bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thoracoscopic Esophagectomy for a Huge Leiomyosarcoma
Authors: Manipadam John Mathew , Bains Satinder Pal Singh , Mahesh S. , Emmanuel Ami Maria , Ramesh H. 
Published: October 2019

AbstractEsophageal leiomyosarcoma is the commonest of all esophageal sarcomas but yet has a very low incidence. These tumors have been resected by the open approach so far. We describe the steps and challenges involved in the thoracoscopic excision of a huge leiomyosarcoma of the esophagus.
Severe Subglottic Tracheal Stenosis Dictates Intercontinental Transfer of a 2-Year-Old Child with Tracheostomy Tube In Situ
Authors: Sahu Manoj Kumar , Chalattil Bipin , Karanjkar Ameya , Singh Sarvesh Pal , Rajashekar Palleti , Devagouru V. , Saxena Anita , Choudhary Shiv 
Published: October 2019

AbstractAtrioventricular septal defect (AVSD) is the most common congenital cardiac anomaly associated with Down’s syndrome. Children with AVSD develop pulmonary arterial hypertension and often require extensive therapy with pulmonary vasodilators in the postoperative period. The postoperative management is complicated by prolonged mechanical ventilation through endotracheal tube or tracheostomy tube. This artificial airway may trigger various airway complications including subglottic tracheal stenosis. The incidence and severity of subglottic tracheal stenosis is high in children with congenital syndromes. Inability to extubate or decannulate trachea and rapid respiratory compromise while attempting to do so directs toward a diagnosis of subglottic tracheal stenosis. The following case report discusses a 2–year-old boy from Nigeria who was discharged with tracheostomy tube in situ due to severe subglottic tracheal stenosis and surgical tracheoplasty could not be done at his present age. The implications of prolonged tracheostomy tube in situ and the hazards thereof during transfer of the child are being described.
A Prospective Randomized Clinical Trial of Efficacy of Algorithm-Based Point of Care Guided Hemostatic Therapy in Cyanotic Congenital Heart Disease Surgical Patients
Authors: Karanjkar Ameya , Kapoor Poonam Malhotra , Sharan Sandeep , Bhardwaj Vandana , Malik Vishwas , Hasija Suruchi , Choudhury Arindam , Chowdhury Ujjwal Kumar , Rajashekar P. 
Published: October 2019

Abstract
Objective Point of care (POC) testing-based algorithm-guided hemostatic therapy has been used in adult as well as pediatric cardiac surgical patients to administer blood components. The authors hypothesized that implementation of POC-based algorithm in pediatric cyanotic congenital surgical patients would reduce the exposure to blood component therapy and improve the clinical outcome.
Design Prospective randomized control trial.
Setting Single-center academic institute.
Participants One hundred seventy pediatric congenital cyanotic surgical patients.
Intervention Implementation of POC and conventional tests-based algorithms.
Measurements and Main Results Algorithm-based blood component therapy was administered in each group. There were no group differences regarding the demographic, clinical, and laboratory characteristics. Amount of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate (primary outcomes) administered was significantly lower in POC group than that in the conventional group (p < 0.001). Among the secondary outcomes, the chest drain output at 6, 12, and 24 hours and number of re-explorations was comparable among both the groups. The duration of mechanical ventilation, duration of intensive care unit (ICU) stay, and hospital stay was significantly short in POC group (p = 0.008, <0.001 and 0.019, respectively).
Conclusion Implementation of POC-based algorithm-guided hemostatic therapy reduced the exposure to blood and blood component therapy and was associated with reduced ICU and hospital stay in pediatric congenital cyanotic surgical patients.
International Council for Standardization in Haematology Recommendations for Hemostasis Critical Values, Tests, and Reporting
Authors: Gosselin Robert C. , Adcock Dorothy , Dorgalaleh Akbar , Favaloro Emmanuel J. , Lippi Giuseppe , Pego João M. , Regan Irene , Siguret Virginie 
Published: October 2019

AbstractThis guidance document was prepared on behalf of the International Council for Standardization in Haematology (ICSH), the aim of which is to provide hemostasis-related guidance documents for clinical laboratories. The current ICSH document was developed by an ad hoc committee, comprising an international collection of both clinical and laboratory experts. The purpose of this ICSH document is to provide laboratory guidance for (1) identifying hemostasis (coagulation) tests that have potential patient risk based on analysis, test result, and patient presentations, (2) critical result thresholds, (3) acceptable reporting and documenting mechanisms, and (4) developing laboratory policies. The basis for these recommendations was derived from published data, expert opinion, and good laboratory practice. The committee realizes that regional and local regulations, institutional stakeholders (e.g., physicians, laboratory personnel, hospital managers), and patient types (e.g., adults, pediatric, surgical) will be additional confounders for a given laboratory in generating a critical test list, critical value thresholds, and policy. Nevertheless, we expect this guidance document will be helpful as a framework for local practice.
Forehead/Brow Reduction or Augmentation with Custom Implants for Enhanced Facial Profileplasty
Authors: Eppley Barry L. 
Published: October 2019

AbstractAfter studying this article, the reader should be able to understand the basic concepts of aesthetic reshaping of the forehead and the different methods to make those upper facial contour changes. The operative techniques for bony forehead and brow bone reduction and biomaterials for forehead and brow bone augmentation are described. Innovations in bony reduction and implant augmentation methods are emphasized.
Chordoma of the Craniocervical Junction: Endoscopic Endonasal Approach
Authors: Voormolen Eduard H. , Champagne Pierre Olivier , Froelich Sebastien 
Published: October 2019

Objective This study was aimed to achieve gross-total removal of a chordoma of the craniocervical junction via an endonasal approach (Fig. 1).
Design The present study is a case report.
Setting The study was conducted at neurosurgical clinic of university hospital.
Participant A 40-year-old male, with normal neurologic exam and no prior medical history, presented with a 2-year history of cervicalgia. On preoperative imaging, a midline lesion, with image characteristics of chordoma, was seen in the lower clivus and odontoid. It had limited lateral extension.
Main Outcome Measures This study measures postoperative neurological deficits and postoperative tumor volume on magnetic resonance imaging (MRI).
Results A binostril approach to the upper nasopharynx was performed using endoscope at 30- and 45-degree angles. Subsequently, a heart-shaped mucosal flap was made and the clivus was drilled to expose the lesion (Fig. 2). After initial debulking, the ring of C1 was slightly drilled to reach the tumor in and around the odontoid. Postoperative MRI showed that a gross-total resection was achieved. The patient had no neurologic deficits postoperatively. Pathologic examination revealed a chordoma of the classical type.
Conclusion An endoscopic endonasal approach, utilizing the heart-shaped flap and angled endoscopes and instruments, can be considered for resection of select cases of craniocervical junction chordoma with limited lateral expansion.The link to the video can be found at: https://youtu.be/rwVoZJRBIEo.
Does Co-occurred Cerebral Palsy Change the Prognosis of West Syndrome?
Authors: Nagy Eszter , Farkas Nelli , Hollódy Katalin 
Published: October 2019

Abstract
Aim We aimed to examine the occurrence of cerebral palsy (CP) in children with West syndrome (WS), to estimate the possible causative factors by analyzing the neuroimaging examinations of patients, to evaluate their cognitive/motor function and epileptic status and to compare the prognosis of children with double pathology of WS and CP and of those without CP.
Methods The clinical and magnetic resonance imaging (MRI) data of 62 patients with West syndrome were evaluated. A total of 39 of 62 patients (63%) suffered from CP (CP group). The non-CP group included 23 patients.
Results Abnormal MRI was found in 55/62 (89%) patients. Main anomalies were: brain malformation (21), hypoxic-ischemic encephalopathy (13), cerebrovascular insult (8), infection (7), and other anomalies (6). In the CP group, the most common MRI abnormalities included pre/perinatal hypoxia/ischemia, brain malformation, cerebrovascular insult, and infection. In the non-CP group, brain malformations were the most frequent. Significantly more negative MRIs were found in the non-CP group. More than 60% of the patients were severely cognitively impaired, almost 90% of them had CP. Not only the occurrence of intellectual disability was lower in the non-CP group, but its severity was milder as well. A total of 78% of the children with CP had a very severe motor disability. Fifty-four percent in the CP and 67% in the non-CP group had therapy-resistant epilepsy.
Conclusion WS has an especially unfavorable prognosis: cerebral anomaly was confirmed in 89% of our patients. CP was present in almost two-thirds of the children with WS, most of them had severe cognitive and motor deficits.
Peri- and Postoperative Pain Management in Multiple Ligament Knee Surgery in the Hospital and Ambulatory Surgery Center Setting
Authors: Fanelli David Gregory , Vu To-Nhu 
Published: October 2019

AbstractThe multiligament knee injury presents as a complex injury pattern that has substantial potential to cause long-term disability. Patients who sustain this injury pattern experience significant pain not only immediately following injury but also throughout the perioperative and postoperative period. Treating pain with major orthopaedic procedures is challenging but technical success of a surgical repair becomes trivial when pain is not effectively managed. This article will (1) provide an outline of the types of pain most often sustained in the multiligament knee injury, (2) outline the phases of pain management for this injury, and (3) provide an overview of persistent postoperative pain. The principles of multimodal analgesia in combination with effective regional anesthesia and attentive intraoperative management can position patients for successful rehabilitation and recovery.
Epidemiology and Management of Children with Hypertensive Crisis: A Single-Center Experience
Authors: Lim Alicia May , Chong Siew Le , Ng Yong Hong , Chan Yoke Hwee , Lee Jan Hau 
Published: October 2019

AbstractMost children who present with hypertensive crisis have a secondary cause for hypertension. This study describes the epidemiology and management of children with hypertensive crisis. A retrospective cohort study was done in a tertiary pediatric hospital from 2009 to 2015. Thirty-seven patients were treated for hypertensive crisis. Twelve (32.4%) patients were treated for hypertensive emergency. The majority of our patients (33 [89.1%]) had a secondary cause of hypertension. The most common identifiable cause of hypertension was a renal pathology (18/37 [48.6%]). Oral nifedipine (23 [62.1%]) was the most frequently used antihypertensive, followed by intravenous labetalol (8 [21.6%]). There were no mortalities or morbidities. Hypertensive crisis in children is likely secondary in nature. Oral nifedipine and intravenous labetalol are both effective treatments.
Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty
Authors: Vakharia Rushabh M. , Sodhi Nipun , Cohen-Levy Wayne B. , Vakharia Ajit M. , Mont Michael A. , Roche Martin W. 
Published: October 2019

AbstractRobotic-assisted unicompartmental knee arthroplasty (RAUKA) is an emerging area of interest. The purpose of this study was to compare (1) different patient demographic profiles; (2) annual primary and revision utilization rates; (3) risk factors for revision procedures; and (4) survivorship between RAUKA and manual UKA (MUKA). Using the PearlDiver database, patients who underwent RAUKA or MUKA between 2005 and 2014 within the Medicare database were identified, yielding a total of 35,061 patients (RAUKA = 13,617; manual = 21,444). Patient demographics (age, gender, comorbidities, Charlson-Comorbidity Index, and geographic region) were compared between cohorts. Annual primary and revision utilization rates as well as risk factors for revision procedures were also compared. Kaplan–Meier survivorship was also calculated. The Pearson χ2 test was used to test for significance in patient demographics, whereas the Welch t-test was used to compare the incidence of revisions as well as the revision burden (proportion of revisions to total sum of primary and revision procedures). Multivariate binomial logistic regression analysis was performed to compare risk factors for revision procedures. There were statistically significant differences in RAUKA versus MUKA patients with respect to age (p < 0.001), gender (p < 0.001), and region (p < 0.001). RAUKA procedures performed increased over 12-fold compared with manual, which increased only 4.5-fold. RAUKA procedures had significantly lower revision incidence (0.99 vs. 4.24%, p = 0.003) and revision burden (0.91 vs. 4.23%, p = 0.005) compared with manuals. For patients undergoing RAUKA, normal (19–24 kg/m2) and obese (30–39 kg/m2) body mass index (p < 0.05), congestive heart failure (p = 0.004), hypothyroidism (p < 0.001), opioid dependency (p = 0.002), and rheumatoid arthritis (p < 0.001) were risk factors for a revision procedure. Kaplan–Meier survival curve 3 years following the index procedure to all-cause revisions demonstrated that RAUKA patients maintained nearly 100% survivorship compared with manual patients who had 97.5% survivorship. The data demonstrate increased utilization of RAUKA in the United States. The current data indicated that RAUKA has significantly lower revision rates and improved survivorship compared with patients undergoing non-RAUKA within Medicare patients.
Robot-Assisted Unicompartmental Knee Arthroplasty: Increasing Surgical Accuracy? A Cadaveric Study
Authors: Iñiguez Magaly , Negrín Roberto , Duboy Jaime , Reyes Nicolás O. , Díaz Rodrigo 
Published: October 2019

AbstractUnicompartmental knee arthroplasty (UKA) represents 10% of knee arthroplasties. Advantages are better functional results, quicker recovery, shorter hospitalization time, and lower blood loss, among others. However, revision rates are larger than total knee arthroplasty. Among the most important factors that explain this are the implant position and alignment, and the correct surgical indication. Greater accuracy in the implant placement may improve clinical results and increase the rate of implant survival. The objective of this study is to evaluate the precision of the Navio robot-assisted system in the position and alignment of medial UKA compared with the conventional technique. This is an experimental pilot study. Twenty-six cadaveric models were randomized into 2 groups: Robot-Assisted surgery (R) and Conventional Surgery (C). Radiological study was performed pre- and post-surgery, evaluating the medial distal femoral angle (MDFA), medial proximal tibial angle (MPTA), tibial slope, tibiofemoral angle (TFA), sagittal femoral angle (SFA), and size of the femoral and tibial components. The main result measurement was the change in postoperative angulation. The results of this study are MDFA median of 1.07° (0.19–4.5) for group R and 0.12° (0.03–10.4) with a significant difference in variances; a Welch t-test of p = 0.013; and an MPTA of 1.28° (0.05–5.87) for R and 1.3°(0.08–14.1) for C with significantly different variances (p = 0.0064). Size of the femoral component has a difference of p < 0.05 between groups. No differences for dispersion of TFA nor for the size of the tibial component were observed. In conclusion, using robot-assisted UKA allows for greater accuracy in the positioning of the implants and in the prediction of the size of the femoral component.
Left Far Lateral Craniotomy for Clipping of a Posterior Inferior Cerebellar Artery Aneurysm
Authors: Zhao Xiaochun , Wicks Robert T. , Mulholland Celene B. , Ducruet Andrew F. , Nakaji Peter 
Published: October 2019

Abstract
Objectives The complex anatomical relationships of neurovascular structures at the craniovertebral junction make the clipping of a posterior inferior cerebellar artery (PICA) aneurysm surgically challenging. We demonstrate the clipping of a PICA aneurysm in the video.
Design, Setting, and Participant A 65-year-old woman presented with a nonsymptomatic unruptured left PICA aneurysm; follow-up angiography showed an increase in its size. Preoperative angiography demonstrated a PICA aneurysm with the neck close to the origin of the PICA. A daughter sac of the aneurysm was also noted. A left far lateral approach was performed. The vagoaccessory triangle was exposed after opening the arachnoid membrane. The origin of the PICA and the aneurysm were revealed after exploration. The aneurysm neck was identified both proximally and distally. Two fenestrated clips were applied; subsequent indocyanine green (ICG) videoangiography demonstrated that the PICA was obstructed. One clip was adjusted, and repeated ICG videoangiography showed the PICA was patent. An endoscope was used before and after the clip application to better understand the anatomy of the aneurysm and inspect clip positions (Fig. 1).
Outcome The patient was neurologically intact postoperatively and was discharged on postoperative day 4.
Conclusion PICA aneurysms require careful treatment. Impingement of adjacent structures can cause severe complications. Lower cranial nerve damage can cause dysphagia, and compromised vertebral/PICA circulation can cause brainstem symptoms, such as Wallenberg's syndrome. Intraoperative ICG videoangiography should be used to evaluate vessel patency, and the endoscope should be used to fully inspect the aneurysm and evaluate the clip application.The link to the video can be found at: https://youtu.be/dKxFQTRA89g.
Far Lateral Craniotomy for Resection of Foramen Magnum Meningioma
Authors: Wicks Robert T. , Zhao Xiaochun , Mulholland Celene B. , Nakaji Peter 
Published: October 2019

Abstract
Objective Foramen magnum meningiomas present a formidable challenge to resection due to frequent involvement of the lower cranial nerves and vertebrobasilar circulation. The video shows the use of a far lateral craniotomy to resect a foramen magnum meningioma.
Design, Setting, and Participant A 49-year-old woman presented with neck pain and was found to have a large foramen magnum meningioma (Fig. 1A, B). Drilling of the posterior occipital condyle was required to gain access to the lateral aspect of the brain stem. The amount of occipital condyle resection varies by patient and pathology.
Outcome/Result Maximal total resection of the tumor was achieved (Fig. 1B, C), and the patient was discharged on postoperative day 4 with no neurologic deficits. The technique for tumor microdissection (Fig. 2) is shown in the video.
Conclusion Given the close proximity of foramen magnum meningiomas to vital structures at the craniocervical junction, surgical resection with careful microdissection and preservation of the overlying dura to prevent postoperative pseudomeningocele is necessary to successfully manage this pathology in those patients who are surgical candidates.The link to the video can be found at: https://youtu.be/Mds9N1x2zE0.
Polymerase III transcription is necessary for T cell priming by dendritic cells
Authors: Reverendo Marisa , Argüello Rafael J. , Polte Christine , Valečka Jan , Camosseto Voahirana , Auphan-Anezin Nathalie , Ignatova Zoya , Gatti Evelina , Pierre Philippe 
Published: October 2019

SignificanceRNA polymerase III-dependent transcription and increased tRNA expression are necessary for MAMP-stimulated DCs to stimulate naïve T cells. Augmented Pol III-dependent transcription is as essential as the switch to glycolysis and other energetic metabolism variations that are now considered as hallmarks of immune cell activation and are all necessary to increase protein synthesis in these cells.
Rapid ocean acidification and protracted Earth system recovery followed the end-Cretaceous Chicxulub impact
Authors: Henehan Michael J. , Ridgwell Andy , Thomas Ellen , Zhang Shuang , Alegret Laia , Schmidt Daniela N. , Rae James W. B. , Witts James D. , Landman Neil H. , Greene Sarah E. , Huber Brian T. , Super James R. , Planavsky Noah J. , Hull Pincelli M. 
Published: October 2019

Significance
Debate lingers over what caused the last mass extinction 66 million years ago, with intense volcanism and extraterrestrial impact the most widely supported hypotheses. However, without empirical evidence for either’s exact environmental effects, it is difficult to discern which was most important in driving extinction. It is also unclear why recovery of biodiversity and carbon cycling in the oceans was so slow after an apparently sudden extinction event. In this paper, we show (using boron isotopes and Earth system modeling) that the impact caused rapid ocean acidification, and that the resulting ecological collapse in the oceans had long-lasting effects for global carbon cycling and climate. Our data suggest that impact, not volcanism, was key in driving end-Cretaceous mass extinction.
Visual fixation patterns during economic choice reflect covert valuation processes that emerge with learning
Authors: Cavanagh Sean E. , Malalasekera W. M. Nishantha , Miranda Bruno , Hunt Laurence T. , Kennerley Steven W. 
Published: October 2019

SignificanceWhere we direct our gaze can have a big impact on what we choose. However, where we choose to gaze during the decision process is not well-characterized, despite the important role it plays. In our study, monkeys performed a simple decision-making experiment where they were free to look around a computer screen showing choice options. They then indicated their economic choice with a joystick movement. When choice options appeared, monkeys rapidly gazed toward more valuable and novel stimuli—suggesting there is a system that orients gaze toward important information. However, despite the gaze preference for novel stimuli, subjects did not prefer to choose them. This suggests the mechanisms governing value-guided attentional capture and value-guided choice are dissociable.
Host–symbiont specificity determined by microbe–microbe competition in an insect gut
Authors: Itoh Hideomi , Jang Seonghan , Takeshita Kazutaka , Ohbayashi Tsubasa , Ohnishi Naomi , Meng Xian-Ying , Mitani Yasuo , Kikuchi Yoshitomo 
Published: October 2019

Significance
How are specific host-symbiont mutualisms stabilized without vertical transmission? This is one of the fundamental questions in evolutionary biology. To ensure specificity, animals and plants have evolved sophisticated sorting mechanisms. Theoretical studies proposed another mechanism, so-called “competition-based selection,” where hosts provide a specific environment to selectively cultivate favorable symbionts and maintain symbiont quality. Although this mechanism is thought to be powerful in open systems, such as gut symbiosis where contaminants regularly invade, until now little experimental evidence has supported its importance in the evolution of symbioses. Through the inoculation of an insect host with a large panel of symbiotic and nonsymbiotic bacteria, we demonstrate that microbial competition is critical to maintain the specificity in an insect gut symbiosis.