bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early life vincristine exposure evokes mechanical pain hypersensitivity in the developing rat
Authors: Schappacher Katie A. , Styczynski Lauren , Baccei Mark L. 
Published: May 2017

Abstract
Vincristine (VNC) is commonly used to treat pediatric cancers, including the most prevalent childhood malignancy, acute lymphoblastic leukemia. Although clinical evidence suggests that VNC causes peripheral neuropathy in children, the degree to which pediatric chemotherapeutic regimens influence pain sensitivity throughout life remains unclear, in part because of the lack of an established animal model of chemotherapy-induced neuropathic pain during early life. Therefore, this study investigated the effects of VNC exposure between postnatal days (P) 11 and 21 on mechanical and thermal pain sensitivity in the developing rat. Low doses of VNC (15 or 30 μg/kg) failed to alter nociceptive withdrawal reflexes at any age examined compared with vehicle-injected littermate controls. Meanwhile, high dose VNC (60 μg/kg) evoked mechanical hypersensitivity in both sexes beginning at P26 that persisted until adulthood and included both static and dynamic mechanical allodynia. Hind paw withdrawal latencies to noxious heat and cold were unaffected by high doses of VNC, suggesting a selective effect of neonatal VNC on mechanical pain sensitivity. Gross and fine motor function appeared normal after VNC treatment, although a small decrease in weight gain was observed. The VNC regimen also produced a significant decrease in intraepidermal nerve fiber density in the hind paw skin by P33. Overall, the present results demonstrate that high-dose administration of VNC during the early postnatal period selectively evokes a mechanical hypersensitivity that is slow to emerge during adolescence, providing further evidence that aberrant sensory input during early life can have prolonged consequences for pain processing.
Semicircular Canal Pressure Changes During High-intensity Acoustic Stimulation
Authors: Maxwell Anne K. , Banakis Hartl Renee M. , Greene Nathaniel T. , Benichoux Victor , Mattingly Jameson K. , Cass Stephen P. , Tollin Daniel J. 
Published: May 2017

Hypothesis:
Acoustic stimulation generates measurable sound pressure levels in the semicircular canals.

Background:
High-intensity acoustic stimuli can cause hearing loss and balance disruptions. To examine the propagation of acoustic stimuli to the vestibular end-organs, we simultaneously measured fluid pressure in the cochlea and semicircular canals during both air- and bone-conducted sound presentation.

Methods:
Five full-cephalic human cadaveric heads were prepared bilaterally with a mastoidectomy and extended facial recess. Vestibular pressures were measured within the superior, lateral, and posterior semicircular canals, and referenced to intracochlear pressure within the scala vestibuli with fiber-optic pressure probes. Pressures were measured concurrently with laser Doppler vibrometry measurements of stapes velocity during stimulation with both air- and bone-conduction. Stimuli were pure tones between 100 Hz and 14 kHz presented with custom closed-field loudspeakers for air-conducted sounds and via commercially available bone-anchored device for bone-conducted sounds.

Results:
Pressures recorded in the superior, lateral, and posterior semicircular canals in response to sound stimulation were equal to or greater in magnitude than those recorded in the scala vestibuli (up to 20 dB higher). The pressure magnitudes varied across canals in a frequency-dependent manner.

Conclusion:
High sound pressure levels were recorded in the semicircular canals with sound stimulation, suggesting that similar acoustical energy is transmitted to the semicircular canals and the cochlea. Since these intralabyrinthine pressures exceed intracochlear pressure levels, our results suggest that the vestibular end-organs may also be at risk for injury during exposure to high-intensity acoustic stimuli known to cause trauma in the auditory system.
Vestibular Restoration and Adaptation in Vestibular Neuritis and Ramsay Hunt Syndrome With Vertigo
Authors: Martin-Sanz Eduardo , Rueda Almudena , Esteban-Sanchez Jonathan , Yanes Joaquin , Rey-Martinez Jorge , Sanz-Fernandez Ricardo 
Published: May 2017

Objective:
To evaluate vestibular restoration and the evolution of the compensatory saccades in acute severe inflammatory vestibular nerve paralysis, including vestibular neuritis and Ramsay Hunt syndrome with vertigo.

Study Design:
Prospective.

Setting:
Tertiary referral center.

Patients:
Vestibular neuritis (n = 18) and Ramsay Hunt syndrome patients with vertigo (n = 13) were enrolled.

Intervention:
After treatment with oral corticosteroids, patients were followed up for 6 months.

Main Outcome Measures:
Functional recovery of the facial nerve was scored according to the House–Brackman grading system. Caloric and video head impulse tests were performed in every patient at the time of enrolment. Subsequently, successive video head impulse test (vHIT) exploration was performed at the 1, 3, and 6-month follow-up.

Results:
Eighteen patients with vestibular neuritis and 13 with Ramsay Hunt syndrome and associated vertigo were included. Vestibular function was significantly worse in patients with Ramsay Hunt syndrome than in those with vestibular neuritis. Similar compensatory saccades velocity and latency values were observed in both groups, in both the caloric and initial vHIT tests. Successive vHIT results showed a significantly higher vestibulo-ocular reflex gain recovery in vestibular neuritis patients than in Ramsay Hunt syndrome patients. A significantly faster reduction in the latency, velocity, and organization of the compensatory saccades was observed in neuritis than in Ramsay Hunt syndrome patients.

Conclusions:
In addition to the recovery of the vestibulo-ocular reflex, the reduction of latency, velocity and the organization of compensatory saccades play a role in vestibular compensation.
Head Shadow and Binaural Squelch for Unilaterally Deaf Cochlear Implantees
Authors: Bernstein Joshua G. W. , Schuchman Gerald I. , Rivera Arnaldo L. 
Published: May 2017

Background:
Cochlear implants (CIs) can improve speech-in-noise performance for listeners with unilateral sensorineural deafness. But these benefits are modest and in most cases are limited to head-shadow advantages, with little evidence of binaural squelch.

Hypothesis:
The goal of the investigation was to determine whether CI listeners with normal hearing or moderate hearing loss in the contralateral ear would receive a larger head-shadow benefit for target speech and noise originating from opposite sides of the head, and whether listeners would experience binaural squelch in the free field in a test involving interfering talkers.

Methods:
Eleven CI listeners performed a speech-identification task in the presence of interfering noise or speech. Six listeners had single-sided deafness (normal or near-normal audiometric thresholds in the acoustic ear) and five had asymmetric hearing loss (hearing loss in the acoustic ear treated with a hearing aid). Listeners were tested with the acoustic ear only and bilaterally with the CI turned on. One set of conditions examined head-shadow effects with target speech and masking noise presented from azimuths of 0 or ±108 degrees. A second set of conditions examined binaural squelch, with target speech presented from the front and interfering talkers symmetrically placed on both sides.

Results:
On average, the largest head-shadow benefit (5 dB) occurred when the target and masking noise were presented on opposite sides of the head. Listeners also showed an average of 2 dB of squelch, but only when the target speech was masked by interfering talkers of the same sex as the target.

Conclusions:
CIs provide listeners with unilateral deafness important benefits for speech perception in complex spatial environments, including a larger head-shadow benefit when speech and noise originate on opposite sides of the head, and an improved ability to perceptually organize an auditory scene with multiple competing voices.
The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or US Government.
Clinical examination for diagnosing circulatory shock
Authors: Hiemstra Bart , Eck Ruben J. , Keus Frederik , van der Horst Iwan C.C. 
Published: May 2017

Purpose of review
In the acute setting of circulatory shock, physicians largely depend on clinical examination and basic laboratory values. The daily use of clinical examination for diagnostic purposes contrasts sharp with the limited number of studies. We aim to provide an overview of the diagnostic accuracy of clinical examination in estimating circulatory shock reflected by an inadequate cardiac output (CO).

Recent findings
Recent studies showed poor correlations between CO and mottling, capillary refill time or central-to-peripheral temperature gradients in univariable analyses. The accuracy of physicians to perform an educated guess of CO based on clinical examination lies around 50% and the accuracy for recognizing a low CO is similar. Studies that used predefined clinical profiles composed of several clinical examination signs show more reliable estimations of CO with accuracies ranging from 81 up to 100%.

Summary
Single variables obtained by clinical examination should not be used when estimating CO. Physician's educated guesses of CO based on unstructured clinical examination are like the ‘flip of a coin’. Structured clinical examination based on combined clinical signs shows the best accuracy. Future studies should focus on using a combination of signs in an unselected population, eventually to educate physicians in estimating CO by using predefined clinical profiles.
Clinic Attendance of Youth With Sickle Cell Disease on Hydroxyurea Treatment
Authors: Ingerski Lisa M. , Arnold Trisha L. , Banks Gabrielle , Porter Jerlym S. , Wang Winfred C. 
Published: May 2017

Objective:The objective of this study is to describe rates of clinic attendance of youth with sickle cell disease prescribed hydroxyurea and examine potential demographic and medical factors related to consistent clinic attendance.Methods:Participants included 148 youth diagnosed with sickle cell disease and prescribed hydroxyurea during a single calendar year. Clinic attendance and potential demographic and medical factors related to attendance were extracted via systematic retrospective medical chart review.Results:Youth attended 90.3% of scheduled appointments and 85.1% of youth attended at least 80% of scheduled clinic appointments during the study window. Adjusting for other factors, multivariate analysis revealed families with fewer children in the household, families with private insurance, youth experiencing fever, and youth not experiencing pain during the calendar year were more likely to consistently attend clinic visits.Conclusions:Adherence to clinic appointments is critical to optimizing health outcomes for youth with sickle cell disease and integral for adequate monitoring of youth prescribed hydroxyurea, in particular. Findings may aid providers in appropriately identifying possible barriers to clinic attendance to develop attendance promotion interventions.
Atlanto-Axial Subluxation After Adenoidectomy
Authors: Gross Isabel Theresia , Bahar-Posey Laleh 
Published: May 2017

Abstract
Atlanto-axial subluxation is a rare but potentially serious complication after otolaryngological procedures. We are describing a case of a 4-year-old child who developed atlanto-axial subluxation of the cervical spine after adenoidectomy. Our patient underwent adenoidectomy and, 18 days later, presented to the emergency department with her neck tilted to the left in a cock-robin position and complaining of neck pain persisting since the surgery. A multiplanar 3-dimensional computed tomography was obtained and confirmed the diagnosis of an atlanto-axial subluxation (Fielding type 3). She was managed conservatively with the application of a cervical collar, anti-inflammatory medication, and manual reduction under anesthesia later in the course because of persistence of her symptoms. It is important to consider this diagnosis in any child who undergoes ENT surgical procedures complaining of neck pain subsequent to surgery or holding the head in a fixed position persistently after surgery. Early diagnosis is important to reduce the time between the onset of symptoms and reduction to reduce the risk or need for surgical intervention.
Personalized Risk Index for Neurocognitive Decline Among People With Well-Controlled HIV Infection
Authors: Yuen Tracy , Brouillette Marie-Josée , Fellows Lesley K. , Ellis Ronald J. , Letendre Scott , Heaton Robert ,   The CHARTER group,, Mayo Nancy 
Published: May 2017

Background:
Little is known about the predictors of neurocognitive decline in HIV+ individuals with good virological control. Identification of modifiable risk factors would allow targeted interventions to reduce the risk of decline in higher risk individuals. The objective of this study was to develop a risk index to predict neurocognitive decline over 3 years in aviremic HIV+ individuals.

Methods:
As part of the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study, HIV+ adults completed clinical evaluation and neuropsychological tests every 6 months. Group-based trajectory analysis was used to detect patterns of neurocognitive change; individuals who deteriorated ≥ 0.5 SD on at least one neuropsychological test were considered decliners. Multiple logistic regression was used to identify baseline sociodemographic, clinical, biological, and lifestyle factors associated with decline in the subgroup that was consistently aviremic during the first 3 years. A risk index was developed using the beta-coefficients from the final regression model.

Results:
Neurocognitive decline occurred in 23 of 191 (12%) participants followed longitudinally. The baseline factors that predicted decline were glomerular filtration rate ≤50 mL/min, known duration of HIV infection ≥15 years, education ≤12 years, and cerebrospinal fluid protein >45 mg/dL.

Conclusions:
Using this analytic approach, neurocognitive decline was uncommon in this sample of aviremic HIV+ individuals. The 3-year risk of decline ranged from 2% in those with no risk factors to 95% in those with all 4. The strongest predictor was glomerular filtration rate, also a predictor of cardiovascular disease. This raises the possibility that controlling vascular risk factors could reduce the risk of neurocognitive decline.
Associations of Low Vitamin D and Elevated Parathyroid Hormone Concentrations With Bone Mineral Density in Perinatally HIV-Infected Children
Authors: Jacobson Denise L. , Stephensen Charles B. , Miller Tracie L. , Patel Kunjal , Chen Janet S. , Van Dyke Russell B. , Mirza Ayesha , Schuster Gertrud U. , Hazra Rohan , Ellis Angela , Brummel Sean S. , Geffner Mitchell E. , Silio Margarita , Spector Stephen A. , DiMeglio Linda A. ,   for the Pediatric HIV/AIDS Cohort Study
Published: May 2017

Background:
Perinatally HIV-infected (PHIV) children have, on average, lower bone mineral density (BMD) than perinatally HIV-exposed uninfected (PHEU) and healthy children. Low 25-hydroxy vitamin D [25(OH)D] and elevated parathyroid hormone (PTH) concentrations may lead to suboptimal bone accrual.

Methods:
PHIV and PHEU children in the Pediatric HIV/AIDS Cohort Study had total body (TB) and lumbar spine (LS) BMD and bone mineral content (BMC) measured by dual-energy x-ray absorptiometry; BMD z-scores (BMDz) were calculated for age and sex. Low 25(OH)D was defined as ≤20 ng/mL and high PTH as >65 pg/mL. We fit linear regression models to estimate the average adjusted differences in BMD/BMC by 25(OH)D and PTH status and log binomial models to determine adjusted prevalence ratios of low 25(OH)D and high PTH in PHIV relative to PHEU children.

Results:
PHIV children (n = 412) were older (13.0 vs. 10.8 years) and more often black (76% vs. 64%) than PHEU (n = 207). Among PHIV, children with low 25(OH)D had lower TB-BMDz [SD, −0.38; 95% confidence interval (CI), −0.60 to −0.16] and TB-BMC (SD, −59.1 g; 95% CI, −108.3 to −9.8); high PTH accompanied by low 25(OH)D was associated with lower TB-BMDz. Among PHEU, children with low 25(OH)D had lower TB-BMDz (SD, −0.34; 95% CI, −0.64 to −0.03). Prevalence of low 25(OH)D was similar by HIV status (adjusted prevalence ratio, 1.00; 95% CI, 0.81 to 1.24). High PTH was 3.17 (95% CI, 1.25 to 8.06) times more likely in PHIV children.

Conclusions:
PHIV and PHEU children with low 25(OH)D may have lower BMD. Vitamin D supplementation trials during critical periods of bone accrual are needed.
Assessing Antiretroviral Use During Gaps in HIV Primary Care Using Multisite Medicaid Claims and Clinical Data
Authors: Monroe Anne K. , Fleishman John A. , Voss Cindy C. , Keruly Jeanne C. , Nijhawan Ank E. , Agwu Allison L. , Aberg Judith A. , Rutstein Richard M. , Moore Richard D. , Gebo Kelly A. ,   for the HIV Research Network
Published: May 2017

Background:
Some individuals who appear poorly retained by clinic visit-based retention measures are using antiretroviral therapy (ART) and maintaining viral suppression. We examined whether individuals with a gap in HIV primary care (≥180 days between HIV outpatient clinic visits) obtained ART during that gap after 180 days.

Setting:
HIV Research Network data from 5 sites and Medicaid Analytic Extract eligibility and pharmacy data were combined.

Methods:
Factors associated with having both an HIV primary care gap and a new (ie, nonrefill) ART prescription during a gap were evaluated with multinomial logistic regression.

Results:
Of 6892 HIV Research Network patients, 6196 (90%) were linked to Medicaid data, and 4275 had any Medicaid ART prescription. Over half (54%) had occasional gaps in HIV primary care. Women, older people, and those with suppressed viral load were less likely to have a gap. Among those with occasional gaps (n = 2282), 51% received a new ART prescription in a gap. Viral load suppression before gap was associated with receiving a new ART prescription in a gap (odds ratio = 1.91, 95% confidence interval: 1.57 to 2.32), as was number of days in a gap (odds ratio = 1.04, 95% confidence interval: 1.02 to 1.05), and the proportion of months in the gap enrolled in Medicaid.

Conclusions:
Medicaid-insured individuals commonly receive ART during gaps in HIV primary care, but almost half do not. Retention measures based on visit frequency data that do not incorporate receipt of ART and/or viral suppression may misclassify individuals who remain suppressed on ART as not retained.
Diagnostics and laboratory role in outbreaks
Authors: Lee Francesca 
Published: May 2017

Purpose of review
The review describes the investigative benefits of traditional and novel molecular epidemiology techniques, while acknowledging the limitations faced by clinical laboratories seeking to implement these methods.

Recent findings
Pulse-field gel electrophoresis and other traditional techniques remain powerful tools in outbreak investigations and continue to be used by multiple groups. Newer techniques such as matrix-assisted laser desorption/ionization-time of flight mass-spectrometry and whole genome sequencing show great promise. However, there is a lack of standardization regarding definitions for genetic relatedness, nor are there established criteria for accuracy and reproducibility. There are also challenges regarding availability of trained bioinformatics staff, and concerns regarding reimbursement.

Summary
There are many tools available for molecular epidemiologic investigation. Epidemiologists and clinical laboratorians should work together to determine which testing methods are best for each institution.
Spatial Distribution of Iron Within the Normal Human Liver Using Dual-Source Dual-Energy CT Imaging
Authors: Abadia Andres F. , Grant Katharine L. , Carey Kathleen E. , Bolch Wesley E. , Morin Richard L. 
Published: May 2017

Objectives
Explore the potential of dual-source dual-energy (DSDE) computed tomography (CT) to retrospectively analyze the uniformity of iron distribution and establish iron concentration ranges and distribution patterns found in healthy livers.

Materials and Methods
Ten mixtures consisting of an iron nitrate solution and deionized water were prepared in test tubes and scanned using a DSDE 128-slice CT system. Iron images were derived from a 3-material decomposition algorithm (optimized for the quantification of iron). A conversion factor (mg Fe/mL per Hounsfield unit) was calculated from this phantom study as the quotient of known tube concentrations and their corresponding CT values. Retrospective analysis was performed of patients who had undergone DSDE imaging for renal stones. Thirty-seven patients with normal liver function were randomly selected (mean age, 52.5 years). The examinations were processed for iron concentration. Multiple regions of interest were analyzed, and iron concentration (mg Fe/mL) and distribution was reported.

Results
The mean conversion factor obtained from the phantom study was 0.15 mg Fe/mL per Hounsfield unit. Whole-liver mean iron concentrations yielded a range of 0.0 to 2.91 mg Fe/mL, with 94.6% (35/37) of the patients exhibiting mean concentrations below 1.0 mg Fe/mL. The most important finding was that iron concentration was not uniform and patients exhibited regionally high concentrations (36/37). These regions of higher concentration were observed to be dominant in the middle-to-upper part of the liver (75%), medially (72.2%), and anteriorly (83.3%).

Conclusions
Dual-source dual-energy CT can be used to assess the uniformity of iron distribution in healthy subjects. Applying similar techniques to unhealthy livers, future research may focus on the impact of hepatic iron content and distribution for noninvasive assessment in diseased subjects.