bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coronary Angiographic Findings in Acute Ischemic Stroke Patients With Elevated Cardiac Troponin
Authors: Mochmann Hans-Christian , Scheitz Jan F. , Petzold Gabor C. , Haeusler Karl Georg , Audebert Heinrich J. , Laufs Ulrich , Schneider Christine , Landmesser Ulf , Werner Nikos , Endres Matthias , Witzenbichler Bernhard , Nolte Christian H. 
Published: March 2016

Background—
A relevant proportion of patients with acute ischemic stroke (AIS) have elevated levels of cardiac troponins (cTn). However, the frequency of coronary ischemia as the cause of elevated cTn is unknown. The aim of our study was to analyze coronary vessel status in AIS patients with elevated cTn compared with patients presenting with non–ST-segment–elevation acute coronary syndrome (NSTE-ACS).

Methods and Results—

Among 2123 consecutive patients with AIS prospectively screened at 2 tertiary hospitals, 13.7% had cTn elevation (>50 ng/L). According to a prespecified sample size estimation, 29 patients with AIS (median age, 76 years [first–third quartiles, 70–82 years]; 52% male) underwent conventional coronary angiography and were compared with age- and sex-matched patients with NSTE-ACS. The primary end point was presence of coronary culprit lesions on coronary angiograms as analyzed by independent interventional cardiologists blinded for clinical data. Median cTn on presentation did not differ between patients with AIS or NSTE-ACS (95 versus 94 ng/L;
P
=0.70). Compared with patients with NSTE-ACS, patients with AIS were less likely to have coronary culprit lesions (7 of 29 versus 23 of 29;
P
<0.001) or any obstructive coronary artery disease (15 of 29 versus 25 of 29;
P
=0.02; median number of vessels with >50% stenosis, 1 [first–third quartiles, 0–2] versus 2 [first–third quartiles, 1–3];
P
<0.01).

Conclusions—
Coronary culprit lesions are significantly less frequent in AIS patients compared with age- and sex-matched patients with NSTE-ACS despite similar baseline cTn levels. Half of all AIS patients had no angiographic evidence of coronary artery disease. Further studies are needed to clinically identify the minority of patients with AIS and angiographic evidence of a culprit lesion.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01263964.
Marital Transition and Risk of Stroke
Authors: Honjo Kaori , Iso Hiroyasu , Ikeda Ai , Inoue Manami , Sawada Norie , Tsugane Shoichiro ,   on behalf of the JPHC Study Group
Published: March 2016

Background and Purpose—
There have been consistent findings reported that marital transition (ie, change in marital status during a given time period) is associated with risk of cardiovascular disease; however, few studies have been conducted on stroke risk, particularly stroke subtypes. Moreover, no studies have examined the moderating effect of living arrangement and employment status on the association between marital transition and stroke risk.

Methods—
We examined sex-specific associations between marital transition and stroke risk using data from Japan Public Health Center–based Prospective Study. We included 24 162 men and 25 626 women who were married at prebaseline (5 years before baseline). Marital transition was determined by marital status at baseline. Weighted hazard ratios of stroke risk were estimated by Cox proportional regression analysis with inverse probability of weighting using a propensity score.

Results—
An increased risk of stroke, particularly hemorrhagic stroke, was observed among men and women with marital transition (ie, married to unmarried); weighted hazard ratios (95% confidence interval [CI]) for men and women were 1.26 (1.13–1.41) and 1.26 (1.09–1.45), respectively. Participants with marital transition and lived with children had increased stroke risk. Living with parents buffered the increased stroke risk owing to marital transition among men; however, no such effect was identified among women. Elevated stroke risk owing to marital transition was magnified among women if they were unemployed; weighted hazard ratio=2.98 (95% CI, 1.66–5.33).

Conclusions—
Living arrangement and employment status modified the positive associations between marital transition and stroke risk, which differed by sex.
Islam and the White House
Authors: al-Rahim Ahmed H. 
Published: March 2016

A reified Islam has been used to delineate the creed, the politics and the culture of about a fifth of the world population. While defining what ‘Islam’ is and is not, before and after the events of September 11, may be a necessary first step to understanding certain ‘facts’ about the theology, law and history of the world’s second largest religion, the semantics of official US government discourse about ‘Islam’ and terrorism have proved to be problematic. The purpose of this article is to provide an analytical survey of the thematics of American presidential public diplomacy. It also analyzes the construction of ideology in the context of the global war on terror, as it relates to Islam as a religion, the variants of political Islam and more broadly on the question of terrorism and the ‘Muslim world’. I begin with the Clinton presidency and continue to George Bush and end with Obama’s first term. This period of American political and public diplomatic history was selected because it clearly illustrates American presidential rhetoric on ‘Islam’ before and after al-Qaʿida’s second attacks on the World Trade Center and before the events of the ‘Arab Spring’ in late 2010.
Endoscopic Radiofrequency Ablation–Assisted Resection of Juvenile Nasopharyngeal Angiofibroma
Authors: McLaughlin Eamon J. , Cunningham Michael J. , Kazahaya Ken , Hsing Julianna , Kawai Kosuke , Adil Eelam A. 
Published: March 2016

ObjectivesTo evaluate the feasibility of radiofrequency surgical instrumentation for endoscopic resection of juvenile nasopharyngeal angiofibroma (JNA) and to test the hypothesis that endoscopic radiofrequency ablation–assisted (RFA) resection will have superior intraoperative and/or postoperative outcomes as compared with traditional endoscopic (TE) resection techniques.Study DesignCase series with chart review.SettingTwo tertiary care pediatric hospitals.Subjects and MethodsTwenty‐nine pediatric patients who underwent endoscopic transnasal resection of JNA from January 2000 to December 2014.ResultsTwenty‐nine patients underwent RFA (n = 13) or TE (n = 16) JNA resection over the 15‐year study period. Mean patient age was not statistically different between the 2 groups (P =.41); neither was their University of Pittsburgh Medical Center classification stage (P =.79). All patients underwent preoperative embolization. Mean operative times were not statistically different (P =.29). Mean intraoperative blood loss and the need for a transfusion were also not statistically different (P =.27 and. 47, respectively). Length of hospital stay was not statistically different (P =.46). Recurrence rates did not differ between groups (P =. 99) over a mean follow‐up period of 2.3 years.ConclusionThere were no significant differences between RFA and TE resection in intraoperative or postoperative outcome parameters.
Cholesterol Granuloma Development following Temporal Bone Surgery
Authors: Sweeney Alex D. , Osetinsky L. Mariel , Hunter Jacob B. , Haynes David S. , Carlson Matthew L. 
Published: March 2016

ObjectiveTo describe the clinical presentation and management of patients with cholesterol granulomas (CGs) that develop following temporal bone surgery.Study DesignCase series with chart review.SettingTwo independent tertiary academic referral centers.Subjects and MethodsA multicenter retrospective review was performed to identify all patients between 2001 and 2014 who were diagnosed with a CG that developed following temporal bone surgery. Patients with a history of idiopathic petrous apex CGs were excluded, as were those with <6 months of follow‐up after diagnosis. Demographic and clinical data were recorded at presentation, and the main outcome measure was symptom evolution over time.ResultsA total of 20 patients met inclusion criteria (median age, 55.0 years; 70.0% female), and their cases were analyzed. Diagnosis was made, on average, 149.5 months (median, 94.5; range, 13.0‐480.0) following a temporal bone operation, which was for chronic ear disease in 75.0% of cases. The most common presenting symptoms were otalgia (55.0%) and otorrhea (40.0%). In patients initially managed with observation, 71.4% required no surgical intervention through a mean of 56.8 months (median, 30; range, 12.0‐178.0) of follow‐up. For those who initially underwent surgical excision, durable symptom relief was achieved in 66.7% of cases.ConclusionPostoperative CG formation in the temporal bone is a rare occurrence that can be encountered years following surgery. The present study suggests that conservative management can be appropriate for many cases in which patients are relatively asymptomatic.
Nonvisualization of Sialoliths during Sialendoscopy
Authors: Galinat Lauren , Curry Joseph , Luginbuhl Adam , Rosen David , Cognetti David M. 
Published: March 2016

ObjectivesAnalyze the characteristics of patients undergoing interventional sialendoscopy for sialolithiasis whose stones were not visualized intraoperatively.Study DesignCase series with chart review.SettingTertiary care hospital.Subjects and MethodsPatients (n = 276) undergoing sialendoscopy between June 2008 and December 2014 were reviewed for patient characteristics, imaging characteristics, and outcomes. Nonvisualization was defined as a sialolith that was documented on imaging preoperatively but not visualized intraoperatively during sialendoscopy, despite successful ductal cannulation and evaluation.ResultsA total of 337 sialendoscopy procedures were preformed. Preoperative imaging documented a sialolith in 203 (60%) cases. Nonvisualization occurred in 31 (15%) cases with sialolith. The parotid gland was involved in 58% (18 of 31) of nonvisualization cases, as opposed to 21% (43 of 203) of all sialolith cases. The submandibular gland was involved in 42% (13 of 31) of nonvisualization cases, as compared with 79% (160 of 203) of all sialolith cases. Nonvisualization occurred in 42% (18 of 43) of parotid cases versus 8% (13 of 160) of submandibular cases, a statistically significant difference (P <. 001). Parotid stones located posterior to the plane of insertion of the posterolateral edge of the masseter were significantly more likely to experience nonvisualization (73%) than those along and anterior to the masseter (25% and 0%, respectively; P =. 009).ConclusionsIntraoperative nonvisualization of a sialolith is more likely to occur in the parotid gland. Proximal stone location may predict nonvisualization. These factors should be considered during treatment planning and counseling for patients with sialolithiasis.
Long‐term Outcomes of Titanium Ossiculoplasty in Chronic Otitis Media
Authors: O’Connell Brendan P. , Rizk Habib G. , Hutchinson Tanisha , Nguyen Shaun A. , Lambert Paul R. 
Published: March 2016

ObjectiveThe primary objective is to report long‐term hearing outcomes (>2 years) after titanium ossiculoplasty in patients with chronic otitis media.Study DesignCase series with chart review.SettingTertiary care hospital.Subjects and MethodsIn total, 156 patients with chronic otitis media undergoing titanium ossiculoplasty were included. The primary outcome measure was the long‐term postoperative ABG. The stability of hearing over time was determined by comparing short‐term and long‐term postoperative air‐bone gap (ABG). Secondary outcome measures included ΔABG, postoperative speech reception thresholds, air‐conduction pure‐tone average (AC PTA), word recognition scores, and percentage of patients achieving ABG ≤20 dB. Revision and extrusion rates were examined.ResultsAt short‐term follow‐up (<6 months), mean postoperative ABG was 18.4 ± 10.6 dB and AC PTA was 31.7 ± 15.2 dB; 67% of patients achieved ABG ≤20 dB. At long‐term follow‐up (>2 years), mean ABG was 20.0 dB ± 15.4 and AC PTA was 35.3 ± 16.1 dB; 60% of patients achieved ABG ≤20. At both short‐ and long‐term follow‐up, ABG and AC PTA were significantly improved compared with preoperative values. No difference in hearing outcomes was observed when comparing partial titanium ossicular prostheses (PORPs) to total titanium ossicular prostheses (TORPs) at either short‐ or long‐term follow‐ups. In patients with both short‐ and long‐term follow‐up (n = 50), deterioration in hearing was noted (3.4 dB, P =. 04). When analyzed by type of prosthesis, PORPs demonstrated statistically significant deterioration in ABG over time (4.9 dB, P =. 02), while TORPs did not (2.5 dB, P =. 50). The long‐term extrusion rate was 3.2%.ConclusionWith a minimum follow‐up of 2 years, titanium ossiculoplasty provides good long‐term hearing results. Modest deterioration in hearing is noted over time.
Antibiotic and Duration of Perioperative Prophylaxis Predicts Surgical Site Infection in Head and Neck Surgery
Authors: Langerman Alexander , Thisted Ronald , Hohmann Samuel , Howell Michael 
Published: March 2016

ObjectiveTo examine the effect of giving antibiotics on the day of surgery (DOS) vs DOS and first postoperative day (DOS+1) for prophylaxis against surgical site infection (SSI) in clean‐contaminated head and neck surgery (CCHNS).Study DesignRetrospective multi‐institution analysis using University HealthSystem Consortium data.MethodsA multivariate logistic regression model of 8836 discharge records from patients undergoing CCHNS was used to determine the odds of SSI for antibiotic agent/duration combinations.SettingNinety‐two academic and affiliated medical centers from 2008 to 2011.ResultsAmpicillin/sulbactam, clindamycin, cefazolin + metronidazole, and cefazolin alone were the most common antibiotics. For patients receiving antibiotics only on DOS, there was no significant difference in odds of SSI based on antibiotic choice. When given on the DOS and DOS+1, patients receiving ampicillin/sulbactam had a reduction in odds of SSI by over two‐thirds (odds ratio [OR], 0.28 [95% confidence interval, 0.13‐0.61], P =. 001, compared with ampicillin/sulbactam on DOS only), whereas this effect was not seen with clindamycin (1.82 [0.93‐3.56], P =. 078, compared with clindamycin on DOS only). Prolonging clindamycin beyond the DOS was associated with a higher odds of SSI compared with DOS‐only ampicillin/sulbactam (OR, 2.66; 95% CI, 1.33‐5.30; P =. 006). These relationships held in a subset of physicians and hospitals that used multiple different regimens. DOS+1 regimens were not associated with an increased odds of antibiotic‐induced complications.ConclusionProlonging ampicillin/sulbactam beyond the day of surgery may have a protective effect against SSI, and 1 or more days of ampicillin/sulbactam may be preferable to multiple days of clindamycin. New randomized trials are needed to define the ideal regimen for CCHNS.
Lean Belt Certification
Authors: Elghouche Alhasan N. , Lobo Brian C. , Wannemuehler Todd J. , Johnson Kimberly E. , Matt Bruce H. , Woodward‐Hagg Heather K. , Kokoska Mimi S. 
Published: March 2016

Since July 2013, 20 trainee participants have completed the quality improvement curriculum within the Indiana University Department of Otolaryngology–Head & Neck Surgery, including 7 otolaryngology residents, 6 otolaryngology‐bound medical students, and 7 psychiatry residents. Nine faculty and staff attended. Participants were highly satisfied with the quality and effectiveness of the program. Following program implementation, 2 otolaryngology residents and 2 medical students initiated their own quality improvement projects. Lean training directly resulted in oral and poster presentations at national conferences, journal publications, and institutional research and quality awards. Students completing the program established a local affiliate group of an international health care quality organization. Quality improvement training can be successfully incorporated into residency training with overwhelming program satisfaction and results in greater scholarly and professional development for motivated participants. The skillset acquired by participants leads to projects that improve patient care, increase value, and justify equipment and personnel retention and expansion.
Feline hip dysplasia
Authors: Perry Karen 
Published: March 2016

Practical relevance: The reported incidence of hip dysplasia (HD) in cats varies dramatically between studies, but the condition is likely more common than we realise. There is little doubt that cats with HD and associated osteoarthritis (OA) suffer pain, and this warrants appropriate therapy. Diagnostic challenges: Clinical signs of HD in cats are often gradual in onset, making them difficult to appreciate, but may include inactivity, pelvic limb lameness, difficulty jumping and climbing stairs, and reluctance to squat to defecate. Often lameness is bilateral, and can be particularly difficult to recognise. The most common radiographic finding is an abnormally shallow acetabulum. Subluxation, however, is not consistently associated with OA in cats and therefore the role that joint laxity plays in disease progression remains uncertain. Degenerative changes of the femoral head and neck seem to develop later than in the dog, and are less marked. Therapeutic challenges: The majority of cats respond to non-surgical management with environmental modulation, physical therapy, dietary modulation, weight loss, nutraceuticals and drug therapy. Should non-surgical management not provide sufficient relief, two salvage surgical options are available: femoral head and neck excision (FHNE) and total hip replacement (THR). While there is a risk of complications with micro-THR, the positive outcomes that have been reported indicate that it should be considered in the treatment of coxofemoral pathology in cats in the same way that THR is considered for larger dogs, especially given the inconsistent results associated with FHNE. Monitoring the effect of treatment is challenging as the assessment of pain in cats is complex and there is no validated scoring system or owner-completed questionnaire yet available for cats. Evidence base: There is a paucity of clinical reports focusing solely on HD in cats. The author draws on a combination of published studies, in cats, dogs and humans, as well as personal clinical experience.
Spinal nociceptive transmission by mechanical stimulation of bone marrow
Authors: Ishida Takashi , Tanaka Satoshi , Sekiguchi Takemi , Sugiyama Daisuke , Kawamata Mikito 
Published: March 2016

Background Since bone marrow receives innervation from A-delta and C-fibers and since an increase in intramedullary pressure in bone marrow may induce acute pain in orthopedic patients during surgery and chronic pain in patients with bone marrow edema, skeletal pain may partly originate from bone marrow. Intraosseous lesions, such as osteomyelitis and bone cancer, are also known to produce cutaneous hypersensitivity, which might be referred pain from bone. However, little is known about pain perception in bone marrow and referred pain induced by bone disease. Thus, we carried out an in vivo electrophysiological study and behavioral study to determine whether increased intraosseous pressure of the femur induces acute pain and whether increased intraosseous pressure induces referred pain in the corresponding receptive fields of the skin. Results Intraosseous balloon inflation caused spontaneous pain-related behavior and mechanical hyperalgesia and allodynia in the lumbosacral region. Single neuronal activities of spinal dorsal horn neurons were extracellularly isolated, and then evoked responses to non-noxious and noxious cutaneous stimuli and intraosseous balloon inflation were recorded. Ninety-four spinal dorsal horn neurons, which had somatic receptive fields at the lower back and thigh, were obtained. Sixty-two percent of the wide-dynamic-range neurons (24/39) and 86% of the high-threshold neurons (12/14) responded to intraosseous balloon inflation, while none of the low-threshold neurons (0/41) responded to intraosseous balloon inflation. Spinally administered morphine (1 µg) abolished balloon inflation-induced spontaneous pain-related behavior and mechanical hyperalgesia in awake rats and also suppressed evoked activities of wide-dynamic-range neurons to noxious cutaneous stimulation and intraosseous balloon inflation. Conclusions The results suggest that mechanical stimulation to bone marrow produces nociception, concomitantly producing its referred pain in the corresponding skin fields. These mechanisms might contribute to pain caused by skeletal diseases.
Why do parents use the emergency department for minor injury and illness? A cross-sectional questionnaire
Authors: Ogilvie Sarah , Hopgood Katie , Higginson Ian , Ives Andrew , Smith Jason E 
Published: March 2016

Objective To understand decision-making when bringing a child to an emergency department. Design A cross-sectional survey of parents attending with children allocated a minor triage category. Setting Emergency department in South West England, serving 450,000 people per annum. Participants All English-speaking parents/caregivers whose children attended the emergency department and were triaged as minor injury/illness. Main outcome measures Parental and child characteristics, injury/illness characteristics, advice seeking behaviour, views regarding emergency department service improvement, GP access and determinants of emergency department use. Results In sum, 373 responses were analysed. The majority of attendances were for minor injury, although illness was more common in <4 year olds. Most presentations were within 4 h of injury/illness and parents typically sought advice before attending. Younger parents reported feeling more stressed. Parents of younger children perceived the injury/illness to be more serious, reporting greater levels of worry, stress, helplessness and upset and less confidence. Parents educated to a higher level were more likely to administer first-aid/medication. Around 40% did not seek advice prior to attending and typically these were parents aged <24 and parents of <1 year olds. The main determinants of use were: advised by someone other than a GP; perceived urgency; perceived appropriateness. The need for reassurance also featured. Conclusions The findings suggest that it is difficult for parents to determine whether their child’s symptoms reflect minor conditions. Efforts should focus on building parental confidence and self-help and be directed at parents of younger children and younger parents. This is in addition to appropriate minor injury/illness assessment and treatment services.