bluuebunny/crossref_metadata_2025_split huggingface dataset:
Importance of Perimodiolar Electrode Position for Psychoacoustic Discrimination in Cochlear Implantation
Authors: Ramos Macias Angel , Perez Zaballos Maria Teresa , Ramos de Miguel Angel , Cervera Paz Javier 
Published: November 2017

Hypothesis:Modiolar proximity of the cochlear implant electrodes and low impedance values have a positive effect on electrical pitch discrimination.Background:The proximity of the cochlear electrode to the modiolar wall can determine changes in tissue and fluid environment. With the onset of soft-surgery techniques, the trauma caused during surgery has been reduced, minimizing fibrous growth.Methods:Computed tomography-scan measurements of electrode-inner wall distance and psychoacoustic electrode discrimination tests were done. Neural Response Telemery and impedance data were used in the study.Results:It was found that patients fitted with perimodiolar arrays have lower impedance values and smaller electrode-inner wall distances than those fitted with straight arrays. These variables were significantly correlated to electrode discrimination. It was found that a closer distance to the modiolus also results in better electrode discrimination.Conclusion:Perimodiolar electrodes could be a better solution in terms of pitch discrimination both because they are closer to the modiolus and because their impedance is lower.
Cochlear Implantation in Children With Congenital Unilateral Deafness: A Case Series
Authors: Beck Rainer Linus , Aschendorff Antje , Hassepaß Frederike , Wesarg Thomas , Kröger Stefanie , Jakob Till F. , Arndt Susan 
Published: November 2017

Objectives:
Cochlear implant is regarded as a treatment option for hearing rehabilitation of adults with unilateral sensorineural hearing loss. A clear benefit has been experienced in regard to speech comprehension in noise, localization, and quality of life. The aim of this study was to investigate the benefit of cochlear implantation for children with congenital unilateral hearing loss.

Study Design:
Retrospective case series.

Setting:
Tertiary referral center; cochlear implant program.

Patients:
Ten children with congenital unilateral hearing loss.

Intervention:
After extensive consultation with the families and intensive counseling, the children received a cochlear implant.

Main Outcome Measures:
Categories of auditory performance, speech discrimination in open set, subjective assessment by Speech, Spatial and Qualities scale questionnaire.

Conclusion:
Eight of ten children use their cochlear implant consistently on a daily basis. Two children who were equipped with an implanted device at a later age tend to nonuse of the device. The evaluation of binaural hearing in small children is still difficult and methods have to be developed to allow objective assessment.
Analysis of Otologic Features of Patients With Primary Ciliary Dyskinesia
Authors: Takeuchi Kazuhiko , Kitano Masako , Sakaida Hiroshi , Usui Satoko , Masuda Sawako , Ogawa Satoru , Ikejiri Makoto , Nagao Mizuho , Fujisawa Takao , Nakatani Kaname 
Published: November 2017

Objective:
To evaluate otologic features of primary ciliary dyskinesia (PCD), especially eardrum features, audiometric findings, and clinical course.

Study Design:
Retrospective patient review.

Setting:
Tertiary referral center.

Patients:
Fifteen patients (mean age, 16.9 years [range, 1–32 yr]; 8 males and 7 females) diagnosed with PCD at our university hospital in the last 12 years.

Intervention:
Diagnostic.

Main Outcome Measures:
Electron microscopy of nasal cilia, gene mutation analysis, endoscopy of 30 eardrums, pure-tone audiometry, and tympanometry.

Results:
All 15 patients showed ciliary ultrastructural abnormalities on electron microscopy and/or biallelic mutations in genes associated with ciliary function or structure. All 30 eardrums examined showed certain abnormalities. Fourteen patients had otitis media with effusion or its sequelae. The remaining patient had chronic otitis media. Pure-tone audiometry revealed the mean air conduction thresholds to be 25.0 and 26.4 dB in the right and left ears, respectively. In the ears with better hearing and worse hearing, the mean air conduction thresholds were 22.3 and 29.0 dB respectively.

Conclusion:
Otologic disease among patients with PCD essentially comprised otitis media with effusion, and the patients’ eardrums showed a variety of findings. Knowledge of these otologic features may lead to the early detection of PCD.
Effectiveness in Rehabilitation of Current Wireless CROS Technology in Experienced Bone-Anchored Implant Users
Authors: Snapp Hillary A. , Hoffer Michael E. , Liu Xuezhong , Rajguru Suhrud M. 
Published: November 2017

Objective:
To compare the effectiveness of current contralateral routing of signal technology (CROS) to bone-anchored implants in experienced bone-anchored implant users with unilateral severe-profound sensorineural hearing loss.

Design:
Prospective, within-subject repeated-measures comparison study.

Setting:
Tertiary referral center.

Patients:
Adult, English-speaking patients (n = 12) with severe-profound unilateral sensorineural hearing loss implanted with a bone-anchored implant for the indication of single-sided deafness.

Intervention:
Subjects were fitted with contralateral routing of signal amplification and tested for speech in noise performance and localization error.

Outcome Measures:
Speech perception in noise was assessed using the BKB-SIN test materials. Localization was assessed using narrow band noises centered at 500 and 4000 Hz, as well as a broadband speech stimulus presented at random to the front hemifield by 19 speakers spatially separated by 10 degrees.

Results:
There was no improvement in localization ability in the aided condition and no significant difference in performance with CROS versus bone-anchored implants (BAI). There was a significant improvement in speech in noise performance for monaural listeners in the aided condition for speech poorer ear/noise better ear, speech front/noise front, and speech front/noise back. No significant difference was observed on performance with CROS versus BAI subjects.

Conclusion:
Contrary to earlier studies suggesting improved performance of BAIs over CROS, the current study found no difference in performance in BAI over CROS devices. Both CROS and BAI provide significant benefit for monaural listeners. The results suggest that noninvasive CROS solutions can successfully rehabilitate certain monaural listening deficits, provide improved hearing outcomes, and expand the reach of treatment in this population.
The prevalence and sociodemographic determinants of uninvestigated dyspepsia in the Czech Republic: a multicentre prospective study accomplished 10 years after the first study from the same geographical areas
Authors: Rejchrt Stanislav , Koupil Ilona , Kopáčová Marcela , Škodová Fendrichová Miluška , Seifert Bohumil , Voříšek Viktor , Špirková Jana , Douda Tomáš , Tachecí Ilja , Bureš Jan 
Published: November 2017

Objective
The epidemiology of uninvestigated dyspepsia was studied in the Czech Republic for the first time in 2001. The aim of the current multicenter prospective study was to evaluate dyspepsia using the same methods in a representative sample of general unselected population from the same geographical areas 10 years later.

Participants and methods
A total of 38 147 individuals comprised the general population for a random two-step selection process. A total of 1836 participants (863 males and 973 females; aged 5–98 years) took part in the questionnaire-based study. Helicobacter pylori status was investigated in all participants by means of 13C-urea breath test.

Results
The overall prevalence of dyspepsia was 2.6% among children and adolescents aged 5–17 years and 16.0% among adults aged 18–98 years. We did not detect any statistically significant sex differences in the prevalence of total dyspepsia or its subtypes. Overall, 2.4% of H. pylori-negative children and adolescents aged less than 18 years reported dyspepsia, and 16.8% of H. pylori-negative adults reported it. Among H. pylori-positive children and adolescents and adults, dyspepsia was present in 8.3 and 15.8%, respectively. Type A dyspepsia (as the only long-lasting symptom) was statistically significantly associated with H. pylori status among children and adolescents. Among adults aged 18 years or older, we noted a lower prevalence of dyspepsia in adults with elementary education compared with university education. Current use of antibiotics was associated with an increased prevalence of dyspepsia in adults.

Conclusion
Despite the substantial decrease of H. pylori infection in the Czech Republic over the past 10 years, the prevalence and sociodemographic determinants of uninvestigated dyspepsia did not change significantly.
Expediting Drug Development for Pediatric Inflammatory Bowel Disease
Authors: Mulberg Andrew E. , Bousvaros Athos , Colletti Richard , Hyams Jeffrey , Lee Kerry Jo , Musaus Joachim , Robinson Anne M. , Rosh Joel , Saeed Shehzad , Taylor‐Zapata Perdita , Zuckerman Eric , Winter Harland S. 
Published: November 2017

ABSTRACTLack of scientific consensus on efficacy endpoints and outcome assessments presents a hurdle for global drug development in pediatric inflammatory bowel disease (IBD). Multiple stakeholders participated in a meeting November 2015, sponsored by The Pediatric IBD Foundation, which is a 501c3 organization formed by parents of children with IBD whose mission is to improve the lives of children with Crohn disease and ulcerative colitis by supporting innovative research and educational programs (www.pedsibd.org). With representatives of the Food and Drug Administration, European Medicines Agency, pediatric gastroenterologists, and representatives of the pharmaceutical industry, this meeting was organized to harmonize present thinking about various aspects of global drug development in pediatric IBD. The meeting was designed to be interactive, allowing participants from the pharmaceutical industry, regulatory agencies, academia, and clinical practice an opportunity to collaborate in a public forum and to identify potential strategies to expedite drug evaluation in children.Before the meeting, a questionnaire focused on the hurdles hindering approval of medications used to treat children with IBD was sent to all participants and other pediatric gastroenterologists in North America and Europe with expertise in IBD. Responses were reviewed by the steering committee and results presented at the meeting. Following the presentation of the survey, participants were divided into small groups composed of representatives from academia, industry, regulatory agencies, and members of the Pediatric IBD Foundation and assigned the task of working together to find solutions to the hurdles that had been identified.Hurdles hindering approval included pediatric trials start later in the development process; lack of enrollment in pediatric trials; lack of monitoring safety registries that might expedite approval; different priorities among stakeholders.This 1‐day meeting discussed how to expedite pediatric drug development in IBD therapy. Hurdles for achieving approvals of pediatric indications for treatments of IBD were identified.
Premature Infants have Lower Gastric Digestion Capacity for Human Milk Proteins than Term Infants
Authors: Demers‐Mathieu Veronique , Qu Yunyao , Underwood Mark A. , Borghese Robyn , Dallas David Charles 
Published: November 2017

ABSTRACTObjectives:Whether premature infants have lower gastric protein digestive capacity than term infants and the extent to which human milk proteases contribute to overall gastric digestion are unknown and were investigated in this study.Methods:Human milk and infant gastric samples were collected from 16 preterm (24–32 wk gestational age) and 6 term (38–40 wk gestational age) mother–infant pairs within a range of 5 to 42 days postnatal age. For each pair, an aliquot of human milk was adjusted to pH 4.5 and incubated for 2 hours at 37 °C to simulate the gastric conditions without pepsin (milkinc). Their gastric protein digestion capacity was measured as proteolysis (free N‐terminals) and protease activities. Two‐way analysis of variance followed by Tukey post hoc test was applied to compare measurements between preterm and term infants as well as among human milk, milkinc, and gastric samples.Results:Measurements of gastric protein digestion were significantly lower in preterm infants than term infants. Overall milk protease activity did not differ between human milk samples from term‐ and preterm‐delivering mothers. As protease activity did not increase with simulated gastric incubation, milk proteases likely contributed minimally to gastric digestion.Conclusions:Preterm infants have lower gastric protein digestion capacity than term infants, which could impair nutrient acquisition. Human milk proteases contribute minimally to overall gastric digestion. The limited activity of milk proteases suggests that these enzymes cannot compensate for the premature infant's overall lower gastric protein digestion.
Prophylactic rtPA in the Prevention of Line‐associated Thrombosis and Infection in Short Bowel Syndrome
Authors: Malec Lynn M. , Cooper James , Rudolph Jeffrey , Michaels Marian G. , Ragni Margaret V. 
Published: November 2017

ABSTRACTBackground:Central venous access devices (CVADs) are essential for total parenteral nutrition administration in patients with short bowel syndrome (SBS). They are, however, fraught with complications including infection and venous thromboembolism (VTE), which increases associated morbidity and mortality in this population. There is evidence linking the development of CVAD‐associated thrombosis and line‐related infection. Thus, it has been postulated that prevention of catheter‐related clot formation could minimize the risk of infection originating from the catheter. Recombinant tissue plasminogen activator (rtPA, alteplase), lyses clots by binding plasmin‐bound fibrin in a clot and cleaving plasminogen to plasmin; moreover, it is widely used to clear occluded CVADs.Methods:Prophylactic rtPA lock therapy in children with SBS was evaluated as a single site pilot study to minimize line‐associated VTE, infection, need for line replacement, and hospitalization at the Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center. rtPA lock therapy was administered by parents/caregivers on a weekly basis over a 6‐month time period in place of heparin lock therapy. Comparisons were made between line‐associated complications in the cohort in the 6 months before study versus during the study period.Results:Six out of 8 subjects completed the study over a 1‐year time period. As a group, subjects experienced a significant decrease in the number of line‐associated bloodstream infections from a mean of 1.9 infections in the 6 months before the study to a mean of 0.5 infections (P = 0.025). There was no change in the need for line replacement amongst subjects while on study. The primary outcome of VTE was not found in the cohort, and it is unclear whether rtPA lock therapy contributed to the lack of thrombosis development. Given the success of rtPA in this pilot study in reducing bloodstream infections, further investigation or rtPA lock therapy in patients with SBS is warranted.
Case Report: Adenocarcinoma of the Lacrimal Gland Presenting as an Abduction Deficit
Authors: DeLuca Crystal L. , Zimmers Regina E. 
Published: November 2017

SIGNIFICANCE
It is imperative to follow the clinical guidelines for abduction deficits to ensure prompt diagnosis of potentially serious etiologies and monitor only those in which a microvascular etiology is most likely. This case reports highlights a rare diagnosis of a malignant tumor of the lacrimal gland presenting as an abduction deficit.

PURPOSE
Tumors of the lacrimal gland can cause abduction deficits, which may mimic an abducens nerve palsy. Abducens nerve palsies are often encountered by optometrists. This case report highlights the appropriate workup of an abduction deficit and reviews the literature of adenocarcinoma not otherwise specified.

CASE REPORT
A 67-year-old white man was transferred to the optometry clinic with a presumed ischemic abducens palsy. He was found to have an isolated left abduction deficit without vascular risk factors that prompted neuroimaging revealing a mass of the lacrimal gland. After an en bloc resection, a diagnosis of adenocarcinoma not otherwise specified was made. The patient underwent aggressive surgical exenteration followed by radiation.

CONCLUSIONS
Using the guidelines for evaluation of an abduction deficit, this serious malignancy was diagnosed. An adenocarcinoma not otherwise specified of the lacrimal gland is rare, and there are limited data on its clinical course, prognosis, and treatment. Recurrence and metastases occur at high rates; therefore, prompt diagnosis and aggressive intervention are crucial.
Failure of Invasive Airway Placement on the First Attempt Is Associated With Progression to Cardiac Arrest in Pediatric Acute Respiratory Compromise*
Authors: Stinson Hannah R. , Srinivasan Vijay , Topjian Alexis A. , Sutton Robert M. , Nadkarni Vinay M. , Berg Robert A. , Raymond Tia T. 
Published: November 2017

Objectives:
The aim of this study was to describe the proportion of acute respiratory compromise events in hospitalized pediatric patients progressing to cardiopulmonary arrest, and the clinical factors associated with progression of acute respiratory compromise to cardiopulmonary arrest. We hypothesized that failure of invasive airway placement on the first attempt (defined as multiple attempts at tracheal intubation, and/or laryngeal mask airway placement, and/or the creation of a new tracheostomy or cricothyrotomy) is independently associated with progression of acute respiratory compromise to cardiopulmonary arrest.

Design:
Multicenter, international registry of pediatric in-hospital acute respiratory compromise.

Setting:
American Heart Association’s Get with the Guidelines-Resuscitation registry (2000–2014).

Patients:
Children younger than 18 years with an index (first) acute respiratory compromise event.

Interventions:
None.

Measurements and Main Results:
Of the 2,210 index acute respiratory compromise events, 64% required controlled ventilation, 26% had return of spontaneous ventilation, and 10% progressed to cardiopulmonary arrest. There were 762 acute respiratory compromise events (34%) that did not require an invasive airway, 1,185 acute respiratory compromise events (54%) with successful invasive airway placement on the first attempt, and 263 acute respiratory compromise events (12%) with failure of invasive airway placement on the first attempt. After adjusting for confounding variables, failure of invasive airway placement on the first attempt was independently associated with progression of acute respiratory compromise to cardiopulmonary arrest (adjusted odds ratio 1.8 [95% CIs, 1.2–2.6]).

Conclusions:
More than 1 in 10 hospitalized pediatric patients who experienced an acute respiratory compromise event progressed to cardiopulmonary arrest. Failure of invasive airway placement on the first attempt is independently associated with progression of acute respiratory compromise to cardiopulmonary arrest.
Neutrophil Activation and Enhanced Release of Granule Products in HIV-TB Immune Reconstitution Inflammatory Syndrome
Authors: Nakiwala Justine K. , Walker Naomi F. , Diedrich Collin R. , Worodria William , Meintjes Graeme , Wilkinson Robert J. , Mayanja-Kizza Harriet , Colebunders Robert , Kestens Luc , Wilkinson Katalin A. , Lowe David M. 
Published: November 2017

Background:
Tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) remains incompletely understood. Neutrophils are implicated in tuberculosis pathology but detailed investigations in TB-IRIS are lacking. We sought to further explore the biology of TB-IRIS and, in particular, the role of neutrophils.

Setting:
Two observational, prospective cohort studies in HIV/TB coinfected patients starting antiretroviral therapy (ART), 1 to analyze gene expression and subsequently 1 to explore neutrophil biology.

Methods:
nCounter gene expression analysis was performed in patients with TB-IRIS (n = 17) versus antiretroviral-treated HIV/TB coinfected controls without IRIS (n = 17) in Kampala, Uganda. Flow cytometry was performed in patients with TB-IRIS (n = 18) and controls (n = 11) in Cape Town, South Africa to determine expression of neutrophil surface activation markers, intracellular cytokines, and human neutrophil peptides (HNPs). Plasma neutrophil elastase and HNP1-3 were quantified using enzyme-linked immunosorbent assay. Lymph node immunohistochemistry was performed on 3 further patients with TB-IRIS.

Results:
There was a significant increase in gene expression of S100A9 (P = 0.002), NLRP12 (P = 0.018), COX-1 (P = 0.025), and IL-10 (P = 0.045) 2 weeks after ART initiation in Ugandan patients with TB-IRIS versus controls, implicating neutrophil recruitment. Patients with IRIS in both cohorts demonstrated increases in blood neutrophil count, plasma HNP and elastase concentrations from ART initiation to week 2. CD62L (L-selectin) expression on neutrophils increased over 4 weeks in South African controls whereas patients with IRIS demonstrated the opposite. Intense staining for the neutrophil marker CD15 and IL-10 was seen in necrotic areas of the lymph nodes of the patients with TB-IRIS.

Conclusions:
Neutrophils in TB-IRIS are activated, recruited to sites of disease, and release granule contents, contributing to pathology.
Are HIV Seroconversions Among Young Men Who Have Sex With Men Associated With Social Network Proximity to Recently or Long-Term HIV-Infected Individuals?
Authors: Morgan Ethan , Skaathun Britt , Duvoisin Rebeccah , Michaels Stuart , Schneider John A. 
Published: November 2017

Abstract:
Debate remains as to the relative HIV transmission contributions from individuals who are recently HIV-infected and individuals who have long-term infections. In this study, we examine the relationship between new HIV seroconversions occurring among young black men who have sex with men and network proximity to recently or long-term HIV-infected individuals. A cohort of young black men who have sex with men (N = 618) was generated through respondent-driven sampling across 3 waves. A recent HIV infection was defined as either: (1) a confirmed seroconversion ≤9 months before interview date or (2) a laboratory confirmed acute infection; long-term HIV-infected individuals were defined as a diagnosis date ≥9 months before interview date. Respondent-driven sampling-weighted logistic regression was used to examine network proximity of HIV transmission events to HIV-infected individuals in the network. Within the cohort, 343 (55.5%) participants were identified as HIV seronegative at baseline. Of these, 33 (9.6%) seroconverted during the study period. The odds of seroconversion increased significantly with each additional recent HIV-infected individual in one's network [adjusted odds ratio = 12.96; 95% confidence interval: 5.69 to 29.50], but were not significantly altered by the number of long-term infected individuals in one's network. In addition, for each member of one's network who used pre-exposure prophylaxis, the odds of seroconversion decreased significantly (adjusted odds ratio = 0.44; 95% confidence interval: 0.20 to 0.96). Early diagnosis and treatment is a critical first step in the HIV care continuum and together with pre-exposure prophylaxis awareness and use are critical targets for disrupting the transmission of HIV through most at-risk networks.