bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Longer Surgery More Dangerous? Operative Duration Not Associated With Complications After Vestibular Schwannoma Resection
Authors: Raghavan Arun M. , Lipschitz Noga , Kohlberg Gavriel D. , Samy Ravi N. , Zuccarello Mario , Pensak Myles L. , Breen Joseph T. 
Published: November 2019

Objective:
To examine the association between operative duration and complications after vestibular schwannoma (VS) surgery.

Study Design:
Retrospective chart review.

Setting:
Tertiary referral center.

Patients:
One hundred forty-eight patients undergoing vestibular schwannoma resection in a single institution.

Intervention:
Vestibular schwannoma resection.

Main Outcome Measures:
Operative duration, surgical approach, tumor size, and postoperative complications.

Results:
Forty-one patients underwent middle cranial fossa (MCF) approach, 46 underwent translabyrinthine (TL) approach, and 61 underwent retrosigmoid (RS) approach. The mean operative duration overall was 407 minutes (MCF—339 min, TL—450 min, RS 420 min). When controlling for tumor size, there was no difference in procedure duration by approach (OR 0.92, CI 0.82–1.02, p=0.11).
When controlling for approach, there was a significant increase in procedure duration by tumor size (OR 1.36, CI 1.23–1.50, p < 0.0001). Increased procedure duration was not associated with 30-day readmission (p = 0.82), cerebrospinal fluid leak (CSF) (p = 0.84), return to the operating room (p = 0.75), postoperative deep vein thrombosis (p = 1.0), postoperative stroke (p = 0.23), or postoperative wound complications (p = 0.70). Longer operative time was associated with increased hospital length of stay (p = 0.04). However, when controlling for tumor size and surgical approach, hospital length of stay was no longer associated with increased procedure duration (OR 1.15, CI 0.98–1.33, p = 0.3).

Conclusion:
Increased operative duration was associated with larger tumor size; however contrary to previous reports, increased operative duration was not associated with postoperative complications.
Replicating Skull Base Anatomy With 3D Technologies: A Comparative Study Using 3D-scanned and 3D-printed Models of the Temporal Bone
Authors: Chae Ricky , Sharon Jeffrey D. , Kournoutas Ioannis , Ovunc Sinem S. , Wang Minghao , Abla Adib A. , El-Sayed Ivan H. , Rubio Roberto Rodriguez 
Published: November 2019

Hypothesis:3D technologies, including structured light scanning (SLS), microcomputed tomography (micro-CT), and 3D printing, are valuable tools for reconstructing temporal bone (TB) models with high anatomical fidelity and cost-efficiency.Background:Operations involving TB require intimate knowledge of neuroanatomical structures—a demand that is currently met through dissection of limited cadaveric resources. We aimed to document the volumetric reconstruction of TB models using 3D technologies and quantitatively assess their anatomical fidelity.Methods:In the primary analysis, 14 anatomical characteristics of right-side TB from 10 dry skulls were measured. Each skull was 3D-scanned using SLS to generate virtual models, which were measured using mesh processing software. Metrics were analyzed using mean absolute differences and one-samplettests with Bonferroni correction. In the secondary analysis, an individualized right-side TB specimen (TBi) was 3D-scanned using SLS and micro-CT, and 3D-printed on a stereolithography printer. Measurements of each virtual and 3D-printed model were compared to measurements of TBi.Results:Significant differences between the physical skulls and virtual models were observed for 11 of 14 parameters (p < 0.0036), with the greatest mean difference in the length of petrous ridge (2.85 mm) and smallest difference in the diameter of stylomastoid foramen (0.67 mm). In the secondary analysis, greater mean differences were observed between TBi and virtual models than between TBi and 3D-printed models.Conclusion:For the first time, our study provides quantitative measurements of TB anatomy to demonstrate that 3D technologies can facilitate individualized and highly accurate reconstructions of TB, which may benefit anatomy education, clinical training, and preoperative planning.
Recent developments in fetal alcohol spectrum disorder
Authors: Baker Joshua J. , Stoler Joan M. 
Published: November 2019

Purpose of review
To highlight research, publications, and medical advancements in fetal alcohol spectrum disorder (FASD) over the past 18 months.

Recent findings
Prevalence numbers have been updated, allowing for a more accurate account of the societal impact. Further work on diagnostic techniques and the underlying mechanisms will allow us to better understand the pathophysiology of FASD and could translate into treatments for the condition. Continued research on new treatments and interventions is needed to improve the affected individual's health care and quality of life. Measurable outcomes allow us to tangibly measure improvements for individuals and families affected by FASD.

Summary
The current review highlights recent publications from January 2018 to August 2019 showing continued medical advancement in improving the care for children and families affected by FASD.
Vitamin D-related immunomodulation in patients with liver cirrhosis
Authors: Triantos Christos , Kalafateli Maria , Aggeletopoulou Ioanna , Diamantopoulou Georgia , Spantidea Panagiota I. , Michalaki Marina , Vourli Georgia , Konstantakis Christos , Assimakopoulos Stelios F. , Manolakopoulos Spilios , Gogos Charalambos , Kyriazopoulou Venetsana , Mouzaki Athanasia , Thomopoulos Konstantinos 
Published: November 2019

Objective(s)
Increasing evidence indicates that vitamin D status is linked to severity of liver cirrhosis and patients’ survival. However, the potential role of vitamin D-related immunomodulation in hepatic decompensation and patients’ mortality in relation to vitamin D deficiency remains unknown. The aim of the current study is to evaluate the association between vitamin D status and vitamin D binding protein (VDBP) levels with serum cytokine and lipopolysaccharide binding protein (LBP) and to examine their role on disease severity and cirrhotics’ mortality.

Methods
One hundred consecutive Caucasian patients with liver cirrhosis were enrolled in the study. 25(OH)D, VDBP, and LBP concentrations were assessed by ELISA. Cytokine tumor necrosis factor-a (TNF-a), interleukin 6 (IL-6), IL-1β, IL-8, IL-10, and IL-12 levels were determined by Cytometric Bead Array.

Results
25(OH)D levels were inversely correlated with CP score, MELD, IL-6, and CP stage and VDBP levels with CP score, MELD, IL-6, IL-8, LBP, and CP stage. Cirrhotics with 25(OH)D deficiency and severe deficiency had significantly higher CP score, increased IL-6 levels and lower VDBP levels. In the multivariate analysis, the independent prognostic factors associated with patients’ survival were CP stage B [hazard ratio = 6.75; 95% confidence interval (CI) 1.32, 34.43; P = 0.022], CP stage C (hazard ratio = 7.39; 95% CI 1.41, 38.81; P = 0.018), the presence of hepatocellular carcinoma (hazard ratio = 4.50; 95% CI 1.54, 13.13; P = 0.006) and 25(OH)D levels (hazard ratio = 0.87; 95% CI 0.80, 0.95; P = 0.002).

Conclusion
The results show that vitamin D status and VDBP levels are associated with liver cirrhosis severity and patients’ mortality, possibly through a proinflammatory immune response.
Dietary fructose and dyslipidemia: new mechanisms involving apolipoprotein CIII
Authors: Hieronimus Bettina , Stanhope Kimber L. 
Published: November 2019

Purpose of review
Chronic consumption of fructose and fructose-containing sugars leads to dyslipidemia. Apolipoprotein (apo) CIII is strongly associated with elevated levels of triglycerides and cardiovascular disease risk. We reviewed the effects of fructose consumption on apoCIII levels and the role of apoCIII in fructose-induced dyslipidemia.

Recent findings
Consumption of fructose increases circulating apoCIII levels compared with glucose. The more marked effects of fructose compared with glucose on apoCIII concentrations may involve the failure of fructose consumption to stimulate insulin secretion. The increase in apoCIII levels after fructose consumption correlates with increased postprandial serum triglyceride. Further, RNA interference of apoCIII prevents fructose-induced dyslipidemia in nonhuman primates. Increases in postprandial apoCIII after fructose, but not glucose consumption, are positively associated with elevated triglycerides in large triglyceride-rich lipoproteins and increased small dense LDL levels.

Summary
ApoCIII might be causal in the lipid dysregulation observed after consumption of fructose and fructose-containing sugars. Decreased consumption of fructose and fructose-containing sugars could be an effective strategy for reducing circulating apoCIII and subsequently lowering triglyceride levels.
Inherited conditions resulting in nephrolithiasis
Authors: Hoppe Bernd , Martin-Higueras Cristina 
Published: November 2019

Purpose of review
Prevalence of pediatric urolithiasis is increasing, which is definitively visible in increasing numbers of presentations in emergency or outpatient clinics. In pediatric patients, a genetic or metabolic disease has to be excluded, so that adequate treatment can be installed as early as possible. Only then either recurrent stone events and chronic or even end-stage kidney disease can be prevented.

Recent findings
The genetic background of mostly monogenic kidney stone diseases was unravelled recently. In hypercalcuria, for example, the commonly used definition of idiopathic hypercalciuria was adopted to the genetic background, here three autosomal recessive hereditary forms of CYP24A1, SLC34A1 and SLC34A3 associated nephrocalcinosis/urolithiasis with elevated 1.25-dihydroxy-vitamin D3 (1.25-dihydroxy-vitamin D3) (calcitriol) levels. In addition either activating or inactivating mutations of the calcium-sensing receptor gene lead either to hypocalcemic hypercalciuria or hypercalcemic hypocalciuria. In primary hyperoxaluria, a third gene defect was unravelled explaining most of the so far unclassified patients. In addition, these findings lead to new treatment options, which are currently evaluated in phase III studies.

Summary
Kidney stones are not the disease itself, but only its first symptom. The underlying disease has to be diagnosed in every pediatric patient with the first stone event.
New approaches to therapeutic drug development for childhood cancers
Authors: Campbell Kevin , Ma Clement , DuBois Steven G. 
Published: November 2019

Purpose of review
We provide an overview of the current landscape of drug development relevant to childhood cancers. We present recent and ongoing efforts to identify therapeutic targets in pediatric cancers. We describe efforts to improve the approach to clinical trials and highlight the role regulatory changes and multistakeholder platforms play in advancing pediatric cancer drug development.

Recent findings
Expanding knowledge of the genetic landscape of pediatric malignancies through clinical genomics studies has yielded an increasing number of potential targets for intervention. In parallel, new therapies for children with cancer have shifted from cytotoxic agents to targeted therapy, with examples of striking activity in patients with tumors driven by oncogenic kinase fusions. Innovative trial designs and recent governmental policies provide opportunities for accelerating development of targeted therapies in pediatric oncology.

Summary
Novel treatment strategies in pediatric oncology increasingly utilize molecularly targeted agents either as monotherapy or in combination with conventional cytotoxic agents. The interplay between new target identification, efforts to improve clinical trial design and new government regulations relevant to pediatric cancer drug development has the potential to advance novel agents into frontline care of children with cancer.
Treatment Decision Making and Regret in Parents of Children With Incurable Cancer
Authors: Ye Zeng Jie , Cheng Meng Hui , Zhang Xiao Ying , Tang Ying , Liang Jian , Sun Zhe , Liang Mu Zi , Yu Yuan Liang 
Published: November 2019

Background
The treatment-related decision-making process is a highly emotional time for parents of children with incurable cancer, and they tend to continue the cancer-directed treatment even when they realize that there is no cure for their child.

Objective
To evaluate whether parents involved in different treatment decisions regretted their treatment decision after their child’s death.

Methods
We collected prospective data from 418 parents of children who died of incurable cancer after receiving cancer care at 1 of 4 hospitals. We assessed parent decisional regret and its association with the type of treatment decision made (non–cancer-directed vs cancer-directed). Propensity score–matched analysis (at a ratio of 1:1) was performed.

Results
One hundred forty-eight parents (35.4%) reported heightened regret. Two isonumerical arms with 103 (non–cancer-directed) and 103 (cancer-directed) resulted after propensity score matching. Parents with a cancer-directed treatment decision (relative risk, 1.53; 95% confidence interval, 1.24–1.90; P = .002) were more likely to report decisional regret compared with those with a non–cancer-directed decision.

Conclusion
Bereaved parents with a cancer-directed treatment decision are more likely to experience increased regret for their decision than bereaved parents involved in a non–cancer-directed treatment decision.

Implications
Shared-decision aids should be prepared for young parents with low education to improve disease-related knowledge, accurate risk perceptions, and options congruent with parents’ values.
Applying the Medications at Transitions and Clinical Handoffs Toolkit in a Rural Primary Care Clinic
Authors: Jarrett Traci , Cochran Jill , Baus Adam 
Published: November 2019

Background:
Adequate medication reconciliation is related to patients' safety. Rural populations are at increased risk of adverse drug events due to errors in medication reconciliation and often receiving medical care across multiple health care entities and across long distances with separate electronic medical records.

Methods:
This study examined the implementation of Medications at Transitions and Clinical Handoffs Toolkit (MATCH) in a rural primary care clinic and assessed the acceptability and feasibility of implementation.

Intervention:
MATCH was developed as a workflow process intervention to improve medication reconciliation.

Results:
Findings from MATCH implementation indicate that the process improved medication reconciliation workflow. A shared definition of current medications across providers and patients was essential.

Conclusions:
Empowering patients and caregivers with tools and language to work with providers, particularly nurses, to conduct medication reconciliation during primary care clinic visits is key to improving patient medication reconciliation in rural settings.
Filling the Gap for Obsessive-Compulsive Disorder Services in Canada
Authors: Taube-Schiff Marlene , Rector Neil A. , Young Rebecca , Larkin Persephone , Richter Margaret A. 
Published: November 2019

Abstract
Obsessive-compulsive disorder (OCD) is a significant psychiatric illness that can impact an individual in terms of their quality of life, functional abilities, and interpersonal relationships. Until recently, services for individuals with severe symptoms of OCD were limited within Canada. The Frederick W. Thompson Anxiety Disorders Centre at Sunnybrook Health Sciences Centre in Toronto, Canada, recently launched an intensive services program for individuals with severe symptoms of OCD. This article provides an overview of the steps that were taken to develop this program. Methods involved incorporation of information gathered from both service users and service providers of these models of treatment within North America and beyond. This article provides a potential treatment model for residential psychiatric treatment that can be applied to OCD and possibly other severe treatment refractory psychiatric illnesses in terms of methods used and generalizable key ingredients.
Utilizing the Cholecystagogue, Ensure Plus, Results in Similar Hepatobiliary Scintigraphy Study Results and Patient Outcomes Status Post Cholecystectomy, in Comparison With Sincalide
Authors: Peacock Justin G. , Katchen Jared M. , Christensen Chad T. , Banks Kevin P. 
Published: November 2019

Objective
To determine if use of the oral cholecystagogue, Ensure Plus (EP), in hepatobiliary scintigraphy (HBS) leads to a similar distribution of normal and abnormal gallbladder ejection fractions (GBEFs) versus other historical secondary findings of chronic biliary disease in a similar patient population compared with the conventional cholecystokinin analog, sincalide. The HBS findings analyzed included the GBEF, small bowel transit time, gallbladder fill time, and reversal of the normal gallbladder versus small bowel transit. The secondary objectives were to determine whether patient outcomes were significantly different for EP and sincalide HBS study patients following cholecystectomy, namely, the surgical pathology and patient-reported biliary-type pain.

Methods
We reviewed all HBS examinations over a retrospective 34-month period. Data from 446 patients who underwent sincalide or EP HBS with GBEF determination for evaluation of chronic symptoms concerning for biliary etiology met the inclusion criteria. The aforementioned HBS findings and postsurgical patient outcomes were obtained for each patient group.

Results
Comparing HBS examinations performed with sincalide or EP, no significant differences were noted in the major HBS findings of similar patient populations. Outcomes for the sincalide and EP groups status post cholecystectomy were assessed to determine their sensitivity, specificity, positive predictive value, and negative predictive value. The outcomes assessed were the histopathology and patient-reported amelioration of biliary-type pain. No significant differences were noted.

Conclusions
The sincalide and EP cholecystagogues did not lead to significantly different HBS findings for similar patient populations or postcholecystectomy outcomes.
Imaging of Prostate Cancer Recurrence in the Vas Deferens With 68Ga-PSMA PET/CT
Authors: Priftakis Dimitrios , Afaq Asim , Bomanji Jamshed 
Published: November 2019

Abstract
Two cases with 68Ga-PSMA–avid prostate cancer recurrence in the vas deferens are presented. These cases highlight the clinical importance of imaging the pattern of local prostate cancer recurrence and the potential difficulties that arise due to the altered anatomy in the prostate bed after prostatectomy or radiotherapy.
Ocular myasthenia gravis: updates on an elusive target
Authors: Melson Andrew T. , McClelland Collin M. , Lee Michael S. 
Published: November 2019

Purpose of review
Ocular myasthenia gravis (OMG) is a complex condition with heterogenous phenotypes and ill-defined diagnostic criteria. Understanding concomitant risk factors and autoimmune serology can help inform prognosis for generalization and guide treatment.

Recent findings
Although antibodies to acetylcholine receptors or muscle-specific kinase likely increase risk of generalization, they are less frequent in OMG. Patients without either antibody tend to have a milder disease process and often have variable antibodies to other end-plate proteins such as LRP4, agrin, or cortactin. The treatment of OMG begins with pyridostigmine and is supplemented by oral prednisone if treatment-resistant or high risk for generalization. Variable oral prednisone regimens have been used with success and further immunosuppression may be best achieved with mycophenolate mofetil and azathioprine. Checkpoint inhibitor-induced myasthenia gravis is increasingly recognized and likely has high rates of mortality associated with myocarditis.

Summary
Our understanding of OMG and its variable phenotypes continues to evolve. Autoantibody testing increasingly provides valuable diagnostic and prognostic information. Despite these improvements, a lack of quality treatment trials creates significant challenges for evidence-based management guidelines.
Differential diagnosis of acute vascular vertigo
Authors: Lee Seung-Han , Kim Ji-Soo 
Published: November 2019

Purpose of review
The current review covers recent advances in vascular vertigo in terms of diagnostic strategies, clinical/laboratory features, pathophysiology, and differential diagnosis.

Recent findings
Acute strokes presenting with isolated dizziness/vertigo without other obvious symptoms or signs of central nervous system involvements may be easily mistaken as peripheral vestibulopathy. For correct diagnosis of vascular vertigo, the importance of clinical history (timing and triggers) and targeted bedside examination cannot be overemphasized. In addition to Head Impulse-Nystagmus-Test of Skew, several differential strategies have been advanced by adopting a combination of clinical history, bedside or laboratory examination, and imaging for diagnosis of vascular vertigo. Circumscribed cerebellar and brainstem lesions may cause isolated central vestibular syndromes with characteristic vestibular and ocular motor manifestations. Recognition of these findings would aid in localizing the lesions and understanding the function of each central vestibular structure. Central positional nystagmus (CPN) may mimic benign paroxysmal positional vertigo (BPPV), but additional oculomotor or neurological findings mostly permit differentiation of CPN from BPPV.

Summary
In acute vestibular syndrome, discriminating vascular causes is still challenging especially when other central symptoms and signs are not evident. An integrated approach based on understanding of clinical features, laboratory findings, speculated mechanisms, and limitations of current diagnostic tests will lead to better clinical practice.
Retinal vessel changes in cerebrovascular disease
Authors: Dumitrascu Oana M. , Koronyo-Hamaoui Maya 
Published: November 2019

Purpose of review
The retina is growingly recognized as a window into cerebrovascular and systemic vascular conditions. The utility of noninvasive retinal vessel biomarkers in cerebrovascular risk assessment has expanded due to advances in retinal imaging techniques and machine learning-based digital analysis. The purpose of this review is to underscore the latest evidence linking retinal vascular abnormalities with stroke and vascular-related cognitive disorders; to highlight modern developments in retinal vascular imaging modalities and software-based vasculopathy quantification.

Recent findings
Longitudinal studies undertaken for extended periods indicate that retinal vascular changes can predict cerebrovascular disorders (CVD). Cerebrovascular ties to dementia provoked recent explorations of retinal vessel imaging tools for conceivable early cognitive decline detection. Innovative biomedical engineering technologies and advanced dynamic and functional retinal vascular imaging methods have recently been added to the armamentarium, allowing an unbiased and comprehensive analysis of the retinal vasculature. Improved artificial intelligence-based deep learning algorithms have boosted the application of retinal imaging as a clinical and research tool to screen, risk stratify, and monitor with precision CVD and vascular cognitive impairment.

Summary
Mounting evidence supports the use of quantitative retinal vessel analysis in predicting CVD, from clinical stroke to neuroimaging markers of stroke and neurodegeneration.