bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alert Timing and Corresponding Intervention With Intraoperative Spinal Cord Monitoring for High-Risk Spinal Surgery
Authors: Yoshida Go , Ando Muneharu , Imagama Shiro , Kawabata Shigenori , Yamada Kei , Kanchiku Tsukasa , Fujiwara Yasushi , Tadokoro Nobuaki , Takahashi Masahito , Wada Kanichiro , Yamamoto Naoya , Kobayashi Sho , Ushirozako Hiroki , Kobayashi Kazuyoshi , Yasuda Akimasa , Tani Toshikazu , Matsuyama Yukihiro 
Published: October 2018

Study Design.
Prospective multicenter study.

Objective.
To analyze the incidence of intraoperative spinal neuromonitoring (IONM) alerts and neurological complications, as well as to determine which interventions are most effective at preventing postoperative neurological complications following IONM alerts in high risk spinal surgeries.

Summary of Background Data.
IONM may play a role in identifying and preventing neural damage; however, few studies have clarified the outcomes of intervention after IONM alerts.

Methods.
We analyzed 2867 patients who underwent surgery for high risk spinal pathology using transcranial electrical motor-evoked potentials from 2010 to 2016. The high-risk spinal surgery cases consisted of 1009 spinal deformity cases, 622 cervical ossification of posterior longitudinal ligament (OPLL) cases, 249 thoracic-OPLL cases, 771 extramedullary spinal cord tumor cases, and 216 intramedullary spinal cord tumor (IMSCT) cases. We set a 70% amplitude reduction as the alarm threshold for transcranial electrical motor-evoked potentials and analyzed the outcomes of the interventions following monitoring alerts and postoperative neurological deficits.

Results.
The true positive, false positive, true negative, false negative, and rescue cases of IONM comprised 126, 234, 2362, 9, and 136 cases, respectively. Most alerts and interventions occurred during correction and release in deformity cases, posterior decompression and dekyphosis in OPLL cases, and tumor resection and surgery suspension with steroid injection in spinal cord tumor cases; however, individual interventions varied. The rescue rates (number of patients rescued with intervention after IONM alert/number of true positive cases plus rescue cases) for deformity, cervical-OPLL, thoracic--OPLL, extramedullary spinal cord tumor, and IMSCT cases were 61.4% (35/57), 82.1% (32/39), 40% (20/50), 52.5% (31/59), and 31.6% (18/57), respectively.

Conclusion.
Our prospective multicenter study identified potential neural damage in 9.5% of cases and 52% rescue cases using IONM. Although the rescue ratios for t-OPLL and IMSCT were relatively low, appropriate intervention immediately after an IONM alert may prevent neural damage even in high-risk spinal surgeries.

Level of Evidence: 3
INTERNAL LIMITING MEMBRANE PEELING AND AIR TAMPONADE FOR STAGE III AND STAGE IV IDIOPATHIC MACULAR HOLE
Authors: Yu Yanping , Liang Xida , Wang Zengyi , Wang Jing , Liu Xinxin , Chen Jinqiu , Liu Wu 
Published: October 2018

Purpose:
To evaluate the effect of internal limiting membrane peeling and air tamponade for idiopathic macular hole, and explore reasons and interventions for persistent holes.

Methods:
One hundred and thirty-five eyes with Stage III and IV idiopathic macular hole that underwent 23-gauge vitrectomy, internal limiting membrane peeling, and air tamponade were reviewed. Eyes with persistent holes underwent a second surgery. Outcome-related factors and interventions treating persistent holes were discussed.

Results:
The initial closure (Type I) rate was 89.63% (121/135). Eyes that underwent the second surgery all obtained final closure (Type I). Diameter of macular hole was significantly smaller (P < 0.001) and duration of symptoms was significantly shorter (P = 0.017) in initially closed cases than in unclosed ones. Binary logistic regression indicated large diameter of macular hole as a risk factor for initial closure (P = 0.004). A cutoff value of 677 μm was provided by receiver operating characteristic curve to predict initial closure (P < 0.001). Best-corrected visual acuity of all individuals improved significantly (P < 0.001) from 20/154 to 20/40 (mean follow-up: 4.5 months).

Conclusion:
Internal limiting membrane peeling and air tamponade for idiopathic macular hole provide satisfactory morphologic and functional outcomes. Large diameter of macular hole and long duration of symptoms are risk factors for initial closure. Proper second surgery can obtain satisfactory outcomes for persistent holes.
BILATERAL ACUTE RETINAL NECROSIS
Authors: Lei Boya , Jiang Rui , Wang Zhujian , Xu Gezhi , Wu Xuyin , Zhou Min 
Published: October 2018

Purpose:
To investigate the clinical characteristics and visual outcome of bilateral acute retinal necrosis.

Methods:
The study included 30 patients (60 eyes) who were diagnosed with bilateral acute retinal necrosis. The medical records were reviewed.

Results:
Twenty-five patients developed the disease in the contralateral eye within 5 months and 5 patients at >2 years after the initial onset. At presentation, 14 of 21 eyes suffered from retinal necrosis of more than 180° in the initially affected eye, whereas 3 of 22 eyes suffered it in the later-affected eye. Retinal detachment occurred in 23 of the 27 initially affected eyes and in 5 of the 27 later-affected eyes. The mean logarithm of the minimum angle of resolution best-corrected visual acuity decreased from 2.0 ± 1.1 (Snellen equivalent counting fingers) to 2.2 ± 1.0 (Snellen equivalent counting fingers) in the initially affected eyes after a follow-up of 34.1 ± 48.2 months (P = 0.529), and improved from 0.5 ± 0.4 (Snellen equivalent 20/66) to 0.3 ± 0.4 (Snellen equivalent 20/40) in the later-affected eyes after a follow-up of 21.2 ± 23.3 months (P = 0.005).

Conclusion:
Bilateral acute retinal necrosis usually occurs in the contralateral eye within a few months, but sometimes after several years. Inflammation and retinal necrosis are less severe in the later-affected eye, with less retinal detachment and a better visual outcome.
OPTICAL COHERENCE TOMOGRAPHY BIOMARKERS TO DISTINGUISH DIABETIC MACULAR EDEMA FROM PSEUDOPHAKIC CYSTOID MACULAR EDEMA USING MACHINE LEARNING ALGORITHMS
Authors: Hecht Idan , Bar Asaf , Rokach Lior , Noy Achiron Romi , Munk Marion R. , Huf Wolfgang , Burgansky-Eliash Zvia , Achiron Asaf 
Published: October 2018

Purpose:
In diabetic patients presenting with macular edema (ME) shortly after cataract surgery, identifying the underlying pathology can be challenging and influence management. Our aim was to develop a simple clinical classifier able to confirm a diabetic etiology using few spectral domain optical coherence tomography parameters.

Methods:
We analyzed spectral domain optical coherence tomography data of 153 patients with either pseudophakic cystoid ME (n = 57), diabetic ME (n = 86), or “mixed” (n = 10). We used advanced machine learning algorithms to develop a predictive classifier using the smallest number of parameters.

Results:
Most differentiating were the existence of hard exudates, hyperreflective foci, subretinal fluid, ME pattern, and the location of cysts within retinal layers. Using only 3 to 6 spectral domain optical coherence tomography parameters, we achieved a sensitivity of 94% to 98%, specificity of 94% to 95%, and an area under the curve of 0.937 to 0.987 (depending on the method) for confirming a diabetic etiology. A simple decision flowchart achieved a sensitivity of 96%, a specificity of 95%, and an area under the curve of 0.937.

Conclusion:
Confirming a diabetic etiology for edema in cases with uncertainty between diabetic cystoid ME and pseudophakic ME was possible using few spectral domain optical coherence tomography parameters with high accuracy. We propose a clinical decision flowchart for cases with uncertainty, which may support the decision for intravitreal injections rather than topical treatment.
COMPARATIVE RISK OF ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION WITH BEVACIZUMAB, AFLIBERCEPT, AND RANIBIZUMAB
Authors: Bavinger J. Clay , Yu Yinxi , VanderBeek Brian L. 
Published: October 2018

Purpose:
To determine whether sterile preloading of anti–vascular endothelial growth factor agents reduces the risk of postintravitreal injection endophthalmitis.

Methods:
This is a retrospective cohort study using medical claims data from a large, national US insurer. Cohorts were created using intravitreal injections of anti–vascular endothelial growth factor injections from 2005 to 2016. For inclusion, patients had to have at least 6 months of data before the injection and were excluded for any previous diagnosis of endophthalmitis, multiple injected drugs on the day of injection, or intraocular surgery within 15 days of the injection or between an injection and a diagnosis of endophthalmitis. The primary outcome was the odds of endophthalmitis after an intravitreal injection.

Results:
A total of 706,725 bevacizumab, 210,849 ranibizumab, and 177,731 aflibercept injections were given to 130,327 patients. Multivariate analysis showed that ranibizumab and aflibercept together had an increased odds of endophthalmitis (odds ratio = 1.29, 95% confidence interval: 1.04–1.59, P = 0.02) compared with bevacizumab. Individually, ranibizumab (odds ratio = 1.25, 95% confidence interval: 0.97–1.61, P = 0.08) and aflibercept (odds ratio = 1.34, 95% confidence interval: 0.99–1.81, P = 0.06) each had higher odds of endophthalmitis, but neither result met significance. Also, when compared with male patients, female patients had a higher odds of getting endophthalmitis (odds ratio: 1.30, 95% confidence interval: 1.05–1.61, P = 0.02).

Conclusion:
The odds of endophthalmitis with aflibercept and ranibizumab combined were higher compared with the sterilely preloaded bevacizumab, arguing for a safety advantage of sterile preloading of anti–vascular endothelial growth factor injections.
Risk Factors for Post–Acute Coronary Syndrome Depression
Authors: Yuan Mei-zhen , Fang Qin , Liu Guang-wei , Zhou Min , Wu Jian-mei , Pu Chun-yun 
Published: October 2018

Background:
The incidence of depression is very common among patients with post–acute coronary syndrome (ACS) and leads to adverse outcomes.

Aims:
The aim of this meta-analysis was to detect risk factors for depression among patients with ACS and to provide clinical evidence for its prevention.

Methods:
The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline to search the PubMed, Web of Science, EMBASE, and EBSCO databases from January 1996 to March 2018. Data that met the inclusion criteria were extracted to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk factors of post-ACS depression.

Results:
A total of 30 articles met the inclusion criteria, and 25 risk factors were found to be associated with depression. The top 5 risk factors are as follows: antidepression treatment (OR, 4.25; 95% CI, 3.41–5.31), housewife status (OR, 4.17; 95% CI, 1.83–9.53), history of depressive disorders (OR, 3.52; 95% CI, 2.69–4.61), widow status (OR, 2.34; 95% CI, 1.05–5.21), and history of congestive heart failure (OR, 2.03; 95% CI, 1.04–3.97). The authors also found that a married status, high education level, and employment are protective factors.

Conclusion:
Clinical personnel should be alerted with regard to the high risk factors of depression, including female gender, low education level, unmarried status, living alone, unemployed status, unhealthy lifestyle, and complications such as cardiovascular, respiratory, and metabolic diseases. In particular, staff should pay attention to a history of previous depression, be concerned with the psychological condition of the patient, and monitor and perform early interventions to reduce the incidence of depression.
Ultrasound Evaluation of Anterior Acromioclavicular Relationship in the Horizontal Plane on 40 Healthy Subjects. A New Possibility for Differential Diagnosis of Acromioclavicular Disjunctions Rockwood Stage 3 and 4? A Pilot Study
Authors: Villatte Guillaume , Lecointe Thibault , Erivan Roger , Mulliez Aurélien , Métais Pierre , Descamps Stéphane , Boisgard Stéphane 
Published: October 2018

Objective:
To evaluate the repeatability and reproducibility of an ultrasound examination of the acromioclavicular joint (ACJ) performed by an orthopaedic surgeon to analyze anterior ACJ relationship in the horizontal plane.

Design:
Prospective observational study on healthy subjects.

Setting:
The study was conducted in 2017 in a university department of orthopaedic surgery and traumatology.

Level of Evidence:
III.

Patients (or Participants):
Forty consecutive volunteers aged 18 to 40 years were involved.

Interventions (or Assessment of Risk Factors or Independent Variables):
The ultrasound examination was performed by 2 orthopaedic surgeons with a SonoSite M-Turbo portable ultrasound machine (Fujifilm, Japan). Distance measurement between the anterior edge of the clavicle (AECL) and the anterior edge of the acromion (AEAC) was done on the right side, then on the left one and repeated by the same examiner.

Main Outcome Measures:
The intra- and interexaminer reproducibility of measurements was analyzed as primary outcome. Concordance of distance measurements between the right and left sides on the same subject was evaluated, as well as the “typical morphology” of the ACJ in the horizontal plane.

Results:
The intra- and interexaminer reproducibility for AECL-AEAC distance measurements was, respectively, 0.95 (0.93-0.97) and 0.87 (0.84-0.90). The correlation between the right and left sides was significant (P < 0.001), with a reproducibility of 0.86 (0.83-0.89). Twenty-seven (67.5%) volunteers were considered to have a “perfect alignment” of the AECL and AEAC.

Conclusions:
This study confirms that it is possible to evaluate with good reproducibility the anterior AC relationship in the horizontal plane and that both sides are similar on the same subject.
Cancer Patients' Long-term Experiences of Participating in a Comprehensive Lifestyle Intervention Study While Receiving Chemotherapy
Authors: Mikkelsen Hilde Elisabeth Timenes , Vassbakk-Brovold Karianne , Antonsen Anne Jørstad , Berntsen Sveinung , Kersten Christian , Fegran Liv 
Published: October 2018

Background
Lifestyle interventions seem promising with regard to cancer patients' potential for physical and psychological health benefits and as an empowerment tool. Nevertheless, there is a lack of knowledge concerning cancer patients' longer-term experiences of participating in comprehensive lifestyle interventions.

Objective
The aim of this study was to explore cancer patients' long-term experiences of participating in a 12-month individualized comprehensive lifestyle intervention study focusing on physical activity, diet, smoking cessation, and stress management while receiving curative or palliative chemotherapy.

Methods
A qualitative design with semistructured interviews of 7 curative and 7 palliative cancer patients was conducted 12 months after inclusion in lifestyle intervention. Data were analyzed following a phenomenological-hermeneutic approach.

Results
Two main themes emerged: (1) awareness of the importance of a healthy lifestyle during cancer treatment and (2) individual follow-up; it's good to have someone to talk to.

Conclusions
Participation in a 12-month comprehensive lifestyle intervention is both feasible and desirable in curative and palliative patients. However, although the curative participants' motivation and perceived ability to adhere to lifestyle recommendations increased during the intervention period, the palliative participants' perceived ability to adhere decreased even though they were overall highly motivated.

Implications for Practice
Our findings encourage the future implementation of lifestyle interventions during cancer treatment, even in cancer patients with advanced disease. However, when implementing lifestyle interventions, healthcare professionals must keep the patients' motivation, perceived ability to adhere to lifestyle recommendations, and individual needs in mind.
Analyses of Mitochondrial DNA and Immune Phenotyping Suggest Accelerated T-Cell Turnover in Treated HIV
Authors: Massanella Marta , Karris Maile Y. , Pérez-Santiago Josué , Yek Christina , Vitomirov Andrej , Mehta Sanjay R. 
Published: October 2018

Background:
HIV infection is associated with premature aging, and mitochondrial integrity is compromised during the aging process. Because mitochondrial toxicity is a consequence of antiretroviral therapies (ARTs), we hypothesized HIV and long-term ART would correlate with immunosenescence and mitochondrial DNA (mtDNA) pathology.

Setting:
Thirteen older HIV-infected individuals (aged >40 years) with virologic suppression (stratified by duration of ART) were compared with 10 uninfected controls well-matched for age.

Methods:
Peripheral blood T-cells were immunophenotyped to measure immune activation, proliferation, and immunosenescence in subsets. mtDNA copies per cell and the relative abundance of mtDNA carrying the “common deletion” (RACD) were quantified by droplet digital polymerase chain reaction.

Results:
Immune activation was higher in HIV-infected individuals than HIV-uninfected individuals in mature CD4+ T-cell subsets (CD4+TTM
P = 0.025, CD4+TEM
P = 0.0020) regardless of ART duration. Cell populations from uninfected individuals were more likely to be more senescent populations in mature CD4+ T-cell subsets (TTM
P = 0.017), and CD8+ (CD8+TEMRA+
P = 0.0026). No differences were observed in mtDNA or RACD levels in any CD4+ T-cell subsets, while CD8+TSCM of infected individuals trended to have more mtDNA (P = 0.057) and reduced RACD (P = 0.0025).

Conclusions:
HIV-infected individuals demonstrated increased immune activation, but reduced senescence in more mature T-cell subsets. Increased mtDNA content and lower RACD in CD8+TSCM suggest immune activation driven turnover of these cells in HIV-infected persons.
Diagnostic Accuracy of Different Surgical Procedures for Axillary Staging After Neoadjuvant Systemic Therapy in Node-positive Breast Cancer
Authors: Simons Janine M. , van Nijnatten Thiemo J. A. , van der Pol Carmen C. , Luiten Ernest J. T. , Koppert Linetta B. , Smidt Marjolein L. 
Published: October 2018

Objective:
The aim of this study was to perform a systematic review and meta-analysis to assess the accuracy of different surgical axillary staging procedures compared with ALND.

Summary of Background Data:
Optimal axillary staging after neoadjuvant systemic therapy (NST) in node-positive breast cancer is an area of controversy. Several less invasive procedures, such as sentinel lymph node biopsy (SLNB), marking axillary lymph node with radioactive iodine seed (MARI), and targeted axillary dissection (a combination of SLNB and a MARI-like procedure), have been proposed to replace the conventional axillary lymph node dissection (ALND) with its concomitant morbidity.

Methods:
PubMed and Embase were searched for studies comparing less invasive surgical axillary staging procedures to ALND to identify axillary burden after NST in patients with pathologically confirmed node-positive breast cancer (cN+). A meta-analysis was performed to compare identification rate (IFR), false-negative rate (FNR), and negative predictive value (NPV).

Results:
Of 1132 records, 20 unique studies with 2217 patients were included in quantitative analysis: 17 studies on SLNB, 1 study on MARI, and 2 studies on a combination procedure. Overall axillary pathologic complete response rate was 37%. For SLNB, pooled rates of IFR and FNR were 89% and 17%. NPV ranged from 57% to 86%. For MARI, IFR was 97%, FNR 7%, and NPV 83%. For the combination procedure, IFR was 100%, FNR ranged from 2% to 4%, and NPV from 92% to 97%.

Conclusion:
Axillary staging by a combination procedure consisting of SLNB with excision of a pre-NST marked positive lymph node appears to be most accurate for axillary staging after NST. More evidence from prospective multicenter trials is needed to confirm this.
Subclonal architecture, evolutionary trajectories and patterns of inheritance of germline variants in pediatric glioblastoma
Authors: Hoffman Mary , Gillmor Aaron H , Kunz Daniel J , Johnston Michael , Nikolic Ana , Narta Kiran , King Jennifer , Ellestad Katrina , Dang Ngoc Ha , Cavalli Florence MG , Kushida Michelle M , Coutinho Fiona J , Luu Betty , Ma Yussanne , Mungall Andrew J , Moore Richard , Marra Marco A , Taylor Michael D , Pugh Trevor J , Dirks Peter B , Senger Donna L , Simons Benjamin D , Chan Jennifer A , Morrissy A Sorana , Gallo Marco 
Published: October 2018

AbstractPediatric glioblastoma (pGBM) is a lethal cancer with no effective therapies. Intratumoral genetic heterogeneity and mode of tumor evolution have not been systematically addressed for this cancer. Whole-genome sequencing of germline-tumor pairs showed that pGBM is characterized by intratumoral genetic heterogeneity and consequent subclonal architecture. We found that pGBM undergoes extreme evolutionary trajectories, with primary and recurrent tumors having different subclonal compositions. Analysis of variant allele frequencies supported a model of tumor growth involving slow-cycling cancer stem cells that give rise to fast-proliferating progenitor-like cells and to non-dividing cells. pGBM patients’ germlines had subclonal structural variants, some of which underwent dynamic frequency fluctuations during tumor evolution. By sequencing germlines of mother-father-patient trios, we found that inheritance of deleterious germline variants from healthy parents cooperate withde novogermline and somatic events to the tumorigenic process. Our studies therefore challenge the current notion that pGBM is a relatively homogeneous molecular entity.