bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of a CI Programming Fitting Tool with Artificial Intelligence in Experienced Cochlear Implant Patients
Authors: Wathour Justine , Govaerts Paul J. , Lacroix Emilie , Naïma Deggouj 
Published: February 2023

Objective
Cochlear implants (CIs) are the treatment of choice for patients with severe to profound hearing loss. The hearing results, however, considerably vary across patients. This may partly be due to variability in the CI fitting. We investigated the effect of FOX, a software tool to program CIs using artificial intelligence (AI), on hearing outcomes.

Methods
Forty-seven experienced CI patients who came to our tertiary CI center for their annual follow-up between 2017 and 2020 were recruited for this study. They received a new CI map created by the AI software tool. CI parameters and auditory outcomes obtained with this new map were compared with those of the initial manual map after 15 days of take-home experience. Within-patient differences were assessed. At the end of the study, the patients were offered a choice to continue using the AI map or to revert to their old manual map.

Results
Several auditory outcomes improved with the AI map, namely, pure tone audiometric threshold at 6,000 Hz (median improvement 10 dB, range = −20 to 50 dB, Z = −2.608, p = 0.008), phonemic discrimination scores (median improvement 10%, range = 0% to 30%, Z = −4.061, p = 0.001), and soft-intensity (median improvement of 10%, range = −20% to 90%, Z = −4.412, p < 0.001) to normal-intensity (median improvement of 10%, range = −30% to 60%, Z = −3.35, p < 0.001) speech audiometric scores.

Conclusion
The AI-assisted CI mapping model as a potential assistive tool may improve audiological outcomes for experienced CI patients, including high-frequency pure tone audiometry and audiometric speech scores at low and normal presentation levels.
Clinical trial registration: NCT03700268
Cochlear Implantation after Stereotactic Radiosurgery for Vestibular Schwannoma: Initial Hearing Improvement and Longevity of Hearing Restoration
Authors: Young Kurtis , Grewal Maeher R. , Diaz Rodney C. , Wu Arthur W. , Miller Mia E. 
Published: February 2023

Objective
The following research question was asked: In patients with vestibular schwannoma (VS) that underwent stereotactic radiosurgery (SRS) and cochlear implantation, were improvements in hearing function observed, and what was the cochlear implant (CI) failure rate of in these patients?

Data Sources
PubMed/Medline, CINAHL (EBSCOhost), and Web of Science articles without restrictions on publication dates were searched.

Study Selection
Inclusion criteria required that the article was a report, a series, or a retrospective review with individual case data available. Non-English articles were excluded. Inclusion criteria required that patients were with VS and underwent subsequent SRS and cochlear implantation. Patients receiving microsurgery or stereotactic radiotherapy on the ipsilateral ear were excluded from this study.

Data Extraction
Included studies were evaluated using full-text evaluation, and data on study characteristics (author names, gender), clinical data (syndromic information, SRS modality), hearing outcomes, and device failure were extracted.

Data Synthesis
Means and averages were obtained for all continuous variables. Percentages were ascertained for all categorical variables.

Conclusions
The majority of patients undergoing CI placement in VS treated with SRS achieved open-set speech perception (79.2%) or environmental sound awareness (6.8%). Twelve implants (20.3%) failed. Three patterns were associated with failure: 1) immediate-onset failure, 2) initial benefit with delayed failure, 3) poor local control with device explantation.
Safety and efficacy of caplacizumab in a case of thrombotic thrombocytopenic purpura in the postpartum period
Authors: Bruzzese Antonella , Vigna Ernesto , Martino Enrica Antonia , Mendicino Francesco , Lucia Eugenio , Olivito Virginia , Mazzulla Rosanna , De Rose Silvia , Cozza Pietro Pasquale , Bova Carlo , Filippelli Gianfranco , Zinno Francesco , Morelli Michele , Morabito Fortunato , Gentile Massimo 
Published: February 2023

Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening disease for which pregnancy and the postpartum period represent risk factors. Here, we present the case of a 39-year-old woman at the 31st week of gestation, who presented with cutaneous haemorrhagic symptoms. The complete blood count showed anaemia, thrombocytopenia, increase in haemolysis indices and undetectable ADAMTS13 activity. Acquired TTP was diagnosed, and she started daily plasma exchange (PEX) and methylprednisolone. After 5 days, an emergency caesarean section was performed with success because of pathologic cardiotocographic findings. After 7 days of PEX, the patient showed an initial laboratoristic improvement; unfortunately, 3 days later, she had a recurrence of disease and started daily PEX, caplacizumab and steroid, obtaining a haematological improvement.
No literature data about caplacizumab use in pregnant or breastfeeding patients are available. In the present study, we describe that caplacizumab in the postpartum period could be well tolerated and effective.
Effect of Delayed Endoscopy Protocol on Timing and Safety of Endoscopy for Foreign Body Ingestion and Esophageal Food Impaction
Authors: Karb Daniel , DeLozier Sara , Raad Dany , Dumot John , Mok Shaffer 
Published: February 2023

Background and Aims:
Endoscopic procedures for foreign body ingestion (FBI) and esophageal food impactions (EFI) performed during on-call hours are associated with increased stress, risk, and cost. We implemented a Foreign Body Algorithm (FBA) designed to delay all but the most urgent endoscopy for EFI and FBI until regular working hours.

Methods:
Using endoscopy records from multiple academic and community hospitals within a large integrated health system in the United states, we identified esophagogastroduodenoscopy (EGD) performed for food impactions and foreign body ingestions occurring between May 2011 and February 2021.

Results:
We identified 479 EGDs performed for FBI and EFI. The introduction of the FBA was associated with a shorter length of stay (LOS) for overall cases (0.35 vs. 0.8 d P<0.001), day cases (0.16 vs. 1.0 d P<0.001), and night cases (0.40 vs. 0.6 d P=0.03). The introduction of the FBA did not change the rate of overall adverse events (AE) or night AE. AE from the entire cohort was rare (3%; 16 total). Of the AE, most were sedation related. The introduction of the FBA did not affect the overall rate of night cases or AE, but the rate of after-hours endoscopy for intentional ingestions decreased from 17.2% to 3.1% (P=0.01).

Conclusion:
This is one of the largest studies of esophageal impactions and foreign bodies in adults in the United States, and the first to examine the effects of a protocol designed to avoid after-hours endoscopy. These results suggest that postponing after-hours EGD until the daytime is not associated with adverse safety outcomes or increased LOS.
Indirect calorimetry: should it be part of routine care or only used in specific situations?
Authors: Sundström Rehal Martin , Tatucu-Babet Oana A. , Oosterveld Timo 
Published: February 2023

Purpose of review
Indirect calorimetry is increasingly recommended to guide energy delivery in the ICU. This review aims to provide a critical overview of current literature in support of these recommendations.

Recent findings
There is insufficient evidence to ascertain a mortality benefit from indirect calorimetry-guided energy delivery. However, large variations in energy expenditure during critical illness pose a risk for significant under- and overfeeding if indirect calorimetry is not routinely used.

Summary
Even in the absence of demonstrable clinical benefits, there is a strong physiological rationale in favor of performing indirect calorimetry. Measurements can be prioritized in complex patients and should be repeated during prolonged ICU stay.
Increased blood lactate during enteral nutrition in the critically ill: associations and treatment options
Authors: Piton Gaël , Reignier Jean , Calame Paul 
Published: February 2023

Purpose of review
To evaluate the significance of blood lactate increase during enteral nutrition in the critically ill, and to propose diagnostic and therapeutic strategies.

Recent findings
Acute mesenteric ischemia occurs in approximately 1% of critically ill patients treated with catecholamine. Recent literature suggests that enteral nutrition is a risk factor of acute mesenteric ischemia, in particular in case of low cardiac output, by a mechanism of nonocclusive mesenteric ischemia. The association of clinical, biological, and computed tomography imaging might help to evaluate the reversibility of acute mesenteric ischemia.

Summary
As enteral nutrition induces an increased metabolic work of the gut, the inadequation between oxygen delivery and demand exposes the gut to a phenomenon of nonocclusive mesenteric ischemia. Before initiation of enteral nutrition,, and before each increase of the enteral nutrition dose, the risk factors of nonocclusive mesenteric ischemia should be searched in order to prevent it. While under enteral nutrition, increased lactate concentration while receiving enteral nutrition requires the urgent search for nonocclusive mesenteric ischemia, and the adaptation of enteral nutrition (reduction, stop, and/or switch to parenteral nutrition or tolerate early nutrient restriction). Early signs of nonocclusive mesenteric ischemia should be searched in order to allow for a rapid diagnosis, before development of irreversible transmural necrosis. After the diagnosis of acute mesenteric ischemia, improving the balance between oxygen demand and delivery to the gut, evaluating the reversibility of the gut ischemia, and performing urgent resection in case of irreversible transmural necrosis should be the main objectives. After the resolution of acute mesenteric ischemia, the benefit risk analysis of enteral nutrition reintroduction should be evaluated.
Nutrition and epigenetic programming
Authors: Carlberg Carsten , Velleuer Eunike 
Published: February 2023

Purpose of review
The aim of this study is to highlight the epigenomic programming properties of nutritional molecules and their metabolites in human tissues and cell types.

Recent findings
Chromatin is the physical expression of the epigenome and has a memory function on the level of DNA methylation, histone modification and 3-dimensional (3D) organization. This epigenetic memory does not only affect transient gene expression but also represents long-lasting decisions on cellular fate. The memory is based on an epigenetic programming process, which is directed by extracellular and intracellular signals that are sensed by transcription factors and chromatin modifiers. Many dietary molecules and their intermediary metabolites serve as such signals, that is they contribute to epigenetic programming and memory. In this context, we will discuss about molecules of intermediary energy metabolism affecting chromatin modifier actions, nutrition-triggered epigenetic memory in pre- and postnatal phases of life; and epigenetic programming of immune cells by vitamin D. These mechanisms explain some of the susceptibility for complex diseases, such as the metabolic syndrome, cancer and immune disorders.

Summary
The observation that nutritional molecules are able to modulate the epigenome initiated the new nutrigenomic subdiscipline nutritional epigenetics. The concept that epigenetic memory and programming is directed by our diet has numerous implications for the interpretation of disease risk including their prevention.
Nutrition in intestinal transplantation: centre stage or supporting act?
Authors: Van Oosterwyck Aude , Lauwers Nathalie , Pauwels Nelle , Vanuytsel Tim 
Published: February 2023

Purpose of review
Intestinal transplantation (ITx), whether isolated or combined with other organs, is now a valid treatment option in some patients with chronic intestinal failure or extensive venous mesenteric thrombosis. The aim in these patients is not only to restore nutritional autonomy, but also to minimize the risk of complications, both short and long term. Despite parenteral nutrition playing a central part in the management of intestinal failure patients, there are little data about the perioperative and postoperative nutritional management of ITx patients, due to small patient populations per centre. In this review, we collected the scientific data available to date.

Recent findings
In this review, we will bundle the limited scientific information about diet after intestinal and multivisceral transplantation combined with recommendations from our own clinical practice in 28 ITx patients in University Hospitals Leuven, Belgium. We will discuss the immediate preoperative period, surgical complications necessitating dietary interventions and the late postoperative phase in a stable outpatient transplant recipient.

Summary
Although no specific research has been done in the field of ITx, we can extrapolate some findings from other solid organ transplants. Prehabilitation might prove to be of importance; Preserving kidney and liver function in the pretransplant period should be pursued. Transition from parenteral to enteral and oral nutrition can be complex due to inherent surgical procedures and possible complications. Ultimately, the goal is to give patients nutritional autonomy, while also minimizing the risk of foodborne infections by teaching patients well tolerated food practices.
Relapsing neuromyelitis optica spectrum disorder due to noncompliance to oral corticosteroid therapy
Authors: Terada Hiroki , ISHII Wakako , Kawaguchi Tadayasu , Aoki Ryoji , Kasuga Yuki , Momoki Emiko , Fuchigami Tatsuo , Morioka Ichiro 
Published: February 2023

Rationale:
Neuromyelitis optica (NMO) is an inflammatory, demyelinating disease of the central nervous system characterized by severe optic neuritis and myelitis. NMO recurrence can be triggered by infection, pregnancy, and the tapering of oral corticosteroid medication.

Patient concerns:
A 14-year-old girl with no remarkable birth or developmental history was admitted to our hospital after experiencing visual loss in the right eye. The right eye was positive for relative afferent pupillary defects.

Diagnosis:
Orbital magnetic resonance imaging revealed a high-intensity area in the right optic nerve. Serum levels of anti–aquaporin 4 (AQP4) antibodies were high. She was diagnosed with anti-AQP4 antibody-positive right-sided optic neuritis.

Interventions:
Her symptoms improved after repeated intravenous methylprednisolone pulse therapy and intravenous immunoglobulin therapy. Subsequently, she continued to take oral steroids as a long-term preventive measure.

Outcomes:
She relapsed twice, at the ages of 14 and 16 years, due to nonadherence to oral corticosteroid medication at her discretion (fears of steroid side effects and worsening infection without other causes), with anti-AQP4 antibody-positive NMO leading to multiple lesions in the cerebral cortex.

Lessons:
To our knowledge, this is the first report of NMO with increasing recurrence severity due to nonadherence to oral corticosteroid medication. This case demonstrates the importance of oral corticosteroid therapy in preventing relapses of anti-AQP4 antibody-positive NMO and suggests the need to educate patients regarding steroid therapy.
Severe preeclampsia superimposed on secondary and resistant hypertension associated with methamphetamine use
Authors: Phinder-Puente Marian Elizabeth , Rodríguez-Relingh Kim , Bautista-Aguilar Gabriela Alejandra , Deloya-Tomas Ernesto , Pérez-Nieto Orlando R. 
Published: February 2023

Introduction:
Preeclampsia (PE) is one of the three main causes of maternal mortality. It is called superimposed PE when, in a pregnant patient with a history of primary or secondary chronic arterial hypertension, blood pressure increases and de novo proteinuria appears or worsens and/or biochemical data such as thrombocytopenia or increased liver enzymes are added. Chronic arterial hypertension predisposes patients to developing it, with a higher risk of complications and severity.

Case presentation:
Here, we present the case of a 25-year-old patient with a history of crystal, crack, and cocaine use for 7 years and a diagnosis of high blood pressure since she was 22 years old, who developed severe PE resistant to antihypertensive drugs.

Conclusions:
The reported case showed severe hypertension in pregnancy (defined as systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg), which persisted because severe hypertension continued despite the designated treatment, which, considering the patient’s age, forced us to suspect secondary hypertension. The incidence of secondary hypertension in patients with superimposed PE is rare. According to the American Heart Association, it occurs in 10% of the cases and is associated with greater maternal and fetal complications. This should be suspected in women <35 years of age with severe or resistant hypertension, without a family history of hypertension, or with biochemical parameters for hypokalemia, hyperazotemia, and albuminuria in the early stages of pregnancy.
Metronidazole-induced neurotoxicity
Authors: Hillaker Emily , Lau James , Boomgaardt Jacob , Weppner Justin 
Published: February 2023

Rationale:
Nervous system toxicity is a rare complication of metronidazole. Prompt identification of metronidazole toxicity combined with a comprehensive physical rehabilitation program is essential to maximizing the patient’s functional outcome.

Patient concerns:
A 58-year-old female was treated with metronidazole for embolic versus hematogenous spread of bacteria resulting in multifocal brain abscesses. Two weeks after discharge, the patient returned to the emergency department with slurred speech, muscle aches, generalized weakness, inability to ambulate, and poor oral intake.

Diagnosis:
Head magnetic resonance imaging revealed symmetric enhanced T2/FLAIR signaling in the dentate nuclei were also present bilaterally, a finding pathognomonic for metronidazole toxicity.

Intervention:
Metronidazole was discontinued, and the patient was enrolled in a comprehensive rehabilitation program.

Outcomes:
She began inpatient rehabilitation dependent for all activities of daily living and requiring moderate assistance for transfers. She could only walk 10 feet with a front-wheeled walker with a 2-person assist. The patient rapidly improved with a comprehensive rehabilitation program, and due to these improvements, she was discharged after 5 days of inpatient rehabilitation. At the time of discharge, she was independent with all activities of daily living and could walk 160 feet independently with a front-wheeled walker.

Lessons:
Prompt recognition and discontinuation of metronidazole remains the only known effective treatment. A comprehensive approach to treatment and rehabilitation is achieved with an early referral to rehabilitation services. This is crucial to minimize morbidity and optimize functional outcomes in this patient population.
Intrapancreatic accessory spleen
Authors: Patel Jay , Daitch Zachary , Heller Stephen , Lee Woo Jung J. , Cappelle Saraswathi 
Published: February 2023

Introduction:
Intrapancreatic accessory spleen (IPAS) is a congenital focus of healthy splenic tissue present outside of the splenic parenchyma. There are numerous locations for IPAS and they are usually found incidentally. The location of ectopic splenic tissue is important as it can often mimic as a neoplasm, most commonly neuroendocrine tumor (NET) due to similar imaging characteristics on nuclear imaging and computed tomography (CT) scan. We report on the finding of an IPAS in the tail of the pancreas for which fine needle aspiration was performed.

Patient concerns:
A 66-year-old man with past medical history of prostate cancer managed with brachytherapy presented to his urologist for workup of persistently elevated prostate specific antigen. He underwent a nuclear medicine whole body scan which revealed uptake in the pancreatic tail for which follow up CT was recommended. The patient was seen by the gastroenterology and a CT scan was obtained. CT revealed a 4 cm × 3 cm isoenhancing mass in the tail of the pancreas without invasion to surrounding structures nor communication with the pancreatic ducts. No lymphadenopathy was noted.

Intervention:
The patient subsequently underwent endoscopic ultrasound (EUS) with fine needle aspiration (FNA) of the mass. EUS revealed a hypoechoic, oval, mass-like structure in the distal pancreatic tail measuring ~20 mm × 20 mm in maximal cross-sectional diameter. FNA of the mass was performed.

Diagnosis:
Cytopathology of the specimen revealed small mature lymphocytes and vessels suggestive of IPAS.

Outcome:
The patient remained asymptomatic through the duration of the workup.

Lessons:
All enhancing pancreatic lesions require further workup to rule out malignancy. Typically, patients undergo scintigraphy for further evaluation or FNA biopsy via EUS for confirmation. Currently, there are no established serum markers or radiographic findings with adequate specificity for diagnosing IPAS. It is important to recognize the impact of incidental findings as they frequently require further testing and often result in procedural intervention. IPAS is often confused with NET, frequently necessitating tissue sampling. While the prevalence of intrapancreatic accessory spleen is higher than initially thought, contrary to NET it carries no inherent risk unless its location compromises vital structures. This highlights the importance of recognizing this anomaly.
Variation and Correlation of Potential Unintended Consequences of Antipsychotic Reduction in Ontario Nursing Homes Over Time
Authors: Harris Daniel A. , Maclagan Laura C. , Pequeno Priscila , Iaboni Andrea , Austin Peter C. , Rosella Laura C. , Guan Jun , Maxwell Colleen J. , Bronskill Susan E. 
Published: February 2023

Background:
Potentially inappropriate antipsychotic use has declined in nursing homes over the past decade; however, increases in the documentation of relevant clinical indications (eg, delusions) and the use of other psychotropic medications have raised concerns about diagnosis upcoding and medication substitution. Few studies have examined how these trends over time vary across and within nursing homes, information that may help to support antipsychotic reduction efforts.

Objective:
To jointly model facility-level time trends in potentially inappropriate antipsychotic use, antidepressant use, and the indications used to define appropriate antipsychotic use.

Research Design:
We conducted a repeated cross-sectional study of all nursing homes in Ontario, Canada between April 1, 2010 and December 31, 2019 using linked health administrative data (N=649). Each nursing home’s quarterly prevalence of potentially inappropriate antipsychotic use, antidepressant use, and relevant indications were measured as outcome variables. With time as the independent variable, multivariate random effects models jointly estimated time trends for each outcome across nursing homes and the correlations between time trends within nursing homes.

Results:
We observed notable variations in the time trends for each outcome across nursing homes, especially for the relevant indications. Within facilities, we found no correlation between time trends for potentially inappropriate antipsychotic and antidepressant use (r=−0.0160), but a strong negative correlation between time trends for potentially inappropriate antipsychotic use and relevant indications (r=−0.5036).

Conclusions:
Nursing homes with greater reductions in potentially inappropriate antipsychotics tended to show greater increases in the indications used to define appropriate antipsychotic use—possibly leading to unmonitored use of antipsychotics.