bluuebunny/crossref_metadata_2025_split huggingface dataset:
RADI-14. Bevacizumab vs Laser Interstitial Thermal Therapy in radiation necrosis from brain metastases: a systematic review and meta-analysis
Authors: Palmisciano Paolo , Haider Ali S , Nwagwu Chibueze D , Wahood Waseem , Sagoo Navraj S , Aoun Salah G , Abdullah Kalil G , El Ahmadieh Tarek Y 
Published: August 2021

Abstract

Objective
Radiation necrosis (RN) represents a serious post-radiotherapy complication in patients with brain metastases. Bevacizumab and laser interstitial thermal therapy (LITT) are viable treatment options, but direct comparative data is scarce. We reviewed the literature to compare the two treatment strategies.

Methods
PubMed, EMBASE, Scopus, and Cochrane databases were searched. All studies of patients with RN from brain metastases treated with bevacizumab or LITT were included. Treatment outcomes were analyzed using indirect meta-analysis with random-effect modeling.

Results
Among the 18 studies included, 143 patients received bevacizumab and 148 underwent LITT. Both strategies were equally effective in providing post-treatment symptomatic improvement (P=0.187, I2=54.8%), weaning off steroids (P=0.614, I2=25.5%), and local lesion control (P=0.5, I2=0%). The mean number of lesions per patient was not statistically significant among groups (P=0.624). Similarly, mean T1-contrast-enhancing pre-treatment volumes were not statistically different (P=0.582). Patterns of radiological responses differed at 6-month follow-ups, with rates of partial regression significantly higher in the bevacizumab group (P=0.001, I2=88.9%), and stable disease significantly higher in the LITT group (P=0.002, I2=81.9%). Survival rates were superior in the LITT cohort, and statistical significance was reached at 18 months (P=0.038, I2=73.7%). Low rates of adverse events were reported in both groups (14.7% for bevacizumab and 12.2% for LITT).

Conclusion
Bevacizumab and LITT can be safe and effective treatments for RN from brain metastases. Clinical and radiological outcomes are mostly comparable, but LITT may relate to superior survival benefits in select patients. Further studies are required to identify the best patient candidates for each treatment group.
RADI-23. Exploring the optimal timing of routine initial surveillance MRI following treatment of brain metastases with stereotactic radiosurgery: a comparison of two approaches
Authors: Lin Timothy , Siu Catherine , Redmond Kristin , Jackson Christopher , Bettegowda Chetan , Lim Michael , Kleinberg Lawrence 
Published: August 2021

Abstract

Purpose
To measure the value of early initial surveillance MRI scans in patients with brain metastases undergoing stereotactic radiosurgery (SRS), as MRI scans are a significant cost and patient stressor.

Methods
We identified a retrospective cohort of patients with brain metastases treated with SRS and followed at a single institution with scheduled 6-week or 12-week initial surveillance MRI. Imaging interval was based on policy of different providers. Outcome measures included new/progressive lesions, salvage treatment, detection of new lesions before symptoms, and use of surgical resection.

Results
Two hundred patients were included: 100 consecutive patients scanned with 6-week and 12-week imaging. Eighty-seven and 74 patients in each group had available follow-up imaging and were analyzed. Median time to MRI was 6.7 weeks and 13.5 (p&lt;.001). No difference in primary site, prior SRS, number of treated brain metastases, or use of targeted therapy/immune checkpoint inhibitors was detected. A lower percentage of patients with 6-week MRI had controlled extracranial disease at initial treatment (30% vs 47%,p=.003). Twenty-eight percent with 6-week MRI had findings concerning for new/progressive disease, compared to 47% with 3-month MRI (p=0.01). Fifteen percent (10/87) with 6-week MRI underwent intervention (i.e. SRS, whole brain radiotherapy, or surgery) compared to 34% (20/74) with 12-week MRI (p=0.004). Of patients receiving SRS, a higher percentage had new/worsening neurologic symptoms (45% vs 30%) at follow-up although a lower percentage had new lesions &gt;1cm (20% vs 50%) when discovered. One patient in each group underwent surgical salvage.

Conclusion
While shorter 6-week interval MRI surveillance post-SRS may detect new/progressive disease less frequently than 12-week MRI surveillance intervals, short interval MRI may be more likely to detect new/progressive lesions before symptoms develop. Surgical salvage was uncommon with either schedule. Further study may identify a high-risk subgroup who would benefit from early surveillance.
SURG-10. The evolving role of neurosurgery for central nervous system metastases in the era of personalized medicine
Authors: Karschnia Philipp , Rhun Emilie Le , Grau Stefan J , Preusser Matthias , Soffietti Riccardo , van den Bent Martin , Vogelbaum Michael , von Baumgarten Louisa , Westphal Manfred , Weller Michael , Tonn Joerg-Christian 
Published: August 2021

Abstract

Background
Novel therapies translating into improved survival of patients with advanced cancer have emerged. The number of metastases in the central nervous system is therefore seen to increase. Neurosurgery assumes an expanding role within multi-disciplinary care structures for such patients.

Methods
We performed a comprehensive literature review on the current status of neurosurgery for brain metastases patients. Based on the extracted data, we developed a review from experts in the field on the role of brain metastasis surgery in the era of personalized medicine.

Results
Traditionally, three metastases were considered the cutoff to offer surgical resection. With respect to the clinical status, the resection of a symptomatic mass may nowadays be considered even in presence of multiple tumors in a multimodal setting: surgical resection of brain metastasis provides immediate relief from mass effect-related symptoms and histology in case of unknown primary tumor; surgery may help stabilizing the disease, thus enabling further therapy; and in situations where immunotherapy is considered and non-surgical management would require long-term steroid administration, surgery may also provide expeditious relief of edema and reduction of needs for steroids. In patients with multiple brain metastasis and mixed response to non-surgical therapy, tumor resampling may allow tissue analysis for expression of molecular tumor targets. In patients with leptomeningeal dissemination and consecutive hydrocephalus, ventriculo-peritoneal shunting improves quality of life but also allows for time to administer more therapy thus prolonging survival. Addressing the limited efficacy of many oncological drugs for brain metastases, clinical trial protocols in which surgical specimens are analyzed for pre-surgically administered agents may offer pharmacodynamic insights.

Conclusion
Comprehensive neurosurgical care will have to be an integral element of multi-disciplinary oncological centres providing care to patients with brain metastases to improve on therapy and tumour biology research.
Ten years after the start of the euro crisis: lessons for financial markets and macroeconomic policies
Authors: Banerjee Anindya , Kouretas Georgios P , Papadopoulos Athanasios P , Tavlas George S 
Published: August 2021

Abstract
The papers in this Special Issue take stock of the functioning of the euro area during its crisis, which encompassed mainly the years 2009–15. They address several questions. For example, what surprises did the euro crisis provide about our knowledge about monetary unions? Why were the interconnections between banking systems and fiscal positions so strong during the euro area crisis? In so doing, they contribute to a deeper understanding of the nature of Europe’s monetary union, the underpinnings of its crisis, and the changes that need to be made to the monetary union so that crises can be prevented in the future.
Formation of self-organizing functionally distinct Rho of plants domains involves a reduced mobile population
Authors: Sternberg Hasana , Buriakovsky Ella , Bloch Daria , Gutman Orit , Henis Yoav I , Yalovsky Shaul 
Published: August 2021

Abstract
Rho family proteins are central to the regulation of cell polarity in eukaryotes. Rho of Plants-Guanyl nucleotide Exchange Factor (ROPGEF) can form self-organizing polar domains following co-expression with an Rho of Plants (ROP) and an ROP GTPase-Activating Protein (ROPGAP). Localization of ROPs in these domains has not been demonstrated, and the mechanisms underlying domain formation and function are not well understood. Here we show that six different ROPs form self-organizing domains when co-expressed with ROPGEF3 and GAP1 in Nicotiana benthamiana or Arabidopsis (Arabidopsis thaliana). Domain formation was associated with ROP–ROPGEF3 association, reduced ROP mobility, as revealed by time-lapse imaging and Fluorescence Recovery After Photobleaching beam size analysis, and was independent of Rho GTP Dissociation Inhibitor mediated recycling. The domain formation depended on the ROPs’ activation/inactivation cycles and interaction with anionic lipids via a C-terminal polybasic domain. Coexpression with the microtubule-associated protein ROP effector INTERACTOR OF CONSTITUTIVELY ACTIVE ROP 1 (ICR1) revealed differential function of the ROP domains in the ability to recruit ICR1. Taken together, the results reveal mechanisms underlying self-organizing ROP domain formation and function.
Sleep in the lesser mouse-deer (Tragulus kanchil)
Authors: Lyamin Oleg I , Siegel Jerome M , Nazarenko Evgeny A , Rozhnov Viatcheslav V 
Published: August 2021

Abstract
The mouse-deer or chevrotains are the smallest of the ungulates and ruminants. They are characterized by a number of traits which are considered plesiomorphic for the Artiodactyla order. The objective of this study was to examine sleep in the lesser mouse-deer (Tragulus kanchil), which is the smallest in this group (body mass &lt; 2.2 kg). Electroencephalogram, nuchal electromyogram, electrooculogram, and body acceleration were recorded in four adult mouse-deer females using a telemetry system in Bu Gia Map National Park in Vietnam. The mouse-deer spent on average 49.7 ± 3.0% of 24 h in non-rapid eye movement (NREM) sleep. REM sleep occupied 1.7 ± 0.3% of 24 h or 3.2 ± 0.5% of total sleep time. The average duration of REM sleep episodes was 2.0 ± 0.2 min, the average maximum was 5.1 ± 1.1 min, and the longest episodes lasted 8 min. NREM sleep occurred in sternal recumbency with the head held above the ground while 64.7 ± 6.4% of REM sleep occurred with the head resting on the ground. The eyes were open throughout most of the NREM sleep period. The mouse-deer displayed polyphasic sleep and crepuscular peaks in activity (04:00–06:00 and 18:00–19:00). The largest amounts of NREM occurred in the morning (06:00–09:00) and the smallest before dusk (at 04:00–06:00). REM sleep occurred throughout most of the daylight hours (08:00–16:00) and in the first half of the night (19:00–02:00). We suggest that the pattern and timing of sleep in the lesser mouse-deer is adapted to the survival of a small herbivorous animal, subject to predation, living in high environmental temperatures in the tropical forest undergrowth.
Lysyl oxidase interactions with transforming growth factor‐β during angiogenesis are mediated by endothelin 1
Authors: Grunwald Hagar , Hunker Kristina L. , Birt Isabelle , Lulu Chen , Aviram Rohtem , Zaffryar‐Eilot Shelly , Ganesh Santhi K. , Hasson Peleg 
Published: August 2021

AbstractCrosstalk between multiple components underlies the formation of mature vessels. Although the players involved in angiogenesis have been identified, mechanisms underlying the crosstalk between them are still unclear. Using the ex vivo aortic ring assay, we set out to dissect the interactions between two key angiogenic signaling pathways, vascular endothelial growth factor (VEGF) and transforming growth factor β (TGFβ), with members of the lysyl oxidase (LOX) family of matrix modifying enzymes. We find an interplay between VEGF, TGFβ, and the LOXs is essential for the formation of mature vascular smooth muscle cells (vSMC)‐coated vessels. RNA sequencing analysis further identified an interaction with the endothelin‐1 pathway. Our work implicates endothelin‐1 downstream of TGFβ in vascular maturation and demonstrate the complexity of processes involved in generating vSMC‐coated vessels.
e-Learning in regional anesthesia
Authors: Prineas Stavros , Cuyx Lotte , Smet Jeroen 
Published: August 2021

Purpose of review
To explore the role and impact of e-learning technologies on regional anesthesia.

Recent findings
21st century technologies, such as ‘smart’ medical appliances, personal computers, sophisticated apps, the ubiquitous Internet, and online ‘e-learning’ curricula, are having a powerful impact on anesthesia training: when we learn, what we learn, and how we learn. But is ‘new’ necessarily ‘better’? The answer will result from the application of developments in IT technology through the current vision of architects of future anesthesia training programs. This narrative review aims to summarize the recent developments in anesthesia e-learning, and to forecast trends using regional anesthesia as an example.

Summary
The review offers some recommendations to ensure that the blessings promised to human learning by this ‘Brave New Cyberworld’ do not become its nemesis.
Discharging select patients without an escort after ambulatory anesthesia: identifying return to baseline function
Authors: Walsh Michael T. 
Published: August 2021

Purpose of review
The current standard of care requires ambulatory surgical patients to have an escort for discharge. Recent studies have started to challenge this dogma. Modern ultrashort acting anesthetics have minimal psychomotor effects after a couple of hours. Driving simulator performance and psychomotor testing return to baseline as soon as 1 h following propofol sedation.

Recent findings
Two recent reports of actual experience with thousands of patients found no increase in complications in patients who were discharged without escort or drove themselves from a sedation center. These studies suggest discharge without escort may be safe in select patients but a method to identify appropriate patients remains undefined.

Summary
A reliable test to document return of function might allow safe discharge without an escort. Currently, there is intense interest in developing reliable, inexpensive, easy to administer psychomotor function testing to improve workplace safety and legally define the effects of drugs on driving impairment. Future studies may be able to adapt this technology and develop a validated test for residual anesthetic impairment.
Surgical Management of Medial Discoid Meniscus in Pediatric and Adolescent Patients
Authors: Feroe Aliya G. , Hussain Zaamin B. , Stupay Kristen L. , Kocher Sophia D. , Williams Kathryn A. , Micheli Lyle J. , Kocher Mininder S. 
Published: August 2021

Background:
Medial discoid meniscus (MDM) is an exceedingly rare anatomic abnormality that presents similarly to other meniscal pathologies. Symptomatic MDM is typically managed arthroscopically with mixed short-term and long-term outcomes, although the existing knowledge about MDM is limited. The purpose of this study was to describe the presentation and surgical treatment of MDM in pediatric and adolescent patients.

Methods:
Medical records of 12 knees with MDM in 8 pediatric and adolescent patients treated between 1991 and 2016 were reviewed retrospectively for patient characteristics, clinical manifestations, radiographic findings, operative techniques, and surgical outcomes.

Results:
Of the 446 knees diagnosed arthroscopically with discoid menisci, lateral discoid meniscus was noted in 434 knees (97.3%) and MDM was present in 12 knees (2.7%). The MDM series included 8 patients of mean age 13.8 years (range: 7.8 to 19.8), of which 5 were males (63%), and 4 (50%) had bilateral involvement. Of the 11 knees with available clinical records, all cases presented symptomatically (pain, mechanical symptoms); 10 (91%) had concurrent physical exam findings. On intraoperative examination, discoid morphologies were described as complete in 4/8 knees (50%) or incomplete in 4/8 (50%), with associated instability in 6/12 (50%). Meniscal tears were reported in 9 cases (75%)—primarily, horizontal cleavage tears. Saucerization was performed in 11 knees (92%), with medial meniscal repair in 7 (58%), when indicated. Retear of the medial meniscus occurred in 4/11 knees (36%) at a mean of 25.8 months postoperation; 2 knees required revisions. One knee developed arthrofibrosis and underwent arthroscopic lysis of adhesions.

Conclusions:
MDM is a rare diagnosis, representing 3% of all discoid menisci, with a nonspecific clinical manifestation. Operative management of symptomatic MDM typically involves saucerization and meniscal repair, when indicated, for concurrent tears. Symptom resolution is common short-term, but long-term outcomes include recurrent meniscal tears. Subsequent observational studies are important to evaluate long-term outcomes, such as arthritic changes, with the advancement of arthroscopic techniques for meniscal preservation.

Level of Evidence:
Level IV—retrospective case series.
Cost-utility Analysis Comparing Bracing Versus Observation for Skeletally Immature Patients with Thoracic Scoliosis
Authors: Ikwuezunma Ijezie , Wang Kevin , Margalit Adam , Sponseller Paul , Jain Amit 
Published: August 2021

Study Design.
Cost-utility analysis.

Objective.
This study aimed to investigate the cost-utility of bracing versus observation in patients with thoracic scoliosis who would be indicated for bracing.

Summary of Background Data.
There is high-quality evidence that bracing can prevent radiographic progression of spinal curvature in adolescent idiopathic scoliosis (AIS) patients with curves between 25° and 40° and Risser 0 to 2 skeletal maturity index. However, to our knowledge, the cost-utility of bracing in AIS has not been established.

Methods.
A decision-analysis model comparing bracing versus observation was developed for a hypothetical 10-year old girl (Risser 0, Sanders 3) with a 35° main thoracic curve. We estimated the probability, cost, and quality-adjusted life years (QALY) for each node based on comprehensive review of the literature. Costs were adjusted for inflation based on Consumer Price Index and reported in terms of 2020 real dollars. Incremental net monetary benefit (INMB) was calculated based on a probabilistic sensitivity analysis using Monte Carlo simulations of 1000 hypothetical patients. One-way sensitivity analyses were performed by varying cost, probability, and QALY estimates.

Results.
Our decision-analysis model revealed that bracing was the dominant treatment choice over observation at $50,000/QALY willingness to pay threshold. In simulation analysis of a hypothetical patient cohort, bracing was associated with lower net lifetime costs ($60,377 ± $5,340 with bracing vs. $85,279 ± $4543 with observation) and higher net lifetime QALYs (24.1 ± 2.0 with bracing vs. 23.9 ± 1.8 with observation). Bracing was associated with an INMB of $36,093 (95% confidence interval $18,894–$55,963) over observation over the patient's lifetime. The model was most sensitive to the impact of bracing versus observation on altering the probability of requiring surgery, either as an adolescent or an adult.

Conclusion.
Cost-utility analysis supports scoliosis bracing as the preferred choice in management of appropriately indicated AIS patients with thoracic scoliosis.

Level of Evidence: 5
Patient Characteristics, Injury Types, and Costs Associated with Secondary Over-Triage of Isolated Cervical Spine Fractures
Authors: Wick Joseph , Le Hai , Wick Katherine , Peddada Kranti , Bacon Adam , Han Gloria , Carroll Trevor , Swinford Steven , Javidan Yashar , Roberto Rolando , Martin Allan , Ebinu Julius , Kim Kee , Klineberg Eric 
Published: August 2021

Study Design.
Retrospective cohort.

Objective.
To aim of this study was to identify patient variables, injury characteristics, and costs associated with operative and non-operative treatment following inter-facility transfer of patients with isolated cervical spine fractures.

Summary of Background Data.
Patients with isolated cervical spine fractures are subject to inter-facility transfer for surgical assessment, yet are often treated nonoperatively. The American College of Surgeons’ benchmark rate of “secondary over-triage” is <50%. Identifying patient and injury characteristics as well as costs associated with treatment following transfer of patients with isolated cervical spine fractures may help reduce rates of secondary over-triage and healthcare expenditures.

Methods.
Patients transferred to a Level-1 trauma center with isolated cervical spine fractures between January 2015 and September 2020 were identified. Patient demographics, comorbidities, insurance data, injury characteristics, imaging workup, treatment, and financial data were collected for all patients. Multivariable logistic regression models were constructed to identify patient and injury characteristics associated with surgical treatment.

Results.
Nearly 75% of patients were treated non-operatively. Over 97% of transfers were accepted by the general surgery trauma service. Multivariable modeling found that higher BMI, presence of any neurologic deficit including spinal cord or isolated spinal nerve root injuries, present smoking status, or cervical spine magnetic resonance imaging obtained post-transfer, were associated with surgical treatment for isolated cervical spine fractures. Among patients with type II dens fractures, increased fracture displacement was associated with surgical treatment. Median charges to patients treated operatively and nonoperatively were $380,890 and $90,734, respectively. Median hospital expenditures for patients treated operatively and nonoperatively were $55,115 and $12,131, respectively.

Conclusion.
A large proportion of patients with isolated cervical spine fractures are subject to over-triage. Injury characteristics are important for determining need for surgical treatment, and therefore interfacility transfer. Improving communication with spine surgeons when deciding to transfer patients may significantly reduce health care costs and resource use.

Level of Evidence: 4