bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with benefit of active middle ear implants compared to conventional hearing aids
Authors: McRackan Theodore R. , Clinkscales William B. , Ahlstrom Jayne B. , Nguyen Shaun A. , Dubno Judy R. 
Published: February 2018

ObjectiveIdentify factors associated with benefit of middle ear implants (MEIs) as compared to conventional hearing aids (HAs).Study DesignIndependent review of audiological data from a multicenter prospective U.S. Food and Drug Administration (FDA) clinical trial. Preoperative and postoperative earphone, unaided/aided/implanted pure‐tone thresholds, and word recognition scores were evaluated.ResultsNinety‐one subjects were included in this study. Mean word recognition was better with MEIs than with HAs (81.8% ± 12.0% vs. 77.6% ± 14.6%, P = 0.035). Word recognition with MEIs showed a low positive correlation with word recognition measured with earphones (r = 0.25, P = 0.016) and a moderate positive correlation with aided word recognition (r = 0.42, P < 0.001). Earphone word recognition alone was not predictive of MEI benefit over HA benefit (r = 0.09, P = 0.41), unlike differences between scores with earphone and HAs (earphone‐aided differences [EAD]) (r = 0.62, P < 0.011). As compared to those with –EADs, subjects with +EADs showed greater improvement in word recognition from unaided to implanted and from HAs to implanted (P < 0.0001). Using the 95% CI for word recognition scores, 16 subjects showed significantly higher scores with the MEI than with HAs. Of those, 14 had +EAD.ConclusionWord recognition benefit derived from conventional HAs and MEIs from this large, multi‐center FDA trial provides further evidence of the importance of aided word recognition in clinical decision making, such as determining candidacy for and success with MEIs.Level of Evidence2b. Laryngoscope, 128:2133–2138, 2018
Patterns of concurrent cigarette, alcohol, and e‐cigarette use: Off‐setting or additive behaviors?
Authors: Parikh Anuraag S. , Bhattacharyya Neil 
Published: February 2018

ObjectivesTo understand nationwide concurrent use of e‐cigarettes (Ecig) with alcohol and conventional cigarettes (Ccig), the major risk factors for head and neck cancer.Study DesignCross‐sectional analysis of nationally representative survey.MethodsThe National Health Interview Surveys for 2014 and 2015 were analyzed for adult responses to specific questions regarding the daily frequency of alcohol, Ccig, and Ecig use. Statistical relationships between these social habits were determined.ResultsA total of 241.1 million adults (raw N = 162,048) were surveyed (mean age 47.1 years, 51.8% female). Of those, 12.1% (29.2 million) and 3.8% (9.08 million) reported being every day Ccig users and some days Ccig users, respectively. A total of 2.3% (5.63 million) and 1.1% (2.76 million) reported being every day Ecig users and some days Ecig users, respectively. In addition, 58.4% of everyday Ecig users reported also being everyday Ccig users (P < 0.001). Furthermore, 25.6% (61.3 million) and 8.3% (20.0 million) of adults reported light drinking (1–3 drinks/week) and moderate/heavy drinking (4–7 drinks/week), respectively. Of the moderate/heavy drinkers, 17.7% were everyday Ccig users, whereas 12.2% of everyday Ccig users were moderate/heavy drinkers (P < 0.001). Among everyday Ecig users, 34.6% and 11.2% were light drinkers and moderate/heavy drinkers, respectively (P < 0.001). Among non‐Ccig users, everyday Ecig users were likely to consume higher levels of alcohol given that 36.5% and 8.9% were light drinkers and moderate/heavy drinkers, respectively (P < 0.01).ConclusionWe demonstrate a substantial level of Ccig use among moderate/heavy drinkers and Ecig users, as well as a novel independent association between Ecig and moderate/heavy alcohol use. These patterns of concurrent risk factor exposure should be considered when counseling patients who report Ecig use.Level of Evidence2b. Laryngoscope, 1817–1821, 2018
Utility of the bow and lean test in predicting subtype of benign paroxysmal positional vertigo
Authors: Choi Seongjun , Choi Hye Rang , Nahm Hyunjoo , Han Kyujin , Shin Jung Eun , Kim Chang‐Hee 
Published: February 2018

Objectives/HypothesisTo investigate the role of the bow and lean test (BLT) in the diagnosis of benign paroxysmal positional vertigo (BPPV).Study DesignRetrospective case‐control study.MethodsBetween March 2015 and June 2017, we enrolled 113 patients with posterior semicircular canal (PSCC) BPPV, 74 patients with lateral semicircular canal (LSCC) canalolithiasis, 53 patients with LSCC cupulolithiasis, and 32 patients with light cupula. We retrospectively assessed bowing nystagmus (BN) and leaning nystagmus (LN).ResultsIn PSCC BPPV, 75% of the patients showed at least one of BN and LN, and direction of nystagmus provoked by a Dix‐Hallpike test on the affected side was consistent with that of LN and opposite to that of BN. In LSCC canalolithiasis, 65% (48 of 74) of the patients showed both BN and LN, which were in the same direction in 38 patients (of 48) and in the opposite direction in 10 patients (of 48). The affected side can be determined according to the results of THE BLT in 74% (55 of 74) of LSCC canalolithiasis patients, and among them, the side determined according to the results of head‐roll test was discordant with that according to the BLT in 20 of 55 patients (36%). In LSCC cupulopathy (n = 85), both BN and LN were persistent and observed in all cases, but we could not distinguish LSCC cupulolithiasis from light cupula according to nystagmus direction in the BLT.ConclusionsAlthough a BLT yields better lateralization in LSCC canalolithiasis, it may be more useful in predicting the diagnosis and lateralization of PSCC BPPV than LSCC canalolithiasis.Level of Evidence4 Laryngoscope, 2600–2604, 2018
Continuous vagal monitoring value in prevention of vocal cord paralysis following thyroid surgery
Authors: Kandil Emad , Mohsin Khuzema , Murcy Mohammad A. , Randolph Gregory W. 
Published: February 2018

Objectives/HypothesisContinuous intraoperative neuromonitoring (CIONM) of the vagus nerve was proposed to obtained frequent repetitive electromyography (EMG) data to recognize early change in intraoperative function of the recurrent laryngeal nerve. We examine our initial experience using this technology.Study DesignRetrospective review.MethodsData for all patients who underwent neck surgery by a single surgeon at a North American institution over a 5‐year period were reviewed. CIONM was used in cases with possible higher risk of traction injury and according to surgeon preference. In these cases, stretch injury was established by warning alarm with threshold of ≥50% reduction in amplitude and/or ≥ 10% increase in latency. Preoperative and postoperative direct laryngoscopy was performed for all patients.ResultsA total of 879 endocrine neck surgeries were performed. CIONM was used to monitor 455 recurrent laryngeal nerves (RLNs) in 344 (39.1%) surgeries. An automatic periodic stimulation (APS) alarm detected impending nerve injury in 33 (9.6%) cases by 64.9% ± 12.7% decrease in amplitude and by 27.3% increase in latency in one case. A total loss of signal (LOS) was detected in 15 (4.36%) cases. The immediate release of causative retraction successfully preserved the nerves in all cases with impending injury; however, there was no improvement in the LOS cases. Other than the cases with LOS, postoperative laryngoscopy showed normal vocal cord function in all cases.ConclusionsAPS technology is safe, feasible, and helpful in approximately 10% of cases in our series, which developed nascent neurapraxia adverse EMG changes associated with intraoperative RLN stretch that could be reversed intraoperatively.Level of Evidence4. Laryngoscope, 128:2429–2432, 2018
Decreasing Revision Surgery in FAMM Flap Reconstruction of the Oral Cavity: Traditional Versus Modified Harvesting Technique
Authors: Ibrahim Badr , Rahal Akram , Bissada Eric , Christopoulos Apostolos , Moubayed Sami P. , Guertin Louis , Tabet Jean‐Claude , Olivier Marie‐Jo , Ayad Tareck 
Published: February 2018

ObjectiveTo compare the surgical and functional outcomes between two harvesting techniques for the inferiorly based facial artery musculomucosal (FAMM) flap for oral cavity and oropharynx reconstructions.MethodsMulticenter retrospective chart review.ResultsWe reviewed 55 cases of FAMM flap, including 29 traditional cases and 26 performed using the modified harvesting method. The overall rate of surgical re‐intervention in the traditional group was 31% (n = 9 of 29) and 15% (n = 4 of 26) in the modified group (P = 0.196). The specific re‐intervention rate for pedicle sectioning was 27% (n = 8 of 29) in the traditional group versus 0% (n = 0 of 26) in the modified group. The overall rate of complications was 21%. Nine out of 10 dentate patients in the traditional group and four out of five in the modified group needed tooth extraction. There was no difference between the two groups in terms of tracheostomy duration (P = 0.338) and time to first oral intake (P = 0.629). Speech and feeding outcomes were similar among groups (P = 0.922; P = 0.700, respectively). Dental rehabilitation was achieved in 67% and 78% of patients in the traditional and modified groups, respectively.ConclusionThe FAMM flap offers a low morbidity approach to reconstruct the oral cavity. The modified approach to harvesting the flap is a safe and effective technique, with similar functional results and equally low morbidity profile as the traditional technique. It has the added advantage of lower rates of secondary surgical interventions.Level of Evidence4. Laryngoscope, 1802–1805, 2018
The impact of adjuvant chemoradiotherapy timing on survival of head and neck cancers
Authors: Tam Moses , Wu S. Peter , Gerber Naamit K. , Lee Anna , Schreiber David , Givi Babak , Hu Kenneth 
Published: February 2018

BackgroundDelays in postoperative head and neck (HN) radiotherapy have been associated with decreased overall survival; however, the impact of delays in postoperative HN chemoradiotherapy remains undefined.MethodsAll patients with nonmetastatic HN cancer (oral cavity, oropharynx, larynx, hypopharynx) who underwent curative intent surgery and received adjuvant chemoradiotherapy were identified from the National Cancer Database (2005–2012). Overall treatment time (OTT) was defined as the time from surgery to the end of radiation therapy. Statistical methods included Cox proportional hazards modeling, which adjusted for clinicopathologic, demographic, and socioeconomic factors. Recursive partitioning analysis (RPA) identified the optimal threshold of OTT via conditional inference trees to estimate the greatest differences in overall survival (OS) on the basis of randomly selected training and validation sets.ResultsA total of 16,733 patients were included, with a median follow‐up of 37 months. Median OS for OTT in a predefined threshold of ≤ 13 weeks was 10.1 years (95% confidence interval [CI], 9.8 years; not reached) compared with 8.7 years (95% CI, 8.2–9.2 years) in > 13 weeks. On multivariate analysis, OTT of > 13 weeks versus ≤ 13 weeks independently increased mortality risk (hazard ratio, 1.10; 95% CI, 1.04–1.17; P = < 0.001). RPA identified an optimal OTT threshold of 97 days (interquartile range: 96–98 days). The OTT threshold of 97 days was confirmed in a full Cox regression model estimating the risk of death according to overall treatment time as a continuous variable.ConclusionIn this large hospital‐based national data, an OTT of greater than approximately 14 weeks most consistently increased the risk of death.Level of Evidence4. Laryngoscope, 128:2326–2332, 2018
Porous Vesicles with Extrusion‐Tunable Permeability and Pore Size from Mixed Solutions of PEO–PPO–PEO Triblock Copolymers
Authors: Schantz A. Benjamin , Ren Tingwei , Pachalla Abhishek , Shen Yuexiao , Hickey Robert J. , Kumar Manish 
Published: February 2018

AbstractBlock copolymer (BC) vesicles in aqueous solution can encapsulate hydrophilic molecules or nanoparticles for drug and gene delivery, enhanced imaging, microreactors, or sensors. Inexpensive, biocompatible poly(ethylene oxide)–poly(propylene oxide)–poly(ethylene oxide) (PEO–PPO–PEO) triblock copolymers (TBCs) would be ideal for these applications if they could form concentrated vesicle solutions to encapsulate such molecules with high efficiency. It is shown that solutions of two PEO–PPO–PEO TBCs (EO5–PO68–EO5 and EO100–PO65–EO100) form vesicles, that the vesicle membranes are permeable to low‐molecular weight (MW) solutes, and that extrusion reduces the membrane permeability and MW cutoff. Osmotic permeabilities before and after extrusion are ≈1000 and ≈10 µm s−1, respectively, while the MW cutoffs for solute rejection are ≈1000 and ≈400 g mol−1. Therefore, it is hypothesized that the vesicles contain pores, and that extrusion reduces the pores' size and the membrane's porosity. These selectively permeable vesicles can function as microreactors or sensors encapsulating large solutes without the need to add channel molecules or proteins.
Geant4‐DNA track‐structure simulations for gold nanoparticles: The importance of electron discrete models in nanometer volumes
Authors: Sakata Dousatsu , Kyriakou Ioanna , Okada Shogo , Tran Hoang N. , Lampe Nathanael , Guatelli Susanna , Bordage Marie‐Claude , Ivanchenko Vladimir , Murakami Koichi , Sasaki Takashi , Emfietzoglou Dimitris , Incerti Sebastien 
Published: February 2018

PurposeGold nanoparticles (GNPs) are known to enhance the absorbed dose in their vicinity following photon‐based irradiation. To investigate the therapeutic effectiveness of GNPs, previous Monte Carlo simulation studies have explored GNP dose enhancement using mostly condensed‐history models. However, in general, such models are suitable for macroscopic volumes and for electron energies above a few hundred electron volts. We have recently developed, for the Geant4‐DNA extension of the Geant4 Monte Carlo simulation toolkit, discrete physics models for electron transport in gold which include the description of the full atomic de‐excitation cascade. These models allow event‐by‐event simulation of electron tracks in gold down to 10 eV. The present work describes how such specialized physics models impact simulation‐based studies on GNP‐radioenhancement in a context of x‐ray radiotherapy.MethodsThe new discrete physics models are compared to the Geant4 Penelope and Livermore condensed‐history models, which are being widely used for simulation‐based NP radioenhancement studies. An ad hoc Geant4 simulation application has been developed to calculate the absorbed dose in liquid water around a GNP and its radioenhancement, caused by secondary particles emitted from the GNP itself, when irradiated with a monoenergetic electron beam. The effect of the new physics models is also quantified in the calculation of secondary particle spectra, when originating in the GNP and when exiting from it.ResultsThe new physics models show similar backscattering coefficients with the existing Geant4 Livermore and Penelope models in large volumes for 100 keV incident electrons. However, in submicron sized volumes, only the discrete models describe the high backscattering that should still be present around GNPs at these length scales. Sizeable differences (mostly above a factor of 2) are also found in the radial distribution of absorbed dose and secondary particles between the new and the existing Geant4 models. The degree to which these differences are due to intrinsic limitations of the condensed‐history models or to differences in the underling scattering cross sections requires further investigation.ConclusionsImproved physics models for gold are necessary to better model the impact of GNPs in radiotherapy via Monte Carlo simulations. We implemented discrete electron transport models for gold in Geant4 that is applicable down to 10 eV including the modeling of the full de‐excitation cascade. It is demonstrated that the new model has a significant positive impact on particle transport simulations in gold volumes with submicron dimensions compared to the existing Livermore and Penelope condensed‐history models of Geant4.
Technical Note: A planning technique to lower normal tissue toxicity in lung SBRT plans based on two likely dependent RTOG metrics
Authors: Narayanasamy Ganesh , Desai Dharmin , Morrill Steven , Zhang Xin , Galhardo Edvaldo , Maraboyina Sanjay , Penagaricano Jose 
Published: February 2018

PurposeIntermediate‐ and low‐dose falloff in stereotactic body radiotherapy (SBRT) of lung tumor is known to relate to normal tissue toxicity. The purpose is twofold to analyze the relation between RTOG parameters (namely, R50%, D2cm) in lung SBRT plans and to explore planning methods that correlate with higher than acceptable dose to normal tissue.MethodsRTOG recommended target dose coverage, conformity index, homogeneity index, R50%, and D2cm were evaluated retrospectively in 105 lung tumor SBRT plans. Deviations in R50% and D2cm were correlated with parameters including prescription dose, tumor location, number of beams or arcs, beam configuration (coplanar or noncoplanar), type of treatment plan (3D‐CRT, IMRT or volumetric arc therapy), and shortest distance to the chest wall.ResultAll plans met the target coverage, conformity index, homogeneity index, and critical organ dose tolerance objectives. Dose falloff product (DFP) of R50% and D2cm has a small variance and small dependence on PTV. Low correlation between DFP and PTV suggests that R50% and D2cm are not independent. Coplanar beam placement was found to be prevalent among plans with large deviations in R50%, D2cm.ConclusionThis study questions the independence of the two RTOG recommended metrics, R50% and D2cm in lung SBRT plans, and suggests that noncoplanar beams may provide better normal tissue sparing by reducing the intermediate dose falloff.
Technical Note: Quantitative accuracy evaluation for spectral images from a detector‐based spectral CT scanner using an iodine phantom
Authors: Duan Xinhui , Arbique Gary , Guild Jeffrey , Xi Yin , Anderson Jon 
Published: February 2018

PurposeThe purpose of this study was to evaluate the quantitative accuracy of spectral images from a detector‐based spectral CT scanner using a phantom with iodine‐loaded inserts.MethodsA 40‐cm long‐body phantom with seven iodine inserts (2–20 mg/ml of iodine) was used in the study. The inserts could be placed at 5.5 or 10.5 cm from the phantom axis. The phantom was scanned five times for each insert configuration using 120 kVp tube voltage. A set of iodine, virtual noncontrast, effective atomic number, and virtual monoenergetic spectral CT images were generated and measurements were made for all the iodine rods. Measured values were compared with reference values calculated from the chemical composition information provided by the phantom manufacturer. Radiation dose from the spectral CT was compared to a conventional CT using a CTDI (32 cm) phantom.ResultsGood agreement between measurements and reference values was achieved for all types of spectral images. The differences ranged from −0.46 to 0.1 mg/ml for iodine concentration, −9.95 to 6.41 HU for virtual noncontrast images, 0.12 to 0.35 for effective Z images, and −17.7 to 55.7 HU for virtual monoenergetic images. For a similar CTDIvol, image noise from the conventional CT was 10% lower than the spectral CT.ConclusionsThe detector‐based spectral CT can achieve accurate spectral measurements on iodine concentration, virtual non‐contrast images, effective atomic numbers, and virtual monoenergetic images.
Interleaved 3D‐CNNs for joint segmentation of small‐volume structures in head and neck CT images
Authors: Ren Xuhua , Xiang Lei , Nie Dong , Shao Yeqin , Zhang Huan , Shen Dinggang , Wang Qian 
Published: February 2018

PurposeAccurate 3D image segmentation is a crucial step in radiation therapy planning of head and neck tumors. These segmentation results are currently obtained by manual outlining of tissues, which is a tedious and time‐consuming procedure. Automatic segmentation provides an alternative solution, which, however, is often difficult for small tissues (i.e., chiasm and optic nerves in head and neck CT images) because of their small volumes and highly diverse appearance/shape information. In this work, we propose to interleave multiple 3D Convolutional Neural Networks (3D‐CNNs) to attain automatic segmentation of small tissues in head and neck CT images.MethodA 3D‐CNN was designed to segment each structure of interest. To make full use of the image appearance information, multiscale patches are extracted to describe the center voxel under consideration and then input to the CNN architecture. Next, as neighboring tissues are often highly related in the physiological and anatomical perspectives, we interleave the CNNs designated for the individual tissues. In this way, the tentative segmentation result of a specific tissue can contribute to refine the segmentations of other neighboring tissues. Finally, as more CNNs are interleaved and cascaded, a complex network of CNNs can be derived, such that all tissues can be jointly segmented and iteratively refined.ResultOur method was validated on a set of 48 CT images, obtained from the Medical Image Computing and Computer Assisted Intervention (MICCAI) Challenge 2015. The Dice coefficient (DC) and the 95% Hausdorff Distance (95HD) are computed to measure the accuracy of the segmentation results. The proposed method achieves higher segmentation accuracy (with the average DC: 0.58 ± 0.17 for optic chiasm, and 0.71 ± 0.08 for optic nerve; 95HD: 2.81 ± 1.56 mm for optic chiasm, and 2.23 ± 0.90 mm for optic nerve) than the MICCAI challenge winner (with the average DC: 0.38 for optic chiasm, and 0.68 for optic nerve; 95HD: 3.48 for optic chiasm, and 2.48 for optic nerve).ConclusionAn accurate and automatic segmentation method has been proposed for small tissues in head and neck CT images, which is important for the planning of radiotherapy.
Recurrence of Ewing sarcoma: Is detection by imaging follow‐up protocol associated with survival advantage?
Authors: Heinemann Melina , Ranft Andreas , Langer Thorsten , Jürgens Herbert , Kreyer Justus , Vieth Volker , Schäfers Michael , Weckesser Matthias , Simon Thorsten , Hassenpflug Wolf , Corbacioglu Selim , Bielack Stefan , Mayer‐Steinacker Regina , Kühne Thomas , van den Berg Henk , Gelderblom Hans , Bauer Sebastian , Stegger Lars , Dirksen Uta 
Published: February 2018

AbstractBackgroundThe Cooperative Ewing Sarcoma Study and the Late Effects Surveillance System of the Society for Paediatric Oncology and Haematology recommend a structured follow‐up imaging protocol (FUIP) for patients with Ewing sarcoma (EwS) with decreasing frequency of imaging over the first 5 years. The present study aims to assess the effectiveness of the FUIP for EwS patients regarding survival after relapse.Patients and methodsA retrospective multicenter analysis on 160 eligible patients with EwS recurrence was performed. Potential survival differences following recurrence diagnosis between patients with protocol‐detected and symptomatic relapse were investigated using the Kaplan–Meier method. Additional subgroup analyses were performed on the relapse type. Overall survival (OS) was calculated from diagnosis of relapse to last follow‐up or death.ResultsIn the multicenter analysis, recurrence was detected by FUIP in 77 of 160 patients (48%) and due to symptoms in 83 patients (52%). Regarding the entire study population, OS was significantly superior in patients with protocol‐detected relapse compared to patients with symptomatic relapse (median, 2.4 vs. 1.2 years; P < 0.001). In the subgroup analyses, patients whose lung recurrences were detected by the FUIP experienced longer survival after recurrence than those whose recurrences were detected symptomatically (P = 0.023). In the 83 symptomatic patients, pain was the most prevalent symptom of relapse (72%).ConclusionFUIP may benefit survival in EwS relapse, especially in lung recurrence. Pain was the leading symptom of relapse.