bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severity of Voice Handicap in Children Diagnosed with Elevated Lesions
Authors: Carroll Linda M. , Mudd Pamela , Zur Karen B. 
Published: August 2013

ObjectiveThis study sought to determine the impact of voice disability on children with elevated vocal fold lesions (nodules, cysts, polyps). The Pediatric Voice Handicap Index (pVHI) was used to assess the impact on functional, physical, and emotional aspects of voice and oral communication. The degree of talkativeness and overall severity of dysphonia were also determined.Study DesignCase series with chart review of children evaluated at a voice clinic from 2007 to 2011.SettingTertiary specialized children's hospital.Subjects and MethodsMedical records of 33 children (11 girls, 22 boys) diagnosed with an elevated vocal fold lesion by a pediatric laryngologist were reviewed for voice disability using the pVHI. The pVHI is a parental proxy of perceived voice handicap in functional, physical, and emotional aspects and includes a talkativeness rating scale and visual analog overall severity rating of voice (VAS). Data were examined for young children (age 2‐5 years), children (age 6‐10 years), and adolescents (age 11‐17 years).ResultsThe VAS was significantly correlated with pVHI‐total. There was no significant difference between age groups for overall pVHI (mean, 29.3) or talkativeness, but all groups had significantly higher functional disability (mean, 16) compared with physical (mean, 8.2) or emotional (mean, 5.1) disability.ConclusionsChildren across all age groups with elevated vocal fold lesions have significant voice disability, greatest for functional aspects of voice. Voice care team professionals must recognize the functional impact of dysphonia on the pediatric patient.
Therapeutic Efficacy of the Combination of Intratympanic Methylprednisolone and Oral Steroid for Idiopathic Sudden Deafness
Authors: Gundogan Onur , Pinar Ercan , Imre Abdulkadir , Ozturkcan Sedat , Cokmez Ozge , Yigiter Ali Cihan 
Published: August 2013

ObjectiveThe purpose of this study was to compare the efficacy of systemic steroid alone and combined with intratympanic methylprednisolone in the treatment of patients with idiopathic sudden sensorineural hearing loss.Study DesignProspective, randomized controlled trial.SettingsKatip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.Subject and MethodsSeventy‐nine patients who met the inclusion criteria for idiopathic sudden sensorineural hearing loss were included in this study. Patients were randomly divided into 2 groups according to treatment: group A received combination therapy (intratympanic methylprednisolone + oral steroid) and group B received oral steroid alone. Of the 79 patients included, 6 patients missed the 1‐month follow‐up visit. Overall, 73 patients (37 combination group, 36 oral steroid group) who completed the 1‐month follow‐up and study intervention were included in the per‐protocol analysis. Both the relationship between certain prognostic factors and the clinical outcome after treatment were analyzed.ResultsCombination therapy showed significant hearing improvement and speech discrimination scores compared with the use of systemic steroids alone (P <. 05). In hearing outcomes in patients with severe hearing loss, combination therapy had statistically significant hearing improvement compared with oral steroid alone (P <. 05).ConclusionWe recommend that combination therapy can be considered as initial treatment especially for patients with severe hearing loss.
Attention deficit/hyperactivity disorder after neonatal surgery: review of the pathophysiology and risk factors
Authors: Sistino JJ 
Published: August 2013

There are many factors that influence the long-term neurological outcomes in children following cardiac surgery. Because there is also complex interaction between these many factors, it is difficult to assess which are primary and modifiable and which can be used to make improvements in outcomes. As survival after complex neonatal heart surgery has increased, the number of children with long-term neurological deficits is becoming more evident and this affects quality of life for children and their families. One area of long-term assessment is the incidence of attention deficit/hyperactivity disorder (ADHD). The incidence rate for ADHD following pediatric cardiac surgery is significantly higher than the normal rate for children of the same age. Because this is a measureable long-term outcome, it can be used to evaluate methods for cerebral protection during surgery as well as the timing of surgical procedures to maximize cerebral oxygen levels. This paper will review the pathophysiological basis for ADHD in this population, based on the similarities between neonatal cardiac surgical patients and pre-term infants. Both populations have an increased risk for ADHD and the etiology and pathological changes in pre-term infants have been widely investigated over the past 25 years. The rate of ADHD in this population is a window into the effects of these pathological changes on long-term outcomes. Reducing the incidence of ADHD in the future in this population should be a primary goal in developing and assessing new cerebral protective strategies during cardiac surgery.
Robust Revascularization, Despite Impaired VEGF Production, After Meniscus Allograft Transplantation in Rabbits
Authors: Xue Chao , Zhang Lei , Shuang Feng , Zhang Yadong , Zhang Yichao , Luo Dianzhong , Kang Xiaoqi , Wang Xishun , Hou Shuxun , Zhong Hongbin 
Published: August 2013

Background: Little is known about vascularization restoration and vascular circulation after allogenic graft transplantation, which are both important prerequisites for optimal use of allograft meniscus transplantation. Purpose: To study vascularization restoration through autograft and allograft meniscus models in Oryctolagus cuniculus. Study Design: Controlled laboratory study. Methods: Forty-eight rabbits at mature bone age were randomized to receive either an autograft or allograft after the meniscus of the left knee was completely resected. Vascularization, blood circulation, histological characteristics of the grafted meniscus and surrounding tissues, and vascular endothelial growth factor (VEGF) expression in the meniscus were assessed at 4, 8, and 12 weeks after allograft or autologous transplantation. Results: The grafted meniscus was in good condition and was well connected to the surrounding joint capsule, and no obvious damage of the joint cartilage at the tibial plateau was observed. Even though the revascularization pattern was similar in the 2 groups, the meniscus body showed vessel growth mainly at the adhesion margin for less than one-third of the meniscus transverse diameter, and no significant vascular distribution was found at the free margin. Blood circulation peaked after 8 weeks at the anterior and posterior horns and declined thereafter. This was mimicked by VEGF expression, which showed a progressive decrease with time, even though the vascular endothelial cells gradually increased over time. There were no statistical differences in the various assessments between the allograft and autograft groups. Conclusion: At 12 weeks after meniscus allografting, the vascular circulation had almost recovered and gradual reconstruction of cells and fibers had begun, mimicking similar observations in the autograft group. Clinical Relevance: Our data provide test reference for clinical rehabilitation after meniscus autograft.
Elevation in Circulating Biomarkers of Cartilage Damage and Inflammation in Athletes With Femoroacetabular Impingement
Authors: Bedi Asheesh , Lynch Evan B. , Sibilsky Enselman Elizabeth R. , Davis Max E. , DeWolf Paul D. , Makki Tarek A. , Kelly Bryan T. , Larson Christopher M. , Henning Phillip T. , Mendias Christopher L. 
Published: August 2013

Background: Femoroacetabular impingement (FAI) is one of the most common causes of early cartilage and labral damage in the nondysplastic hip. Biomarkers of cartilage degradation and inflammation are associated with osteoarthritis. It was not known whether patients with FAI have elevated levels of biomarkers of cartilage degradation and inflammation. Hypothesis: Compared with athletes without FAI, athletes with FAI would have elevated levels of the inflammatory C-reactive protein (CRP) and cartilage oligomeric matrix protein (COMP), a cartilage degradation marker. Study Design: Controlled laboratory study. Methods: Male athletes with radiographically confirmed FAI (n = 10) were compared with male athletes with radiographically normal hips with no evidence of FAI or hip dysplasia (n = 19). Plasma levels of COMP and CRP were measured, and subjects also completed the Short Form–12 (SF-12) and Hip Disability and Osteoarthritis Outcome Score (HOOS) surveys. Results: Compared with controls, athletes with FAI had a 24% increase in COMP levels and a 276% increase in CRP levels as well as a 22% decrease in SF-12 physical component scores and decreases in all of the HOOS subscale scores. Conclusion: Athletes with FAI demonstrate early biochemical signs of increased cartilage turnover and systemic inflammation. Clinical Relevance: Chondral injury secondary to the repetitive microtrauma of FAI might be reliably detected with biomarkers. In the future, these biomarkers might be used as screening tools to identify at-risk patients and assess the efficacy of therapeutic interventions such as hip preservation surgery in altering the natural history and progression to osteoarthritis.
The epidemiology of HIV infection in Morocco: systematic review and data synthesis
Authors: Kouyoumjian S P , Mumtaz G R , Hilmi N , Zidouh A , El Rhilani H , Alami K , Bennani A , Gouws E , Ghys P D , Abu-Raddad L J 
Published: August 2013

Summary Morocco has made significant strides in building its HIV research capacity. Based on a wealth of empirical data, the objective of this study was to conduct a comprehensive and systematic literature review and analytical synthesis of HIV epidemiological evidence in this country. Data were retrieved using three major sources of literature and data. HIV transmission dynamics were found to be focused in high-risk populations, with female sex workers (FSWs) and clients contributing the largest share of new HIV infections. There is a pattern of emerging epidemics among some high-risk populations, and some epidemics, particularly among FSWs, appear to be established and stable. The scale of the local HIV epidemics and populations affected show highly heterogeneous geographical distribution. To optimize the national HIV response, surveillance and prevention efforts need to be expanded among high-risk populations and in geographic settings where low intensity and possibly concentrated HIV epidemics are emerging or are already endemic.
Physician-patient interactions and outcomes in systemic lupus erythematosus (SLE): a conceptual model
Authors: Beusterien K , Bell JA , Grinspan J , Utset TO , Kan H , Narayanan S 
Published: August 2013

Objective The objective was to develop a conceptual model illustrating the relationships between the physician-patient relationship and patient outcomes, including health status and regimen satisfaction, in systemic lupus erythematosus (SLE). Methods This was a cross-sectional survey of a geographically diverse sample of adults with SLE in the United States. Patients completed a Web-based survey that focused on physician interactions, clinical management, and patient outcomes, including patient perception of treatment regimen and health status. All survey variables related to physician interactions and patient perceptions of their health and satisfaction were evaluated for incorporation into a patient-centered model using cluster analysis. Structural equation modeling (SEM) was conducted to assess the inter-relationships observed among the variables to inform the development of a conceptual model of SLE patient-centered care. Results A total of 302 SLE patients completed the survey. The majority of patients were female (94.3%) with a mean age of 46 years. The cluster analysis resulted in six main factors: 1) physician interactions, 2) current health and hope, 3) satisfaction with treatment, 4) bedside manner, 5) discussion of lupus impacts during physician visits, and 6) steroid treatment. The significant relationships among the factors showed that positive physician interactions, such as including the patient in treatment decisions, were associated with higher satisfaction with treatment regimen and patients feeling that SLE was well controlled, a more favorable perception of current health, and being more hopeful about future health. Among the components of physician interactions, setting goals with patients is particularly important, as this was significantly associated with the patient being more hopeful about future health. Being steroid free was significantly related to higher treatment satisfaction. Conclusion The study findings informed a conceptual model of SLE patient-centered care that may be used to create more targeted education programs in the management of SLE, with the goal to improve patient outcomes.
The psychotherapeutic implications of functional neuroimaging studies of anxiety disorders
Authors: Cheung Peter 
Published: August 2013

Objective: To explore and discuss the psychotherapeutic implications of functional neuroimaging findings in anxiety disorders. Conclusions: Therapeutic implications of the neural system dysfunctions found in functional neuroimaging studies of anxiety disorders include: emotional dysregulation can probably be found in all anxiety disorders except obsessive compulsive disorder and needs to be addressed; the probable salience of enhancing implicit emotion regulation in improving overall treatment outcome; the importance of addressing insecure attachment in establishing and maintaining the therapeutic relationship; the need to enhance the reward-approach system especially in chronic treatment-resistant patients; the need to address traumatic memory in anxiety disorders other than PTSD among those with a traumatic history. There is likely to be a need for therapeutic techniques and strategies of different psychotherapy schools to be utilized to adequately address the various neural dysfunctions in patients with anxiety disorders.
The relationship between total and regional corpus callosum atrophy, cognitive impairment and fatigue in multiple sclerosis patients
Authors: Yaldizli Özgür , Penner Iris-Katharina , Frontzek Karl , Naegelin Yvonne , Amann Michael , Papadopoulou Athina , Sprenger Till , Kuhle Jens , Calabrese Pasquale , Radü Ernst Wilhelm , Kappos Ludwig , Gass Achim 
Published: August 2013

Objective: The objective of this paper is to investigate the relationship between total and regional corpus callosum (CC) atrophy, neuropsychological test performance and fatigue in multiple sclerosis (MS) patients. Methods: We conducted a cross-sectional study in 113 MS patients: mean age 48±11 years, 75/113 women, 84/113 relapsing–remitting MS, mean disease duration 21±9 years, mean Expanded Disability Status Scale (EDSS) score 3.2±1.7. All patients underwent brain magnetic resonance imaging, standardised neurological assessment and comprehensive cognitive testing including assessments for fatigue and depression. Total and regional CC atrophy was assessed using the corpus callosum index (CCI). Results: CCI correlated more strongly with T2- and T1-lesion volume and whole brain volume than with disease duration or EDSS score. CCI correlated strongly with the verbal fluency test (VFT), Symbol Digit Modalities Test (SDMT) and Paced Auditory Serial Addition Test (PASAT). Multivariate regression analysis revealed that atrophy of the posterior CC segment was significantly associated with poor outcome in the PASAT, VFT and SDMT. In contrast, atrophy of the anterior CC segment was significantly associated with fatigue severity and poor outcome in the long-term memory test. Conclusions: Atrophy of the CC is associated with cognitive impairment and fatigue. Regional CCI results indicate that these associations are partially spatially segregated.
Oxysterols and cholesterol precursors correlate to magnetic resonance imaging measures of neurodegeneration in multiple sclerosis
Authors: van de Kraats C , Killestein J , Popescu V , Rijkers E , Vrenken H , Lütjohann D , Barkhof F , Polman CH , Teunissen CE 
Published: August 2013

Background: Cholesterol homeostasis is important for formation and maintenance of myelin and axonal membranes in the central nervous system (CNS). The concentrations of the brain specific cholesterol metabolite 24S-hydroxycholesterol (24OHC) and cholesterol precursors have been shown to be altered in multiple sclerosis (MS). However, how changes in sterol levels relate to the pathological processes in MS is not clear. Methods: In this study, we compared serum and cerebrospinal fluid (CSF) sterol levels between 105 MS (51 relapsing–remitting (RR); 39 secondary progressive (SP) and 15 primary progressive (PP)) and 49 control patients. Sterol levels were correlated to magnetic resonance imaging (MRI) markers of disease activity. Results: We found decreased serum 24OHC and 27-hydroxycholesterol (27OHC) and increased CSF lathosterol in MS patients compared to control patients ( p=0.018, p=0.002 and p=0.002, respectively). Subgroup analysis showed that serum 24OHC levels were negatively correlated to normalized brain volume measurements in relapse-onset MS patients ( r= −0.326, p=0.004). Conclusions: These results confirm that cholesterol homeostasis is disturbed in MS and suggest that changes in cholesterol synthesis are related to neurodegenerative pathological processes as seen on the MRI. The data seem to be in line with the recently reported observation that high dose statins may have a positive effect on clinical disability in secondary progressive MS.
Circulating vitamin D binding protein levels are not associated with relapses or with vitamin D status in multiple sclerosis
Authors: Smolders Joost , Peelen Evelyn , Thewissen Mariëlle , Menheere Paul , Damoiseaux Jan , Hupperts Raymond 
Published: August 2013

Background: A low vitamin D status has been associated with multiple sclerosis (MS). Most circulating vitamin D metabolites are bound to vitamin D binding protein (DBP). Objectives: The purpose of this study was to explore whether there is an association between MS and DBP. Methods: We compared DBP concentrations in blood samples of controls ( n = 30) and subjects with relapsing–remitting MS (RRMS) during remission ( n = 29) and relapse ( n = 15). Furthermore, we explored correlations of DBP with 25- hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D levels (1,25(OH)2D), and the effect of high-dose vitamin D3 supplementation on DBP levels in RRMS patients ( n = 15). Results: DBP-concentration did not differ between the sub-groups measured, and there was no correlation between DBP and vitamin D metabolite concentration within the physiological range. Upon supplementation of high doses vitamin D3, DBP concentration remained unaltered. After supplementation, serum 1,25(OH)2D( R = 0.517, p = 0.049), but not 25(OH)D, correlated positively with DBP. Conclusions: We found no association between DBP, MS, and vitamin D status within the physiological range. After high - dose vitamin D supplementation, DBP concentrations may be relevant for vitamin D metabolism.
Computer-assisted rehabilitation of attention in patients with multiple sclerosis: results of a randomized, double-blind trial
Authors: Amato MP , Goretti B , Viterbo RG , Portaccio E , Niccolai C , Hakiki B , Iaffaldano P , Trojano M 
Published: August 2013

Background: There is controversial information on the efficacy of cognitive rehabilitation in multiple sclerosis (MS). Objective: The objective of this paper is to test a home-based computerized program for retraining attention dysfunction in MS. Methods: Relapsing–remitting patients who failed > 2 tests of attention on an extensive neuropsychological battery were randomized to specific or nonspecific computerized training (ST, n-ST), in one-hour sessions, twice a week for three months. Outcome measures included neuropsychological assessment, depression, fatigue, everyday activities and a visual analogue scale assessing attentive performance (VAS). Assessments were repeated after the interventions and after a further three months. Statistical analysis included the analysis of variance (ANOVA) for repeated measures. Results: Eighty-eight out of 102 randomized patients completed the study (69 women, age 40.9 ± 11.5 years, disease duration 13.0 ± 8.7 years, Expanded Disability Status Scale score 2.7 ± 1.5). Fifty-five patients were randomized to ST, 33 to n-ST. A benefit of the ST was observed on the Paced Auditory Serial Addition Test ( p < 0.002). However, patient self-report did not reveal differences between ST and n-ST patient groups. Conclusion: Although our program trained different attention components, we could detect some improvements exclusively on tasks of sustained attention. Moreover, patient self-perceived results may be independent of the training program.
Upper Cervical Spine Fusion in Children With Skeletal Dysplasia
Authors: Pakkasjärvi N. , Mattila M. , Remes V. , Helenius I. 
Published: August 2013

Background: Skeletal dysplasias have been associated with upper cervical instability. Many patients are initially asymptomatic, but the instability may progress to subluxation and dislocation and complications thereof, including death. Surgery is hampered by petite osseous structures and low bone formation rate. Aim: To review the outcomes of surgical fusion of upper cervical instability in children with rare skeletal dysplasias. Material and Methods: A retrospective study of eight children with five different rare skeletal dysplasias needing upper cervical instrumented stabilization. Cases were evaluated for clinical, radiologic, and quality-of-life outcomes, with median follow-up time of 5 years. Results: Six patients underwent posterior, segmental cervical spine instrumentation and fusion (three C1/C2 fusions, three occipitocervical fusions), one anterior cervical instrumented spinal fusion, and one anteroposterior fusion. Autogenous bone grafting was used in all patients, and seven were immobilized using a halo body jacket. Nonunion in occipitocervical fusions was common in these patients (3/8 patients). Rib autograft from occiput to cervical spine with recombinant human BMP-2 was used to salvage nonunions. Conclusions: Surgical fixation in the pediatric cervical spine is hampered by fragile posterior structures. A postoperative immobilization by halo vest for 4 months is customary. Selective anterior corpectomy and plate fixation is not recommended in pediatric patients with skeletal dysplasias. Level of Evidence: Level 4, Case Series