bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of cervical lymph node metastasis with contrast-enhanced ultrasound and association between presence of BRAFV600E and extrathyroidal extension in papillary thyroid carcinoma
Authors: Zhan Jia , Zhang Long-hui , Yu Qing , Li Chao-lun , Chen Yue , Wang Wen-Ping , Ding Hong 
Published: August 2020

Objective: This study aimed to evaluate the correlation between cervical lymph node metastasis (CLNM) and each of the ultrasound features, immunohistochemical factors, and B-type Raf (BRAFV600E) mutation. Methods: A retrospective analysis was performed on 405 patients with single papillary thyroid carcinoma (PTC) nodules, all of whom underwent preoperative sonographic examinations, including gray-scale ultrasound, color Doppler ultrasound, and contrast-enhanced ultrasound (CEUS). All PTC patients were evaluated using 14 clinical and sonographic features, eight immunohistochemical factors, and BRAFV600E. Multivariate analyses were performed to identify the risk factors for CLNM, and an equation for CLNM was established. The diagnostic value of each modality was compared with a receiver operating characteristic (ROC) curve. Results: Among the 405 PTC nodules removed surgically, CLNM was confirmed in 138 patients, whereas extrathyroidal extension was confirmed in 185 patients. Multivariate analyses indicated significant differences between CLNM and non-CLNM groups in three conventional ultrasound features ( p < 0.05), whereas other sonographic features, eight immunohistochemical factors, and BRAFV600E did not indicate significant differences. A ROC curve of 0.757 in the equation exhibited a significant difference compared with the solo factors ( p < 0.05 for all). Hyper or isoechoic enhancement at peak time on CEUS was associated with CLNM, whereas the presence of the BRAFV600E mutation was associated with extrathyroidal extensions although BRAF appeared to be uncorrelated with CLNM in the present study. Conclusion: Intensity at peak time, homogeneity, and size are the three most significant features in predicting CLNM in PTC patients, and the presence of the BRAFV600E mutation was associated with extrathyroidal extensions when PTCs showed a hyper or isoechoic enhancement at peak time in CEUS.
Endoscopic Study of the Distribution of Olfactory Filaments: A Cadaveric Study
Authors: Soriano Roberto M. , Solares C. Arturo , Pradilla Gustavo , DelGaudio John M. 
Published: August 2020

Objective Provide a detailed anatomical description of the olfactory filaments (OF) and their distribution in the nasal cavity through endoscopic endonasal dissection. Methods Four cadaveric specimens (8 sides) were used in this study. Nasoseptal (NSM), middle (MTM) and superior turbinate (STM) mucosa dissection was performed to identify the OF and follow them superiorly to the cribriform plate (CP). Measurements of the OF were taken on the NSM, MTM, STM under direct endoscopic visualization. A Student’s T-Test was performed to compare means. Results The NSM contained a mean of 11 OF, distributed over surface area (SA) of 173 ± 31 mm2 with the highest density of OF being found at the posterior NSM. The MTM contained a mean 6 OF, covering a mean SA of 77 mm2, with the first OF found 5 mm from the anterior border of the MTM, on average. The STM had a mean 9 OF, with the OF covering a mean SA of 96 mm2. Overall mean OF length was 6 mm. The STM OF were significantly greater in number, with a greater distance from the first OF to last OF (p < 0.05) than the MTM OF. Summary The STM and MTM combined were found to have a greater density of OF than the NSM. The STM contains a significantly greater number of OF covering a greater area than the MTM OF. Preservation of the STM and MTM in skull base defect repair, and in routine sinus surgery, can be as beneficial for olfactory function as preservation of the NSM; particularly in CP defect repair. Moreover, our findings indicate that nasoseptal flap harvest performed at least 6 mm from the skull base preserves OF in the NSM. To our knowledge, this is the first anatomical study of the OF through direct endoscopic observation and measurements.
Multiple Site Cryoablation Treatment of the Posterior Nasal Nerve for Treatment of Chronic Rhinitis: An Observational Feasibility Study
Authors: M. Yen David , B. Conley David , O’Malley Ellen M. , Byerly Tracy A. , Johnson Jacob 
Published: August 2020

Background Cryoablation of the posterior nasal nerve at the middle meatus has been shown to successfully treat nasal obstruction and symptoms of chronic rhinitis. Cryoablation of both the middle and inferior meatus has not yet been studied. Objectives To evaluate the safety and feasibility of cryoablation of the posterior nasal nerve at both the middle and inferior meatus locations to treat chronic rhinitis. Methods Participants underwent bilateral cryoablation of the posterior nasal nerve at both the middle meatus and inferior meatus and were assessed through 3 months post treatment. The primary endpoint is the change from baseline to 3-month follow-up in the reflective Total Nasal Symptom Score (rTNSS). Other assessments include additional patient-reported outcomes, physician assessment, and independent review and scoring of imaging. Results Thirty participants were enrolled at 3 US centers. There was a significant improvement from baseline in the median rTNSS (–4.0, P < .001) at 3 months. Statistically significant improvements from baseline ( P < .001) were also observed with the Nasal Obstruction Symptom Score (NOSE), nasal symptom visual analog scale (VAS), Sino-Nasal Outcomes Score (SNOT-22), and mini Rhinoconjunctivitis Quality of Life Questionnaire (mini RQLQ). Clinical Global Impression – Improvement (CGI-I) indicated that 89.7% (26/29) of participants experienced improvement at 3 months. No serious adverse events were reported. Conclusion Cryoablation at both the middle meatus and inferior meatus appears to be a safe and feasible option for treatment of chronic rhinitis. In this feasibility study, there is significant improvement in symptoms post treatment. Adverse events are minor and transient.
Medical Malpractice Claims and Mitigation Strategies Following Spine Surgery
Authors: Jackson Keith L. , Rumley Jacob , Griffith Matthew , Linkous Timothy R. , Agochukwu Uzondu , DeVine John 
Published: August 2020

Study Design: Narrative review. Objective: The aim of this narrative review is to examine trends in malpractice litigation arising from spine surgery. We also hope to detail mitigation strategies that surgeons can employ to decrease their risk of a claim. Methods: A review of the relevant literature examining the prevalence, risks, and outcomes of malpractice litigation following spine surgery was conducted using the MEDLINE and Embase databases. Results: Combined queries identified 1140 potentially relevant articles. After eliminating duplicate articles and screening by title and abstract, 38 articles underwent full-text review. Of these, 22 were deemed relevant to the research questions posed. Evaluation of references identified 1 additional relevant article. Spine surgery represents one of the most litigious specialties in the United States health care system. The available literature points to a consistent pattern of common allegations leading to litigation following spine surgery. While a majority of filed lawsuits end in the surgeon’s favor, these cases carry high monetary and time expenditures regardless of outcome. Furthermore, the threat of a malpractice lawsuit motivates many surgeons to practice defensive medicine by utilizing unnecessary or unindicated tests and studies. Conclusion: Through the examination of trends in malpractice claims and case outcomes, surgeons may be able to adapt practices to minimize their risk of litigation. These changes can include, but are not limited to, identification of those procedures that are most litigious and a more thorough discussion of the informed consent process to include operative and nonoperative treatments prior to all procedures. More important, however, spine surgeons can potentially serve as advocates for change.
Dural Injury in Unilateral Biportal Endoscopic Spinal Surgery
Authors: Lee Han Gyu , Kang Moo Sung , Kim So Yeon , Cho Kwang Chun , Na Young Cheol , Cho Jin Mo , Jin Byung Ho 
Published: August 2020

Study Design: Retrospective study. Objectives: Unilateral biportal endoscopic surgery (UBES) is a popular surgical method used to treat degenerative spinal diseases because of its merits, such as reduced tissue damage and outstanding visual capacity. However, dural injury is the most common complication of UBES with an incidence rate of 1.9% to 5.8%. The purpose of this study was to analyze the pattern of dural injury during UBES and to report the clinical course. Methods: We retrospectively reviewed the medical and radiographic records of surgically treated patients who underwent UBES at a single institute between January 2018 and December 2019. Results: Fifty-three patients, representing 67 segments, underwent UBES. Seven dural injuries occurred, and the incidence rate was 13.2%. Among 16 far lateral approaches, 2 dural injuries of the exiting roots occurred and were treated with fibrin sealant reinforcement. Among 51 median approaches, dural injury occurred at the thecal sac (n = 3) and traversing root (n = 2). A dural injury of the shoulder of the traversing root was treated with a fibrin sealant; however, a defect in the thecal sac required a revision for reconstruction. The other 2 thecal sac injuries were directly repaired via microscopic surgery. Conclusions: Dural injury during UBES can occur because of the various anatomical features of the meningo-vertebral ligaments. Direct repair of the central dural defect should be considered under microscopic vision. A linear tear in the lateral dura or root can be controlled with a simple patchy reinforcement under endoscopic vision.
Prediction of Final Body Height for Female Patients With Adolescent Idiopathic Scoliosis
Authors: Cheung Prudence Wing Hang , Mannem Abhishek , Cheung Jason Pui Yin 
Published: August 2020

Study Design: Retrospective cohort study. Objectives: To explore the possibility of predicting final body height at maturity based on associating parameters at the time of diagnosing adolescent idiopathic scoliosis (AIS), while examining the effect of curve magnitude and deterioration. Methods: A total of 284 female patients with AIS (mean age 12.2 ± 1.1 years, 52.5% premenarchal) were followed till skeletal maturity, indicated by ≥Risser stage 4, static body height and arm span over the past 6 months, and postmenarche 2 years. Standing body height, arm span, menarchal status, Risser staging, distal radius and ulna (DRU) classification, Sanders staging (SS), Cobb angles (major and minor curves), and Lenke curve types at initial presentation were examined. Patients with/without curve deterioration were compared. Multiple linear regression was used for predicting final body height (cm), and remaining height increase (%). Results: Baseline body height was 152.1 ± 7.1 cm and major curve Cobb angle was 27.1° ± 7.4°, whereas at maturity they were 159.5 ± 5.4 cm and 32.5° ± 9.3°, respectively. For patients presented at Risser stage 0 or 1, radius grade (R) 6, ulnar grade (U) 5, or SS3, those with curve deterioration exhibited greater height increase potential at initial presentation ( P < .05) than those without deterioration. No intergroup difference was found for patients presented at ≥Risser 2, R7, U6, SS4. Predictive baseline parameters were age, body height, Cobb angle (major curve), curve type, and DRU grades. Prediction models of final body height ( R 2 = 0.735, P < .001) and remaining height increase ( R 2 = 0.742, P < .001) were established. Conclusions: Final body height prediction model was derived for female patients with AIS, with baseline body height and ulnar grading having larger impacts than other parameters.
A Novel Reparability Assessment Scoring System for Full-Thickness Rotator Cuff Tears
Authors: Park In , Kang Jun-Seok , Lee Hye-Ah , Jo Yoon-Geol , Shin Sang-Jin 
Published: August 2020

Background: It is difficult to predict the arthroscopic reparability of rotator cuff tears preoperatively when the repair is challenging. This can result in unsatisfactory outcomes and a high retear rate. Purpose: To develop an assessment score reflecting factors in rotator cuff tears that can predict reparability before surgery. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively enrolled 170 patients with rotator cuff tears larger than 2 cm who underwent arthroscopic repair. Patients were categorized into “complete repair” and “partial repair” groups based on the area of the exposed footprint after arthroscopic rotator cuff repair. In each group, preoperative magnetic resonance imaging factors (tear size, fatty infiltration, remnant tendon length, atrophy), clinical factors (range of motion, American Shoulder and Elbow Surgeons score, Constant score), and patient demographics were evaluated. Receiver operating characteristic curve analysis was used to choose the optimal cutoff value. A reparability assessment score was formulated through stepwise selection using variables that showed significant between-group differences on univariate analysis. We selected 4 variables and assigned a relative score for each variable based on estimated coefficient values. The sum of the scores for each factor ranged from 0 to 5. Results: The average rotator cuff tear size was 28 × 26 mm. The torn rotator cuff was repaired completely in 74 patients (43.5%) and partially in 96 patients (56.5%). The following factors were chosen for the reparability assessment score: positive tangent sign (odds ratio [OR], 5.969; P = .001), fatty infiltration of the infraspinatus of grade ≤2 (OR, 3.537; P = .001), coronal tear size ≥26 mm (OR, 3.315; P = .002), and remnant tendon length <15 mm (OR, 2.584; P = .017). Complete repair was possible if the sum of the scores was <3 (area under curve, 0.803; 95% CI, 0.739-0.867; sensitivity, 51.0%; specificity, 95.9%). Conclusion: In patients with a score of <3 on the novel reparability assessment score, complete repair was obtainable, whereas in patients with a score of ≥3, complete repair was difficult and other methods such as biologic grafts or arthroplasty had to be considered for a favorable prognosis.
A Case of Penetrating Foreign Body Causing Mild Symptoms of Acute Carpal Tunnel Syndrome
Authors: AlHasan Rashed N. , Louri Nayef A. 
Published: August 2020

Carpal tunnel syndrome (CTS) is a neuropathy brought about by the entrapment and compression of the median nerve as it travels through the carpal tunnel. The hallmark of classic CTS is pain or paraesthesia (numbness, burning, or tingling) in the palmar aspect of the first 3 digits, as well as the radial aspect of the fourth digit. Although idiopathic in nature, many risk factors have been attributed to the development of CTS. These factors include diabetes mellitus, acromegaly, thyroid disease, rheumatoid arthritis, pregnancy, the use of steroids, and the repetitive use of hand and wrist. The prevalence also seems to be higher in obese women. In literature, trauma, foreign body, tumors, or anatomical variations are considered to be infrequent causes of CTS. A rare form of CTS is the acute carpal tunnel syndrome (ACTS) that presents mainly after injuries to the upper extremities. The patient typically acknowledges trauma to the wrist secondary to a foreign body at the time of injury. In some cases, small fragments may penetrate the wrist and remain unnoticed causing acute neurological symptoms. In literature, there were limited studies that reported the development of ACTS secondary to missed foreign bodies following trauma. This report presents a case of ACTS sustained following a penetrating foreign body (pellet) to the right wrist. Removal of the foreign body resulted in complete recovery with no neurological sequelae.
Exploitable metabolic dependencies in MLL-ENL–induced leukemia
Authors: Garcia-Cuellar Maria-Paz , Lawlor Jennifer , Böttcher Martin , Mougiakakos Dimitrios , Metzler Markus , Slany Robert K. 
Published: August 2020

Abstract
Mixed-lineage leukemia (MLL) fusions are transcriptional activators that induce leukemia, with a dismal prognosis that mandates further elucidation of their transformation mechanism. In this study, knockdown of the direct MLL-ENL target gene polypyrimidine tract binding protein-1 (PTBP1) was rate limiting for cell proliferation and caused a metabolic phenotype associated with reduced glucose consumption and lactate production. This effect was accompanied by a reduction of splice isoform-2 of pyruvate kinase M (PKM2). Because PKM2 restricts glycolytic outflow to provide anabolic intermediates, we tested the consequences of glucose, energy, and Ser/Gly starvation for cell physiology. Administration of deoxyglucose, energetic decoupling with rotenone, and inhibition of Ser biosynthesis by CBR5884 had a significantly stronger influence on self-renewal and survival of transformed cells than on normal controls. In particular, inhibition of Ser synthesis, which branches off glycolysis caused accumulation of reactive oxygen species, DNA damage, and apoptosis, predominantly in leukemic cells. Depletion of exogenous Ser/Gly affected proliferation and self-renewal of murine and human leukemia samples, even though they are classified as nonessential amino acids. Response to Ser/Gly starvation correlated with glucose transport, but did not involve activation of the AMPK energy homeostasis system. Finally, survival times in transplantation experiments were significantly extended by feeding recipients a Ser/Gly-free diet. These results suggest selective starvation as an option for supportive leukemia treatment.
Improving the antitumor activity of R-CHOP with NGR-hTNF in primary CNS lymphoma: final results of a phase 2 trial
Authors: Ferreri Andrés J. M. , Calimeri Teresa , Ponzoni Maurilio , Curnis Flavio , Conte Gian Marco , Scarano Eloise , Rrapaj Eltjona , De Lorenzo Daniela , Cattaneo Dario , Fallanca Federico , Nonis Alessandro , Foppoli Marco , Lopedote Paolo , Citterio Giovanni , Politi Letterio S. , Sassone Marianna , Angelillo Piera , Guggiari Elena , Steffanoni Sara , Tarantino Vittoria , Ciceri Fabio , Bordignon Claudio , Anzalone Nicoletta , Corti Angelo 
Published: August 2020

Abstract
Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the standard treatment of diffuse large B-cell lymphoma (DLBCL). Primary DLBCL of the central nervous system (CNS) (primary central nervous system lymphoma [PCNSL]) is an exception because of the low CNS bioavailability of related drugs. NGR–human tumor necrosis factor (NGR-hTNF) targets CD13+ vessels, enhances vascular permeability and CNS access of anticancer drugs, and provides the rationale for the treatment of PCNSL with R-CHOP. Herein, we report activity and safety of R-CHOP preceded by NGR-hTNF in patients with PCNSL relapsed/refractory to high-dose methotrexate-based chemotherapy enrolled in a phase 2 trial. Overall response rate (ORR) was the primary endpoint. A sample size of 28 patients was considered necessary to demonstrate improvement from 30% to 50% ORR. NGR-hTNF/R-CHOP would be declared active if ≥12 responses were recorded. Treatment was well tolerated; there were no cases of unexpected toxicities, dose reductions or interruptions. NGR-hTNF/R-CHOP was active, with confirmed tumor response in 21 patients (75%; 95% confidence interval, 59%-91%), which was complete in 11. Seventeen of the 21 patients with response to treatment received consolidation (ASCT, WBRT, and/or lenalidomide maintenance). At a median follow-up of 21 (range, 14-31) months, 5 patients remained relapse-free and 6 were alive. The activity of NGR-hTNF/R-CHOP is in line with the expression of CD13 in both pericytes and endothelial cells of tumor vessels. High plasma levels of chromogranin A, an NGR-hTNF inhibitor, were associated with proton pump inhibitor use and a lower remission rate, suggesting that these drugs should be avoided during TNF-based therapy. Further research on this innovative approach to CNS lymphomas is warranted. The trial was registered as EudraCT: 2014-001532-11.
Estimating the potential for dementia prevention through modifiable risk factors elimination in the real-world setting: a population-based study
Authors: Rolandi Elena , Zaccaria Daniele , Vaccaro Roberta , Abbondanza Simona , Pettinato Laura , Davin Annalisa , Guaita Antonio 
Published: August 2020

Abstract
Background
Preventing dementia onset is one of the global public health priorities: around 35% of dementia cases could be attributable to modifiable risk factors. These estimates relied on secondary data and did not consider the concurrent effect of non-modifiable factors and death.
Here, we aimed to estimate the potential reduction of dementia incidence due to modifiable risk factors elimination, controlling for non-modifiable risk factors and for the competing risk of death.

Methods
Participants from the InveCe.Ab population-based prospective cohort (Abbiategrasso, Italy) without a baseline dementia diagnosis and attending at least one follow-up visit were included (N = 1100). Participants underwent multidimensional assessment at baseline and after 2, 4, and 8 years, from November 2009 to January 2019.
Modifiable risk factors were low education, obesity, hypertension, diabetes, depression, smoking, physical inactivity, hearing loss, loneliness, heart disease, stroke, head injury, and delirium. Non-modifiable risk factors were age, sex, and APOE ε4 genotype. The primary endpoint was dementia diagnosis within the follow-up period (DSM-IV criteria). We performed competing risk regression models to obtain sub-hazard ratio (SHR) for each exposure, with death as competing risk. The exposures associated with dementia were included in a multivariable model to estimate their independent influence on dementia and the corresponding population attributable fraction (PAF).

Results
Within the study period (mean follow-up, 82.3 months), 111 participants developed dementia (10.1%). In the multivariable model, APOE ε4 (SHR = 1.89, 95% CI 1.22–2.92, p = 0.005), diabetes (SHR = 1.56, 95% CI 1.00–2.39, p = 0.043), heart disease (SHR = 1.56, 95% CI 1.03–2.36, p = 0.037), stroke (SHR = 2.31, 95% CI 1.35–3.95, p = 0.002), and delirium (SHR = 8.70, 95% CI 3.26–23.24, p <  0.001) were independently associated with increased dementia risk. In the present cohort, around 40% of dementia cases could be attributable to preventable comorbid diseases.

Conclusions
APOE ε4, diabetes, heart disease, stroke, and delirium independently increased the risk of late-life dementia, controlling for the competing risk of death. Preventive intervention addressed to these clinical populations could be an effective approach to reduce dementia incidence. Further studies on different population-based cohort are needed to obtain more generalizable findings of the potential of dementia prevention in the real-world setting.

Trial registration
ClinicalTrials.gov, NCT01345110.