bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enlargement of Eustachian Tube Lumen in Patulous Eustachian Tube Patients Compared to that by Aging
Authors: Ikeda Ryoukichi , Kusano Yusuke , Kawamura Yoshinobu , Oshima Hidetoshi , Kikuchi Toshiaki , Kawase Tetsuaki , Katori Yukio , Kobayashi Toshimitsu 
Published: January 2022

Objective:
To evaluate the Eustachian tube (ET) dimensions in patulous ET (PET) patients compared with that by aging using sitting 3D computed tomography (CT).

Study Design:
Retrospective study.

Setting:
Tertiary referral center.

Subjects and methods:
A retrospective survey of medical records in Sen-En Rifu Hospital identified 105 ears of 76 PET patients and 65 ears of 34 patients without ET dysfunction findings (non-PET). Subjects in both PET and non-PET groups were then divided into two age groups. Groups A and C defined as non-PET and PET subjects respectively, who were under the age of 60 years, while Groups B and D defined of non-PET and PET subjects respectively, who were 60 years and above. 3D CT (Accuitomo; Morita, Kyoto, Japan) was performed on all subjects in the sitting position. The ET lumen from the ET pharyngeal orifice to 15 mm was analyzed.

Results:
No significant difference in the ET lumen near the pharyngeal orifice was found between Group A and C; however, there was a significant difference in the ET at points lateral to the pharyngeal orifice. The ET lumen was significantly larger at the site close to the pharyngeal orifice in Group B as compared to that of Group A. For the two groups of PET classified according to the size of the pharyngeal orifice and area close to the isthmus, age was only significantly different between two groups of pharyngeal orifice. On the contrary, sonotumometry and Ohta method were significantly different between the two groups of the area close to the isthmus.

Conclusion:
The lumen of the ET is enlarged in both PET and aging. However, the responsible site was found to be different. While the enlargement of the ET lumen in 60 years and above subjects without PET mainly occurred near the pharyngeal orifice of the ET, it was near the isthmus in under 60 years PET patients. Further study of possible clinical implications of these findings as well as treatment strategy are required.
Association between coronary artery calcium score and in-stent restenosis after drug-eluting stent implantation
Authors: Zheng Xiaowen , Xu Ke , Yang Xiaoxiao , Yang Wentao , Zhang Weifeng , Jiang Yue , Zhang Yipeng , Qiu Xingbiao , Shi Hongyu , Jiang Lisheng , Shen Linghong , He Ben 
Published: January 2022

Background
Coronary artery calcium (CAC) is a modifiable contributor of in-stent restenosis (ISR), but quantitative analyses using a noninvasive approach are limited. We aimed to investigate the associations between CAC score derived from ECG-gated coronary computed tomography angiography (CCTA) or non-gated non-contrast chest computed tomography (NCCT) and ISR.

Methods
We included 368 lesions in 194 patients with coronary drug-eluting stent implantations in final analyses. CAC was quantified using the Agatston score. Primary endpoint was ISR, defined as lumen diameter stenosis over 50% at the stent segment or its proximal or distal edges (5-mm segments adjacent to the stent), at angiographic follow-up.

Results
The CAC scores in either CCTA/2.5 mm group (r = 0.7702; P < 0.0001) or NCCT/5 mm group (r = 0.7105; P < 0.0001) were both correlated with in-stent diameter stenosis. The receiver-operating characteristic curve analysis identified a CAC score >245 in CCTA/2.5 mm group as the optimal ISR cutoff (sensitivity, 60.0%; specificity, 83.7%; area under the curve, 0.744; P < 0.001), and >209 in NCCT/5 mm group (sensitivity, 46.7%; specificity, 91.9%; area under the curve, 0.704; P < 0.001). Multivariable logistic regression models indicated a CAC score >245 in CCTA/2.5 mm group and >209 in NCCT/5 mm group independently associated with an 8.46- and 21.89-fold increase in ISR, respectively (all P < 0.01).

Conclusions
Either a CAC score >245 in CCTA/2.5 mm or >209 in NCCT/5 mm was significantly associated with increased risk in ISR.
Acute traumatic brain injury in frail patients: the next pandemic
Authors: Baggiani Marta , Guglielmi Angelo , Citerio Giuseppe 
Published: January 2022

Purpose of review
To highlight recent findings on the evaluation and impact of frailty in the management of patients with traumatic brain injury (TBI).

Recent findings
Frailty is not a direct natural consequence of aging. Rather, it commonly results from the intersection of age-related decline with chronic diseases and conditions. It is associated with adverse outcomes such as institutionalization, falls, and worsening health status. Growing evidence suggests that frailty should be a key consideration both in care planning and in adverse outcome prevention. The prevalence of elderly patients with TBI is increasing, and low-energy trauma (i.e., ground or low-level falls, which are typical in frail patients) is the major cause. Establishing the real incidence of frailty in TBI requires further studies. Failure to detect frailty potentially exposes patients to interventions that may not benefit them, and may even harm them. Moreover, considering patients as ‘nonfrail’ purely on the basis of their age is unacceptable. The future challenge is to shift to a new clinical paradigm characterized by more appropriate, goal-directed care of frail patients.

Summary
The current review highlights the crucial importance of frailty evaluation in TBI, also given the changing epidemiology of this condition. To ensure adequate assessment, prevention and management, both in and outside hospital, there is an urgent need for a valid screening tool and a specific frailty-based and comorbidity-based clinical approach.
Distant metastasis from head and neck cancer: role of surgical treatment
Authors: Vartanian Jose Guilherme , Gross Jefferson Luis , Kowalski Luiz Paulo 
Published: January 2022

Purpose of review
The rates of distant metastases in patients with head and neck squamous cell carcinoma varies from 3 to 50%. Metastases are usually multiple, diagnosed within 24 months after treatment and sited in the lungs, bone or liver. This review highlights the importance of a personalized treatment approach in such patients.

Recent findings
In patients with primary tumor controlled and with oligometastatic disease, surgical options can be considered, especially for lung metastases. Overall survival for patients who are candidates for lung metastasectomy can be as high as 59%. In bone and liver metastases, resection is not frequently used but radiofrequency ablation is a promising option. Finally, mediastinal and axillary lymph node metastasis are classified as distant metastases, and lymph node dissection is the treatment of choice whenever the disease is limited to these sites.

Summary
Patients with distant metastases usually are considered incurable; however, an aggressive local treatment of solitary distant metastases should be considered in highly selected patients, with a potential increase of overall survival.
Digital Eyestrain and the Critical Fusion Frequency
Authors: Yan Keying , Rosenfield Mark 
Published: January 2022

SIGNIFICANCE
Although the high prevalence of digital eyestrain has been well established, to date, there is no objective measurement of this condition. Previous studies have suggested that digital eyestrain may be associated with decreased critical fusion frequency, but the published evidence to support this association is sparse.

PURPOSE
This study sought to determine whether symptoms of digital eyestrain after a sustained computer task are indeed associated with changes in critical fusion frequency.

METHODS
The experiment was performed on 30 young visual-normal subjects. They attended two sessions, during which they undertook a 20-minute reading task. This comprised either reading random words from a tablet computer or a story from a printed children's book. Critical fusion frequency was measured both before and immediately after each of the reading tasks. In addition, the level of digital eyestrain was assessed by subjects completing a questionnaire regarding ocular and visual symptoms experienced during each of the reading trials.

RESULTS
The mean increase in digital eyestrain symptoms after the digital and printed conditions was 11.37 (standard error of the mean [SEM], 2.23) and 4.40 (SEM, 1.34), respectively. Both the post-task symptom change (P < .001) and the difference between the two reading conditions (P = .004) were significant. The mean change in critical fusion frequency after the digital and printed conditions was −0.42 (SEM, 0.25) and −0.72 (SEM, 0.26), respectively. Neither the post-task change nor the difference between the two reading conditions was significant. In addition, when considering the digital condition only, no significant correlation was observed between the changes in critical fusion frequency and reported symptoms.

CONCLUSIONS
These results do not support the proposal that changes in critical fusion frequency can be used as an objective measure of eyestrain or other symptoms of digital eyestrain.
The Impact of Ineffective Esophageal Motility on Patients Undergoing Magnetic Sphincter Augmentation
Authors: Baison George N. , Jackson Anee S. , Wilshire Candice L. , Bell Reginald C. W. , Lazzari Veronica , Bonavina Luigi , Ayazi Shahin , Jobe Blair A. , Schoppmann Sebastian F. , Dunn Colin P. , Lipham John C. , Dunst Christy M. , Farivar Alexander S. , Bograd Adam J. , Louie Brian E. 
Published: January 2022

Objective:
To evaluate and characterize outcomes of MSA in patients with IEM.

Summary Background Data:
MSA improves patients with gastroesophageal reflux and normal motility. However, many patients have IEM, which could impact the outcomes of MSA and discourage use.

Methods:
An international, multi-institutional case control study of IEM patients undergoing MSA matched to normal patients was performed. Primary outcomes were new onset dysphagia and need for postoperative interventions.

Results:
A total of 105 IEM patients underwent MSA with matching controls. At 1 year after MSA: GERD-Health Related Quality of Life was similar; DeMeester scores in IEM patients improved to 15.7 and 8.5 in controls (P = 0.021); and normalization of the DeMeester score for IEM = 61.7% and controls = 73.1% (P = 0.079).
In IEM patients, 10/12 (83%) with preop dysphagia had resolution; 11/66 (17%) had new onset dysphagia and 55/66 (83%) never had dysphagia. Comparatively, in non-IEM patients, 22/24 (92%) had dysphagia resolve; 2/24 (8%) had persistent dysphagia; 7/69 (10%) had new onset dysphagia, and 62/69 (90%) never had dysphagia.
Overall, 19 (18%) IEM patients were dilated after MSA, whereas 12 (11%) non-IEM patients underwent dilation (P = 0.151). Nine (9%) patients in both groups had their device explanted.

Conclusions:
Patients with IEM undergoing MSA demonstrate improved quality of life and reduction in acid exposure. Key differences in IEM patients include lower rates of objective GERD resolution, lower resolution of existing dysphagia, higher rates of new onset dysphagia and need for dilation. GERD patients with IEM should be counselled about these possibilities.
Population-based Trends in Obesity and Kidney Transplantation Among Patients With End-stage Kidney Disease
Authors: Wakam Glenn K. , Sheetz Kyle H. , Gerhardinger Laura , Montgomery John R. , Waits Seth A. 
Published: January 2022

Background.
Obesity is a barrier to transplant, reducing access and leading to worse outcomes versus nonobese adults. Most transplant centers in the United States maintain body mass index (BMI) cutoffs to listing for kidney transplantation of 35 to 40 kg/m2. There is little contemporary data on the prevalence of obesity among patients with end-stage kidney disease (ESKD) despite its impact on clinical outcomes and healthcare expenditures.

Methods.
We utilized data from the US Renal Data System from 2008 to 2016 to identify a prevalent cohort of 1 079 410 patients with ESKD. Linear regression determined trends in the proportion of patients within each category of BMI. We also evaluated geographic variation in rates of obesity and transplantation across the United States.

Results.
Among the 1 079 410 ESKD patients, the largest cohort of patients were those with obesity (n = 423 270; 39.2%). There were 309 707 (28.7%) patients with an overweight BMI and 274 683 (25.4%) with a normal BMI. The proportion of patients with obesity increased significantly from 36.8% in 2008 to 40.2% in 2016 (trend 0.28; 95% confidence interval, 0.05-0.51). There was significant geographic variation by state with rates of obesity ranging from 32.3% to 45.4% and state transplant rates among those obese patients ranging from 22.5% to 46.8%. There is a weak correlation between states with increased rates of obese ESKD patients and states with an increased obesity transplant rate as indicated with r = 0.40 (P = 0.003).

Conclusions.
Beneficiaries with obesity are now the largest and fastest growing demographic among patients with ESKD in the United States.
Dual Lactate Clearance in the Viability Assessment of Livers Donated After Circulatory Death With Ex Situ Normothermic Machine Perfusion
Authors: Xu Min , Zhou Fangyu , Ahmed Ola , Randle Lucy V. , Shin Jun-Kyu , Zhu Yuehui , Upadhya Gundumi A. , Byrnes Kathleen , Wong Brian , Kim Jae-Sung , Lin Yiing , Chapman William C. 
Published: January 2022

Background.
Perfusate lactate clearance (LC) is considered one of the useful indicators of liver viability assessment during normothermic machine perfusion (NMP); however, the applicable scope and potential mechanisms of LC remain poorly defined in the setting of liver donation after circulatory death.

Methods.
The ex situ NMP of end-ischemic human livers was performed using the OrganOx Metra device. We further studied the extracellular signal-regulated kinases (phospho-extracellular signal-regulated kinase1/2 [pERK1/2]) pathway and several clinical parameters of these livers with successful LC (sLC, n = 5) compared with non-sLC (nLC, n = 5) in the perfusate (<2.2 mmol/L at 2 h, n = 5, rapid retrieval without normothermic regional perfusion).

Results.
We found the pERK1/2 level was substantially higher in the nLC livers than in the sLC livers (n = 5) at 2- and 6-h NMP (P = 0.035 and P = 0.006, respectively). Immunostaining showed that upregulation of pERK1/2 was in both the hepatocytes and cholangiocytes in the nLC livers. Successful LC was associated with a marginally higher glycogen restoration than nLC at 2 h NMP (n = 5, P = 0.065). Furthermore, bile lactate levels in all sLC livers were cleared into the normal range at 6 h NMP, whereas in the nLC group, only 2 livers had lower bile lactate levels, and the other livers had rising bile lactate levels in comparison with the corresponding perfusate lactate levels. The necrosis scores were higher in the nLC than in the sLC livers (n = 5) at 0- and 6-h NMP (P = 0.047 and P = 0.053, respectively).

Conclusions.
The dual LC in perfusate and bile can be helpful in evaluating the hypoxic injury of hepatocytes and cholangiocytes during the NMP of donation after circulatory death in liver donors.
Discordance Between SARS-CoV-2–specific Cell-mediated and Antibody Responses Elicited by mRNA-1273 Vaccine in Kidney and Liver Transplant Recipients
Authors: Fernández-Ruiz Mario , Almendro-Vázquez Patricia , Carretero Octavio , Ruiz-Merlo Tamara , Laguna-Goya Rocío , San Juan Rafael , López-Medrano Francisco , García-Ríos Estéfani , Más Vicente , Moreno-Batenero Miguel , Loinaz Carmelo , Andrés Amado , Pérez-Romero Pilar , Paz-Artal Estela , Aguado José María 
Published: January 2022

Background.
Severe acute respiratory syndrome coronavirus 2–specific cell-mediated immunity (SARS-CoV-2-CMI) elicited by mRNA-based vaccines in solid organ transplant (SOT) recipients and its correlation with antibody responses remain poorly characterized.

Methods.
We included 44 (28 kidney, 14 liver, and 2 double organ) recipients who received the full series of the mRNA-1273 vaccine. SARS-CoV-2-CMI was evaluated at baseline, before the second dose, and at 2 wk after completion of vaccination by an ELISpot-based interferon-γ FluoroSpot assay using overlapping peptides covering the S1 domain. SARS-CoV-2 immunoglobulin G seroconversion and serum neutralizing activity against the spike protein were assessed at the same points by commercial ELISA and an angiotensin-converting enzyme-2/spike antibody inhibition method, respectively. Postvaccination SARS-CoV-2-CMI was compared with 28 healthcare workers who received the BNT162b2 vaccine.

Results.
Positive SARS-CoV-2-CMI increased from 6.8% at baseline to 23.3% after the first mRNA-1273 dose and 59.5% after the completion of vaccination (P < 0.0001). Lower rates were observed for immunoglobulin G seroconversion (2.3%, 18.6%, and 57.1%, respectively) and neutralizing activity (2.3%, 11.6%, and 31.0%). There was a modest correlation between neutralizing titers and the magnitude of SARS-CoV-2-CMI (Spearman’s rho: 0.375; P = 0.015). Fifteen recipients (35.7%) mounted SARS-CoV-2-CMI without detectable neutralizing activity, whereas 3 (7.1%) did the opposite, yielding poor categorical agreement (Kappa statistic: 0.201). Rates of positive SARS-CoV-2-CMI among SOT recipients were significantly decreased compared with nontransplant controls (82.1% and 100.0% after the first dose and completion of vaccination, respectively; P < 0.0001). Kidney transplantation, the use of tacrolimus and prednisone, and the number of immunosuppressive agents were associated with lower cell-mediated responses. Results remained unchanged when 3 recipients with prevaccination SARS-CoV-2-CMI were excluded.

Conclusions.
Two-thirds of SOT recipients mounted SARS-CoV-2-CMI following vaccination with mRNA-1273. Notable discordance was observed between vaccine-induced cell-mediated and neutralizing humoral immunities. Future studies should determine whether these patients with incomplete responses are effectively protected.
Hormonal and metabolic profiles of obese and nonobese type 2 diabetes patients: implications of plasma insulin, ghrelin, and vitamin D levels
Authors: Giha Hayder A. , AlDehaini Dhuha M. B. , Joatar Faris E. , Ali Muhalab E. , Al-Harbi Einas M. , Al Qarni Ali A. 
Published: January 2022

Background
Type 2 diabetes (T2D) is associated with obesity whereas loss of weight is a feature of the disease; however, the two states are not mutually exclusive. Obesity is linked with changes in hormonal activity and overall body metabolism.

Materials and methods
In this study, 408 T2D patients were recruited in three distinct studies conducted in Bahrain, Saudi Arabia, and Kuwait in three different intervals between 2001 and 2019. In addition to demographics, glycemic and lipid profiles were obtained in all studies, whereas plasma insulin and HOMA-IR, vitamin D, and ghrelin were analyzed in Saudi Arabia. Different techniques such as chemical auto-analyzer, ELISA, chemiluminescent immunoassay, radioimmunoassay were used.

Results
The obese (BMI ≥ 30 kg/m2) compared with nonobese (BMI 18.5 to <30) patients with diabetes were more likely to be women (P < 0.001), smaller in age (P = 0.028), and with shorter disease duration (P = 0.018). Unexpectedly, the glycemic and lipid profiles were consistently comparable between the two groups in the three sites. Furthermore, vitamin D was strikingly lower in obese patients with diabetes (P = 0.007). Finally, plasma ghrelin (P = 0.163), insulin (P = 0.063), and HOMA-IR (P = 0.166) were comparable between obese and nonobese patients with diabetes.

Conclusion
Diabetic obesity was significantly associated with female sex, young age, short disease duration, and noticeably low vitamin D, and a trend of high insulin levels. However, the obese and nonobese patients had comparable metabolic profiles with no differences in insulin resistance and ghrelin levels. Further studies, especially at a molecular level, are needed to explore this topic which is barely investigated.
Comparative diagnostic performance of the new chromatographic Affimer®-based rapid antigen detection against SARS-CoV-2 and other standard antigen tests for COVID-19 in a clinical setting
Authors: Gil-Garcia A.I. , Lopez-Lopez A. , Rubio J.M. , Montoya J.J. , Ouahid Y. , Madejon A. , Castan P. 
Published: January 2022

AbstractThe availability of accurate and rapid diagnostic tools for COVID-19 is essential for tackling the ongoing pandemic. In this context, researchers in the UK have started testing a new Lateral Flow Device (LFD) based on proprietary Biotinylated anti SARS-CoV-2 S1 Affimer® technology that binds to the SARS-CoV2-S1 protein in anterior nasal swab samples, generating an ultra-sensitive method for detection. This international study aimed to compare its performance against other available antigen-detecting rapid diagnostic tests (Ag-RDTs) in a real-world clinical setting. The study was completed under the frame of Project SENSORNAS RTC-20176501 in collaboration with MiRNAX Biosens Ltd. and Hospital Carlos III, it was documented internally and deposited in agreement to the ISO 13485 norm. All the data obtained are currently under submission and review from the Ethics Committee of Universidad Autonoma de Madrid.
Point-of-Care MRI with Artificial Intelligence to Measure Midline Shift in Acute Stroke Follow-Up
Authors: Kundu Prantik , Mohseni Salehi Seyed Sadegh , Cahn Bradley A. , Mazurek Mercy H. , Yuen Matthew M. , Welch E. Brian , Gordon-Kundu Barbara S. , Schlemper Jo , Sze Gordon , Kimberly W. Taylor , Rothberg Jonathan M. , Sofka Michal , Sheth Kevin N. 
Published: January 2022

AbstractBackground and PurposeIn stroke, timely treatment is vital for preserving neurologic function. However, decision-making in neurocritical care is hindered by limited accessibility of neuroimaging and radiological interpretation. We evaluated an artificial intelligence (AI) system for use in conjunction with bedside portable point-of-care (POC)-MRI to automatically measure midline shift (MLS), a quantitative biomarker of stroke severity.Materials and MethodsPOC-MRI (0.064 T) was acquired in a patient cohort (n=94) in the Neurosciences Intensive Care Unit (NICU) of an academic medical center in the follow-up window during treatment for ischemic stroke (IS) and hemorrhagic stroke (HS). A deep-learning architecture was applied to produce AI estimates of midline shift (MLS-AI). Neuroradiologist annotations for MLS were compared to MLS-AI using non-inferiority testing. Regression analysis was used to evaluate associations between MLS-AI and stroke severity (NIHSS) and functional disability (mRS) at imaging time and discharge, and the predictive value of MLS-AI versus clinical outcome was evaluated.ResultsMLS-AI was non-inferior to neuroradiologist estimates of MLS (p<1e-5). MLS-AI measurements were associated with stroke severity (NIHSS) near the time of imaging in all patients (p<0.005) and within the IS subgroup (p=0.005). In multivariate analysis, larger MLS-AI at the time of imaging was associated with significantly worse outcome at the time of discharge in all patients and in the IS subgroup (p<0.05). POC-MRI with MLS-AI >1.5 mm was positively predictive of poor discharge outcome in all patients (PPV=70%) and specifically in patients with IS (PPV=77%).ConclusionThe integration of portable POC-MRI and AI provides automatic MLS measurements that were not inferior to time-consuming, manual measurements from expert neuroradiologists, potentially reducing neuroradiological burden for follow-up imaging in acute stroke.