bluuebunny/crossref_metadata_2025_split huggingface dataset:
A “Goldilocks” Approach to Hearing Aid Self-Fitting: Ear-Canal Output and Speech Intelligibility Index
Authors: Mackersie Carol , Boothroyd Arthur , Lithgow Alexandra 
Published: June 2018

Objectives:
The objective was to determine self-adjusted output response and speech intelligibility index (SII) in individuals with mild to moderate hearing loss and to measure the effects of prior hearing aid experience.

Design:
Thirteen hearing aid users and 13 nonusers, with similar group-mean pure-tone thresholds, listened to prerecorded and preprocessed sentences spoken by a man. Starting with a generic level and spectrum, participants adjusted (1) overall level, (2) high-frequency boost, and (3) low-frequency cut. Participants took a speech perception test after an initial adjustment before making a final adjustment. The three self-selected parameters, along with individual thresholds and real-ear-to-coupler differences, were used to compute output levels and SIIs for the starting and two self-adjusted conditions. The values were compared with an NAL second nonlinear threshold-based prescription (NAL-NL2) and, for the hearing aid users, performance of their existing hearing aids.

Results:
All participants were able to complete the self-adjustment process. The generic starting condition provided outputs (between 2 and 8 kHz) and SIIs that were significantly below those prescribed by NAL-NL2. Both groups increased SII to values that were not significantly different from prescription. The hearing aid users, but not the nonusers, increased high-frequency output and SII significantly after taking the speech perception test. Seventeen of the 26 participants (65%) met an SII criterion of 60% under the generic starting condition. The proportion increased to 23 out of 26 (88%) after the final self-adjustment. Of the 13 hearing aid users, 8 (62%) met the 60% criterion with their existing hearing aids. With the final self-adjustment, 12 out of 13 (92%) met this criterion.

Conclusions:
The findings support the conclusion that user self-adjustment of basic amplification characteristics can be both feasible and effective with or without prior hearing aid experience.
Pedicle Perforation While Inserting Screws Using O-arm Navigation During Surgery for Adolescent Idiopathic Scoliosis
Authors: Oba Hiroki , Ebata Shigeto , Takahashi Jun , Koyama Kensuke , Uehara Masashi , Kato Hiroyuki , Haro Hirotaka , Ohba Tetsuro 
Published: June 2018

Study Design.
An observational cohort study.

Objective.
The aim of this study was to compare the rate of pedicle perforation while inserting screws (PS) using O-arm navigation during surgery for scoliosis with that reported previously and to determine the risk factors specific to O-arm navigation.

Summary of Background Data.
O-arm navigation provides intraoperative three-dimensional fluoroscopic imaging with an image quality similar to that of computed tomography. Surgeons have started using O-arm navigation in treatment of adolescent idiopathic sclerosis (AIS). However, there are few reports of the perforation rate when using O-arm navigation to insert pedicle screws for AIS. To our knowledge, no information has been published regarding risk factors for pedicle perforation by PS when using O-arm navigation during surgery for AIS.

Methods.
We retrospectively reviewed the cases of 23 consecutive patients with AIS (all female; mean age 15.4 years, range 12–19 years) who had all undergone PS fixation under O-arm navigation.

Results.
There were 11 major pedicle perforations (Grade 2 or 3) by the 404 screws (2.7%). For both Grade 1 to 3 and Grade 2 or 3 perforations, the pedicle perforation rate by the ninth or subsequent screws was significantly higher than that for the other two groups (screws 1–4, 5–8) (P < 0.01). Grade 1 to 3, Grades 2 or 3, and Grade 3 perforation rates after a previous perforation were significantly higher than those in patients without a previous perforation (P < 0.01). The rate of screw deviation can increase significantly to 12.2% after insertion of 8.

Conclusion.
The rate of major perforation of pedicles after inserting PS using O-arm navigation during surgery for AIS is relatively low. However, we recommend caution using intraoperative navigation after inserting eight pedicle screws because after this, the trajectory deviation rate can increase significantly.

Level of Evidence: 3
Cost Analysis of Magnet-driven Growing Rods for Early-onset Scoliosis at 5 Years
Authors: Harshavardhana Nanjundappa S. , Noordeen Mohammed H.H. , Dormans John P. 
Published: June 2018

Study Design.
Prospective case series of nine children with early-onset scoliosis (EOS) treated by a single surgeon with a novel implant, the magnet-driven growing rod (MdGR) in a publicly funded health care service accounting for “payer costs” (PC) incurred.

Objective.
The aim of this study was to compare the cost-effectiveness of MdGR versus conventional growing rods (CGRs) with respect to the PC incurred for treating EOS at 5 years.

Summary of Background Data.
Cost estimate and mathematical modeling study projections of MdGR have shown despite high insertional costs, it breaks even with CGR by 3 to 4 years. However, no clinical study to date exists either supporting or refuting this hypothesis.

Methods.
Nine patients with EOS secondary to idiopathic (two), congenital (one), syndromic (three), and neuromuscular (three) etiologies treated by submuscular insertion of MdGR against stringent inclusion criteria formed the study cohort. We collected costs incurred with all aspects of care over the lifetime of device (or at least 5 years) from payers’ perspective to compute and report average PC incurred per patient. We performed this cost analysis by comparing the MdGR PC against literature reported PC for CGR at 5 years.

Results.
There were five single rod (SR) and two dual rod (DR) de novo MdGR insertions, while two patients had conversion of CGR to MdGR. MdGR alone accounted for at least 50% of overall budget. The MdGR was at least 40% more cost-effective in comparison to the CGR (£34,741 vs. £52,293) and there were seven MdGR graduates.

Conclusion.
The first study reporting direct PC incurred in EOS treated by MdGR that is devoid of any mathematical modeling and deterministic sensitivity analysis is presented. The true societal/human cost savings taking into consideration indirect costs are likely to be significantly higher. MdGR is a promising novel implant that may eventually become the “standard of care” for certain EOS etiologies.

Level of Evidence: 4
Rigid Internal Fixation for Traumatic Cranio-Cervical Dissociation in Infants and Young Children
Authors: Keen Joseph R. , Ayer Robert E. , Taha Asma , Zouros Alexander 
Published: June 2018

Study Design.
Retrospective review.

Objective.
Evaluate radiographic and clinical outcomes for infants and children, who underwent rigid occipito-cervical fixation for traumatic craniocervical dissociation (tCCD).

Summary of Background Data.
Traumatic craniocervical dissociation is devastating. Children are at high risk but make up a large number of survivors. Non-rigid fixation has traditionally been favored over screw and rod constructs due to inherent challenges involved with instrumenting the pediatric craniocervical junction. Therefore, outcomes for rigid occipito-cervical instrumentation in infants and young children with tCCD remain uncertain.

Methods.
Retrospective review of children who survived tCCD between 2006 and 2016 and underwent rigid occipito-cervical fixation.

Results.
Fifteen children, from 8 months to 8 years old (mean, 3.8 yr), were either a passenger (n = 11) or a pedestrian (n = 4) in a motor vehicle accident. Seven patients had weakness: five with quadriplegia, one with hemiparesis, and one with bilateral upper extremity paresis. Ten patients had concurrent C1–2 instability. At last follow-up, four patients had improved motor function: one with bilateral upper extremity paresis and one with hemiparesis regained full strength, one with quadriplegia regained function on one side while another regained function in bilateral upper extremities. All underwent rigid posterior occipito-cervical fixation, with two patients requiring additional anterior and posterior fixation at non-contiguous levels. Fourteen patients were stable on flexion-extension x-rays at a mean follow-up of 31 months (9–1 yr or longer, 7–2 yr or longer). There were no cases of deformity, growth disturbance, or subaxial instability.

Conclusion.
Children who survive tCCD may regain function after stabilization. Rigid internal rod and screw fixation in infants and young children safely provided long-term stability. We advocate using C2 translaminar screws to exploit the favorable anatomy of pediatric lamina to minimize the risks of occipitocervical (OC) instrumentation.

Level of Evidence: 4
An Evidence-based Approach to the Management of Children With Morquio A Syndrome Presenting With Craniocervical Pathology
Authors: Williams Nicole , Narducci Alessandro , Eastwood Deborah M , Cleary Maureen , Thompson Dominic 
Published: June 2018

Study Design.
Retrospective case series

Objective.
The aim of this study was to review clinical and radiological outcomes of craniovertebral surgery in children with Morquio A syndrome (Mucopolysaccharidosis type IVA) and develop an evidence-based management algorithm.

Summary of Background Data.
Myelopathy secondary to craniovertebral pathology is a common cause of neurological disability in Morquio A syndrome. Previously unresolved surgical controversies include the value of surveillance, surgical indications, and operative technique.

Methods.
A retrospective case-based review of children with Morquio A syndrome and craniovertebral pathology seen in a tertiary referral pediatric center from 1992 to 2016 was performed. Patients treated nonoperatively and operatively were included. Medical records and imaging were reviewed to determine clinical and radiological findings at initial assessment, before cervical spine surgery, early postoperative period, and final follow-up. The clinical outcomes of interest were neurological status and mobility at follow-up, complications, and need for further surgery.

Results.
Twenty-seven patients were included. Surgical indications were radiological evidence of cervicomedullary compression alone (six cases) or with clinical evidence of myelopathy (12 cases). Eighteen patients (median age 6.2 years, range 3.5–15.9 years) underwent surgery, with median follow-up of 8.5 years. Occiput to upper cervical spine fusion with C1 decompression was performed in all cases with the addition of autologous calvarial graft in young patients (12 cases) and occipital-cervical plate fixation in older children (six cases). Neurological improvement occurred in 38% of cases but by one functional level only. Six of nine conservatively treated patients remained independent walkers.

Conclusion.
Surgery for craniovertebral pathology is required in the majority of children with Morquio A syndrome. Close clinical and radiological surveillance is essential for timely intervention. Occiput to cervical fusion is safe and feasible even in young patients and improves clinical and radiological parameters.

Level of Evidence: 4
Primary Visceral Merkel Cell Carcinoma: A Case Report and Review of the Literature
Authors: Siref Andrew , Hendifar Andrew , Balzer Bonnie 
Published: June 2018

Abstract:
A 63-year-old white man with no significant previous medical or surgical history presented with painless jaundice after 3 weeks of dark urine, yellow stools, and a 9-pound weight loss. Bilirubin, aspartate transaminase, alanine transaminase, and alkaline phosphatase were elevated, and a computed tomography scan detected a 10-cm, ill-defined mass at the porta hepatis compressing the common bile duct. He underwent endoscopic retrograde cholangiopancreatography with stenting and ultrasound-guided biopsies. Histologic sections showed a neoplastic population of small ovoid cells with a high N:C ratio, nuclear hyperchromasia, “smoky” chromatin and abundant mitotic figures, and characteristic of high-grade neuroendocrine carcinoma (HGNECA). Immunohistochemistry showed synaptophysin, chromogranin, Golgi pattern CK20 reactivity, and strong diffuse expression of Merkel cell polyomavirus, supporting a diagnosis of Merkel cell carcinoma (MCC). A metastatic workup, including complete skin examination and positron emission tomography scan, revealed no other site of disease. Although this patient fits the classic demographic pattern for MCC, he lacks cutaneous involvement and significant risk factors for MCC including immunosuppression and concurrent or previous malignancy. Histologically, the differential diagnosis in this anatomical site is primary or occult metastatic organ-based small-cell HGNECA. Although pure nodal MCC accounts for a minute subset of MCC, it is almost exclusively described in superficial and extremity-draining nodal basins (eg, axillary or inguinal regions). Primary visceral nodal MCC accounts for fewer than 5 cases ever reported. This case illustrates the importance of recognizing the morphologic features characteristic of MCC, regardless of anatomical location, and the value of immunohistochemistry in diagnosis, which aid in differentiating it from non-MCC mimics. Development of targeted therapy has made distinction between MCC and non-MCC HGNECA increasingly important. This patient initially responded to PD-L1 inhibitor therapy but ultimately died with disease 10 months after diagnosis.
A Predictive Model for Primary Closure Lengths in Mohs Surgery Based on Skin Cancer Type, Dimensions, and Location
Authors: Theroux Zachary A. , Blechman Adam B. , Russell Mark A. 
Published: June 2018

BACKGROUND
Surgical scar length is a common concern among patients undergoing Mohs micrographic surgery (MMS).

OBJECTIVE
This study evaluates 3 metrics of preoperative lesion size to determine which correlates best with primary linear closure lengths for nonmelanoma skin cancers (NMSCs) treated with MMS. This metric is then used to develop predictive models for linear closure lengths in 10 different anatomical regions.

MATERIALS AND METHODS
A retrospective study of 4,049 NMSCs treated with MMS and repaired with primary linear closure was conducted. Primary closure lengths were plotted against preoperative lesion circumference, area, and short axis length. Linear regression analysis was performed.

RESULTS
Preoperative NMSC circumference correlated best with closure length. Twenty-one of the 28 regression models had coefficients of determination (R
2) above 0.5. Closure lengths increased by 0.52 to 1.1 mm, depending on location, for every millimeter increase in preoperative NMSC circumference.

CONCLUSION
Preoperative lesion circumference is directly proportional to primary closure length and is a better indicator of closure length than preoperative area and short axis for MMS of NMSCs. Closure lengths located on the nasal tip, supratip, or periocular areas are most sensitive to differences in NMSC size. These data might aid Mohs surgeons with preoperative planning for wound reconstruction and patient counseling.
Evaluation of Safe and Effectiveness of an Injectable Solution Acid Deoxycholic Based for Reduction of Localized Adiposities
Authors: Amore Roberto , Amuso Domenico , Leonardi Vincenza , Leva Francesco , Sibaud Andrea Carnovale , Guida Antonio , Costa Ezio , Terranova Ferdinando , Amodeo Vincenzo , Gkritzalas Konstantinos 
Published: June 2018

Background:
The use of deoxycholic acid to reduce localized fat deposits is a procedure that has been in use for about 30 years. Its effectiveness as treatment is due to emulsification of phospholipids and therefore, solubilization of the biological membranes with resulting fat necrosis. The purpose of the study was to assess the effectiveness and the safety of an injectable solution containing sodium deoxycholtate 1.25% (DB125), used as intralipotherapy.

Methods:
The effectiveness and safety of DB125 solution have been assessed with a multicentre observational prospective study carried out between February and October 2017. The 221 selected patients presented with various forms and degrees of localized fat in several areas. Intralipotherapy treatments were performed 6 weeks apart and until the clinical result was obtained. Aesthetic outcomes were evaluated by the authors using preoperative and postoperative photographic documentation and by the patients with their level of satisfaction by filling out an anonymous form. Major adverse events were reported by each doctor who performed the treatment.

Results:
Two hundred twenty-one patients treated in 273 cases of different localized fat deposits. One hundred eighty-five patients who could be assessed for final results gave the effectiveness of the treatment an average score of 7.4. The failure percentage of the treatment was 3.8%. The medical evaluation showed treatment success in 93.5% of cases. Adverse events can be divided into 2 groups: minor adverse events, which are very frequent and major ones, which are extremely rare. For both groups, the adverse events can be ascribed to localized problems in the treatment area.

Conclusion:
Studies have shown that the second-generation solution containing sodium deoxycholate 1.25% is effective and safe to treat different localized fat deposits. The high degree of effectiveness shown in the study was not associated with a lesser degree of handling because, at the doses indicated and with the use of intralipotherapy, the occurrence of adverse events was minimal.
A Novel Method for Quick Assessment of Internal And External Radiation Exposure in the Aftermath of a Large Radiological Incident
Authors: Korir Geoffrey , Karam P. Andrew 
Published: June 2018

Abstract
In the event of a significant radiological release in a major urban area where a large number of people reside, it is inevitable that radiological screening and dose assessment must be conducted. Lives may be saved if an emergency response plan and radiological screening method are established for use in such cases. Thousands to tens of thousands of people might present themselves with some levels of external contamination and/or the potential for internal contamination. Each of these individuals will require varying degrees of radiological screening, and those with a high likelihood of internal and/or external contamination will require radiological assessment to determine the need for medical attention and decontamination. This sort of radiological assessment typically requires skilled health physicists, but there are insufficient numbers of health physicists in any city to perform this function for large populations, especially since many (e.g., those at medical facilities) are likely to be engaged at their designated institutions. The aim of this paper is therefore to develop and describe the technical basis for a novel, scoring-based methodology that can be used by non-health physicists for performing radiological assessment during such radiological events.
Dose Comparison Using Thermoluminescent Dosimeters During Multislice Computed Tomography With Different Parameters for Simulated Spine Tumor Examination
Authors: Hsieh Chih-Chuan , Li Chiao-Zhu , Lin Meng-Chi , Yang Yun-Ju , Hong Kun-Ting , Chen Yi-Hsun , Syu Zih-Hsian , Ju Da-Tong 
Published: June 2018

Abstract
This study aims to compare the effect of Philips’ Brilliance 64‐slice and 256‐slice (multislice) computed tomography on effective doses when changing the operating parameters for simulated examinations of patients’ spine tumors, including changes in pitch, tube voltage (kV), and effective tube current-time product (mA s). This study considers the possibility of using other probable operating conditions to reduce patients’ effective doses. The absorbed doses to organs and skin are measured by taking data from thermoluminescent dosimeters (GR‐200 and GR‐200F) in relevant positions on the anthropomorphic Rando phantom. We also used an American College of Radiology computed tomography accreditation phantom to experiment with image spatial resolution under various scan conditions in order to achieve results over 5 line pairs per cm, the analytical capability required to meet diagnostic needs. The results show that, in general, when we change the pitch, effective tube current-time product, and tube voltage, the effective doses from 256‐slice computed tomography exceed those from 64‐slice computed tomography.
Association Between Advanced Keratoconus and Serum Levels of Zinc, Calcium, Magnesium, Iron, Copper, and Selenium
Authors: Bamdad Shahram , Owji Naser , Bolkheir Alireza 
Published: June 2018

Purpose:
To investigate the possibility of an association between serum levels of zinc (Zn), calcium (Ca), magnesium (Mg), iron (Fe), copper (Cu), and selenium (Se) and advanced keratoconus (KCN).

Methods:
In this study, 50 patients with advanced KCN and 50 control subjects were included. Plasma levels of Zn, Ca, Mg, Fe, Cu, and Se were compared between the groups.

Results:
Mean ± SD age of the patients in the case and control groups was 29.3 ± 3.5 and 28.9 ± 5.9 years, respectively (P = 0.669). Among serum parameters, there were no statistically significant differences between the 2 groups in serum levels of Ca, Mg, and Fe (P > 0.05), whereas serum levels of Zn and Cu were significantly lower in the case group than the control group [65.92 ± 7.90 vs. 87.36 ± 13.64 μg/dL and 78.48 ± 11.96 vs. 116.34 ± 20.87 μg/dL, respectively (both P < 0.001)] as well as the serum level of Se [79.76 ± 19.16 vs. 87.41 ± 15.91 μg/dL (P = 0.032)].

Conclusions:
The lower serum levels of Zn, Cu, and Se in patients with advanced KCN compared with healthy controls indicate the possible role of antioxidants in the etiopathogenesis of KCN, which points to early treatment of this progressive degenerative disease with supplementation therapy, rather than keratoplasty techniques.
Association Between Urinary Tract Infections and Antipsychotic Drug Use in Older Adults
Authors: van Strien Astrid M. , Souverein Patrick C. , Keijsers Carolina J.P.W. , Heerdink Eibert R. , Derijks Hieronymus J. , van Marum Rob J. 
Published: June 2018

Abstract

Background

Antipsychotic drugs are frequently prescribed to older adults, but they may be associated with serious adverse effects. The objective was to investigate the association between use of antipsychotics in older adults and the risk of urinary tract infections (UTIs).

Methods

Design

This study was designed as a cohort study.

Setting

Data were obtained from the Clinical Practice Research Datalink from January 1, 2000, to September 29, 2016.

Participants

Primary care patients 65 years or older in the United Kingdom with a first prescription for an oral antipsychotic were included in the study.

Measurements

Incidence of UTIs was calculated for periods with and without exposure to antipsychotic drugs in one cohort. Cox proportional hazard regression analysis with Andersen-Gill extension for recurrent events was used to calculate hazard ratios (HRs) with 95% confidence interval (CI).

Results

During the study period, 191,827 individuals with a first prescription for an oral antipsychotic drug were identified. Current use of antipsychotics was associated with an increased risk of UTI compared with past use (adjusted HR, 1.31; 95% CI, 1.28–1.34). This effect was strongest in the first 14 days of use (adjusted HR, 1.83; 95% CI, 1.73–1.95) and in individuals who used more than one antipsychotic drug concomitantly (adjusted HR, 1.64; 95% CI, 1.45–1.87). The risk was slightly higher for typical antipsychotics than for atypical antipsychotics. Stratification by sex showed that risk estimates were slightly higher in men than in women.

Conclusions

Use of antipsychotics was associated with an increased risk of UTIs in both men and women, particularly in the first weeks after the start of treatment.