bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obstructive Sleep Apnea
Authors: Scott Brian , Johnson Romaine F. , Mitchell MD Ron B. 
Published: March 2016

IntroductionThe severity of obstructive sleep apnea in children determines perioperative management and is an indication for postoperative polysomnography. The relationship between increasing weight and sleep apnea severity in children remains unclear.ObjectivesTo compare demographic, clinical, and polysomnography parameters in normal‐weight, overweight, obese, and morbidly obese children, as well as identify demographic factors that predict sleep apnea severity.Study DesignCase series with chart review.SettingAcademic children’s hospital.MethodsA retrospective chart review of 290 children aged 2 to 18 years who underwent polysomnography at an academic children’s hospital was performed. Demographics, clinical findings, and polysomnographic parameters were recorded. Children were categorized as normal weight, overweight, obese, or morbidly obese. Differences were assessed using linear and logistical regression models. Significance was set at P <. 05.ResultsMorbidly obese were older than normal‐weight children (mean, 8.0 ± 0.5 years vs 5.8 ± 0.3 years; P <. 001) and less likely to have a normal polysomnogram (16% vs 48%; P =. 02). There were no differences in sex, ethnicity, birth status (term or preterm), or tonsil size between normal‐weight, overweight, obese, and morbidly obese children. Sleep efficiency and percentage of time in rapid eye movement were decreased in morbidly obese compared with other children (P <. 05). The apnea‐hypopnea index was positively correlated with increasing body mass index z score only as a function of increasing age (P <. 001).ConclusionObstructive sleep apnea severity is correlated with a combination of increasing age and weight but not with either variable independently. This study suggests that obese and morbidly obese older children are most likely to have severe obstructive sleep apnea.
Efficacy of Upper Airway Stimulation on Collapse Patterns Observed during Drug‐Induced Sedation Endoscopy
Authors: Ong Adrian A. , Murphey Alexander W. , Nguyen Shaun A. , Soose Ryan J. , Woodson B. Tucker , Vanderveken Olivier M. , de Vries Nico , Gillespie M. Boyd 
Published: March 2016

ObjectiveTo describe upper airway collapse patterns observed on drug‐induced sedation endoscopy (DISE) during screening for a clinical trial and to evaluate the impact of collapse patterns found on preoperative DISE on response rates to upper airway stimulation (UAS) therapy.Study DesignRetrospective review of an ongoing prospective multi‐institutional cohort study.SettingTwenty‐two participating institutions of the STAR trial.Subjects and MethodIn total, 222 subjects were screened with DISE to determine eligibility for an implantable UAS device. Supine laryngoscopy was performed during moderate sedation (propofol and/or midazolam). Airway collapse pattern and severity were graded at 4 levels, including velum, oropharynx, tongue base, and epiglottis (VOTE classification). Patients with complete concentric collapse (CCC) at the velum were excluded from implantation.ResultsThe CCC at the velum was observed in 52 (23%) of screened subjects, and these subjects were subsequently excluded from implantation. Of the 170 subjects without CCC at the velum, 126 (77%) underwent implantation: 121 (96%) had multilevel collapse and 5 (4%) had single‐level collapse. When comparing preimplantation DISE findings, UAS responders at 12 months had lower baseline VOTE scores compared with therapy nonresponders.ConclusionDrug‐induced sedation endoscopy is an efficient and safe method for determining UAS eligibility and has the potential to identify UAS nonresponders. Most patients had multilevel airway collapse, illustrating the limitations of single‐level upper airway surgery in treating obstructive sleep apnea. Upper airway stimulation is effective therapy for most patients with multilevel airway collapse; however, patients with complete anterior‐posterior or lateral soft palate and/or epiglottic collapse may be at increased risk of therapy failure.
Financial and Health Impacts of Multidisciplinary Aerodigestive Care
Authors: Skinner Margaret L. , Lee Seohee K. , Collaco Joseph M. , Lefton‐Greif Maureen A. , Hoch Jeannine , Au Yeung Karla J. 
Published: March 2016

Objectives(1) Analyze upstream and downstream activity before and after enrollment with the Multidisciplinary Pediatric Aerodigestive Care Team (MPACT). (2) Identify potential demand for MPACT services with ICD‐9 data.Study DesignRetrospective review of financial claims data.SettingTertiary care children’s center.SubjectsPediatric patients (0‐18 years old) enrolled with MPACT (pediatric otolaryngology, gastroenterology, pulmonary, speech‐language pathology).MethodsCase mix data from fiscal years (FYs) 2010‐2013 were analyzed for primary, secondary, and tertiary ICD‐9 codes in 4 aerodigestive diagnostic categories (ADCs): dysphagia, chronic cough, gastroesophageal disease, and chronic pulmonary disease/asthma. Inclusion criteria included patients <18 years old, seen by MPACT, with FY2010‐FY2013 case mix data and ≥2 ADCs. Unique outpatient and inpatient encounters and associated charges were evaluated to determine upstream and downstream activity trends.ResultsOf the 126 patients meeting inclusion criteria, 55 (44%) had ≥3 ADCs, and 11 (9%) had 4. These 126 patients received outpatient care during 3068 unique encounters. Outpatient total charges were $282,102 before and $744,542 after MPACT intervention. Eighty‐six (68%) patients received inpatient care during 423 unique encounters. Inpatient charges were $4,257,137 before and $2,872,849 after MPACT enrollment. Overall, a net reduction of $921,848 in total charges, $7316 per MPACT patient, was noted. FY2010‐FY2014 data identified an additional 1728 pediatric patients with ≥2 ADCs not enrolled in MPACT.ConclusionA cohort of children with aerodigestive disease experienced a shift from inpatient to outpatient care with an overall 20% reduction in patient charges when the years before and after MPACT enrollment were compared. Available ICD‐9 data suggest potential demand for MPACT services.
Death after cessation of treatment by cystic fibrosis patients: An international survey of clinicians
Authors: Pisaturo Marisa , Deppen Alain , Rochat Isabelle , Robinson Walter M , Hafen Gaudenz M 
Published: March 2016

Background: Little is known about cystic fibrosis patients, who are not considered to be terminally ill, and who die after voluntary cessation of treatment. Aim: This study was undertaken to provide an international snapshot of this issue. Design: An online survey was distributed across three continents. Setting: Distribution to the medical directors of the cystic fibrosis centres affiliated with the US Cystic Fibrosis Foundation, Cystic Fibrosis Australia (inclusion of New Zealand) and to every clinician member of the European Cystic Fibrosis Society. Results: More than 200 cystic fibrosis patients not considered to be terminally ill and, who voluntarily ceased treatment, were reported by the clinicians surveyed. Detailed data were reported in 102 patients (4 children, 25 adolescents and 73 adults). Only one child, six adolescents and one adult were judged by clinicians not to be competent to make the decision to stop treatment. Time-consuming and low immediate-impact therapies, such as respiratory physiotherapy, were most frequently discontinued. Resignation was the main reported reason for discontinuing treatment, followed by reactive depression and lack of familial support. A total of 69% of the patients received palliative care and 72% died in the 6 months following cessation of treatment. Conclusion: Death of cystic fibrosis patients, not considered to be terminally ill, is reported in Europe, the United States and Australia due to voluntary cessation of treatment.
Reliability and Associated Risk Factors for Performance on the Vestibular/Ocular Motor Screening (VOMS) Tool in Healthy Collegiate Athletes
Authors: Kontos Anthony P. , Sufrinko Alicia , Elbin R.J. , Puskar Alicia , Collins Michael W. 
Published: March 2016

Background: The Vestibular/Ocular Motor Screening (VOMS) is a newly developed screening tool that evaluates vestibular and ocular motor symptom (eg, headache, dizziness, nausea, fogginess) provocation after a sport-related concussion. Baseline data on the VOMS are needed to extend the application of this measure to broad age groups and to document normal variations in performance. Purpose: The primary purpose of this study was to examine the internal consistency of the VOMS in a large sample of healthy, nonconcussed collegiate athletes. The secondary purpose was to investigate the effects of patient sex and history of motion sickness, migraines, and concussions on baseline VOMS scores. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 263 National Collegiate Athletic Association Division I athletes (mean ± SD age, 19.85 ± 1.35 years) completed self-reported demographic and medical history at preseason physical examinations and baseline screening. Internal consistency of the VOMS was assessed with Cronbach α. A series of univariate nonparametric tests (χ2 with odds ratios [ORs] and 95% CIs) were used to examine the associations among medical history risk factors and VOMS clinical cutoff scores (score of ≥2 for any individual VOMS symptom, near point of convergence [NPC] distance of ≥5 cm), with higher scores representing greater symptom provocation. Results: Internal consistency of the VOMS was high (Cronbach α = .97), and 89% of athletes scored below cutoff levels (ie, 11% false-positive rate). Female athletes (OR, 2.99 [95% CI, 1.34-6.70]; P = .006) and those with a personal history of motion sickness (OR, 7.73 [95% CI, 1.94-30.75]; P = .009) were more likely to have ≥1 VOMS scores above cutoff levels. No risk factors were associated with increased odds of an abnormal NPC distance. Conclusion: The VOMS possesses internal consistency and an acceptable false-positive rate among healthy Division I collegiate student-athletes. Female sex and a history of motion sickness were risk factors for VOMS scores above clinical cutoff levels among healthy collegiate student-athletes. Results support a comprehensive baseline evaluation approach that includes an assessment of premorbid vestibular and oculomotor symptoms.
Surface PEGylation of intraocular lens for PCO prevention: An in vivo evaluation
Authors: Xu Xu , Tang Jun-Mei , Han Yue-Mei , Wang Wei , Chen Hao , Lin Quan-Kui 
Published: March 2016

Posterior capsular opacification (PCO) is a common complication in cataract surgery. The development of PCO is attributed to the combination of adhesion, migration, proliferation, and transdifferentiation of the residual lens epithelial cells (LEC) onto the interface of intraocular lens (IOL) material and lens posterior, in which the initial adhesion is the beginning step and plays important roles. In the present study, hydrophilic polyethylene glycol (PEG) was immobilized onto IOL surface via plasma-aided chemical grafting procedure. The attenuated total reflection – Fourier transform infrared (ATR-FTIR) and contact angle (CA) – measurements indicate the successful surface PEGylation, as well as the excellent hydrophilicity of the surfaces. Compared with pristine IOL, the PEGylation does not influent its optical property, whereas the initial adhesion of LEC is greatly inhibited. In vivo ocular implantation results show that the PEGylated IOL presents good in vivo biocompatibility, and can effectively prevent the PCO development.
Improving PEEK bioactivity for craniofacial reconstruction using a 3D printed scaffold embedded with mesenchymal stem cells
Authors: Roskies Michael , Jordan Jack O , Fang Dongdong , Abdallah Mohamed-Nur , Hier Michael P , Mlynarek Alex , Tamimi Faleh , Tran Simon D 
Published: March 2016

Objective Polyetheretherketone (PEEK) is a bioinert thermoplastic that has been investigated for its potential use in craniofacial reconstruction; however, its use in clinical practice is limited by a poor integration with adjacent bone upon implantation. To improve the bone–implant interface, two strategies have been employed: to modify its surface or to impregnate PEEK with bioactive materials. This study attempts to combine and improve upon the two approaches by modifying the internal structure into a trabecular network and to impregnate PEEK with mesenchymal stem cells. Furthermore, we compare the newly designed PEEK scaffolds' interactions with both bone-derived (BMSC) and adipose (ADSC) stem cells. Design Customized PEEK scaffolds were designed to incorporate a trabecular microstructure using a computer-aided design program and then printed via selective laser sintering (SLS), a 3D-printing process with exceptional accuracy. The scaffold structure was evaluated using microCT. Scanning electron microscopy (SEM) was used to evaluate scaffold morphology with and without mesenchymal stem cells (MSCs). Adipose and bone marrow mesenchymal cells were isolated from rats and cultured on scaffolds. Cell proliferation and differentiation were assessed using alamarBlue and alkaline phosphatase assays, respectively. Cell morphology after one week of co-culturing cells with PEEK scaffolds was evaluated using SEM. Results SLS 3D printing fabricated scaffolds with a porosity of 36.38% ± 6.66 and density of 1.309 g/cm2. Cell morphology resembled viable fibroblasts attaching to the surface and micropores of the scaffold. PEEK scaffolds maintained the viability of both ADSCs and BMSCs; however, ADSCs demonstrated higher osteodifferentiation than BMSCs ( p < 0.05). Conclusions This study demonstrates for the first time that SLS 3D printing can be used to fabricate customized porous PEEK scaffolds that maintain the viability of adipose and bone marrow-derived MSCs and induce the osteodifferentiation of the adipose-derived MSCs. The combination of 3D printed PEEK scaffolds with MSCs could overcome some of the limitations using PEEK biopolymers for load-bearing bone regeneration in craniofacial reconstruction.
Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux
Authors: Horisberger Monika , Haeni David , Henninger Heath B. , Valderrabano Victor , Barg Alexej 
Published: March 2016

Background: The current gold standard in the treatment of severe hallux rigidus is arthrodesis of the first metatarsophalangeal (MTP-I) joint. We present the results of a new 3-component MTP-I prosthesis. We determined (1) the intraoperative and perioperative complications; (2) survivorship of prosthesis components and rate of secondary surgeries for any reason; (3) prosthetic component stability and radiographic alignment; (4) the degree of pain relief; and (5) the midterm functional outcomes including radiographic range of motion (ROM). Methods: From 2008 to 2010, we prospectively included 29 MTP-I prostheses in 25 patients. The average age of the patients was 63.1 years (range, 48-87 years). The average follow-up was 49.5 months (range, 36-62 months). We observed complications and reoperations. A visual analog scale for pain and the American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score were obtained pre- and postoperation. Component stability and alignment were assessed using weight-bearing radiographs. Fluoroscopy was used to determine radiographic MTP-I ROM. Results: Seven (24.1%) patients underwent 1 or more secondary surgeries. Four cases (13.7%) eventually had a conversion to MTP-I arthrodesis. Two patients (3 cases) died from causes not related to the procedure. This left 22 feet in 19 patients for final follow-up. All but 3 remaining prostheses showed stable osteointegration and no migration, but MTP-I alignment showed high variability. The average pain score decreased from 5.9 (range, 3-9) to 1.2 (range, 0-5). The average AOFAS forefoot score increased from 55 (range, 0-80) to 83.5 (range, 58-95). Range of motion initially increased from 37.8 degrees (range, 0-60 degrees) to 88.6 degrees (range, 45-125 degrees) intraoperatively and decreased to 29.0 degrees (range, 11-52 degrees) at latest follow-up. Conclusion: Our data suggest that total arthroplasty of MTP-I leads to a high amount of revision surgeries, but the remaining patients had significant pain relief at midterm follow-up. However, we observed high variability regarding the prosthesis component alignment and poor range of motion. Level of Evidence: Level IV, prospective cohort study.
Gradual stiffness versus magnetic imaging‐guided variable stiffness colonoscopes: A randomized noninferiority trial
Authors: Garborg Kjetil , Wiig Håvard , Hasund Audun , Matre Jon , Holme Øyvind , Noraberg Geir , Løberg Magnus , Kalager Mette , Adami Hans‐Olov , Bretthauer Michael 
Published: March 2016

BackgroundColonoscopes with gradual stiffness have recently been developed to enhance cecal intubation.ObjectiveWe aimed to determine if the performance of gradual stiffness colonoscopes is noninferior to that of magnetic endoscopic imaging (MEI)‐guided variable stiffness colonoscopes.MethodsConsecutive patients were randomized to screening colonoscopy with Fujifilm gradual stiffness or Olympus MEI‐guided variable stiffness colonoscopes. The primary endpoint was cecal intubation rate (noninferiority limit 5%). Secondary endpoints included cecal intubation time. We estimated absolute risk differences with 95% confidence intervals (CIs).ResultsWe enrolled 475 patients: 222 randomized to the gradual stiffness instrument, and 253 to the MEI‐guided variable stiffness instrument. Cecal intubation rate was 91.7% in the gradual stiffness group versus 95.6% in the variable stiffness group. The adjusted absolute risk for cecal intubation failure was 4.3% higher in the gradual stiffness group than in the variable stiffness group (upper CI border 8.1%). Median cecal intubation time was 13 minutes in the gradual stiffness group and 10 minutes in the variable stiffness group (p  < 0.001).ConclusionsThe study is inconclusive with regard to noninferiority because the 95% CI for the difference in cecal intubation rate between the groups crosses the noninferiority margin. (ClinicalTrials.gov identifier: NCT01895504).
25‐OH vitamin D level has no impact on the efficacy of antiviral therapy in naïve genotype 1 HCV‐infected patients
Authors: Belle Arthur , Gizard Emmanuel , Conroy Guillaume , Lopez Anthony , Bouvier‐Alias Magali , Rouanet Stéphanie , Peyrin‐Biroulet Laurent , Pawlotsky Jean‐Michel , Bronowicki Jean‐Pierre 
Published: March 2016

Background and aimThe impact of 25‐OH vitamin D on sustained viral response (SVR) to antiviral therapy and on fibrosis progression in hepatitis C is debated. We assessed the impact of 25‐OH vitamin D concentration on the efficacy of antiviral therapy in naïve genotype 1 hepatitis C virus (HCV)‐infected patients.MethodsThe study population consisted of treatment‐naïve genotype 1 patients enrolled in a randomised controlled trial. A total of 516 patients received peginterferon α‐2a 180 µg/week plus ribavirin 800 mg/day for 24 weeks. There were 349 patients with undetectable HCV RNA (<50 IU/ml) at week 24 (W24) who were randomised to continue dual therapy (n  = 173) or to continue peginterferon alone (n  = 176) until week 48. 25‐OH vitamin D concentration was measured at baseline in frozen serum.ResultsA total of 461 patients could be analysed for virologic response at W24, and 285 (119 non‐responders at W24 + 166 responders who continued dual therapy until W48) for the impact of SVR. There were 487 patients who could be analysed for fibrosis progression. Metavir fibrosis scores (centralised analysis) were: F1 30%, F2 34%, F3 27% and F4 9%. Median 25‐OH vitamin D concentrations were similar in virologic responders (13.5 ng/ml) and in non‐responders at W24 (12.6 ng/ml), as well as in patients with SVR (12.8 ng/ml) and without SVR (12.8 ng/ml, 3.99) at W72. Median 25‐OH vitamin D concentrations were: F1: 14.30 ng/ml, F2: 13.50 ng/ml, F3: 13.30 ng/ml and F4: 12.80 ng/ml.ConclusionIn this study, 25‐OH vitamin D level has no impact on the efficacy of antiviral therapy in naïve genotype 1 HCV‐infected patients.
C1q/TNF-Related Protein-9 (CTRP9) Levels Are Associated With Obesity and Decrease Following Weight Loss Surgery
Authors: Wolf Risa M. , Steele Kimberley E. , Peterson Leigh A. , Zeng Xiange , Jaffe Andrew E. , Schweitzer Michael A. , Magnuson Thomas H. , Wong G. William 
Published: March 2016

Abstract

Context:
C1q/TNF-related protein-9 (CTRP9) is a novel adipokine that has beneficial metabolic and cardiovascular effects in various animal models. Alterations in circulating CTRP9 have also been observed in patients with cardiovascular disease and diabetes, but little is known about the impact of obesity and bariatric surgery on CTRP9 concentrations.

Objective:
The aim of this study was to compare CTRP9 levels in obese and lean subjects and to determine whether circulating CTRP9 levels in morbidly obese patients are altered by bariatric surgery.

Design, Setting, and Participants:
Fifty-nine obese bariatric surgical patients and 62 lean controls were recruited to participate in a cross-sectional study at an academic medical center. The obese patients were further invited to participate in a cohort study, and 21 returned for analysis at 3 and 6 months postsurgery.

Intervention:
Bariatric surgery (Roux-en-Y gastric bypass and vertical sleeve gastrectomy) was the intervention for this study.

Main Outcome Measures:
Fasting serum was obtained from all subjects on entry to the study and was analyzed in the core laboratory for hemoglobin A1c, glucose, aspartate aminotransferase, alanine aminotransferase, total cholesterol, high- and low-density lipoprotein cholesterol, and triglycerides; CTRP9, insulin, adiponectin, and leptin were measured by ELISA. Serum from the patients in the cohort study was also analyzed at 3 and 6 months.

Results:
Serum CTRP9 was significantly higher in the obese group compared to the lean group. CTRP9 was associated with obesity, even after controlling for age, gender, and ethnicity. Following bariatric surgery, there was a significant decrease in weight at 3 and 6 months postprocedure, accompanied by decreases in CTRP9, hemoglobin A1c and leptin, and an increase in serum adiponectin.

Conclusions:
CTRP9 levels are elevated in obesity and significantly decrease following weight loss surgery. Our data suggest that CTRP9 may play a compensatory role in obesity, similar to that of insulin, and is down-regulated following weight loss surgery.
How to measure color using spectrometers and calibrated photographs
Authors: Johnsen Sönke 
Published: March 2016

ABSTRACT
The measurement of color in biology has become increasingly common. These measurements are not limited to color vision research, but are also found in studies of communication, signaling, camouflage, evolution and behavior, and in the examination of environmental, artificial and biogenic light. Although the recent availability of portable spectrometers has made it simpler to measure color, guidance on how to make these measurements has not kept pace. Because most biologists receive little training in optics, many measure the wrong thing, or measure the right thing in the wrong way. This Commentary attempts to give biologists a brief overview of how to measure light and color using spectrometers and calibrated photographs. It focuses in particular on the inherent ambiguities of many optical measurements, and how these can be addressed.