bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meta-analysis of Cochlear Implantation Outcomes Evaluated With General Health-related Patient-reported Outcome Measures
Authors: McRackan Theodore R. , Bauschard Michael , Hatch Jonathan L. , Franko-Tobin Emily , Droghini Harris Richard , Velozo Craig A. , Nguyen Shaun A. , Dubno Judy R. 
Published: December 2017

Objective:
Determine the change in general health-related quality of life (HRQOL) after cochlear implantation and association with speech recognition.

Study Design:
Meta-analysis.

Methods:
Search was performed following the PRISMA statement using PubMed, Medline, Scopus, and CINAHL. Studies on adult cochlear implant (CI) patients measuring HRQOL before and after cochlear implantation were included. Standardized mean difference (SMD) for each measure and pooled effects were determined. A meta-analysis of correlations was also performed between all non-disease-specific patient-reported outcome measures (PROMs) and speech recognition after cochlear implantation.

Results:
Twenty-two articles met criteria for meta-analysis of HRQOL improvement, but 15 (65%) were excluded due to incomplete statistical reporting. From the seven articles with 274 CI patients that met inclusion criteria, pooled analyses showed a medium positive effect of cochlear implantation on HRQOL (SMD = 0.79). Subset analysis of the HUI-3 measure showed a large effect (SMD = 0.84). Nine articles with 550 CI patients met inclusion criteria for meta-analysis of correlations between non-disease specific PROMs and speech recognition after cochlear implantation. Pooled analysis showed a low correlation between non-disease-specific PROMs and word recognition in quiet (r = 0.35), sentence recognition in quiet (r = 0.40), and sentence recognition in noise (r = 0.32).

Conclusion:
Although regularly used, HRQOL measures are not intended to measure nor do they accurately reflect the complex difficulties facing CI patients. Only a medium positive effect of cochlear implantation on HRQOL was observed along with a low correlation between non-disease-specific PROMs and speech recognition. The use of such instruments in this population may underestimate the benefit of cochlear implantation.
Mobile Hearing Testing Applications and the Diagnosis of Sudden Sensorineural Hearing Loss: A Cautionary Tale
Authors: Sethi Rosh K. V. , Ghanad Iman , Kanumuri Vivek , Herrmann Barbara , Kozin Elliott D. , Remenschneider Aaron K. 
Published: December 2017

Objective:
Mobile hearing applications (apps) are available for hearing testing, personal sound amplification, as well as hearing aid modulation. Hearing testing apps are gaining popularity, especially in resource-limited settings. The reliability of mobile hearing testing apps, however, is not well characterized.

Patients/interventions:
A case study of a single patient with a complaint of sudden hearing loss presenting to a tertiary-care hospital.

Main Outcome Measure:
Comparison of a mobile hearing testing app results with standard audiogram.

Results:
A commercially available mobile hearing testing app was used after hours to determine if a patient's hearing complaints were consistent with sudden sensorineural hearing loss. The hearing app produced a rudimentary audiogram that was consistent with unilateral SSNHL. Given contraindications to oral treatment, preparations for possible intratympanic dexamethasone after a full audiometric evaluation were completed. Confirmatory audiogram the following day demonstrated normal hearing without evidence of hearing loss. Steroid treatment was aborted and appropriate counseling provided.

Conclusion:
While mobile hearing testing apps offer improved access to hearing screening in resource-limited settings, caution must be exercised when interpreting data and making clinical decisions based upon results. The role of professional audiologists remains critical. Further testing and validation of specific apps is required.
Photopolymerized Microfeatures Guide Adult Spiral Ganglion and Dorsal Root Ganglion Neurite Growth
Authors: Xu Linjing , Seline Alison E. , Leigh Braden , Ramirez Mark , Guymon C. Allan , Hansen Marlan R. 
Published: December 2017

Hypothesis:
Microtopographical patterns generated by photopolymerization of methacrylate polymer systems will direct growth of neurites from adult neurons, including spiral ganglion neurons (SGNs).

Background:
Cochlear implants (CIs) provide hearing perception to patients with severe to profound hearing loss. However, their ability to encode complex auditory stimuli is limited due, in part, to poor spatial resolution caused by spread of the electrical currents in the inner ear. Directing the regrowth of SGN peripheral processes towards stimulating electrodes could help reduce current spread and improve spatial resolution provided by the CI. Previous work has demonstrated that micro- and nano-scale patterned surfaces precisely guide the growth of neurites from a variety of neonatal neurons including SGNs. Here, we sought to determine the extent to which adult neurons likewise respond to these topographical surface features.

Methods:
Photopolymerization was used to fabricate methacrylate polymer substrates with micropatterned surfaces of varying amplitudes and periodicities. Dissociated adult dorsal root ganglion neurons (DRGNs) and SGNs were cultured on these surfaces and the alignment of the neurite processes to the micropatterns was determined.

Results:
Neurites from both adult DRGNs and SGNs significantly aligned to the patterned surfaces similar to their neonatal counterparts. Further DRGN and SGN neurite alignment increased as the amplitude of the microfeatures increased. Decreased pattern periodicity also improved neurite alignment.

Conclusion:
Microscale surface topographic features direct the growth of adult SGN neurites. Topographical features could prove useful for guiding growth of SGN peripheral axons towards a CI electrode array.
Cochlear Implantation in Chronic Otitis Media With Cholesteatoma and Open Cavities: Long-term Surgical Outcomes
Authors: Vashishth Ashish , Fulcheri Andrea , Prasad Sampath Chandra , Dandinarasaiah Manjunath , Caruso Antonio , Sanna Mario 
Published: December 2017

Objectives:
To evaluate the long-term surgical outcomes of cochlear implantation (CI) in chronic otitis media (COM) with cholesteatoma and open cavities using subtotal petrosectomy (STP). To review device explantation (DE) patients and reimplantation considerations.

Study Design:
Retrospective review.

Setting:
Otology and skull base center.

Patients and Methods:
Charts of 35 patients (36 ears) with COM with cholesteatoma, including open cavities, who underwent CI were reviewed for surgical outcomes and DE. Patient demographics, pathologies, previous surgeries, staging of implantation, salient intraoperative findings at the time of implantation and follow-up were evaluated. Details of patients with DE were evaluated for cause, operative findings, and reimplantation considerations.

Results:
Mean age of patients was 65.94 years. Nineteen open cavities, 11 primary cholesteatomas, 3 petrous bone cholesteatomas, and 3 atelectatic middle ears represented the pathologies with 31 patients of CI with concurrent STP and 5 patients where implantation was staged. The mean follow-up was 7.16 years ranging from 2 to 13 years. Four patients (11%) had DE due to extrusion and cavity infection with three reimplanted in same or contralateral ear. All explantations occurred within 24 months of primary implantation. No residual or recurrent cholesteatoma was observed in any of the patients during follow-up.

Conclusion:
CI is feasible in COM with cholesteatoma and open cavities with the use of STP and single-stage implantation can be performed in the absence of purulence. Despite low risk of residual cholesteatoma post meticulous disease removal, risk of DE remains, particularly in open cavity patients, and is higher than standard implantation. Reimplantation is often possible with careful considerations.
Heat Shock Proteins in Human Perilymph: Implications for Cochlear Implantation
Authors: Schmitt Heike , Roemer Ariane , Zeilinger Carsten , Salcher Rolf , Durisin Martin , Staecker Hinrich , Lenarz Thomas , Warnecke Athanasia 
Published: December 2017

Objective:
Biomarkers reflecting the etiology and pathophysiology of inner ear diseases are limited. Evaluation of proteins in the perilymph may improve our understanding of inner ear disease. Heat shock proteins (HSP) belong to a superfamily of stress proteins and promote refolding of denatured proteins. The aim of the study was to analyze HSP in human perilymph and to identify possible correlation with audiological and etiologic data.

Methods:
Sampling of the perilymph was performed during cochlear implantation and vestibular schwannoma removal. Individual proteins were identified by a shot-gun proteomics approach by orbitrap mass spectrometry. Expression of HSP genes was determined in human cochlear tissue that was obtained during transcochlear surgeries.

Results:
Ten subgroups of HSP were identified in human perilymph samples. Increased levels of HSP were detected in a higher percentage in the perilymph of patients with residual hearing when compared with patients with no residual hearing in cochlear implantation. In patients with complete preservation of residual hearing, HSP 90 is identified in a lower percentage whereas HSP 70 1A/1B and 6 was identified in all the samples. Constitutive expression of HSP family members was verified in normal cochlear tissue.

Conclusion:
The 10 HSP variants are not identified in all the perilymph samples, but in a higher proportion in patients with residual hearing compared with patients with no residual hearing. In-depth proteome analysis of perilymph samples in correlation to patients’ audiogram data shows an increased concentration of HSP in patients with residual hearing. An increase in specific HSP in patients with loss of residual hearing after cochlear implantation was not observed.
High Resolution Three-Dimensional Delayed Contrast MRI Detects Endolymphatic Hydrops in Patients With Vertigo and Vestibular Schwannoma
Authors: Moayer Roxana , Ishiyama Gail P. , Karnezis Stellios , Sepahdari Ali R. , Ishiyama Akira 
Published: December 2017

Objective:
Advances in high resolution magnetic resonance imaging (MRI) have enabled the detection of endolymphatic hydrops (EH), a pathological ballooning of the endolymphatic fluid system, known to be associated with Menière's disease. When a patient has a known diagnosis of vestibular schwannoma and develops recurrent episodic vertigo spells, many surgeons recommend surgical intervention, attributing the vestibular symptoms to the vestibular schwannoma. The aim of this study is to evaluate the clinical outcome in patients with vestibular schwannoma and EH, treated medically, for recurrent spells of vertigo.

Patients:
Two patients with EH and vestibular schwannoma who presented with recurrent spells of vertigo are included. Both had characteristic low frequency hearing loss ipsilateral to the schwannoma.

Intervention:
MRI sequences with 3T scanner (Skyra, Siemens Healthcare, Erlangen, Germany) using high resolution three-dimensional delayed postcontrast protocol included “cisternographic” T2 and delayed intravenous-enhanced three-dimensional fluid-attenuation inversion recovery (DIVE-3D-FLAIR) sequences, performed with 2350 ms (bright perilymph) and 2050 ms (bright endolymph) inversion times and with subtracted images.

Main Outcome Measure:
MRI FLAIR evaluation of EH and presence or absence of vestibular symptoms.

Results:
Both patients had resolution of the disabling vertigo spells with a diuretic, and Patient 1 had unchanged EH, while Patient 2 had partial resolution of the EH and the FLAIR hyperintensity.

Conclusion:
When EH coexists with vestibular schwannoma in a patient presenting with recurrent vertigo spells, medical treatments for EH may alleviate the vestibular symptoms. We recommend that patients with small vestibular schwannomas who present with vertigo spells undergo high resolution MRI to evaluate for EH and undergo a trial of medical treatment with diuretics.
Cartilage Conduction Hearing Aids for Severe Conduction Hearing Loss
Authors: Nishimura Tadashi , Hosoi Hiroshi , Saito Osamu , Shimokura Ryota , Yamanaka Toshiaki , Kitahara Tadashi 
Published: December 2017

Objective:
To assess the benefits of a new type of hearing aid using cartilage conduction (CC) in patients with severe conduction hearing loss and evaluate its potential for practical use.

Study Design:
Consecutive, prospective case series.

Patients:
Forty-one subjects (21 with bilateral aural atresia; 15 with unilateral aural atresia; and 5 others) participated in this study.

Intervention:
Fitting and gain adjustments of the CC hearing aids were performed to the ear(s) with conduction hearing loss.

Main Outcome Measures:
The function gains were measured. Evaluation of the measurements of speech performance-intensity functions, speech recognition scores, tolerance of environmental noise, and subject questionnaires were also performed, and judged according to the “Guidelines for the evaluation of hearing aid fitting” established by the Japan Audiological Society.

Results:
The thresholds were significantly improved by CC hearing aids. The functional gains for CC hearing aids were nearly equivalent to that for their previously used hearing aids. The style of the transducer fixation and the type of aural atresia had no significant influence on the functional gains. Most of the assessment results were judged to be sufficient. Before the trial, bone conduction hearing aids had been used most frequently by bilateral aural atresia subjects. However, after the trial, most subjects continued to use CC hearing aids instead of reverting back to their original device. Overall, 39 subjects continued use of the CC hearing aids. No severe adverse effects were noted in the trial.

Conclusion:
Cartilage conduction hearing aids could be an additional and beneficial option for severe conduction hearing loss from aural atresia.
Early Outcomes With a Slim, Modiolar Cochlear Implant Electrode Array
Authors: McJunkin Jonathan L. , Durakovic Nedim , Herzog Jacques , Buchman Craig A. 
Published: December 2017

Objective:
To describe outcomes from cochlear implantation with a new, slim modiolar electrode array.

Study Design:
Retrospective cohort study.

Setting:
Tertiary referral centers.

Patients:
Adult cochlear implant candidates.

Interventions:
Cochlear implantation with CI532 (Cochlear Corp).

Main Outcome Measures:
Pre- and postoperative speech perception scores, operative details, and postoperative computed tomography (CT) reconstructions of array location.

Results:
One hundred seventeen patients are implanted to date. There were eight tip rollovers identified with intraoperative x-ray and resolved with reinsertion. An additional rollover was identified on postoperative CT. CT reconstructions in 17 of 23 patients showed complete scala tympani placement with a wrap factor of 58% (range 53–64%) and a mean insertion angle of 406 degrees (range 360–452 degrees). Three implants demonstrated array translocation with electrodes in the scala vestibuli. Consonant-nucleus-consonant word scores improved from 10% preoperatively to 48% at 3 months postoperatively. Pure-tone thresholds were preserved postoperatively in 37 to 52% of patients across frequencies from 250 to 4000 Hz. Functional pure-tone thresholds (≤80 dB) were recorded in 9 to 25% of patients.

Conclusion:
CI532 array insertion results in consistent scala tympani location and provides expected audiologic performance. Initial hearing preservation results are not consistent with current electro-acoustic arrays.
Effect of nutritional risk on short-term outcomes after laparoscopic-assisted gastrectomy: a prospective study from two centers
Authors: Chen Wei-Zhe , Chen Xi-Yi , Zhang Feng-Min , Dong Qian-Tong , Ji Yan-Bin , Chen Xiao-Lei , Zhuang Cheng-Le , Chen Xiao-Xi 
Published: December 2017

Background/aim
The aim of this prospective double-center study was to explore the effect of nutritional risk on short-term outcomes in the patients who had gastric cancer and underwent a laparoscopic-assisted gastrectomy.

Patients and methods
We conducted a study of patients who underwent laparoscopic-assisted gastrectomy in two large centers between June 2014 and April 2017. Patients’ demographic and clinical characteristics and postoperative short-term outcomes were prospectively analyzed. Patients were divided into two groups depend on the preoperative presence of nutritional risk. Clinical variables were compared. Univariate analyses and multivariate logistic regression analyses evaluating the risk factors for postoperative complications were performed.

Results
A total of 256 patients, comprising 187 males and 69 females, met the inclusion criteria and were included in this study. The mean age was 61.81 years, the average BMI was 22.44 kg/m2, and the average preoperative serum albumin was 39.42 g/l. Older age (P=0.001), higher tumor stage (P=0.047), lower BMI (P<0.001), lower preoperative serum albumin (P=0.005), and lower hemoglobin (P=0.013) were more common in the nutritional risk group. There were no significant differences in the short-term postoperative outcomes between nutritional risk and non-nutritional risk groups. Advanced age (P=0.024) and hypoalbuminemia (P=0.004) were independent risk factors for postoperative complications after laparoscopic-assisted gastrectomy.

Conclusion
Nutritional risk may not be a clinical predictor of short-term outcomes after laparoscopic-assisted gastrectomy. Advanced age and preoperative hypoalbuminemia were independent risk factors for grade II or more postoperative complications.
A systematic review and meta-analysis of second-line immunosuppressants for autoimmune hepatitis treatment
Authors: De Lemos-Bonotto Michele , Valle-Tovo Cristiane , Costabeber Ane M. , Mattos Angelo A. , Azeredo-da-Silva André L.F. 
Published: December 2017

Introduction
The gold-standard treatment for autoimmune hepatitis (AIH) is a prednisone/azathioprine combination. However, subgroups of patients may be unresponsive to this treatment. The aim of this study is to evaluate the efficacy of second-line immunosuppressive therapies for AIH through a systematic review and meta-analysis in adult patients.

Patients and methods
The systematic review was registered at the PROSPERO platform under number 42015019831. Databases MEDLINE (PubMed), Lilacs, Cochrane, and Scielo were searched. The keywords used were ‘Hepatitis, Autoimmune’ and descriptors terms (MeSH and DeCS). These terms were linked with each immunosuppressant of interest.

Results
A total of 1532 studies were identified. Of these, 1492 were excluded on the basis of title and abstract reading. Among the 40 studies retrieved for detailed full-text analysis, a total of 15 fulfilled the inclusion criteria for the analysis. The most studied second-line immunosuppressive was mycophenolate mofetil (MM). The mean reduction of aminotransferases was observed in 94.3% with tacrolimus/prednisone, 91.3% for cyclosporine/prednisone, 85.5% for budesonide, and 78.7% MM/prednisone. For MM/prednisone, the mean rate of histological remission was 88.6%, liver transplantation was indicated in 11.4%, and the mortality rate was 7.2%. Limitations were also present, such as the lack of randomized-controlled trials and prospective studies, the small number of patients, and the heterogeneity between remission criteria.

Conclusion
This is the first systematic review and meta-analysis to compare the second-line imunossupressant therapy for AIH. The most studied second-line immunosuppressive is the MM, with a reasonable histological remission. The use of combined tacrolimus/prednisone was the most effective for the normalization of aminotransferases.
Total bile acid levels are associated with left atrial volume and cardiac output in patients with cirrhosis
Authors: Voiosu Andrei M. , Wiese Signe , Voiosu Theodor A. , Hove Jens , Bendtsen Flemming , Møller Søren 
Published: December 2017

Background and aims
Bile acids (BAs) are potent signaling molecules involved in the regulation of several metabolic and functional aspects of cardiovascular homeostasis. BA pool alteration in cirrhosis may contribute toward the development of hemodynamic and cardiac disturbances. We aimed to investigate the association between total BA levels and echocardiographic and biochemical markers of cardiac dysfunction in cirrhotic patients.

Methods
Cirrhotic patients were enrolled prospectively in this hypothesis-generating study and evaluated for cardiac and hemodynamic dysfunction through clinical, echocardiographic, and biochemical means. Associations between total serum BA concentrations and markers of systolic or diastolic dysfunction and the presence of cirrhotic cardiomyopathy were tested through univariate and multivariate analyses.

Results
Fifty-eight patients with cirrhosis were assessed in this monocentric study. 49 (85%) patients had decompensated cirrhosis according to the Child class. The median total BA level was 45 µmol/l. There was no correlation between BA levels and the etiology of cirrhosis (P=0.2), current alcohol use (P=0.8), sex (P=0.1), smoking status (P=0.2), age, or BMI. Systolic and diastolic dysfunction were rare in the cohort. Total BA levels associated with several echocardiographic parameters of the hyperdynamic syndrome in univariate analysis but only with left atrial volume in multivariate analysis (P=0.007). BA concentrations did not differ according to the presence of echocardiographically diagnosed cirrhotic cardiomyopathy in the two models tested.

Conclusion
Total serum BA levels are associated with enlarged left atrial volume and markers of the hyperdynamic circulation in patients with cirrhosis irrespective of the etiology or the severity of liver disease.
Physician and Nurse Perceptions of Gentle Cesarean Birth
Authors: Mercier Rebecca J. , Durante Julia C. 
Published: December 2017

Abstract

Background:
Protocols for neonatal care and mother–baby interaction at cesarean birth frequently differ from those at vaginal birth. There is increasing interest in adopting family-friendly or gentle protocols for women having cesarean birth. Current evidence suggests challenges in achieving interdepartmental cooperation and consensus are potential barriers to implementing gentle cesarean protocols.

Purpose:
To describe how care providers' professional role and characteristics may affect perception about gentle cesarean birth techniques and inform specific concerns about protocol changes.

Study Design and Methods:
A cross-sectional survey with mixed-methods analysis incorporating quantitative and qualitative conventional content analysis was used. A structured survey was distributed via email to all care providers on the labor and birth unit, including attending physicians, resident physicians in training, fellows, labor nurses, respiratory therapists, and operating room technicians. Quantitative responses were analyzed with bivariable tests and logistic regression to describe associations between provider attitudes and provider characteristics. Open-ended responses were analyzed with conventional content analysis to develop a model describing influences on overall provider attitudes.

Results:
Physicians and nurses generally have positive attitudes on benefits of gentle cesarean techniques. Their perceptions overall are informed by the balance of concerns about patient safety and logistical challenges versus perceived benefits of the techniques. On an individual level, care provider demographic and professional characteristics of gender and prior experience affected attitudes more than their specific role in patient care.

Clinical Implications:
Most labor and birth care providers have positive attitudes about gentle cesarean birth. Implementation of such programs should prioritize patient safety, educate physician and nurses about potential benefits for patients, and use experienced physicians and nurses as ambassadors to increase acceptance.