bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nonepileptic, Stereotypical, and Intermittent Symptoms (NESIS) in Patients With Subdural Hematoma: Proposal for a New Clinical Entity With Therapeutic and Prognostic Implications
Authors: Levesque Mathieu , Iorio-Morin Christian , Bocti Christian , Vézina Caroline , Deacon Charles 
Published: September 2019

Abstract

BACKGROUND
Transient neurological symptoms (TNS) are frequent in patients with subdural hematomas (SDH) and many will receive a diagnosis of epilepsy despite a negative workup.

OBJECTIVE
To explore if patients with TNS and a negative epilepsy workup (cases) evolved differently than those with a positive EEG (controls), which would suggest the existence of alternative etiologies for TNS.

METHODS
We performed a single-center, retrospective, case-control study of patients with TNS post-SDH. The demographics and clinical and semiological features of cases and controls were compared. The outcome and response to antiepileptic drugs were also assessed and a scoring system developed to predict negative EEG.

RESULTS
Fifty-nine patients with SDH-associated TNS were included (39 cases and 20 controls). Demographic characteristics were comparable in both groups. Dysphasia and prolonged episodes were associated with a negative EEG. Clonic movements, impaired awareness, positive symptomatology, complete response to antiepileptic drugs, and mortality were associated with a positive EEG. Using semiological variables, we created a scoring system with a 96.6% sensitivity and 100% specificity in predicting case group patients. The differences observed between both groups support the existence of an alternative etiology to seizures in our case group. We propose the term NESIS (NonEpileptic, Stereotypical, and Intermittent Symptoms) to refer to this subgroup and hypothesize that TNS in these patients might result from cortical spreading depolarization.

CONCLUSION
We describe NESIS as a syndrome experienced by SDH patients with specific prognostic and therapeutic implications. Independent validation of this new entity is now required.
Predictors of Local Control of Brain Metastasis Treated With Laser Interstitial Thermal Therapy
Authors: Bastos Dhiego Chaves de Almeida , Rao Ganesh , Oliva Isabella Claudia Glitza , Loree Jonathan M , Fuentes David T , Stafford R Jason , Beechar Vivek B , Weinberg Jeffrey S , Shah Komal , Kumar Vinodh A , Prabhu Sujit S 
Published: September 2019

Abstract

BACKGROUND
Laser Interstitial Thermal Therapy (LITT) has been used to treat recurrent brain metastasis after stereotactic radiosurgery (SRS). Little is known about how best to assess the efficacy of treatment, specifically the ability of LITT to control local tumor progression post-SRS.

OBJECTIVE
To evaluate the predictive factors associated with local recurrence after LITT.

METHODS
Retrospective study with consecutive patients with brain metastases treated with LITT. Based on radiological aspects, lesions were divided into progressive disease after SRS (recurrence or radiation necrosis) and new lesions. Primary endpoint was time to local recurrence.

RESULTS
A total of 61 consecutive patients with 82 lesions (5 newly diagnosed, 46 recurrence, and 31 radiation necrosis). Freedom from local recurrence at 6 mo was 69.6%, 59.4% at 12, and 54.7% at 18 and 24 mo. Incompletely ablated lesions had a shorter median time for local recurrence (P < .001). Larger lesions (>6 cc) had shorter time for local recurrence (P = .03). Dural-based lesions showed a shorter time to local recurrence (P = .01). Tumor recurrence/newly diagnosed had shorter time to local recurrence when compared to RN lesions (P = .01). Patients receiving systemic therapy after LITT had longer time to local recurrence (P = .01). In multivariate Cox-regression model, the HR for incomplete ablated lesions was 4.88 (P < .001), 3.12 (P = .03) for recurrent tumors, and 2.56 (P = .02) for patients not receiving systemic therapy after LITT. Complication rate was 26.2%.

CONCLUSION
Incompletely ablated and recurrent tumoral lesions were associated with higher risk of treatment failure and were the major predicting factors for local recurrence. Systemic therapy after LITT was a protective factor regarding local recurrence.
Reducing Nicotine Without Misleading the Public: Descriptions of Cigarette Nicotine Level and Accuracy of Perceptions About Nicotine Content, Addictiveness, and Risk
Authors: Byron M Justin , Hall Marissa G , King Jessica L , Ribisl Kurt M , Brewer Noel T 
Published: September 2019

AbstractSignificanceThe public incorrectly believes very low nicotine content (VLNC) cigarettes are less carcinogenic than current cigarettes, a belief associated with lower motivation to quit under a VLNC standard. We examined how different descriptions of the nicotine level in VLNC cigarettes affect the accuracy of the public’s perceptions about nicotine content, addictiveness, and cancer risk.MethodsParticipants were a national convenience sample of 1353 US adults (22% smokers). In an online experiment, we randomized participants to a VLNC description using (1) concise language; (2) a percentage; (3) an interpretation; (4) a percentage and interpretation; (5) a percentage and a pictograph; or (6) a percentage, interpretation, and pictograph; or to a control description using (7) FDA's “minimally or nonaddictive” phrasing. We assessed accuracy of perceived nicotine content, addictiveness, and cancer risk compared to current cigarettes.ResultsCompared to control, the percentage description resulted in more accurate perceptions about nicotine content (76% vs. 49% accuracy) and addictiveness (44% vs. 34%), but less accurate perceptions about cancer risk (56% vs. 68%; all ps &lt; .05). Adding interpretation or pictographs to the percentage description did not increase accuracy. The concise language description reduced accuracy of perceived nicotine content and addictiveness but increased accuracy of cancer risk (all ps &lt; .05).ConclusionsStating that 95% of nicotine would be removed more accurately conveyed the nicotine content and addictiveness of VLNC cigarettes. However, descriptions that better conveyed nicotine content and addictiveness misled people about cancer risk.ImplicationsImplementation of a VLNC standard should include plans for a communication campaign that conveys that VLNC cigarettes will be less addictive but equally toxic to smoke. Stating the percent reduction in nicotine is likely to more clearly communicate reduced addictiveness but may also exacerbate risk misperceptions. VLNC communication requires further study to ensure the public accurately understands a VLNC standard.
Using mixed methods to map vaguely defined research areas
Authors: Degn Lise , Mejlgaard Niels , Schneider Jesper Wiborg 
Published: September 2019

AbstractThe aim of this article is to present an alternative method for science mapping, which remedies some of the classic limitations to e.g. using co-citation analysis as a mapping tool. With the emergence of new, more complex and interdisciplinary areas of research it becomes important to adjust our understandings of how to study these areas, and the argument of the present paper is that in order to provide high-resolution maps of emerging scientific areas, we need to start in the ‘cognitive colleges’ of the research areas themselves. To do so, a mixed methods design with co-nomination as its backbone is proposed. The potential and limitations of the alternative approach to science mapping are discussed based on an empirical example of mapping an vaguely defined research area in Denmark.
Cerebellar contribution to emotional body language perception: a TMS study
Authors: Ferrari Chiara , Ciricugno Andrea , Urgesi Cosimo , Cattaneo Zaira 
Published: September 2019

Abstract
Consistent evidence suggests that the cerebellum contributes to the processing of emotional facial expressions. However, it is not yet known whether the cerebellum is recruited when emotions are expressed by body postures or movements, or whether it is recruited differently for positive and negative emotions. In this study, we asked healthy participants to discriminate between body postures (with masked face) expressing emotions of opposite valence (happiness vs anger, Experiment 1), or of the same valence (negative: anger vs sadness; positive: happiness vs surprise, Experiment 2). While performing the task, participants received online transcranial magnetic stimulation (TMS) over a region of the posterior left cerebellum and over two control sites (early visual cortex and vertex). We found that TMS over the cerebellum affected participants’ ability to discriminate emotional body postures, but only when one of the emotions was negatively valenced (i.e. anger). These findings suggest that the cerebellar region we stimulated is involved in processing the emotional content conveyed by body postures and gestures. Our findings complement prior evidence on the role of the cerebellum in emotional face processing and have important implications from a clinical perspective, where non-invasive cerebellar stimulation is a promising tool for the treatment of motor, cognitive and affective deficits.
Retinal Changes in Schizophrenia: A Systematic Review and Meta-analysis Based on Individual Participant Data
Authors: Kazakos Charalampos T , Karageorgiou Vasilios 
Published: September 2019

Abstract

Background
Retinal assessment has indicated the presence of neuronal loss in neurodegenerative disorders, but its role in schizophrenia remains unclear. We sought to synthesize the available evidence considering 3 noninvasive modalities: optical coherence tomography, electroretinography, and fundus photography, and examine their diagnostic accuracy based on unpublished individual participant data, when provided by the primary study authors.

Methods
We searched MEDLINE, SCOPUS, clinicaltrials.gov, PSYNDEX, Cochrane Controlled Register of Trials (CENTRAL), WHO International Clinical Trials Registry Platform, and Google Scholar, up to October 30, 2018. Authors were contacted and invited to share anonymized participant-level data. Aggregate data were pooled using random effects models. Diagnostic accuracy meta-analysis was based on multiple cutoffs logistic generalized linear mixed modeling. This study was registered with PROSPERO, number CRD42018109344.

Results
Pooled mean differences of peripapillary retinal nerve fiber layer thickness in micrometer between 694 eyes of 432 schizophrenia patients and 609 eyes of 358 controls, from 11 case-control studies, with corresponding 95% confidence intervals (CIs) by quadrant were the following: −4.55, 95% CI: −8.28, −0.82 (superior); −6.25, 95% CI: −9.46, −3.04 (inferior); −3.18, 95% CI: −5.04, −1.31 (nasal); and −2.7, 95% CI: −4.35, −1.04 (temporal). Diagnostic accuracy, based on 4 studies, was fair to poor, unaffected by age and sex; macular area measurements performed slightly better.

Conclusion
The notion of structural and functional changes in retinal integrity of patients with schizophrenia is supported with current evidence, but diagnostic accuracy is limited. The potential prognostic, theranostic, and preventive role of retinal evaluation remains to be examined.
The True Effect of a Lumbar Dural Tear on Complications and Cost
Authors: Alluri Ram , Kang H. Paco , Bouz Gabriel , Wang Jeffrey , Hah Raymond J. 
Published: September 2019

Study Design.
Retrospective database analysis.

Objective.
The aim of this study was to match risk factors for complications in patients who did and did not sustain a dural tear while undergoing posterior lumbar spine surgery and compare local and systemic complications.

Summary of Background Data.
Current data do not adequately define whether the event of sustaining an isolated dural tear increases the risk for postoperative complications while controlling for other confounding risk factors.

Methods.
The PearlDiver Database was queried for patients who underwent posterior lumbar spine decompression and/or fusion for degenerative pathology. Patients with and without dural tears were 1:2 matched based on demographic variables and comorbidities. Complications, cost, length of stay (LOS), and readmission rates were analyzed.

Results.
The 1:2 matched cohort included 9038 patients with a dural tear and 17,340 patients without a dural tear. All complications assessed were significantly higher in the dural tear group (P < 0.03). Venothromboembolic (VTE) events occurred in 1.3% of patients with a dural tear and 0.9% of patients without a dural tear (odds ratio [OR] 1.46, P < 0.0001). Meningitis occurred in 25 patients (0.3%) with a dural tear and eight patients (<0.1%) without a dural tear (OR 6.0, P < 0.0001). Patients with a dural tear had 120% higher medical costs, 200% greater LOS, and were two times more likely to be readmitted (P < 0.0001).

Conclusion.
Sustaining a dural tear while undergoing posterior lumbar spinal decompression and/or fusion for degenerative pathology significantly increased the risk of complications and increased length of stay, risk of readmission, and overall 90-day hospital cost. Dural tears specifically increased the risk of a VTE complication by 1.46 times and meningitis by six times; these are important complications to have a high degree of suspicion for in the setting of durotomy, as they can lead to significant morbidity for the patient.

Level of Evidence: 3
Body Mass Index and Modified Glasgow Prognostic Score Are Useful Predictors of Surgical Site Infection After Spinal Instrumentation Surgery
Authors: Kobayashi Yutaka , Inose Hiroyuki , Ushio Shuta , Yuasa Masato , Hirai Takashi , Yoshii Toshitaka , Okawa Atsushi 
Published: September 2019

Study Design.
Retrospective observational study.

Objective.
To analyze a large consecutive cohort of patients who had undergone spinal instrumentation surgery, to characterize a patient population with surgical site infections (SSI), and to identify preoperative risk factors associated with SSI.

Summary of Background Data.
Malnutrition is a risk factor for SSI in many health conditions; however, the evidence connecting preoperative malnutrition with SSI in spinal instrumentation surgery is limited because of the small number of retrospective studies. While the modified Glasgow prognostic score (mGPS), C-Reactive protein (CRP)–albumin ratio (CAR), controlling nutritional status index (CONUT), prognostic nutritional index (PNI), platelet–lymphocyte ratio (PLR), and neutrophil–lymphocyte ratio (NLR) are established methods for evaluating nutritious status, little has been reported on the predictive value of these indicators with respect to postoperative spinal infection.

Methods.
We retrospectively investigated 384 patients who underwent spinal instrumentation surgery. We evaluated the significance of risk factors, including mGPS, CAR, CONUT, PNI, PLR, and NLR. We then performed stepwise logistic regression analysis to analyze the concurrent effects of various factors on the prevalence of SSI.

Results.
Of the 384 patients analyzed, 14 were diagnosed with SSIs. Univariate analysis showed that preoperative BMI, lymphocyte count, albumin, erythrocyte sedimentation rate, CRP, CONUT, mGPS, CAR, and PNI were risk factors for SSI. Stepwise logistic regression analysis revealed that higher mGPS and lower BMI before surgery were independent risk factors for SSI. A receiver operating characteristic curve showed that the cut-off values of mGPS and BMI were 1 and 20.39, respectively.

Conclusion.
The risk factors for SSI after spinal instrumentation surgery were mGPS more than or equal to 1 and BMI less than or equal to 20.39 kg/m2. These findings could help to identify patients at higher risk of SSI after spinal instrumentation surgery.

Level of Evidence: 4
Should Sagittal Spinal Alignment Targets for Adult Spinal Deformity Correction Depend on Pelvic Incidence and Age?
Authors: Protopsaltis Themistocles S. , Soroceanu Alexandra , Tishelman Jared C. , Buckland Aaron J. , Mundis Gregory M. , Smith Justin S. , Daniels Alan , Lenke Lawrence G. , Kim Han Jo , Klineberg Eric O. , Ames Christopher P. , Hart Robert A. , Bess Shay , Shaffrey Christopher I. , Schwab Frank J. , Lafage Virginie 
Published: September 2019

Study Design.
Retrospective analysis.

Objective.
Determine whether deformity corrections should vary by pelvic incidence (PI).

Summary of Background Data.
Alignment targets for deformity correction have been reported for various radiographic parameters. The T1 pelvic-angle (TPA) has gained in applications for adult spinal deformity (ASD) surgical-planning since it directly measures spinal alignment separate from pelvic- and lower-extremity compensation. Recent studies have demonstrated that ASD corrections should be age specific.

Methods.
A prospective database of consecutive ASD patients was analyzed in conjunction with a normative spine database. Clinical measures of disability included the Oswestry Disability Index (ODI) and Short Form 36 Survey (SF-36) Physical Component Score (PCS). Baseline relationships between TPA, age, PI, and ODI/SF-36 PCS scores were analyzed in the ASD and asymptomatic patients. Linear regression modeling was used to determine alignment targets based on PI and age-specific normative SF-36-PCS values.

Results.
Nine hundred three ASD patients (mean 53.7 yr) and 111 normative subjects (mean 50.7 yr) were included. Patients were subanalyzed by PI: low, medium, high (<40, 40–75, >75); and age: elderly (>65 yr, n = 375), middle age (45–65 yr, n = 387), and young (18–45 yr, n = 141). TPA and SRS-Schwab parameters correlated with age and PI in ASD and normative subjects (r = 0.42, P < 0.0001). ODI correlated with PCS (r = 0.71, P < 0.0001). Linear regression analysis using age-normative SF-36-PCS values demonstrated that ideal spinopelvic alignment is less strict with increasing PI and age.

Conclusion.
Targets for ASD correction should vary by age and PI. This is demonstrated in both asymptomatic and ASD subjects. Using age-normative SF-36 PCS values, alignment targets are described for different age and PI categories. High-PI patients do not require as rigorous realignments to attain age-specific normative levels of health status. As such, sagittal spinal alignment targets increase with increasing age as well as PI.

Level of Evidence: 3
Measles and Vaccination
Authors: Schmidt Karen 
Published: September 2019

ABSTRACT:
As the increasingly fierce debate about vaccines grows, so do the number of measles cases. Personal choice, inaccurate understanding, and legislative action are fueling vaccine refusal for this previously eradicated, highly contagious viral infection. In August 2019, measles cases had spread to 30 U.S. states and were spreading globally, endangering mainly young children and those unable to be vaccinated. Herd immunity is being eroded as parents refuse vaccinations or choose alternate vaccine schedules. Nurses are in a prime position to educate and advocate for vaccinations that safeguard public health.
Hand-Crafted Endoluminal Vacuum-Assisted Drainage for Anastomotic Leak After IPAA
Authors: Okkabaz Nuri , Esen Eren , Schwartzberg David M. , Remzi Feza H. , Kirat Hasan T. 
Published: September 2019

INTRODUCTION:
The vacuum-assisted drainage has many applications in managing complex wound healing. It quickens the recovery period by its hyperemic effect on the exposed zone, decreasing bacterial colonization, preventing tissue edema, and promoting granulation of the wound. However, its use in anastomotic leak after IPAA is scarcely studied, especially because a proprietary endoluminal vacuum-assisted closure system was removed from the US market.

TECHNIQUE:
We applied a hand-crafted endoluminal vacuum-assisted closure system using the existing standard wound vacuum-assisted closure supplies to 2 patients who developed an anastomotic leak with a presacral abscess after completion proctectomy with J-pouch construction.

RESULTS:
We changed the endoluminal vacuum-assisted closure drain every 2 to 3 days, and both patients had substantial improvements in their abscess cavity after the seventh and ninth applications.

CONCLUSIONS:
Anastomotic leak at the IPAA traditionally takes up to a year to heal, which causes a significant toll on the psychosocial life of the patient and delayed stoma closure. Therefore, we believe that facilitating the healing process by using our hand-crafted endoluminal vacuum-assisted closure drain might provide a great value to patients’ quality of life.
Evaluation of Gastroesophageal Reflux in Children Born With Esophageal Atresia Using pH and Impedance Monitoring
Authors: Vergouwe Floor W.T. , van Wijk Michiel P. , Spaander Manon C.W. , Bruno Marco J. , Wijnen René M.H. , Schnater Johannes M. , IJsselstijn Hanneke 
Published: September 2019

ABSTRACTObjectives:The aim of the study was to evaluate acid and nonacid gastroesophageal reflux in infants and school‐aged children with esophageal atresia (EA) using pH‐impedance (pH‐MII) monitoring.Methods:Between 2012 and 2017, all 24‐hour pH‐MII studies performed in infants (⩽18 months) and 8‐year olds with EA were included. Antiacid therapy was discontinued before study. Exclusion criteria were: isolated tracheoesophageal fistula; esophageal replacement therapy; tube feeding; and monitoring <18 hours. Automatically detected retrograde bolus movements (RBM) were manually reviewed and modified/deleted if necessary.Results:We included 57 children (51% boys; 2% isolated EA; 44% thoracoscopic EA repair): 24 infants (median age 0.6 years) and 33 school‐aged children (median age 8.2 years). Of the automatically detected 3313 RBM, 1292 were manually deleted from the tracings: 52% of nonacid RBM and 8% of acid RBM (mainly misinterpreted swallows or 1 event recognized as several events). In infants, median reflux index (RI; pH <4) was 2.6% (abnormal in n = 2), median RBM was 61 (62% nonacid, 58% mixed), and median of the mean BCT was 11 seconds. In older children, median RI was 0.3% (abnormal in n = 4), median RBM was 21 (64% nonacid; 75% mixed), and median of the mean BCT was 13 seconds.Conclusions:Most children with EA off medication have a normal RI, yet experience a significant number of nonacid RBM. After manual revision of the tracings, a high percentage of RBM was deleted. Our data show that automated impedance analysis software needs refinement for use in infants and children with EA and question the need for standard antiacid therapy in these patients.