bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immunophenotype of Vestibular Schwannomas
Authors: Bi Wenya Linda , Gupta Saksham , Mei Yu , Abdulmohsen Sally Al , Giantini Larsen Alexandra , Unadkat Prashin , Ramkissoon Shakti , Abedalthagafi Malak , Dunn Ian F. 
Published: November 2020

Background:
Vestibular schwannomas exhibit a uniquely variable natural history of growth, stability, or even spontaneous regression. We hypothesized that a transitory population of immune cells, or immunomodulation of tumors cells, may influence the growth pattern of schwannomas. We therefore sought to characterize the impact of the immune microenvironment on schwannoma behavior.

Methods:
Forty-eight vestibular schwannomas with preoperative magnetic resonance imaging and 11 with serial imaging were evaluated for presence of immune infiltrates (including the pan-leukocyte marker Cluster of Differentiation (CD)45, CD4 and CD8 T-cell, and CD68 and CD163 macrophages) as well as expression of immunomodulatory regulators (Programmed Death Ligand 1 (PD-L1), Programmed Death Ligand 2 (PD-L2), LAG-3, TIM-3, V-domain Ig Suppressor of T cell Activation). Maximal diameter, volume, and recurrence were annotated.

Results:
Vestibular schwannomas were characterized by diverse signatures of tumor infiltrating leukocytes and immunomodulatory markers. The median tumor volume was 4.7 cm3 (Interquartile Range (IQR) 1.0–13.0) and maximum diameter was 2.3 cm (IQR 1.5–3.2). Among tumors with serial imaging, the median volumetric growth was 0.04 cm3/mo (IQR 0.01–0.18). Tumor volume and maximum diameter demonstrated strong concordance (R2 = 0.90; p < 0.001). Vestibular schwannoma volume was positively associated with CD4, CD68, and CD163, but not CD8, immune infiltration (all p < 0.05). Tumor growth was positively associated with CD163 and PD-L1 (both p < 0.05). Further, CD163 modified this effect: the relationship between PD-L1 and growth strengthened with increasing CD163 infiltration (R2 = 0.81, p = 0.007). No other immune cell types modified this relationship. These associations were inconsistently observed for maximum diameter and linear growth.

Conclusion:
Vestibular schwannomas demonstrate variable expression of immune regulatory markers as well as immune infiltrates. Tumor size is associated with immune infiltrates and tumor growth is associated with PD-L1, especially in the presence of M2-subtype macrophages. Volumetric measures may associate with the biological signature more accurately than linear parameters. Future exploration of the role of immune modulation in select schwannomas will further enhance our understanding of the biology of these tumors and suggest potential therapeutic avenues for control of tumor growth.
Predicting Long-Term Facial Nerve Outcomes After Resection of Vestibular Schwannoma
Authors: Tawfik Kareem O. , Alexander Thomas H. , Saliba Joe , Mastrodimos Bill , Cueva Roberto A. 
Published: November 2020

Objectives:
1) Describe the effect of tumor size on facial nerve (FN) outcomes after microsurgical resection of vestibular schwannoma (VS).
2) Describe the effect of surgical approach, preoperative radiation, and early postoperative facial function on long-term FN outcomes.

Study Design:
Retrospective analysis.

Setting:
Tertiary referral center.

Patients:
Adult (≥18 yr) patients underwent translabyrinthine or retrosigmoid VS resection by a single neurotologist and single neurosurgeon between February 2008 and December 2017.

Main Outcome Measures:
Long-term FN outcomes (≥12 mo) according to House–Brackmann (HB) grade.

Results:
During the study period, 350 patients underwent VS resection, of whom 290 met inclusion criteria. Translabyrinthine surgery was performed in 54% (n = 158) and retrosigmoid in 45% (n = 131). One patient underwent a combined approach. Among patients who underwent retrosigmoid approach, none had a tumor more than 30 mm. Gross total resection was achieved in 98% (n = 283). Long-term HB1–2 function was achieved in 90% (n = 261). On univariate analysis, tumor size (per cm increase), history of preoperative radiation, and worse HB score at discharge predicted worse FN function. Multivariate analysis showed that tumor size (per cm increase) and history of radiation were independent predictors of FN function. For patients with tumors less than 30 mm, multivariate analysis of tumor size and surgical approach was performed; tumor size remained predictive of worse FN function (odds ratio [OR] 2.362, p = 0.0035), whereas surgical approach was not significantly predictive (p = 0.7569).

Conclusion:
Tumor size and history of radiation predict long-term FN function after VS resection. When accounting for tumor size, the translabyrinthine and retrosigmoid approaches yield equivalent FN results.
Rural-Urban Differences in Nursing Home Risk-adjusted Rates of Emergency Department Visits
Authors: Xu Huiwen , Bowblis John R. , Caprio Thomas V. , Li Yue , Intrator Orna 
Published: November 2020

Background:
Higher risk-adjusted rate of emergency department (ED) visits might reflect poor quality of nursing home (NH) care; however, existing evidence is limited regarding rural-urban differences in ED rates of NHs, especially for long-stay residents.

Objectives:
To determine and quantify sources of rural-urban differences in NH risk-adjusted rates of any ED visit, ED without hospitalization or observation stay (outpatient ED), and potentially avoidable ED visits (PAED) of long-stay residents.

Research Design:
We calculated quarterly NH risk-adjusted rates using 2011–2013 national Medicare claims and Minimum Data Set 3.0, and then implemented Generalized Estimating Equation models to examine rural-urban differences in ED rates and Blinder-Oaxaca decomposition to quantify the contributions of NH and market factors.

Subjects:
Privately owned, free-standing NHs in the United States (N=13,260).

Results:
Over the study period, risk-adjusted rates averaged 9.8% for any ED, 3.3% for outpatient ED, and 3.2% for PAED. Compared with urban NHs, rural NHs were associated with significantly lower rates of any ED, outpatient ED, and PAED (β=−1.67%, −0.44%, and −0.28%; all P<0.01). Observable differences in market factors (nursing home bed concentration, hospital beds, and the existence of a critical access hospital) explained about half of the rural-urban differences in rates of any ED and PAED, but not outpatient ED.

Conclusions:
Decomposition analyses suggested that lower ED rates in rural NHs appear to be related to market availability of hospital resources. Policymakers may focus on not only reducing unnecessary ED visits but also ensuring equitable hospital access in rural areas.
Integration of Clozapine-associated Harm Obsessions into Cognitive Behavioral Conceptualization and Treatment Planning for Thought Broadcasting: A Case Study
Authors: KOPELOVICH SARAH L. , WOOD KEITH , COTES ROBERT O. , GOLDSMITH DAVID R. 
Published: November 2020

Background and Objectives:
As many as 30% of individuals with a schizophrenia spectrum disorder experience obsessive-compulsive symptoms (OCS). Clozapine has demonstrated superior efficacy for the treatment of medication-resistant schizophrenia but it is also associated with an increased risk for OCS. Because pharmacologic management of clozapine-related OCS can be particularly challenging, cognitive behavioral therapy (CBT) should be considered. Nevertheless, there are few detailed accounts of CBT for OCS and schizophrenia.

Methods:
The authors describe the interdisciplinary outpatient care of a client who had a 25-year history of schizoaffective disorder, bipolar type, and OCS. The case formulation was used to guide interventions to target core schemas of being dangerous and defective. The case study describes the cognitive behavioral formulation, treatment targets, treatment course, and functional and symptom response.

Results:
The client received 21 sessions of a formulation-based CBT for psychosis protocol, which included a 6-session course of exposure with response prevention, consisting of imaginal and in vivo exposure to multiple salient harm stimuli. Reduced ratings of distress and a 50% reduction in OCS suggest that habituation and inhibitory learning occurred. The treatment of OCS resulted in the complete resolution of thought broadcasting. Subsequently, the client was more successful in his efforts to adhere to an action schedule.

Limitations:
The use of both the treatment approach described in this clinical case report and contemporaneous medication management preclude comment on the mechanism(s) of the therapeutic change observed in this case.

Conclusions:
This report presents a means of conceptualizing the interplay between thought broadcasting and harm obsessions and discusses considerations in identifying and treating individuals with similar comorbid conditions, particularly in the context of clozapine treatment for medication-resistant psychosis.
Sensory Recovery of the Breast following Innervated and Noninnervated Lateral Thigh Perforator Flap Breast Reconstruction
Authors: Beugels Jop , van Kuijk Sander M. J. , Lataster Arno , van der Hulst René R. W. J. , Tuinder Stefania M. H. 
Published: November 2020

Background:
The lateral thigh perforator flap, based on the tissue of the upper lateral thigh, is an excellent option for autologous breast reconstruction. The aim of this study was to introduce the technique to perform a nerve coaptation in lateral thigh perforator flap breast reconstruction and to analyze the results by comparing the sensory recovery of the reconstructed breast and donor site between innervated and noninnervated lateral thigh perforator flaps.

Methods:
A prospective cohort study was conducted of patients who underwent an innervated or noninnervated lateral thigh perforator flap breast reconstruction between December of 2014 and August of 2018. Direct nerve coaptation was performed between a branch of the lateral femoral cutaneous nerve and the anterior cutaneous branch of the intercostal nerve. Sensory testing was performed with Semmes-Weinstein monofilaments to assess the sensation of the native skin, flap skin, and donor site during follow-up.

Results:
In total, 24 patients with 37 innervated lateral thigh perforator flaps and 18 patients with 26 noninnervated lateral thigh perforator flaps were analyzed (median follow-up, 17 and 15 months, respectively). Significantly lower mean monofilament values were found for the native skin (adjusted difference, −0.83; p = 0.011) and flap skin (adjusted difference, –1.11; p < 0.001) of the reconstructed breast in innervated compared to noninnervated flaps. For the donor site, no statistically significant differences were found between both groups.

Conclusions:
Nerve coaptation in lateral thigh perforator flap breast reconstruction resulted in a significantly better sensory recovery of the reconstructed breast compared to noninnervated flaps. The data also suggest that harvesting a sensory nerve branch does not compromise the sensory recovery of the upper lateral thigh.
Endoscopy-Assisted Total Mastectomy with and without Immediate Reconstruction: An Extended Follow-Up, Multicenter Study
Authors: Kuo Yao-Lung , Chang Chih-Hao , Chang Tzu-Yen , Chien Hsiung-Fei , Liao Li-Min , Hung Chin-Sheng , Lin Shih-Lung , Chen Shou-Tung , Chen Dar-Ren , Lai Hung-Wen 
Published: November 2020

Background:
Endoscopy-assisted total mastectomy has been used for surgical intervention of breast cancer patients; however, large cohort studies with long-term follow-up data are lacking.

Methods:
Breast cancer patients who underwent endoscopy-assisted total mastectomy from May of 2009 to March of 2018 were collected prospectively from multiple centers. Clinical outcome, impact of different phases, oncologic results, and patient-reported aesthetic outcomes of endoscopy-assisted total mastectomy were reported.

Results:
A total of 436 endoscopy-assisted total mastectomy procedures were performed; 355 (81.4 percent) were nipple-sparing mastectomy, and 81 (18.6 percent) were skin-sparing mastectomy. Three hundred fourteen (75.4 percent) of the procedures were associated with immediate breast reconstruction; 255 were prosthesis based and 59 were associated with autologous flaps. The positive surgical margin rate for endoscopy-assisted total mastectomy was 2.1 percent. In morbidity evaluation, there were 19 cases (5.4 percent) with partial nipple necrosis, two cases (0.6 percent) with total nipple necrosis, and three cases (0.7 percent) with implant loss. Compared with the early phase, surgeons operating on patients in the middle or late phase had significantly decreased operation time and blood loss. With regard to patient-reported cosmetic outcomes, approximately 94.4 percent were satisfied with the aesthetic results. Patients who underwent breast reconstruction with preservation of the nipple had higher satisfaction rates. Over a median follow-up of 54.1 ± 22.4 months, there were 14 cases of locoregional recurrence (3.2 percent), three distant metastases (0.7 percent), and one mortality (0.2 percent).

Conclusion:
This multicenter study showed that endoscopy-assisted total mastectomy is a reliable surgical intervention for early breast cancer, with high patient satisfaction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Universal screening for blunt cerebrovascular injury
Authors: Black Jonathan A. , Abraham Peter J. , Abraham Mackenzie N. , Cox Daniel B. , Griffin Russell L. , Holcomb John B. , Hu Parker J. , Kerby Jeffrey D. , Liptrap Elizabeth J. , Thaci Bart , Harrigan Mark R. , Jansen Jan O. 
Published: November 2020

BACKGROUND
Blunt cerebrovascular injury (BCVI) can result in thromboembolic stroke. Many trauma centers selectively screen patients with cervical computed tomographic angiography (CTA) based on clinical criteria. In 2016, our institution adopted universal screening for BCVI for all blunt trauma patients. The aim of this study was to accurately determine the incidence of BCVI and to evaluate the diagnostic performance of the Denver criteria (DC), expanded Denver criteria (eDC), and Memphis criteria (MC) in selecting patients for screening.

METHODS
Retrospective cohort study of adult (≥16 years) blunt trauma patients who presented to the Level I trauma center at University of Alabama at Birmingham. We reviewed all CTA reports and selected CTA images to obtain the true incidence rate of BCVI. We then evaluated the diagnostic performance of the DC, eDC, and MC.

RESULTS
A total of 6,800 patients who had suffered blunt trauma were evaluated, of whom 6,287 (92.5%) had a neck CTA. Of these, 480 (7.6%) patients had CTA evidence of BCVI. The eDC identified the most BCVI cases (sensitivity 74.7%) but had the lowest positive predictive value (14.6%). The DC and MC had slightly greater positive predictive values (19.6% and 20.6%, respectively) and had the highest diagnostic ability in terms of likelihood ratio (2.8 and 2.9) but had low sensitivity (57.5% and 47.3%). Consequently, if relying on the traditional screening criteria, the DC, eDC, and MC would have respectively resulted in 42.5%, 25.3%, and 52.7% of patients with BCVI identified by universal screening not receiving a neck CTA to screen for BCVI.

CONCLUSION
Blunt cerebrovascular injury is even more common than previously thought. The diagnostic performance of selective clinical screening criteria is poor. Consideration should be given to the implementation of universal screening for BCVI using neck CTA in all blunt trauma patients.

LEVEL OF EVIDENCE
Diagnostic, level III.
In vitro: Natural Compounds (Thymol, Carvacrol, Hesperidine, And Thymoquinone) Against Sars-Cov2 Strain Isolated From Egyptian Patients
Authors: Seadawy M.G , Gad A.F , Elhoseny M.F , ELharty B.El , Shamel M.D , Elfiky Abdo A. , Ahmed Aya , Zekri Abdel Rahman N. 
Published: November 2020

AbstractThe current pandemic of the coronavirus disease-2019 (COVID-19) has badly affected our life during the year 2020. SARS-CoV-2 is the primary causative agent of the newly emerged pandemic. Natural flavonoids, Terpenoid and Thymoquinone are tested against different viral and host-cell protein targets. These natural compounds have a good history in treating Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV). Molecular docking combined with cytotoxicity and plaque reduction assay is used to test the natural compounds against different viral (Spike, RdRp, and Mpro) and host-cell (TMPRSS II, keap 1, and ACE2) targets. The results demonstrate the binding possibility of the natural compounds (Thymol, Carvacrol, Hesperidine, and Thymoquinone) to the viral main protease (Mpro). Some of these natural compounds were approved to start clinical trail from Egypt Center for Research and Regenerative Medicine ECRRM IRB (Certificate No.IRB00012517)
An assessment of the literature on cause-related marketing: implications for international competitiveness and marketing research
Authors: Vrontis Demetris , Christofi Michael , Katsikeas Constantine S. 
Published: November 2020

PurposeA substantial, albeit scattered, body of research evidence is accumulating in the cause-related marketing (CRM) research stream. Thus, there is a need of a systematic overview of extant literature to map and holistically understand the CRM domain.Design/methodology/approachTo address this issue and make progress in this important area, the authors systematically review and critically examine the state of academic research on CRM.FindingsBased on a systematic review of 105 journal articles published over the past 30 years, the results reveal that CRM research is a vibrant and rapidly growing domain in the broader marketing field. This assessment exercise also shows that the current state of knowledge about CRM is characterized by persisting knowledge gaps, conflicting empirical results, theoretical inconsistencies, as well as by the absence of international marketing research on the CRM domain.Originality/valueTherefore, the authors critically evaluate the extant CRM research with the aim of increasing its coherence, quality, scope, impact and international dimension. Based on this evaluation, the authors develop an ambitious research agenda that addresses a number of promising research paths embracing different international perspectives. Finally, the authors discuss the contributions to the literature and the implications for both academics and practitioners.
The experience of adults recovering from an eating disorder in professionally-led support groups
Authors: Waller Archana , Paganini Chiara , Andrews Katrina , Hutton Vicki 
Published: November 2020

PurposeThe aim of the study is to explore the experience of eating disorder support group participants. The research question is “What is the experience of adults recovering from an eating disorder in a professionally-led monthly support group?”Design/methodology/approachThis qualitative study explored the experience of adults recovering from an eating disorder in a professionally-led monthly support group. Participants were 18 adults recovering from an eating disorder who attended a monthly support group. The data were collected using an online anonymous survey and then analysed using a thematic analysis.FindingsThe main themes that emerged were: (1) sharing the pain and promise, (2) cautions and concerns and (3) facilitators have influence. The findings indicate that the support group provided a safe space to share their lived experience, that it reduced stigma and isolation, and improved participants' motivation and engagement. Moreover, the results revealed some challenges to the functioning of the group. These included management of discussions and dominant members, need for psycho-educational information and managing intense feelings, relating to body-related comparison and other mental disorder comorbidities.Originality/valueThis is the first study highlighting the valuable role of the facilitator in balancing content with compassion, in ensuring safety in the group, and potentially fulfilling a valuable education function in supporting participants in their eating disorder recovery journey.
Cockayne syndrome proteins CSA and CSB maintain mitochondrial homeostasis through NAD+ signaling
Authors: Okur Mustafa N. , Fang Evandro F. , Fivenson Elayne M. , Tiwari Vinod , Croteau Deborah L. , Bohr Vilhelm A. 
Published: November 2020

AbstractCockayne syndrome (CS) is a rare premature aging disease, most commonly caused by mutations of the genes encoding the CSA or CSB proteins. CS patients display cachectic dwarfism and severe neurological manifestations and have an average life expectancy of 12 years. The CS proteins are involved in transcription and DNA repair, with the latter including transcription‐coupled nucleotide excision repair (TC‐NER). However, there is also evidence for mitochondrial dysfunction in CS, which likely contributes to the severe premature aging phenotype of this disease. While damaged mitochondria and impaired mitophagy were characterized in mice with CSB deficiency, such changes in the CS nematode model and CS patients are not fully known. Our cross‐species transcriptomic analysis in CS postmortem brain tissue, CS mouse, and nematode models shows that mitochondrial dysfunction is indeed a common feature in CS. Restoration of mitochondrial dysfunction through NAD+ supplementation significantly improved lifespan and healthspan in the CS nematodes, highlighting mitochondrial dysfunction as a major driver of the aging features of CS. In cerebellar samples from CS patients, we found molecular signatures of dysfunctional mitochondrial dynamics and impaired mitophagy/autophagy. In primary cells depleted for CSA or CSB, this dysfunction can be corrected with supplementation of NAD+ precursors. Our study provides support for the interconnection between major causative aging theories, DNA damage accumulation, mitochondrial dysfunction, and compromised mitophagy/autophagy. Together, these three agents contribute to an accelerated aging program that can be averted by cellular NAD+ restoration.