bluuebunny/crossref_metadata_2025_split huggingface dataset:
Secondary hemorrhagic complications in aneurysmal subarachnoid hemorrhage: when the impact hits hard
Authors: Darkwah Oppong Marvin , Buffen Kathrin , Pierscianek Daniela , Herten Annika , Ahmadipour Yahya , Dammann Philipp , Rauschenbach Laurèl , Forsting Michael , Sure Ulrich , Jabbarli Ramazan 
Published: February 2019

OBJECTIVEClinical data on secondary hemorrhagic complications (SHCs) in patients with aneurysmal subarachnoid hemorrhage (SAH) are sparse and mostly limited to ventriculostomy-associated SHCs. This study aimed to elucidate the incidence, risk factors, and impact on outcome of SHCs in a large cohort of SAH patients.METHODSAll consecutive patients with ruptured aneurysms treated between January 2003 and June 2016 were eligible for this study. Patients’ charts were reviewed for clinical data, and imaging studies were reviewed for radiographic data. SHCs were divided into those associated with ventriculostomy and those not associated with ventriculostomy, as well as into major and minor bleeding forms, depending on clinical impact.RESULTSSixty-two (6.6%) of the 939 patients included in the final analysis developed SHCs. Ventriculostomy-associated bleedings (n = 16) were independently predicted by mono- or dual-antiplatelet therapy after aneurysm treatment (p = 0.028, adjusted odds ratio [aOR] = 10.28; and p = 0.026, aOR = 14.25, respectively) but showed no impact on functional outcome after SAH. Periinterventional use of thrombolytic agents for early effective anticoagulation was the only independent predictor (p = 0.010, aOR = 4.27) of major SHCs (n = 38, 61.3%) in endovascularly treated patients. In turn, a major SHC was independently associated with poor outcome at the 6-month follow-up (modified Rankin Scale score > 3). Blood thinning drug therapy prior to SAH was not associated with SHC risk.CONCLUSIONSSHCs present a rare sequela of SAH. Antiplatelet therapy during (but not before) SAH increases the risk of ventriculostomy-associated bleedings, but without further impact on the course and outcome of SAH. The use of thrombolytic agents for early effective anticoagulation carries relevant risk for major SHCs and poor outcome.
The caroticoclinoid foramen in fetal and infantile orbitosphenoid, presphenoid, and sphenoid bones: developmental and neurosurgical considerations
Authors: Zdilla Matthew J. 
Published: February 2019

OBJECTIVEThe presence of a caroticoclinoid foramen may increase the likelihood of adverse neurosurgical events. Despite the clinical importance of the caroticoclinoid foramen, its study has been mostly limited to adult populations. Therefore, the object of this study was to describe the prevalence, morphology, and development of the caroticoclinoid foramen among varied sexes and races in early life.METHODSThe study analyzed caroticoclinoid foramina in dry orbitosphenoid, presphenoid, and sphenoid bones from a population of 101 fetal and infantile crania of varied sex and race.RESULTSA caroticoclinoid foramen, whether complete, near complete, or partial, was found in 36 of 199 sides (18.1%). Of the 98 crania with bilaterally intact sides, 21 (21.4%) had the presence of at least one caroticoclinoid foramen. Caroticoclinoid foramina were found unilaterally and bilaterally, in both female and male crania (9/41, 22.0%; 12/57, 21.1%, respectively) and, likewise, in crania of both black and white races (9/54, 16.7%; 12/44, 27.3%, respectively). Caroticoclinoid foramina were formed from cornuate bony projections from the anterior clinoid process, middle clinoid process, or both anterior and middle clinoid processes. Caroticoclinoid foramina were also found in isolated orbitosphenoid bones from individuals as young as 4 months’ fetal age.CONCLUSIONSThe caroticoclinoid foramen occurs in approximately one of every 5 sides and in one in every 5 individuals of perinatal age and should, therefore, be considered a common finding in both fetuses and infants. It is common in both females and males as well as in both black and white races, alike. Furthermore, the caroticoclinoid foramen can be found in individuals as young as 4 months of fetal age. Failure to anticipate the presence of a caroticoclinoid foramen will place important neurovascular structures, including the internal carotid artery, at risk of injury. Neurosurgeons should, therefore, anticipate the caroticoclinoid foramen even in their youngest patients.
Spinal Instability Neoplastic Score component validation using patient-reported outcomes
Authors: Hussain Ibrahim , Barzilai Ori , Reiner Anne S. , McLaughlin Lily , DiStefano Natalie M. , Ogilvie Shahiba , Versteeg Anne L. , Fisher Charles G. , Bilsky Mark H. , Laufer Ilya 
Published: February 2019

OBJECTIVEThe Spinal Instability Neoplastic Score (SINS) correlates with preoperative disability and response to stabilization, with patients with higher scores experiencing greater relief after surgery. However, there is a paucity of data demonstrating the extent to which each component contributes to preoperative clinical status and response to stabilization surgery. The objectives of this study were 2-fold. First, to determine how SINS components correlate with pre- and postoperative patient-reported outcomes (PROs). Second, to determine whether patients with higher SINS (10–12) in the “indeterminate” group respond differently to surgery compared to patients with lower SINS (7–9).METHODSSINS and PROs were prospectively collected in 131 patients undergoing stabilization surgery for metastatic spinal disease. Association of SINS components and their individual scores with preoperative symptom burden and PRO symptom change after surgery was analyzed using the Spearman rank correlation coefficient (rho) and the Kruskal-Wallis test. SINS and association with preoperative PRO scores and mean differences in post- and preoperative PRO scores were compared for 2 SINS categories within the indeterminate group (7–9 vs 10–12) using the Wilcoxon 2-sample test and Wilcoxon signed-rank test.RESULTSThe presence of mechanical pain, followed by metastatic location, correlated most strongly with preoperative functional disability measures and lower disability PRO scores following surgical stabilization. Blastic rather than lytic bone lesions demonstrated stronger association with pain reduction following stabilization. Following surgery, patients with SINS 10–12 demonstrated markedly greater improvement in pain and disability PRO scores nearly across the board compared to patients with SINS 7–9.CONCLUSIONSThe presence of mechanical pain has the strongest correlation with preoperative disability and improvement in pain and disability PRO scores after surgery. Radiographic components of SINS also correlate with preoperative symptom severity and postoperative PRO, supporting their utilization in evaluation of spinal instability. Among patients with indeterminate SINS, patients with higher scores experience greater reduction in pain and disability PRO scores following surgical stabilization, suggesting that the indeterminate-SINS group includes distinct populations.
Utility of topical tranexamic acid for adult patients with spinal deformity and contraindications to systemic tranexamic acid: initial experience and report of 2 cases
Authors: Desai Bhargav D. , Taylor Davis G. , Chen Ching-Jen , Buell Thomas J. , Mullin Jeffrey P. , Naik Bhiken I. , Smith Justin S. , Shaffrey Christopher I. 
Published: February 2019

Tranexamic acid (TXA) is an antifibrinolytic agent with demonstrated efficacy in reducing blood loss when administered systemically. However, in patients with contraindications to systemic or intravenous TXA, topical TXA (tTXA) has been shown to reduce perioperative blood loss, with some studies suggesting equivalence compared to systemic TXA. However, these studies have been conducted in healthy cohorts without contraindications to systemic TXA. In the surgical management of adult spinal deformity (ASD), comorbid disease is commonly encountered and may preclude use of systemic TXA. In this subset of patients with ASD who have contraindications for systemic TXA, use of tTXA has not been reported.The primary objective of this study was to conduct a systematic review on the use of tTXA in spine surgery and to present the authors’ initial experience with tTXA as a novel hemostatic technique for 2 patients with medically complex ASD. Both patients had contraindications to systemic TXA use and underwent high-risk, long-segment fusion operations for correction of ASD. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to obtain studies related to spine surgery and tTXA from the National Institutes of Health PubMed (www.pubmed.gov) database. Criteria for final selection included a demonstration of quantitative data regarding operative or postoperative blood loss with the use of tTXA, and selection criteria were met by 6 articles.Topical TXA may offer a potential therapeutic role in reducing intra- and postoperative blood loss following long-segment spinal fusion surgeries, particularly for medically complex patients with contraindications to systemic TXA. It is reasonable to consider the use of tTXA as a salvage technique in complex high-risk patients with contraindications to systemic TXA, although further research is needed to delineate safety, magnitude of benefit, and optimization of dosing.
Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy: a randomized controlled trial with 5-year outcomes
Authors: MacDowall Anna , Canto Moreira Nuno , Marques Catarina , Skeppholm Martin , Lindhagen Lars , Robinson Yohan , Löfgren Håkan , Michaëlsson Karl , Olerud Claes 
Published: February 2019

OBJECTIVEThe method of artificial disc replacement (ADR) has been developed as an alternative treatment to fusion surgery after decompression for cervical degenerative disc disease (DDD) with radiculopathy. Preserving the motion of ADR devices aims to prevent immobilization side effects such as adjacent-segment pathology (ASP). However, long-term follow-up evaluations using MRI are needed to investigate if this intent is achieved.METHODSThe authors performed a randomized controlled trial with 153 patients (mean age 47 years) undergoing surgery for cervical radiculopathy. Eighty-three patients received an ADR and 70 patients underwent fusion surgery. Outcomes after 5 years were assessed using patient-reported outcome measures using the Neck Disability Index (NDI) score as the primary outcome; motion preservation and heterotopic ossification by radiography; ASP by MRI; and secondary surgical procedures.RESULTSScores on the NDI were approximately halved in both groups: the mean score after 5 years was 36 (95% confidence interval [CI] 31–41) in the ADR group and 32 (95% CI 27–38) in the fusion group (p = 0.48). There were no other significant differences between the groups in six other patient-related outcome measures. Fifty-four percent of the patients in the ADR group preserved motion at the operated cervical level and 25% of the ADRs were spontaneously fused. Seventeen ADR patients (21%) and 7 fusion patients (10%) underwent secondary surgery (p = 0.11), with 5 patients in each group due to clinical ASP.CONCLUSIONSIn patients with cervical DDD and radiculopathy decompression as well as ADR, surgery did not result in better clinical or radiological outcomes after 5 years compared with decompression and fusion surgery.Clinical trial registration no.: 44347115 (ISRCTN).
Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression
Authors: McGrath Lynn B. , White-Dzuro Gabrielle A. , Hofstetter Christoph P. 
Published: February 2019

OBJECTIVEMinimally invasive lumbar unilateral tubular laminotomy for bilateral decompression has gradually gained acceptance as a less destabilizing but efficacious and safe alternative to traditional open decompression techniques. The authors have further advanced the principles of minimally invasive surgery (MIS) by utilizing working-channel endoscope–based techniques. Full-endoscopic technique allows for high-resolution off-axis visualization of neural structures within the lateral recess, thereby minimizing the need for facet joint resection. The relative efficacy and safety of MIS and full-endoscopic techniques have not been directly compared.METHODSA retrospective analysis of 95 consecutive patients undergoing either MIS (n = 45) or endoscopic (n = 50) unilateral laminotomies for bilateral decompression in cases of lumbar spinal stenosis was performed. Patient demographics, operative details, clinical outcomes, and complications were reviewed.RESULTSThe patient cohort consisted of 41 female and 54 male patients whose average age was 62 years. Half of the patients had single-level, one-third had 2-level, and the remaining patients had 3- or 4-level procedures. The surgical time for endoscopic technique was significantly longer per level compared to MIS (161.8 ± 6.8 minutes vs 99.3 ± 4.6 minutes; p < 0.001). Hospital stay for MIS patients was on average 2.4 ± 0.5 days compared to 0.7 ± 0.1 days for endoscopic patients (p = 0.001). At the 1-year follow-up, endoscopic patients had a significantly lower visual analog scale score for leg pain than MIS patients (1.3 ± 0.3 vs 3.0 ± 0.5; p < 0.01). Moreover, the back pain disability index score was significantly lower in the endoscopic cohort than in the MIS cohort (20.7 ± 3.4 vs 35.9 ± 4.1; p < 0.01). Two patients in the MIS group (epidural hematoma) and one patient in the endoscopic group (disc herniation) required a return to the operating room acutely after surgery (< 14 days).CONCLUSIONSLumbar endoscopic unilateral laminotomy for bilateral decompression is a safe and effective surgical procedure with favorable complication profile and patient outcomes.
Perfil Sociodemográfico e Nutricional de Pacientes Oncológicos em Terapia Nutricional Enteral
Authors: Bortoletto Michelle Martins , Souza Iury Antônio de , Dias Anna Marcella Neves , Almeida Nilva Maria de , Mendonça Elisa Grossi 
Published: February 2019

Introdução: Os pacientes oncológicos apresentam alto risco nutricional, sendo a desnutrição e a caquexia comumente observadas nesses indivíduos. A terapia nutricional enteral (TNE) é uma terapêutica que pode oferecer inúmeros benefícios. Objetivo: Identificar o perfil sociodemográfico e nutricional de pacientes oncológicos relacionando-os aos efeitos da TNE com estado nutricional e à evolução clínica desses pacientes. Método: Estudo clínico retrospectivo com revisão de prontuários eletrônicos de pacientes admitidos, no período de setembro de 2016 a abril de 2017, em um hospital oncológico público e privado, no município de Juiz de Fora - MG. As análises estatísticas foram por meio de frequências e proporções e média e desvio-padrão a depender das variáveis, sendo p<0,05. Resultados: Entre os 96 prontuários analisados, 68,75% eram do gênero masculino, 54,16% idosos, 52,1% ex-tabagistas, 39,6% ex-etilistas e 46,9% apresentavam câncer de cabeça e pescoço. Destes, 44,8% apresentavam suspeita de desnutrição e 39,6% estavam desnutridos. A média do índice de massa corporal (IMC) foi de 19,44±4,83 kg/m² e o peso 52,91±12,97 kg antes da TNE, e 18,76±4,47 kg/m² e 51,01±12,69 kg após sete dias em TNE, não apresentando diferença significativa entre os valores obtidos antes e após a TNE. A classificação do percentual da perda de peso no início da TNE evidenciou 88,5% com perda de peso grave e, após sete dias de terapia, houve uma redução nesse percentual para 46,9%. Conclusões: A maioria dos pacientes oncológicos apresenta um comprometimento progressivo do estado nutricional. A TNE contribuiu de modo positivo para o retardo da perda de peso desses pacientes.
Trabalho e Adoecimento: as Repercussões Sociais do Tratamento da Leucemia Linfoblástica Aguda
Authors: Torres Joana Polycarpo , Assis Eliane Santos de 
Published: February 2019

Introdução: Trata-se de uma abordagem sobre os impactos do processo de tratamento da leucemia linfoblástica aguda (LLA ) na vida social dos indivíduos a partir de sua inserção no mundo do trabalho. Objetivo: Problematizar as repercussões sociais do tratamento da LLA , identificando de que maneira a inserção no mercado de trabalho (formal ou informal) impacta no processo de tratamento no âmbito do Sistema Único de Saúde (SUS). Método: Estudo qualitativo com análise crítico-reflexiva à luz do referencial teórico do materialismo histórico-dialético. A pesquisa se deu por meio de um roteiro de entrevista semiestruturado aplicado a nove pacientes adultos em tratamento, considerados ativos para o mercado de trabalho. Resultados: Foi identificado o perfil dos participantes do estudo com base em dados sociodemográficos que refletem uma predominância de jovens em situação de restrição financeira e dependência de familiares em diversos âmbitos da vida. A partir da análise das entrevistas, foram elucidados tanto a condição de trabalhador dos indivíduos durante o processo de tratamento oncológico como os impactos oriundos da precária inserção no mercado de trabalho na atual conjuntura política, econômica e social que vem conformando a fragmentação das políticas públicas. Conclusão: Foi possível compreender como as crescentes e, ainda, as mais recentes mudanças na divisão sociotécnica do trabalho têm contribuído para o aumento das disparidades sociais existentes e, principalmente, o quanto tal contexto toma uma dimensão singular e alarmante no âmbito do tratamento oncológico.
Filgrastim Biossimilar para Mobilização de Células Progenitoras antes do Transplante Autólogo: Análise Retrospectiva de Pacientes com Mieloma Múltiplo e Linfomas
Authors: Pinto Simões Belinda , Fogliatto Laura Maria , Arcuri Leonardo Javier , Zanella Capra Marcelo Eduardo 
Published: February 2019

Introdução: O filgrastim, que desempenha um papel fundamental na coleta de células progenitoras de sangue periférico (CPSP), está disponível há quase 25 anos, e existem vários biossimilares de filgrastim sendo comercializados. Objetivo: Avaliar se um filgrastim biossimilar (Filgrastine®) foi associado com mobilização efetiva em pacientes submetidos à coleta de CPSP para transplante autólogo de medula óssea. Método: Foram revisados os prontuários de pacientes com mieloma múltiplo e linfomas tratados em três instituições no Brasil. O desfecho primário (taxa de sucesso de mobilização) foi a proporção de pacientes na população intenção de tratar (ITT), em que pelo menos 2 x 106 células CD34+/kg foram coletadas por leucaférese nos dias 5 e/ou 6. A população per protocolo (PP) foi composta por pacientes que receberam pelo menos quatro dias de Filgrastine e tiveram pelo menos uma contagem de CD34+ nos dias 5 ou 6. Resultados: A dose diária de Filgrastine (no D1, com pequenas alterações subsequentes) variou de 8,5 a 28,9 mcg/Kg nos 52pacientes na população ITT, com uma mediana de 13,8 mcg/Kg; 51 pacientes receberam pelo menos quatro doses. Uma média de 2,84±1,97 x 106 células CD34+/kg foram coletadas. A taxa de sucesso de mobilização foi de 53,9% (IC 95%, 39,5% a 67,8%) na população ITT e 62,2% (IC 95%, 46,5% a 76,2%) nos 45 pacientes da população PP. A mobilização foi considerada efetiva pelos pesquisadores em 80,8% dos pacientes da população ITT e 88,9% daqueles na população PP. Conclusão: Apesar de sua natureza observacional, este estudo sugere que Filgrastine esteja associado com as taxas de sucesso esperadas na coleta de CPSP para transplante autólogo de medula óssea.
A Atenção Oncológica e os 30 Anos do Sistema Único de Saúde
Authors: Migowski Arn , Atty Adriana Tavares de Moraes , Tomazelli Jeane Glaucia , Dias Maria Beatriz Kneipp , Jardim Beatriz Cordeiro 
Published: February 2019

O objetivo do presente artigo é apresentar um panorama geral da evolução da organização da atenção oncológica ao longo da história do SUS.
Plan China de la Secretaría de Estado de Comercio
Authors: Káiser Moreiras José Luis 
Published: February 2019

El Plan China es el primer plan PASE (País con Actuación Sectorial Estratégica) que se está elaborando para consolidar, incrementar y diversificar la exportación española, todo ello en el marco de la Estrategia de Internacionalización de la Economía Española 2017-2027 (EIEE), que fue aprobada en el Consejo de Ministros del 8 de septiembre. La EIEE surge bajo el nuevo modelo de desarrollo sostenible de la economía española, que requiere asegurar la contribución positiva estructural del sector exterior con un impacto positivo sobre la creación de empleo. De ahí la necesidad de una estrategia de internacionalización a medio plazo para cohesionar todas las acciones en materia de internacionalización de los diferentes ministerios y comunidades autónomas. La Secretaria de Estado de Comercio ha querido empezar por el plan PASE para China por la importancia del continente asiático en la economía mundial y estar considerado como un país prioritario en sus políticas de internacionalización. Con China tenemos una cuota muy inferior a nuestra cuota en el comercio mundial y estamos proporcionalmente más lejos que nuestros competidores. Podemos afirmar que sin un crecimiento sostenido de nuestras exportaciones al mercado chino va a ser difícil incrementar nuestra cuota en los mercados mundiales en los próximos años. Actualmente, el saldo negativo de nuestro comercio con China es prácticamente igual la totalidad del déficit comercial español.
La seguridad de las inversiones en Iberoamérica y el proyecto Iberfides
Authors: Cavallé Cruz Alfonso , Casilda Béjar Ramón 
Published: February 2019

América Latina constituye, desde los primeros años de la década de los noventa del pasado siglo, la región donde las principales empresas y bancos españoles iniciaron su expansión internacional. Posteriormente, se le unieron una creciente cantidad de pequeñas y medianas empresas. España se sitúa como el primer inversor europeo y segundo mundial por detrás de Estados Unidos. En un mundo cada vez más globalizado e interconectado se hace ineludible buscar soluciones prácticas que, sin merma de las garantías y seguridad, faciliten las relaciones comerciales, empresariales, interpersonales y familiares, que son especialmente intensas en el ámbito iberoamericano.
Hoy juega a favor de la creación un sistema de colaboración interinstitucional iberoamericano para la interconexión documental y negocial utilizando las nuevas herramientas tecnológicas. La alianza de la seguridad jurídica con la tecnológica se convierte en vehículo y puente de unión facilitador de las relaciones jurídicas transnacionales y de las inversiones. Iberoamérica cuenta con sistemas comunes de seguridad jurídica preventiva, enmarcados en la Unión Internacional del Notariado (UINL), lo que puede potenciar la contratación y la circulación internacional ágil, eficiente y segura de la documentación mediante el proyecto Iberfides.