bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Hearing Impairment in Mahabubnagar District, Telangana State, India
Authors: Bright Tess , Mactaggart Islay , Kuper Hannah , Murthy G. V. , Polack Sarah 
Published: May 2018

Objectives:
To estimate the prevalence of hearing impairment in Mahabubnagar district, Telangana state, India.

Methods:
A population-based prevalence survey of hearing impairment was undertaken in 2014. Fifty-one clusters of 80 people aged 6 months and older were selected using probability-proportionate-to-size sampling. A two-stage hearing screening was conducted using otoacoustic emissions on all participants followed by pure-tone audiometry on those aged 4 years and older who failed otoacoustic emissions. Cases of hearing impairment were defined using the World Health Organization definition of disabling hearing impairment: a pure-tone average of thresholds at 500, 1000, 2000, and 4000 Hz of ≥41 dB HL for adults and ≥31 dB HL for children based on the better ear. Possible causes of hearing impairment were ascertained by a certified audiologist. Reported hearing difficulties were also measured in this survey and compared with audiometry results.

Results:
Three thousand five hundred seventy-three people were examined (response rate 87%), of whom 52% were female. The prevalence of disabling hearing impairment was 4.5% [95% confidence interval (CI) = 3.8 to 5.3). Disabling hearing impairment prevalence increased with age from 0.4% in those aged 4 to 17 years (95% CI = 0.2 to 1.1) to 34.7% (95% CI = 28.7 to 41.1) in those aged older than 65 years. No difference in prevalence was seen by sex. Ear examination suggested that the possible cause of disabling hearing impairment was chronic suppurative otitis media for 6.9% of cases and dry perforation for 5.6% cases. For the vast majority of people with disabling hearing impairment, a possible cause could not be established. The overall prevalence of reported or proxy reported hearing impairment was 2.6% (95% CI = 2.0 to 3.4), and this ranged from 0.6% (95% CI = 0.08 to 4.4) in those aged 0 to 3 years to 14.4% (95% CI = 9.8 to 20.7) in those aged older than 65 years.

Conclusions:
Disabling hearing impairment in Telangana State is common, affecting approximately 1 in 23 people overall and a third of people aged older than 65 years. These findings suggest that there are a substantial number of individuals with hearing impairment who could potentially benefit from improved access to low-cost interventions.
Management of Simultaneous Patellar Tendon and Anterior Cruciate Ligament Ruptures—A Systematic Review of Available Literature
Authors: Matthews Alexander Handel , Fraser Ethan James , Parkinson Benjamin 
Published: May 2018

Background:
Combined rupture of the anterior cruciate ligament (ACL) and patellar tendon (PT) is a rare injury pattern. Currently, little evidence exists to help guide management decisions for these patients.

Methods:
A systematic literature search was conducted using PubMed (MEDLINE) and Scopus (EMBASE and MEDLINE) for all articles reporting on combined rupture of the ACL and PT. The characteristic injury mechanisms, common presentation findings, and outcomes of simultaneous and staged treatment strategies were determined to provide guidance for the management of this uncommon injury pattern. An additional case report from our institution is also reported.

Results:
Overall, 17 studies met the inclusion criteria and were included in our qualitative review. The mean age at injury was 30 years (range, 15–50 years). A high-energy injury with a rapid deceleration event through a flexed knee on a fixed foot is commonly described as the mechanism of injury. Anterior cruciate ligament rupture was missed on initial clinical examination in 24.1% compared with 17.2% for PT rupture. Injuries to the medial collateral ligament and menisci occured in 65.5% of cases. Outcome scores were reported in 41.4% (12/22) of patients undergoing staged or simultaneous repair. The Lysholm score postoperatively was 96 ± 3.3 for the staged group compared with 85.3 ± 18.6 for simultaneous repair. There were no clear differences between range of motion, time to return to sport, and complication rates between the groups.

Conclusions:
A high index of suspicion is required to detect concomitant ACL injuries when assessing high-energy PT ruptures. Simultaneous or staged protocols to address both injuries are safe and effective management strategies for this rare combined injury pattern.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Pull-out of Upper Thoracic Pedicle Screws Can Cause Spinal Canal Encroachment in Growing Rod Treatment
Authors: Bekmez Senol , Kocyigit Aykut , Olgun Zeynep Deniz , Ayvaz Mehmet , Demirkiran Halil Gokhan , Karaagaoglu Ergun , Yazici Muharrem 
Published: May 2018

Background:
Proximal foundation failure is a common complication of growing rod (GR) treatment for early-onset scoliosis. Spinal canal encroachment due to pull-out of pedicle screw used as proximal foundation has been anecdotally reported in GR patients. The aim of this study is to report the prevalence of spinal canal encroachment of pedicle screws in GR treatment and determine risk factors using a single-center cohort.

Methods:
Inclusion criteria were: (1) GR for early-onset scoliosis and (2) pull-out of at least 1 proximal anchor pedicle screw. Patients were divided into 2 groups according to the presence of medial screw migration. Medial migration of the screw was confirmed by computed tomography. The extracted data included demographic, clinical, and radiographic information.

Results:
A total of 21 patients (of 96) met inclusion criteria (21.8%). None of the screws appeared malpositioned on early postoperative x-ray. Average follow-up until screw failure was 50.4 months (64 to 85 mo) and average number of lengthenings 8.1 (4 to 13). Computed tomography revealed canal encroachment in 11 patients (group 1), and no encroachment in 10 (group 2). There was no significant difference between groups for age, follow-up or number of lengthenings. At the time of screw pull-out, coronal plane deformity was increased compared with early postoperative x-ray in all; however, this increase was significantly higher in group 1 (45.7 vs. 35 degrees, P=0.002). Proximal junctional angle (PJA) was increased in both groups at the time of pull-out. While not statistically significant, PJA increased linearly in group 1 but spiked in group 2 at the time of pull-out. There was no neurological event preoperatively, intraoperatively or postoperatively. Failed screws were safely revised in either planned/unplanned surgeries.

Conclusions:
In patients with proximal anchor failure of GR, especially if there is increase of coronal deformity and/or PJA, possible spinal encroachment should be kept in mind.

Level of Evidence:
Level IV—retrospective case series.
Novel Placement of Cortical Bone Trajectory Screws in the Lumbar Spine
Authors: Gao Hai , Zhang Renjie , Jia Chongyu , Xing Tao , Zhang Jianxiang , Dong Fulong , Ge Peng , Song Peiwen , Xu Peng , Zhang Huaqing , Li Huimin , Shen Cailiang 
Published: May 2018

Study Design:
This is a radiographic and cadaveric study.

Objective:
The aim of this study was to conduct a detailed comparison about the parameters between the ideal cortical bone trajectory (CBT) and practical CBT screw.

Summary of Background Data:
CBT screws have recently become popular in spinal surgery, mainly because of their improved fixation while minimizing soft tissue dissection. However, to our knowledge, no previous study has provided a detailed comparison on the parameters between the ideal CBT and practical CBT screws.

Materials and Methods:
The 3-dimensional computed tomography scans of 126 spinal vertebrae separated from 40 lumbar spines were studied. After determining the CBT, the maximal screw length, maximal screw diameter, lateral angle (LA), and cephalad angle (CA) were calculated. Thereafter, CBT screws were inserted into these cadaveric lumbar spines. Subsequently, the lateral angle of screw (LAs) and cephalad angle of screw (CAs) of the screws were measured using 3-dimensional computed tomography.

Results:
As for the ideal CBT, the maximal screw length gradually increased from L1 (32.0 mm) to L4 (35.3 mm) and then decreased at L5 (34.8 mm). Moreover, the maximal screw diameter increased from L1 (4.5 mm) to L5 (7.5 mm). The LA from L1 to L5 were 9.2, 9.4, 9.9, 11.2, and 12.0 degrees, respectively. The CA from L1 to L5 were 25.8, 25.8, 26.3, 26.8, and 26.0 degrees, respectively. As for the actual CBT screw, the LAs from L1 to L5 were 12.7, 14.1, 13.2, 12.4, and 13.0 degrees, respectively. The CAs from L1 to L5 were 25.4, 27.5, 29.2, 30.1, and 30.5 degrees, respectively. Significant differences were observed between the angles of the ideal trajectory and the actual screw.

Conclusions:
Parameters of the actual CBT screw are slightly larger than the optimal trajectory measurements. The CAs and LAs are ∼25–30 and 10–16 degrees, respectively. L1 and L2 should be given considerable attention when using the CBT technique. And the trajectory measurements can only be used as a guide in clinical practice.
Inhibition of Vascular Endothelial Cell Leak Following Escherichia coli Attachment in an Experimental Model of Sepsis
Authors: McHale Tony M. , Garciarena Carolina D. , Fagan Robert P. , Smith Stephen G. J. , Martin-Loches Ignacio , Curley Gerard F. , Fitzpatrick Fidelma , Kerrigan Steve W. 
Published: May 2018

Objectives:
The vascular endothelium is a major target of sepsis-induced events, and endothelial activation accounts for much of the pathology of sepsis. Urinary tract infections and pneumonia caused by Escherichia coli are among of the most common infections causing sepsis in both community and hospital settings. Currently, there are no approved drugs on the market to treat the underlying pathophysiology of sepsis. The aim of this study is to elucidate the molecular mechanism by which E. coli induces endothelial injury as a result of attachment.

Design:
Laboratory research using a hemodynamic perfusion ex vivo model.

Setting:
Research Laboratories of Royal College of Surgeons in Ireland and Beaumont Hospital.

Patients:
Ex vivo human vascular endothelial cells.

Interventions:
Addition of αVβ3 antagonist, cilengitide.

Measurements and Main Results:
Clinical strains of E. coli isolated from patients with sepsis bound to sheared human endothelial cells under static and hemodynamic shear conditions. Binding was dependent on E. coli cell membrane protein outer membrane protein A attaching directly to endothelial cell integrin αVβ3. Attachment resulted in disturbances in endothelial barrier integrity, as determined by loss of tight junction protein staining, permeability changes, and ultimately cell death by apoptosis. Using a low concentration of the αVβ3 antagonist cilengitide or using a strain deficient in outer membrane protein A resulted in a significant reduction in endothelial dysfunction following infection.

Conclusions:
Inhibition of E. coli binding to endothelial cell αVβ3 by cilengitide prevents endothelial dysfunction and may, therefore, present as a novel early therapeutic for the treatment of sepsis.
Acute Neurologic Complications During Extracorporeal Membrane Oxygenation: A Systematic Review
Authors: Sutter Raoul , Tisljar Kai , Marsch Stephan 
Published: May 2018

Objectives:
We determine the frequency, risk factors, and mortality of neurologic complications in adults on extracorporeal membrane oxygenation and propose an algorithm for preventive strategies.

Data Sources:
PubMed, Embase, and Cochrane databases.

Study Selection:
Screening was performed using predefined search terms to identify cohort studies reporting neurologic complications in adults during extracorporeal membrane oxygenation from 1990 to 2017.

Data Extraction:
The final reference list was generated on the basis of relevance to the discussed topics. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation classification of evidence scheme.

Data Synthesis:
In 44 studies, the median frequency of acute neurologic complications is 13% (1–78%; 5% intracranial hemorrhages, 5% ischemic strokes, 2% seizures). Neurologic complications are reported more frequently with venoarterial extracorporeal membrane oxygenation compared with venovenous extracorporeal membrane oxygenation (14 vs eight studies) with a median proportion of complications of 15% (6–33%; 95% CI, 8–19) for venoarterial extracorporeal membrane oxygenation. Median in-hospital mortality is higher with neurologic complications (83%; interquartile range, 54–100% vs 42%; interquartile range, 24–55% without neurologic complications; p < 0.001). Median mortality is 96% for hemorrhages, 84% for ischemic strokes 84%, and 40% for seizures. Risk factors are age, preextracorporeal membrane oxygenation cardiac arrest, hypoglycemia, and administration of inotropes. Hemorrhages are associated with female gender, duration of ventilation and extracorporeal membrane oxygenation, decreased serum fibrinogen, heparin, serum creatinine greater than 2.6 mg/dL, hemodialysis, and thrombocytopenia. Increased odds for ischemic stroke is seen with a preextracorporeal membrane oxygenation serum lactate greater than 10 mmol/L. No studies report daily coagulation monitoring and neurologic assessments, and quality of evidence was low to very low.

Conclusions:
Neurologic complications are reported frequently and with high occurrence rate, especially with venoarterial extracorporeal membrane oxygenation, and associated with high mortality calling for daily weaning from sedation and neuromuscular blockers for neurologic assessment and coagulation monitoring. The low quality of evidence indicates the need for higher quality studies in this context.
Reversible Microvascular Hyporeactivity to Acetylcholine During Diabetic Ketoacidosis
Authors: Joffre Jérémie , Bourcier Simon , Hariri Geoffroy , Miailhe Arnaud-Felix , Bigé Naike , Dumas Guillaume , Dubée Vincent , Boelle Pierre-Yves , Abdallah Idriss , Baudel Jean-Luc , Guidet Bertrand , Maury Eric , Ait-Oufella Hafid 
Published: May 2018

Objectives:
Metabolic acidosis is commonly observed in critically ill patients. Experimental studies suggested that acidosis by itself could impair vascular function, but this has been poorly investigated in human.

Design:
Prospective observational study.

Setting:
Medical ICU in a tertiary teaching hospital.

Patients:
To assess the relationship between metabolic acidosis severity and microvascular reactivity, we included adult diabetic patients admitted in ICU for ketoacidosis. Microvascular response to acetylcholine iontophoresis was measured at admission (baseline) and after correction of metabolic acidosis (24 hr).

Interventions:
None.

Measurements and Main Results:
Thirty-nine patients with diabetic ketoacidosis were included (68% male), with a median age of 43 (31–57) years. At admission, microvascular reactivity negatively correlated with acidosis severity (R = –0.53; p < 0.001). Microvascular response was strongly depressed at pH less than 7.20 (area under the curve, 1,779 [740–3,079] vs 12,944 [4,874–21,596] at pH > 7.20; p < 0.0001). In addition, acidosis severity was significantly correlated with capillary refill time (R = 0.50; p = 0.02). At H24, after rehydration and insulin infusion, clinical and biological disorders were fully corrected. After acidosis correction, microvascular reactivity increased more in patients with severe baseline acidosis (pH < 7.20) than in those with mild baseline acidosis (area under the curve, +453% [213%–1,470%] vs +121% [79%–312%]; p < 0.01).

Conclusions:
We identified an alteration of microvascular reactivity during metabolic acidosis in critically ill patients with diabetic ketoacidosis. Microvascular hyporeactivity recovered after acidosis correction.
Current questions in bone sarcomas
Authors: Strauss Sandra J. , Whelan Jeremy S. 
Published: May 2018

Purpose of review
Osteosarcoma and Ewing sarcoma, the most common primary bone tumours in young people, are curable in most patients. However, these tumours remain a significant challenge due to the complexity and intensity of treatment and its long-term morbidity and the significant proportion of patients in whom treatment is unsuccessful. This review addresses questions about current management and emerging therapeutic targets for patients with osteosarcoma, Ewing sarcoma and chondrosarcoma, the commonest bone sarcoma but more common in older patients.

Recent findings
The largest collaborative international study in osteosarcoma, EURAMOS-1 determined that treatment of patients with resectable disease should not be altered on basis of pathological response to neoadjuvant chemotherapy. In view of little improvement in outcome being evident in recent years, novel therapeutic approaches are required. Putative targets and clinical trials of novel agents are discussed, including emerging targets such as poly (ADP-ribose) polymerase inhibition and isocitrate dehydrogenase inhibition in Ewing sarcoma and chondrosarcoma, respectively. Newer radiotherapy techniques including proton beam and particle ion therapy may be important for local tumour control in selected patients.

Summary
Collaborative studies are essential to answer current questions and investigate novel therapies in these malignancies to improve outcome and quality of life for patients.
Breast-conservation Therapy After Neoadjuvant Chemotherapy Does Not Compromise 10-Year Breast Cancer–specific Mortality
Authors: Arlow Renee L. , Paddock Lisa E. , Niu Xiaoling , Kirstein Laurie , Haffty Bruce G. , Goyal Sharad , Kearney Thomas , Toppmeyer Deborah , Stroup Antoinette M. , Khan Atif J. 
Published: May 2018

Objectives:
Neoadjuvant chemotherapy can increase the rate of breast-conserving surgery by downstaging disease in patients with breast cancer. The aim of this study was to determine whether patients who received neoadjuvant chemotherapy have equal survival after breast-conservation therapy compared with mastectomy.

Material and Methods:
Using the New Jersey State Cancer Registry (NJSCR) patients with a primary breast cancer diagnosed between 1998 and 2003 who underwent neoadjuvant chemotherapy were selected (n=1,468). Of those, only patients who received lumpectomy plus radiation (n=276) or mastectomy without radiation (n=442) were included in the analysis. The main outcome measured included 10-year breast cancer–specific mortality, with 90% of patients with known vital status through the end of 2011.

Results:
Baseline characteristics did not differ significantly between the breast-conservation and mastectomy without radiation groups except with respect to summary stage and lymph node involvement. After propensity score matching these differences were no longer statistically significant; however, both estrogen and progesterone status achieved statistical significance. The Kaplan-Meier survival curve showed that the breast-conservation group had significantly higher breast cancer–specific survival than the mastectomy group (P=0.0046). After adjusting for the propensity score in the regression model, the breast-conservation group continued to show significantly better survival than the mastectomy group (hazard ratios, 0.46; 95% confidence interval, 0.27-0.78).

Conclusions:
This study is consistent with previous research showing that breast-conserving surgery after neoadjuvant chemotherapy does not reduce breast cancer–specific survival. In fact, patients undergoing breast-conservation after neoadjuvant therapy appeared to have better survival than patients undergoing mastectomy without radiation.
The Significance of Para-Aortic Nodal Size and the Role of Adjuvant Systemic Chemotherapy in Cervical Cancer
Authors: Manders Dustin B. , Sims Travis T. , Bailey April , Hwang Lindsay , Richardson Debra L. , Miller David S. , Kehoe Siobhan M. , Albuquerque Kevin V. , Lea Jayanthi S. 
Published: May 2018

Objective:
Cervical cancer metastatic to the para-aortic lymph nodes (PALNs) carries a poor prognosis. Despite extended-field radiation therapy (EFRT), only 30% to 50% of patients will survive 3 years. We sought to examine the treatment regimens used, associated toxicities, and treatment outcomes in patients with cervical cancer metastatic to PALN.

Methods:
A retrospective review was performed of all patients with cervical cancer treated at a single institution between January 1, 2007 and November 1, 2014. Included patients had PALN metastases as the most distant site of disease, and all treatment plans were designated as curative. Excluded patients had other distant disease or treatment plans considered palliative. Standard treatment consisted of EFRT with concurrent platinum-based chemotherapy.

Results:
Fifty-one of 344 patients (14.8%) fulfilled the inclusion criteria. The median age was 48.4 years. Forty-four patients received standard EFRT; 7 also received adjuvant platinum/taxane chemotherapy. Thirty-nine of 51 (76%) of patients achieved a complete response to primary treatment. Twelve of 51 (24%) had persistent disease or progression at the completion of treatment. Of responders, 15 of 39 (38%) recurred for an overall treatment failure rate of 27 of 51 (53%). Nineteen of 27 (70%) of treatment failures occurred outside the radiated field. Adjuvant chemotherapy following EFRT was not predictive of progression-free survival or overall survival. PALN diameter ≥1 cm was a significant negative prognostic indicator for overall survival.

Conclusions:
Over half of patients with cervical cancer metastatic to the PALN failed extended-field chemoradiation. Most failures occurred outside the radiated field suggesting PALN involvement is a surrogate marker of systemic disease. These findings underscore the need for effective systemic therapy, especially in patients with PALN ≥1 cm in size.
Regional Lymph Node Metastases in Groin Sarcomas
Authors: Ng Deanna Wan Jie , Koh Ye Xin , Tan Grace Hwei Ching , Soo Khee Chee , Teo Melissa Ching Ching 
Published: May 2018

Introduction:
The evaluation of lymph nodes and the role of groin dissection for groin sarcomas has been controversial where there have not been previous studies or guidelines published. In this study, we aim to first formulate a clinical approach in the evaluation of regional lymph nodal metastases. Second, we aim to also evaluate the role of regional lymphadenectomy in the setting of pathologically involved regional lymph nodes for groin sarcomas.

Materials and Methods:
In total, 43 consecutive patients with groin sarcomas underwent treatment at the National Cancer Centre Singapore between 2002 and 2015. Univariate comparisons were performed using the log-rank test. A Cox multivariate analysis was performed for disease-specific survival to identify independent prognostic factors.

Results:
The median disease-free survival was 18 months (range, 1 to 180 mo). The median overall survival (OS) was 28 months (range, 3 to 180 mo). In total, 28 patients underwent a groin dissection. Of the 28 patients who underwent groin dissections, 15 had negative lymph node involvement, 7 had positive lymph node involvement and 6 had lymphovascular invasion.
On univariate analysis, grade (P=0.047) and clinical and/or radiological involvement (P=0.039) were significant for regional lymph nodal metastases.
The 5-year OS for patients with positive lymph nodes was 31%.

Conclusions:
Our study suggests that the evaluation of lymph nodes via groin dissections in groin sarcomas in the Asian population should be based primarily on clinical and radiologic evidence. Regional lymph node dissection seems to confer OS benefit in patients with these high-risk tumors and can improve local control of disease.