bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterizing Treatment Utilization Patterns for Trigeminal Neuralgia in the United States
Authors: Zakrzewska Joanna M. , Wu Ning , Lee John Y.K. , Werneburg Brian , Hoffman Deborah , Liu Ying 
Published: February 2018

Background and Aim:
Trigeminal neuralgia (TN) is a rare orofacial disorder characterized by severe unilateral paroxysmal pain in the region of the fifth cranial nerve. Clinical guidelines recommend carbamazepine (only US Food and Drug Administration–approved drug for TN) and oxcarbazepine as first-line therapies. We utilized the US Truven Health MarketScan database to examine treatment patterns among patients with TN.

Methods:
Included patients were aged 18 years and above, newly diagnosed with TN (≥2 TN diagnoses ≥14 days apart; no diagnosis in the previous year), continuously enrolled 1 year before index, with ≥3 years’ follow-up postindex. We assessed utilization of selected pharmacotherapies (carbamazepine, oxcarbazepine, pregabalin, gabapentin, baclofen, duloxetine, topiramate), surgery (posterior fossa, radiosurgery), and injections (peripheral anesthetic injections, Gasserian ganglion procedures) for TN.

Results:
In total, 3685 patients were included (2425 commercial, 1260 Medicare; 71.8% female; age, mean [SD], 59 [15] y). Overall, 72.5% of patients received at least 1 studied medication, most commonly carbamazepine (51.7%) or gabapentin (48.6%). In total, 65% of pharmacologically treated patients had ≥2 treatment episodes; 41.6% had ≥3 (defined by a change in pharmacotherapy [monotherapy/combination] regimen). Overall, 12.3% had surgery and 7.3% injections; 42.9% received opioids for TN.

Conclusions:
In the 3 years after diagnosis, patients with TN in the United States receive a variety of pharmacological treatments, including opioids, despite carbamazepine being the only approved medication. A notable proportion utilize surgeries/injections. A high proportion of pharmacologically treated patients receive multiple treatment episodes, suggesting frequent therapy switching, perhaps because of suboptimal efficacy/tolerability. Our data suggest a high burden of illness associated with TN.
Full-endoscopic Uniportal Odontoidectomy and Decompression of the Anterior Cervicomedullary Junction Using the Retropharyngeal Approach
Authors: Ruetten Sebastian , Hahn Patrick , Oezdemir Semih , Baraliakos Xenophon , Merk Harry , Godolias Georgios , Komp Martin 
Published: February 2018

Study Design.
A study of a series of consecutive full-endoscopic uniportal decompressions of the anterior craniocervical junction with retropharyngeal approach.

Objective.
The aim of this study was to evaluate the direct anterior decompression of the craniocervical junction in patients with bulbomedullary compression using a full-endoscopic uniportal technique via an anterolateral retropharyngeal approach.

Summary of Background Data.
Acute or progressive myelopathy may necessitate direct anterior decompression of the craniocervical junction and odontoidectomy. Different techniques with individual advantages and disadvantages can be used. In addition to the gold standard – the transoral approach – there is increasing experience with the endoscopic transnasal technique. Other alternative procedures are also being developed.

Methods.
Between 2013 and 2016, eight patients with basilar impression, retrodental pannus, or retrodental infection were operated in the full-endoscopic uniportal technique with a retropharyngeal approach. Anterior decompression of the bulbomedullary junction with odontoidectomy was performed. All patients additionally underwent posterior stabilization. Imaging and clinical data were collected in follow-up examinations for 1 year.

Results.
The bulbomedullary junction was adequately decompressed. No problems due to swelling of pharyngeal soft tissue occurred. One patient required revision due to secondary bleeding. No other complications were observed. All patients had a good clinical outcome with stable regression of the myelopathy symptoms and/or healing of the infection. The imaging follow-up showed sufficient decompression of bone and soft tissue in all cases. No evidence was found of increasing instability or failure of posterior fusion.

Conclusion.
In the operated patients, the full-endoscopic uniportal surgical technique with anterior retropharyngeal approach was found to be a sufficient and minimally invasive method with the known advantages of an endoscopic procedure under continuous irrigation. It should not be viewed only as competition for other surgical techniques – due to its individual technical parameters, it can also be considered to be an alternative or complementary procedure.

Level of Evidence: 4
The Randomized Educational Acute Respiratory Distress Syndrome Diagnosis Study: A Trial to Improve the Radiographic Diagnosis of Acute Respiratory Distress Syndrome*
Authors: Goddard Shannon L. , Rubenfeld Gordon D. , Manoharan Venika , Dev Shelly P. , Laffey John , Bellani Giacomo , Pham Tai , Fan Eddy 
Published: February 2018

Objectives:
Radiographic criteria for acute respiratory distress syndrome have been criticized for poor reliability. Our objective was to test an educational intervention to improve the radiographic identification of acute respiratory distress syndrome by participants in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure study.

Design:
Randomized controlled trial.

Settings:
Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure study centers.

Subjects:
Study coordinators in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure study.

Interventions:
Participants were randomized to either an online training module followed by a test module (intervention) or test module followed by training module (control).

Measurements and Main Results:
The primary outcome was the number of radiographs correctly identified as meeting criteria for acute respiratory distress syndrome on an online test module (out of 11). Prespecified secondary analyses included a comparison of agreement between the groups and subgroup analyses by profession, age, years of experience, and stated familiarity with diagnostic criteria for acute respiratory distress syndrome. Four-hundred sixty-three study participants consented to participate. There was no effect of the intervention on correct answers by participants (proportion correct 58% [intervention] vs 56% [control]; p = 0.15), or in any subgroup analyses. Overall agreement between raters was 0.296 for the intervention and 0.272 for the control (p < 0.001).

Conclusions:
Participant recognition of radiographic criteria for acute respiratory distress syndrome was low, with poor agreement. This was not impacted by an educational intervention designed to improve accuracy of identification of radiographic criteria for acute respiratory distress syndrome.
Racial Differences in Sepsis Mortality at U.S. Academic Medical Center–Affiliated Hospitals*
Authors: Chaudhary Ninad S. , Donnelly John P. , Wang Henry E. 
Published: February 2018

Objectives:
To determine the racial disparities in severe sepsis hospitalizations and outcomes in U.S. academic medical center–affiliated hospitals.

Design:
Retrospective analysis of sepsis hospitalizations.

Settings:
U.S. academic medical center–affiliated hospitals participating in Vizient Consortium from 2012 to 2014.

Patients:
Sepsis hospitalizations using International Classification of Diseases, Ninth revision, discharge diagnoses codes defined by the Angus method.

Interventions:
None.

Measurements and Main Results:
We compared rates of sepsis hospitalization, ICU admission, organ dysfunction, and hospital mortality between blacks and whites. We repeated the analyses stratified by community-acquired, healthcare-associated, and hospital-acquired sepsis subtypes. Of 10,244,780 hospitalizations in our cohort, 1,114,386 (10.9%) had sepsis. Sepsis subtypes included community-acquired sepsis (61.8%), healthcare-associated sepsis (23.8%), and hospital-acquired sepsis (14.4%). Although the proportion of discharges with sepsis was lower for blacks than whites (106.72 vs 109.43 per 1,000 hospitalizations; p < 0.001), the proportion of black sepsis hospitalizations was higher for individuals greater than 30 years old. Blacks exhibited lower adjusted sepsis hospital mortality than whites (odds ratio, 0.85; 95% CI, 0.84–0.86). The adjusted odds of hospital mortality following community-acquired, healthcare-associated, and hospital-acquired sepsis were lower for blacks than whites.

Conclusions:
In this current series of hospital discharges at U.S. academic medical center–affiliated hospitals, blacks exhibited lower adjusted rates of sepsis hospitalizations and mortality than whites.
MiSight Assessment Study Spain: Adverse Events, Tear Film Osmolarity, and Discontinuations
Authors: Ruiz-Pomeda Alicia , Pérez-Sánchez Belén , Prieto-Garrido Francisco L. , Gutiérrez-Ortega Ramón , Villa-Collar César 
Published: February 2018

Objectives:
To assess the relative clinical success of MiSight contact lenses (CLs) (study group) and distance single-vision (SV) spectacles (control group) in children in terms of adverse events (AEs), discontinuations, and tear film osmolarity over a 2-year period.

Methods:
Seventy-four subjects aged 8 to 12 with myopia of −0.75 to −4.00 D and astigmatism less than 1.00 D were randomly assigned to MiSight CLs or SV groups. Subjects were monitored at 6-month intervals over the course of 24 months and advised to report to the clinic immediately should AEs occur. Adverse events were categorized as serious, significant, and nonsignificant. Discontinuation was defined as cessation of participation in the study.

Results:
Forty-four children were corrected with MiSight CLs and 33 with SV spectacles. No serious or significant AEs were found in any of the participants in either group. Two nonsignificant AEs were found in MiSight group, corresponding to a foreign body on the cornea in two children. There were five discontinuations in MiSight group, one because of change of residence and four because of unwillingness to use the CL. There were no discontinuations in SV group. Neither group showed any significant changes in osmolarity data over the 24 months of follow-up (P≥0.05).

Conclusions:
No clinically serious events were observed in either group. Our results show that correct use of MiSight CLs is a safe option for myopia correction. The success of this treatment requires a combination of proper lens fitting, good adherence to routine follow-ups, and timely treatment of complications.
Improved Neurodevelopment After Initiation of Antiretroviral Therapy in Human Immunodeficiency Virus–infected Children
Authors: Gómez Laurén A. , Crowell Claudia S. , Njuguna Irene , Cranmer Lisa M. , Wamalwa Dalton , Chebet Daisy , Otieno Vincent , Maleche-Obimbo Elizabeth , Gladstone Melissa , John-Stewart Grace , Benki-Nugent Sarah 
Published: February 2018

Background:
Late human immunodeficiency virus (HIV) diagnosis after severe co-morbidity remains common in resource-limited settings. Neurodevelopmental recovery during antiretroviral therapy (ART) for late-diagnosed children is understudied. We determined 6-month neurodevelopmental trajectories in HIV-infected children initiating ART during hospitalization.

Methods:
HIV-infected children initiated ART after HIV diagnosis during hospitalization in Kenya. The Malawi Developmental Assessment Tool was administered after clinical stabilization within 1 month and at 6 months post-ART initiation. Baseline versus 6-month Z scores for each developmental domain were compared; cofactors for change in Z scores were evaluated using linear regression.

Results:
Among 74 children, median age was 1.7 years (interquartile range, 0.8–2.4) and median Z scores for gross motor, fine motor, social and language domains were −1.34, −1.04, −0.53 and −0.95, respectively. At baseline, children with higher plasma viremia had lower social Z scores (P = 0.008). Better nourished (weight-for-age Z score [WAZ] ≥−2) children had higher Z scores in all developmental domains (all P values ≤0.05). After 6 months on ART (n = 58), gross and fine motor Z scores improved significantly (mean change 0.39; P = 0.007 and 0.43; P = 0.001, respectively), but social and language did not. Children with better immune and growth response to ART had higher gains in gross motor (0.05 per unit-gain CD4%; P = 0.04; 0.34 per unit-gain WAZ; P = 0.006 and 0.44 per unit-gain height-for-age Z score; P = 0.005), social (0.37 per unit-gain WAZ; P = 0.002) and language (0.25 per unit-gain height-for-age Z score; P = 0.01).

Conclusions:
Children had significant neurodevelopmental gains during 6 months of ART, and children with better growth and immune recovery had greater improvement. Prompt commencement of ART may improve neurodevelopment in addition to immunity and growth.
The Association Between Depressive Symptoms and N-Terminal Pro–B-Type Natriuretic Peptide With Functional Status in Patients With Heart Failure
Authors: Saleh Zyad T. , Wu Jia-Rong , Salami Ibrahim , Yousef Khalil , Lennie Terry A. 
Published: February 2018

Background:
N-terminal pro–B-type natriuretic peptide (NT-proBNP) and depressive symptoms are each associated with functional status in patients with heart failure (HF), but their association together with functional status has not been examined.

Objective:
The aim of this study was to determine whether functional status scores differ as a function of depressive symptoms and NT-proBNP levels considered together.

Methods:
We studied 284 patients with HF who were divided into 4 groups based on the median split of NT-proBNP levels and cut point for depressive symptoms (Beck Depression Inventory ≥ 14): (1) low NT-proBNP of 562.5 pg/mL or less without depressive symptoms, (2) low NT-proBNP of 562.5 pg/mL or less with depressive symptoms, (3) high NT-proBNP of greater than 562.5 pg/mL without depressive symptoms, and (4) high NT-proBNP of greater than 562.5 pg/mL with depressive symptoms. The Duke Activity Status Index was used to assess functional status.

Results:
Nonlinear regression demonstrated that patients without depressive symptoms were more than twice as likely to have higher (better) functional status scores than patients with depressive symptoms regardless of NT-proBNP levels after controlling for age, gender, prescribed antidepressants, and body mass index. Functional status levels of patients with low NT-proBNP did not differ from those with high NT-proBNP in the presence of depressive symptoms.

Conclusion:
When examined together, depressive symptoms rather than NT-proBNP levels predicted functional status.

Clinical Implications:
Adequate treatment of depressive symptoms may lead to better functional status regardless of HF severity.
Risk factors for low bone mineral density in pediatric inflammatory bowel disease: the positive role of physical activity
Authors: Nobile Stefano , Grand Richard J. , Pappa Helen M. 
Published: February 2018

Objective
In pediatric inflammatory bowel disease (IBD), the prevalence of low bone mineral density (BMD) and bone fractures and the relationship between these are still debated. Our aim was to report data from a cohort of pediatric patients with IBD.

Patients and methods
Cross-sectional assessment of growth and BMD [(dual-energy x-ray absorptiometry (DXA)] and retrospective chart review were performed to report the lifetime prevalence of bone fractures and clinical associations with patients’ data.

Results
We examined 216 patients with IBD, 8–25 years old (median: 14 years). Low BMD was found in 12.5% (spine) and 27% (total body). Multiple regression analysis showed that BMD was predicted by Z-scores for height and weight at DXA. History of menstrual irregularities and nasogastric tube feedings was associated with lower BMD, whereas physical activity and higher Z-score for height at DXA were associated with higher BMD.
The prevalence of lifetime fractures was 11.8%. Patients with a history of fractures had lower Z-scores for spine BMD (−1.20 vs. −0.69, P=0.020) and total-body BMD (−1.30 vs. −0.75, P=0.014) compared with those without a history of fractures. Patients with spine BMD Z-score of up to −2 SD score had significantly increased prevalence of fractures compared with those with Z-score more than −2 SD score (28 vs. 10%, P=0.015).

Conclusion
This study provides further insight into risk factors for low BMD in pediatric IBD. Novel findings were the association between low BMD and fractures, and the positive relationship between BMD and physical activity.
Assessment of prognostic performance of Albumin–Bilirubin, Child–Pugh, and Model for End-stage Liver Disease scores in patients with liver cirrhosis complicated with acute upper gastrointestinal bleeding
Authors: Xavier Sofia A. , Vilas-Boas Ricardo , Boal Carvalho Pedro , Magalhães Joana T. , Marinho Carla M. , Cotter José B. 
Published: February 2018

Objective
The Albumin–Bilirubin (ALBI) score was developed recently to assess the severity of liver dysfunction. We aimed to assess its prognostic performance in patients with liver cirrhosis complicated with upper gastrointestinal bleeding (UGIB) while comparing it with Child–Pugh (CP) and Model for End-stage Liver Disease (MELD) scores.

Patients and methods
This was a retrospective unicentric study, including consecutive adult patients with cirrhosis admitted for UGIB between January 2011 and November 2015. Clinical, analytical, and endoscopic variables were assessed and ALBI, CP, and MELD scores at admission were calculated.

Results
This study included 111 patients. During the first 30 days of follow-up, 12 (10.8%) patients died, and during the first year of follow-up, another 10 patients died (first-year mortality of 19.8%).
On comparing the three scores, for in-stay and 30-day mortality, only the ALBI score showed statistically significant results, with an area under the curve (AUC) of 0.80 (P<0.01) for both outcomes. For first-year mortality, AUC for ALBI, CP, and MELD scores were 0.71 (P<0.01), 0.64 (P<0.05), and 0.66 (P=0.02), respectively, whereas for global mortality, AUC were 0.75 (P<0.01), 0.72 (P<0.01), and 0.72 (P<0.01), respectively. On comparing the AUC of the three scores, no significant differences were found in first-year mortality and global mortality.

Conclusion
In our series, the ALBI score accurately predicted both in-stay and 30-day mortality, whereas CP and MELD scores could not predict these outcomes. All scores showed a fair prognostic prediction performance for first-year and global mortality. These results suggest that the ALBI score is particularly useful in the assessment of short-term outcomes, with a better performance than the most commonly used scores.
Visualization of Myocardial Infarction in Postmortem Multiphase Computed Tomography Angiography
Authors: Sabatasso Sara , Vanhaebost Jessica , Doenz Francesco , Palmiere Cristian , Michaud Katarzyna , Dedouit Fabrice , Grabherr Silke 
Published: February 2018

Abstract
Recent studies have indicated that multiphase postmortem computed tomography angiography (MPMCTA) allows detection of a pathological enhancement of the myocardium in regions that correlate with the localization of the infarction at histology. The aim of this study was to verify this hypothesis by examining MPMCTA images in cases of myocardial infarction. Therefore, we investigated 10 autopsy cases where death was attributed to myocardial infarction or which showed cardiovascular pathology. As a control group, we selected 10 cases of non-natural (namely, not cardiac) death. The MPMCTA was performed in both groups to ascertain whether a pathological enhancement could be observed. We detected a myocardial enhancement in all cardiac death cases, in the same region that showed infarction at histology. No enhancement was observed in control cases. These results have important implications in the routine management of sudden cardiac death cases. In fact, MPMCTA can not only orient about the cause of death before autopsy, but can especially help to identify affected regions for guiding and improving the sampling for microscopic examination.
Fatal Road Traffic Vehicle Collisions With Pedestrian Victims
Authors: Chatzaraki Vasiliki , Thali Michael J. , Ampanozi Garyfalia , Schweitzer Wolf 
Published: February 2018

Abstract
Fatal car-to-pedestrian collisions regularly appear in the forensic pathologist's routine, particularly in places of extended urbanization. Postmortem computed tomography has gained an exceptional role to supplement autopsy worldwide, giving information that is supplementary or complimentary to conventional autopsy. In this retrospective study, a total number of 320 findings in a series of 21 pedestrians fatally hit by cars and trucks of both postmortem computed tomography and autopsy were correlated. According to our results, it is best to combine both methods to give well-founded answers to questions pertaining to both collision reconstruction and cause of death.
Hemangioma of the Hard Palate in an Elderly Patient as a Life-Threatening Surgical Emergency
Authors: Uluyol Sinan 
Published: February 2018

AbstractHemangiomas of the head and neck are common benign tumors usually in childhood. They are rarely seen in hard palate. The authors present a geriatric patient with abundant hemorrhage due to a capillary hemangioma of the hard palate. Management and treatment approaches of this rare, urgent, and life-threatening situation is discussed.
Endoscopic Modified Medial Maxillectomy for Fungal Ball of the Hypoplastic Maxillary Sinus With Bony Hypertrophy
Authors: Nomura Kazuhiro , Ikushima Hiroyuki , Ozawa Daiki , Shimizu Yuichi , Arakawa Kazuya , Suzuki Jun , Hidaka Hiroshi , Katori Yukio , Ohyama Kenji 
Published: February 2018

Abstract
Sinus fungal ball is defined as noninvasive chronic rhino-sinusitis with a clump of mold in the paranasal sinuses, typically affecting the maxillary sinus. Fairly good outcomes of endoscopic surgery have been reported where the ball is removed through the antrostomy. However, the affected sinus tends to have a smaller cavity and thicker bony walls. As such, it is often challenging to maintain a window size that is sufficient to control possible recurrence. The endoscopic modified medial maxillectomy procedure was applied to a 61-year old and a 70-year old female patient with maxillary sinus fungal ball. Using this method, we created a much larger inferior meatal antrostomy without difficulty. The window provided us with an endoscopic view of the whole sinus and complete eradication of the lesion. Endoscopic modified medial maxillectomy is useful as a surgical procedure for maxillary sinus fungal ball and should be considered for better outcomes.
Maxillo-Mandibular Reconstruction in Pediatric Patients: How To Do It?
Authors: Valentini Valentino , Califano Luigi , Cassoni Andrea , Marco Della Monaca , Raponi Ingrid , Priore Paolo , Fadda Maria Teresa , Dell’Aversana Orabona Giovanni , Terenzi Valentina 
Published: February 2018

Abstract
Maxillo-mandibular reconstruction in pediatric patients involves particular functional and cosmetic implications. Attention is required for the craniofacial growth over time, involvement of the permanent dentition, facial symmetry, and donor site morbidity. Our aim is to identify the best reconstructive options for maxilla-mandibular defects in children (<18 years) based on our experience with 25 pediatric patients. We believe that reconstruction has to be performed at the same time as resection in pediatric patients. Local flaps should be reserved for cases of maxillary defects because of malignant neoplasms, which ultimately have poor prognosis. In cases of large mandibular defects, radiotherapy is eventually required. When the condition of the soft tissues is poor (because of previous surgery, etc), free flaps potentially represent the best options. Nevertheless, in patients younger than 5 years old (with no damaged tissues), reconstruction with rib grafts should be performed, and the use of titanium plates should be reserved for very select cases (such as temporary reconstruction in toddlers).