bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transpulmonary Pressure Describes Lung Morphology During Decremental Positive End-Expiratory Pressure Trials in Obesity*
Authors: Fumagalli Jacopo , Berra Lorenzo , Zhang Changsheng , Pirrone Massimiliano , Santiago Roberta R. De Santis , Gomes Susimeire , Magni Federico , dos Santos Glaucia A. B. , Bennett Desmond , Torsani Vinicius , Fisher Daniel , Morais Caio , Amato Marcelo B. P. , Kacmarek Robert M. 
Published: April 2017

Objectives:
Atelectasis develops in critically ill obese patients when undergoing mechanical ventilation due to increased pleural pressure. The current study aimed to determine the relationship between transpulmonary pressure, lung mechanics, and lung morphology and to quantify the benefits of a decremental positive end-expiratory pressure trial preceded by a recruitment maneuver.

Design:
Prospective, crossover, nonrandomized interventional study.

Setting:
Medical and Surgical Intensive Care Units at Massachusetts General Hospital (Boston, MA) and University Animal Research Laboratory (São Paulo, Brazil).

Patients/Subjects:
Critically ill obese patients with acute respiratory failure and anesthetized swine.

Interventions:
Clinical data from 16 mechanically ventilated critically ill obese patients were analyzed. An animal model of obesity with reversible atelectasis was developed by placing fluid filled bags on the abdomen to describe changes of lung mechanics, lung morphology, and pulmonary hemodynamics in 10 swine.

Measurements and Main Results:
In obese patients (body mass index, 48 ± 11 kg/m2), 21.7 ± 3.7 cm H2O of positive end-expiratory pressure resulted in the lowest elastance of the respiratory system (18.6 ± 6.1 cm H2O/L) after a recruitment maneuver and decremental positive end-expiratory pressure and corresponded to a positive (2.1 ± 2.2 cm H2O) end-expiratory transpulmonary pressure. Ventilation at lowest elastance positive end-expiratory pressure preceded by a recruitment maneuver restored end-expiratory lung volume (30.4 ± 9.1 mL/kg ideal body weight) and oxygenation (273.4 ± 72.1 mm Hg). In the swine model, lung collapse and intratidal recruitment/derecruitment occurred when the positive end-expiratory transpulmonary pressure decreased below 2–4 cm H2O. After the development of atelectasis, a decremental positive end-expiratory pressure trial preceded by lung recruitment identified the positive end-expiratory pressure level (17.4 ± 2.1 cm H2O) needed to restore poorly and nonaerated lung tissue, reestablishing lung elastance and oxygenation while avoiding increased pulmonary vascular resistance.

Conclusions:
In obesity, low-to-negative values of transpulmonary pressure predict lung collapse and intratidal recruitment/derecruitment. A decremental positive end-expiratory pressure trial preceded by a recruitment maneuver reverses atelectasis, improves lung mechanics, distribution of ventilation and oxygenation, and does not increase pulmonary vascular resistance.
Perceived Mentoring Practices in Developmental-Behavioral Pediatrics Fellowship Programs
Authors: Diekroger Elizabeth A. , Reyes Charina , Myers Katherine M. , Li Hong , Kralovic Shanna K. , Roizen Nancy 
Published: April 2017

ABSTRACT:

Objective:
Junior physicians describe mentoring relationships as integral to their career development and success. Current evidence suggests that mentoring is under-utilized despite interest from trainees. The purpose of this study is to describe the mentoring practices in developmental-behavioral pediatric (DBP) fellowship programs and identify mentoring needs of DBP fellows and recent graduates.

Methods:
DBP fellows and recent graduates less than 5 years out of training from US-based DBP fellowship programs were contacted to complete a survey on their mentoring experiences in fellowship and early career.

Results:
A total of 90 respondents completed the entire survey including 47 current DBP fellows and 43 recent graduates. Only 52% of respondents reported having a formal faculty mentor during their fellowship. Only 45% of recent graduates reported that they currently have a mentor, of those without a current mentor 83% said they would like to have a mentor. Adequate mentoring during fellowship was lowest for career development and research (34% and 27%). Satisfaction with mentoring was associated with having a formal mentor (p < .001) and receiving mentoring in multiple areas (p < .001). Qualitative responses suggested that effective mentoring addresses the mentee's career goals, provides insight into being a developmental-behavioral pediatrician, assists in navigating academics, and involves a personal relationship.

Conclusion:
Results suggest opportunities for improved mentoring in DBP fellowship programs, particularly in the areas of career development and research and that there is a significant need for mentorship among recent graduates. Findings from this study can inform program improvement in mentoring for DBP fellows and recent graduates.
Comorbid Mental Disorders in Fetal Alcohol Spectrum Disorders: A Systematic Review
Authors: Weyrauch Deland , Schwartz Megan , Hart Brandon , Klug Marilyn G. , Burd Larry 
Published: April 2017

ABSTRACT:

Objective:
A systematic review of published literature to estimate prevalence of comorbid mental disorders in fetal alcohol spectrum disorders (FASDs) and compare with general population prevalence estimates.

Methods:
A PubMed search was used to locate articles reporting on FASD and mental disorders published through June 2015. Next, lists of published studies from all issues of the National Organisation for Foetal Alcohol Syndrome—UK publication Fetal Alcohol Forum—were searched. Weighted average prevalence was estimated for the comorbid mental disorders with sufficient data for analysis. We then compared prevalence of mental disorders in the FASD population with rates in the mental health literature.

Results:
We identified 26 articles reporting 5984 cases of FASD. Of the 15 comorbid mental disorders, 11 had sufficient data for inclusion in the analysis. Attention-deficit/hyperactivity disorder occurred in 50% of persons with FASD (10 times the expected rate). Intellectual disability occurred at 23 times the expected rate. In 5 of the 12 disorders, rates in the FASD population significantly exceeded expected rates by 10% to 45%.

Conclusion:
Increased rates of mental disorders in people with FASD are commonly reported. Mental health providers should routinely consider FASD in the diagnosis and management of mental illness and developmental disorders. The quality of the research and precision of comorbidity estimates would be improved by additional studies including people with FASD and non-FASD comparison subjects. Until these studies are available, this review provides the best available estimates of comorbid mental disorders in people with FASD.
Descemetorhexis Without Grafting for Fuchs Endothelial Dystrophy—Supplementation With Topical Ripasudil
Authors: Moloney Gregory , Petsoglou Constantinos , Ball Matthew , Kerdraon Yves , Höllhumer Roland , Spiteri Natasha , Beheregaray Simone , Hampson Judith , D'Souza Mario , Devasahayam Raj N. 
Published: April 2017

Purpose:
To report the safety and efficacy of descemetorhexis without grafting as a primary intervention in Fuchs dystrophy, and the use of a ROCK inhibitor, ripasudil as a salvage agent in failing cases.

Methods:
Twelve eyes of 11 patients underwent central descemetorhexis not exceeding 4 mm. All had Fuchs dystrophy–producing visual symptoms, requesting intervention. Exclusion criteria were a peripheral endothelial cell count <1000 and central edema. Corneal clearance and visual parameters were recorded monthly until corneal clearance was observed, then at intervals of 6 months. Cases failing to clear by month 2 were considered for salvage treatment. This consisted of treatment with 1 of 2 formulations of Rho-associated kinase inhibitor eye drops. Endothelial keratoplasty was planned as the final salvage procedure in unsuccessful cases.

Results:
Nine of 12 eyes cleared spontaneously between 2 and 6 months. One eye failed to clear by month 5 and topical Y-27632 was administered, without success. Endothelial keratoplasty was performed. In 2 eyes, healing stalled at 3 and 2 months. In both cases, topical ripasudil administered 6 times a day for 2 weeks resulted in complete corneal clearance. In cases achieving corneal clearance, best spectacle corrected visual acuity improved from a mean of 0.26 to 0.125 (logMAR) with subjective improvement in quality of vision.

Conclusions:
In Fuchs dystrophy with visual degradation due to central guttae, descemetorhexis without grafting is a viable procedure for visual rehabilitation. Careful patient selection is required, but the advent of topical ripasudil as a salvage agent suggests that a broader application of the surgery may be possible. Further study into the use of this agent is now needed.
Neuronal Fibers and Neurotransmitter Receptor Expression in the Human Endolymphatic Sac
Authors: Møller Martin Nue , Kirkeby Svend , Vikeså Jonas , Nielsen Finn Cilius , Cayé-Thomasen Per 
Published: April 2017

Introduction:
Recent studies suggest that the human endolymphatic sac (ES) may have multiple functions, including an ion-transport capacity comparable to the kidney, an immunological capacity and a possible natriuretic capacity. Further, there have been speculations of a yet undefined role in intracranial pressure homeostasis. The anatomical location towards the sigmoid sinus would suggest a possible endo- and/or paracrine signaling. However, neuronal connections may also apply, but it remains very scarcely explored in the human ES.

Study Design:
DNA micro-arrays and immunohistochemistry were used for analyses of fresh human ES tissue samples.

Methods:
A total of 30 tissue samples from the human ES were obtained during translabyrinthine surgery for vestibular schwannoma. Microarray technology was used to investigate tissue sample gene expression, using adjacent dura mater as control. The expression of genes specific for neuronal signaling was determined and results for selected key molecules verified by immunohistochemistry. Transmission electron microscopy was used for ultrastructural analysis.

Results:
For the transmission electron microscopy analysis, a direct innervation of the ES was observed with unmyelinated fibers imbedded in the ES epithelial lining. The microarrays confirmed, that several molecules involved in neuronal signaling were found expressed significantly in the ES DNA profile, such as the Cholecystokinin peptide and related receptors, Dopamine receptors 2 and 5, vesicular monoamine transporter 2 (VMAT2), plasma monoamine transporter (PMAT), and Serotonin 1D. All peptides were verified by immunohistochemistry.

Conclusions:
Based on global gene expression profiling and immuno-histochemical labeling, we conclude that the human ES expresses neuropeptide receptors and monoamine transporters. Combined with the ultrastructural demonstration of unmyelinated axons imbedded within the epithelial lining, the findings suggest that neuro-signaling mechanisms are involved in functions exerted by the ES.
Systematic Review on the Trial Period for Bone Conduction Devices in Single-Sided Deafness: Rates and Reasons for Rejection
Authors: Wendrich Anne W. , Kroese Tiuri E. , Peters Jeroen P. M. , Cattani Guido , Grolman Wilko 
Published: April 2017

Objective:
To systematically review the literature to evaluate the trial period of bone conduction devices (BCDs) for adult patients with single-sided deafness (SSD).

Data Sources:
The PubMed, Embase, and Cochrane Library databases were searched from their inception up to August 15, 2016 for SSD, BCD, and their synonyms.

Study Selection:
In total, 523 articles were retrieved, of which 12 satisfied the eligibility quality criteria. Our outcomes of interest were: 1) the BCD implantation rejection percentage, 2) reasons to reject BCD implantation, and 3) possible prognostic factors predicting the trial outcome.

Data Extraction and Synthesis:
At critical appraisal, six studies (n = 471 patients) scored a moderate to high directness of evidence and a medium or low risk of bias and were selected for data extraction. Due to heterogeneity between studies, pooling of data for meta-analysis was not feasible. Therefore, results of studies were summarized per outcome: 1) after the BCD trial, 32.0 to 69.6% of SSD patients rejected BCD implantation, 2) the three main reasons for rejection were experiencing limited benefit from the device, patients fearing or being unfit for surgery and cosmetic aspects, 3) no clear prognostic factors predicting the trial outcome could be identified.

Conclusion:
Roughly half of patients rejected BCD implantation after a trial period. From the current literature it is unclear which patients could benefit most from BCD implantation. High level of evidence studies should be conducted to investigate possible prognostic factors that predict the BCD trial outcome.
Ipsilesional Nystagmus Induced by Vibration in Subjects With Ménière's Disease or Vestibular Schwannoma
Authors: Vargas Gamarra María Fernanda , Krstulovic Claudio , Pérez Guillén Vanesa , Pérez-Garrigues Herminio 
Published: April 2017

Objective:
To analyze the frequency in which vibration-induced nystagmus (VIN) with ipsilesional direction appears in subjects with Ménière's disease (MD) or vestibular schwannoma (VS).

Study Design:
Cross-sectional study.

Setting:
Tertiary referral center.

Patients:
Fifty-two subjects with MD and 21 subjects with vestibular schwannoma.

Intervention:
Videonystagmographic recordings of VIN at 30, 60, and 100 Hz.

Main Outcome Measures:
Direction and slow phase velocity of VIN at 30, 60, and 100 Hz.

Results:
Ipsilesional Nystagmus was observed in 8 of 52 subjects with MD (15.4%) and in 11 of 21 subjects affected of unilateral VS (52.4%). Ipsilesional nystagmus was significantly higher in patients with VS (p = 0.003). The frequency of appearance of ipsilesional nystagmus in the subjects with VS who has not been treated was significantly higher than those who underwent radiosurgery (84.6% vs 0%, p = 0.046).

Conclusion:
Ipsilesional vibration-induced Nystagmus can be present in subjects with vestibular deficits caused by MD and VS.
Tendonitis and Tendon Rupture After Treatment With Rituximab: A Case Series
Authors: Alqahtani Ali , Sabha Marwa , Abdelfattah Thaer , Srour Khaled , Dhayihi Turki , Kahaleh Bashar , Altorok Nezam 
Published: April 2017

Clinical Data:
Rituximab is a mouse/human chimeric anti-CD20 IgG1 monoclonal antibody used to treat cancer and autoimmune conditions. Side effects of rituximab include fever, rash, cytopenia and hypotension, back pain, arthralgia, and myalgia. Here, we report on 3 patients who developed moderate to severe tendonitis after the second infusion of rituximab.

Therapeutic Challenge:
We report 3 patients who developed tendonitis after the second infusion of rituximab. These patients were undergoing treatment for connective tissue diseases. All 3 patients received 2 rituximab infusions, 2 weeks apart. The 3 cases developed clinical tendonitis that was confirmed by magnetic resonance imaging in 2 cases.

Interpretation:
This is the first case series reporting new onset tendonitis in patients with connective tissue diseases after rituximab therapy. All 3 cases developed tendonitis 1 week after receiving the second dose of rituximab. Clinical features of tendonitis resolved 3–4 months in all cases. The underlying pathogenic mechanism by which rituximab causes tendonitis is not clear, but tendonitis and tendon rupture have been reported after using other medications such as quinolones. The tendon damage was progressive leading to tendon rupture in 1 patient, highlighting the importance of early recognition. It is plausible that there is a cause–effect relation between tendonitis and administration of rituximab in our 3 cases, since none of these cases had previous history of tendonitis; however, more data are needed to confirm this observation.
Methylphenidate attenuates the response to cold pain but not to aversive auditory stimuli in healthy human: a double-blind randomized controlled study
Authors: Pud Dorit , Broitman Eelena , Hameed Omar , Suzan Erica , Aviram Joshua , Haddad May , Hadad Salim , Shemesh Rafi , Eisenberg Elon 
Published: April 2017

Abstract

Introduction:
We recently showed that the psycho-stimulant norepinephrine–dopamine reuptake inhibitor methylphenidate (MP) prolonged cold pain threshold and tolerance in adults with attention-deficit hyperactivity disorder (ADHD).

Objectives:
The objectives of the present study were to: (1) examine whether MP has antinociceptive properties in healthy men; (2) test MP's effects on responses to aversive auditory stimuli. The underlying aim was to determine whether MP exerts antinociceptive properties or more generalized, nonspecific attenuating effects on different aversive sensory modalities.

Methods:
This double-blind, crossover, randomized placebo-controlled study consisted of 2 sessions one week apart from each other. In each session, pain threshold (seconds) and tolerance (seconds) in response to painful cold stimulation were measured. Additionally, threshold (dB) and tolerance (seconds) to loud aversive auditory stimuli (500 Hz, 2000 Hz and white noise) were also tested prior to and 2 hours following the administration of a single dose of either 20 mg MP or an identical looking placebo.

Results:
Forty men, 26.1 ± 4.0 (mean ± SD) years were enrolled in the study. Wilcoxon signed-rank test analyses showed that MP, but not the placebo, produced a significant increase in cold pain threshold (from 4.1 ± 2.6 to 5.4 ± 3.1 seconds, P = 0.001 and from 4.5 ± 2.6 to 4.3 ± 2.7 seconds, P = 0.2, respectively) and tolerance (from 57.8 ± 54.0 to 73.8 ± 61.8 seconds, P = 0.001 and from 52.5 ± 53.7 sec to 57.0 ± 52.9 seconds, P = 0.1, respectively). No significant changes were found in any of the auditory parameters.

Conclusion:
These results suggest that MP has an effect on nociceptive pathways rather than a nonspecific, generalized attenuating effect on aversive sensory stimuli.
Etiology of Leaks Following Sleeve Gastrectomy: Current Evidence
Authors: Hussain Abdulzahra , Vasas Peter , Kirk Katie , Finney John , Balchandra Srinivasan 
Published: April 2017

Purpose:
The purpose of this paper is to study the causes of leaks following sleeve gastrectomy (SG).

Materials and Methods:
Pubmed was searched during January 2016 for publications reporting leak after SG. A total of 205 publications were identified, of which 17 papers were selected.

Results:
In about 3018 patients, reinforcement was used compared with 4595 patients, in whom no reinforcement was applied; both groups were representing matched bariatric populations. The use of reinforcement/buttressing has resulted in different rates of leaks ranging from 0% to 3.9%; whereas with no reinforcement/buttressing, the leak rate was 0.16% to 3.5%. The use of reinforcement/buttressing did not result in reduction of leak to a statistical significance although the trend was suggesting so (P=0.06), whereas no reinforcement/buttressing did not statistically increase the leak rate (P=0.10).

Conclusions:
No statistical significant difference of leak with or without reinforcement. This mean case complexity and surgical technique and experience are the sole factors for leaks following SG.
The Feasibility of Thoracoscopic Resection in Bronchiectasis
Authors: Baysungur Volkan , Dogruyol Talha , Ocakcioglu Ilhan , Misirlioglu Aysun , Evman Serdar , Kanbur Serda , Alpay Levent , Tezel Cagatay 
Published: April 2017

Introduction:
Minimally invasive surgery is the treatment of choice in early-stage lung cancer. However, experience in infectious lung disease, primarily bronchiectasis, is limited probably because of the presence of dense pleural adhesions, multiple lymph nodes, and spiral bronchial arteries. The present study shows our experience of video-assisted thoracoscopic surgery (VATS) lobectomy and segmentectomy in the treatment of bronchiectasis.

Materials and Methods:
Patients who underwent VATS lobectomy or segmentectomy in our clinic between April 2008 and 2015 were retrospectively evaluated. Surgery was indicated in patients with radiologic localized bronchiectasis who also had a history of recurrent lower respiratory tract infection or expectorating mucopurulent secretion. The patients were analyzed in terms of age, sex, thoracotomy conversion rate, postoperative drainage amount, chest tube removal time, length of hospital stay, morbidity, and mortality.

Results:
A total of 44 patients initially underwent VATS pulmonary anatomic resection and 41 procedures were completed on 40 patients. One patient had bilateral resection. Fifteen patients were male individuals and 26 were female individuals. The average age was 31.4 (15 to 57) years. Forty lobectomies and 1 segmentectomy were performed. The conversion rate was 6.8%. VATS was performed on 28 patients by 3 ports, 8 patients by 2 ports, and 5 patients by a single port. In terms of anatomic resections, 18 patients underwent left lower lobectomy, 8 right lower lobectomy, 8 middle lobectomy, 6 right upper lobectomy, and 1 patient underwent lingular segmentectomy. No major postoperative complication or mortality was observed. Prolonged air leak was observed in 2 patients and subcutaneous emphysema occurred in 2 patients. The average postoperative drainage amount, chest tube removal time, and length of hospital stay were 320 mL, 3.1 (1 to 11) days, and 4.6 (2 to 11) days, respectively.

Conclusions:
VATS pulmonary resection is a safe, feasible, and effective treatment in the surgery of bronchiectasis with low morbidity and mortality rates. Moreover, because of cosmetic results, patients with benign diseases such as bronchiectasis could be initiated by minimally invasive surgery options just like patients with malignancies.
Optical Coherence Tomography in Neuroretinitis: Epipapillary Infiltrates and Retinal Folds
Authors: Zatreanu Luca , Sibony Patrick A. , Kupersmith Mark J. 
Published: April 2017

Abstract:
Neuroretinitis is a form of papillitis associated with the delayed onset of an exudative macular star among other inflammatory ocular findings. We describe 4 patients with neuroretinitis who displayed several distinctive and novel findings on spectral-domain optical coherence tomography (OCT) that include “epipapillary infiltrates” and an atypical pattern of inner retinal folds. The recognition of these findings on OCT may help in the early diagnosis of neuroretinitis.
Sleep-Induced Apraxia of Eyelid Opening
Authors: Reggie Sara N. , Chen John J. , Lee Michael S. , Chung Sophia M. 
Published: April 2017

Background:
Apraxia of eyelid opening (AEO) primarily has been described as bilateral loss of volitional ability to open the eyes at certain times and often associated with neurodegenerative disease. Rarely, it can occur in isolation and as an idiopathic phenomenon. There are a few reports of unilateral AEO only on awakening from sleep. We report an additional 11 patients with this unusual variation of AEO.

Methods:
Retrospective, observational case series of patients collected from 3 separate neuro-ophthalmology practices.

Results:
All 11 patients were Caucasian women with a mean age of 59 years (range 35–80 years). All experienced AEO on awakening from sleep. Eight patients had unilateral AEO, and 3 had bilateral symptoms. The duration of episodes ranged from 3 weeks to several years. Ten of the patients reported manually elevating the eyelid to open it, while 1 patient waited for the eyelid to open spontaneously. After initial manual elevation, all patients reported normal function and position of the eyelids for the remainder of the day. Seven patients had a history of autoimmune disease. Slit-lamp and fundus examinations were negative for ocular pathology to explain the patients' symptoms, and 9 patients had unremarkable brain imaging.

Conclusions:
AEO occurring only on awakening from sleep is a rare entity. Neuroimaging and extensive laboratory testing are not indicated without associated neurologic or ocular findings. There may be a Caucasian female preponderance and autoimmune link in patients with AEO, but further studies are required.