bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Outcomes and Prognostic Factors of Complications in Takayasu Arteritis
Authors: Comarmond Cloé , Biard Lucie , Lambert Marc , Mekinian Arsène , Ferfar Yasmina , Kahn Jean-Emmanuel , Benhamou Ygal , Chiche Laurent , Koskas Fabien , Cluzel Philippe , Hachulla Eric , Messas Emmanuel , Resche-Rigon Matthieu , Cacoub Patrice , Mirault Tristan , Saadoun David 
Published: July 2017

Background:
Because of the wide variation in the course of Takayasu arteritis (TA), predicting outcome is challenging. We assess long-term outcome and prognosis factors for vascular complications in patients with TA.

Methods:
A retrospective multicenter study of characteristics and outcomes of 318 patients with TA fulfilling American College of Rheumatology and Ishikawa criteria was analyzed. Factors associated with event-free survival, relapse-free survival, and incidences of vascular complications were assessed. Risk factors for vascular complications were identified in a multivariable model.

Results:

The median age at TA diagnosis was 36 [25–47] years, and 276 patients (86.8%) were women. After a median follow-up of 6.1 years, relapses were observed in 43%, vascular complications in 38%, and death in 5%. Progressive clinical course was observed in 45%, carotidodynia in 10%, and retinopathy in 4%. The 5- and 10-year event-free survival, relapse-free survival, and complication-free survival were 48.2% (42.2; 54.9) and 36.4% (30.3; 43.9), 58.6% (52.7; 65.1) and 47.7% (41.2; 55.1), and 69.9% (64.3; 76.0) and 53.7% (46.8; 61.7), respectively. Progressive disease course (
P
=0.018) and carotidynia (
P
=0.036) were independently associated with event-free survival. Male sex (
P
=0.048), elevated C-reactive protein (
P
=0.013), and carotidynia (
P
=0.003) were associated with relapse-free survival. Progressive disease course (
P
=0.017), thoracic aorta involvement (
P
=0.009), and retinopathy (
P
=0.002) were associated with complication-free survival.

Conclusions:
This nationwide study shows that 50% of patients with TA will relapse and experience a vascular complication ≤10 years from diagnosis. We identified specific characteristics that identified those at highest risk for subsequent vascular complications.
Detecting Intracranial Vessel Wall Lesions With 7T-Magnetic Resonance Imaging
Authors: Harteveld Anita A. , van der Kolk Anja G. , van der Worp H. Bart , Dieleman Nikki , Zwanenburg Jaco J.M. , Luijten Peter R. , Hendrikse Jeroen 
Published: July 2017

Background and Purpose—
Vessel wall magnetic resonance imaging sequences have been developed to directly visualize the intracranial vessel wall, enabling detection of vessel wall changes, including those that have not yet caused luminal narrowing. In this study, vessel wall lesion burden was assessed in patients with recent posterior circulation ischemia using 7T-magnetic resonance imaging and compared with matched healthy controls.

Methods—
Fifty subjects (25 patients and 25 matched healthy controls) underwent 7T-magnetic resonance imaging with an intracranial vessel wall sequence before and after contrast administration. Two raters scored the presence and contrast enhancement of arterial wall lesions in individual segments of the circle of Willis and its primary branches. Total burden and distribution of vessel wall lesions and lesion characteristics (configuration, thickening pattern, and contrast enhancement) were compared both between and within both groups.

Results—

Overall, vessel wall lesion burden and distribution were comparable between patients and controls. Regarding individual arterial segments, only vessel wall lesions in the posterior cerebral artery were more frequently observed in patients (18.0%) than in controls (5.4%;
P
=0.003). Many of these lesions showed enhancement, both in patients (48.9%) and in controls (43.5%;
P
=0.41). In patients, the proportion of enhancing lesions was higher in the posterior circulation (53.3%) than in the anterior circulation (20.6%;
P
=0.008).

Conclusions—
Although overall intracranial vessel wall lesion burden and contrast enhancement were comparable between patients with recent posterior circulation ischemia and healthy controls, this study also revealed significant differences between the 2 groups, suggesting an association between posterior circulation lesion burden/enhancement and ischemic events.

Clinical Trial Registration—

URL:
http://www.trialregister.nl
. Unique identifier: NTR5688.
MJO Propagation Shaped by Zonal Asymmetric Structures: Results from 24 GCM Simulations
Authors: Wang Bin , Lee Sun-Seon 
Published: July 2017

Abstract
Eastward propagation is an essential characteristic of the Madden–Julian oscillation (MJO). Yet, simulation of MJO propagation in general circulation models (GCMs) remains a major challenge and understanding the causes of propagation remains controversial. The present study explores why the GCMs have diverse performances in MJO simulation by diagnosis of 24 GCM simulations. An intrinsic linkage is found between MJO propagation and the zonal structural asymmetry with respect to the MJO convective center. The observed and realistically simulated MJO eastward propagations are characterized by stronger Kelvin easterly waves than Rossby westerly waves in the lower troposphere, which is opposite to the Gill pattern where Rossby westerly waves are 2 times stronger than Kelvin easterly waves. The GCMs simulating stronger Rossby westerly waves tend to show a stationary MJO. MJO propagation performances are robustly correlated with the quality of simulated zonal asymmetries in the 850-hPa equatorial zonal winds, 700-hPa diabatic heating, 1000–700-hPa equivalent potential temperature, and convective instability. The models simulating realistic MJO propagation are exemplified by an eastward propagation of boundary layer moisture convergence (BLMC) that leads precipitation propagation by about 5 days. The BLMC stimulates MJO eastward propagation by preconditioning and predestabilizing the atmosphere, and by generating lower-tropospheric heating and available potential energy to the east of precipitation center. The MJO structural asymmetry is generated by the three-way interaction among convective heating, moisture, and equatorial wave and boundary layer dynamics. In GCMs, differing convective heating representation could produce different MJO structural asymmetry, and thus different propagations. Diagnosis of structural asymmetry may help revealing the models’ deficiency in representing the complex three-way interaction processes, which involves various parameterized processes.
The Chilean Coastal Orographic Precipitation Experiment: Observing the Influence of Microphysical Rain Regimes on Coastal Orographic Precipitation
Authors: Massmann Adam K. , Minder Justin R. , Garreaud René D. , Kingsmill David E. , Valenzuela Raul A. , Montecinos Aldo , Fults Sara Lynn , Snider Jefferson R. 
Published: July 2017

Abstract
The Chilean Coastal Orographic Precipitation Experiment (CCOPE) was conducted during the austral winter of 2015 (May–August) in the Nahuelbuta Mountains (peak elevation 1.3 km MSL) of southern Chile (38°S). CCOPE used soundings, two profiling Micro Rain Radars, a Parsivel disdrometer, and a rain gauge network to characterize warm and ice-initiated rain regimes and explore their consequences for orographic precipitation. Thirty-three percent of foothill rainfall fell during warm rain periods, while 50% of rainfall fell during ice-initiated periods. Warm rain drop size distributions were characterized by many more and relatively smaller drops than ice-initiated drop size distributions. Both the portion and properties of warm and ice-initiated rainfall compare favorably with observations of coastal mountain rainfall at a similar latitude in California. Orographic enhancement is consistently strong for rain of both types, suggesting that seeding from ice aloft is not a requisite for large orographic enhancement. While the data suggest that orographic enhancement may be greater during warm rain regimes, the difference in orographic enhancement between regimes is not significant. Sounding launches indicate that differences in orographic enhancement are not easily explainable by differences in low-level moisture flux or nondimensional mountain height between the regimes.
Diagnostic Laryngeal Electromyography: The Wake Forest Experience 1995–1999
Authors: Koufman James A. , Postma Gregory N. , Whang Chris S. , Rees Catherine J. , Amin Milan R. , Belafsky Peter C. , Johnson Paul E. , Connolly Kieran M. , Walker Francis O. 
Published: July 2017

BACKGROUND:Laryngeal electromyography (LEMG) is a valuable diagnostic/prognostic test for patients with suspected laryngeal neuromuscular disorders.OBJECTIVE:To report our experience with diagnostic LEMG at the Center for voice Disorders of Wake Forest University and to evaluate the impact of LEMG on clinical management.METHODS:Retrospective chart review of 415 patients who underwent diagnostic LEMG over a 5‐year period (1995–1999).RESULTS:Of 415 studies, 83% (346 of 415) were abnormal, indicating a neuropathic process. LEMG results altered the diagnostic evaluation (eg, the type of radiographic imaging) in 11% (46 of 415) of the patients. Unexpected LEMG findings (eg, contralateral neuropathy) were found in 26% (107 of 415) of the patients, and LEMG results differentiated vocal fold paralysis from fixation in 12% (49 of 415). Finally, LEMG results altered the clinical management (eg, changed the timing and/or type of surgical procedure) in 40% (166 of 415) of the patients.CONCLUSIONS:LEMG is a valuable diagnostic test that aids the clinician in the diagnosis and management of laryngeal neuromuscular disorders.
The Importance of Hyaluronic Acid in Vocal Fold Biomechanics
Authors: Chan Roger W. , Gray Steven D. , Titze Ingo R. 
Published: July 2017

OBJECTIVE:This study examined the influence of hyaluronic acid (HA) on the biomechanical properties of the human vocal fold cover (the superficial layer of the lamina propria).STUDY DESIGN:Vocal fold tissues were freshly excised from 5 adult male cadavers and were treated with bovine testicular hyaluronldase to selectively remove HA from the lamina propria extracellular matrix (ECM). Linear viscoelastic shear Properties (elastic shear modulus and dynamic viscosity) of the tissue samples before and after enzymatic treatment were quantified as a function of frequency (0.01 to 15 Hz) by a parallel‐plate rotational rheometer at 37°C.RESULTS:On removing HA from the vocal fold ECM, the elastic shear modulus (G′) or stiffness of the vocal fold cover decreased by an average of around 35%, while the dynamic viscosity (η′) Increased by 70% at higher frequencies (>1 Hz).CONCLUSION:The results suggested that HA plays an important role in determining the blomechanical properties of the vocal fold cover. As a highly hydrated glycosaminoglycan in the vocal fold ECM, it likely contributes to the maintenance of an optimal tissue viscosity that may facilitate phonation, and an optimal tissue stiffness that may be important for vocal fundamental frequency control.SIGNIFICANCE:HA has been proposed as a potential bioimplant for the surgical repair of vocal fold ECM defects (eg, vocal fold scarring and sulcus vocalis). Our results suggested that such clinical use may be potentially optimal for voice production from a blomechanical perspective.
Long‐Term Results of the First 500 Cases of Acoustic Neuroma Surgery
Authors: Wiet Richard J. , Mamikoglu Bulent , Odom Linda , Hoistad Dick L. 
Published: July 2017

OBJECTIVE:This retrospective study focuses on 2 outcome results after surgical intervention for acoustic neuroma: (1) facial nerve status, and (2) hearing preservation.STUDY DESIGN:A total of 484 patients with an acoustic neuroma.RESULTSPostoperative facial nerve outcomes were significantly different (P < 0.001) according to the size of the tumors. Tumor size had even more influence on the immediate postoperative results. In addition, statistical significance (P < 0.05) was demonstrated in comparing facial nerve outcomes with the surgeon's surgical experience. We also noted that as the patient's age increases, the likelihood for facial dysfunction may increase for all postoperative intervals. The overall success rate of retaining useful hearing was 27% (26 of 95). Class A hearing was retained in 66% (W of 15) of cases operated on through middle fossa approach in the last 5 years.CONCLUSION:This study demonstrates that tumor size and surgeon's experience are the most significant factors influencing the facial nerve status and hearing outcome after removal of acoustic neuroma. (Otolaryngol Head Neck Surg 2001;124:645–51.)
Transnasal Mucosal Flap Rotation Technique for Repair of Posterior Choanal Atresia
Authors: Dedo Herbert H. 
Published: July 2017

PURPOSE:To describe improved surgical treatment for posterior choanal atresia (PCA) by creating mucosal flaps with the aid of operating microscope, CO2 laser, self‐retaining nasal retractor, and stenting with a flat polytetrafluoroethylene (Teflon) keel.MATERIALS AND METHODS:Retrospective study of 19 patients with PCA, their ages ranging from 6 days to 4 years 4 months at the time of first repair, representing a total of 32 PCA repairs. Four patients had unilateral PCA, and one did not return for follow‐up and could not be located. A transnasal microscopic approach uses a myringotomy knife or CO2 laser to create an anterior mucosal flap; the CO2 laser is also used to remove any bone plate and to create the posterior flap. The flaps then are rotated into position and are kept separated by a flat Teflon keel instead of a traditional round stent to avoid pressure necrosis. When a stable epithelialized opening (2 × 2 to 3 × 4 mm) is created, it is enlarged by subsequent staged transnasal CO2 laser submucosal scar excisions with preservation of the overlying mucosa. This creates rotation or sliding flaps to speed healing and prevents circumferential scar contraction.RESULTS:Eighteen patients were re‐examined after periods of 3 months to more than 5 years from when their first epithelialized orifice was created with nasal endoscopy to measure the final orifice size. All 18 patients had clinically adequate‐to‐good bilateral nasal airways at the latest follow‐up with an average orifice size of 3 × 5 mm and a range of 2 × 2 to 4 × 10 mm. This “same day surgery” technique with staged procedures provides similar or better patency rates than a single transpalatal approach but with less surgical morbidity. It has a much lower restenosis rate than the transnasal puncture or PCA excision with prolonged round tube stenting and multiple dilation technique.
A Comparison of Retention and Complication Rates of Large‐Bore (Paparella II) and Small‐Bore Middle Ear Ventilating Tubes
Authors: Klingensmith Mark R. , Strauss Melvin , Conner George H. 
Published: July 2017

Large‐bore myringotomy tubes are usually reserved for the treatment of refractory middle ear effusion. Theoretically, they have an extended intubation time and a higher complication rate. There is, however, scant support of this in the literature. The duration of intubation, efficacy, and complication rates of the large‐bore Paparella type II tube were compared with Paparella type I, Shepard, and Armstrong tubes. The study included 242 patients with 600 intubations. In addition, a subpopulation of patients receiving their initial intubation during this study was reviewed. Findings were similar for both groups. Paparella type II tubes had a prolonged period of intubation and a decreased reintubation rate when compared with the smaller bore tubes. Larger bore tubes had an increased complication rate when compared with the smaller bore tubes. Complications included occasional or frequent otorrhea and an increased rate of permanent perforation of the tympanic membrane. There was no instance of cholesteatoma formation secondary to intubation. Guidelines are presented for the use of the Paparella type II tube.
Normal Nasal Resistance
Authors: Pallanch John F. , McCaffrey Thomas V. , Kern Eugene B. 
Published: July 2017

Eighty normal adults without nasal symptoms were studied to determine normal nasal resistance values and the variation of nasal resistance in normal adults. A microprocessor‐based system for collection and analysis of transnasal pressure and flow was used to obtain nasal resistance values. Unilateral and total transnasal pressure and flow values were determined before and after decongestion of the nose with 1% phenylephrine spray. The distribution of the 80 resistance values was found to be skewed to the right. Log transformation of the resistance values was the best method to normalize their distribution. The mean and variation of normal nasal resistance are reported at flows of 0.1 and 0.2 L/sec, at pressures of 0.5 and 1 cm H2O, and at radii of 1, 2, and 3 on the pressure‐flow curve.
Feasibility of an Epidemiologic Study of Submariners Who Received Radium Irradiation Treatment
Authors: Kang Han K. 
Published: July 2017

Thousands of World War II veterans reportedly received nasopharyngeal irradiation with radium‐tipped applicators for treatment of middle ear pressure problems known as aerotitis media. Because of concerns about adverse health effects of radiation exposure, including the increased risk of head and neck cancer, the feasibility of identification of a large number of veterans with documented exposure for an epidemiologic study was investigated. The irradiation treatments were found to have occurred at the New London Naval Medical Research Department, at several Naval Hospitals, and aboard ships during the period from 1945 to 1952. Documentation of the treatment on veterans' medical records was sparse and inconsistent. Only 8 of 668 records reviewed were found to have evidence of the radium treatment: 7 from 33 self‐reported veterans and 1 from 635 names on submarine school class rosters and submarine muster rolls. There appears to be no practical way to identify from military service and medical records a large number of submariners who received the treatment.
Navy Review of Nasopharyngeal Radium Treatments of Submarine Candidates
Authors: George Capt J. D. 
Published: July 2017

From approximately 1945 through 1960 nasopharyngeal radium treatments were used to treat barotrauma incurred during submarine escape training by submarine candidates. Concern has been expressed that the treatments placed submarine candidates at significantly Increased risk of having brain cancer develop. The concern is based on brain cancer incidence rates reported in a study of Washington County children. Using comparable populations' risk coefficients and secondary brain tumor incidence rates, the excess number of brain cancers per 10,000 subjects during the 42.5 years after treatment was calculated to be 0.5 to 2.8 cases and 1 case, respectively. Personnel records of a sample of those treated and others whose treatment status was unknown were reviewed to determine the feasibility of an epidemiologic study to confirm the cancer risk. The records indicated treatments were not consistently documented to confirm who was treated. In addition, social security numbers are not known to aid in determination of vital status. In conclusion, nasopharyngeal irradiation does not appear to pose a significant risk to submariners, and it is not feasible to use the submariner population to do a meaningful epidemiologic Study to Clarify the cancer risk.
New Strategies Using ‘Low-Dose’ Mycophenolate Mofetil to Reduce Acute Rejection in Patients following Kidney Transplantation
Authors: Ulsh Paula J. , Yang Harold C. , Holman Michael J. , Ahsan Nasimul 
Published: July 2017

Context Tacrolimus, microemulsion cyclosporine (Neoral), and mycophenolate mofetil (MMF) at 2 and 3 grams daily have demonstrated superior immunosuppressive properties in several recent clinical trials involving solid-organ transplants. An effective immunosuppression may be maintained with lower doses of MMF administered with either tacrolimus or microemulsion cyclosporine. Objective To compare tacrolimus plus “low-dose” MMF-based immunosuppressive regimen (TMBIR) with Neoral plus “low-dose” MMF-based immunosuppressive regimens (NMBIR) among kidney transplant recipients. Design Prospective, randomized study. Patients 53 consecutive adult recipients of kidney transplant. Both groups (TMBIR and NMBIR) were equally matched on demographic characteristics. Interventions Participants were randomized to receive orally either tacrolimus (0.08 mg/kg twice daily) (n=27) or Neoral (4 mg/kg twice daily) (n=26). Both regimens were started before surgery and continued when allograft demonstrated no postoperative acute tubular necrosis. Both groups received similar “low-dose” MMF (500 mg twice daily) and prednisone (2 mg/kg/day to taper off after 1 year). Switch from tacrolimus to Neoral or vice versa was allowed after refractory rejection or serious adverse events. Main Outcome Measure Acute rejection and patient and graft survival 1 year following kidney transplant. Results One-year patient survival rates were 88.9% for the TMBIR group and 100% for the NMBIR group; 1-year graft survival rates were 88.9% for the TMBIR group and 96.1% for the NMBIR group. No significant differences were found in the incidence of biopsy-confirmed acute rejection (14.8% TMBIR vs 23% NMBIR). Steroid-resistant rejections requiring cytolytic antibody therapy were higher in the NMBIR group (50% vs 25%). Three patients crossed over from NMBIR to TMBIR for refractory rejections and 1 patient crossed over from TMBIR to NMBIR for new onset seizure. Three episodes of cytomegalovirus infection were observed in the TMBIR group. Other adverse events were similar in both groups. Conclusions Both tacrolimus and microemulsion cyclosporine combined with “low-dose” MMF and corticosteroids provide effective immunosuppression and have similar adverse events in kidney transplant recipients.
Ethical Analysis of Organ Recovery Denials by Medical Examiners, Coroners, and Justices of the Peace
Authors: Shafer Teresa J. , Schkade Lawrence L. , Siminoff Laura A. , Mahoney Timothy A. 
Published: July 2017

Context Despite its pivotal nature, until the early 1990s the role of medical examiners, coroners, and justices of the peace was largely ignored in discussions of the critical shortage of organs for transplantation in the United States. These officials have the right to determine, from a medico-legal perspective, whether a deceased person can be an organ donor. Thus, they play an important role in the donation process. Using a principles-based ethical framework, this article examines the problem of nonrecovery of life-saving organs for transplantation in the United States because a medical examiner or other official denies recovery. Objective The goals of organ donation and the collection of forensic evidence are not mutually exclusive. An analysis of the ethical principles and obligations of beneficence, respect for autonomy, and justice reveals that medical examiners and other officials could probably, after appropriate review, release all cases under their jurisdiction for organ donation. Conclusion Medical examiners, coroners, and justices of the peace could assume a leadership role, working together on public policy with medical, social, and legal groups, spearheading efforts to stop the loss of organs due to official denials, up to and including state and federal regulation and legislation. Beyond their professional obligations, as agents of a social institution, medical examiners and other officials have the more general ethical responsibility of promoting the public health and welfare and of reinforcing societal consensus that transplantation is a social good which should be optimized through formal and informal activities.