bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Characteristics and Treatment Outcomes for Patients With External Auditory Canal Cholesteatoma
Authors: Morita Shinya , Nakamaru Yuji , Fukuda Atsushi , Fujiwara Keishi , Hoshino Kimiko , Homma Akihiro 
Published: November 2017

Objective:
We aimed to evaluate the clinical features and treatment outcomes for patients with idiopathic and secondary external auditory canal cholesteatoma (EACC), and to validate the treatment strategy from the perspective of hearing as well as etiology and staging.

Study Design:
Retrospective case series.

Setting:
Tertiary referral center and affiliated hospitals.

Patients:
Fifty-eight patients with idiopathic EACC and 14 patients with secondary EACC.

Intervention:
Conservative management and surgery.

Main Outcome Measure:
Air conduction (AC) pure-tone averages (PTAs) and mean air-bone gaps (ABGs).

Results:
There were no significant differences between hearing values before and after conservative management for idiopathic EACC patients with stages I–III, indicating that hearing abilities were preserved. For idiopathic EACC patients with stage IV disease treated with surgery, the AC PTA threshold and mean ABG significantly improved from a preoperative value of 60.3 dB HL to a postoperative value of 32.4 dB HL (p = 0.013), and from 34.3 to 9.5 dB HL (p < 0.001), respectively. For secondary EACC, the AC PTA threshold and mean ABG significantly improved from a preoperative value of 49.5 dB HL to a postoperative value of 23.2 dB HL (p < 0.001), and from 31.4 to 6.7 dB HL (p < 0.001), respectively.

Conclusion:
The treatment modalities should be selected based on the perspective of hearing as well as the extent of disease and etiology. The early lesions can be treated conservatively, whereas the advanced lesions or cases refractory to conservative management require complete surgical removal of EACC.
Quality of life outcomes after endoscopic approaches to intracranial tumors
Authors: Schaberg Madeleine R. 
Published: November 2017

Purpose of review
To review the literature on quality of life (QOL) in endoscopic approaches to anterior and central intracranial skull-base disease. As endoscopic surgical techniques have gained widespread acceptance and complications and morbidity remain low and comparable with microscopic and open approaches, a shift to focusing on patients’ perception of their own well being as an important outcome parameter has been made. In addition to the traditional measurements of surgical outcomes (extent of resection, recurrence rate, morbidity, survival, and complication rate), the success of a surgery can now be assessed using QOL measures.

Recent findings
The main tools for assessing QOL in endoscopic skull-base surgery (anterior skull-base questionnaire and 22-item sinonasal outcome test) were not specifically designed for endoscopic skull-base approaches, and recently, a new tool was introduced and validated, the skull-base inventory, adding to our armamentarium, but it has not yet been widely employed. Endoscopic skull-base surgery leads to improved or sustained long-term QOL overall but it is significantly influenced by tumor disease. Specific endoscopic surgical technique (such as nasoseptal flap closure) appears to have less impact on QOL.

Summary
It is becoming critical to assess therapeutic interventions in terms of impact on a patient's QOL. QOL can be useful in comparing efficacy of surgical interventions, and in the future, it will likely become a reportable indicator of surgical outcome and guide our surgical technique recommendations. Large-scale prospective multicenter trials would be beneficial.
Safety of Appetite Manipulation in Children with Feeding Disorders Admitted to an Inpatient Feeding Program
Authors: Pollow Alyssa S. , Karls Catherine A. , Witzlib Mary , Noel Richard J. , Goday Praveen S. , Silverman Alan H. 
Published: November 2017

ABSTRACTObjective:Appetite manipulation can be effective in weaning children off gastrostomy tube feeding dependence but can cause dehydration, hypoglycaemia, and ketone body production, which is anorexigenic. As the safety of this approach has not been described, our aim was to describe adverse events observed when weaning children from G‐tube dependence using our appetite manipulation protocol.Methods:This was a retrospective study of prospectively collected data of patients who completed our inpatient tube‐weaning protocol. Daily safety parameters included twice‐daily urine specific gravities and urine ketones and fasting capillary blood glucose. Graded clinical interventions to manage adverse events were collected.Results:A total of 143 children with a mean age of 4.8 ± 2.4 years were seen in the inpatient feeding program of which 74 (51.7%) were male. The children were hospitalized 10.1 ± 2.5 days with the vast majority being discharged between days 11 and 14. Overall, 78.2% of patients experienced at least 1 adverse event: urine specific gravity >1.020 was seen in 60.5%, ketonuria in 48.9%, and hypoglycemia (⩽60 mg/dL) in 13.4%. Only 2 children had blood glucose levels <40 mg/dL and these were corrected with oral supplementation. Graded clinical interventions to manage adverse events included oral rehydration in 89.9% of children and supplemental tube feeding in 25.2%.Conclusions:Adverse effects are common when appetite manipulation is used to wean children off G‐tube dependence. Anticipating, monitoring, and having a clear intervention plan in a closely monitored setting are necessary to safely use this method.
The Role of Combination Therapy in Pediatric Inflammatory Bowel Disease
Authors: Day Andrew S. , Gulati Ajay S. , Patel Nishaben , Boyle Brendan , Park K.T. , Saeed Shehzad A. 
Published: November 2017

ABSTRACTThe treatment goal for children suffering from inflammatory bowel disease has been evolving with biologic therapies like anti‐tumor necrosis factor agents assuming a more central role in treatment of more aggressive and extensive phenotype. Earlier introduction of anti‐tumor necrosis factor agents have shown to be more effective and may even alter the natural history of inflammatory bowel disease. Development of anti‐drug antibodies, however, limits long‐term usage and leads to dose adjustment in almost half of patients treated with these medications. One of the strategies to minimize the development of anti‐drug antibodies has been concomitant use of immunomodulator medications, resulting in fewer infusion reactions and sustained trough levels, potentially lowering the need for dose adjustments. Balanced with these benefits of optimized dosing and likely more sustained response, however, is the concern about increased risk of complications, such as infections and malignancies. The current manuscript reviews the available pediatric literature regarding efficacy, safety, and side effect profile of combination (immunomodulator and biologics) therapy in pediatric Crohn disease and ulcerative colitis, with particular emphasis on cost constraints, and recommendations for selection of patients who would benefit most from combination therapy.
Allergic Colitis With Pneumatosis Intestinalis in an Infant
Authors: Liu Helena , Turner Troy W.S. 
Published: November 2017

Abstract
Inflammatory causes of bloody diarrhea during infancy include necrotizing enterocolitis and allergic colitis, often due to cow’s milk protein. We report this case of cow’s milk protein allergy, managed successfully with elimination of dietary antigen, to highlight the unusual finding of pneumatosis intestinalis on abdominal x-ray, a radiographic hallmark associated with necrotizing enterocolitis. Detailed patient’s history, clinical presentation, and physical examinations are discussed for cow’s milk protein allergy and necrotizing enterocolitis.
Effects of Platelet-Rich Plasma on Pain and Muscle Strength in Patients With Knee Osteoarthritis
Authors: Wu Yung-Tsan , Hsu Kao-Chih , Li Tsung-Ying , Chang Cheng-Kuang , Chen Liang-Cheng 
Published: November 2017

Objective
No studies comparing the effects of platelet-rich plasma (PRP) injection and placebo injection in bilateral knee osteoarthritis in the same patient, or discussing muscle strength after PRP injection, have been published.

Design
Twenty patients with bilateral knee osteoarthritis were eligible, and 40 knees were randomized into two groups: PRP (knees [right or left by a coin toss] receiving a single intra-articular PRP injection) and saline group (the contralateral knee of the same patient, into which single 4-mL intra-articular injection of normal saline was administered). The primary outcome measure was Western Ontario and McMaster's Universities Osteoarthritis Index and the secondary included isokinetic test results. The evaluation was at baseline and at 2 wks, 1, 3, and 6 mos after injection.

Results
The PRP group showed a significant reduction in the Western Ontario and McMaster's Universities Osteoarthritis Index pain and total scores compared with normal saline group (P < 0.05). Although a significantly greater percentage of knee strength (extensor > flexor) was found in the PRP group during a longer follow-up period, PRP treatment resulted in insignificant differences in muscle strength compared with normal saline.

Conclusions
Platelet-rich plasma treatment significantly improves pain, stiffness, and disability in patients with knee osteoarthritis compared with normal saline treatment. Additional strength training is recommended to enhance muscle strength recovery.
Prescription Opioid Use among Opioid-Naive Women Undergoing Immediate Breast Reconstruction
Authors: Marcusa Daniel P. , Mann Rachel A. , Cron David C. , Fillinger Brooklyn R. , Rzepecki Alexandra K. , Kozlow Jeffrey H. , Momoh Adeyiza , Englesbe Michael , Brummett Chad , Waljee Jennifer F. 
Published: November 2017

Background:
Cancer patients may be particularly vulnerable to the deleterious effects of prolonged opioid use. The authors explored the factors that influence postoperative opioid prescription fills among women following postmastectomy reconstruction.

Methods:
Using the Truven Health MarketScan Research Databases, the authors identified a cohort of 4113 opioid-naive patients undergoing mastectomy and immediate breast reconstruction between January of 2010 and August of 2014. Outcomes included average daily oral morphine equivalents and the incidence of prolonged opioid fills (between 90 and 120 days after surgery). Using multivariable regression, the authors examined the effect of patient demographic characteristics, reconstructive technique, comorbid medical and psychiatric conditions, and postoperative complications on outcome variables.

Results:
In this cohort, 90 percent of patients filled opioid prescriptions perioperatively, and 10 percent continued to fill prescriptions beyond 3 months after surgery. Patients with depression were more likely to fill prescriptions of higher average daily oral morphine equivalents (74.2 mg versus 58.3 mg; p < 0.01), and patients with anxiety were more likely to fill opioids for prolonged periods (13.4 percent versus 9.1 percent; p < 0.01). Patients undergoing autologous free flap reconstruction were less likely to fill prescriptions for a prolonged period following surgery (5.9 percent versus 10.2 percent; p < 0.001).

Conclusions:
Prescription opioid fills are common following breast reconstruction, and 10 percent of all patients continue to fill opioid prescriptions beyond 3 months after surgery. Prolonged fills are influenced by both patient factors and surgical procedure, and attention should be directed toward identifying opioid alternatives when possible.

CLINCAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Evidence-Based Performance Measures: Quality Metrics for the Care of Patients Undergoing Breast Reconstruction
Authors: Manahan Michele A. , Wooden William A. , Becker Stephen M. , Cacioppo Jason R. , Edge Stephen B. , Grandinetti Amanda C. , Gray Diedra D. , Holley Susan O. , Karp Nolan S. , Kocak Ergun , Rao Roshni , Rosson Gedge D. , Schwartz Jaime S. , Sitzman Thomas J. , Soltanian Hooman T. , TerKonda Sarvam P. , Wallace Anne M. 
Published: November 2017

Summary:
The American Society of Plastic Surgeons commissioned the Breast Reconstruction Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing breast reconstruction surgery. Two outcome measures were identified. The first desired outcome was to reduce the number of returns to the operating room following reconstruction within 60 days of the initial reconstructive procedure. The second desired outcome was to reduce flap loss within 30 days of the initial reconstructive procedure. All measures in this report were approved by the American Society of Plastic Surgeons Breast Reconstruction Performance Measures Work Group and the American Society of Plastic Surgeons Executive Committee. The Work Group recommends the use of these measures for quality initiatives, Continuing Medical Education, Maintenance of Certification, American Society of Plastic Surgeons’ Qualified Clinical Data Registry reporting, and national quality reporting programs.
Medication Adherence in a Nationwide Cohort of Veterans Initiating Pre-exposure Prophylaxis (PrEP) to Prevent HIV Infection
Authors: van Epps Puja , Maier Marissa , Lund Brian , Howren Matthew Bryant , Beck Brice , Beste Lauren , Skolnik Avy , Vaughan-Sarrazin Mary , Ohl Michael E. 
Published: November 2017

Background:
Current guidelines for pre-exposure prophylaxis (PrEP) to prevent HIV infection call for long-term, daily use of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC). Little is known about long-term adherence with TDF/FTC prescribed for PrEP in routine clinical practice.

Setting:
Veterans Health Administration (VHA) clinics.

Methods:
We used VHA data to create a nationwide cohort of Veterans initiating PrEP between July 1, 2012, and June 30, 2016. We examined pharmacy refill data to estimate adherence based on the proportion of days covered (PDC) by TDF/FTC in the first year and used logistic regression to identify patient characteristics associated with high adherence (ie, PDC >0.8). We also quantified how often Veterans discontinued PrEP in the first year, based on a gap of 120 days or more in medication possession.

Results:
Among 1086 individuals initiating PrEP, the median PDC for TDF/FTC in the first year was 0.74 (interquartile range 0.40–0.92). In multivariable analysis, high adherence was associated with older age (odds ratio 1.97; 1.41–2.74 for age 50–64 compared with <35), white compared with black race (odds ratio 2.12; 1.53–2.93), and male sex (odds ratio 3.39; 1.37–8.42). Forty-four percent discontinued PrEP in the first year.

Conclusions:
First-year adherence with TDF/FTC was overall high in a nationwide cohort of PrEP users. Differences in adherence by age, race, and sex suggest potential for disparities in PrEP effectiveness in routine clinical practice.
High Acceptability and Increased HIV-Testing Frequency After Introduction of HIV Self-Testing and Network Distribution Among South African MSM
Authors: Lippman Sheri A. , Lane Tim , Rabede Oscar , Gilmore Hailey , Chen Yea-Hung , Mlotshwa Nkuli , Maleke Kabelo , Marr Alexander , McIntyre James A. 
Published: November 2017

Background:
South African men who have sex with men (MSM) have a high burden of undiagnosed HIV infection and HIV-testing rates incommensurate with their risk. HIV self-testing (HIVST) may increase testing uptake, frequency, and earlier HIV detection and treatment.

Setting:
Gert Sibande and Ehlanzeni districts, Mpumalanga Province, South Africa.

Methods:
We conducted a longitudinal HIVST study among MSM between June 2015 and May 2017. Overall 127 HIV-negative MSM were provided with up to 9 test kits of their choice—oral fluid or blood fingerstick—to use themselves and distribute to their networks. Surveys conducted 3- and 6-month post–enrollment elicited information on HIVST experiences, preferences, acceptability, utilization, and distribution. We used generalized estimating equations to assess changes in testing frequency.

Results:
Ninety-one percent of participants self-tested. All participants who self-tested reported being likely to self-test again, with over 80% preferring HIVST to clinic-based testing. Fingerstick was preferred to oral fluid tests by approximately 2:1. Returning participants distributed 728 tests to sexual partners (18.5% of kits), friends (51.6%), and family (29.8%). Six participants seroconverted during the study, and 40 new diagnoses were reported among test recipients. Frequent (semi-annual) testing increased from 37.8% before the study to 84.5% at follow-up (P < 0.001), and participants reported anticipated frequent testing of 100% if HIVST were available compared with 84% if only clinic-testing were available in the coming year (P < 0.01).

Conclusions:
HIVST use and network distribution is acceptable and feasible for MSM in South Africa and can increase testing uptake and frequency, potentially improving early detection among MSM and their networks.
Increased Delay Between Gadolinium Chelate Administration and T1-Weighted Magnetic Resonance Imaging Acquisition Increases Contrast-Enhancing Tumor Volumes and T1 Intensities in Brain Tumor Patients
Authors: Piechotta Paula L. , Bonekamp David , Sill Martin , Wick Antje , Wick Wolfgang , Bendszus Martin , Kickingereder Philipp 
Published: November 2017

Objectives
The aim of this study was to evaluate the impact of delayed T1-weighted (T1-w) MRI acquisition after gadolinium chelate administration on brain tumor volumes and T1-w intensities.

Materials and Methods
Fifty-five patients with histologically confirmed, contrast-enhancing intra-axial brain tumors were analyzed in this prospective test-retest study. Patients underwent 2 consecutive 3 T MRI scans (separated by a 1-minute break) during routine follow-up with contrast-enhanced T1 (ceT1-w), T2, and FLAIR acquisition. Macrocyclic gadolinium chelate–based contrast agent was only administered before the first ceT1-w acquisition; median latency to ceT1-w acquisition was 6.72 minutes (IQR, 6.53–6.92) in the first and 16.27 minutes (IQR, 15.49–17.26) in the second scan. Changes in tumor volumes and relative ceT1-w intensities between the 2 acquisitions were quantitatively assessed following semiautomated tumor segmentation (separately for contrast-enhancement [CE], necrosis [NEC], and nonenhancing [NE] tumor).

Results
Semiautomatically segmented CE tumor volumes were significantly larger in the second acquisition (median +32% [1.2 cm3]; IQR, 16%–62%; P < 0.01), which corresponded to a 10% increase in CE tumor diameter (+0.3 cm). Contrarily, NEC and NE tumor volumes were significantly smaller (median −24% [IQR, −36% to −54%], P < 0.01 for NEC and −2% [IQR, −1% to −3%], P = 0.02 for NE tumor). Bland-Altman plots confirmed a proportional bias toward higher CE and lower NEC volumes for the second ceT1-w acquisition. Relative ceT1-w intensities for both early- (regions already enhancing in the first scan) and late-enhancing (newly enhancing regions in the second scan) tumor were significantly increased in the second acquisition (by 5.8% and 27.3% [P < 0.01, respectively]). Linear-mixed effects modeling confirmed that the increase in CE volumes and CE intensities is a function of the interval between contrast agent injection and ceT1-w acquisition (P < 0.01 each).

Conclusions
Our study indicates that the maximum extent of CE tumor volumes and intensities may increase beyond the time frame of 4 to 8 minutes after contrast agent injection and potentially affects the diagnosis of progressive or recurrent disease because late-enhancing recurrent disease might not be unequivocally detected on standard follow-up MRI.
Optic Disc Edema in Glial Fibrillary Acidic Protein Autoantibody–Positive Meningoencephalitis
Authors: Chen John J. , Aksamit Allen J. , McKeon Andrew , Pittock Sean J. , Weinshenker Brian G. , Leavitt Jacqueline A. , Morris Padraig P. , Flanagan Eoin P. 
Published: November 2017

Background:
Glial fibrillary acidic protein (GFAP) autoantibody–positive meningoencephalitis is a newly described entity characterized by a corticosteroid-responsive meningoencephalomyelitis. Some patients with GFAP autoantibody–positive meningoencephalitis have been found to have optic disc edema, which has previously not been well characterized.

Methods:
We performed a retrospective, observational case series of Mayo Clinic patients found to have GFAP-IgG and optic disc edema from January 1, 2000, to December 31, 2016. We identified 40 patients with GFAP-IgG seropositivity by tissue-based immunofluorescence and cell-based assay. Patients were screened for the following inclusion criteria: 1) serum, cerebrospinal fluid, or both that yielded a characteristic astrocytic pattern of mouse tissue immunostaining with confirmation of IgG reactive with specific GFAPα isoform by cell-based assay; 2) meningoencephalitis or encephalitis; and 3) optic disc edema. We excluded those with coexisting aquaporin-4-IgG or insufficient clinical information.

Results:
Ten patients had optic disc edema and met inclusion criteria. The median age was 39.5 years and 60% were men. Visual acuity was unaffected and disc edema was bilateral in all cases. Mild vitreous cell was noted in 3 patients. The optic disc edema resolved with corticosteroid treatment but resulted in mild optic atrophy in 2 patients. The median lumbar puncture opening pressure was 144 mm H2O (range, 84–298 mm H2O). Brain MRI revealed radial perivascular enhancement in all except 1 patient. Fluorescein angiography was available for 1 patient with optic disc edema, which showed leakage from the venules.

Conclusions:
Patients with GFAP autoantibody–positive meningoencephalitis can have optic disc edema that can mimic papilledema. The cause of the optic disc edema remains uncertain, but most patients did not have raised intracranial pressure.