bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Impact of Sonographically Guided Biopsy of Salivary Gland Masses and Surrounding Lymph Nodes
Authors: Feld Rick , Nazarian Levon N. , Needleman Laurence , Lev-Toaff Anna S. , Segal Sharon R. , Rao Vijay M. , Bibbo Marluce , Lowry Louis D. 
Published: May 2019

Although fine-needle aspiration biopsy of salivary gland masses has been reported in the otolaryngology literature, the use of sonography to guide the biopsy of nonpalpable masses and masses seen on other cross-sectional imaging studies has not been described. Our goal was to evaluate sonographically guided biopsy of masses and lymph nodes related to the salivary glands. We analyzed the records of 18 patients who had undergone fine-needle aspiration biopsy of a salivary gland mass or lymph node with a 25-, 22-, or 20-gauge needle. A definitive cytologic diagnosis was made for 13 of the 18 patients (72%); cytology was suggestive but not definitive in three patients (17%) and insufficient in two (11%). Definitive diagnoses were made in three cases of reactive lymph node, in two cases each of lymph node metastasis and Warthin's tumor, and in one case each of pleomorphic adenoma, adenoid-cystic carcinoma, schwannoma-neurofibroma, parotid metastasis, parotid lymphoma, and Sjögren ‘s-related lymphoid-epithelial lesion. Sonographically guided biopsy allows for confident needle placement in masses seen on computed tomography and magnetic resonance imaging. Sonography can usually distinguish a perisalivary lymph node from true intrasalivary masses, and it can help the surgeon avoid the pitfall of a nondiagnostic aspiration of the cystic component of masses. We conclude that sonographically guided biopsy of salivary gland masses can provide a tissue diagnosis that can have a direct impact on clinical decision making.
Impact of Distraction Osteogenesis Maxillary Expansion on the Internal Nasal Valve in Obstructive Sleep Apnea
Authors: Abdelwahab Mohamed , Yoon Audrey , Okland Tyler , Poomkonsarn Sasikarn , Gouveia Chris , Liu Stanley Yung‐Chuan 
Published: May 2019

ObjectiveTo assess the effect of distraction osteogenesis maxillary expansion (DOME) on objective parameters of the internal nasal valve and correlate findings with subjective outcomes.Study DesignRetrospective cohort study.SettingTertiary referral center.Subjects and MethodsAfter Institutional Review Board approval, included subjects were those with obstructive sleep apnea, had undergone DOME from September 2014 to April 2018, and had cone beam computed tomography scans available before and after expansion. Measurement of the internal nasal valve parameters was performed with Invivo6 Software (version 6.0.3). Interrater reliability of all pre‐ and postexpansion parameters was measured. Patient‐reported outcome measures included the Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE) and Epworth Sleepiness Scale scores, and correlation between objective and subjective outcomes were evaluated by Spearman correlation analysis.ResultsThirty‐two subjects met inclusion criteria. All showed significant improvement in their subjective outcomes as well as an increase in their internal valve parameters. Significant correlation was observed between increased angles and improvement in postexpansion NOSE score (right angle, P =. 024; left angle, P =. 029).ConclusionDOME widens the internal nasal valve objectively (dimensions), which correlates significantly with subjective improvement (NOSE scores).
Upper Airway Stimulation Response in Older Adults with Moderate to Severe Obstructive Sleep Apnea
Authors: Withrow Kirk , Evans Sean , Harwick John , Kezirian Eric , Strollo Patrick ,   ADHERE Registry Investigators
Published: May 2019

ObjectiveTo evaluate the impact of age on safety, efficacy, and usage of upper airway stimulation (UAS).Study DesignMulticenter observational study.SettingThirteen US hospitals and 3 German hospitals.Subjects and MethodsThe ADHERE registry is a multicenter database enrolling patients undergoing UAS implantation from October 2016 to April 2018. Outcome measures included the Epworth Sleepiness Scale, apnea‐hypopnea index (AHI), therapy usage, and complications. Data were segmented by age (<65 vs ≥65 years).ResultsYounger adults (n = 365) were a mean ± SD 52.7 ± 7.9 years old and 82% male, with a body mass index of 29.6 ± 3.8. Older adults (n = 235) were 71.1 ± 4.8 years old and 71% male, with a body mass index of 28.8 ± 3.8. Baseline AHI was similar (younger, 36.2 ± 15.9; older, 36.1 ± 14.8). Both groups had lower AHI at 12 months versus baseline (P <. 001), but the older group showed a greater reduction (7.6 ± 6.9 vs 11.9 ± 13.4, P =. 01). The Epworth Sleepiness Scale score decreased from 12.3 ± 5.4 to 7.1 ± 4.8 (P <. 001) among younger adults and from 10.7 ± 5.7 to 6.3 ± 4.4 (P <. 001) among older adults. Usage was slightly higher among older adults (6.0 ± 2.0 vs 5.4 ± 2.1 hours/night, P =. 02). Surgical time was similar between younger patients (2.4 ± 0.7 hours) and older patients (2.3 ± 0.7 hours, P =. 40), with comparably low complications.ConclusionAHI reduction and therapy usage were found to be somewhat higher among patients aged ≥65 years who were treated with UAS. Surgical complications were low, in contrast to traditional sleep surgery.
High‐Frequency Ultrasound: A Novel Diagnostic Tool to Measure Pediatric Tonsils in 3 Dimensions
Authors: Kay‐Rivest Emily , Saint‐Martin Christine , Daniel Sam J. 
Published: May 2019

ObjectiveA wide variety of pathologies can affect the palatine tonsils. Ultrasound is a commonly used modality for assessing head and neck masses in children; however, its use in tonsillar evaluation has not been widely explored. The objective of this study was to measure 3‐dimensional tonsillar size with ultrasound, in centimeters, and correlate these measurements with actual ex vivo dimensions on pathology specimens.Study DesignWe performed a prospective cohort study.SettingThe study was set in a tertiary care children’s hospital.Subjects and MethodsChildren undergoing tonsillectomy were included in the study. Transcervical high‐frequency ultrasonography (HFU) was performed prior to surgery to obtain 3‐dimensional measurements of the right and left palatine tonsils. Mean sizes were compared to ex vivo tonsil measurements and correlations were obtained.ResultsSeventy‐five consecutive children underwent a transcervical HFU, with a total of 150 tonsils analyzed. The mean differences between HFU and pathology measurements were −0.08 cm and −0.24 cm for the right and left craniocaudal axes, −0.19 cm and −0.18 cm for the right and left mediolateral axes, and 0.05 cm and 0.03 cm for the right and left anteroposterior axes. Correlation coefficients between ultrasound and pathology measurements were all above 0.5.ConclusionHFU can accurately measure the size of pediatric tonsils in 3 dimensions.
Cannabidivarin completely rescues cognitive deficits and delays neurological and motor defects in male Mecp2 mutant mice
Authors: Zamberletti Erica , Gabaglio Marina , Piscitelli Fabiana , Brodie James S , Woolley-Roberts Marie , Barbiero Isabella , Tramarin Marco , Binelli Giorgio , Landsberger Nicoletta , Kilstrup-Nielsen Charlotte , Rubino Tiziana , Di Marzo Vincenzo , Parolaro Daniela 
Published: May 2019

Background: Recent evidence suggests that 2-week treatment with the non-psychotomimetic cannabinoid cannabidivarin (CBDV) could be beneficial towards neurological and social deficits in early symptomatic Mecp2 mutant mice, a model of Rett syndrome (RTT). Aim: The aim of this study was to provide further insights into the efficacy of CBDV in Mecp2-null mice using a lifelong treatment schedule (from 4 to 9 weeks of age) to evaluate its effect on recognition memory and neurological defects in both early and advanced stages of the phenotype progression. Methods: CBDV 0.2, 2, 20 and 200 mg/kg/day was administered to Mecp2-null mice from 4 to 9 weeks of age. Cognitive and neurological defects were monitored during the whole treatment schedule. Biochemical analyses were carried out in brain lysates from 9-week-old wild-type and knockout mice to evaluate brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1) levels as well as components of the endocannabinoid system. Results: CBDV rescues recognition memory deficits in Mecp2 mutant mice and delays the appearance of neurological defects. At the biochemical level, it normalizes BDNF/IGF1 levels and the defective PI3K/AKT/mTOR pathway in Mecp2 mutant mice at an advanced stage of the disease. Mecp2 deletion upregulates CB1 and CB2 receptor levels in the brain and these changes are restored after CBDV treatment. Conclusions: CBDV administration exerts an enduring rescue of memory deficits in Mecp2 mutant mice, an effect that is associated with the normalization of BDNF, IGF-1 and rpS6 phosphorylation levels as well as CB1 and CB2 receptor expression. CBDV delays neurological defects but this effect is only transient.
First experiences of a low-dose protocol for CT-guided musculoskeletal biopsies combining different radiation dose reduction techniques
Authors: Alagic Zlatan , Alagic Haris , Bujila Robert , Srivastava Subhash , Jasim Saif , Lindqvist Maria , Wick Marius C 
Published: May 2019

Background The use of computed tomography (CT) for image guidance during biopsies is a powerful approach. The method is, however, often associated with a significant level of radiation exposure to the patient and operator. Purpose To investigate if a low-dose protocol for CT-guided musculoskeletal (MSK) biopsies, including a combination of different radiation dose (RD) techniques, is feasible in a clinical setting. Material and Methods Fifty-seven patients underwent CT-guided fine-needle aspiration cytology (FNAC) utilizing the low-dose protocol (group A). A similar number of patients underwent CT-guided FNAC using the reference protocol (group B). Between-group comparisons comprised radiation dose, success rate, image quality parameters, and workflow. Results In group A, the mean total dose-length product (DLP) was 41.2 ± 2.9 mGy*cm, which was statistically significantly lower than of group B (257.4 ± 22.0 mGy*cm), corresponding to a mean dose reduction of 84% ( P<0.001). The mean CTDIvol for the control scans were 1.88 ± 0.09 mGy and 13.16 ± 0.40 mGy for groups A and B, respectively ( P < 0.001). The success rate in group A was 91.2% and 87.9% in group B ( P = 0.56). No negative effect on image-quality parameters, time of FNAC, and number of control scans were found. Conclusion We successfully developed a low-dose protocol for CT-guided MSK biopsies that maintains diagnostic accuracy and image quality at a fraction of the RD compared to the reference biopsy protocol at our clinic.
Comparison of ultrasonography and CT for preoperative nodal assessment of patients with papillary thyroid cancer: diagnostic performance according to primary tumor size
Authors: Yang So Yeon , Shin Jung Hee , Hahn Soo Yeon , Lim Yaeji , Hwang Seok Young , Kim Tae Hyuk , Kim Jee Soo 
Published: May 2019

Background Indications for computed tomography (CT) in preoperative patients with thyroid cancer are still controversial. Purpose To determine the value of CT and ultrasonography (US) in preoperative lymph node assessment of patients with papillary thyroid carcinoma (PTC) according to primary tumor size. Material and Methods A total 453 patients with surgically proven PTC who underwent US and CT for preoperative evaluation in 2010 at our tertiary referral center were included. The diagnostic sensitivity, specificity, and accuracy of US, CT, and the combination of US and CT (US/CT) in the preoperative nodal assessment were compared. We performed subgroup analysis to compare the findings according to primary tumor size. Results In overall tumors, adding CT to US had greater sensitivity, lower specificity, and greater accuracy in predicting central lymph node metastasis (LNM) but lower accuracy in prediction of lateral LNM. In smaller cancers (≤1 cm), US alone had greater specificity and accuracy than CT alone or US/CT in predicting lateral LNM. In larger cancers (>1 cm), CT had greater sensitivity and accuracy than US in predicting central LNM, while US had greater specificity and accuracy than CT in predicting lateral LNM. There were no patients with smaller tumors who showed retropharyngeal and superior mediastinal LNM diagnosed by CT alone. Conclusion CT is superior to US for detecting central LNM in preoperative patients with PTCs > 1 cm. However, there are no benefits to adding CT to US to predict lateral LNM in small cancers (≤1 cm).
Quantitative PET/MR imaging of lung cancer in the presence of artifacts in the MR-based attenuation correction maps
Authors: Kuttner Samuel , Lassen Martin Lyngby , Øen Silje Kjærnes , Sundset Rune , Beyer Thomas , Eikenes Live 
Published: May 2019

Background Positron emission tomography (PET)/magnetic resonance (MR) imaging may become increasingly important for assessing tumor therapy response. A prerequisite for quantitative PET/MR imaging is reliable and repeatable MR-based attenuation correction (AC). Purpose To investigate the frequency and test–retest reproducibility of artifacts in MR-AC maps in a lung cancer patient cohort and to study the impact of artifact corrections on PET-based tumor quantification. Material and Methods Twenty-five lung cancer patients underwent single-day, test–retest, 18F-fluorodeoxyglucose (FDG) PET/MR imaging. The acquired MR-AC maps were inspected for truncation, susceptibility, and tissue inversion artifacts. An anatomy-based bone template and a PET-based estimation of truncated arms were employed, while susceptibility artifacts were corrected manually. We report the frequencies of artifacts and the relative difference (RD) on standardized uptake value (SUV) based quantification in PET images reconstructed with the corrected AC maps. Results Truncation artifacts were found in all 50 acquisitions (100%), while susceptibility and tissue inversion artifacts were observed in six (12%) and 26 (52%) of the scans, respectively. The RD in lung tumor SUV was < 5% from bone and truncation corrections, while up to 20% RD was introduced after susceptibility artifact correction, with large inconsistencies between test–retest scans. Conclusion The absence of bone and truncation artifacts have limited effect on the PET quantification of lung lesions. In contrast, susceptibility artifacts caused significant and inconsistent underestimations of the lung tumor SUVs, between test–retest scans. This may have clinical implications for patients undergoing serial imaging for tumor therapy response assessment.
The accuracy of elastographic strain ratio and ultrasound thickness in the differentiation of thin and thick cutaneous melanoma
Authors: Berghe Alexandra S , Şenilă Simona C , Rogojan Liliana , Lenghel Lavinia M , Bolboacă Sorana D , Solomon Carolina M 
Published: May 2019

Background Cutaneous melanoma is the most deadly of skin neoplasms. Few studies have investigated the role of elastography characteristics so the ability of elastography in the differentiation of thin and thick cutaneous melanoma is still narrow. Purpose To investigate the accuracy of elastography in differentiating thin and thick melanoma, by measuring strain ratio (SR) between the lesion and adjacent dermis and hypodermis. Material and Methods We investigated by ultrasound and elastography 52 melanoma lesions in 49 patients. The receiver operating characteristic (ROC) curve method was used to investigate the accuracy of ultrasound and elastographic measurement of SR to surrounding tissue, in the differentiation of thin and thick melanomas. The histopathological measurement of lesions depth called Breslow index was the golden standard test. Results Areas under the curve (AUC) showed low accuracy for SR to hypodermis in distinguishing between thin melanomas and others (AUC = 0.739, 95% confidence interval [CI] = 0.508–0.970]) with a cut-off value of 0.950, being the only statistically significant result in matter of elastographic measurements. Highly statistically significant results were obtained for B-mode ultrasound depth measurements of the lesion, with an AUC = 0.970 (95% CI = 0.927–1.0) in discriminating thin melanomas of others and 0.951 (95% CI = 0.869–1.0) in discriminating thick melanomas of other types. Conclusion Despite the appearance that SR may correlate with the depth of the lesion, elastography, by measuring the SRs to dermis and hypodermis, does not have enough accuracy in distinguishing thin and thick melanoma.
Posterior Labral Repairs of the Shoulder Among Baseball Players: Results and Outcomes With Minimum 2-Year Follow-up
Authors: Kercher James S. , Runner Robert P. , McCarthy Timothy P. , Duralde Xavier A. 
Published: May 2019

Background: There is a paucity of information regarding the treatment of posterior labral tears of the shoulder for baseball players. Reports regarding treatment and postoperative outcomes are more limited than its anterior and superior counterparts. Purpose: To evaluate the clinical presentation, surgical findings, postoperative outcomes, and rate of return to sport after arthroscopic repair of posterior labral injuries of the shoulder among baseball players. Study Design: Case series; Level of evidence, 4. Methods: Retrospective review was performed of baseball players who underwent arthroscopic posterior labral repair between 2009 and 2015 by a single surgeon, with a minimum 2-year follow-up. The group was composed of 32 male patients involved in recreational (6.3%), high school (43.8%), college (31.3%), and professional (18.8%) baseball, with a mean age of 20.5 years. Patients were categorized by chief complaint, clinical findings, surgical findings, and concomitant procedures performed. Pre- and postoperative measures included pain scale, range of motion, American Shoulder and Elbow Surgeons shoulder score, return to play, and patient satisfaction. Results: A variety of tear patterns were identified; 32% involved 90° of the posterior superior labrum; 35% involved the posterior 180°; and 32% involved 90° of the posterior inferior labrum. The dominant mechanism of injury was throwing (34.4%). The most common chief complaint was pain (n = 25, 78%), followed by pain and instability symptoms (n = 6, 18.8%), with only 3% citing isolated sensation of instability. Magnetic resonance imaging clearly identified tear patterns in 75% of cases. American Shoulder and Elbow Surgeons scores significantly improved ( P < .0001), increasing on average 30.9 points from the preoperative mean of 65.4 to a postoperative mean of 96.3. No significant range of motion deficits were noted. Tear size and number of anchors utilized did not influence outcomes. Ninety-four percent of athletes returned to play, 61% at previous levels, and 6% did not return. Pitchers had a lower return to previous level of play than position players (41% vs 86%, P = .0113). Conclusion: Arthroscopic treatment of posterior labral tears of baseball players was effective in improving pain and function, resulting in 94% patient satisfaction and 94% return to sport, with 61% returning to previous level of play. Patient presentation is variable, with a majority of patients citing pain rather than instability.
How Is Psychological Outcome Related to Knee Function and Return to Sport Among Adolescent Athletes After Anterior Cruciate Ligament Reconstruction?
Authors: Beischer Susanne , Hamrin Senorski Eric , Thomeé Christoffer , Samuelsson Kristian , Thomeé Roland 
Published: May 2019

Background:Adult patients who succeed in returning to their preinjury levels of sport after anterior cruciate ligament (ACL) reconstruction have been characterized by a more positive psychological response. It is not known whether this relationship is valid for adolescent athletes.Purpose:To investigate psychological readiness to return to sport, knee-related self-efficacy, and motivation among adolescent (15-20 years old) and adult (21-30 years old) athletes after ACL reconstruction. A further aim was to compare athletes (15-30 years old) who had recovered their muscle function and returned to sport with athletes who had not.Study Design:Case-control study; Level of evidence, 3.Methods:Data were extracted from a rehabilitation-specific register 8 and 12 months after ACL reconstruction. Athletes previously involved in knee-strenuous sport who had undergone primary ACL reconstruction were included. Data comprised psychological patient-reported outcomes and results from 5 tests of muscle function. Comparisons were performed between age groups, between athletes who had and had not recovered their muscle function, and between patients who had returned to sport and not.Results:In all, 384 (50% females) and 271 athletes (52% females) were included at the 8- and 12- month follow-ups, respectively. Enhanced self-efficacy was reported at both follow-ups by adolescents and by athletes who had recovered their muscle function. Athletes who had recovered their muscle function reported higher ( P = .0007) motivation to achieve their goals. Subgroup analyses on patient sex revealed findings similar to those in the main analyses for females but not for males. Moreover, adolescent and adult athletes who had returned to sport reported significantly higher levels on the Knee Self-Efficacy Scale and the ACL–Return to Sport After Injury scale at both follow-ups.Conclusion:Adolescent athletes, especially females, perceived enhanced self-efficacy, had a higher return-to-sport rate, and were more motivated to reach their goals after ACL reconstruction compared with adults. Regardless of age, athletes who had returned to sport and athletes with more symmetrical muscle function had a stronger psychological profile.
Continuous Electroencephalographic Monitoring in the Intensive Care Unit: A Cross-Sectional Study
Authors: Koffman Lauren , Rincon Fred , Gomes Joao , Singh Sarabdeep , He Yitian , Ritzl Eva , Bleck Thomas P. , Kaplan Peter W. , Nyquist Paul 
Published: May 2019

Objective: Research on continuous electro-encephalographic monitoring (cEEG) in the intensive care unit (ICU) has previously focused on neuroscience ICUs. This study determines cEEG utilization within a sample of specialty ICUs world-wide. Methods: A cross-sectional electronic survey of attending level physicians across various intensive care settings. Twenty-five questions developed from consensus statements on the use of cEEG in the critically ill sent as an electronic survey. Results: Of all, 9344 were queried and 417 (4.5%) responses were analyzed with 309 (74%) from the United States and 74 (18%) internationally. Intensive care units were: medical (10%), surgical (6%), neurologic/neurosurgical (12%), cardiac (4%), trauma (3%), pediatrics (29%), burn (<1%), multidisciplinary (30%), and other (5%). Intensive care units were: academic (65%), community (18%), public (3%), military (1%), and other (13%). Specialized cEEG teams were available in 71% of ICUs. Rapid 24/7 access and cEEG interpretation was available in 32% of ICUs. Interpretation changed clinical management frequently (28%) and sometimes (45%). Conclusions: Despite guideline recommendations for cEEG use, there is a discordance between availability, night coverage, and immediate interpretation. Only 27% have institutional protocols for indications and duration of cEEG monitoring. Furthermore, cEEG may be underutilized in nonneurologic ICUs as well as ICUs in smaller nonacademic affiliated hospitals and those outside of the United States.