bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-Effectiveness of Treatments after Closed Extraarticular Distal Radius Fractures in Older Adults from the WRIST Clinical Trial
Authors: Yoon Alfred P. , Shauver Melissa J. , Hutton David W. , Chung Kevin C. ,   For the WRIST Group
Published: November 2020

Background:
This study performs an economic analysis of volar locking plate, external fixation, percutaneous pinning, or casting in elderly patients with closed distal radius fractures.

Methods:
This is a secondary analysis of the Wrist and Radius Injury Surgical Trial, a randomized, multicenter, international clinical trial with a parallel nonoperative casted group of patients older than 60 years with surgically indicated, extraarticular closed distal radius fractures. Thirty-Six-Item Short-Form Health Survey–converted utilities and total costs from Medicare were used to calculate quality-adjusted life-years and incremental cost-effectiveness ratio.

Results:
Casted patients were self-selected and older (p < 0.001) than the randomized surgical cohorts, but otherwise similar in sociodemographic characteristics. Quality-adjusted life-years for percutaneous pinning were highest at 9.17 and external fixation lowest at 8.81. Total costs expended were $16,354 for volar locking plates, $16,012 for external fixation, $11,329 for percutaneous pinning, and $6837 for casting. The incremental cost-effectiveness ratios for volar locking plates and external fixation were dominated by percutaneous pinning and casting. The ratio for percutaneous pinning compared to casting was $28,717. Probabilistic sensitivity analysis revealed a 10, 5, 53, and 32 percent chance of volar locking plate, external fixation, percutaneous pinning, and casting, respectively, being cost-effective at the willingness-to-pay threshold of $100,000 per quality-adjusted life-year.

Conclusions:
Casting is the most cost-effective treatment modality in the elderly with closed extraarticular distal radius fractures and should be considered before surgery. In unstable closed fractures, percutaneous pinning, which is the most cost-effective surgical intervention, may be considered before volar locking plates or external fixation.
99mTc-PSMA SPECT/CT Versus 68Ga-PSMA PET/CT in the Evaluation of Metastatic Prostate Cancer
Authors: Fallahi Babak , Khademi Niloufar , Karamzade-Ziarati Najme , Fard-Esfahani Armaghan , Emami-Ardekani Alireza , Farzanefar Saeed , Eftekhari Mohammad , Beiki Davood 
Published: November 2020

Background

99mTc–prostate-specific membrane antigen (PSMA) SPECT/CT is less expensive and readily available modality compared with 68Ga-PSMA PET/CT for imaging prostate cancer (PC). The aim of this study is to compare the value of these 2 modalities in patients confirmed or suspicious to have metastatic prostate cancer.

Patients and Methods
Twenty-two patients with the mean age of 66.6 ± 10.1 years were studied using 99mTc-PSMA SPECT/CT and 68Ga-PSMA PET/CT, with less than 7 days interval between the 2 imaging procedures. Whole-body PET/CT was done 60 minutes after IV injection of 185 MBq (5 mCi) of 68Ga-PSMA. 99mTc-PSMA SPECT/CT was performed 3 hours after IV injection of 555 to 740 MBq (15–20 mCi) of 99mTc-PSMA. The images of each modality were interpreted independently, and the results were compared according to patient-based as well as region-based analyses.

Results
In patient-based evaluation, both 99mTc-PSMA SPECT/CT and 68Ga-PSMA PET/CT scans were positive in 95.45% (21/22). In region-based evaluation, 68Ga-PSMA PET/CT detected 53 regions (median of 2 regions per patient; range, 0–5), whereas 43 (median of 2 regions per patient; range, 0–5) were detected by 99mTc-PSMA SPECT/CT. Most of these differences could be explained by lower detection rate of 99mTc-PSMA SPECT/CT in prostate bed (n = 6). PET/CT detected more involved regions than SPECT/CT (P = 0.007), whereas similar frequency of extraprostatic lesions were diagnosed in both modalities (P = 0.102). Significant correlation was also demonstrated between serum prostate-specific antigen level and imaging parameters of disease extension detected by 2 modalities.

Conclusions

99mTc-PSMA SPECT/CT could be a potential substitute for 68Ga-PSMA PET/CT in high-risk patients, except when evaluation of prostate bed is of major concern.
Usual and Rare Abdominal Location of Giant Cell Arteritis Diagnosed and Follow-up With 18F-FDG PET/CT
Authors: Bonnefoy Pierre-Benoît , Goutte Julie , Jacquet-Francillon Nicolas , Habouzit Vincent , Prevot Nathalie 
Published: November 2020

Abstract
Giant cell arteritis is not an uncommon disease, and its extension is furthermore finely assessed with new-generation PET/CT system. 18F-FDG PET/CT is increasingly used in case of large-vessel vasculitis for optimal diagnosis, activity monitoring (even when treated with interleukin 6 receptor inhibitor), and evaluation damage progression. We reported the case of a 61-year-old woman with common giant cell arteritis pattern on 18F-FDG PET/CT (aorta and large arteries) and uptakes in all aorta branches, mainly impressive and uncommon in the abdomen. After 2 years of therapeutic optimization including IV tocilizumab and monitoring with 18F-FDG PET/CT, a complete metabolical response was assessed.
Gastrointestinal Stromal Tumor Incidentally Detected on 18F-Fluciclovine PET/CT
Authors: Raghavan Kesav , Flavell Robert R. , Westphalen Antonio C. , Behr Spencer C. 
Published: November 2020

Abstract
We present a case of metastatic gastrointestinal stromal tumor incidentally detected on 18F-fluciclovine PET/CT. A 68-year-old man with history of intermediate-risk prostate cancer (Gleason score 4 + 3 = 7; pT2cN0M0) previously treated with retropubic radical prostatectomy, adjuvant whole pelvis radiation, and androgen deprivation therapy (leuprolide) presented with slowly rising serum prostate-specific antigen over 3 years, concerning for recurrent prostate cancer. To identify potential sites of recurrent disease, an 18F-fluciclovine PET/CT was obtained. Multiple tracer-avid mesenteric masses and enlarged lymph nodes were found throughout the abdomen and pelvis, later biopsy-proven to reflect metastatic gastrointestinal stromal tumor.
Restoration of Ramus Height in Child Patients With Extracapsular Condylar Fractures: Is This Mission Almost Impossible to Accomplish?
Authors: Zhou Hai-Hua , Lv Kun , Yang Rong-Tao , Li Zhi , Li Zu-Bing 
Published: November 2020

Objective:
This study aimed to assess whether ramus height is restored in children with extracapsular condylar fractures treated by conservative or surgery procedures.

Methods:
The sample consisted of 35 children (collected consecutively) less than 12 years old who presented with extracapsular condylar fractures and treated within an 8-year period (June 2011 to April 2019). Data on the age, gender, date of injury, mechanism of trauma, location and pattern of mandibular condylar fracture, associated injuries and treatment methods were recorded and analyzed. Ramus height restoration is the main evaluation indicator during the follow-up period.

Results:
Within the 8-year record retrieval, the 35 children sustained 41 extracapsular condylar fractures. For the sample size, 10 (24.4%) and 31 (75.6%) had condylar neck and base fractures, respectively. Deviation and green-stick fracture were the predominant types in condylar neck and base fractures, accounting for more than 3 quarters (31, 75.6%). The majority (33, 80.5%) of patients were treated with nonsurgical treatment, and 8 (19.5%) were treated by open reduction and internal fixation (ORIF). During the follow-up period (1–1419 days, average time of 110.6 days), only 1 patient (with bilateral extracapsular condylar fractures) had their ramus height restored (follow-up period, 256 days). Most members of the ORIF group (5 of 8, 62.5%) postoperatively showed bended ramus (deviated angularly/fragment angulation).

Conclusion:
Conservative treatment could hardly restore the ramus height of children with extracapsular condylar fractures. Anatomically or totally restoring the ramus height is difficult even with the surgical treatment of ORIF; however, surgical treatment of ORIF can substantially restore the ramus height for dislocated fractures or seriously displaced fractures.
The Upper Buccal Musculomucosal Flap for Nasal Lining and Columellar Defect Reconstruction
Authors: Yen Cheng-I , Chang Chun-Shin , Chen Hung-Chang , Yang Shih-Yi , Chang Shu-Yin , Yang Jui-Yung , Chuang Shiow-Shuh , Hsiao Yen-Chang 
Published: November 2020

Abstract
Restoring the nasal lining is a great challenge in the reconstruction of nasal defects. In this series, the authors present our experience in using the upper buccal musculomucosal (UBMM) flap for the reconstruction of full thickness columellar or nasal lining defects. Ten patients who underwent UBMM flap reconstruction of columellar or nasal lining defects, with or without composite grafting, were identified between December of 2014 and February of 2017. The records were retrospectively reviewed to determine the demographics, nasal deformity etiology, surgical technique, complications, flap survival rate and duration of follow-up. Of these ten patients, three were men, and seven were women; the average age was 48.1 years (range, 34–66 years). Four patients underwent bilateral UBMM flaps, and 6 patients underwent unilateral UBMM flap reconstruction. All of the donor sites were closed without complications, except for one small granuloma that occurred 8 months later. Of the total 14 flaps, 7 healed well, 6 healed well after minimal debridement in the clinic, and one failed and was replaced with a contralateral UBMM flap. The average follow-up time was 20.1 months (range, 8–38 months). All patients had satisfactory aesthetic and functional outcomes. Due to the limited availability of healthy local tissue for nasal lining reconstruction after multiple surgeries, the UBMM flap serves as an applicable choice to restore columellar or nasal lining defects, with minimal donor site morbidity and no visible external scarring.
Septal Reconstruction With Folded Porous Polythylene Implants: An Alternative Technique for the Correction of Severe Saddle Nose Deformities in Asian Populations
Authors: Min Peiru , Wang Zhuwei , Zhang Zheng , Zhang Yixin , Pu Zheming 
Published: November 2020

Background:
Congenital or secondary deficiency in septal cartilage leads to an unpleasant cosmetic appearance and compromised function as well. Rhinoplasty maneuvers such as spreader graft and septal extension graft with autologous tissue have been exhibited to correct the deformities. However, the relatively severe donor site morbidity stands as a main concern for both surgeons and patients.

Methods:
From January of 2014 to April of 2018, 52 patients presenting septal deformities underwent rhinoplasty with our modified technique. A piece of Medpor (8438) was tailored, folded and then placed as a combination of spreader and septal extension graft. The surgical outcomes were evaluated both objectively and subjectively.

Results:
All the patients were followed up for 12 to 24 months postoperatively. The ratio of tip projection and the nasal length exhibited significant improvement in all our patients. Nasal obstruction subjectively mended among the 24 patients who had airway obstruction complaint preoperatively. Only 2 patients had severe adverse events and the implants were removed instantly.

Conclusions:
With our modified technique, Medpor proved to be an effective and reliable material for the reconstruction of septal cartilage, which provides us an alternative way to achieve extended spreader and septal extension graft with one single implant in the correction of saddle nose.

Level of Evidence: Level IV, therapeutic study.
Intravascular Papillary Endothelial Hyperplasia as a Cause of Reversible Vision Loss
Authors: Liu Catherine , Daigle Patrick , Munoz David G. , Nijhawan Navdeep 
Published: November 2020

Abstract
Intravascular papillary endothelial hyperplasia (IPEH) is a benign vascular lesion that is formally diagnosed on histopathology. IPEH seldom presents in periocular tissues and is even less commonly seen deep within the orbit. As with cavernous hemangioma, this lesion tends to distort surrounding structures and can cause a significant mass effect in the orbit. The authors present an unusual case of orbital IPEH that resulted in severe proptosis and progressive vision loss from optic nerve compression. In toto surgical excision of the lesion resulted in significant recovery of vision loss and resolution of symptoms associated with proptosis. To the best of our knowledge, this case is the first to illustrate the potential for visual recovery after surgery in a patient with compressive optic neuropathy from orbital IPEH.
The Hematopoietic Stem/Progenitor Cell Response to Hemorrhage, Injury, and Sepsis: A Review of Pathophysiology
Authors: Kelly Lauren S. , Darden Dijoia B. , Fenner Brittany P. , Efron Philip A. , Mohr Alicia M. 
Published: November 2020

ABSTRACT
Hematopoietic stem/progenitor cells (HSPC) have both unique and common responses following hemorrhage, injury, and sepsis. HSPCs from different lineages have a distinctive response to these “stress” signals. Inflammation, via the production of inflammatory factors, including cytokines, hormones, and interferons, has been demonstrated to impact the differentiation and function of HSPCs. In response to injury, hemorrhagic shock, and sepsis, cellular phenotypic changes and altered function occur, demonstrating the rapid response and potential adaptability of bone marrow hematopoietic cells. In this review, we summarize the pathophysiology of emergency myelopoiesis and the role of myeloid-derived suppressor cells, impaired erythropoiesis, as well as the mobilization of HSPCs from the bone marrow. Finally, we discuss potential therapeutic options to optimize HSPC function after severe trauma or infection.
Telemedicine for neuro-ophthalmology: challenges and opportunities
Authors: Liu Yin Allison , Ko Melissa W. , Moss Heather E. 
Published: November 2020

Purpose of review
Telemedicine for neuro-ophthalmology (tele-neuro-ophthalmology) has the potential to increase access to neuro-ophthalmic care by improving efficiency and decreasing the need for long-distance travel for patients. Requirements for decreased person-to-person contacts during the COVID-19 pandemic accelerated adoption of tele-neuro-ophthalmology. This review highlights the challenges and opportunities with tele-neuro-ophthalmology.

Recent findings
Tele-neuro-ophthalmology programs can be used for triage, diagnostic consultation, and long-term treatment monitoring. Formats include telephone appointments, interprofessional collaborations, remote data interpretation, online asynchronous patient communication, and video visits. Barriers to long-term implementation of tele-neuro-ophthalmology arise from data quality, patient engagement, workflow integration, state and federal regulations, and reimbursement. General neurologists may collaborate with local eye care providers for ophthalmic examination, imaging, and testing to facilitate efficient and effective tele-neuro-ophthalmology consultation.

Summary
Tele-neuro-ophthalmology has tremendous potential to improve patient access to high-quality cost-effective neuro-ophthalmic care. However, many factors may impact its long-term sustainability.
Vision loss and hallucinations: perspectives from neurology and ophthalmology
Authors: Hamedani Ali G. 
Published: November 2020

Purpose of review
The aim of this article is to summarize the evidence for visual impairment as a risk factor for visual hallucinations in neurologic disease and recent advances in our understanding of the central visual pathways that mediate this association.

Recent findings
Recent studies have described the prevalence Charles Bonnet syndrome and questioned its lack of association with cognitive impairment, used advanced neuroimaging to show that disinhibition of the occipital lobe is involved in the pathogenesis of visual hallucinations in Parkinson's disease, and demonstrated that visual impairment because of eye disease is a consistent risk factor for visual hallucinations across a number of different neurodegenerative disease populations.

Summary
Through connections between the primary visual cortex and other brain structures, visual function is closely tied to visual hallucinations. Given that the vast majority of vision loss is caused by ophthalmic disease, much of which is preventable or treatable, the detection and treatment of vision loss in at-risk populations may reduce the burden and consequences of visual hallucinations in older adults.
A Survey of Provider Satisfaction of a New, Flexible Extended-Length Pharyngeal Airway to Relieve Upper Airway Obstruction During Deep Sedation
Authors: McMurray Roxanne , Gordan Leah 
Published: November 2020

ABSTRACTBackgroundMaintaining an open airway in a spontaneously-breathing patient under deep sedation, or deep monitored anaesthesia care, can be challenging. Specifically, current oral airways are not long enough to displace obstruction caused by redundant pharyngeal tissue, prompting external maneuvers by anesthetists that can impact patient outcomes and facility operational efficiency. As procedures increase at outpatient surgical centers, there is a need for an anesthesia provider-validated airway device that can sufficiently open an obstructed airway and maintain airway patency.MethodsThis prospective, multi-center user-experience survey evaluated anesthesia provider experience of a new airway device for adult patients with airway obstruction during deep sedation. The novel external airway has a longer flexible tubing allowing for displacement of pharyngeal tissue, smaller diameter to allow placement alongside an endoscopy bite block, and is manufactured with softer material to allow ease of insertion and patient comfort.ResultsFifty-four anaesthetists at 15 hospital systems reported their experience of airway use in 86 cases. The novel airway device was 95% successful in establishing and maintaining a patent airway (n=68). Survey responses indicated that the airway was easy to place (93%), allowed for a “hands-off approach” (98%), and would improve airway management practice and patient outcomes (86%).ConclusionsThis pilot study demonstrated that the novel external airway is an effective and satisfactory method for anaesthesia providers to alleviate airway obstruction during deep sedation. Additional studies will be initiated to confirm efficacy and cost-effectiveness in patient populations and clinical environments that will most benefit from the new airway device.
Protein phosphatase 2A, complement component 4, and APOE genotype linked to Alzheimer’s disease using a systems biology approach
Authors: Jun Gyungah R. , You Yang , Zhu Congcong , Meng Gaoyuan , Chung Jaeyoon , Panitch Rebecca , Hu Junming , Xia Weiming ,   The Alzheimer’s Disease Genetics Consortium, Bennett David A. , Foroud Tatiana M. , Wang Li-San , Haines Jonathan L. , Mayeux Richard , Pericak-Vance Margaret A. , Schellenberg Gerard D. , Au Rhoda , Lunetta Kathryn L. , Ikezu Tsuneya , Stein Thor D. , Farrer Lindsay A. 
Published: November 2020

ABSTRACTBackgroundRecent reports suggest that the rare apolipoprotein E (APOE) Christchurch mutation and ε2 allele protect against Alzheimer’s disease (AD) pathology by reducing the burden of tau pathology. However, the mechanism(s) underlying the ε2 protective effect linking to tau is largely unknown.MethodsThe role of the ε2 allele in Alzheimer’s disease (AD) was investigated a genome-wide association study (GWAS) for AD among 2,120 ε2 carriers from the Alzheimer Disease Genetics Consortium (ADGC), and then prioritized by gene network analysis, differential gene expression analysis at tissue- and cell-levels as well as methylation profiling of CpG sites, in prefrontal cortex tissue from 761 brains of the Religious Orders Study and Memory and Aging Project (ROSMAP) and the Framingham Heart Study (FHS), Boston University Alzheimer’s Disease Center (BUADC). The levels of two catalytic subunit proteins from protein phosphatase 2A (PPP2CA and PPP2CB) were validated in prefrontal cortex area of 193 of the FHS/BUADC brains. The findings from human autopsied brains were further validated by a co-culture experiment of human isogenic APOE induced pluripotent stem cell (iPSC) derived neurons and astrocytes.ResultsOf the significantly associated loci with AD among APOE ε2 carriers (P<10−6), PPP2CB (P=1.1×10−7) was the key node in the APOE ε2-related gene network and contained the most significant CpG site (P=7.3×10−4) located 2,814 base pair upstream of the top-ranked GWAS variant. Among APOE ε3/ε4 subjects, the level of Aβ42 was negatively correlated with protein levels of PPP2CA (P=9.9×10−3) and PPP2CB (P=2.4×10−3), and PPP2CA level was correlated with the level of pTau231 level (P=5.3×10−3). Significant correlations were also observed for PPP2CB with complement 4B (C4B) protein levels (P=3.3×10−7) and PPP2CA with cross reactive protein (CRP) levels (P=6.4×10−4). C1q level was not associated with Aβ42, pTau231, PPP2CB, or C4B levels. We confirmed the significant correlation of PPP2CB expression with pTau231/tTau ratio (P=0.01) and C4A/B (P=2.0×10−4) expression observed in brain tissue in a co-culture experiment of iPSC derived neurons and astrocytes.ConclusionWe demonstrated for the first time a molecular link between a tau phosphatase and the classical complement pathway, especially C4, and AD-related tau pathology.
Largest GWAS (N=1,126,563) of Alzheimer’s Disease Implicates Microglia and Immune Cells
Authors: Wightman Douglas P , Jansen Iris E , Savage Jeanne E. , Shadrin Alexey A , Bahrami Shahram , Rongve Arvid , Børte Sigrid , Winsvold Bendik S , Drange Ole Kristian , Martinsen Amy E , Skogholt Anne Heidi , Willer Cristen , Bråthen Geir , Bosnes Ingunn , Nielsen Jonas Bille , Fritsche Lars , Thomas Laurent F. , Pedersen Linda M , Gabrielsen Maiken E , Johnsen Marianne Bakke , Meisingset Tore Wergeland , Zhou Wei , Proitsi Petra , Hodges Angela , Dobson Richard , Velayudhan Latha ,   23andMe Research Team, Sealock Julia M , Davis Lea K , Pedersen Nancy L. , Reynolds Chandra A. , Karlsson Ida K. , Magnusson Sigurdur , Stefansson Hreinn , Thordardottir Steinunn , Jonsson Palmi V. , Snaedal Jon , Zettergren Anna , Skoog Ingmar , Kern Silke , Waern Margda , Zetterberg Henrik , Blennow Kaj , Stordal Eystein , Hveem Kristian , Zwart John-Anker , Athanasiu Lavinia , Saltvedt Ingvild , Sando Sigrid B , Ulstein Ingun , Djurovic Srdjan , Fladby Tormod , Aarsland Dag , Selbæk Geir , Ripke Stephan , Stefansson Kari , Andreassen Ole A. , Posthuma Danielle 
Published: November 2020

SummaryLate-onset Alzheimer’s disease is a prevalent age-related polygenic disease that accounts for 50-70% of dementia cases1. Late-onset Alzheimer’s disease is caused by a combination of many genetic variants with small effect sizes and environmental influences. Currently, only a fraction of the genetic variants underlying Alzheimer’s disease have been identified2,3. Here we show that increased sample sizes allowed for identification of seven novel genetic loci contributing to Alzheimer’s disease. We highlighted eight potentially causal genes where gene expression changes are likely to explain the association. Human microglia were found as the only cell type where the gene expression pattern was significantly associated with the Alzheimer’s disease association signal. Gene set analysis identified four independent pathways for associated variants to influence disease pathology. Our results support the importance of microglia, amyloid and tau aggregation, and immune response in Alzheimer’s disease. We anticipate that through collaboration the results from this study can be included in larger meta-analyses of Alzheimer’s disease to identify further genetic variants which contribute to Alzheimer’s pathology. Furthermore, the increased understanding of the mechanisms that mediate the effect of genetic variants on disease progression will help identify potential pathways and gene-sets as targets for drug development.