bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Late Hip Dysplasia Occur After Normal Ultrasound Screening in Breech Babies?
Authors: Morris Andrew R. , Thomas Joanna M.C. , Reading Isabel C. , Clarke Nicholas M.P. 
Published: August 2017

Background:
Recent literature has raised concern regarding the occurrence of late dysplasia after normal screening in breech babies. One paper states a late dysplasia incidence of 29%. This finding is in contrast with other published work, which suggests breech presentation is predictive of spontaneous stabilization of the unstable neonatal hip. We decided to identify the rate of late dysplasia after normal screening in our patient cohort and also to investigate the use of a prophylactic abduction diaper.

Methods:
During the study period of December 2012 to June 2014, breech babies referred to the screening program at our institution were identified. Ninety babies were prospectively enrolled into the study and randomized to either the observational arm or prophylactic treatment with the Healthy Hip Diaper (HALO, Minnetonka, MN). All babies had a normal initial clinical examination and ultrasound. Regular follow-up including clinical and ultrasound examination was undertaken culminating in pelvic x-rays performed at 13±1 months. A total of 63% of patients elected against their randomization to prophylactic treatment, 28% opted for prophylactic treatment against their randomization to observation only, meaning a total of 40% of babies proceeded against their initial randomization. In total, 75% of recruited babies completed follow-up. Dysplasia was defined as an acetabular index >2 SD from the mean sex, age, and side-specific values.

Results:
The overall rate of radiographic dysplasia at 13 months was 7.4%. The rate was 5% in those using a Healthy Hip Diaper and 8.3% in those under observation only. This was not a statistically significant difference. Two patients required operative intervention, one requiring capsulorraphy with acetabuloplasty, the other requiring an arthrogram. Overall compliance with the abduction diaper was low.

Conclusions:
We conclude that late radiographic dysplasia does occur after normal clinical and ultrasound screening in breech babies, although not to the same extent as recently published data. We cannot recommend prophylactic abduction devices for breech babies who have a normal hip ultrasound at 6 weeks of age. Consideration must be given to further clinical and radiographic follow-up for hip dysplasia when the risk factor of breech presentation is present.

Level of Evidence:
Level II—prospective comparative trial.
Selective Activation of Basal Forebrain Cholinergic Neurons Attenuates Polymicrobial Sepsis–Induced Inflammation via the Cholinergic Anti-Inflammatory Pathway
Authors: Zhai Qian , Lai Dengming , Cui Ping , Zhou Rui , Chen Qixing , Hou Jinchao , Su Yunting , Pan Libiao , Ye Hui , Zhao Jing-Wei , Fang Xiangming 
Published: August 2017

Objectives:
Basal forebrain cholinergic neurons are proposed as a major neuromodulatory system in inflammatory modulation. However, the function of basal forebrain cholinergic neurons in sepsis is unknown, and the neural pathways underlying cholinergic anti-inflammation remain unexplored.

Design:
Animal research.

Setting:
University research laboratory.

Subjects:
Male wild-type C57BL/6 mice and ChAT-ChR2-EYFP (ChAT) transgenic mice.

Interventions:
The cholinergic neuronal activity of the basal forebrain was manipulated optogenetically. Cecal ligation and puncture was produced to induce sepsis. Left cervical vagotomy and 6-hydroxydopamine injection to the spleen were used.

Measurements and Main Results:
Photostimulation of basal forebrain cholinergic neurons induced a significant decrease in the levels of tumor necrosis factor-α and interleukin-6 in the serum and spleen. When cecal ligation and puncture was combined with left cervical vagotomy in photostimulated ChAT mice, these reductions in tumor necrosis factor-α and interleukin-6 were partly reversed. Furthermore, photostimulating basal forebrain cholinergic neurons induced a large increase in c-Fos expression in the basal forebrain, the dorsal motor nucleus of the vagus, and the ventral part of the solitary nucleus. Among them, 35.2% were tyrosine hydroxylase positive neurons. Furthermore, chemical denervation showed that dopaminergic neurotransmission to the spleen is indispensable for the anti-inflammation.

Conclusions:
These results are the first to demonstrate that selectively activating basal forebrain cholinergic neurons is sufficient to attenuate systemic inflammation in sepsis. Specifically, photostimulation of basal forebrain cholinergic neurons activated dopaminergic neurons in dorsal motor nucleus of the vagus/ventral part of the solitary nucleus, and this dopaminergic efferent signal was further transmitted by the vagus nerve to the spleen. This cholinergic-to-dopaminergic neural circuitry, connecting central cholinergic neurons to the peripheral organ, might have mediated the anti-inflammatory effect in sepsis.
Admission to Intensive Care for Palliative Care or Potential Organ Donation: Demographics, Circumstances, Outcomes, and Resource Use
Authors: Melville Andrew , Kolt Gali , Anderson David , Mitropoulos Joanna , Pilcher David 
Published: August 2017

Objectives:
To describe the characteristics, circumstances, change over time, resource use, and outcomes of patients admitted to ICUs in Australia and New Zealand for the purposes of “palliative care of a dying patient” or “potential organ donation,” and compare with actively managed ICU patients.

Design:
A retrospective study of data from the Australian and New Zealand Intensive Care Society Adult Patient Database and a nested cohort analysis of a single center.

Setting:
One hundred seventy-seven ICUs in Australia and New Zealand and a nested analysis of one university-affiliated hospital ICU in Melbourne, VIC, Australia.

Patients:
Three thousand seven hundred “palliative care of a dying patient” and 1,115 “potential organ donation” patients from 2007 to 2016. The nested cohort included 192 patients.

Interventions:
No interventions. Data extracted included patient demographics, diagnoses, length of stay, circumstances, and outcome of admission.

Measurements and Main Results:
ICU admissions for “palliative care of a dying patient” and “potential organ donation” increased from 179 in 2007 to 551 in 2016 and from 44 in 2007 to 174 in 2016 in each respective group, though only the “potential organ donation” cohort showed an increase in proportion of total ICU admissions. Lengths of stay in ICU were a mean of 33.8 hours (median, 17.5; interquartile range, 6.4–38.8) and 44.7 hours (26.6; 16.0–44.6), respectively, compared with 74.2 hours (41.5; 21.7–77.0) in actively managed patients. Hospital mortality was 86.6% and 95.9%, respectively. In the nested cohort of 192 patients, facilitating family discussions about goals of treatment and organ donation represented the most common reason for ICU admission.

Conclusions:
Patients admitted to ICU to manage end-of-life care represent a small proportion of overall ICU admissions, with an increasing proportion of “potential organ donation” admissions. They have shorter ICU lengths of stay than actively managed patients, suggesting resource use for these patients is not disproportionate.
Factors Associated with Developmental Behavioral Pediatricians Prescribing Psychotropic Medication to Children with Autism Spectrum Disorder: A Study of Three DBPNet Sites
Authors: Jackel Carissa , Shults Justine , Wiley Susan , Meinzen-Derr Jareen , Augustyn Marilyn , Blum Nathan 
Published: August 2017

ABSTRACT:

Objective:
Psychotropic medications are frequently prescribed to children with autism spectrum disorder (ASD), but little is known about the prescribing practices of developmental-behavioral pediatricians (DBPs). Our objective was to determine whether clinical site, age, insurance, or comorbidities influenced DBPs prescribing psychotropic medication for children with ASD.

Methods:
A retrospective analysis was performed using electronic health record data of all patients with ASD seen at 3 academic developmental-behavioral pediatrics (DBP) clinical programs from January 2010 to December 2011. Data included age, diagnoses, primary insurance, and medications prescribed. Factors associated with prescribing psychotropic medication were examined using generalized estimating equations.

Results:
Sites varied in the frequency with which they prescribed psychotropic medication for children with ASD (site 1: 33.1%, site 2: 49.3%, site 3: 4.0%; p < .001). We found that the following factors predicted prescribing of psychotropic medications: comorbidities (odds ratio [OR]: 2.87; 95% confidence interval [CI], 2.58–3.18), age, and primary insurance. However, the impact of insurance depended on age. For 3- to 5-year-old children, those on Medicaid were more likely to be prescribed psychotropic medications than those with private insurance (OR: 1.65; 95% CI, 1.29–2.12). This was particularly true for alpha-2-adrenergic agonists (OR: 2.48; 95% CI, 1.56–3.92) and atypical antipsychotics (OR: 2.57; 95% CI, 1.46–4.55).

Conclusion:
There are large variations in prescribing psychotropic medication to children with ASD at 3 academic DBP programs. Further research is needed to understand factors that contribute to higher use of psychotropic medication in young children with Medicaid.
Evaluation of a Novel Hybrid Viable Bioprosthetic Mesh in a Model of Mesh Infection
Authors: Ha Ally , Criman Erik T. , Kurata Wendy E. , Matsumoto Karen W. , Pierce Lisa M. 
Published: August 2017

Background:
The reported incidence of mesh infection in contaminated operative fields is as high as 30% regardless of material used. Our laboratory previously showed that augmenting acellular bioprosthetic mesh with allogeneic mesenchymal stem cells (MSC) enhances resistance to bacterial colonization in vivo and preserves mesh integrity. This study’s aim was to determine whether augmentation of non-crosslinked porcine dermis (Strattice) with commercially available, cryopreserved, viable MSC-containing human placental tissue (Stravix) similarly improves infection resistance after inoculation with Escherichia coli (E. coli) using an established mesh infection model.

Methods:
Stravix was thawed per manufacturer’s instructions and 2 samples were tested for cell viability using a Live/Dead Cell assay at the time of surgery. Rats (N = 20) were implanted subcutaneously with 1 piece of Strattice and 1 piece of hybrid mesh (Strattice + Stravix sutured at the corners). Rats were inoculated with either sterile saline or 106 colony-forming units of E. coli before wound closure (n = 10 per group). At 4 weeks, explants underwent microbiologic and histologic analyses.

Results:
In E. coli–inoculated animals, severe or complete mesh degradation concurrent with abscess formation was observed in 100% (10/10) hybrid meshes and 90% (9/10) Strattice meshes. Histologic evaluation determined that meshes inoculated with E. coli exhibited severe acute inflammation, which correlated with bacterial recovery (P < 0.001). Viability assays performed at the time of surgery failed to verify the presence of numerous live cells in Stravix.

Conclusions:
Stravix cryopreserved MSC-containing human umbilical tissue does not improve infection resistance of a bioprosthetic mesh in vivo in rats after inoculation with E. coli.
Patient-Reported Disability Measures Do Not Correlate with Electrodiagnostic Severity in Carpal Tunnel Syndrome
Authors: Tulipan Jacob E. , Lutsky Kevin F. , Maltenfort Mitchell G. , Freedman Mitchell K. , Beredjiklian Pedro K. 
Published: August 2017

Background:
Electrophysiologic studies including electromyography and nerve conduction studies play a role in the evaluation of carpal tunnel syndrome (CTS), despite evidence that these studies do not correlate with CTS-specific symptom scores. There is a lack of evidence comparing electrophysiologic data with general measures of function.

Methods:
Fifty patients presenting for CTS treatment over an 8-month period were analyzed retrospectively. All patients completed surveys including the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and the Medical Outcomes Study 12-Item Short-Form Survey [(physical component summary 12, mental component summary (MCS-12)]. Electromyography and nerve conduction studies were performed on all patients and compared with outcome scores.

Results:
Analysis demonstrated no relationship between DASH or MCS-12 and electrodiagnostic severity. No significant correlations were noted between DASH or MCS-12 and median motor or sensory latency. There was a moderate–weak correlation (rho = 0.34) between more severe electrophysiologic grade and better function based on physical component summary 12.

Conclusions:
Electrodiagnostic severity grades do not correlate with patient-reported disability, including the DASH and MCS–12 surveys. There is a counterintuitive correlation between more-severe electrodiagnostic findings and decreased physical disability. These findings indicate that disability may not correlate with electrodiagnostic severity of median neuropathy in CTS.
PREVALENCE OF VITREOMACULAR ADHESION IN PATIENTS WITHOUT MACULOPATHY OLDER THAN 40 YEARS
Authors: Rodman Julie A. , Shechtman Diana , Sutton Brad M. , Pizzimenti Joseph J. , Bittner Ava K. ,   VAST Study Group
Published: August 2017

Purpose:To determine the prevalence and factors influencing vitreomacular adhesion (VMA) or vitreomacular traction (VMT) in subjects without maculopathy older than age 40 years.Methods:In a prospective cross-sectional study, 1,950 eyes in 1,090 participants aged 40 to 89 years representing various ethnic groups from 14 centers in the United States underwent a comprehensive eye examination, including spectral domain optical coherence tomography. A team of independent, masked readers classified the presence or absence of VMA/VMT on spectral domain optical coherence tomography based on the International Vitreomacular Traction Study Group rubric.Results:Across all eyes, the prevalence of VMA or VMT was 39% or 1%, respectively. For every 1-year increase in age, there was a statistically significant 7% decreased odds of having VMA or VMT (95% confidence interval [CI]: 0.89–0.96;P< 0.001), whereas African Americans had 55% significantly reduced odds of having VMA or VMT when than whites (95% CI: 0.23–0.90;P= 0.025). Vitreomacular adhesion >1,500μm was significantly more likely than VMA <1,500μm in younger adults (95% CI: 0.70–0.86;P< 0.001), hyperopes versus emmetropes (95% CI: 1.49–35.9;P= 0.01), primary eye care versus tertiary practices (95% CI: 0.03–0.92;P= 0.04), and patients without hyperlipidemia (95% CI: 0.04–0.83;P= 0.03).Conclusion:Vitreomacular adhesion is highly prevalent among middle-aged adults. Diagnostic screening with spectral domain optical coherence tomography may help to accurately detect VMA or VMT, prompting routine monitoring and timely therapeutic intervention.
A Smartphone Application for Customized Frequency Table Selection in Cochlear Implants
Authors: Jethanamest Daniel , Azadpour Mahan , Zeman Annette M. , Sagi Elad , Svirsky Mario A. 
Published: August 2017

Hypothesis:
A novel smartphone-based software application can facilitate self-selection of frequency allocation tables (FAT) in postlingually deaf cochlear implant (CI) users.

Background:
CIs use FATs to represent the tonotopic organization of a normal cochlea. Current CI fitting methods typically use a standard FAT for all patients regardless of individual differences in cochlear size and electrode location. In postlingually deaf patients, different amounts of mismatch can result between the frequency-place function they experienced when they had normal hearing and the frequency-place function that results from the standard FAT. For some CI users, an alternative FAT may enhance sound quality or speech perception. Currently, no widely available tools exist to aid real-time selection of different FATs. This study aims to develop a new smartphone tool for this purpose and to evaluate speech perception and sound quality measures in a pilot study of CI subjects using this application.

Methods:
A smartphone application for a widely available mobile platform (iOS) was developed to serve as a preprocessor of auditory input to a clinical CI speech processor and enable interactive real-time selection of FATs. The application's output was validated by measuring electrodograms for various inputs. A pilot study was conducted in six CI subjects. Speech perception was evaluated using word recognition tests.

Results:
All subjects successfully used the portable application with their clinical speech processors to experience different FATs while listening to running speech. The users were all able to select one table that they judged provided the best sound quality. All subjects chose a FAT different from the standard FAT in their everyday clinical processor. Using the smartphone application, the mean consonant–nucleus–consonant score with the default FAT selection was 28.5% (SD 16.8) and 29.5% (SD 16.4) when using a self-selected FAT.

Conclusion:
A portable smartphone application enables CI users to self-select frequency allocation tables in real time. Even though the self-selected FATs that were deemed to have better sound quality were only tested acutely (i.e., without long-term experience with them), speech perception scores were not inferior to those obtained with the clinical FATs. This software application may be a valuable tool for improving future methods of CI fitting.
Physiological Mechanisms in Combined Electric–Acoustic Stimulation
Authors: Sato Mika , Baumhoff Peter , Tillein Jochen , Kral Andrej 
Published: August 2017

Objective:Electrical stimulation is normally performed on ears that have no hearing function, i.e., lack functional hair cells. The properties of electrically-evoked responses in these cochleae were investigated in several previous studies. Recent clinical developments have introduced cochlear implantation (CI) in residually-hearing ears to improve speech understanding in noise. The present study documents the known physiological differences between electrical stimulation of hair cells and of spiral ganglion cells, respectively, and reviews the mechanisms of combined electric and acoustic stimulation in the hearing ears.Data Sources:Literature review from 1971 to 2016.Conclusions:Compared with pure electrical stimulation the combined electroacoustic stimulation provides additional low-frequency information and expands the dynamic range of the input. Physiological studies document a weaker synchronization of the evoked activity in electrically stimulated hearing ears compared with deaf ears that reduces the hypersynchronization of electrically-evoked activity. The findings suggest the possibility of balancing the information provided by acoustic and electric input using stimulus intensity. Absence of distorting acoustic–electric interactions allows exploiting these clinical benefits of electroacoustic stimulation.
Isolated Second Implant Adaptation Period in Sequential Cochlear Implantation in Adults
Authors: Smilsky Kari , Dixon Peter R. , Smith Leah , Shipp David , Ng Amy , Millman Tara , Stewart Suzanne , Nedzelski Julian M. , Lin Vincent Y. , Chen Joseph M. 
Published: August 2017

Objective:
To determine if depriving the use of the first cochlear implant (CI1) impacts adaptation to a sequential implant (CI2).

Study Design:
Prospective cohort.

Setting:
Academic center.

Patients:
Sixteen unilateral cochlear implant recipients undergoing contralateral implantation (sequential bilateral) were matched according to age, etiology, duration of deafness, device age, and delay between implants.

Intervention:
During a 4-week adaptation period after CI2 activation, patients underwent deprivation of CI1 or were permitted continued use of it.

Main Outcome Measures:
Speech perception scores and subjective quality of life outcomes before CI2 and at 1, 3, 6, and 12-months following activation.

Results:
Maximal CI2 speech perception scores in quiet were achieved by 1-month postactivation for the “deprivation” group (71.3% for hearing in noise test [HINT], p = 0.767 for change beyond 1-mo) compared with 6-months for the “continued use” group (67.9% for HINT, p = 0.064 for change beyond 6-mo). The “deprivation” group experienced a temporary drop in CI1 scores (67.9% for HINT in quiet at 1-mo versus 78.4% pre-CI2, p = 0.009) recovering to 77.3% by 3-months; unchanged from baseline levels (p = 1.0). A binaural advantage over the better hearing ear was present for HINT sentences with noise (72.4% versus 58.8% for “deprivation”, p = 0.001; 71.5% versus 52.7% for “continued use,” p = 0.01). Missing data precluded a meaningful analysis of subjective quality of life outcome scales.

Conclusion:
Bilateral cochlear implantation improves speech perception compared with one implant. A period of deprivation from CI1 shortens time to maximum speech perception by CI2 without long-term consequences on the performance of CI1.
The Impact of Comorbidities in the Aging Population on Cochlear Implant Outcomes
Authors: Wilkerson Brent Jerome , Porps Sandra F. , Babu Seilesh C. 
Published: August 2017

Objectives:
Cochlear implants have been used for many years for bilateral profound hearing loss. General longevity has continued to increase and, therefore, the age at which cochlear implants are placed has concomitantly increased. Our purpose is to determine whether outcomes and complications are significantly different in the elderly.

Study Design:
Retrospective, clinical review.

Setting:
Tertiary referral center, primarily ambulatory setting.

Patients:
One hundred and one patients with moderate-to-profound hearing loss who ranged in age from 18 to 89 years. Subjects were divided into younger (<69, n = 51) and older (>70, n = 50) groups for analysis.

Intervention:
All patients received either a unilateral or bilateral multichannel cochlear implant. The change in hearing in noise testing and AZBio testing between pre and postimplantation was evaluated in each group.

Main Outcome Measures:
Primary outcome measures include preimplant and postimplant hearing in noise test (HINT) and/or AZBio speech perception testing. Preimplant HINT/AZBio was compared with postimplant HINT/AZBio for each patient and between the two groups. In addition, we reviewed the comorbidities between the two groups as well as complication rates between less than 70 and more than 70 group.

Results:
Both the younger and the older group demonstrated a significant improvement in postimplant HINT and/or AZBio scores. No statistically significant difference was noted in precochlear implant HINT/AZBio testing (p = 0.65/p = 0.48) between the two groups or the postimplant HINT/AZBio testing (p = 0.19/p = 0.22) between the two groups. Although, more than 70 yo group had significantly more comorbidities, the complication rates between the groups were insignificant. There was no shown association of specific comorbidities to complications between the two groups.

Conclusions:
Both older and younger patients can receive a significant improvement in speech perception with cochlear implantation. Older patients tend to have more comorbidities compared with the younger patients, however, the complication rates are not higher in this population.