target for intervention.
Cochlear Implant Use Remains Consistent Over Time in Children With Single-Sided Deafness
Authors: Ganek Hillary V. , Cushing Sharon L. , Papsin Blake C. , Gordon Karen A. 
Published: September 2019

Objectives:
To measure the acceptance of a cochlear implant by children with single-sided deafness (SSD) using datalogging technology in the cochlear implant processor.

Design:
Datalogs from follow-up clinical audiology appointments for 23 children with SSD were extracted from their cochlear implant processors ranging from 1 to 8 visits (M = 3.74, SD = 1.79). The number of hours the cochlear implant was in use per day, the number of times the coil disconnected from the internal device, and the percentage of daily cochlear implant use in different auditory environments were collected from the datalogs. Linear mixed-effects regressions were used to analyze the relationship between age, hearing experience, cochlear implant use, and coil-offs per day. Nonlinear regressions were conducted to evaluate cochlear implant use in different environments.

Results:
Children with SSD wore their cochlear implants for 6.22 (SD = 2.81; range = 0.0004 to 14.74) hours per day on average. No significant change in cochlear implant use was seen as the children grew older or gained more hearing experience. As hearing experience increased, the number of coil-offs per day was reduced. Preschoolers spent more time in “music” and “speech” and less time in “noise” and “quiet” than older and younger children while older children spent more time in “speech-in-noise.”

Conclusions:
Children with SSD consistently wear their cochlear implants. However, the auditory environments to which they are exposed vary over time. Regular cochlear implant use by this population suggests that it does not detract from a normal-hearing ear and that children with SSD appreciate access to bilateral input.
Overgrowth of the Femur After Internal Fixation in Children With Femoral Shaft Fracture—A Multicenter Study
Authors: Park Kyeong-Hyeon , Park Byoung Kyu , Oh Chang-Wug , Kim Dae-Wook , Park Hoon , Park Kun-Bo 
Published: September 2019

Objectives:
To evaluate overgrowth after internal fixation for pediatric femur fracture and to identify any factors related with overgrowth in terms of fracture type and fixation method.

Design:
Retrospective comparative study.

Setting:
Multicenter, children's hospital and general hospital.

Patients/Participants:
Eighty-seven children between 4 and 10 years of age were included. Length-stable fracture was noted in 49 children, and length-unstable fracture was found in 38 children.

Intervention:
Thirty-six children were treated by minimal invasive plate osteosynthesis (MIPO), and elastic stable intramedullary nail fixation (ESIN) was used in 51 children.

Main Outcome Measurements:
The degree of overgrowth after internal fixation compared to fracture type, fracture site, and surgical method. Multivariable logistic regression analysis was conducted to identify factors related with overgrowth.

Results:
The average overgrowth of the femur was 10.5 ± 7.3 mm. There was no patient who required correction for final leg length discrepancy (>2 cm). There was no significant difference in overgrowth between ESIN (9.9 ± 7.2 mm) and MIPO (11.2 ± 7.6 mm) (P = 0.417). Overgrowth was similar among length-unstable fractures (12.3 ± 7.4 mm) and length-stable fractures (9.2 ± 7.0 mm), although it was statistically greater in length-unstable fractures (P = 0.048). In the MIPO group, length-unstable fractures were associated with an increased log odds of 6.873 for overgrowth of the femur (P = 0.042).

Conclusions:
Femur overgrowth after internal fixation seems to not be a clinically significant problem, regardless of whether that be for length-stable or length-unstable fractures and whether they were treated by MIPO or ESIN. Length-unstable fracture may be a risk factor for overgrowth in children. However, the difference is very small, and the postoperative overgrowth would likely not be a significant factor in deciding the surgical plan.

Level of Evidence:
Therapeutic Level III. See Instructions for authors for a complete description of levels of evidence.
VEPTR Treatment of Early Onset Scoliosis in Children Without Rib Abnormalities: Long-term Results of a Prospective, Multicenter Study
Authors: El-Hawary Ron , Morash Kevin , Kadhim Muayad , Vitale Michael , Smith John , Samdani Amer , Flynn John 
Published: September 2019

Background:
In 2007, this prospective study on vertical expandable prosthetic titanium rib (VEPTR) treatment of early onset scoliosis in children without rib abnormalities was initiated. Two-year follow-up results have previously been reported. This study examines whether, at 5-year follow-up, VEPTR continues to control scoliosis and allow spinal growth.

Methods:
A prospective, multicenter, observational cohort design was used. Patients underwent traditional VEPTR implantation ≥5 years before analysis. Preimplantation and last available images were compared, regardless of whether VEPTR remained in vivo. Additional analysis was performed if VEPTR was in vivo ≥5 years.

Results:
This study included 59 patients (mean age at VEPTR implantation, 6.1±2.4 y; mean follow-up, 6.9±1.4 y). Currently, 24 patients still have VEPTR, whereas 24 have converted (13 fusions, 6 MCGR, 3 growing rods, 1 hybrid, and 1 Shilla). Three have had VEPTR explanted, 6 are unknown, and 2 have deceased. On last available imaging (n=59; mean follow-up, 4.8±1.9 y), scoliosis improved from 71.8±18.0 degrees preoperatively to 60.9±20.3 degrees (P<0.001) and T1- T12 height increased (15.8±3.2 to 19.3±3.8 cm, P<0.001). T1-S1 height also increased (24.8±4.4 to 31.2±5.3 cm, P<0.001), representing 119% age-matched growth. Composite improvement of scoliosis, T1-T12, and T1-S1 height was achieved in 79% of patients. A subset of 29 patients with VEPTR was analyzed at most recent follow-up ≥5 years while VEPTR remained in vivo (24 patients with VEPTR above, and 5 who later converted to other devices). Mean age at implantation was 5.0±2.2 years, with a mean VEPTR treatment duration of 6.2±1.1 years. Scoliosis improved from preoperatively (69.3±14.5 to 61.6±16.1 degrees, P=0.006), with mild recurrence from postoperative to 5 years. T1-T12 height increased (15.0±3.3 to 18.7±3.3 cm, P<0.001) and T1-S1 height increased (23.7±4.5 to 30.1±4.6 cm, P<0.001), representing 83% age-matched growth. Composite improvement was achieved in 83% of patients. Instrumented sagittal length also increased during this period (21.8±4.2 to 30.3±5.1 cm, P<0.001).

Conclusion:
At a 5-year follow-up, VEPTR continues to control scoliosis and allow spinal growth.

Level of Evidence:
Level II—prospective cohort, therapeutic study.
Is Initial Posterior Atlantoaxial Fixation and Fusion Applying Bilateral C1–2 Transarticular Screws and C1 Laminar Hooks Reliable for Acute Pediatric Atlantoaxial Instability?
Authors: Guo Xiang , Han Zhao , Chen Qunxiang , Yang Jun , Chen Fei , Guo Qunfeng , Lin Peida , Ni Bin 
Published: September 2019

Study Design.
A retrospective case series study with at least 10 years of follow-up data.

Objective.
To validate the reliability of bilateral C1–2 transarticular screws and C1 laminar hooks and a bone autograft for acute pediatric atlantoaxial instability.

Summary of Background Data.
The reliability of initial posterior atlantoaxial fusion in pediatric patients is still controversial. To date, however, only a few published articles with short-term follow-up data are available to help spinal surgeons understand the effects of posterior atlantoaxial fusion in the skeletally immature spine.

Methods.
Five pediatric patients with acute atlantoaxial instability underwent atlantoaxial fusion using the above technique over a 3-year period. During a minimum 10-year follow-up period, not only outcomes and complications were investigated, but the vertical growth of the constructed spine in relation to the growth of the entire cervical spine, overall cervical spinal alignment, and adjacent-segment instability were evaluated.

Results.
The clinical follow-up indicated solid fusion and complete clinical relief from symptoms. No neural or vascular impairment was observed. The radiological evaluation showed that all patients had growth within the fusion construct reaching a mean 35.4% of the entire cervical spine. There were no radiological indicators of subaxial instability, even when cervical sagittal alignments became straight with a mean C2–7 angle of 6.4°.

Conclusion.
The results showed that initial posterior atlantoaxial fusion accomplished with bilateral C1–2 transarticular screws, C1 laminar hooks fixation, and bony autograft is a reliable surgical technique for treating acute pediatric atlantoaxial instability without negative effects on vertical growth at the fused level or the stability of the subaxial spine.

Level of Evidence: 3
Independent Association Between Type of Intraoperative Blood Transfusion and Postoperative Delirium After Complex Spinal Fusion for Adult Deformity Correction
Authors: Elsamadicy Aladine A. , Adil Syed M. , Charalambous Lefko , Drysdale Nicolas , Koo Andrew B. , Lee Megan , Kundishora Adam J. , Camara-Quintana Joaquin , Kolb Luis , Laurans Maxwell , Abbed Khalid , Karikari Isaac O. 
Published: September 2019

Study Design.
Retrospective cohort study.

Objective.
To determine whether type of intraoperative blood transfusion used is associated with increased incidence of postoperative delirium after complex spine fusion involving five levels or greater.

Summary of Background Data.
Postoperative delirium after spine surgery has been associated with age, cognitive status, and several comorbidities. Intraoperative allogenic blood transfusions have previously been linked to greater complication risks and length of hospital stay. However, whether type of intraoperative blood transfusion used increases the risk for postoperative delirium after complex spinal fusion remains relatively unknown.

Methods.
The medical records of 130 adult (≥18 years old) spine deformity patients undergoing elective, primary complex spinal fusion (more than or equal to five levels) for deformity correction at a major academic institution from 2010 to 2015 were reviewed. We identified 104 patients who encountered an intraoperative blood transfusion. Of the 104, 15 (11.5%) had Allogenic-only, 23 (17.7%) had Autologous-only, and 66 (50.8%) had Combined transfusions. The primary outcome investigated was the rate of postoperative delirium.

Results.
There were significant differences in estimated blood loss (Combined: 2155.5 ± 1900.7 mL vs. Autologous: 1396.5 ± 790.0 mL vs. Allogenic: 1071.3 ± 577.8 mL vs. None: 506.9 ± 427.3 mL, P < 0.0001) and amount transfused (Combined: 1739.7 ± 1127.6 mL vs. Autologous: 465.7 ± 289.7 mL vs. Allogenic: 986.9 ± 512.9 mL, P < 0.0001). The Allogenic cohort had a significantly higher proportion of patients experiencing delirium (Combined: 7.6% vs. Autologous: 17.4% vs. Allogenic: 46.7% vs. None: 11.5%, P = 0.002). In multivariate nominal-logistic regression analysis, Allogenic (odds ratio [OR]: 24.81, 95% confidence interval [CI] [3.930, 156.702], P = 0.0002) and Autologous (OR: 6.43, 95% CI [1.156, 35.772], P = 0.0335) transfusions were independently associated with postoperative delirium.

Conclusion.
Our study suggests that there may be an independent association between intraoperative autologous and allogenic blood transfusions and postoperative delirium after complex spinal fusion. Further studies are necessary to identify the physiological effect of blood transfusions to better overall patient care and reduce healthcare expenditures.

Level of Evidence: 3
Clinicopathological and Immunohistochemical Study of 14 Cases of Morbihan Disease: An Insight Into Its Pathogenesis
Authors: Ramirez-Bellver Jose L. , Pérez-González Yosmar C. , Chen Ko R. , Díaz-Recuero Jose L. , Requena Luis , Carlson John A. , Llamas-Velasco Mar 
Published: September 2019

Introduction:
Morbihan disease (MORD) is rare with only 45 clear-cut cases previously reported. Histopathologic findings are supposed to be nonspecific. We report 14 patients and review the previous cases.

Objectives:
To characterize the clinicopathologic findings, outcomes, and immunophenotype of MORD.

Material and Methods:
Inclusion criteria were a clinical picture of persistent, nonpitting edema affecting the mid and or upper third of the face and histopathological findings fitting previous reports and exclusion of other entities.

Results:
The majority of our patients were males (71.5%) with a male/female ratio of 10/4. The mean age when diagnosed was 58.8 years. Eyelids and forehead were the most frequently involved areas. Two of the patients presented previous rosacea. Most constant histopathological findings were lymphatic vessel dilatations in the upper dermis and the presence of mast cells (7.5 in 10 high-power field as a mean). Mild edema was also present in most of the cases. Granulomas were found in 7 of the cases, and immunostaining with CD68 and CD14 only revealed an additional case.

Conclusions:
MORD occurs more in middle-aged males, not associated with rosacea and mostly affects eyelids and forehead. Granulomas are not mandatory for the diagnosis. Histopathology of MORD fits within the spectrum of localized lymphedema.
Joint and independent neurotoxic effects of early life exposures to a chemical mixture
Authors: Oulhote Youssef , Coull Brent , Bind Marie-Abele , Debes Frodi , Nielsen Flemming , Tamayo Ibon , Weihe Pal , Grandjean Philippe 
Published: September 2019

Background:Exposure to mercury (Hg) is associated with adverse developmental effects. However, Hg occurs with a multitude of chemicals. We assessed the associations of developmental exposure to multiple pollutants with children’s neurodevelopment using a novel approach.Methods:Hg, polychlorinated biphenyls (PCBs), and perfluoroalkyl substances (PFASs) were measured in maternal and children’s blood at 5 years (n = 449 and 419). At 7 years, children were administered Boston Naming Test (BNT) and the Strengths and Difficulties Questionnaire (SDQ). We used the G-formula combined with SuperLearner to estimate independent and joint effects of chemicals at both ages. We constructed flexible exposure-response relationships and assessed interactions.Results:Most chemicals showed negative relationships with BNT scores. An interquartile range (IQR) increase in maternal Hg and perfluorooctanoic acid (PFOA) was associated with 0.15 standard deviation (SD) (95% confidence interval [CI] = –0.29, –0.03) and 0.14 SD (95% CI = –0.26, –0.05) lower scores in BNT, whereas a joint IQR increase in the mixture of chemicals was associated with 0.48 SD (95% CI = –0.69, –0.25) lower scores in BNT. An IQR increase in PFOA was associated with 0.11 SD (95% CI = 0.02, 0.26) higher total SDQ difficulties scores. Maternal ∑PCBs concentrations were associated with lower SDQ scores (β = –0.09 SD; 95% CI = –0.19, 0), whereas 5 years ∑PCBs showed a negative association (β = –0.09 SD; 95% CI = –0.21, 0). Finally, a joint IQR increase in the mixture was associated with 0.22 SD (95% CI = 0.04, 0.4) higher SDQ scores.Conclusions:Using a novel statistical approach, we confirmed associations between prenatal mercury exposure and lower cognitive function. The potential developmental effects of PFASs need additional attention.