bluuebunny/crossref_metadata_2025_split huggingface dataset:
General anaesthesia during caesarean sections: implications for the mother, foetus, anaesthetist and obstetrician
Authors: Ratnayake Gamunu , Patil Vinod 
Published: October 2019

Purpose of review
A general anaesthetic is usually given for an emergency caesarean section (Category 1), where there is imminent threat to the mother or foetus. There are many risks in performing a general anaesthetic. The aim of this review is to highlight the effects and risks to the mother and foetus of each step of a general anaesthetic.

Recent findings
Anaesthetic techniques are changing, and the traditional mantra of using a general anaesthetic for an emergency caesarean sections is being challenged. There are also multiple potential risks of a general anaesthetic that are being better defined. This ranges from awareness during surgery, through to foetal and maternal risks of complications.

Summary
This review will outline the different stages of a general anaesthetic and highlight the risks. This summary will allow a better understanding of anaesthetic risks. This will allow obstetricians to have a more informed conversation with an anaesthetist as to form of anaesthetic required (general anaesthetic versus spinal or epidural top-up). The review will also allow obstetricians to give more informed consent to mothers and be aware of the postoperative risks.
Preventing term stillbirth: benefits and limitations of using fetal growth reference charts
Authors: Halimeh Rawad , Melchiorre Karen , Thilaganathan Basky 
Published: October 2019

Purpose of review
This review examines the variation in clinical practice with regards to ultrasound estimation of fetal weight, as well as calculation of fetal weight centiles.

Recent findings
Placental dysfunction is associated with fetal smallness from intrauterine malnutrition as well as fetal disability and even stillbirth from hypoxemia. Although estimating fetal weight can be done accurately, the issue of which fetal weight centile chart should be used continues to be a contentious topic. The arguments against local fetal growth charts based on national borders and customization for variables known to be associated with disease are substantial. As for other human diseases such as hypertension and diabetes, there is a rationale for the use of an international fetal growth reference standard. Irrespective of the choice of fetal growth reference standard, a significant limitation of small for gestational age (SGA) detection programs to prevent stillbirth is that the majority of stillborn infants at term were not SGA at the time of demise.

Summary
Placental dysfunction can present with SGA from malnutrition and/or stillbirth from hypoxemia depending on the gestational age of onset. Emerging data show that at term, fetal Doppler arterial redistribution is associated more strongly with perinatal death than fetal size. Properly conducted trials of the role for maternal characteristics, fetal size, placental biomarkers, and Doppler assessing fetal well-being are required urgently.
Trends in Estimated Thyroid, Salivary Gland, Brain, and Eye Lens Doses From Intraoral Dental Radiography Over Seven Decades (1940 TO 2009)
Authors: Fontana R.C. , Pasqual E. , Miller D.L. , Simon S.L. , Cardis E. , Thierry-Chef I. 
Published: October 2019

Abstract
The purpose of this study is to support retrospective dose estimation for epidemiological studies by providing estimates of historical absorbed organ doses to the brain, lens of the eye, salivary glands, and thyroid from intraoral dental radiographic examinations performed from 1940 to 2009. We simulated organ doses to an adult over 10 y time periods from 1940 to 2009, based on commonly used sets of x-ray machine settings collected from the literature. Simulations to estimate organ dose were performed using personal computer x-ray Monte Carlo software. Overall, organ doses were less than 1 mGy for a single intraoral radiograph for all decades. From 1940 to 2009, doses to the brain, eye lens, salivary glands, and thyroid decreased by 86, 96, 95, and 89%, respectively. Of these four organs, the salivary glands received the highest doses, with values decreasing from about 0.23 mGy in the 1940s to 0.025 mGy in the 2000s for a single intraoral radiograph. Based on simulations using collected historical data on x-ray technical parameters, improvements in technology and optimization of the technical settings used to perform intraoral dental radiography have resulted in a decrease in absorbed dose to the brain, eye lens, salivary glands, and thyroid over the period from 1940 to 2009.
Impact of Minimal Residual Disease Detection by Next-Generation Flow Cytometry in Multiple Myeloma Patients with Sustained Complete Remission after Frontline Therapy
Authors: Terpos Evangelos , Kostopoulos Ioannis V. , Kastritis Efstathios , Ntanasis-Stathopoulos Ioannis , Migkou Magdalini , Rousakis Pantelis , Argyriou Alexandra T. , Kanellias Nikolaos , Fotiou Despina , Eleutherakis-Papaiakovou Evangelos , Gavriatopoulou Maria , Ziogas Dimitrios C. , Papanota Aristea-Maria , Spyropoulou-Vlachou Marilyn , Trougakos Ioannis P. , Tsitsilonis Ourania E. , Paiva Bruno , Dimopoulos Meletios A. 
Published: October 2019

Abstract
Minimal residual disease (MRD) was monitored in 52 patients with sustained CR (≥2 years) after frontline therapy using next-generation flow (NGF) cytometry. 25% of patients initially MRD- reversed to MRD+. 56% of patients in sustained CR were MRD+; 45% at the level of 10−5; 17% at 10−6. All patients who relapsed during follow-up were MRD+ at the latest MRD assessment, including those with ultra-low tumor burden. MRD persistence was associated with specific phenotypic profiles: higher erythroblasts’ and tumor-associated monocytes/macrophages’ predominance in the bone marrow niche. NGF emerges as a suitable method for periodic, reproducible, highly-sensitive MRD-detection at the level of 10−6.
Psychometric Properties of the Keratoconus Outcomes Research Questionnaire: A Save Sight Keratoconus Registry Study
Authors: Kandel Himal , Pesudovs Konrad , Ferdi Alex , Mills Richard , Chen Jern Yee , Watson Adam , Poon Alexander , Downie Laura E. , Watson Stephanie L. 
Published: October 2019

Purpose:
The aim of this study was to evaluate the psychometric properties of the Keratoconus Outcomes Research Questionnaire (KORQ) in patients enrolled in the Save Sight Keratoconus Registry.

Methods:
A cross-sectional study was conducted utilizing prospectively collected web-based registry data. The psychometric properties of the KORQ were assessed using both classical test theory and Rasch analysis. Andrich group rating scale variant of the Rasch analysis was conducted using Winsteps software, Version 3.92.1.

Results:
The KORQ was completed by 189 patients with keratoconus (men, 67.7%; white, 69.8%; median age 29 years; better eye median values: visual acuity, 75 LogMAR letters; Kmax, 51.3 D; K2, 46.5 D; thinnest pachymetry, 485 μm). Cronbach's α for the “Activity Limitation” and “Symptoms” scales were 0.95 and 0.91, respectively, with both scales free from floor or ceiling effects. On Rasch analysis, the category thresholds were ordered and well-spaced for both scales. The Activity Limitation scale had excellent psychometric properties including person separation index (3.6), unidimensionality (variance explained, 65.4%), fit statistics (<1.3 MnSq), and measurement range (3.6 logits). Similarly, the Symptoms scale had satisfactory psychometric properties including person separation index (2.5), unidimensionality (variance explained, 54.3%), fit statistics (<1.30 MnSq except for 1 item), and measurement range (2.0 logits). Both scales were well targeted to the population and free of differential item functioning.

Conclusions:
The KORQ is a psychometrically robust patient-reported outcome measure for evaluating quality of life parameters in keratoconus. It enables routine collection and monitoring of meaningful patient-reported outcome data in clinical settings, including registries.
Association Between Early Sjögren Markers and Symptoms and Signs of Dry Eye
Authors: Hubschman Sasha , Rojas Mario , Kalavar Meghana , Kloosterboer Amy , Sabater Alfonso L. , Galor Anat 
Published: October 2019

Purpose:
Animal models suggest that early markers of Sjögren syndrome (EMS)—antibodies against salivary protein 1, parotid secretory protein, and carbonic anhydrase 6 (CA6)—are more accurate signals of early Sjögren when compared with classic markers (anti-Ro and anti-La). To further understand the relationship between EMS and dry eye (DE), we compared symptoms and signs of DE in subjects who tested positive versus negative for EMS.

Methods:
In this cross-sectional study, patients at the Miami Veterans Affairs Eye Clinic who were tested for EMS underwent a standard ocular surface examination. Indications for EMS testing included DE symptoms in combination with dry mouth symptoms, low tear production, corneal staining, or a Sjögren disease-associated autoimmune disease. Statistical tests performed were the χ2 test, Fisher exact test, independent sample t test, and Spearman correlation.

Results:
Seventy-three percent of 44 patients tested positive for 1 or more EMS. CA6 IgG was most frequently elevated, followed by CA6 IgM and parotid secretory protein IgG. EMS-positive versus EMS-negative subjects were more likely to escalate DE treatment past artificial tears to topical cyclosporine (n = 32, 100% vs. n = 9, 75%, P = 0.02). There were no demographic or comorbidity differences between EMS-positive and EMS-negative subjects, and marker levels did not correlate with more severe tear film measures.

Conclusions:
Most of the individuals with DE tested positive for 1 or more EMS antibodies, including men and Hispanics. Future studies will be needed to understand how to incorporate EMS data into the care of an individual with DE.
Astigmatism Orientation After Deep Anterior Lamellar Keratoplasty for Keratoconus and Its Correlation With Preoperative Peripheral Corneal Astigmatism
Authors: Elkadim Mohamed , Myerscough James , Bovone Cristina , Busin Massimo 
Published: October 2019

Purpose:
To evaluate the orientation of keratometric astigmatism (KA) after deep anterior lamellar keratoplasty (DALK) for keratoconus and its correlation with preoperative peripheral KA.

Methods:
This is a retrospective, single-center observational study including keratoconic patients undergoing DALK between January 2016 and January 2017 with regular astigmatism postoperatively. The orientation of postoperative KA was classified as with-the-rule (WTR), against-the-rule, or oblique and was correlated with the corresponding preoperative peripheral KA, calculated by the sinusoidal fitting of points of the axial keratometric power map at 8 mm diameter.

Results:
Forty-one keratoconic eyes were included, with the most common orientation of KA post-DALK being WTR (65.9%), followed by against-the-rule (19.5%) and oblique (14.6%). A significant correlation was found between preoperative peripheral KA and post-DALK KA regarding axis (P < 0.001, r = 0.88) and power (P = 0.0128, r = 0.23).

Conclusions:
The axis of post-DALK astigmatism and to a lesser extent its respective power in keratoconic eyes can be predicted using the preoperative peripheral KA, with “WTR” being the most common astigmatic orientation.
Efficacy of Amniotic Membrane Transplantation for the Treatment of Corneal Ulcers
Authors: Schuerch Kaspar , Baeriswyl Andrea , Frueh Beatrice E. , Tappeiner Christoph 
Published: October 2019

Purpose:To evaluate the outcome of amniotic membrane transplantation (AMTX) as a treatment for corneal ulcers.Methods:Patients treated with AMTX for refractory corneal ulcers between 2012 and 2017 were evaluated in a retrospective analysis. Primary outcome measure was complete reepithelialization.Results:A total of 149 patients were included (mean age 68 ± 18 years). The mean duration between ulcer onset and AMTX was 42 ± 46 days. The longest time between ulcer diagnosis and AMTX was found in bacterial ulcers and the shortest time to AMTX in eyes with trauma/chemical burns (mean 65 ± 15 days and 14 ± 4 days, respectively). In 70% of the patients, a single AMTX procedure was sufficient to achieve epithelial closure (21% <1 month, 40% within 1 –3 months, and 9% within 3–6 months). Treatment failure was observed in 30% of all patients, and most of them underwent further interventions. Highest closure rates were found in bacterial ulcers, herpetic ulcers, and neurotrophic ulcers (80%, 85%, and 93%, respectively), whereas the lowest reepithelialization rates were found in ulcers after corneal surgery and ulcers associated with rheumatic disease (52% and 57%, respectively).Conclusions:AMTX is a valuable treatment option to achieve corneal epithelial wound healing in cases refractory to conventional treatment. Success rates differ depending on the etiology of ulcer.
Oxaliplatin-induced neuropathy occurs through impairment of haemoglobin proton buffering and is reversed by carbonic anhydrase inhibitors
Authors: Potenzieri Alberto , Riva Beatrice , Rigolio Roberta , Chiorazzi Alessia , Pozzi Eleonora , Ballarini Elisa , Cavaletti Guido , Genazzani Armando A. 
Published: October 2019

Abstract
Oxaliplatin is a cornerstone chemotherapeutic used in the treatment of colorectal cancer, the third leading cause of death in Western countries. Most side effects of this platinum-containing drug are adequately managed in the clinic, although acute and long-term neurotoxicity still severely compromises the quality of life of patients treated with oxaliplatin. We have previously demonstrated that therapeutically relevant concentrations/doses of oxaliplatin lead to a reduction in intracellular pH in mouse dorsal root ganglion (DRG) neurons in vitro and in vivo and that this alteration sensitizes TRPA1 and TRPV1 channels, which most likely mediate the allodynia associated with treatment. In this study, we show that oxaliplatin leads to a reduction of intracellular pH by forming adducts with neuronal haemoglobin, which acts in this setting as a proton buffer. Furthermore, we show that FDA-approved drugs that inhibit carbonic anhydrase (an enzyme that is linked to haemoglobin in intracellular pH homeostasis), ie, topiramate and acetazolamide, revert (1) oxaliplatin-induced cytosolic acidification and TRPA1 and TRPV1 modulation in DRG neurons in culture, (2) oxaliplatin-induced cytosolic acidification of DRG of treated animals, and (3) oxaliplatin-induced acute cold allodynia in mice while not affecting OHP-induced cytotoxicity on cancer cells. Our data would therefore suggest that reversal of oxaliplatin-induced cytosolic acidification is a viable strategy to minimize acute oxaliplatin-induced symptoms.
Gene amplification and tumor grading in parosteal osteosarcoma
Authors: Chen Paul Chih-Hsueh , Yen Chueh-Chuan , Hung Giun-Yi , Pan Chin-Chen , Chen Wei-Ming 
Published: October 2019

Background:Parosteal osteosarcoma (POS) is a unique low grade osteosarcoma. Two separate oncogenes,MDM2andCDK4, are specifically amplified in POS. Its clinical behavior is usually indolent. In some occasions, it may progress to high grade and become fatal. Malignant transformation with high grade differentiation is the most reliable indicator to predict its aggressiveness and metastatic potential. This study is to discover the relationship between gene amplification and grading.Methods:Retrospective analysis of MDM2/CDK4 expression/amplification using immunostaining, multiplex quantitative polymerase chain reaction (MQPCR) and fluorescencein situhybridization (FISH) were studied on 14 patients with recurrent POS.Results:Forty tumor specimens in formalin-fixed paraffin-embedded blocks from 14 patients of POS were included in this study. Twenty-seven tumors are low-grade, 13 are high-grade. All POS showed increased expression of both MDM2 and CDK4 proteins, but not those from conventional osteosarcoma. Except some tumors were non-informative (poor DNA quality), the rest of POS had a marked increase ofMDM2andCDK4genes copies by MQPCR, and confirmed byMDM2FISH. Moreover, the folds of amplification increase as tumors progress. And, the amplification folds in high-grade POS are consistently higher than those of conventional ones.Conclusion:FISH and MQPCR are both useful assays for estimating oncogene amplification status in bone tumors. Amplification levels ofMDM2andCDK4are related to tumor grading and progression. Molecular determination of gene amplification status can be a reliable alternative for predicting clinical behavior of POS at small biopsies.
Regulatory cytokines prescribe the outcome of the inflammation in the process of pseudoexfoliation production
Authors: SarenacVulovic Tatjana , Pavlovic Sladjana , Lutovac Mitar , Zdravkovic Vladimir , Sreckovic Suncica , Zdravkovic Nemanja 
Published: October 2019

Background:
The purpose of this study is to reveal the participation of different regulatory cytokines within the process of pseudoexfoliation (PEX).

Methods:
Our study included 140 patients referred to cataract surgery with early and late stage of pseudoexfoliation syndrome (XFS) or pseudoexfoliation glaucoma (XFG). Humor and serum levels of cytokines: transforming growth factor beta (TGF-β), platelet-derived growth factor (PDGF), epidermal growth factor (EGF), insulin-like growth factor (IGF), IL-8 and interferon-inducible T cell alpha chemoattractant (ITAC) were measured in a sample using high sensitivity enzyme-linked immunoabsorbent assay (ELISA) kit.

Results:
Our results indicate that profibrotic action induced by increasing TGF-β and PDGF locally activates fibrous tissue production in the early XFS with a prolonged effect of PDGF (late XFS) and finally (XFG stage) it is dominantly controlled by EGF and IGF. ITAC overrides angiogenetic effects of IL-8 in XFG.

Conclusion:
Based on our findings, local chronic inflammation in the eye is accompanied by the secretion of different profibrotic cytokines (TGF-β, PDGF, EGF, IGF, IL-8) without angiogenesis due to effects of ITAC.
Recidivism After Endoscopic Treatment of Cholesteatoma
Authors: Killeen Daniel E. , Tolisano Anthony M. , Kou Yann Fuu , Kutz Joe Walter , Isaacson Brandon 
Published: October 2019

Objective:
To investigate the recidivism rate of cholesteatoma treated via endoscopic ear surgery (EES), either via transcanal endoscopic ear surgery or endoscopic assisted tympanomastoidectomy compared with a microscopic postauricular approach.

Study Design:
Retrospective chart review.

Setting:
Academic otology practice.

Patients:
Adult patients (18 years and older) with at least 11 months of surgical follow-up who were treated for cholesteatoma via endoscopic techniques or microscopic postauricular approach.

Intervention:
Use of the endoscope for cholesteatoma dissection.

Main Outcome Measure:
Residual or recurrent cholesteatoma identified at second look surgery or postoperative diffusion-weighted magnetic resonance imaging.

Results:
Fifty-nine patients treated for cholesteatoma via endoscopic techniques and 35 patients treated via microscopic postauricular approach were analyzed. The endoscopic group required significantly fewer mastoid procedures (28% versus 80%, p-value 0.001). Postoperative changes in median ABG (5 dB versus 3.75 dB, p = 0.9519), median PTA (6.875 dB versus 1.25 dB, p = 0.3864), and median word recognition score (0% versus 0%, p = 0.3302) were not significantly different between the EES and microscopic surgery groups. Median operative times were not significantly different between the two groups (182 min endoscopic versus 174 min microscopic, p-value 0.66). The rate of residual disease (17% EES versus 17% microscopic, p = 0.959) or disease recurrence (18% endoscopic versus 20% microscopic, p = 0.816) were not significantly different between the two groups.

Conclusions:
EES is an effective option for cholesteatoma management with similar rates of recurrent or residual disease as compared with the more traditional microscopic postauricular approach in these samples.
Obesity Is Not Associated With Postoperative Complications After Vestibular Schwannoma Surgery in a Large Single Institution Series
Authors: Lipschitz Noga , Kohlberg Gavriel D. , Walters Zoe A. , Tawfik Kareem O. , Samy Ravi N. , Pensak Myles L. , Zuccarello Mario , Andaluz Norberto , Dinapoli Vincent A. , Breen Joseph T. 
Published: October 2019

Objective:
Determine whether elevated body mass index (BMI) is associated with postoperative complications after vestibular schwannoma (VS) surgery.

Study Design:
Retrospective case series.

Setting:
Tertiary referral center.

Patients:
Two hundred six patients undergoing surgery for VS between 2010 and 2017, grouped into obese and nonobese patients.

Intervention:
Surgery for VS resection.

Main Outcome Measures:
Postoperative facial nerve outcomes, length of hospital stay, presence of postoperative cerebrospinal fluid leak, 30-day readmission, return to the operating room, wound complications, cardiovascular and thromboembolic complications.

Results:
After excluding 1 patient for missing BMI, our cohort included 205 patients. Seventy-nine patients (38.5%) were obese (mean BMI 36.2 kg/m2, range 30–55.1) and the remaining 126 (61.5%) were nonobese (mean BMI 25.0, range 18.8–29.8 kg/m2). Compared with nonobese patients, obesity was not associated with postoperative cerebrospinal fluid leak (OR 1.1, 95% CI 0.93–1.1), length of hospital stay (OR 0.98, 95% CI 0.65–1.47), 30-day readmission rates (1.04, 95% CI 0.95–1.14), return to operating room (OR 1.05, 95% CI 0.98–1.11), or other wound-related complications (OR 0.99, 95% CI 0.94–1.04).

Conclusion:
In this cohort, elevated BMI was not associated with an increased risk for postoperative complications after VS surgery. Our findings may mitigate concerns associated with surgical management of VS in obese patients.
Combined Endoscopic and Microscopic Surgery for Perilabyrinthine Lesions: Feasibility and Technique
Authors: Wei Xingmei , Gao Zhiqiang , Tian Xu , Zhao Yang , Feng Guodong 
Published: October 2019

Objectives:To determine the feasibility of endoscopic-assisted surgery for lesions involving the perilabyrinthine recesses, and develop and validate a technique for this kind of lesions that increases the possibility of preserving the labyrinth and cochlea.Study Design:Observational study.Setting:Referral center.Cases:Five patients who underwent endoscopy-assisted surgery for lateral skull base pathology involving the perilabyrinthine recesses between July 2010 and March 2016 were reviewed.Interventions:Clinical data of the five patients were collected.Main Outcomes Measures:Hearing level and recurrence.Results:Three of the five patients (three women, two men) had petrous bone cholesteatomas, one a facial neurofibroma, and one a petrous bone cholesterol granuloma. Complete excision with labyrinth and cochlea preservation was achieved using an endoscopic-assisted technique in all patients. Four had preoperative conductive hearing loss and one was totally deaf. In one patient, the postoperative air-bone gap was 30 dB lower than preoperatively levels, one stayed the same, and one was 30 dB because of closing of the external ear canal. After an average follow-up of 62.9 months, no patient had recurrence.Conclusions:Endoscope-assisted surgery is feasible for lesions involving the perilabyrinthine recesses and increases the likelihood to preserve the structure and function of labyrinth/cochlea, which may provide chances for artificial hearing devices implantation.