bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serotonin Syndrome After Treatment of Nausea and Vomiting in Pregnancy
Authors: Wiseman Daniel , Samoukovic Gordan , Durcan Liam , Malhamé Isabelle 
Published: September 2022

BACKGROUND:
Nausea and vomiting in pregnancy often require pharmacotherapy for symptom management. Serotonin syndrome is a rare clinical entity that can be precipitated by the medications used to treat nausea and vomiting in pregnancy.

CASE:
A 35-year-old pregnant individual with a history of hyperemesis gravidarum in an earlier pregnancy requiring prolonged hospitalization presented with nausea and vomiting at 7 weeks of gestation. She was incidentally found to have severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection when she was universally screened at the time of admission. She required pharmacotherapy, including prochlorperazine and ondansetron for treatment of nausea as well as sumatriptan for migraine. She developed acute spasticity, autonomic dysfunction, and temperature rise, precipitated by antiemetic therapy, consistent with serotonin syndrome. The syndrome resolved with supportive care and benzodiazepines.

CONCLUSION:
Serotonin syndrome is a serious clinical entity that can be provoked by the pharmacotherapy given to treat nausea and vomiting in pregnancy. This medical emergency requires early recognition and prompt management.
Improving the cosmetic outcome of Salter osteotomy through the modification of iliac crest graft harvesting site: a pilot clinical study
Authors: Yeganeh Ali , Moghtadaei Mehdi , Farahini Hossein , Amiri Shayan , Mahmoudi Mani , Hamidpour Yasaman , Hajializade Mikaiel 
Published: September 2022

Background:
The conventional graft harvesting site in a Salter osteotomy might impair the cosmetic appearance of patients with developmental dysplasia of the hip (DDH). The authors evaluated if an alternative graft donor site on the iliac bone could eliminate this concern.

Methods:
In a prospective study, 23 patients who had DDH with an indication for Salter osteotomy were included. In 10 patients (study group), the vertical triangular graft was harvested from the one-third anterolateral section of the iliac wing. In the remaining 13 patients (control group), the graft was harvested from the conventional site. The radiographic measures, including acetabular index and center edge angle, Severin criteria, clinical outcomes (McKay criteria), and complication rates of the two groups were compared.

Results:
The clinical outcome, acetabular index, center-edge angle, and Severin criteria of the patients of the two groups were statistically comparable. Union of harvested sites was seen in all patients. The mean duration of surgery and blood loss were statistically comparable (P=0.49 and P=0.33, respectively). The rate of osteonecrosis was similar in the two groups. The only graft site morbidity was the anterior superior iliac spine (ASIS) asymmetry that was seen in all patients of the control group and no patients of the study group; a mean horizontal level difference of 2.2±0.5 cm was observed between the affected and unaffected ASIS of the control group.

Conclusions:
Vertical triangular graft harvest from the one-third anterolateral section of iliac wing in Salter osteotomy improves the cosmetic outcome through the reduction of pelvic deformity.

Level of Evidence:
Level III.
Diagnostic Utility of Endocervical Curettage During Colposcopy Among Patients of Varying Risk Factors
Authors: Wang Stephanie M. , Hoeppner Catherine , Kazma Jamil , Keegan Emma , Werner Logan , Chappell Nicole P. 
Published: September 2022

Objective
Endocervical curettage (ECC) during colposcopy is recommended in certain circumstances; however, diagnostic use remains unclear. We evaluate the utility of ECC among patients with non-fully visualized squamocolumnar junction (SCJ) and certain patient socioeconomic factors.

Methods
Retrospective chart analysis was completed for patients aged older than 21 years who underwent a colposcopy at 2 study sites between 2012 and 2021. Demographics and histopathologic results were analyzed.

Results
A total of 1,516 colposcopies were reviewed; 73.8% (n = 1,119) had an ECC with colposcopy. Of those, 92.1% (n = 1,031) had benign ECC whereas 13.9% (n = 156) had a positive ECC at time of colposcopy. Most patients with benign ECC had benign/low-grade squamous intraepithelial lesion pathology on colposcopy biopsy (82.3%; n = 914; p < .001), and most patients with high-grade squamous intraepithelial lesion (HSIL) on ECC had HSIL on colposcopy biopsy (63.4%; n = 52; p < .001) However, when looking at patients with high-grade pathology on colposcopy biopsy, it was seen that most had benign or low-grade squamous intraepithelial lesion on ECC (79.5%; n = 205; p < .001). Most patients with adequately visualized SCJ on colposcopy were noted to have HSIL on biopsy and negative ECC (73%; n = 81; p < .001). This result was similar in patients with non-fully visualized SCJ, although not statistically significant. When stratified by socioeconomic status, most patients with high-grade lesions had a benign ECC.

Conclusions
Endocervical curettage has been described to increase the identification of high-grade lesions at time of colposcopy. This descriptive study shows that many high-grade lesions at time of excisional procedure had a benign ECC on colposcopy, with no demonstrated clear additional utility in high-risk groups.
Combined Arterial and Venous Phase Computed Tomographic Imaging of the Skull Base in Pulsatile Tinnitus
Authors: Formeister Eric J. , Xiao Grace , Clark James , Carey John P. , Hui Ferdinand , Agrawal Yuri , Sun Daniel Q. 
Published: September 2022

Objective
To describe the demographic, clinical, and radiologic findings in a consecutive series of patients presenting with a chief complaint of pulsatile tinnitus (PT).

Study Design
Retrospective review of 157 patients undergoing a combined arterial/venous phase computed tomographic (CT) imaging study.

Setting
Tertiary referral center.

Patients
Adult patients referred to neurotology faculty for evaluation of PT between 2016 and 2020.

Interventions
Triple phase high-resolution arteriography/venography/temporal bone CT.

Main Outcome Measures
Prevalence of osseous, venous, and/or arterial pathology, clinicodemographic characteristics.

Results
One hundred fifty-seven adults (mean age, 52 years; 79.6% female) were evaluated. A history of migraine headaches was common (19.7%). The average body mass index was 30.0 (standard deviation, 6.8), and 17.2% of subjects had a diagnosis of obstructive sleep apnea. Idiopathic intracranial hypertension was diagnosed by elevated opening pressure on lumbar puncture in 13.4%. Comorbid depression and anxiety were common (25.5% and 26.1%, respectively). Overall, abnormalities were found in 79.0% of scans, with bilateral transverse sinus stenosis (TSS) seen in 38.9% and unilateral TSS found in 20.4%. Fifteen subjects (9.6%) had evidence of osseous etiologies, including superior canal dehiscence or thinning in 8.9% and sigmoid sinus dehiscence in one subject. There were 3 dural arteriovenous fistulae identified. Unilateral PT was ipsilateral to the side of TSS in 84.4% of subjects with unilateral TSS.

Conclusion
In a large consecutive series of patients with PT referred for CT venography/arteriography, transverse sinus stenosis was the most common finding at 59%. Venous etiologies for PT should be suspected when patients are referred to neurotologists for evaluation.
Quality-of-Life Outcomes After Modified Subtotal Petrosectomy With Ear Canal Closure for Chronic Otitis Media
Authors: Macielak Robert J. , Lohse Christine M. , Tuchscherer Amy M. , Carlson Matthew L. 
Published: September 2022

Objective
To assess quality-of-life (QoL) outcomes after modified subtotal petrosectomy with ear canal closure (mSTP) for chronic otitis media.

Study Design
Survey study.

Setting
Tertiary referral center.

Patients
Patients with chronic otitis media.

Interventions
mSTP.

Main Outcome Measures
Survey results from enrolled patients on the validated disease-specific Chronic Ear Survey (CES) and Chronic Otitis Media Outcome Test-15 (COMOT-15) regarding their current state of health and, if surgery was performed within 3 years of enrollment, their state of health before mSTP.

Results
A total of 23 patients were studied, including 19 who underwent surgery within 3 years of enrollment. Postoperatively, mean total CES scores were 80 and COMOT-15 scores were 41, with a higher CES and a lower COMOT-15 indicating better QoL. There were statistically significant improvements after mSTP in the CES activity restriction (25% difference; p = 0.008), symptom (17% difference; p = 0.007), and medical resource (13% difference; p = 0.03) domain and total (18% difference; p = 0.006) scores. In addition, there were statistically significant improvements in the COMOT-15 ear symptom (−22% difference; p < 0.001) domain and total (−16% difference; p = 0.01) scores; however, improvements in the hearing function and mental health domains did not achieve statistical significance. Postoperative COMOT-15 total scores were significantly better for patients who underwent aural rehabilitation compared to those who did not (−17% difference; p < 0.001).

Conclusion
Modified subtotal petrosectomy with ear canal closure is a useful intervention for patients with recalcitrant chronic otitis media, offering improved QoL in appropriately selected patients. Aural rehabilitation, when feasible, provides the potential for further QoL improvement.
Further Evidence for Individual Ear Consideration in Cochlear Implant Candidacy Evaluation
Authors: Patro Ankita , Lindquist Nathan R. , Holder Jourdan T. , Tawfik Kareem O. , O'Malley Matthew R. , Bennett Marc L. , Haynes David S. , Gifford René , Perkins Elizabeth L. 
Published: September 2022

Objective
To report speech outcomes after cochlear implantation (CI) for asymmetric hearing loss (AHL) and assess the influence of contralateral hearing.

Study Design
Retrospective review.

Setting
Tertiary referral center.

Patients
One hundred eighty-eight adults (mean age, 70 yr) undergoing CI for AHL from 2015 to 2020. Candidacy included pure-tone average (PTA) at least 70 dB hearing level and AzBio in quiet 60% or less in the implanted ear and AzBio in quiet greater than 40% in the contralateral ear.

Main Outcome Measures
PTA; Consonant-Nucleus-Consonant (CNC) word, AzBio sentences scores; Speech, Spatial, and Qualities of Hearing Scale (SSQ).

Results
Mean preoperative PTA and AzBio in the implanted and contralateral ears were 85.2 and 68.1 dB hearing level and 24.7% and 69.2%, respectively. Mean CNC in the implanted ear increased from 18.3% preoperatively to 44.4% (p < 0.0001) at 6 months and 49.3% (p < 0.0001) at 12 months. Mean AzBio in the implanted ear improved from 24.7% preoperatively to 60.3% (p < 0.0001) at 6 months and 64.3% (p < 0.0001) at 12 months. Patients demonstrated significant improvement in all SSQ domains at 6 and 12 months. When comparing patients with preoperative contralateral AzBio greater than 60% versus 41% to 60%, no significant differences existed in postoperative CNC scores (6-mo: 47% versus 41%, p = 0.276; 12-mo: 51% versus 47%, p = 0.543). There were no significant differences in 6-month (p = 0.936) or 12-month (p = 0.792) CNC scores between patients with AHL (contralateral ear AzBio >40%) and 169 unilateral CI patients meeting the traditional Medicare criteria (contralateral ear AzBio ≤40%).

Conclusion
CI recipients with AHL derive significant speech improvements, supporting individual ear consideration for CI candidacy and patient benefit outside of current Medicare criteria.
Unidirectional Vertical Vestibuloocular Reflex Adaptation in Humans Using 1D and 2D Scenes
Authors: Todd Christopher J. , Schubert Michael C. , Rinaudo Carlo N. , Migliaccio Americo A. 
Published: September 2022

Hypothesis
The vertical vestibuloocular reflex (VOR) in response to pitch head impulses can be optimally trained to increase in one direction using a two-dimensional (2D) visual training target with minimal effect on the horizontal VOR.

Background
We modified the incremental VOR adaptation (IVA) technique, shown to increase the horizontal VOR in patients with vestibular hypofunction, to drive vertical VOR adaptation in healthy control subjects.

Methods
We measured the horizontal and vertical active (self-generated) and passive (imposed) head impulse VOR gains (eye velocity/head velocity) before and after 15 minutes of unidirectional downward IVA training. IVA training consisted of two sessions, one using a single-dot one-dimensional (1D) target, the other a grid-of-dots 2D target.

Results
The downward head impulse VOR gain significantly increased because of training by 13.3%, whereas the upward VOR gain did not change. The addition of extraretinal (2D) feedback did not result in greater adaptation, i.e., 1D and 2D gain increases were 15.5% and 10.6%, respectively. The vertical VOR gain increase resulted in a 3.2% decrease in horizontal VOR gain.

Conclusion
This preliminary study is the first to show that physiologically relevant (high frequency) unidirectional increases in vertical VOR gain are possible with just 15 minutes of training. This study sets the basis for future clinical trials examining vertical IVA training in patients, which may provide the first practical rehabilitation treatment to functionally improve the vertical VOR.
Injury severity score as a predictor of mortality in adult trauma patients by injury mechanism types in the United States: A retrospective observational study
Authors: Colnaric Jure M. , El Sibai Rayan H. , Bachir Rana H. , El Sayed Mazen J. 
Published: September 2022

Injury severity score (ISS) is commonly used in trauma registries to describe injury severity and to predict outcomes in trauma patients regardless of injury mechanism. This study examined the correlation between ISS and mortality in adult trauma patients presenting to emergency departments in the United States with different mechanisms of injury.
A retrospective observational study was conducted using the 2014 Nationwide Emergency Department Sample. Patients’ characteristics were stratified by mortality. Receiver operating characteristic (ROC) curves were generated for death against ISS for each mechanism of injury. A logistic regression model was conducted for each mechanism of injury to determine whether ISS (≥16 vs <16) is a predictor of mortality.
The study sample consisted of 16,147,058 weighted adult trauma patients. Median age was 46 years. Slightly over half were females (51.9%). Falls, motor vehicle accidents and being struck by or against, were the most commonly reported mechanisms of injury (44.6%, 18.1%, and 15.3%, respectively). The overall mortality in the study population was 0.4%. The area under the ROC curve was highest in injuries sustained in accidents involving machinery (0.947; 95% confidence intervals [CI], 0.896-0.998), followed by motor vehicle traffic (MVA) (0.788; 95% CI, 0.775-0.801) and cutting or piercing (0.746; 95% CI, 0.701-0.791). Deceased patients were accurately identified by ISS 65.2% in injury by machinery, 47.7% in injury involving MVA, 39.7% in injury by firearm and 31.4% in injury by assault. After adjusting for confounders, the multivariate models in which ISS was the main independent factor performed best in predicting mortality from firearm and machinery mechanism of injuries.
Although the ROC curve analysis demonstrated a moderate or high discriminatory ability to identify deceased patients in 6 out of twelve mechanisms, and the multivariate analysis revealed that ISS was a significant predictor of mortality in 9 out of 12 injury mechanisms, the sensitivities of all logistic regression models were poor. The ISS ≥ 16 threshold alone therefore should not be used to identify patients with high-mortality risk. The mortality risk assessment should be done individually and be based on clinical evaluation.
Posttraumatic Stress Disorder Among Health Care Workers During the COVID-19 Pandemic
Authors: Bayazit Huseyin , Ozel Mehmet , Arac Songul , Dulgeroglu-Bayazit Dilruba , Joshi Astik 
Published: September 2022

Background:
Coronavirus disease 2019 (COVID-19) has taken a significant toll on people worldwide, and in particular, on the health care workers (HCWs) who have worked on the frontlines in the fight against the pandemic. The goal of this study was to investigate the prevalence of posttraumatic stress disorder (PTSD) and related factors in HCWs in the era of COVID-19.

Methods:
This cross-sectional survey study was conducted between September 15, and October 15, 2020, among HCWs in Turkey. The survey consisted of self-administered questionnaires, which included questions about sociodemographic variables, experiences caring for patients with COVID-19, and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), a trauma screening tool. The online survey was completed by 1833 HCWs. Univariate and multivariate logistic regression analyses were used to identify independent predictors of PTSD.

Results:
The mean age of the participants was 32.7±7.0 years; 81.9% were physicians, and 56.5% were female. The rates of COVID-19 history in the respondents, a family member, or a coworker were 13.6%, 32.3%, and 12.6%, respectively. Among the HCWs who participated, 39.9% met the criteria for PTSD. Compared with the physicians, the nonphysician HCWs had a higher rate of PTSD (49.5% vs. 36%) (P<0.001) and higher PCL-5 scores (53.31±19.6 vs. 42.5±20.3) (P<0.001). In addition, 9.7% of the surveyed HCWs reported having suicidal ideation during the COVID-19 pandemic. Independent predictors of PTSD in HCWs were working on a COVID-19 unit, feeling isolated, suicidal ideation, being a nonphysician HCW, fear of spreading coronavirus to family, female sex, and a history of having COVID-19.

Conclusions:
HCWs were at risk for impairment in mental well-being in the era of COVID-19, with a significant number experiencing PTSD as well as suicidal ideation. Therefore, HCWs, especially those who are working on a COVID-19 unit and are female, should be monitored regularly for PTSD.
The Presence of a Cost–Volume Relationship in Robotic-assisted Thoracoscopic Lung Resections
Authors: Verma Arjun , Hadaya Joseph , Richardson Shannon , Vadlakonda Amulya , Ramezani Ramin , Revels Sha’Shonda , Benharash Peyman 
Published: September 2022

Objective:To characterize the relationship between institutional robotic-assisted pulmonary lobectomy volume and hospitalization costs.Background:The high cost of robotic-assisted thoracoscopic surgery (RATS) is among several drivers of hesitation among nonadopters. Studies examining the impact of institutional experience on costs of RATS lobectomy are lacking.Methods:Adults undergoing RATS lobectomy for primary lung cancers were identified from the 2016 to 2018 Nationwide Readmissions Database. A multivariable regression to model hospitalization costs was developed with the inclusion of hospital RATS lobectomy volume as restricted cubic splines. The volume corresponding to the inflection point of the spline was used to categorize hospitals as high- (HVH) or low-volume (LVH). We subsequently examined the association of HVH status with adverse events, length of stay, costs, and 30-day, nonelective readmissions.Results:An estimated 14,756 patients underwent RATS lobectomy during the study period, with median cost of $23,000. Upon adjustment for patient and operative characteristics, hospital RATS volume was inversely associated with costs. Although only 17.2% of centers were defined as HVH, 51.7% of patients were managed at these centers. Patients at HVH and LVH had similar age, sex, and distribution of comorbidities. Notably, patients at HVH had decreased risk-adjusted odds of adverse events (adjusted odds ratio: 0.62,P<0.001), as well as significantly reduced length of stay (−0.8 d,P<0.001) and costs (−$3900,P<0.001).Conclusions:Increasing hospital RATS lobectomy volume was associated with reduced hospitalization costs. Our findings suggest the presence of streamlined care pathways at high-volume centers, which influence costs of care.
The Presence of Myelinated Nerves and Schwann Cells in White Adipose Tissue: Proximity to Synaptic Vesicle Containing Nerve Terminals and Potential Role in BTBR ob/ob Demyelinating Diabetic Neuropathy
Authors: Willows Jake W. , Gunsch Gilian , Paradie Emma , Blaszkiewicz Magdalena , Tonniges Jeffrey R. , Pino Maria F. , Smith Steven R. , Sparks Lauren M. , Townsend Kristy L. 
Published: September 2022

ABSTRACTPeripheral neuropathy is a pathophysiological state of nerve degeneration and loss of tissue innervation. The most prominent cause of small fiber neuropathy is diabetes which can be demyelinating in nature, but this has not yet been explored in adipose tissue. Both demyelinating neuropathies and axonopathies implicate Schwann cells (SCs), the peripheral glial required for nerve myelination and regeneration after injury. Here, we perform a comprehensive assessment of SCs and myelination patterns of subcutaneous white adipose tissue (scWAT) nerves, including changes that occur with obesity and other imbalanced energy states in mice and humans. We found that mouse scWAT is densely innervated by both myelinated and unmyelinated sensory and sympathetic nerves. Accordingly, scWAT is home to both myelinating and non-myelinating SCs – the greater proportion of which are myelinating. Furthermore, SCs were found closely associated with synaptic vesicle-containing nerve terminals in scWAT. Obese BTBR ob/ob mice exhibit diabetic peripheral neuropathy in scWAT, and display concordant demyelination specific to small fibers, which was also associated with a decrease in the pan-SC marker Sox10 and compensatory increase in Krox20 gene expression. Together this suggests that adipose SCs may be involved in regulating the plasticity or the neuropathy of adipose tissue nerves.
A third SARS-CoV-2 mRNA vaccine dose in people receiving hemodialysis overcomes B cell defects but elicits a skewed CD4+T cell profile
Authors: Sannier Gérémy , Nicolas Alexandre , Dubé Mathieu , Marchitto Lorie , Nayrac Manon , Tastet Olivier , Tauzin Alexandra , Lima-Barbosa Raphaël , Laporte Mélanie , Cloutier Rose , Flores Alina Sreng , Boutin Marianne , Gong Shang Yu , Benlarbi Mehdi , Ding Shilei , Bourassa Catherine , Gendron-Lepage Gabrielle , Medjahed Halima , Goyette Guillaume , Brassard Nathalie , Ortega-Delgado Gloria-Gabrielle , Niessl Julia , Gokool Laurie , Morrisseau Chantal , Arlotto Pascale , Rios Norka , Tremblay Cécile , Martel-Laferrière Valérie , Prat Alexandre , Bélair Justin , Beaubien-Souligny William , Goupil Rémi , Nadeau-Fredette Annie-Claire , Lamarche Caroline , Finzi Andrés , Suri Rita S. , Kaufmann Daniel E. 
Published: September 2022

ABSTRACTCellular immune defects associated with suboptimal responses to SARS-CoV-2 mRNA vaccination in people receiving hemodialysis (HD) are poorly understood. We longitudinally analyzed antibody, B cell, CD4+and CD8+T cell vaccine responses in 27 HD patients and 26 low-risk control individuals (CI). The first two doses elicit weaker B cell and CD8+T cell responses in HD than in CI, while CD4+T cell responses are quantitatively similar. In HD, a third dose robustly boosts B cell responses, leads to convergent CD8+T cell responses and enhances comparatively more Thelper (TH) immunity. Unsupervised clustering of single-cell features reveals phenotypic and functional shifts over time and between cohorts. The third dose attenuates some features of THcells in HD (TNFα/IL-2 skewing), while others (CCR6, CXCR6, PD-1 and HLA-DR overexpression) persist. Therefore, a third vaccine dose is critical to achieve robust multifaceted immunity in hemodialysis patients, although some distinct THcharacteristics endure.