bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relationship Between Intensity Coding and Binaural Sensitivity in Adults With Cochlear Implants
Authors: Todd Ann E. , Goupell Matthew J. , Litovsky Ruth Y. 
Published: October 2016

Objectives:
Many bilateral cochlear implant users show sensitivity to binaural information when stimulation is provided using a pair of synchronized electrodes. However, there is large variability in binaural sensitivity between and within participants across stimulation sites in the cochlea. It was hypothesized that within-participant variability in binaural sensitivity is in part affected by limitations and characteristics of the auditory periphery which may be reflected by monaural hearing performance. The objective of this study was to examine the relationship between monaural and binaural hearing performance within participants with bilateral cochlear implants.

Design:
Binaural measures included dichotic signal detection and interaural time difference discrimination thresholds. Diotic signal detection thresholds were also measured. Monaural measures included dynamic range and amplitude modulation detection. In addition, loudness growth was compared between ears. Measures were made at three stimulation sites per listener.

Results:
Greater binaural sensitivity was found with larger dynamic ranges. Poorer interaural time difference discrimination was found with larger difference between comfortable levels of the two ears. In addition, poorer diotic signal detection thresholds were found with larger differences between the dynamic ranges of the two ears. No relationship was found between amplitude modulation detection thresholds or symmetry of loudness growth and the binaural measures.

Conclusions:
The results suggest that some of the variability in binaural hearing performance within listeners across stimulation sites can be explained by factors nonspecific to binaural processing. The results are consistent with the idea that dynamic range and comfortable levels relate to peripheral neural survival and the width of the excitation pattern which could affect the fidelity with which central binaural nuclei process bilateral inputs.
Patient Eligibility for Randomized Controlled Trials in Critical Care Medicine: An International Two-Center Observational Study*
Authors: Ivie Ryan M. J. , Vail Emily A. , Wunsch Hannah , Goldklang Monica P. , Fowler Robert , Moitra Vivek K. 
Published: October 2016

Objective:
We conducted this study to determine the generalizability of information gained from randomized controlled trials in critically ill patients by assessing the incidence of eligibility for each trial.

Design:
Prospective, observational cohort study. We identified the 15 most highly cited randomized controlled trials in critical care medicine published between 1998 and 2008. We examined the inclusion and exclusion criteria for each randomized controlled trial and then assessed the eligibility of each patient admitted to a study ICU for each randomized controlled trial and calculated rates of potential trial eligibility in the cohort.

Setting:
Three ICUs in two academic medical centers in Canada and the United States.

Patients:
Adults admitted to participating medical or surgical ICU in November 2010 or July 2011.

Measurements and Main Results:
Among the 15 trials, the most common trial inclusion criteria were clinical criteria for sepsis (six trials) or acute respiratory distress syndrome (four trials), use of invasive mechanical ventilation (five trials) or related to ICU type or duration of ICU stay (five trials). Of the 93 patients admitted to a study ICU, 52% of patients (n = 48) did not meet enrollment criteria for any studied randomized controlled trial and 30% (n = 28) were eligible for only one of the 15. Trial ineligibility was mostly due to failure to meet inclusion criteria (87% of screening assessments) rather than meeting specific exclusion criteria (52% of screening assessments). Of the positive screening assessments, 85% occurred on the first day of ICU admission.

Conclusions:
Slightly more than half of the patients assessed were not eligible for enrollment in any of 15 major randomized controlled trials in critical care, most often due to the absence of the specific clinical condition of study. The majority of patients who met criteria for a randomized controlled trial did so on the first day of ICU admission.
Advances and controversies in the management of medullary thyroid carcinoma
Authors: Maia Ana Luiza , Wajner Simone Magagnin , Vargas Carla Vaz Ferreira 
Published: October 2016

Purpose of review
Medullary thyroid carcinoma (MTC) comprises approximately 4% of all malignant thyroid neoplasms. Although the majority of patients have a good prognosis, a subgroup of patients develops progressive disease and requires systemic therapy. Here, we focused on the current MTC therapeutic approaches and discussed the advantages and disadvantages of molecular targeted therapies.

Recent findings
Targeted molecular therapies that inhibit RET and other tyrosine kinase receptors involved in angiogenesis have been shown to improve progression-free survival in patients with advanced MTC. Two drugs, vandetanib and cabozantinib, have been approved for the treatment of progressive or symptomatic MTC, and several others have exhibited variable efficacy. No tyrosine kinase inhibitor has been shown to improve survival. Although no definitive recommendation can currently be made, cumulative data indicate that knowledge of the tumor mutational profile may facilitate improvements in targeted therapy for MTC.

Summary
Tyrosine kinase inhibitors are effective therapeutic agents for the treatment of progressive MTC. Nevertheless, it is not clear who will benefit the most from therapy, and the decision regarding when and how to initiate the treatment should be made based on the patient's medical history and tumor behavior. Hopefully, in the near future, molecular profiling of MTC can be used to determine the most effective molecular therapeutic target.
Novel insights in the regulation and function of macrophages in the tumor microenvironment
Authors: Bolli Evangelia , Movahedi Kiavash , Laoui Damya , Van Ginderachter Jo A. 
Published: October 2016

Purpose of review
Tumors contain not only cancer cells but also nontransformed types of cells, the stromal cells. A bidirectional interplay exists between transformed and nontransformed cells leading to tumor progression and metastasis. Tumor-associated macrophages (TAMs) are the most abundant tumor-infiltrating leukocytes characterized by a high heterogeneity and plasticity. TAMs exhibit strong protumoral activities and are related to bad prognosis and worse overall survival in various cancer types.

Recent findings
Recent progress has delineated the existence of distinct TAM subsets in primary tumors and metastatic sites regulated by diverse mechanisms and triggering strong protumoral functions such as immunossuppression, angiogenesis, metastasis and resistance to current therapies.

Summary
Delineating the regulatory pathways governing TAM heterogeneity and activation could present a novel frontier in cancer therapy. TAM targeting/repolarization is considered as a promising novel therapeutic modality in combination with standard-of-care therapies or immuno checkpoint blockers.
Anatomy of the Cervicomental Region: Insights From an Anatomy Laboratory and Roundtable Discussion
Authors: Kenkel Jeffrey M. , Jones Derek H. , Fagien Steven , Glaser Dee Anna , Monheit Gary D. , Stauffer Karen , Sykes Jonathan M. 
Published: October 2016

Abstract
In 2015, ATX-101 (deoxycholic acid injection; Kybella in the United States and Belkyra in Canada; Kythera Biopharmaceuticals, Inc., Westlake Village, CA [an affiliate of Allergan plc, Dublin, Ireland]) was approved as a first-in-class injectable drug for reduction of submental fat. Use of a pharmacologic/injectable therapy within the submental region requires a thorough understanding of cervicomental anatomy to ensure proper injection technique and safe administration. To this end, an anatomy laboratory was conducted to review key external landmarks and important internal anatomic structures that characterize the lower face and anterior neck. External landmarks that define the boundaries of the cervicomental and submental regions were identified including the inferior mandibular border, the anterior border of the sternocleidomastoid muscle, the antegonial notch, the submental crease, the thyroid notch, and the hyoid bone. Relevant internal anatomic structures, including preplatysmal submental fat (the target tissue for ATX-101) and the platysma muscle as well as critical neurovascular and glandular tissues were revealed by dissection. Of particular interest was the marginal mandibular branch of the facial nerve because it typically courses along the inferior mandibular border near the proposed treatment area for ATX-101.
Combined exercise reduces arterial stiffness, blood pressure, and blood markers for cardiovascular risk in postmenopausal women with hypertension
Authors: Son Won-Mok , Sung Ki-Dong , Cho Jae-Min , Park Song-Young 
Published: October 2016

Abstract

Objective:
Postmenopausal women exhibit elevated brachial-ankle pulse wave velocity (baPWV), an indicator of arterial stiffness, which is associated with an increased risk of cardiovascular events and mortality. The purpose of this study is to examine the impact of combined resistance and aerobic exercise training on baPWV, blood pressure (BP), and cardiovascular fitness in postmenopausal women with stage 1 hypertension.

Methods:
Twenty postmenopausal women (age, 75 ± 2 y; systolic BP, 152 ± 2 mm Hg, diastolic BP, 95 ± 3 mm Hg) were randomly assigned to a “no-exercise” (CON, n = 10) or combined exercise (EX, n = 10) group. The EX group performed resistance and aerobic exercise for 12 weeks, 3 times per week. Exercise intensity was increased gradually, from 40% to 70% of heart rate reserve, every 4 weeks. BaPWV, BP, blood nitrite/nitrate, endothelin-1 (ET-1), cardiovascular fitness, and body composition were measured before and after the 12-week intervention.

Results:
BP, baPWV (−1.2 ± 0.4 m/s), ET-1 (−2.7 ± 0.3 μmol/mL), nitrite/nitrate (+4.5 ± 0.5 μM), functional capacity, and body composition were significantly improved (P < 0.05) in the EX group after 12 weeks of training, but no changes were observed in the CON group.

Conclusions:
These findings indicate that 12 weeks of combined exercise training improves arterial stiffness, BP, ET-1, blood nitrite/nitrate, functional capacity, and body composition in postmenopausal women with stage 1 hypertension. Thus, this study provides evidence that combined exercise training is a useful therapeutic method to improve cardiovascular health which can reduce cardiovascular disease risk in postmenopausal women with hypertension.
Short- and Long-term Effects of Pulmonary Rehabilitation in Patients With Mild COPD
Authors: Jácome Cristina , Marques Alda 
Published: October 2016

PURPOSE:
Pulmonary rehabilitation (PR) is effective in patients with moderate to severe chronic obstructive pulmonary disease (COPD). However, the effects of PR in patients with mild COPD have not yet been established. Thus, this study investigated the short- and long-term effects of PR in patients with mild COPD in comparison with patients with moderate to severe disease.

METHODS:
A total of 32 patients with mild (group 1) and 29 with moderate to severe (group 2) COPD completed the study. Both groups participated in a 12-week PR program with exercise training and psychosocial support and education. Outcome measures at baseline, 3 (post-PR), 6, and 9 months later included 6-minute walk test (6MWT); Modified Medical Research Council Dyspnea Scale; 1-repetition maximum chest press and knee extension; a brief physical activity assessment; the number of exacerbations in the past 3 months and the St. George Respiratory Questionnaire (SGRQ).

RESULTS:
Improvements in the 6MWT, chest press, knee extension, and physical activity were observed post-PR (P < .001), with no differences between the 2 groups. Reduction in the number of exacerbations (P < .001) and improvements in the SGRQ total (P < .001) were also observed, however, with greater magnitude in group 2 (P = .029 and P < .001, respectively). Except for peripheral muscle strength (P < .002), all the achieved benefits were sustained at 6 and 9 months (P > .05).

CONCLUSIONS:
Pulmonary rehabilitation improves exercise tolerance, muscle strength, physical activity, and health-related quality of life and reduces exacerbations in patients with mild COPD as it does in patients with moderate to severe COPD. Moreover, most of these benefits were maintained at 9-month follow-up, suggesting that PR could be part of the management of mild COPD.
RECURRENCE IN PATIENTS WITH TYPE 3 NEOVASCULARIZATION (RETINAL ANGIOMATOUS PROLIFERATION) AFTER INTRAVITREAL RANIBIZUMAB
Authors: Kim Jae Hui , Chang Young Suk , Kim Jong Woo , Kim Chul Gu , Lee Dong Won 
Published: October 2016

Purpose:
To evaluate the incidence, timing, and characteristics of recurrence in patients with Type 3 neovascularization who were initially treated with ranibizumab.

Methods:
This retrospective study included 42 patients (42 eyes) who were diagnosed with Type 3 neovascularization and treated with 3 monthly injections of ranibizumab. The 12-month follow-up data of these patients were analyzed. The time of recurrence after the initial treatment was recorded. In eyes with recurrence, the association of the duration until the first recurrence and the incidence of multiple recurrences was analyzed.

Results:
During the 12 months, recurrence was noted in 32 patients (76.2%), with 20 experiencing multiple recurrences. The first recurrence occurred (mean ± SD) 5.3 ± 1.8 months (range, 2–9 months) after the third ranibizumab injection. The first recurrence was noted in 20 eyes (62.5%) at 4 months to 6 months after the third injection. A significantly higher incidence of multiple recurrences was noted in patients who experienced their first recurrence less than 6 months after the third injection (13 of 16 eyes, 83.3%) compared with patients who had their first recurrence 6 or more months after the third injection (5 of 14 eyes, 35.7%) (P = 0.011).

Conclusion:
Recurrence did not occur in 23.8% of the patients with Type 3 neovascularization who were initially treated with 3 monthly ranibizumab injections. Close follow-up examination may be needed 4 months to 6 months after the third ranibizumab injection. The close follow-up or continuous injection may also be required for patients with early first recurrences.
Utilization of Positive and Negative Controls to Examine Comorbid Associations in Observational Database Studies
Authors: Desai Jigar R. , Hyde Craig L. , Kabadi Shaum , St Louis Matthew , Bonato Vinicius , Katrina Loomis A. , Galaznik Aaron , Berger Marc L. 
Published: October 2016

Background:Opportunities to leverage observational data for precision medicine research are hampered by underlying sources of bias and paucity of methods to handle resulting uncertainty. We outline an approach to account for bias in identifying comorbid associations between 2 rare genetic disorders and type 2 diabetes (T2D) by applying a positive and negative control disease paradigm.Research Design:Association between 10 common and 2 rare genetic disorders [Hereditary Fructose Intolerance (HFI) and α-1 antitrypsin deficiency] and T2D was compared with the association between T2D and 7 negative control diseases with no established relationship with T2D in 4 observational databases. Negative controls were used to estimate how much bias and variance existed in datasets when no effect should be observed.Results:Unadjusted association for common and rare genetic disorders and T2D was positive and variable in magnitude and distribution in all 4 databases. However, association between negative controls and T2D was 200% greater than expected indicating the magnitude and confidence intervals for comorbid associations are sensitive to systematic bias. A meta-analysis using this method demonstrated a significant association between HFI and T2D but not for α-1 antitrypsin deficiency.Conclusions:For observational studies, when covariate data are limited or ambiguous, positive and negative controls provide a method to account for the broadest level of systematic bias, heterogeneity, and uncertainty. This provides greater confidence in assessing associations between diseases and comorbidities. Using this approach we were able to demonstrate an association between HFI and T2D. Leveraging real-world databases is a promising approach to identify and corroborate potential targets for precision medicine therapies.
Using the Objective Structured Clinical Examination to Assess ACGME Competencies in Pediatric Gastroenterology Fellows
Authors: Solomon Aliza B. , Reed Rachel , Benkov Keith , Kingsbery Joseph , Lusman Sarah S. , Malter Lisa B. , Levine Jeremiah , Rabinowitz Simon S. , Wolff Martin , Zabar Sondra , Weinshel Elizabeth 
Published: October 2016

Background:The Accreditation Council for Graduate Medical Education has described 6 core competencies with which trainees should demonstrate proficiency. Using the Objective Structured Clinical Examination (OSCE), we aimed to assess 4 of these competencies among Pediatric Gastrointestinal (GI) fellows (PGs).Methods:Eight first‐year PGs from 6 medical centers in the New York area participated in a 4‐station OSCE with trained standardized patient (SP) actors. The cases included an emergency department (ED) consult, or “ED Consult” for lower gastrointestinal bleeding; “Breaking Bad News” focusing on CF nutritional complications; “Second Opinion” for abdominal pain; “Transition of Care” for inflammatory bowel disease. At each station, attending faculty observed the encounters behind a 1‐way mirror. SPs and faculties provided immediate feedback to the examined fellows. Previously validated OSCE checklists were used to assess performance. On completion, fellows attended debriefing sessions and completed surveys about the educational value.Results:Median overall milestone competency scores were 6.9 (PC1), 4.8 (PC2), 5.9 (MK1), 5.7 (MK2), 6.4 (ICS1), 6.9 (Prof1), and 6.7 (Prof3). Overall, fellows score highest (7/9) on the inflammatory bowel disease “Transition of Care” case, found the “Breaking Bad News” Cystic Fibrosis OSCE to be the most challenging, and were most comfortable with the “ED Consult” OSCE, as a commonly encountered scenario. Overall, the fellows rated the educational value of the program highly.Conclusions:To our knowledge, although the OSCE has been validated in other medical fields, this is the first OSCE program developed for PGs fellows. These OSCEs have included Accreditation Council for Graduate Medical Education competencies, serving to assess fellows’ skills in these areas while exposing them to challenging medical and psychosocial cases that they may not frequently encounter.
Multimodal Imaging of Serpiginous Choroiditis
Authors: Khan Hashim Ali , Shahzad Muhammad Aamir 
Published: October 2016

ABSTRACT

Purpose
To report a case of atypical serpiginous choroiditis with previously unreported findings on optical coherence tomographic angiography.

Case Report
A 35-year-old otherwise healthy man had a 1-week history of vision loss in his right eye. The visual acuity in right eye was counting fingers at 1 meter. Fundoscopy showed a classic peripapillary serpiginous lesion and a solitary macular lesion. Fundus fluorescein angiography revealed early hypofluorescence of active lesions with gradual increase in fluorescence across the phase of angiogram. Optical coherence tomography showed hyperreflectivity in outer retinal layers and loss of ellipsoid zone band. The patient was treated with oral prednisone and visual acuity returned to near normal. The inflammation recurred once the patient discontinued corticosteroid therapy. The flare-up was treated with intravenous methylprednisolone followed by oral steroids. Oral azathioprine was added as a steroid-sparing agent and oral prednisone was tapered slowly and discontinued. The visual acuity returned to normal with settlement of all lesions after initiating azathioprine. Optical coherence tomography showed reintegration of retinal anatomy. No recurrence was seen after discontinuation of corticosteroids. Optical coherence tomographic angiography in resolved serpiginous choroiditis was consistent with loss of choriocapillaris homogeneity.

Conclusions
Serpiginous choroiditis may manifest with multifocal lesions and may be confused with relentless placoid chorioretinitis. However, it ends up in a typical geographic scar. Optical coherence tomography can be used to monitor the changes in retinal structure. Choriocapillaris changes as seen on optical coherence tomographic angiography may be a possible mechanism behind the development of choroidal neovascularization in later stages of the disease.
Separation of Thoraco-Omphalo-Ischiopagus Conjoined Twins: Surgical Planning, Management, and Outcomes
Authors: Trost Jeffrey G. , Lin Lawrence O. , Clark Sarah Jane , Khechoyan David Y. , Hollier Larry H. , Buchanan Edward P. 
Published: October 2016

Background:
Conjoined twins are a rare medical phenomenon that offers a unique challenge for medical professionals. The complex anatomy of conjoined twins dictates their survival and amenability to separation, making each case different in terms of medical management, surgical planning, and patient outcomes. Thoraco-omphalo-ischiopagus twins, joined from the thorax to the pelvis, are one of the rarest orientations recorded in the medical literature, and successful separation of this subset of conjoined twins has not been documented. This report presents a novel case of thoraco-omphalo-ischiopagus tetrapus twins who were successfully separated at 10 months of age. The preoperative planning, operative details, and postoperative course are discussed as they relate to the reconstructive effort.

Methods:
Three-dimensional medical modeling was pursued early in the planning process and was used to estimate the soft-tissue requirements for reconstruction and to design custom tissue expanders.

Results:
The reconstructive effort required postponement until respiratory status was optimized. Even with elaborate preoperative planning, primary closure of the abdomen was limited because of tissue edema and other less predictable patient factors. Delayed closure of the abdominal wall was made possible with negative-pressure wound therapy and secondary flap advancements.

Conclusion:
Preoperative coordination with necessary vendors, a multidisciplinary surgical effort, and optimal timing of the surgical intervention all contribute to the successful separation and long-term survival of thoraco-omphalo-ischiopagus conjoined twins.

Clinical Question/Level of Evidence:
Therapeutic, V.
The “Air in the CT X-ray Tube Oil” Artifact—Examples of the Quality Control Images and the Evaluation of Four Potential Clinical Patients' Head Computed Tomography Cases
Authors: Törmänen Juhani , Rautiainen Jari , Tahvonen Pirita , Leinonen Kimmo , Nieminen Miika T. , Tervonen Osmo 
Published: October 2016

Abstract
We present a newly reposted scanner-based artifact—with 4 potential patients' head computed tomography (CT) cases—the “Air in the CT X-ray Tube Oil” artifact with a 64-slice multidetector CT. This artifact mimics diseases, which cause hypodense findings in CT images. It can be difficult to notice in the clinical patient imaging but can be also very difficult to verify in quality control tests.