bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Ultrasound-Guided Platelet-Rich Plasma Injection of the Sacroiliac Joint as a Treatment for Chronic Low Back Pain
Authors: Broadhead Devin Y , Douglas Hannah E , Bezjian Wallace Laurie M , Wallace Patrick J , Tamura Sarah , Morgan Kyle C , Hemler Douglas E 
Published: December 2019

ABSTRACTBack pain and its associated complications are of increasing importance among military members. The sacroiliac joint (SIJ) is a common source of chronic low back pain (LBP) and functional disability. Many patients suffering from chronic LBP utilize opioids to help control their symptoms. Platelet-rich plasma (PRP) has been used extensively to treat pain emanating from many different musculoskeletal origins; however, its use in the SIJ has been studied only on a limited basis. The patient in this case report presented with chronic LBP localized to the SIJ and subsequent functional disability managed with high-dose opioids. After failure of traditional treatments, she was given an ultrasound-guided PRP injection of the SIJ which drastically decreased her pain and disability and eventually allowed for complete opioid cessation. Her symptom relief continued 1 year after the injection. This case demonstrates the potential of ultrasound-guided PRP injections as a long-term treatment for chronic LBP caused by SIJ dysfunction in military service members, which can also aid in the weaning of chronic opioid use.
Estrogen-induced transcription at individual alleles is independent of receptor level and active conformation but can be modulated by coactivators activity
Authors: Stossi Fabio , Dandekar Radhika D , Mancini Maureen G , Gu Guowei , Fuqua Suzanne A W , Nardone Agostina , De Angelis Carmine , Fu Xiaoyong , Schiff Rachel , Bedford Mark T , Xu Wei , Johansson Hans E , Stephan Clifford C , Mancini Michael A 
Published: December 2019

Abstract
Steroid hormones are pivotal modulators of pathophysiological processes in many organs, where they interact with nuclear receptors to regulate gene transcription. However, our understanding of hormone action at the single cell level remains incomplete. Here, we focused on estrogen stimulation of the well-characterized GREB1 and MYC target genes that revealed large differences in cell-by-cell responses, and, more interestingly, between alleles within the same cell, both over time and hormone concentration. We specifically analyzed the role of receptor level and activity state during allele-by-allele regulation and found that neither receptor level nor activation status are the determinant of maximal hormonal response, indicating that additional pathways are potentially in place to modulate cell- and allele-specific responses. Interestingly, we found that a small molecule inhibitor of the arginine methyltransferases CARM1 and PRMT6 was able to increase, in a gene specific manner, the number of active alleles/cell before and after hormonal stimulation, suggesting that mechanisms do indeed exist to modulate hormone receptor responses at the single cell and allele level.
Fornicotomy for the Treatment of Epilepsy: An Examination of Historical Literature in the Setting of Modern Operative Techniques
Authors: Kundu Bornali , Lucke-Wold Brandon , Foster Chase , Englot Dario J , Urhie Ogaga , Nwafor Divine , Rolston John D 
Published: December 2019

Abstract
Fornicotomy has been used to treat intractable temporal lobe epilepsy with mixed success historically; however, modern advances in stereotactic, neurosurgical, and imaging techniques offer new opportunities to target the fornix with greater precision and safety. In this review, we discuss the historical uses and quantify the outcomes of fornicotomy for the treatment of temporal lobe epilepsy, highlight the potential mechanisms of benefit, and address what is known about the side effects of the procedure. We find that fornicotomy, with or without anterior commissurotomy, resulted in 61% (83/136) of patients having some seizure control benefit. We discuss the potential operative approaches for targeting the fornix, including laser ablation and the use of focused ultrasound ablation. More work is needed to address the true efficacy of fornicotomy in the modern surgical setting. This review is intended to serve as a framework for developing this approach.
Proceedings of the Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) Oligodendroglioma Workshop
Authors: Penas-Prado Marta , Wu Jing , Cahill Daniel P , Brat Daniel J , Costello Joseph F , Kluetz Paul G , Cairncross J Gregory , van den Bent Martin , Verhaak Roel G W , Aboud Orwa , Burger Peter , Chang Susan M , Cordova Christine , Huang Raymond Y , Rowe Lindsay S , Taphoorn Martin J B , Gilbert Mark R , Armstrong Terri S ,   NCI-CONNECT Oligodendroglioma Workshop, Aarons David , Camphausen Kevin , Claus Elizabeth , Cordeiro Brittany , Ducray Francois , Figarella-Branger Dominique , French Pim , Greene Brock , Heiss John D , Jenkins Robert , LeBlanc Amy , Mendoza Tito , Oliver Kathy , Quezado Martha , Raygada Margarita , Romo Carlos , Rubinstein Lawrence , Siegel Christine , Sul Joohee , Ueki Keisuke , Weller Michael , Wen Patrick Y , Willmarth Nicole , Yuan Ying , Zaghloul Kareem 
Published: December 2019

Abstract

Background
Oligodendroglioma is a rare primary central nervous system (CNS) tumor with highly variable outcome and for which therapy is usually not curative. At present, little is known regarding the pathways involved with progression of oligodendrogliomas or optimal biomarkers for stratifying risk. Developing new therapies for this rare cancer is especially challenging. To overcome these challenges, the neuro-oncology community must be particularly innovative, seeking multi-institutional and international collaborations, and establishing partnerships with patients and advocacy groups thereby ensuring that each patient enrolled in a study is as informative as possible.

Methods
The mission of the National Cancer Institute’s NCI-CONNECT program is to address the challenges and unmet needs in rare CNS cancer research and treatment by connecting patients, health care providers, researchers, and advocacy organizations to work in partnership. On November 19, 2018, the program convened a workshop on oligodendroglioma, one of the 12 rare CNS cancers included in its initial portfolio. The purpose of this workshop was to discuss scientific progress and regulatory challenges in oligodendroglioma research and develop a call to action to advance research and treatment for this cancer.

Results
The recommendations of the workshop include a multifaceted and interrelated approach covering: biology and preclinical models, data sharing and advanced molecular diagnosis and imaging; clinical trial design; and patient outreach and engagement.

Conclusions
The NCI-CONNECT program is well positioned to address challenges in oligodendroglioma care and research in collaboration with other stakeholders and is developing a list of action items for future initiatives.
How do patients with malignant brain tumors experience general practice care and support? Qualitative analysis of English Cancer Patient Experience Survey (CPES) data
Authors: Fraulob Isabell , Davies Elizabeth A 
Published: December 2019

Abstract

Background
English Cancer Patient Experience Survey (CPES) data show patients with brain cancer report the least-positive experiences of general practice support. We aimed to understand these findings by identifying the issues described in qualitative survey feedback and suggest how care may be improved.

Methods
We reviewed 2699 qualitative comments made to open questions about what was good or might be improved about National Health Service care between 2010 and 2014. We identified 84 (3%) specific comments about general practice care and used open coding and framework analysis to develop a thematic framework.

Results
We identified 3 key themes and 12 subthemes: first, the experience of initial diagnosis by a general practitioner (GP), including apparent complexity of making the diagnosis, apparent slowness in referral for investigation, referral made by patient or family, delay in receiving scan results, and whether the GP quickly identified the problem and referred to a specialist; second, the experience of care and support from the general practice, including lack of supportive response from the GP, lack of follow-up care from the GP, lack of family involvement by the GP, lack of GP knowledge about management, and whether the GP responded in a supportive way to the diagnosis; and third, the experience of overall coordination in care, including lack of communication between the hospital and general practice and good communication about the care plan.

Conclusion
Qualitative responses from patients with brain cancer reveal their needs for better emotional and practical support within primary care. Suggestions include increasing the speed of initial referral for investigation, the depth of discussion about diagnostic difficulties, and developing coordinated care plans with cancer centers.
Serum tryptophan-derived quinolinate and indole-3-acetate are associated with carotid intima-media thickness and its evolution in HIV-infected treated adults
Authors: Boyd Anders , Boccara Franck , Meynard Jean-Luc , Ichou Farid , Bastard Jean-Philippe , Fellahi Soraya , Samri Assia , Sauce Delphine , Haddour Nabila , Autran Brigitte , Cohen Ariel , Girard Pierre-Marie , Capeau Jacqueline ,   Collaboration in HIV, Inflammation and Cardiovascular Disease study
Published: December 2019

Abstract

Background
HIV-infected individuals undergoing effective antiretroviral therapy (ART) present an increased risk of atherosclerotic cardiovascular disease. We identified serum metabolites associated with carotid intima-media-thickness (c-IMT) and its evolution.

Methods
143 hydrophilic serum metabolites were measured by ultra-performance-liquid-chromatography coupled to high-resolution mass-spectrometry in 49 HIV+ART+, 48 HIV+ART-naïve, and 50 HIV-negative age-matched, never-smoking, male triads. Metabolites differentially altered between groups (“features”) were defined as having a Benjamini-Hochberg adjusted p-value &lt;0.05 from a t-test and &gt;0.25 log2 absolute mean fold-change in metabolite levels. c-IMT was measured across 12 sites at inclusion in all individuals and at the carotid-artery (cca) after a median 5.1 years in 32 HIV+ART+ individuals. Difference in c-IMT (cross-sectional analysis) and slope of cca-IMT regression/progression per year (longitudinal analysis) for each log10(area) increase in metabolite level was estimated with linear regression.

Results
Compared to HIV-, metabolite features of HIV+ART+ were increased N6,N6,N6-trimethyl-L-lysine and decreased ferulate and 5-hydroxy-L-tryptophan; while features of HIV+ART-naïve were increased malate, kynurenine, 2-oxoglutarate, and indole-3-acetate and decreased succinate and 5-hydroxy-L-tryptophan. In HIV+ART+ individuals, quinolinate and/or indole-3-acetate were positively associated with c-IMT (p&lt;0.03), cca-IMT (p&lt;0.03) and with cca-IMT progression (p&lt;0.008). These associations were not observed in HIV+ART-naive or HIV-negative individuals. In HIV+ART+ individuals, the metabolites xanthosine and uridine, from nucleotide metabolism, and g-butyrobetaine, from lysine/dietary choline degradation, were also positively or negatively associated with c-IMT and/or cca-IMT (all p&lt;0.01), but not its evolution.

Conclusion
In these highly-selected HIV-positive ART-controlled males, two novel metabolites derived from tryptophan catabolism, indole-3-acetate and quinolinate, were associated with c-IMT and its progression.
COVERING THE PATIENT’S ARM SUPPORT IN LEAD REDUCED THE RADIATION DOSE RATE TO THE CARDIOLOGISTS DURING PERCUTANEOUS CORONARY INTERVENTIONS: A PHANTOM STUDY
Authors: Fukuda Atsushi , Lin Pei-Jan Paul 
Published: December 2019

Abstract
The aim of the study was to estimate organ dose rate reduction to a female anthropomorphic phantom, which simulated the cardiologist, during percutaneous coronary interventions (PCI) when the patient’s arm support was covered with 0.4-mm lead foil. Organ dose rates were determined using five radiation detectors inserted into the left eye, left thyroid, left breast, left liver lobe and uterus of the phantom. A male anthropomorphic phantom was placed on the examination table of an angiography system. Heart images of the patient phantom were acquired under 10 gantry angulations typical for PCI. The lead-covered arm support did not interfere with any of the cardiac images. The median organ dose rate reductions to the left eye, left thyroid, left breast, left liver lobe and uterus were 7.8, 36.0, 28.8, 35.7 and 33.5%, respectively. The lead-covered arm support substantially reduced scattered radiation to the female cardiologist without interfering with clinical environments.
Timing of Office-Based Pessary Care
Authors: Propst Katie , Mellen Colleen , O'Sullivan David M. , Tulikangas Paul K. 
Published: December 2019

OBJECTIVE:
To evaluate the influence of pessary visit intervals on development of vaginal epithelial abnormalities.

METHODS:
We conducted a randomized, noninferiority trial of office-based pessary care. Eligible participants were adult women wearing a ring, Gellhorn, or incontinence dish pessary to treat pelvic organ prolapse or incontinence or both. Patients were randomized 1:1 to routine pessary care (office visits every 12 weeks, “routine” arm) or to extended pessary care (office visits every 24 weeks, “extended” arm). The primary study outcome was rate of vaginal epithelial abnormalities (epithelial break or erosion) at the final study visit (48 weeks). The predetermined noninferiority margin was 7.5%.

RESULTS:
From January 2015 through June 2017, inclusive, 448 patients were screened and 130 were randomized, 64 to the routine arm and 66 to the extended arm. Baseline characteristics of the study arms were similar with the exception of pessary type, with ring pessary more common in the routine arm and Gellhorn pessary more common in the extended arm (P=.02). The rate of epithelial abnormalities at the final study visit (48 weeks) was 7.4% in the routine arm and 1.7% in the extended arm (difference, −5.7 percentage points; 95% CI −7.4 to −4), which met the criterion for noninferiority. Rates of all types of epithelial abnormalities did not differ between arms at any time point. Increasing duration of pessary use (P=.003) and history of prior epithelial abnormalities were associated with development of epithelial abnormalities (P=.01). Other than epithelial abnormalities, no adverse events related to pessary use occurred in either arm.

CONCLUSION:
In women who receive office-based pessary care and are using a ring, Gellhorn, or incontinence dish pessary, routine follow-up every 24 weeks is noninferior to every 12 weeks based on incidence of vaginal epithelial abnormalities.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02371083.
Mifepristone Antagonization With Progesterone to Prevent Medical Abortion
Authors: Creinin Mitchell D. , Hou Melody Y. , Dalton Laura , Steward Rachel , Chen Melissa J. 
Published: December 2019

OBJECTIVE:
To estimate the efficacy and safety of mifepristone antagonization with high-dose oral progesterone.

METHODS:
We planned to enroll 40 patients in a double-blind, placebo-controlled, randomized trial. We enrolled patients at 44–63 days of gestation with ultrasound-confirmed gestational cardiac activity who were planning surgical abortion. Participants ingested mifepristone 200 mg and initiated oral progesterone 400 mg or placebo 24 hours later twice daily for 3 days, then once daily until their planned surgical abortion 14–16 days after enrollment. Follow-up visits were scheduled 3±1, 7±1, and 15±1 days after mifepristone intake with ultrasonography and blood testing for human chorionic gonadotropin and progesterone. Participants exited from the study when they had their surgical abortion or earlier for gestational cardiac activity absence, gestational sac expulsion, or medically indicated suction aspiration. We assessed the primary outcome of continued gestational cardiac activity at approximately 2 weeks (15±1 day), side effects after drug ingestion, and safety outcomes including hemorrhage and emergent treatment.

RESULTS:
We enrolled participants from February to July 2019 and stopped enrollment after 12 patients for safety concerns. Mean gestational age was 52.5 days. Two (one per group) voluntarily discontinued 3 days after mifepristone ingestion for subjective symptoms (nausea and vomiting, bleeding). Among the remaining 10 patients (five per group), gestational cardiac activity continued for 2 weeks in four in the progesterone group and two in the placebo group. One patient in the placebo group had no gestational cardiac activity 3 days after mifepristone use. Severe hemorrhage requiring ambulance transport to hospital occurred in three patients; one received progesterone (complete expulsion, no aspiration) and two received placebo (aspiration for both, one required transfusion). We halted enrollment after the third hemorrhage. No other significant side effects were reported.

CONCLUSION:
We could not estimate the efficacy of progesterone for mifepristone antagonization due to safety concerns when mifepristone is administered without subsequent prostaglandin analogue treatment. Patients in early pregnancy who use only mifepristone may be at high risk of significant hemorrhage.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03774745.
Instagram Users' Experiences of Miscarriage
Authors: Mercier Rebecca J. , Senter Katherine , Webster Rachel , Henderson Riley Amy 
Published: December 2019

OBJECTIVE:
To explore the shared experiences of miscarriage using a qualitative analysis of social media posts on Instagram.

METHODS:
We performed this qualitative study by collecting text, photos, hashtags, and emoji from 200 Instagram posts on five arbitrarily selected days in 2019. Key eligibility criteria included posts that described a personal experience of miscarriage and that used the hashtag #ihadamiscarriage. Through directed content analysis, our multidisciplinary team conducted open coding to identify common topics in the data, developed a code book, and coded all posts. Twenty-five percent of posts were double-coded by two team members and analyzed for agreement. The codes were organized into overarching themes.

RESULTS:
Intercoder reliability was excellent (kappa 0.95). Themes included medical and physical experiences of miscarriage, social experiences of miscarriage, the emotional spectrum of experiencing a miscarriage, family identity and the effects of miscarriage, and mechanisms of processing and coping through a miscarriage. We observed complex and often conflicted emotional states and noted that the effects of miscarriage were felt for months and years by many Instagram users. Use of social media and disclosure of miscarriage was a source of coping for many users.

CONCLUSION:
Women post about their miscarriages on social media for a variety of reasons, especially to find support and community and to help break the silence around miscarriage. Health care providers may consider discussing use of this platform as a support and coping mechanism in the setting of pregnancy loss.
Henry Versus Thompson Approach for Fixation of Proximal Third Radial Shaft Fractures: A Multicenter Study
Authors: Dashe Jesse , Murray Brett , Tornetta Paul , Grott Kelly M. , Mullis Brian , Bellevue Kate D. , Firoozabadi Reza , Kempegowda Harish , Horwitz Daniel S. , Patel Shaan , Fontenot Philip B. , Mir Hassan R. , Ruder John A. , Bosse Michael J. , Westberg Jerald , Sandberg Benjamin , Bramlett Kasey J. , Marcantonio Andrew J. , Sadauskas Alex J. , Cannada Lisa K. , Goodwin Alexandra , Miller Anna N. , Fox Mary Patricia , Klatman Samuel H. 
Published: December 2019

Objective:
To compare the volar Henry and dorsal Thompson approaches with respect to outcomes and complications for proximal third radial shaft fractures.

Design:
Multicenter retrospective cohort study.

Patients/Participants:
Patients with proximal third radial shaft fractures ± associated ulna fractures (OTA/AO 2R1 ± 2U1) treated operatively at 11 trauma centers were included.

Intervention:
Patient demographics and injury, fracture, and surgical data were recorded. Final range of motion and complications of infection, neurologic injury, compartment syndrome, and malunion/nonunion were compared for volar versus dorsal approaches.

Main Outcome:
The main outcome was difference in complications between patients treated with volar versus dorsal approach.

Results:
At an average follow-up of 292 days, 202 patients (range, 18–84 years) with proximal third radial shaft fractures were followed through union or nonunion. One hundred fifty-five patients were fixed via volar and 47 via dorsal approach. Patients treated via dorsal approach had fractures that were on average 16 mm more proximal than those approached volarly, which did not translate to more screw fixation proximal to the fracture. Complications occurred in 11% of volar and 21% of dorsal approaches with no statistical difference.

Conclusions:
There was no statistical difference in complication rates between volar and dorsal approaches. Specifically, fixation to the level of the tuberosity is safely accomplished via the volar approach. This series demonstrates the safety of the volar Henry approach for proximal third radial shaft fractures.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Early Radiographic Union Score for Hip Is Predictive of Femoral Neck Fracture Complications Within 2 Years
Authors: Bernaus Martí , Slobogean Gerard P. , Bzovsky Sofia , Heels-Ansdell Diane , Zhou Qi , Bhandari Mohit , Swiontkowski Marc , Sprague Sheila ,   on behalf of the FAITH Investigators
Published: December 2019

Objectives:
To determine if the Radiographic Union Score for Hip (RUSH) measured at 3 and 6 months after femoral neck fracture were predictive of reoperation for infection, nonunion, delayed union, avascular necrosis, or implant failure within 24 months of initial surgery.

Design:
Secondary analysis of a randomized controlled trial. Logistic regression was performed to investigate associations between lower RUSH and reoperation. Results were reported as odds ratios (OR), 95% confidence intervals (CIs), and associated P values. All tests were 2 tailed with alpha = 0.05.

Setting:
Eighty-one clinical sites across 8 countries.

Patients/Participants:
Data from 734 of the clinical trial participants with radiographs at 3 and 6 months after fracture fixation were included.

Intervention:
A reviewer blinded to patients' outcomes independently assigned a RUSH at each follow-up time point.

Main Outcome Measures:
Revision surgery rate related to intervention.

Results:
Lower RUSH at 3 and 6 months were associated with increased odds of reoperation within 24 months of fracture fixation. For every 2-point decrease in RUSH at 3 months, there was a 16% increase in the odds of a patient experiencing a re-operation (OR, 1.16; 95% CI, 1.10–1.22; P < 0.0001). A similar association was observed at the 6-month assessment for every 2-point decrease (OR = 1.05; 95% CI, 1.01–1.09; P = 0.005).

Conclusions:
Decreased radiographic healing as early as 3 months post fracture fixation is associated with developing patient important femoral neck fracture reoperations. This relationship may guide early treatment decisions, suggesting that 3- and 6-month RUSH are a useful surrogate measure of reoperations within 24 months of fracture fixation.

Level of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.