bluuebunny/crossref_metadata_2025_split huggingface dataset:
Receiving a diagnosis of young onset dementia: Evidence-based statements to inform best practice
Authors: O’Malley Mary , Parkes Jacqueline , Campbell Jackie , Stamou Vasileios , LaFontaine Jenny , Oyebode Jan R , Carter Janet 
Published: October 2020

Introduction Better understanding of patient experience is an important driver for service improvements and can act as a lever for system change. In the United Kingdom, the patient experience is now a central issue for the National Health Service Commissioning Board, clinical commissioning groups and the providers they commission from. Traditionally, dementia care in the United Kingdom has focused predominantly on the individual experience of those with late onset dementia, while the voice of those with young onset dementia has been, comparatively, unheard. This study aims to improve the understanding of the personal experience of younger people undergoing investigation for dementia. Methods A modified Delphi approach was undertaken with 18 younger people with dementia and 18 supporters of people with young onset dementia. Questions were informed by a scoping review of the literature (O’Malley, M., Carter, J., Stamou, V., Lafontaine, J., & Parkes, J. (2019a). Receiving a diagnosis of young onset dementia: A scoping review of lived experiences. Ageing & Mental Health, 0(0), 1-12). Summary individual statements were refined over two rounds to a final list of 29 key statements. Results Twenty-seven of these statements were rated as absolutely essential or very important and included (1) for the general practitioner to identify dementia in younger people, (2) clinicians should be compassionate, empathic and respectful during the assessment and particularly sensitive when providing information about a diagnosis, and (3) remembering that receiving the diagnosis is a lot to absorb for a person with dementia and their supporter. Statistical analyses found no difference in the scoring patterns between younger people with dementia and supporters, suggesting similar shared experiences during the diagnostic process. Conclusion Understanding the uniquely personal experience of young people going through the process of diagnosis for dementia is essential to provide person-centred, needs-led, and cost-effective services. Patient’s values and experiences should be used to support and guide clinical decision-making.
Methylene blue usage for determining accessory artery ligation in donor kidneys
Authors: Li Yang , Song Yajun , Hu Wengang , Wang Xu , Xiao Ya , Huang Chibing 
Published: October 2020

Objectives. We present a technique for determining whether to ligate or preserve accessory arteries in donor kidneys before implantation. Methods. Forty-three living-related donor kidneys in patients from January 2014 to February 2018 at our institution were included, all of which had dual arteries without the same stem. Among them, 19 cases of accessory arterial blood supply were evaluated using methylene blue (MB) perfusion, and accessory arteries supplying less than 10% of the total MB perfusion volume were ligated. The other 24 cases were assessed using a conventional method in which arteries with diameters less than 2 mm were ligated. The back-table surgical time, Doppler ultrasonography index, renal function and complications were compared between the 2 groups. Results. All patients underwent successful kidney transplantation. The back-table surgical time in the MB group was longer than that in the conventional group (42.70 ± 4.70 min vs 34.64 ± 5.30 min, P < .05). The serum creatinine level in the MB group was significantly lower than that in the conventional group 1 month after the operation (103.15 ± 19.26 μmol/L vs 119.17 ± 28.32 μmol/L, P < .05). No differences in the Doppler ultrasonography index or postoperative complications were noted. Conclusions. MB perfusion provides an easy and effective method to make decisions regarding arterial ligation and helps preserve renal function without increasing the number of complications after transplantation.
Short-Term Morbidity and Predictors of Adverse Events Following Esthesioneuroblastoma Surgery
Authors: Goshtasbi Khodayar , Birkenbeuel Jack L. , Abouzari Mehdi , Lehrich Brandon M. , Yasaka Tyler M. , Abiri Arash , Muhonen Ethan G. , Hsu Frank P. K. , Kuan Edward C. 
Published: October 2020

Introduction The short-term adverse events and predictors of morbidity in surgical resection of esthesioneuroblastoma (ENB) are largely unknown, and investigating these variables can help direct planning for at-risk patients. Methods The 2005–2017 National Surgical Quality Improvement Program database was queried to identify patients with a diagnosis of ENB undergoing skull base surgery for tumor resection. Information regarding demographics, patient morbidity score, pre-operative and intra-operative data, and post-operative outcomes were extracted. Cox proportional hazard analysis was utilized to assess complication and readmission/reoperation rates. Results A total of 95 patients undergoing skull base surgery for resection of ENB were included. Mean age, BMI, operation time, and post-operative length of stay (LOS) of the cohort were 53.6 ± 16.2 years, 29.1 ± 6.5, 392.0 ± 204.6 minutes, and 5.8 ± 4.6 days, respectively. In total, 31 patients (32.6%) experienced at least one 30-day adverse event, which included blood transfusion intra-operatively or within 72 hours from the operation (22.1%), readmission (10.7%), intubation >48 hours (7.4%), reintubation (4.2%), organ or space infection (4.2%), reoperation (4.0%), superficial or deep surgical site infection (2.1%), sepsis (2.1%), pulmonary embolism (1.1%), and myocardial infarction (1.1%). Patients who experienced at least one adverse event had significantly higher operation time (486.8 ± 230.4 vs. 347.5 ± 176.2 minutes, p = 0.002), LOS (9.2 ± 5.6 days vs. 4.2 ± 3.0, p < 0.001), and lower hematocrit (37.3 ± 5.9 vs. 41.2 ± 3.8, p < 0.001) and albumin levels (3.8 ± 0.6 vs. 4.2 ± 0.3, p = 0.009). Patients with a higher American Society of Anesthesiologists (ASA) score (HR = 2.39; p = 0.047) or longer operation time (HR = 1.004; p = 0.001) had a significantly higher risk for experiencing adverse events. Obesity was not associated with different intra- or post-operative outcomes, but older patients had shorter operations ( p = 0.002) and LOS ( p = 0.0014). Conclusion Longer operation time and lower pre-operative hematocrit and albumin levels may all increase complication rates in ENB resection. Patients with high ASA score or more advanced age may have different short-term outcomes.
Making the Grade? Modification of Dental Radiograph Quality Ratings
Authors: Rodgers George D , Sharif Mohammad O , Smith Adam B , Kellett Margaret , Brunton Paul A 
Published: October 2020

Aims To compare the intra- and inter-assessor agreement and operator preference of a modified (four-grade) quality rating system for dental radiographs with the current National Radiological Protection Board (NRPB) (three-grade) quality rating system. Methods Sixty radiographic images of varying quality were selected by retrospective review of dental records from a general dental practice. The images were sorted into groups to represent examples of radiographic quality (1=excellent, 2=diagnostically acceptable, 3=diagnostically compromised, 4=unacceptable). A ‘gold standard’ for radiological quality assessment was provided by a consultant in dental and maxillofacial radiology. A compact disc (CD) of the 60 images was produced and posted to a panel of 14 general dental practitioners (GDPs) who were asked to grade the quality of the images using two different systems on two occasions separated by a washout period of two days. The practitioners graded the radiographs using the currently accepted method for assessing radiographic quality (the three-grade NRPB system) and the alternative four-grade system. The quality of the images on the CD was deemed appropriate by the consultant. Results The strength of inter-assessor agreement was weaker when using a four-grade system in comparison to a three-grade system, reducing to a mean of κ=0.51 from a mean of κ=0.61 when using the original grading system. Mean agreement did not fall below ‘moderate agreement’ (κ=0.41–0.60). Eleven of the 14 GDPs preferred the four-grade system. Conclusion The GDPs who participated in this study preferred the four-grade system to the three-grade system when comparing the quality of dental radiographs. However, the strength of agreement was weaker when using the four-grade system in comparison to the three-grade system. Overall, the results are equivocal. However, they should help to inform specialist dental radiology panels, should revision of quality grading be undertaken in the future.
Treatment of lavage drainage under spinal endoscopy on lumbar spinal tuberculosis with vertebral lesions
Authors: Zhang Xun , Wang Keran , Xia Yu , Gao Xiang , Du Yu , Chen Liang 
Published: October 2020

To investigate the efficacy and safety of the treatment of percutaneous endoscopic debridement (PED) and continuous lavage drainage (CLD) on lumbar tuberculosis. Total 31 patients diagnosed with lumbar tuberculosis, who underwent the PED and CLD from January 2012 to January 2018 in our hospital were included. The operation time, intraoperative blood loss, complications were analyzed. The recovery of local tuberculosis was evaluated by erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and visual analogue scale (VAS) before and after operation. The patients were followed up for 18 to 84 months. At the last follow-up, lumbar lordosis (LL), the Japanese Orthopaedic Association (JOA) score and imaging data were used to evaluate the recovery of spinal structure and function. There were no complications for all patients. During the follow-up of 3 to 12 months after operation, ESR and CRP returned to normal. The VAS score of local pain was significantly lower than that before operation ( p < 0.05). The LL and JOA scores of the patients at the last follow-up were significantly better than those before operation ( p < 0.05), and the lumbar CT and MR suggested the healing of vertebral lesions. PED and CLD might be an effective surgical treatment for spinal tuberculosis.
The Prognostic Value of Metabolic Profiling in Older Patients With a Proximal Femoral Fracture
Authors: van der Sijp Max P.L. , Suchiman H. Eka D. , Eijk Monica , Vojinovic Dina , Niggebrugge Arthur H. P. , Blauw Gerard J. , Achterberg Wilco P. , Slagboom P. Eline 
Published: October 2020

Introduction: High mortality rates of approximately 20% within 1 year after treatment are observed for patients with proximal femoral fractures. This preliminary study explores the prognostic value of a previously constructed mortality risk score based on a set of 14 metabolites for the survival and functional recovery in patients with proximal femoral fractures. Materials and Methods: A prospective observational cohort study was conducted including patients admitted with a proximal femoral fracture. The primary outcome was patient survival, and the recovery of independence in activities of daily living was included as a secondary outcome. The mortality risk score was constructed for each patient and its prognostic value was tested for the whole population. Results: Data was available form 136 patients. The mean age of all patients was 82.1 years, with a median follow-up of 6 months. Within this period, 19.0% of all patients died and 51.1% recovered to their prefracture level of independence. The mortality score was significantly associated with mortality (HR, 2.74; 95% CI, 1.61-4.66; P < 0.001), but showed only a fair prediction accuracy (AUC = 0.68) and a borderline significant comparison of the mortality score tertile groups in survival analyses (P = 0.049). No decisive associations were found in any of the analyses for the functional recovery of patients. Discussion: These findings support the previously determined prognostic value of the mortality risk score. However, the independent prognostic value when adjusted for potential confounding factors is yet to be assessed. Also, a risk score constructed for this specific patient population might achieve higher accuracies for the prediction of survival and functional recovery. Conclusions: A modest prediction accuracy was observed for the mortality risk score in this population. More elaborate studies are needed to validate these findings and develop a tailored model for clinical purposes in this patient population.
Do Pediatric Patients With Anterior Cruciate Ligament Tears Have a Higher Rate of Familial Anterior Cruciate Ligament Injury?
Authors: Bram Joshua T. , Pascual-Leone Nicolas , Patel Neeraj M. , DeFrancesco Christopher J. , Talathi Nakul S. , Ganley Theodore J. 
Published: October 2020

Background: Several studies have examined the anterior cruciate ligament (ACL) injury history among relatives of patients undergoing ACL reconstruction (ACLR), but they have primarily analyzed adults with variable results. Hypothesis: We hypothesized that he rate of familial ACL injuries among pediatric patients with ACL tears would be greater than that among pediatric patients with uninjured knees. Study Design: Cohort study; Level of evidence, 3. Methods: Pediatric patients (≤18 years of age) who underwent ACLR between January 2009 and May 2016 were contacted to complete a questionnaire on subsequent complications and family history of ACL tears. A control cohort was recruited from children with uninjured knees seen in the concussion clinic of our institution. Binary logistic regression was used to determine the factors predictive of having a familial ACL tear history or complications. Results: Overall, 450 pediatric patients with primary ACL tears were included. Age at the time of surgery was 14.9 ± 2.2 years with a follow-up of 4.3 ± 2.1 years. When compared with 267 control patients, those with an ACL tear reported a higher rate of first-degree relatives with an ACL injury history (25.1% vs 12.0%; P < .001). In multivariate analysis, children with ACL injury had nearly 3 times (odds ratio [OR], 2.7) higher odds of having a first-degree relative with an ACL tear (95% CI, 1.7-4.2; P < .001). Patients were stratified by the number of first-degree relatives with ACL tears: no relatives, 1 relative, or ≥2 relatives. Children with ≥2 first-degree relatives were more likely to sustain a postoperative graft failure (OR, 5.1; 95% CI 1.7-15.2; P = .003) or a complication requiring surgical intervention (OR, 7.5; 95% CI, 2.6-22.0; P < .001). Conclusion: A family history of ACL injury is more likely in pediatric patients with ACL tears than in uninjured children. Further, patients undergoing primary ACLR as well as a strong family history of ACL tears are more likely to sustain a postoperative graft rupture or complication requiring surgery.
Small-Gauge Pars Plana Vitrectomy for Visually Significant Vitreous Floaters
Authors: Fink Samantha , Kumar Jaya B. , Cunningham Matthew A. 
Published: October 2020

Purpose: This article evaluates our experience at a retina-only private practice with small-gauge pars plana vitrectomy (PPV) for visually significant vitreous floaters. We review the surgical outcomes, complication rates, and percentage of second-eye surgery for the same indication. Methods: A retrospective, interventional case series was conducted of consecutive patients undergoing PPV for significant vitreous floaters from September 2014 to December 2018 at a high-volume vitreoretinal surgery practice. Preoperative visual acuity (VA), complication rates, and visual outcome following surgery were evaluated. Results: A total of 104 eyes in 81 patients underwent PPV for visually significant floaters; 35 (43.2%) patients had PPV in both eyes. Mean preoperative VA was 0.16 ± 0.17 logMAR (∼20/29 Snellen equivalent) and improved to 0.12 ± 0.15 logMAR (∼20/26 Snellen; Wilcoxon test, P = .008) at the last follow-up after PPV. All patients had improvement in VA at the final postoperative visit, with a VA of 20/40 or better achieved in 93.3% of cases. The complication rate of vitreous hemorrhage postoperatively was 0.96%. There were no cases of postoperative retinal tears, breaks, or endophthalmitis. Conclusions: Small-gauge PPV in the carefully selected patient is an effective and safe procedure to eliminate symptoms. VA following PPV for vitreous floaters significantly improved. Nearly half of the patients studied (43.2%) underwent PPV in the other eye.
Conservative management of a fourth ventricular epidermoid in a patient with Gardner syndrome
Authors: Heller Gordon D. 
Published: October 2020

Gardner Syndrome is a rare disease with clinical manifestations of familial intestinal polyposis with osteomas. Cutaneous and subcutaneous lesions are common and epidermoid cyst is a characteristic dermatologic finding. This case report presents a novel finding of an intracranial epidermoid situated in the fourth ventricle in a patient with Gardner Syndrome. This intracranial epidermoid has been followed with sequential magnetic resonance imaging (MRI) for 10 years with progressive growth of the lesion. This suggests the conservative management is an option in patients with an enlarging epidermoid cyst in the fourth ventricle. Plain language summary Non-operative treatment of a cyst in the brain in a syndrome called Gardner syndrome. What is Gardner syndrome? Gardner syndrome is a rare disease and form of familial adenomatous polyposis (FAP) that is characterized by multiple small growths of cells (polyps) in the colon and various types of tumors, both noncancerous (benign) and cancerous (malignant). It is caused by changes (mutations) in the APC gene. Abnormal changes on the skin and under the skin are common as well as growths called epidermoid cysts. The cysts develop when cells that are meant to become skin, hair, and nails (epithelial cells) are trapped among the cells that form the brain. Epidermoid brain cysts may be diagnosed by magnetic resonance imaging (MRI) and computerized tomography (CT) scans. Typical treatment usually involves surgery. What was the aim of this case report? To present a different management strategy for patients with Gardner Syndrome with epidermoid brain cysts. How was this patient treated? This patient is the first patient with Gardner Syndrome with a very rare epidermoid brain cyst reported to be treated in a conservative manner. The patient was monitored for 10 years with regular MRI scans and the cyst continued to grow over this time. Despite this growth the patient has shown no signs of a buildup of fluid in the cavities deep within the brain (called hydrocephalus). The patient experienced nonfocal headaches, which were relieved with medication so doctors decided not to surgically remove the cyst. Why is this case important? Conservative management of epidermoid brain cysts in Gardner patients has not been reported before. This case report shows that conservative management may be an alternative option for patients with a growing epidermoid cyst in the fourth ventricle of the brain. Conservative treatment is designed to avoid invasive treatments or surgery and provides a different option for patients who are unable to have surgery.
GTS-21, an α7nAChR agonist, increases pulmonary bacterial clearance in mice by restoring hyperoxia-compromised macrophage function
Authors: Sitapara Ravikumar A. , Gauthier Alex G. , Patel Vivek S. , Lin Mosi , Zur Michelle , Ashby Charles R. , Mantell Lin L. 
Published: October 2020

AbstractBackgroundMechanical ventilation, in combination with supraphysiological concentrations of oxygen (i.e., hyperoxia), is routinely used to treat patients with respiratory distress, such as COVID-19. However, prolonged exposure to hyperoxia compromises the clearance of invading pathogens by impairing macrophage phagocytosis. Previously, we have shown that the exposure of mice to hyperoxia induces the release of the nuclear protein high mobility group box-1 (HMGB1) into the pulmonary airways. Furthermore, extracellular HMGB1 impairs macrophage phagocytosis and increases the mortality of mice infected withPseudomonas aeruginosa(PA). The aim of this study was to determine whether GTS-21 (3-(2,4-dimethoxybenzylidene) anabaseine), an α7 nicotinic acetylcholine receptor (α7nAChR) agonist, could (1) inhibit hyperoxia-induced HMGB1 release into the airways; (2) enhance macrophage phagocytosis and (3) increase bacterial clearance from the lungs in a mouse model of ventilator-associated pneumonia.MethodGTS-21 (0.04, 0.4, and 4 mg/kg) or saline were administered by intraperitoneal injection to mice that were exposed to hyperoxia (≥ 99% O2) and subsequently challenged with PA.ResultsThe systemic administration of 4 mg/kg i.p. of GTS-21 significantly increased bacterial clearance, decreased acute lung injury and decreased accumulation of airway HMGB1 compared to the saline control. To determine the mechanism of action of GTS-21, RAW 264.7 cells, a macrophage-like cell line, were incubated with different concentrations of GTS-21 in the presence of 95% O2. The phagocytic activity of macrophages was significantly increased by GTS-21 in a dose-dependent manner. In addition, GTS-21 significantly inhibited the cytoplasmic translocation and release of HMGB1 from RAW 264.7 cells and attenuated hyperoxia-induced NF-κB activation in macrophages and mouse lungs exposed to hyperoxia and infected with PA.ConclusionsOur results indicate that GTS-21 is efficacious in improving bacterial clearance and reducing acute lung injury via enhancing macrophage function by inhibiting the release of nuclear HMGB1. Therefore, the α7nAChR represents a possible pharmacological target to improve the clinical outcome of patients on ventilators by augmenting host defense against bacterial infections.