bluuebunny/crossref_metadata_2025_split huggingface dataset:
Direction-Changing Positional Nystagmus in Acute Otitis Media Complicated by Serous Labyrinthitis: New Insights into Positional Nystagmus
Authors: Choi Jin Woo , Han Kyujin , Nahm Hyunjoo , Shin Jung Eun , Kim Chang-Hee 
Published: January 2019

Objective:
To demonstrate characteristic nystagmus findings in acute otitis media (AOM) complicated by serous labyrinthitis and discuss the mechanism of direction-changing positional nystagmus (DCPN) in this condition.

Patients:
A patient with AOM complicated by serous labyrinthitis on the left side.

Intervention:
Video nystagmography and 3D fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI).

Main Outcome Measures:
Characterize positional nystagmus in a head-roll test observing the change of nystagmus direction in process of time and compare findings of temporal bone 3D FLAIR MRI.

Results:
A previously healthy 50-year-old man who complained of acute otalgia, hearing loss, and vertigo was diagnosed with AOM complicated by serous labyrinthitis on the left side. A head-roll test performed on the day when vertigo developed showed persistent geotropic DCPN. While pre- and postcontrast T1-weighted MRI showed no signal abnormality in both inner ears, 10-minute delay postcontrast 3D FLAIR image showed enhancement in the inner ear on the left side. Four-hour-delay postcontrast 3D FLAIR images showed more conspicuous enhancement of the whole cochlea, vestibule, and semicircular canals on the left side.

Conclusions:
In AOM complicated by serous labyrinthitis, density of perilymph may increase due to direct penetration of cytokines and other inflammatory mediators from the middle ear into perilymph and breakdown of blood–labyrinth barrier that causes vascular leakage of serum albumin into perilymph. The density difference between perilymph and endolymph makes the semicircular canal gravity sensitive. A buoyant force is also generated by gravity, causing indentation of endolymphatic membrane in the ampulla and cupula displacement. Thus, at the early stage of serous labyrinthitis, a head-roll test may elicit persistent geotropic DCPN, of which the direction can be changed over time.
Cochlear Implant Receiver-Stimulator Migration Using the Subperiosteal Pocket Technique: Objective Measurements of Early and Late Positioning
Authors: Maxwell Anne K. , Cass Stephen P. 
Published: January 2019

Objective:
Current clinical practice for fixation of the cochlear implant receiver-stimulator (RS) may not follow recommended manufacturer's guidelines. We investigated short- and long-term RS migration using a subperiosteal pocket technique via serial objective position measurements since previous literature provided only subjective or short-term evaluation.

Study Design:
Retrospective review.

Setting:
Tertiary referral center.

Patients:
We reviewed all patients who underwent cochlear implantation by the senior author between 2012 and 2018. At least two comparison measurements were available for 73 implants in 62 patients, 72.6% adults and 27.4% children.

Interventions:
RS placement using a subperiosteal pocket technique.

Main Outcome Measure:
Distance between the pinna and RS magnet in the early (<6 mo) and late (>6 mo) postoperative period.

Results:
In the early postoperative period, mean RS distance was 57.0 mm (SD 9.4 mm) from the pinna compared with baseline intraoperative distance of 55.8 mm (SD 8.4 mm), p = 0.44. With some shifts closer and some farther from the pinna, there was a 3.0 mm mean absolute value migration (median 2 mm, SD 3.8 mm, range 0–15 mm). Fourteen implants (25.9%) migrated >5 mm in the early period, 35.7% closer, and 64.3% farther from pinna. In the late postoperative period, mean RS final distance was 56.6 mm (SD 10.1 mm), compared with its baseline of 59.0 mm (SD 9.2 mm), p = 0.29. Seven implants (19.4%) demonstrated shifts >5 mm, with a mean 3.6 mm shift (median 2 mm, SD 4.5 mm, range 0–17 mm).

Conclusion:
A subperiosteal pocket technique demonstrated objective RS migration in 20 to 25% of adult and pediatric patients, nearly all of which were not clinically apparent unless measured. Additionally, none of these patients experienced associated symptoms or device failures.
Efficacy of robotic radical hysterectomy for cervical cancer compared with that of open and laparoscopic surgery
Authors: Zhang Sha-sha , Ding Tian , Cui Zheng-hui , Lv Yuan , Jiang Ruo-an 
Published: January 2019

Abstract

Background:
To perform a meta-analysis of high-quality studies comparing robotic radical hysterectomy (RRH) vs laparoscopic radical hysterectomy (LRH), and open radical hysterectomy (ORH) for the treatment of cervical cancer.

Methods:
A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was performed to identify studies that compared RRH with LRH or ORH. The selection of high-quality, nonrandomized comparative studies was based on a validated tool (methodologic index for nonrandomized studies) since no randomized controlled trials have been published. Outcomes of interest included conversion rate, operation time, intraoperative estimated blood loss (EBL), length of hospital stay (LOS), morbidity, mortality, number of retrieved lymph nodes (RLNs), and long-term oncologic outcomes.

Results:
Twelve studies assessing RRH vs LRH or ORH were included for this meta-analysis. In comparison with LRH, there was no difference in operation time, EBL, conversion rate, intraoperative or postoperative complications, LOS, and tumor recurrence (P > .05). Compared with ORH, patients underwent RRH had less EBL (weighted mean difference [WMD] = −322.59 mL; 95% confidence interval [CI]: −502.75 to −142.43, P < .01), a lower transfusion rate (odds ratio [OR] = 0.14, 95% CI: 0.06–0.34, P < .01), and shorter LOS (WMD = −2.71 days; 95% CI: −3.74 to −1.68, P < .01). There was no significant difference between RRH and LRH with respect to the operation time, intraoperative or postoperative complications, RLN, and tumor recurrence (P > .05).

Conclusion:
Our results indicate that RRH is safe and effective compared to its laparoscopic and open counterpart and provides favorable outcomes in postoperative recovery.
Contrast-enhanced ultrasound for evaluating the pathologic response of breast cancer to neoadjuvant chemotherapy
Authors: Jia Kun , Li Li , Wu Xiao Jing , Hao Mei Jin , Xue Hong Yuan 
Published: January 2019

Abstract

Objective:
Recent reports have suggested that contrast-enhanced ultrasound (CEUS) can be used to monitor the pathologic responses of breast cancer (BC) to neoadjuvant chemotherapy (NAC); however, the diagnostic performance of CEUS in BC has yet to be confirmed. Thus, we conducted a meta-analysis of related studies to explore the relationship between CEUS and pathologic responses of BC to NAC.

Materials and methods:
We searched PubMed, Embase, Web of Science, ScienceDirect, and China National Knowledge Infrastructure databases for studies published until September 31, 2018. Study-specific odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, and then ORs with 95% CIs were pooled to estimate the prognostic role of CEUS for the pathologic responses of BC to NAC.

Results:
Pooled meta-analysis of the 9 eligible studies that included 424 patients indicated the high performance of CEUS for monitoring pathologic responses to NAC (OR = 31.83, 95% CI: 16.69–60.67, P < .001), with no significant heterogeneity (I
2 = 0.0%, P = .529). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 87% (95% CI: 0.81–0.92), 84% (95% CI: 0.74–0.91), 5.5 (95% CI: 3.3–9.2), 0.15 (95% CI: 0.10–0.23), and 36 (95% CI: 18–70), respectively. An area under the curve of 0.92 (95% CI: 0.89–0.94) suggests a high ability for prognostic detection. Although Begg's funnel plot (P = .057) indicated the presence of publication bias among the included studies, the trim-and-fill method verified the stability of the pooled outcomes. Sensitivity analysis suggested that the pooled OR was robust.

Conclusion:
Our results suggest that CEUS has a high diagnostic performance for the pathologic responses of BC to NAC. Further and better-designed studies should be performed to verify the clinical applications of CEUS for monitoring BC responses to NAC.
The effect of surgical fecal stream diversion of the healthy colon on the colonic microbiota
Authors: van der Sluis Wouter B. , Bouman Mark-Bram , Mullender Margriet G. , Degen Malieka C. , Savelkoul Paul H.M. , Meijerink Wilhelmus J.H.J. , de Boer Nanne K.H. , van Bodegraven Adriaan A. , Budding Andries E. 
Published: January 2019

Objectives
The intestinal microbiota plays an important role in intestinal health. After colonic diversion from the fecal stream, luminal nutrients for bacteria are expected to be depleted, inducing changes in microbial composition. In this study, we describe microbial changes in the healthy colon following surgical fecal stream diversion, studied in the surgically constructed sigmoid-derived neovagina.

Methods
At various postoperative times after sigmoid vaginoplasty, rectal, neovaginal, and skin microbial swabs were obtained for microbial analysis by interspacer profiling, a PCR-based bacterial profiling technique. Differences in bacterial profiles, in terms of bacterial abundance and phylum diversity, were assessed. Microbial dissimilarities between anatomical locations were analyzed with principal coordinate analysis and partial least squares discriminant analysis.

Results
Bacterial samples were obtained from 28 patients who underwent sigmoid vaginoplasty. By principal coordinate analysis, microbial profiles of samples from the sigmoid-derived neovagina were distinctively different from rectal samples. Partial least squares discriminant analysis showed that the most discriminative species derived from the phylum Bacteroidetes. The abundance and diversity of Bacteroidetes species were reduced following fecal stream diversion compared with rectal samples (median Shannon diversity index of 2.76 vs. 2.18, P<0.01). Similar abundance of Phyla Firmicutes, Actinobacteria, Fusobacteria, Verrucomicrobia, and Proteobacteria was observed.

Conclusion
By analyzing the microbiome of sigmoid-derived neovaginas, we studied the effects of fecal diversion on the microbial composition of the healthy intestine. Most changes were observed in the phylum Bacteroidetes, indicating that these bacteria are likely part of the diet-dependent (butyrate-producing) colonic microbiome. Bacteria of other phyla are likely to be part of the diet-independent microbiome.
Efficacy of Sacubitril/Valsartan in Hypertension
Authors: Malik Aaqib H. , Aronow Wilbert S. 
Published: January 2019

Background:
Sacubitril/valsartan (LCZ696) has progressed to be one of the most promising medication since its approval for chronic heart failure with reduced ejection fraction. Recent data have suggested a superior blood pressure control with LCZ696.

Study Question:
What is the antihypertensive efficacy and safety profile of sacubitril/valsartan?

Data Sources:
Randomized controlled trials (RCTs) comparing the efficacy and safety of LCZ696 against a placebo or angiotensin receptor blocker (ARB). RCTs were identified from a comprehensive search in PubMed, Embase, Cochrane library, and clinicaltrials.gov.

Study Design:
We used a change in systolic and diastolic blood pressures, both sitting as well as ambulatory, to calculate relevant effect sizes with their standard errors from the available change in mean and SD data. In addition, we also collected categorical data for the reported adverse effects from these trials. We performed a series of pairwise meta-analyses between LCZ696 versus an active comparator or a placebo.

Results:
Eleven RCTs with a total of 6028 participants had the relevant data available. Our meta-analysis showed that LCZ696 is an effective and a safe treatment for hypertension. It outperformed ARBs in every category, and the results are consistent across the different dosages of LCZ696. Compared with ARBs, 200 mg of LCZ696 reduced systolic blood pressure and diastolic blood pressure (DBP) by 4.62 mm Hg (95% confidence interval, 3.33–5.90, P < 0.001) and 2.13 mm Hg (95% confidence interval, 1.69–2.57, P < 0.001), respectively. Similarly, 400 mg of LCZ696 reduced systolic blood pressure and diastolic blood pressure by 5.50 mm Hg (2.94–8.07, P < 0.001) and 2.51 mm Hg (1.80–3.21, P < 0.001), respectively, in comparison with ARBs. The adverse effects with LCZ696 were not significantly higher compared with ARBs or placebo.

Conclusions:
Sacubitril/valsartan is more effective for the management of hypertensive patients, compared with an ARB. Long-term prospective studies are required to identify whether this result translates into morbidity and mortality benefits.
Missing Data in Marginal Structural Models
Authors: Liu Shao-Hsien , Chrysanthopoulou Stavroula A. , Chang Qiuzhi , Hunnicutt Jacob N. , Lapane Kate L. 
Published: January 2019

Background:
The use of marginal structural models (MSMs) to adjust for time-varying confounding has increased in epidemiologic studies. However, in the setting of MSMs, recommendations for how best to handle missing data are contradictory. We present a plasmode simulation study to compare the validity and precision of MSMs estimates using complete case analysis (CC), multiple imputation (MI), and inverse probability weighting (IPW) in the presence of missing data on time-independent and time-varying confounders.

Materials and Methods:
Simulations were based on a cohort substudy using data from the Osteoarthritis Initiative which estimated the marginal causal effect of intra-articular injection use on yearly changes in knee pain. We simulated 81 scenarios with parameter values varied on missing mechanisms (MCAR, MAR, and MNAR), percentages of missing (10%, 20%, and 30%), type of confounders (time-independent, time-varying, either or both), and analytical approaches (CC, IPW, and MI). The performance of CC, IPW, and MI methods was compared using relative bias, mean squared error of the estimates of interest, and empirical power.

Results:
Across scenarios defined by missing data mechanism, extent of missing data, and confounder type, MI generally produced less biased estimates (range: 1.2%–6.7%) with better precision (range: 0.17–0.18) compared with IPW (relative bias: −5.3% to 8.0%; precision: 0.19–0.53). Empirical power was constant across the scenarios using MI.

Conclusions:
Under simple yet realistically constructed scenarios, MI seems to confer an advantage over IPW in MSMs applications.
Quality assurance in head and neck cancer surgery: where are we, and where are we going?
Authors: Simon Christian , Dietz Andreas , Leemans C. René 
Published: January 2019

Purpose of review
The scope of this review is to summarize current efforts in quality assurance for head and neck cancer surgery. National and international initiatives are summarized and progress in terms of identification of process indicators and outcome indicators delineated.

Recent findings
Massive efforts have been made in order to improve quality of head and neck cancer surgery. New guidelines for quality assurance of head and neck cancer surgery in clinical trials have recently been proposed by EORTC.

Summary
Quality assurance programs can be tested within the clearly defined environment of prospective clinical trials. If positive, such programs could be rolled out within national healthcare systems, if feasible. Testing quality programs in clinical trials could be a versatile tool to help head neck cancer patients benefit from such initiatives on a global level.
Radiation-induced papillary thyroid cancer: is it a distinct clinical entity?
Authors: Bresciani Lorenzo , Orlandi Ester , Piazza Cesare 
Published: January 2019

Purpose of review
To present the current status of knowledge regarding radiation-induced papillary thyroid cancer (RIPTC), defining its epidemiologic, pathologic, and clinical characteristics, with ensuing possible therapeutic and prognostic consequences.

Recent findings
Cumulative evidence shows that RIPTC resembles sporadic papillary thyroid cancer (PTC) of comparable age, both in terms of clinical-pathological features and prognosis. Therefore, more aggressive treatment does not seem to be required when managing RIPTC as its prognosis is comparable to that of never-irradiated patients.

Summary
Radiation exposure in childhood is a well-documented risk factor for development of PTC. Therefore, increased exposure to medical or environmental radiation may be in part responsible, along with increased screening, of the recent burgeoning incidence of PTC. A specific morphological and molecular portrait of RIPTC is unlikely to exist. The more aggressive histologic and clinical features initially reported in radiation-induced cases are consistent with the expectations in nonradiation-related PTC of a comparable age. Aggressive histology, nodal, and distant metastases correlate with early age at onset rather than with radiation exposure. Although relapses are frequent in children, long-term cancer-specific mortality is approximately 1%, lower than that observed for adults and comparable between irradiated and nonirradiated cohorts. RIPTC does not require more aggressive surgery or more adjuvant treatments, as prognosis is as good as that of sporadic PTC when matched for stage and treatment received.
Air pollution, ambient temperature, green space and preterm birth
Authors: Kloog Itai 
Published: January 2019

Purpose of review
Preterm birth is the leading cause of global child mortality, and survivors are at increased risk of multiple morbidities that can continue into adulthood. Recent studies have suggested that maternal exposure to air pollution and high and low ambient temperatures may increase the risk of preterm birth, whereas proximity to green space may decrease it. This review summarizes these findings and suggests avenues for further research.

Recent findings
Particulate matter may be associated with an increased risk of preterm birth, but the magnitude of the effect remains unclear. Heat and cold likely increase the risk of preterm birth, with stronger evidence for heat. The first and third trimesters may be sensitive periods for exposure to both temperature and particulate matter, but the underlying biological mechanisms are incompletely understood. Context-appropriate green space can substantially reduce particulate matter levels and mitigate urban heat islands.

Summary
In a warming, urbanizing world, exposure to unusual temperatures and elevated particulate matter levels represent an increasing risk for pregnant women. Green infrastructure might help mitigate this risk, but further research is needed to confirm its effects in complex urban environments and evaluate the contribution of both indoor and outdoor particulate matter and air temperature to personal exposure and preterm birth.
Human Fibrinogen Concentrate and Fresh Frozen Plasma in the Management of Severe Acquired Hypofibrinogenemia in Children With Acute Lymphoblastic Leukemia: Results of a Retrospective Survey
Authors: Giordano Paola , Grassi Massimo , Saracco Paola , Luciani Matteo , Colombini Antonella , Testi Anna M. , Micalizzi Concetta , Petruzziello Fara , Putti Maria C. , Casale Fiorina , Consarino Caterina , Mura Rosa M. , Mastrodicasa Elena , Notarangelo Lucia D. , Onofrillo Daniela , Pollio Berardino , Rizzari Carmelo , Tafuri Silvio , De Leonardis Francesco , Corallo Paola C. , Santoro Nicola 
Published: January 2019

Objective of the Study:
In this study we aimed to retrospectively evaluate how centers, belonging to the Associazione Italiana Ematologia e Oncologia Pediatrica (AIEOP), manage severe acquired hypofibrinogenemia in children with acute lymphoblastic leukemia, particularly evaluating the therapeutic role of human fibrinogen concentrate (HFC) and fresh frozen plasma (FFP).

Methods:
We conducted a survey among AIEOP centers; thereafter, we collected and analyzed data with regard to the treatment of episodes of severe acquired hypofibrinogenemia occurring during the induction and reinduction phases of the AIEOP-BFM ALL 2009 protocol.

Results:
In total, 15 of the 37 AIEOP centers invited to join the survey agreed to collect the data, with 10 and 5 centers declaring to react to severe acquired hypofibrinogenemia (<70 mg/dL) by administering HFC or FFP, respectively. Of the 150 episodes of severe hypofibrinogenemia occurring in 101 patients, 47.3% were treated with HFC and 52.7% with FFP, with a normalization of fibrinogen levels achieved in greater proportion and in a shorter amount of time in the HFC group as compared with the FFP group. None of the patients presented with bleeding or thrombosis during the observation period.

Conclusions:
Even with the limitations of the retrospective nature of this study, HFC seems to be a safe and effective alternative to FFP for replacement therapy in case of severe hypofibrinogenemia in children with acute lymphoblastic leukemia.
Applied Force During Prone Restraint
Authors: Kroll Mark W. , Brave Michael A. , Kleist Scott R. , Ritter Mollie B. , Ross Darrell L. , Karch Steven B. 
Published: January 2019

Introduction
It has been suggested that law enforcement officer (LEO) weight on the backs of prone subjects may cause asphyxia.

Methods
Law enforcement officers used their agency-trained “local” single- and double-knee techniques, the “Wisconsin” 3-Point Ground Stabilization, and the Human Factor Research Group Inc single-knee tactical handcuffing techniques, and the weight force was measured.

Results
Forty-one LEOs (36 men, 5 women) participated, aged 38.4 ± 8.3 years, and weighing 96.2 ± 19.4 kg. The double-knee technique transmitted more weight than single knee (P < 0.0001). Wisconsin technique force was lower than other single-knee techniques (P < 0.0001). Double-knee weight was 23.3 kg plus 24% of LEO's body weight. Mean values for local and Human Factor Research Group Inc single-knee were 30.9 and 32.9 kg, respectively. The Wisconsin single knee weight force was given by 15.4 kg plus 9.5 kg for a male.

Conclusions
A double-knee technique applies more weight force than single-knee techniques. The Wisconsin single-knee technique provides the least weight force of single-knee techniques. Law enforcement officer body weight is irrelevant to prone-force weight with single-knee techniques. With double-knee restraint, it has a modest influence. Our data do not support the hypothesis of restraint asphyxia.
A Case of Bilateral Extracranial Internal Carotid Artery Dissection Due to the Helmet Strap After Motorcycle Crash
Authors: Gioia Sara , Franceschetto Lisa , Lancia Massimo , Bacci Mauro , Suadoni Fabio 
Published: January 2019

Abstract
The authors report a case of a man who developed stroke symptoms a few days after a road accident on his motorcycle. Radiographic examinations revealed the presence of bilateral dissection of the extracranial internal carotid arteries with signs of involvement of the brain parenchyma.
The location, timing, and presentation lead to the conclusion that the carotid lesions were secondary to the motorcycle collision; in particular, we suppose that it is due to the pressure exerted by the helmet strap worn. Although helmets have undoubtedly prevented serious injuries, this report highlights that the helmets themselves may cause injuries, especially to cervical soft tissues and vessels.
Fatal Intestinal Obstruction in a Patient With Fetal Alcohol Syndrome
Authors: Wygant Cassandra Maria , Cohle Stephen D. 
Published: January 2019

Abstract
We describe an 8-year-old white boy with a history of fetal alcohol syndrome and pica, who was found dead on the floor by his mother. The child died from massive intestinal dilatation causing asphyxia. We discuss the potential pathogenetic mechanisms of intestinal dilation in patients with fetal alcohol syndrome.