bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fully Endoscopic Supracerebellar Infratentorial Approach for Resection of Third Ventricle Germ Cell Tumor: 2-Dimensional Operative Video
Authors: Song Jianping , Hua Wei , Pan Zhiguang , Zhu Wei 
Published: July 2018

Abstract
Pineal tumor that extends into the posterior portion of the third ventricle is extremely deep-seated and surgically challenging. Various microscopic approaches have been introduced to acquire access to the posterior third ventricle, but still the exposure and visualization are relatively unfavorable. However, recently the application of high-definition endoscope gave neurosurgeons a much more magnified and clearer view of anatomy around the pineal region and third ventricle. The widely used supracerebellar infratentorial approach has been proven to offer a sufficient surgical corridor for fully endoscopic surgery for pineal tumor.
We presented a case of a 13-yr-old male child with a posterior third ventricle tumor, which was surgically resected fully with the endoscope. An informed consent has been obtained from the patient and his guardians. In order to gain enough auto-retraction by gravity, diminish the pitfalls of the semisitting position, and enhance the surgeon's ergonomics, the patient was positioned with a modified “head-up” park bench position (the upper body was elevated and the head was slightly extended instead of anteflexion). The tumor was approached through suboccipital midline supracerebellar infratentorial trajectory. The superficial and deep drainage veins above the vermis were sacrificed and the quadrigeminal cistern was entered to expose the tumor. The first and the most important step of the operation was to de-vascularize the tumor bilaterally, then the tumor could be debulked and circumferentially resected. The gross total resection was achieved.
Fully endoscopic supracerebellar infratentorial approach is feasible and efficient when addressing lesions located at the posterior portion of the third ventricle.
MicroRNA‐31‐5p enhances the Warburg effect via targeting FIH
Authors: Zhu Biying , Cao Xiuye , Zhang Wenqiang , Pan Guoping , Yi Qing , Zhong Wenbin , Yan Daoguang 
Published: July 2018

ABSTRACTThe enhanced expression of miR‐31 has been observed in many human malignancies including lung cancer, and this microRNA regulates several aspects of oncogenesis. However, the role of miR‐31‐5p in energy metabolism remains elusive. Here, we confirm that H1299 and A549 cells, 2 lung cancer cell lines, relay on aerobic glycolysis as main source of ATP. Inhibition of miR‐31‐5p leads to decreased glycolysis and ATP production, while miR‐31‐5p overexpression increases them. Hypoxia inducible factor 1 (HIF‐1) up‐regulates the expression of glycolytic enzymes, and the HIF‐1α inhibitor (FIH) inhibits HIF‐1 activity. Because FIH is a direct target of miR‐31‐5p, inhibition of miR‐31‐5p results in enhanced FIH expression and suppression of HIF‐1 signaling, while over‐expression of miR‐31‐5p has the opposite effects. Via this mechanism, miR‐31‐5p up‐regulates aerobic glycolytic genes and maintains energy homeostasis. To further validate the mechanism of miR‐31‐5p in glycolysis regulation, we show that overexpression or knockdown of FIH rescued the effects of miR‐31‐5p or miR‐31‐5p inhibitor on HIF activation and its target gene expression, respectively. Finally, by means of an A549 cell xenograft mouse model, we demonstrate that the miR‐31‐5p promotes cell proliferation via enhancing glycolysis. In summary, this study reveals that miR‐31‐5p promotes the Warburg effect via direct targeting of FIH.—Zhu, B., Cao, X., Zhang, W., Pan, G., Yi, Q., Zhong, W., Yan, D. MicroRNA‐31‐5p enhances the Warburg effect via targeting FIH. FASEB J. 33, 545–556 (2019). www.fasebj.org
Which Protocol for Milrinone to Treat Cerebral Vasospasm Associated With Subarachnoid Hemorrhage?
Authors: Crespy Thibaud , Heintzelmann Magali , Chiron Celia , Vinclair Marc , Tahon Florence , Francony Gilles , Payen Jean-François 
Published: July 2018

Background:
Milrinone has emerged as an option to treat delayed cerebral ischemia after subarachnoid hemorrhage. However, substantial variation exists in the administration of this drug. We retrospectively assessed the effectiveness of 2 protocols in patients with angiographically proven cerebral vasospasm.

Methods:
During 2 successive periods, milrinone was administered using either a combination of intra-arterial milrinone infusion followed by intravenous administration until day 14 after initial bleeding (IA+IV protocol), or a continuous intravenous milrinone infusion for at least 7 days (IV protocol). The primary endpoint was the reversion rate of vasospastic arterial segments following the first IA infusion of milrinone (IA+IV protocol) compared with the reversion rate during the first week of IV infusion (IV protocol).

Results:
There were 24 and 77 consecutive patients in IA+IV and IV protocols, respectively. The reversion rate was comparable between the 2 protocols: 71% (95% confidence interval [CI], 59%-83%) in the IA+IV protocol versus 64% (95% CI, 58%-71%) in the IV protocol (P=0.36). Rescue procedures for persistence or recurrence of vasospasm, that is, mechanical angioplasty and/or IA milrinone infusion, were similar between the 2 protocols. Patients with a good neurological outcome at 1 year, that is, modified Rankin Scale scores 0-2, were comparable between the 2 protocols. Side effects of milrinone were uncommon and equally distributed within the 2 protocols.

Conclusions:
These findings indicate that a continuous IV infusion of milrinone was as efficient as combined IA+IV infusion and suggest that this modality could be considered as a first easy-to-use option to treat patients with CVS.
Impact of CPAP on Forehead Near-infrared Spectroscopy Measurements in Patients With Acute Respiratory Failure: Truth or Illusion
Authors: Doerr Claudius , Kietaibl Clemens , Doerr Katharina , Hagmann Michael , Baumann Lukas , Kimberger Oliver , Ullrich Roman , Markstaller Klaus , Klein Klaus U. 
Published: July 2018

Background:
Critically ill patients with acute respiratory failure admitted to an intensive care unit are at high risk for cerebral hypoxia. We investigated the impact of continuous positive airway pressure (CPAP) therapy on regional cerebral tissue oxygenation (rSO2).

Materials and Methods:
In total, 40 extubated surgical intensive care unit patients requiring classic oxygen therapy (COT) for acute respiratory failure were examined. Near-infrared spectroscopy (INVOS 5100C, Covidien) was used for 30 minutes to detect bilateral rSO2 during COT via facemask (6 L/min) and CPAP therapy (40% fraction of inspired oxygen, 8 cm H2O CPAP) using a randomized crossover study design. Patients served as their own control. Continuous hemodynamic routine monitoring and blood gas analysis were performed. The effect of CPAP therapy on rSO2 and influence of assessed covariables were investigated using a mixed linear model.

Results:
Median rSO2 increased from 57.9% (95% confidence interval [CI], 54.2-61.5) during COT to 62.8% (95% CI, 59.2-66.5) during CPAP therapy (P<0.0001). The estimated difference from the mixed model between COT and CPAP is −5.0 (95% CI, −6.3 to −3.7). Median arterial partial pressure of carbon dioxide decreased from 47.8±5.1 mm Hg during COT to 43.1±5 mm Hg during CPAP (P<0.001), whereas arterial partial pressure of oxygen remained unchanged (P=0.329). In total, 23% of patients had SO2 levels <50%, with a higher prevalence under COT.

Conclusions:
Our results reveal that CPAP therapy compared with COT may influence rSO2 in patients with acute respiratory failure. However, the cause of the rSO2 increase following CPAP application remains to be elucidated, and the accuracy of cerebral oximetry during CPAP therapy in patients with acute respiratory failure remains questionable.
Readmissions, Length of Stay, and Mortality After Primary Surgery for Adult Spinal Deformity
Authors: Pitter Frederik T. , Lindberg-Larsen Martin , Pedersen Alma B. , Dahl Benny , Gehrchen Martin 
Published: July 2018

Study Design.
Cohort study.

Objective.
To report outcome after primary surgery for adult spinal deformity (ASD), and assess risk factors for extended length of stay (extLOS) and readmission within 90 days.

Summary of Background Data.
Complications after ASD surgery have been reported in 20% to 50% of patients. A few studies have focused on detailed information concerning postoperative morbidity.

Methods.
Patients >18 years undergoing primary instrumented surgery for ASD in Denmark in the period 2006 to 2016 were included. Patients were identified in the Danish National Patient Registry (DNPR) using procedure codes for instrumented spine surgery combined with diagnosis of spinal deformity. Information on length of stay (LOS), readmissions, and mortality were retrieved from the DNPR. Medical records were reviewed for causes of extLOS (LOS >10 days) and readmission within 90 days after surgery. Charlson Comorbidity Index (CCI) was calculated for all patients based on DNPR.

Results.
We included 892 patients. Median LOS was 8 days (interquartile range, IQR, 7–11). A total of 175 (28.0%) patients had extLOS; 81% because of “medically” related complications. Most common medically related reason (>50%) for extLOS was pain/mobilization difficulties. The 90-days readmission risk was 13.8%; 74.5% of readmissions were “medically” related, primarily opioid related side effects (18.2%), and pain/mobilization issues (15.2%); 25.5% of readmissions were “surgically” related and 16.7% of patients required revision surgery. Ninety-days mortality was 0.9%. Age groups 61 to 70 years, >70 years, CCI score 1 to 2 and CCI score ≥3 were associated with increased risk of extLOS (odds ratio, OR = 1.79, 2.01, 1.81, and 2.49, respectively). Age group >70 years and CCI score 1 to 2 were associated with increased risk of readmission (OR = 2.21 and 1.83).

Conclusion.
Increasing age and comorbidity were associated with increased risk extLOS and readmission. Pain/mobilization difficulties were the most common postoperative complications. A future focus on early mobilization and pain management may improve outcome of ASD patients.

Level of Evidence: 3
Ponte Osteotomies Increase the Risk of Neuromonitoring Alerts in Adolescent Idiopathic Scoliosis Correction Surgery
Authors: Buckland Aaron J. , Moon John Y. , Betz Randal R. , Lonner Baron S. , Newton Peter O. , Shufflebarger Harry L. , Errico Thomas J. 
Published: July 2018

Study Design.
Observational cohort study of prospective database registry.

Objective.
To determine the incidence of neurological complications in AIS patients undergoing surgical treatment with PO.

Summary of Background Data.
Despite the widespread use of Ponte Osteotomies (PO) in adolescent idiopathic scoliosis (AIS) correction, outcomes and complications in patients treated with this technique have not been well characterized.

Methods.
A multicenter prospective registry of patients undergoing surgical correction of AIS was queried at 2-year follow-up for patient demographics, surgical data, deformity characteristics, and peri-operative complications. A neurological complication was defined as perioperative nerve root or spinal cord injury as identified by the surgeon. Patients were divided into those who underwent peri-apical PO and those without, and further stratified by Lenke curve classification into 3 groups (I-types 1 and 2, II-types 3, 4, 6, and III-type 5). Patients with- and without neurological complications were compared with respect to baseline demographics, surgical variables, curve types, fusion construct types (screws vs. hybrid), curve magnitude (coronal and sagittal Cobb), apical vertebral translation, and coronal-deformity angular ratios (C-DAR).

Results.
Of 2210 patients included in the study, 1611 underwent PO. Peri-operative neurological complications occurred in 7 patients, with 6 in the PO group (0.37%) and 1 in non-PO group (0.17%) though this was not a statistically significant risk factor for peri-operative neurological injury (P = 0.45). Neuromonitoring alerts were recorded in 168 patients (7.6%: 9.3% PO group; 4.2% no-PO group (P < 0.001)). Multivariate logistic regression analysis found PO and curve magnitude to be independent risk factors for intraoperative neuromonitoring alerts (P < 0.01).

Conclusion.
PO and curve magnitude were independent risk factors for intraoperative neuromonitoring alerts in surgical AIS correction. The effect of Ponte osteotomy on neurological complications remains unknown due to the low incidence of these complications.

Level of Evidence: 3
Pedicle Screw Designs in Spinal Surgery
Authors: Seng Wei Ren Daniel , Chou Siaw Meng , Siddiqui Shiblee S. , Oh Jacob Y.L. 
Published: July 2018

Study Design.
An experimental laboratory-based biomechanical study.

Objective.
The objective of this study was to evaluate, in a synthetic bone model, the difference in primary and revision pull-out strength using pedicle screws of different thread designs.

Summary of Background Data.
Over the past few decades, there has been a growing interest in optimizing the screw pull-out strength using various screw designs (single-thread, mixed-thread, dual-thread). Although primary pull-out strength has been studied previously, little is known about revision pull-out strength of different pedicle screws.

Methods.
The pull-out strengths of three different pedicle screw designs (single-thread, mixed-thread, dual-thread) were tested in standardized polyurethane foam in three sequences. Sequence 1: A 6.5 mm screw was inserted into the foam block and the primary pull-out strength measured. Sequence 2: A 6.5 mm screw was inserted, removed, and then reinserted into the same foam block. The revision pull-out strength was then measured. Sequence 3: A 6.5 mm screw was inserted, removed and a 7.5-mm screw of the same thread design was reinserted. The revision pull-out strength was then measured.

Results.
The primary pull-out strength was similar across screw designs, although dual-thread screws showed higher primary pull-out strength (2628.8 N) compared to single-thread screws (2184.4 N, P < 0.05). For revision pull-out strength, the mixed-thread screws had significant reduction in revision pull-out strength of 18.6% (1890.2 N, P = 0.0173). Revision with a larger diameter screw improved the pull-out strength back to baseline. Single and dual-thread screws showed no significant reduction in revision pull-out strength.

Conclusion.
The dual-threaded screws provided the strongest primary pull-out strength for spinal fixation. The mixed-thread screws, however, had the poorest revision pull-out strength, decreasing by 18.6% compared to other screw designs. In cases in which mixed-threaded screws have to be revised (at the index or revision surgery), surgeons should consider the use of larger diameter screws to improve the pull-out strength.

Level of Evidence: 5
FULL DIAGNOSTIC VITRECTOMY WITH POSTERIOR VITREOUS DETACHMENT INDUCTION FOR THE DIAGNOSIS OF VITRITIS DUE TO UNCERTAIN ETIOLOGY
Authors: Patel Darshak S. , Khan Imran J. , Zayed Mohammed G. , Partridge Dave , Rennie Ian G. , Mudhar Hardeep S. , Sheard Richard 
Published: July 2018

Purpose:
To report on the diagnostic outcomes and safety of full diagnostic vitrectomy (FDV) with surgical posterior vitreous detachment induction for diagnosing vitritis of uncertain etiology.

Methods:
Forty-nine patients underwent primary FDV using the cassette washings for histopathological analysis. In addition, an undiluted core vitreous sample was obtained for microbial analysis in suspected infective cases. Cases were retrospectively given a diagnosis of inflammatory, infective, or neoplastic based on the results at final follow-up and the outcome of primary FDV categorized as diagnostic or nondiagnostic. The success of FDV was evaluated in relation to the final diagnosis. The need for additional intraocular biopsies and intraoperative or postoperative complications was also recorded.

Results:
Full diagnostic vitrectomy was diagnostic in 26/49 cases (53%) and nondiagnostic in 23 (47%). The diagnostic success rate was greatest in neoplastic (16/20, 80%) and infective cases (9/13, 69%). Seven cases (14%) required additional biopsies to establish the diagnosis, and in 15/49 cases (31%), no cause of vitritis was identified. Intraoperative retinal breaks occurred in 3/49 cases (6%) and retinal detachment in 1/49 cases (2%). Three of 49 cases (6%) developed transiently elevated intraocular pressure postoperatively.

Conclusion:
Full diagnostic vitrectomy in combination with an undiluted core vitreous biopsy for suspected infections is safe and effective at securing a diagnosis in vitritis, particularly in cases of neoplasia.
MOSAICISM AS A PROPOSED MECHANISM FOR ASYMMETRIC RETINAL TESSELLATIONS
Authors: Raevis Joseph J. , Denisova Ksenia , Mechel Elzbieta , Shrier Eric M. 
Published: July 2018

Background/Purpose:
Report a case of markedly asymmetric retinal tessellations and propose mosaicism as a mechanism.

Methods and Results:
A 59-year-old pseudophakic woman presented with uncorrected 20/20 vision and was found to have markedly different retinal tessellation appearances in both eyes. The axial lengths were 25.66 mm and 25.88 mm in the right and left eyes, respectively, and no significant asymmetrical choroidal thinning was seen on optical coherence tomography or optical coherence tomography angiography. Fluorescein angiogram showed significant hyperfluorescence, representing the underlying choroid, which correlated with the tessellation patterns in the left eye. She had no other ocular or systemic findings such as stripes or whorled skin.

Conclusion:
This is the first reported case of markedly asymmetric retinal tessellation patterns that are not due to asymmetric axial myopia or choroidal thinning. We propose that mosaicism is a possible mechanism causing this finding.
A Common Glaucoma-risk Variant of SIX6 Alters Retinal Nerve Fiber Layer and Optic Disc Measures in a European Population: The EPIC-Norfolk Eye Study
Authors: Khawaja Anthony P. , Chan Michelle P.Y. , Yip Jennifer L.Y. , Broadway David C. , Garway-Heath David F. , Viswanathan Ananth C. , Luben Robert , Hayat Shabina , Hauser Michael A. , Wareham Nicholas J. , Khaw Kay-Tee , Fortune Brad , Allingham R. Rand , Foster Paul J. 
Published: July 2018

Purpose:
A common missense variant in the SIX6 gene (rs33912345) is strongly associated with primary open-angle glaucoma (POAG). We aimed to examine the association of rs33912345 with optic disc and retinal nerve fiber layer (RNFL) measures in a European population.

Methods:
We examined participants of the population-based EPIC-Norfolk Eye Study. Participants underwent confocal laser scanning tomography (Heidelberg Retina Tomograph II, HRT) to estimate optic disc rim area and vertical cup-disc ratio (VCDR). Scanning laser polarimetry (GDxVCC) was used to estimate average RNFL thickness. The mean of right and left eye values was considered for each participant. Genotyping was performed using the Affymetrix UK Biobank Axiom Array. Multivariable linear regression with the optic nerve head parameter as outcome variable and dosage of rs33912345 genotype as primary explanatory variable was used, adjusted for age, sex, disc area, axial length, and intraocular pressure. We further repeated analyses stratified into age tertiles.

Results:
In total, 5433 participants with HRT data and 3699 participants with GDxVCC data were included. Each “C” allele of rs33912345 was associated with a smaller rim area (−0.030 mm2 [95% CI −0.040, −0.020]; P=5.4×10−9), a larger VCDR (0.025 [95% CI 0.017, 0.033]; P=3.3×10−10) and a thinner RNFL (−0.39 μm [95% CI -0.62, -0.15]; P=0.001). The RNFL association was strongest in the oldest age tertile, whereas rim area and VCDR associations were strongest in the youngest and oldest age tertiles.

Conclusions:
The protein-coding SIX6 variant rs33912345, previously associated with POAG, has a functional effect on glaucoma-associated optic nerve head traits in Europeans.
Catastrophizing, pain, and functional outcomes for children with chronic pain: a meta-analytic review
Authors: Miller Megan M. , Meints Samantha M. , Hirsh Adam T. 
Published: July 2018

Abstract
Pediatric chronic pain is associated with numerous negative outcomes including increased physical disability, increased rates of depression and anxiety, and decreased quality of life (QOL). Pain catastrophizing–broadly conceptualized as including rumination, magnification, and helplessness cognitions surrounding one's pain–has been linked with poor functional outcomes in children with chronic pain. Pain catastrophizing in pediatric chronic pain is often considered a key factor on which to focus treatment efforts. However, absent a systematic review that integrates the relevant literature, this call for routine assessment and targeted treatment may be premature. This study aimed to: (1) meta-analytically quantify the relationship between catastrophizing and pain and functional/psychosocial outcomes (functional disability/physical functioning, anxiety, depression, and QOL) in children with chronic pain, and (2) examine potential moderators of these relationships. Using a random-effects model, a total of 111 effect sizes from 38 studies were analyzed. Effect sizes ranged from medium to large, with anxiety, depression, and QOL demonstrating a strong association with catastrophizing. Pain intensity and physical disability had a moderate association with catastrophizing. These relationships were robust, minimizing potential publication bias. None of the examined moderators were significant. The strong relationships found between catastrophizing and anxiety, depression, and QOL suggest that successfully intervening on catastrophizing could have far reaching implications in improving pain outcomes in pediatric chronic pain.
Neural mechanisms supporting the relationship between dispositional mindfulness and pain
Authors: Zeidan Fadel , Salomons Tim , Farris Suzan R. , Emerson Nichole M. , Adler-Neal Adrienne , Jung Youngkyoo , Coghill Robert C. 
Published: July 2018

Abstract
Interindividual differences in pain sensitivity vary as a function of interactions between sensory, cognitive–affective, and dispositional factors. Trait mindfulness, characterized as the innate capacity to nonreactively sustain attention to the present moment, is a psychological construct that is associated with lower clinical pain outcomes. Yet, the neural mechanisms supporting dispositional mindfulness are unknown. In an exploratory data analysis obtained during a study comparing mindfulness to placebo analgesia, we sought to determine whether dispositional mindfulness is associated with lower pain sensitivity. We also aimed to identify the brain mechanisms supporting the postulated inverse relationship between trait mindfulness and pain in response to noxious stimulation. We hypothesized that trait mindfulness would be associated with lower pain and greater deactivation of the default mode network. Seventy-six meditation-naive and healthy volunteers completed the Freiburg Mindfulness Inventory and were administered innocuous (35°C) and noxious stimulation (49°C) during perfusion-based functional magnetic resonance imaging. Higher Freiburg Mindfulness Inventory ratings were associated with lower pain intensity (P = 0.005) and pain unpleasantness ratings (P = 0.005). Whole brain analyses revealed that higher dispositional mindfulness was associated with greater deactivation of a brain region extending from the precuneus to posterior cingulate cortex during noxious heat. These novel findings demonstrate that mindful individuals feel less pain and evoke greater deactivation of brain regions supporting the engagement sensory, cognitive, and affective appraisals. We propose that mindfulness and the posterior cingulate cortex should be considered as important mechanistic targets for pain therapies.