bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Traumatic Injury and Osseointegration Failure in Children With Percutaneous Bone Conduction Implants
Authors: Purcell Patricia L. , Ziai Hedyeh , Xu Josie , Gordon Karen A. , Papsin Blake C. , Cushing Sharon L. 
Published: July 2019

Objective:
This study examines the incidence and management of traumatic loss or osseointegration failure of percutaneous bone conduction implants in children.

Study Design:
Case series.

Setting:
Pediatric tertiary care institution.

Patients:
Children who underwent percutaneous osseointegrated implant placement from 1996 to 2016.

Interventions:
Clinical evaluation and revision surgery after implant loss.

Main Outcome Measures:
This study compares the characteristics of children who experienced traumatic loss of implant to those who did not to calculate odds ratios (ORs) describing the risk of injury and investigate device utilization after implant failure.

Results:
One hundred forty-seven children received percutaneous bone conduction devices; 129 were followed for at least 1 year. Trauma occurred in 19 of 129 cases (15%). Among children with traumatic injury, mean age at initial surgery was 5 years (SD = ±3.3), and 42% had a developmental delay. Among children without traumatic injury, mean age at initial surgery was 6.5 years (SD = ±4.4), and 28% had a developmental delay. Multivariate logistic regression found no significant differences in age, sex, or developmental delay associated with implant loss. In five of 19 traumatic cases (26%), the implant remained in situ due to either skull fracture or abutment loss. In the remaining 14 of 19 cases (74%), there was osseointegration failure with extrusion of the implant. Seventeen children underwent revision surgery utilizing previously placed “sleeper,” or backup, osseointegrated implant, and 14 (82%) of these continued to use their device. Two patients with extruded implants did not undergo revision surgery.

Conclusion:
Traumatic injury or osseointegration failure leads to loss of percutaneous bone conduction implants in approximately 15% of children. Revision surgery is often successful.
Effect of Vestibular Exercises Associated With Repositioning Maneuvers in Patients With Benign Paroxysmal Positional Vertigo: A Randomized Controlled Clinical Trial
Authors: Rodrigues Daniele Leite , Ledesma Alleluia Lima Losno , Pires de Oliveira Carlos Augusto , Bahmad Fayez 
Published: July 2019

In addition to positional vertigo, it is quite common for patients with benign paroxysmal positional vertigo (BPPV) to present complaints associated with balance problems and a feeling of dizziness even after repositioning maneuvers.

Objective:
It was to evaluate the additional effects of vestibular rehabilitation exercises as a therapeutic resource in the treatment of BPPV, to improve symptoms and reduce recurrence.

Study Design:
This was an experimental, prospective, randomized, controlled study.

Setting:
Instituto Brasiliense de Otorrinolaringologia (IBORL) from August 2016 to September 2017.

Patients:
Thirty-two individuals, both men and women, over 18 years of age with BPPV.

Intervention:
They were randomly assigned to two groups: the control group (n = 15) performing only the maneuver technique as treatment and the experimental group (n = 17) performing the maneuvers and vestibular rehabilitation exercises. Patients underwent treatment and responded to the dizziness handicap inventory (DHI) and visual analog scale (VAS) questionnaires for comparison between groups. Participants were followed up for 6 months to observe recurrence of symptoms.

Main Outcome Measures:
To investigate the additional effects of vestibular exercises in the treatment of BPPV.

Results:
The experimental group had a lower level of dizziness in the posttreatment period (p < 0.05) and a lower incidence of recurrences (p = 0.038) than the control group.

Conclusions:
Vestibular exercises performed after repositioning treatments for BPPV increased the overall efficacy of treatment by improving symptoms with a lower rate of recurrence.
A Transcutaneous Active Middle Ear Implant (AMEI) in Children and Adolescents: Long-term, Multicenter Results
Authors: Hempel John-Martin , Sprinzl Georg , Riechelmann Herbert , Streitberger Christian , Giarbini Nadia , Stark Thomas , Zorowka Patrick , Koci Viktor , Magele Astrid , Strenger Tobias , Müller Joachim , Wollenberg Barbara , Frenzel Henning 
Published: July 2019

Objective:
Evaluation of the long-term safety and performance of an active middle ear implant (AMEI) in the treatment of hearing loss in children and adolescents with a primary focus on improvement in speech discrimination.

Study Design:
Prospective, multicentric, single-subject repeated-measures design in which each subject serves as his or her own control.

Subjects:
Thirty-one pediatric subjects aged 5 to 17 years.

Intervention:
Implantation of an active middle ear implant.

Methods:
Improvement in word recognition scores, speech reception thresholds (SRT) in quiet and noise, in addition to air conduction, bone conduction, and sound field thresholds were evaluated in two age groups.

Results:
Residual hearing did not change over time and speech intelligibility significantly improved and remained stable after 36 months. Children aged 5 to 9 improved in WRS from 21.92 to 95.38% and in SRT in quiet and in noise respectively from 62.45 dB SPL (sound pressure level) and +1.14 dB SNR to 42.07 dB SPL and −4.45 dB SNR. Adolescents aged 10 to 17 improved in WRS from 12.78 to 84.71% and in SRT in quiet and in noise respectively from 63.96 dB SPL and +3.32 dB SNR to 35.31 dB SPL and −4.55 dB SNR.

Conclusions:
The AMEI, under investigation, is a safe treatment for children and adolescents, and significantly improved audiological performance that remains stable on the long-term scale (up to 36 mo postimplantation). In general, all adult-related issues and questions regarding safety and performance can also be applied to the pediatric population, as no apparent specific issues developed.
Osteonecrosis of the External Auditory Canal Associated With Oral Sorafenib Therapy: Sorafenib and Temporal Bone Osteonecrosis
Authors: Canzano Federica , Di Lella Filippo , Manuguerra Roberta , Vincenti Vincenzo 
Published: July 2019

Objective:
To present the first case of osteonecrosis of the external auditory canal associated with sorafenib treatment. Patient: 58-year-old patient with right-sided otorrhea and otalgia was treated for otitis externa for 1 month without improvement. Otoscopic examination revealed a large defect in the inferior wall of the tympanic bone filled with skin debris and bony fragments. Previous medical history included treatment with sorafenib for metastatic renal cell cancer; he had never been exposed to radiotherapy. Computed tomography of the temporal bone showed a large right external auditory canal bony erosion with involvement of the tympanic bone and bony sequestra extending to the mastoid cells and temporomandibular joint. Histologic examination revealed necrotic bone and inflammatory changes with no signs of malignancy. A diagnosis of osteonecrosis of external auditory canal was made.

Intervention:
Right subtotal petrosectomy with obliteration of surgical cavity with abdominal fat was performed.

Results:
Final histological report revealed avascular necrosis of the bone with perivascular lymphocitic infiltration of the soft tissues. Diagnosis of medication-related external auditory canal osteonecrosis was confirmed.

Conclusion:
Medication-related osteonecrosis of the temporal bone is not a well-known entity among otolaryngologists and could therefore be misclassified as another diagnosis. In patients with othorrea and earache following sorafenib treatment, temporal bone osteonecrosis should be suspected.
Challenges in conducting long-term outcomes studies in critical care
Authors: Wilcox M. Elizabeth , Ely E. Wesley 
Published: July 2019

Purpose of review
Evaluating longer term mortality, morbidity, and quality of life in survivors of critical illness is a research priority. This review details the challenges of long-term follow-up studies of critically ill patients and highlights recently proposed methodological solutions.

Recent findings
Barriers to long-term follow-up studies of critical care survivors include high rates of study attrition because of death or loss to follow-up, data missingness from experienced morbidity, and lack of standardized outcome as well as reporting of key covariates. A number of recent methods have been proposed to reduce study patients attrition, including minimum data set selection and visits to transitional care or home settings, yet these have significant downsides as well. Conducting long-term follow-up even in the absence of such models carries a high expense, as personnel are very costly, and patients/families require reimbursement for their time and inconvenience.

Summary
There is a reason why many research groups do not conduct long-term outcomes in critical care: it is very difficult. Challenges of long-term follow-up require careful consideration by study investigators to ensure our collective success in data integration and a better understanding of underlying mechanisms of mortality and morbidity seen in critical care survivorship.
Oral Nano Vitamin D Supplementation Reduces Disease Activity in Ulcerative Colitis
Authors: Ahamed Z Rizwan , Dutta Usha , Sharma Vishal , Prasad Kaushal Kishor , Popli Priyanka , Kalsi Dimple , Vaishnavi Chetana , Arora Sunil , Kochhar Rakesh 
Published: July 2019

Introduction:
Vitamin D possesses anti-inflammatory properties and could be beneficial in ulcerative colitis (UC).

Methods:
We studied the effect of oral nano vitamin D3 supplementation on disease activity in active UC [ulcerative colitis disease activity index (UCDAI)≥3]. Patients with active UC and vitamin D <40 ng/mL were randomized to receive either oral nano vitamin D (60,000 IU/d×8 d) or placebo. They were evaluated for disease activity (UCDAI scores, C-reactive protein, erythrocyte sedimentation rate, and fecal calprotectin) at baseline and reassessed at 4 weeks. The response was defined as a 3-point reduction in UCDAI score at 4 weeks and reduction in inflammatory markers.

Results:
The median vitamin D levels increased from 15.4 to 40.83 mg/dL in vitamin D group (P≤0.001) and marginally from 13.45 to 18.85 mg/dL (P=0.027) in controls. The 3-point reduction in UCDAI was seen more often in vitamin D group as compared with the control (53% vs. 13%; P=0.001). Increase in vitamin D levels correlated with reduction in UCDAI score (P≤0.001; ρ=−0.713), C-reactive protein (P≤0.001; ρ=−0.603), and calprotectin (P=0.004; ρ=−0.368). Patients who achieved target vitamin D of >40 ng/mL (n=17) more often had a 3-point reduction in UCDAI (80% vs. 20%; P≤0.001) and reduction in grade of severity from 60% to 35% (P=0.038). Vitamin D administration (odds ratio, 9.17; 95% confidence interval, 2.02-41.67) and baseline histologic activity (odds ratio, 1.92; 95% confidence intervals, 1.2-3.08) independently predicted response.

Conclusions:
Oral nano vitamin D supplementation in active UC is associated with a reduction in disease activity and severity grade and is seen more often in those who achieved a target vitamin D level of 40 ng/mL.
Subclinical hypothyroidism in pregnancy
Authors: Toloza Freddy J.K. , Abedzadeh-Anaraki Sanaz , Maraka Spyridoula 
Published: July 2019

Purpose of review
Subclinical hypothyroidism (SCH) is a common diagnosis among women of reproductive age. The importance of sufficient maternal thyroid supply during pregnancy is well known. Nevertheless, the effects of SCH during pregnancy and the efficacy of its treatment on maternofetal outcomes are not well established. This review discusses the recent evidence on SCH in pregnancy and how this evidence is reflected in current clinical care.

Recent findings
Recent observational studies have found a positive association between SCH during pregnancy and adverse maternal, neonatal and offspring outcomes, mainly in thyroid peroxidase autoantibody positive women. Although interventional studies have shown a benefit of levothyroxine (LT4) treatment on selected pregnancy outcomes, there was no effect on offspring neurodevelopment.

Summary
Current evidence strengthens the association between SCH with both maternofetal and offspring adverse outcomes. An earlier and more individualized diagnostic assessment taking into consideration predictors of thyroid dysfunction and major risk factors for complications could result in better management of SCH during pregnancy. The effectiveness of LT4 on improving maternofetal and long-term offspring outcomes is still not fully elucidated.
Metamizole for Postoperative Pain in Pediatric Patients Undergoing Subarachnoid Anesthesia
Authors: Lupu Mary N. , Miulescu Magdalena , Dobre Michaela , Vesa Doina 
Published: July 2019

Background:
Efficient postoperative pain management, which is aimed at decreasing the risk of complications and drug-induced side effects, without affecting the quality of analgesia, is part of today's concept of enhanced recovery after surgery, that is, fast-track surgery.

Study Question:
The objective of this study was to determine whether effective management of acute postoperative pain was possible without opioids, while avoiding complications, drug-induced side effects, and suboptimal treatment. Introduction of metamizole, which has regained popularity, into a multimodal analgesia regimen was used, as opioids are not routinely administered.

Study Design:
The study was prospective, observational, unrandomized, and without the control group.

Measures and Outcomes:
This study was performed in a pediatric hospital with 300 beds and an average of 1700 annual surgical interventions. The study group comprised 378 patients aged 1–17 years, undergoing lower abdominal or limb surgery between June 2016 and June 2017. Children underwent subarachnoid anesthesia combined with intravenous sedation and received not routinely but on demand postoperative opioid analgesia. The pain was self-assessed by the pediatric patient or was assessed by the nurse using pain scores.

Results:
Metamizole proved to be safe, efficient, and very well tolerated by children. Multimodal analgesia using acetaminophen, nonsteroidal anti-inflammatory drug with metamizole for the treatment of moderate to severe pain in children undergoing surgery, required a single opioid dose in 292 patients (77.24%) of the 378 in this study.

Conclusions:
In pediatric patients undergoing surgery, subarachnoid anesthesia combined with intravenous sedation, multimodal analgesia that includes metamizole, and nonpharmacological complementary therapies in pain management enable avoidance or reduction of opioids to a single dose, without undertreatment. There is also a minimum of anesthesia, accelerated children's recovery and a rapid return to presurgical levels of function.
Treatment of Multiple Myeloma With Daratumumab in a Kidney Transplant Patient
Authors: Yang Danwen , Agrawal Nikhil , Marcus Chelsea , Roy Neil , Richards Katelyn R. , Nahas Myrna R. , Cardarelli Francesca 
Published: July 2019

Clinical Features:
A middle-aged man with history of kidney transplantation was diagnosed with multiple myeloma (MM); he was treated with cyclophosphamide, bortezomib, and dexamethasone (CyBorD) for induction therapy. However, a repeat bone marrow biopsy after treatment revealed 10% clonal plasma cell involvement. Given residual disease, his treatment regimen was changed to daratumumab, bortezomib, and dexamethasone in an attempt to achieve minimal residual disease.

Therapeutic Challenge:
Daratumumab was recently approved for treatment of relapsed or refractory MM; there are no data regarding the safety and effectiveness in solid organ transplant patients.

Solution:
Our patient was treated with a daratumumab-based regimen for MM. His renal function was monitored closely along with donor-specific antibody to assess for risk of graft rejection. His renal function remained stable with minimal proteinuria and negative donor-specific antibody during the treatment course.
Right ventricular failure in congenital heart disease
Authors: Friedberg Mark K. , Reddy Sushma 
Published: July 2019

Purpose of review
We aim to review select literature pertaining to congenital heart disease (CHD)-induced right ventricular (RV) function and failure.

Recent findings
We review recent findings pertaining to children and adults with repaired tetralogy of Fallot (rTOF), systemic RV and hypoplastic left heart syndrome (HLHS). We emphasize pathophysiological mechanisms contributing to RV dysfunction in these conditions, the risk factors for adverse outcomes and the continuing challenges in treating these patients. We discuss how recent pathology findings, as well as developments in imaging and computer modeling have broadened our understanding of the pathophysiology of these conditions. We further review developments in the molecular and cellular basis of RV failure; and in particular, the RV molecular response to stress in repaired tetralogy of Fallot (rTOF). We highlight some of the genetic complexities in HLHS and how these may influence the long-term outcomes in these patients.

Summary
Recent literature has led to new understandings in the pathology, pathophysiology, risk factors for adverse outcomes, molecular and genetic basis for RV dysfunction and failure in CHD. Although these findings provide new therapeutic targets, the treatment of RV failure at this time remains limited.
Update on pediatric heart failure
Authors: Del Castillo Sylvia , Shaddy Robert E. , Kantor Paul F. 
Published: July 2019

Purpose of review
This review highlights recent advances in the diagnosis and management of children with heart failure. We emphasize the clinical approach to patient care in the areas of acute decompensated heart failure, chronic heart failure, and failure of the patient with single ventricle physiology.

Recent findings
Important guidelines regarding the recognition and management of heart failure in children have been proposed and adopted, providing guidance for early recognition and ongoing management. Early diuresis, and avoidance of excessive inotropic agent use, in favor of milrinone as an inotropic-vasodilator agent, are emphasized. Close monitoring of airway pressures to improve ventricular filling, and extubation to positive pressure or high-flow nasal cannula therapy are also important. Chronic heart failure therapy requires combination treatment with diuretics, and the three major classes of drugs. Management of the failing Fontan requires attention to the hepatic, pulmonary and lymphatic circulations.

Summary
Improved outcomes in children with heart failure are possible. Inherent in this success is the engagement of an interdisciplinary team-based approach to care, with early recognition and escalation of care for specific patients who are not improving as predicted.
The good bugs: the use of probiotics in pediatrics
Authors: Sansotta Naire , Peroni Diego G. , Romano Simone , Rugiano Anna , Vuilleumier Pierluigi , Baviera Giuseppe 
Published: July 2019

Purpose of review
There is growing evidence encouraging the use of probiotics in many conditions in children. However, given the wide number of probiotics available and contradictory data in the literature, the health-care provider is often faced with uncertainness about whether or not to use probiotics and which one(s) to choose. We here review current hypotheses regarding the efficacy and safety of probiotics and evaluate the available data on the use of probiotics in most common diseases in children. Considering that probiotics have strain-specific effects, we will focus on individual probiotic strains rather than on probiotics in general.

Recent findings
Strain-specific efficacy was clearly demonstrated with Lactobacillus rhamnosus GG and Saccharomyces boulardii I-745 in the treatment of acute infectious diarrhea, Lactobacillus reuteri DSM 17938 in infantile colics, Lactobacillus rhamnosus GG, and VSL#3 in irritable bowel syndrome. In addition, encouraging results are seen for use of probiotics in necrotizing enterocolitis, food allergy, and nonalcoholic fatty liver disease. However, the data available for constipation are to be considered somewhat equivocal.

Summary
The clinical relevance of these findings indicates that healthcare providers need to take strain-specificity and disease specificity of probiotics into consideration when recommending probiotic for their patients.
Long-acting reversible contraceptives for adolescent females: a review of current best practices
Authors: Sherin Margaret , Waters Joseph 
Published: July 2019

Purpose of review
This review will address the need for adolescent contraception, compare the benefits of long-acting reversible contraceptives (LARC) with non-LARC methods, discuss unique barriers to LARC for adolescents, and provide physicians with latest recommendations for counseling adolescents on contraception.

Recent findings
The United States has the highest adolescent birth rate of any developed country at 18.8 births per 1000 females aged 15–19 years. This rate is more than double the rate in France (9/1000) and Spain (9/1000), and nearly 1.6× the rate in the United Kingdom (12/1000). As the most effective and user-independent methods of contraception, LARC have the potential to notably lower the adolescent birth rate. However, despite higher rates of patient satisfaction and continuation with LARC, adolescent LARC usage remains low. Just 4.3% of all American females aged 15–19 years who reported using some form of contraception between 2006 and 2010 used an intrauterine device (IUD) or subdermal implant, compared with 96% who used the male condom and 56% who used the oral contraceptive pill (OCP). Barriers to adolescent LARC usage include patient and provider misinformation, high upfront costs, and issues of confidentiality and consent.

Summary
LARC methods are recommended by most reproductive and adolescent healthcare organizations as the most effective contraceptive options for adolescent females. Pediatricians should provide their adolescent patients with up-to-date information on all options for contraception, including risks and benefits. It is important for them to remove their own personal biases when counseling patients and work to reduce barriers to LARC for adolescent females.