bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intratympanic Dexamethasone in the Treatment of Ménière's Disease: A Comparison of Two Techniques
Authors: Beyea Jason A. , Instrum Ryan S. , Agrawal Sumit K. , Parnes Lorne S. 
Published: April 2017

Objective:
To assess the efficacy and safety of two different intratympanic dexamethasone (IT Dex) injection protocols for intractable unilateral Ménière's disease.

Study Design:
Prospective case series.

Setting:
Tertiary neurotology clinic.

Patients:
One hundred six consecutive adult patients with definite unilateral Ménière's disease who had failed medical management were studied for an average of 1,061 days. None had previous oral steroid, IT steroid, or ablative treatment.

Interventions:
Two different IT Dex regimes, either a single injection or a series of four injections, that were subsequently repeated as indicated.

Main Outcome Measure:
Requirement for subsequent ablative therapy in the form of intratympanic gentamicin, vestibular nerve section, or labyrinthectomy. Hearing outcomes were measured using pure-tone average of 0.5, 1, 2, and 3 kHz on standard audiometry.

Results:
The number of intratympanic dexamethasone injections per patient ranged from 1 to 29 (median = 4). Using the Kaplan–Meier method, predicted survival (patients not requiring ablative therapy) at 2 and 4 years after initial treatment was 83.9 and 79.3%, respectively. The injection series protocol ultimately yielded 5% better survival than the single injection protocol, but this was not statistically significant. Injections did not protect against hearing loss, and the most recent pure-tone averages declined compared with pretreatment values by an average of 8.27 dB (p < 0.05). The treatments did not result in any acute hearing losses, permanent tympanic membrane perforations, or other significant adverse events.

Conclusion:
Intratympanic dexamethasone injections were successful in controlling vertigo insofar as they were able to obviate ablative therapy in the majority of Ménière's disease patients in this study. The injection series protocol may have been more beneficial compared with the single injection, although the difference between the two protocols was nonsignificant. Hearing mildly declined over the treatment course, which likely represents natural disease progression. The lack of adverse events suggests that IT Dex may be a nonablative option for patients with bilateral disease or only hearing/vestibular ears.
Medical Expenditures Associated With Diabetes Among Youth With Medicaid Coverage
Authors: Shrestha Sundar S. , Zhang Ping , Thompson Theodore J. , Gregg Edward W. , Albright Ann , Imperatore Giuseppina 
Published: April 2017

Background:
Information on diabetes-related excess medical expenditures for youth is important to understand the magnitude of financial burden and to plan the health care resources needed for managing diabetes. However, diabetes-related excess medical expenditures for youth covered by Medicaid program have not been investigated recently.

Objective:
To estimate excess diabetes-related medical expenditures among youth aged below 20 years enrolled in Medicaid programs in the United States.

Methods:
We analyzed data from 2008 to 2012 MarketScan multistate Medicaid database for 6502 youths with diagnosed diabetes and 6502 propensity score matched youths without diabetes, enrolled in fee-for-service payment plans. We stratified analysis by Medicaid eligibility criteria (poverty or disability). We used 2-part regression models to estimate diabetes-related excess medical expenditures, adjusted for age, sex, race/ethnicity, year of claims, depression status, asthma status, and interaction terms.

Results:
For poverty-based Medicaid enrollees, estimated annual diabetes-related total medical expenditure was $9046 per person [$3681 (no diabetes) vs. $12,727 (diabetes); P<0001], of which 41.7%, 34.0%, and 24.3% were accounted for by prescription drugs, outpatient, and inpatient care, respectively. For disability-based Medicaid enrollees, the estimated annual diabetes-related total medical expenditure was $9944 per person ($14,149 vs. $24,093; P<0001), of which 41.5% was accounted for by prescription drugs, 31.3% by inpatient, and 27.3% by outpatient care.

Conclusions:
The per capita annual diabetes-related medical expenditures in youth covered by publicly financed Medicaid programs are substantial, which is larger among those with disabilities than without disabilities. Identifying cost-effective ways of managing diabetes in this vulnerable segment of the youth population is needed.
A Method to Account for Variation in Congenital Heart Surgery Length of Stay*
Authors: Brennan Andrew , Gauvreau Kimberlee , Connor Jean , Almodovar Melvin , DiNardo James , Banka Puja , Nathan Meena , Mathieu Derek , Kaza Aditya , Mayer John E. , Bergersen Lisa 
Published: April 2017

Objectives:
We sought to develop a risk-adjustment methodology for length of stay in congenital heart surgery, as none exist.

Design:
Prospective cohort analysis combined with previously obtained retrospective cohort analysis of a Department of Cardiovascular Surgery clinical database.

Patients:
Patients discharged from Boston Children’s Hospital between October 1, 2006, and May 31, 2014, that underwent a congenital heart surgery procedure(s) linked to one of 103 surgical procedure types.

Measurements and Main Results:
Six thousand two hundred nine discharges during the reporting period at Boston Children’s Hospital comprised the cohort. Seven Surgical Length Categories were developed to group surgical procedure types. A multivariable model for outcome length of stay was built using a derivation cohort consisting of a 75% random sample, starting with Surgical Length Categories and considering additional a priori factors. Postoperative factors were then added to improve predictive performance. The remaining 25% of the cohort was used to validate the multivariable models. The coefficient of determination (R
2) was used to estimate the variability in length of stay explained by each factor. The Surgical Length Categories yielded an R
2 of 42%. Model performance increased when the a priori factors preoperative status, noncardiac abnormality, genetic anomaly, preoperative catheterization during episode of care, weight less than 3 kg, and preoperative vasoactive support medication were introduced to the model (R
2 = 60.8%). Model performance further improved when postoperative ventilation greater than 7 days, operating room time, postoperative catheterization during episode of care, postoperative reintubation, number of postoperative vasoactive support medications, postoperative ICU infection, and greater than or equal to one secondary surgical procedure were added (R
2 = 76.7%). The validation cohort yielded an R
2 of 76.5%.

Conclusions:
We developed a statistically valid procedure-based categorical variable and multivariable model for length of stay of congenital heart surgeries. The Surgical Length Categories and important a priori and postoperative factors may be used to pursue a predictive tool for length of stay to inform scheduling and bed management practices.
Lifestyle and Neurocognition in Older Adults With Cardiovascular Risk Factors and Cognitive Impairment
Authors: Blumenthal James A. , Smith Patrick J. , Mabe Stephanie , Hinderliter Alan , Welsh-Bohmer Kathleen , Browndyke Jeffrey N. , Lin Pao-Hwa , Kraus William , Doraiswamy P. Murali , Burke James , Sherwood Andrew 
Published: April 2017

ABSTRACT

Objective
The aim of the study was to determine the relationship of lifestyle factors and neurocognitive functioning in older adults with vascular risk factors and cognitive impairment, no dementia (CIND).

Methods
One hundred sixty adults (M [SD] = 65.4 [6.8] years) with CIND completed neurocognitive assessments of executive function, processing speed, and memory. Objective measures of physical activity using accelerometry, aerobic capacity determined by exercise testing, and dietary habits quantified by the Food Frequency Questionnaire and 4-Day Food Diary to assess adherence to the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets were obtained to assess direct effects with neurocognition. Potential indirect associations of high-sensitivity C-reactive protein and the Framingham Stroke Risk Profile also were examined.

Results
Greater aerobic capacity (β = 0.24) and daily physical activity (β = 0.15) were associated with better executive functioning/processing speed and verbal memory (βs = 0.24; 0.16). Adherence to the DASH diet was associated with better verbal memory (β = 0.17). Greater high-sensitivity C-reactive protein (βs = −0.14; −0.21) and Framingham Stroke Risk Profile (β = −0.18; −0.18) were associated with poorer executive functioning/processing speed and verbal memory. Greater stroke risk partially mediated the association of aerobic capacity with executive functioning/processing speed, and verbal memory and greater inflammation partially mediated the association of physical activity and aerobic fitness, with verbal memory.

Conclusions
Higher levels of physical activity, aerobic fitness, and adherence to the DASH diet are associated with better neurocognitive performance in adults with CIND. These findings suggest that the adoption of healthy lifestyle habits could reduce the risk of neurocognitive decline in vulnerable older adults.

Clinical Trial Registration

NCT01573546.
Associations of Lifetime Trauma and Chronic Stress With C-reactive Protein in Adults Ages 50 Years and Older: Examining the Moderating Role of Perceived Control
Authors: Elliot Ari J. , Mooney Christopher J. , Infurna Frank J. , Chapman Benjamin P. 
Published: April 2017

ABSTRACT

Objective
The aim of the study was to investigate whether high perceived control mitigates systemic inflammatory risk associated with traumatic and chronic stress exposures in older adults.

Methods
A sample of community-dwelling adults ages 50 years and older (N = 4779) was drawn from the Health and Retirement Study. Structural equation models tested interactions of lifetime trauma and chronic stress with mastery and perceived constraints predicting baseline levels and 4-year change in C-reactive protein (CRP).

Results
There were significant interactions of lifetime trauma (β = −.058, p = .012) and chronic stress (β = −.069, p = .010) with mastery as related to baseline CRP levels. Both measures were associated with higher CRP at low (β = .102, p = .003; β = .088, p = .015) but not high levels of mastery. In addition, chronic stress interacted with baseline mastery (β = .056, p = .011) and change in mastery (β = −.056, p = .016) to predict 4-year change in CRP. Chronic stress was associated with an increase in CRP at high baseline mastery (β = .071, p = .022) and when mastery decreased during follow-up (β = .088, p = .011). There were no main effects of stress or control variables other than an association of constraints with a larger increase in CRP (β = .062, p = .017). Interactions were minimally attenuated (<15%) upon further adjustment for negative affect, body mass index, smoking, and physical activity.

Conclusions
High mastery may protect against elevated systemic inflammation associated with substantial lifetime trauma exposure. Individuals who experience declines in mastery may be most susceptible to increases in inflammation associated with chronic stress.
Gelfoam Interposition Minimizes Risk of Fistula and Postoperative Bleeding in Modified-Furlow Palatoplasty
Authors: Li Jing , Gerety Patrick A. , Johnston James , Taylor Jesse A. 
Published: April 2017

Abstract
Failure to accomplish a tension-free, watertight closure predisposes the palatoplasty patient to fistula formation. Perioperative bleeding also places the patient at risk for adverse airway events (AAE). This study introduces the incorporation of a hemostatic gelatin sponge (Gelfoam) into layered palatoplasty to minimize adverse postoperative bleeding and fistula formation. A retrospective chart review was performed to identify subjects who underwent Furlow palatoplasty with insertion of Gelfoam from 2010 to 2015. Exclusion criteria include age >3 years, prior palate surgery, <30-day follow-up, immunosuppressive state, and diagnosis of Treacher–Collins or Apert Syndrome. Demographic data include age, sex, cleft laterality, prior surgeries, Veau classification, Pierre Robin status, and tracheostomy dependence. Primary outcome was fistula formation. Secondary outcomes included perioperative metrics and AAE.
One hundred subjects met criteria, 45% female. Average age was 14.6 months. Subjects with syndromes comprised 28%, with 16% diagnosed with Pierre Robin. Two subjects were tracheostomy-dependent. Prior cleft and mandibular procedures were performed in 55%. Isolated palatal defects were seen in 46%, unilateral lip and palate in 41%, and bilateral lip and palate in 13%. The majority of defects were Veau II and III (35% and 34%, respectively). Adverse airway events occurred in 2%, one of which resulted in reintubation. One subject (1%) was found to have a postoperative fistula.
The incorporation of Gelfoam in the modified-Furlow palatoplasty results in a low rate of oronasal fistula (1%) and low perioperative risk of AAE. Further prospective comparison of this method to others will be the focus of future work.
Assessment of Sarcopenia as a Predictor of Poor Outcomes After Esophagectomy in Elderly Patients With Esophageal Cancer
Authors: Nakashima Yuichiro , Saeki Hiroshi , Nakanishi Ryota , Sugiyama Masahiko , Kurashige Junji , Oki Eiji , Maehara Yoshihiko 
Published: April 2017

Objective:
The objective of the study was to elucidate the impact of sarcopenia in elderly patients with esophageal cancer on postoperative complications and long-term survival after surgery for esophageal cancer.

Summary Background Data:
Sarcopenia, defined as loss of skeletal muscle mass with age, has been identified as a poor prognostic factor for malignancies. This retrospective study investigated the effect of sarcopenia on surgical outcomes among young and elderly patients with esophageal cancer.

Methods:
Data were collected for 341 consecutive patients who underwent esophagectomy for esophageal cancer. Patients were assigned to 2 groups according to age (younger than 65 years and 65 years or older) and the presence of sarcopenia.

Results:
Sarcopenia was present in 170 of 341 patients (49.9%) with esophageal cancer and in 74 of 166 elderly patients (44.6%). The incidence of anastomotic leak and in-hospital death was significantly higher in the elderly sarcopenia group than in the elderly nonsarcopenia group (31.5% vs 15.2%, P = 0.015, 6.8 vs 0.0%, P = 0.037, respectively), and the overall survival rate in patients with sarcopenia correlated with a significantly poor prognosis in the elderly group (P < 0.001). Multivariate analysis revealed that sarcopenia was a risk factor for an anastomotic leak (P = 0.034) and was an unfavorable prognostic factor for survival (P < 0.001). Those correlations between sarcopenia and surgical outcomes were not observed in the young group.

Conclusions:
Sarcopenia and worse surgical outcomes were significantly associated patients with in esophageal cancer aged 65 years and older but not in those younger than 65 years.
Single molecule fluorescencein situhybridisation for quantitating post-transcriptional regulation inDrosophilabrains
Authors: Yang Lu , Titlow Joshua S. , Ennis Darragh , Smith Carlas , Mitchell Jessica , Young Florence L. , Waddell Scott , Ish-Horowicz David , Davis Ilan 
Published: April 2017

AbstractRNAin situhybridization can be a powerful method to investigate post-transcriptional regulation, but analysis of intracellular mRNA distributions in thick, complex tissues like the brain poses significant challenges. Here, we describe the application of single-molecule fluorescentin situhybridization (smFISH) to quantitate primary transcription and post-transcriptional regulation in whole-mountDrosophilalarval and adult brains. Combining immunofluorescence and smFISH probes for different regions of a single gene, i.e., exons, 3’UTR, and introns, we show examples of a gene that is regulated post-transcriptionally and one that is regulated at the level of transcription. We also show that the method can be used to co-visualise a variety of different transcripts and proteins in neuronal stems cells as well as deep brain structures such as mushroom body neuropils. Finally, we introduce the use of smFISH as asensitivealternative to conventional antibody labelling to mark specific neural stem cell populations in the brain.
Components of alcohol use and all-cause mortality
Authors: Hartz Sarah M. , Oehlert Mary , Horton Amy C. , Grucza Richard , Fisher Sherri L. , Nelson Karl G. , Sumerall Scott W. , Chad Neal P. , Regnier Patrice , Chen Guoqing , Williams Alexander , Bhattarai Jagriti , Evanoff Bradley , Bierut Laura J. 
Published: April 2017

AbstractImportanceCurrent recommendations for low-risk drinking are based on drinking quantity: up to one drink daily for women and two drinks daily for men. Drinking frequency has not been independently examined for its contribution to mortality.ObjectiveTo evaluate the impact of drinking frequency on all-cause mortality after adjusting for drinks per day and binge drinking behavior.DesignTwo independent observational studies with self-reported alcohol use and subsequent all-cause mortality: the National Health Interview Survey (NHIS), and data from Veteran’s Health Administration clinics (VA).SettingEpidemiological sample (NHIS) and VA outpatient database (VA Corporate Data Warehouse).Participants208,661 individuals from the NHIS interviewed between 1997 and 2009 at the age of 30 to 70 with mortality follow-up in the last quarter of 2011; 75,515 VA outpatients born between 1948 and 1968 who completed an alcohol survey in 2008 with mortality follow-up in June 2016.ExposuresQuantity of alcohol use when not binging (1-2 drinks on typical day, 3-4 drinks on typical day), frequency of non-binge drinking (never, weekly or less, 2-3 times weekly, 4 or more times weekly), and frequency of binge drinking (never, less than weekly, 1-3 times weekly, 4 or more times weekly). Covariates included age, sex, race, and comorbidity.Main Outcomes and MeasuresAll-cause mortality.ResultsAfter adjusting for binge drinking behavior, survival analysis showed an increased risk for all-cause mortality among people who typically drink 1-2 drinks four or more times weekly, relative to people who typically drink 1-2 drinks at a time weekly or less (NHIS dataset HR=1.15, 95% CI 1.06-1.26; VA dataset HR=1.31, 95% CI 1.15-1.49).Conclusions and RelevanceDrinking four or more times weekly increased risk of all-cause mortality, even among those who drank only 1 or 2 drinks daily. This was seen in both a large epidemiological database and a large hospital-based database, suggesting that the results can be generalized.
Association between substance use disorder and polygenic liability to schizophrenia
Authors: Hartz Sarah M. , Horton Amy , Oehlert Mary , Carey Caitlin E. , Agrawal Arpana , Bogdan Ryan , Chen Li-Shiun , Hancock Dana B. , Johnson Eric O. , Pato Carlos , Pato Michele , Rice John P. , Bierut Laura J. 
Published: April 2017

AbstractBackgroundThere are high levels of comorbidity between schizophrenia and substance use disorder, but little is known about the genetic etiology of this comorbidity.MethodsHere, we test the hypothesis that shared genetic liability contributes to the high rates of comorbidity between schizophrenia and substance use disorder. To do this, polygenic risk scores for schizophrenia derived from a large meta-analysis by the Psychiatric Genomics Consortium were computed in three substance use disorder datasets: COGEND (ascertained for nicotine dependence n=918 cases, 988 controls), COGA (ascertained for alcohol dependence n=643 cases, 384 controls), and FSCD (ascertained for cocaine dependence n=210 cases, 317 controls). Phenotypes were harmonized across the three datasets and standardized analyses were performed. Genome-wide genotypes were imputed to 1000 Genomes reference panel.ResultsIn each individual dataset and in the mega-analysis, strong associations were observed between any substance use disorder diagnosis and the polygenic risk score for schizophrenia (mega-analysis pseudo R2range 0.8%-3.7%, minimum p=4×10-23).ConclusionsThese results suggest that comorbidity between schizophrenia and substance use disorder is partially attributable to shared polygenic liability. This shared liability is most consistent with a general risk for substance use disorder rather than specific risks for individual substance use disorders and adds to increasing evidence of a blurred boundary between schizophrenia and substance use disorder.
System Identification Using Compressed Sensing Reveals Signaling-Decoding System by Gene Expression
Authors: Tsuchiya Takaho , Fujii Masashi , Matsuda Naoki , Kunida Katsuyuki , Uda Shinsuke , Kubota Hiroyuki , Konishi Katsumi , Kuroda Shinya 
Published: April 2017

SUMMARYCells decode information of signaling activation at a scale of tens of minutes by downstream gene expression with a scale of hours to days, leading to cell fate decisions such as cell differentiation. However, no system identification method with such different time scales exists. Here we used compressed sensing technology and developed a system identification method using data of different time scales by recovering signals of missing time points. We measured phosphorylation of ERK and CREB, immediate early gene expression products, and mRNAs of decoder genes for neurite elongation in PC12 cell differentiation and performed system identification, revealing the input–output relationships between signaling and gene expression with sensitivity such as graded or switch-like response and with time delay and gain, representing signal transfer efficiency. We predicted and validated the identified system using pharmacological perturbation. Thus, we provide a versatile method for system identification using data with different time scales.HighlightsWe developed a system identification method using compressed sensing.This method allowed us to find a pathway using data of different time scales.We identified a selective signaling-decoding system by gene expression.We validated the identified system by pharmacological perturbation.eTOC BlurbWe describe a system identification method of molecular networks with different time-scale data using a signal recovery technique in compressed sensing.