bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inferior Turbinate Hypertrophy: A Review of the Evolution of Management in Children
Authors: Komshian Sevan R. , Cohen Michael B. , Brook Christopher , Levi Jessica R. 
Published: December 2018

Background Historically, there has been uncertainty in the treatment of inferior turbinate hypertrophy (ITH) in children. Although management always begins with medical therapy, the decision to offer surgery in resistant cases is becoming more widely practiced. In the pediatric population, turbinate reduction can be achieved with turbinectomy, electrocautery, lasers, submucous microdebridement, and radiofrequency volumetric tissue reduction (RVTR). However, there remains a lack of consensus on the preferred approach to treatment. Objective To compare how the efficacy, duration, and complications of different surgical methods has changed the management of inferior turbinate hypertrophy in children over time. Methods In March 2018, a comprehensive literature search was performed in PubMed for all inferior turbinate hypertrophy management-related studies in children. Inclusion criteria included children (age, 1–17 years). Exclusion criteria included reviews and abstracts. Results Each technique has experienced a period of popularity over the last 30 years in parallel with the technology available at the time as well as evidence from studies in adults. The literature for ITH management in children has largely followed these trends, with a recent improvement in the quality of studies mirroring the overall increase in surgical practice. Of all methods currently used, RVTR and submucous microdebridement offer the least invasive and most efficacious relief of nasal obstruction. Conclusion This review provides an overview of the evolution of ITH management in children and, based on historic and current evidence, proposes the following graduated recommendation to treatment: (1) a 3-month trial of medical management, (2) evaluation for adenoid hypertrophy for consideration of concurrent adenoidectomy, and (3) RVTR or submucous microdebridement as the first-line surgical approach.
Amifampridine phosphate in the treatment of muscle-specific kinase myasthenia gravis: a phase IIb, randomized, double-blind, placebo-controlled, double crossover study
Authors: Bonanno Silvia , Pasanisi Maria Barbara , Frangiamore Rita , Maggi Lorenzo , Antozzi Carlo , Andreetta Francesca , Campanella Angela , Brenna Greta , Cottini Lorenzo , Mantegazza Renato 
Published: December 2018

Objective: The aim of this study is to determine the safety and the efficacy of amifampridine phosphate in muscle-specific kinase antibody-positive myasthenia gravis, in a 1:1 randomized, double-blind, placebo-controlled, switchback, double crossover study. Methods: Eligible patients had muscle-specific kinase myasthenia gravis, >18 years of age, and Myasthenia Gravis Foundation of America class II–IV with a score of ⩾9 on Myasthenia Gravis Composite scale. After the run-in phase, during which amifampridine phosphate was titrated to a tolerable and effective dosage, patients were randomized to receive placebo–amifampridine–placebo sequence or amifampridine–placebo–amifampridine sequence daily for 7 days. Then, patients switched treatment arms twice, for a total of 21 days of double-blind treatment. Safety was determined by serial assessments of adverse events/serious adverse events, physical examinations, and clinical and laboratory tests. The co-primary outcome measures included changes from baseline of Quantitative Myasthenia Gravis score and Myasthenia Gravis–specific Activities of Daily Living Profile score. The secondary outcome measures comprised changes from baseline of Myasthenia Gravis Composite score, Myasthenia Gravis Quality of Life scale—15 questions, Fatigue Severity Scale, and Carlo Besta Neurological Institute–Myasthenia Gravis scale. Statistical analyses were assessed using a switchback model for three-period, two-treatment crossover design. Results: A total of 10 patients were screened, enrolled, and treated. Transient paresthesias (60%) were the only amifampridine phosphate–related adverse events reported. Four patients were randomized to receive placebo–amifampridine–placebo sequence and three patients to receive amifampridine–placebo–amifampridine sequence. The co-primary objectives were statistically met (Quantitative Myasthenia Gravis score: p = 0.0003 and Myasthenia Gravis–specific Activities of Daily Living Profile score: p = 0.0006), as well as all the secondary endpoints (Myasthenia Gravis Composite score: p < 0.0001, Myasthenia Gravis Quality of Life scale—15 questions: p = 0.0025, Fatigue Severity Scale: p = 0.0061, and Carlo Besta Neurological Institute–Myasthenia Gravis scale: p = 0.0014). Conclusion: Despite the low number of patients, MuSK-001 study provided evidence that amifampridine phosphate, in the range of 30–60 mg daily dose, was safe and effective in treating muscle-specific kinase myasthenia gravis, suggesting the need for a large multi-center trial to confirm these results.
Reaching out to diabetic soles: Outreach foot care pilot project
Authors: Rickards Tracey , Cornish Tammy 
Published: December 2018

Objectives: To assess the effectiveness of outreach foot care services as a tool for engagement with isolated vulnerable seniors. To improve foot health of diabetic seniors, thus avoiding expensive and potentially life-threatening diabetic complications. Methods: Four validated tools are used to gather data: InLow 60-second Diabetic Foot Screen©, Short Diabetes Knowledge Instrument for Older and Minority Adults, Brief Healthcare Questionnaire (Patient Health Questionnaire-9), and the Health-Related Quality of Life Questionnaire. Results: Five monthly visits to 20 participants resulted in multiple co-morbidities being identified, improvements in foot status and diabetic knowledge realized, and determinants of health addressed. Seniors needed support and resources to engage in diabetes self-management. Conclusion: The importance of regular foot care as a key element of any self-management plan for diabetes cannot be understated, nor can increasing social services spending to include coverage for foot care thereby avoiding expensive healthcare. Using foot care as a tool for engagement conferred access to vulnerable seniors who ultimately benefited from healthcare and social interactions with a provider.
Complete laparoscopic excision of a hepatic cyst and omentopexy in a Persian cat
Authors: Lafuente Sofía , Fresno Laura , Anselmi Carlo , Lloret Albert , Espada Ivonne , Santos Laura 
Published: December 2018

Case summary Congenital or acquired hepatic cystic lesions in cats are a rare condition. Congenital hepatic cysts are often present as part of a systemic polycystic disease involving several organs. Most cats with hepatic cysts remain clinically normal for their lives, although some patients may show abdominal distension, vomiting, abdominal pain and jaundice. An 11-year-old female neutered Persian cat was presented to our institution 3 days after the onset of inappropriate defecation and urination. This patient had a history of polycystic kidney disease and a small hepatic cystic lesion. Physical examination showed pain on abdominal palpation. Abdominal ultrasonography revealed an increase in the size of the hepatic cyst and a partial obstruction of the biliary tract. Owing to the progression of the hepatic cyst, laparoscopic excision and omentalisation were performed. The cyst was completely resected using a 5 mm laparoscopic vessel sealer/divider device. It was removed from the abdomen through one of the portals and was submitted for histological study. After cyst excision, omentopexy was performed using 4-0 USP braided absorbable material. At follow-up examination 5 days later, the physical examination was normal and abdominal palpation was not painful. A biopsy report confirmed the diagnosis of a liver cyst. A follow-up abdominal ultrasonography performed 6 months after surgery revealed no recurrence of the liver cyst. Relevance and novel information To our knowledge, this is the first case report describing the laparoscopic technique of liver cystectomy and omentopexy in veterinary medicine. Minimally invasive surgery is gaining widespread acceptance within the veterinary community because of its benefits. However, further investigation with prospective studies are necessary.
Fatal pulmonary hemorrhage associated with vascular amyloid deposition in a cat
Authors: Mawby Dianne I , Whittemore Jacqueline C , Donnell Robert L 
Published: December 2018

Case summary An adult female spayed Siamese-cross cat of unknown age was presented for bilateral hemorrhagic otorrhea. Nasopharyngeal polyps were diagnosed by CT and biopsy; bilateral ventral bulla osteotomies were performed. Episodic epistaxis, otic hemorrhage and hemoptysis with respiratory distress progressed over 18 months. Systolic blood pressure, complete blood count, plasma biochemistries, prothrombin time, partial thromboplastin time and coagulation factor 12, 9 and 8 activities were normal. Serial thoracic radiographs revealed patchy interstitial to alveolar patterns. Airway hemorrhage prevented diagnostic bronchoscopy. Respiratory hemorrhage was ultimately fatal. Amyloid deposition was identified in pulmonary vasculature, bronchial wall, lymphoid tissues, nasal-pharyngeal tissue and tympanic bullae based on microscopic examination and confirmed by Congo red staining with green birefringence under polarized light. Relevance and novel information Amyloidosis should be considered as a differential diagnosis in cats with spontaneous hemorrhage of the respiratory or otic tracts. Although systemic amyloidosis is associated with a grave prognosis, this case suggests that prolonged survival is possible after the initial onset of signs in cats with pulmonary amyloidosis.
Differences in the Nasal Inflammatory Response to Cynodon dactylon From Rural and Urban Areas in Patients With Allergic Rhinitis
Authors: Sánchez Jorge , Sánchez Andres , Sánchez Jorge 
Published: December 2018

Background Epidemiological and experimental studies suggest that air pollution has a negative impact on human health and modifies the environment. However, the clinical implications of changes in environmental allergens secondary to air pollution have been little studied. Objectives To explore if the growth conditions of the Cynodon dactylon (rural vs urban area) modify the inflammatory response among patients with allergic rhinitis. Methodology: Two extracts were prepared for diagnostic test with Cyn d proteins obtained from rural and urban environment. Skin prick test (SPT), nasal challenge test (NCT), and eosinophil count in nasal mucus were performed in 3 groups: healthy subjects without rhinitis, rhinitis with (+) Cyn d, and rhinitis with (−) Cyn d. Results There was a 97% concordance in the positive and negative results of the SPT with the 2 extracts. However, Cyn d-urban extract generated larger wheals ( P = .03) and a higher number of patients with rhinitis presented a positive NCT to this extract (n = 7 vs 14, P = .04). Patients with positive NCT had a significant increase in eosinophils in mucus, but there was no difference between the extracts. The healthy controls did not react to the extracts tested in the skin or nasal test. Conclusion The findings suggest that the growth conditions in urban area of Cynodon dactylon can generate changes in the protein extract and have clinical implications in patients with allergic rhinitis.
Management of Coats Disease Microaneurysms With Fundus Fluorescein Angiography-Guided Navigated Laser
Authors: Brown David , Kozak Igor , Lampen Shaun I. R. , Chhablani Jay 
Published: December 2018

Purpose: The purpose of this case series is to test the safety and efficacy of navigated laser in the treatment of microaneurysms in Coats disease. Methods: In a multicenter, retrospective case series, 10 individuals with active, leaking Coats-related microaneurysms in the macula were included. All participants were treated with the Navilas navigated laser (OD-OS, GmbH, Teltow, Germany) in a navigated treatment mode guided by fundus fluorescein angiography with a minimum of 4-month follow-up. Primary outcomes included central retinal thickness, best-corrected visual acuity, and microaneurysm closure rate. Results: Mean age at navigated laser was 38.8 years (range, 14-61 years). Anatomic improvement or stabilization was noted in all participants (–10 µm), with stability within 10 letters of presenting visual acuity (±0.0 logarithm of the minimum angle of resolution [logMAR] [Snellen equivalent, 20/20]). No patient received any additional antivascular endothelial growth factor (anti-VEGF) treatment after the first navigated laser session. Patients could even discontinue previous anti-VEGF treatments. Conclusion: In this study, angiography-guided navigated laser treatment was a safe and effective treatment modality for Coats disease. The digital planning and navigated application of the laser seem to allow for good efficacy and a low complication rate.
Adsorption capacity of sodic- and dendrimers-modified stevensite
Authors: Hajjaji Mohamed , Beraa Abdellah , Coppel Yannick , Laurent Régis , Caminade Anne-Marie 
Published: December 2018

ABSTRACTThe adsorption capacities of nano-sized organoclays composed of a stevensite-rich clay (R), phosphorus dendrimers (GC1 and GC2) and Na+-saturated clay were evaluated for their capacity to adsorb chromate and methylene blue (MB) in the range of 298–318 K. The adsorption kinetics and the isotherms were analysed based on kinetic equations and isotherm models and by adopting a non-linear regression procedure. In addition, the organoclays and the Na+-saturated clays were characterized principally by solid-state nuclear magnetic resonance spectroscopy. The pseudo-second-order rate equation described kinetics data well, and the adsorption rates were not limited by the intraparticle diffusion or by the liquid film diffusion. Both chemical species were adsorbed spontaneously (–31 <ΔG°T<–10 kJ/mol), but the adsorbents had a high affinity for MB species. The adsorption isotherms of chromate were fitted better by the Freundlich model, while those of MB followed the Langmuir model. Chromate adsorption took place at the edges and the free surfaces of stevensite, particularly at the protonated aluminols. MB was adsorbed as MBH2+and MB+. The MB protonation occurred at the clay surfaces, and MB+ions were located at the planar surfaces of stevensite as well as at the external surfaces of aggregates. Moreover, the tetrahedral sheet of stevensite involved in the formation of GC1-based organoclays was the subject of a partial chemical modification.
The effect of calcination temperature on metakaolin structure for the synthesis of zeolites
Authors: Król Magdalena , Rożek Piotr 
Published: December 2018

ABSTRACTThe aim of this research was to determine the temperature of kaolin calcination in order to obtain an intermediate product (metakaolin) for the synthesis of geopolymers with potential application as self-supporting zeolitic membranes. The products obtained were analysed with X-ray diffraction (XRD), Fourier-transform infrared (FTIR) spectroscopy and scanning electron microscopy (SEM). The structural analysis of the metakaolins obtained suggested that the optimal temperature for the proposed application is 700°C. After alkali activation of metakaolin, it is possible to obtain zeolite A and hydroxysodalite. The factors analysed, determining the type and quantity of crystalline phases, were activation temperature and concentration of sodium hydroxide solution (activator). The largest amounts of zeolites were obtained by alkali activation with 9 mol/dm3 NaOH solution at 70°C.
Interactions of bentonite with metal and concrete from the FEBEX experiment: mineralogical and geochemical investigations of selected sampling sites
Authors: Kaufhold S. , Dohrmann R. , Ufer K. , Kober F. 
Published: December 2018

ABSTRACTThe FEBEX experiment, a full-scale, high-level radioactive waste repository test, ran for ~18 years and hence is the longest-running disposal test to date. The test consisted of a heater emplaced in an envelope of compacted bentonite at the Grimsel test site, Switzerland. The water content of the bentonite was somewhat lower near the heater and increased towards the granite. This phenomenon probably led to gradients in the exchangeable cation population at various locations within the bentonite buffer. The cement (shotcrete) bentonite interface of one block was characterized by a thin (0.1–1.0 mm) reaction zone in which bentonite constituents, carbonates and sulfates occurred. Cation exchange and a slight decrease of the cation exchange capacity were observed near the heater. Oxic corrosion was observed predominantly at the bentonite/steel liner interfaces, pointing towards a role of air entrapped between the liner and heater during emplacement. At the liner surface, intimate intergrowth of bentonite constituents, metal and corrosion products was observed. At the face of the heater, the bentonite blocks were in direct contact with the heater surface without any signs of metal corrosion. Instead, a significant increase in the Mg content was recorded, which is in agreement with previous large-scale disposal tests. The FEBEX experiment proved that the Mg increase and corrosion were independent processes. The increase in Mg may be explained by the formation of trioctahedral domains or the precipitation of neoformed silicates. For the first time, however, brucite was identified as an additional phase that formed at the metal/bentonite interface, pointing towards a special role for Mg mobility in the bentonite barrier.
CD19 Chimeric Antigen Receptor Therapy for Refractory Aggressive B-Cell Lymphoma
Authors: Jacobson Caron A. 
Published: December 2018

PURPOSE Anti-CD19–directed chimeric antigen receptor (CAR) T-cell therapy has had a resounding effect on the treatment of chemotherapy-insensitive aggressive B-cell non-Hodgkin lymphoma (B-NHL). There are now two US Food and Drug Administration (FDA)–approved products available for treating these patients, and a third product is expected to be approved in the coming months. The question remains: Is there a preferred or best product for my patient? However, answering that question is more complicated than simply balancing the reported efficacy and toxicity results. DESIGN This review outlines potential confounding factors involving the three products and their pivotal clinical trials and highlights additional considerations of manufacturing reliability and overall cost that must be considered when weighing one product against another. It will also review the directions in which the field is moving and strategies being examined to improve efficacy as well as toxicity. CONCLUSION Because a randomized three-arm clinical trial is unlikely, a product may have to be chosen on the basis of results from treatment centers that have experience with all three products. But by the time those results are available, they are likely to be outdated because, given the rapid evolution of the field, the next product will probably have been identified.
Narcolepsy, Anesthesia, and Sedation: A Survey of the Perioperative Experience of Patients With Narcolepsy
Authors: Hershner Shelley , Kakkar Rahul , Chung Frances , Singh Mandeep , Wong Jean , Auckley Dennis 
Published: December 2018

BACKGROUND:
Patients with narcolepsy may be at increased perioperative risk due to the interactions among anesthesia, narcolepsy, and narcolepsy medications. This study sought to determine the perioperative experience of narcoleptic patients undergoing anesthesia or sedation, the frequency of perioperative counseling, and self-reported surgical complications.

METHODS:
A 22-question survey was developed by expert consensus and distributed by the Narcolepsy Network. Recruitment was via the Narcolepsy Network’s list-serve and a Facebook link to the survey. One thousand and twenty respondents reported a diagnosis of narcolepsy and 1 or more procedures under anesthesia or sedation. Descriptive, comparative statistics and logistic regression were utilized.

RESULTS:
Respondents were mostly women (79.5%) and Caucasian (84.9%), with a mean age of 45 ± 16 years. Most respondents did not receive counseling regarding the possibility of increased sleepiness (70%), cataplexy (90%), or drowsy driving (59%) postanesthesia. More than half of respondents reported adverse events (medication withdrawal symptoms, inadequate pain relief, increased cataplexy). Subjects with cataplexy more frequently reported surgical complications (70% vs 31%; P = .03) and medication withdrawal symptoms (stimulant medications: odds ratio, 3.0 [95% CI, 1.9, 3.06]; P > .001 and antidepressant medications: odds ratio, 6.5 [95% CI, 2.1–19.5]; P = .001). Of the total sample, 18% indicated surgical complications. Undergoing 5 or more separate surgeries or procedures was associated with a 2-fold increase in self-reported complications (odds ratio, 2.2 [95% CI, 1.3–3.4]; P = .001), difficulty waking (odds ratio, 2.1 [95% CI, 1.45–3.06]; P = .001), and inadequate pain relief (odds ratio, 1.77 [95% CI, 1.01–3.13]; P < .05).

CONCLUSIONS:
Most narcoleptic patients report not receiving counseling regarding potential worsening of narcolepsy symptoms postanesthesia or an increased risk of drowsy driving. Enhanced education of perioperative providers about potential narcolepsy-related issues is essential. Respondents frequently self-report adverse events in the perioperative period. Future studies should clarify the perioperative risk associated with narcolepsy to optimize the care and safety of narcoleptic patients.
A Key Role for the Genetic Counsellor in the Genomics Era
Authors: Joseph Flora M. 
Published: December 2018

New genetic testing technologies such as microarrays and whole exome sequencing mean the diagnostic potential for a child with a development disorder is greatly increased over traditional testing techniques. With this increased potential comes increased expectations from families and professionals about the answers a diagnosis will provide. However, limitations remain and a proportion of individuals will continue to remain undiagnosed. In addition, some individuals will receive novel or very rare diagnoses about which very little is known in terms of prognosis and effective treatments. In this paper, I present an argument for why these families would benefit from additional Genetic Counsellor support and how Clinical Genetics services in the UK could provide this support. I acknowledge that resources are limited, but as demands on services increase and interactions with families become shorter, I argue that this kind of service should be prioritised, for the benefit of these families.