bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemorrhagic Presentation of Rathke Cleft Cysts: A Surgical Case Series
Authors: Schooner Lauren , Wedemeyer Michelle A , Bonney Phillip A , Lin Michelle , Hurth Kyle , Mathew Anna , Liu C Jason , Shiroishi Mark , Carmichael John D , Weiss Martin H , Zada Gabriel 
Published: August 2019

Abstract

BACKGROUND
Rathke cleft cysts (RCCs) are benign sellar and suprasellar lesions commonly presenting as asymptomatic incidental findings. Rarely, RCCs hemorrhage and mimic pituitary apoplexy on presentation.

OBJECTIVE
To review a series of hemorrhagic RCCs for physicians encountering this rare presentation.

METHODS
A database review of >1700 transsphenoidal pituitary operations was performed at the USC Pituitary Center to identify patients with pathologically confirmed RCCs presenting with acute symptoms and evidence of hemorrhage at the time of surgery. Surgical treatment involved transsphenoidal RCC fenestration and drainage. Clinical, endocrine, and imaging outcomes were reviewed.

RESULTS
A total of 119 RCCs were identified, and 6 (5.0%) presented with hemorrhage mimicking pituitary apoplexy. Presenting symptoms included acute onset headaches (5/6), vision loss (2/6), and oculomotor nerve palsy (n = 1). Endocrine disturbances at presentation included pre-existing amenorrhea in all female patients (3/3), hypothyroidism (n = 2), panhypopituitarism (n = 2), and one with profound hyponatremia (Na 116 meq/L). All patients underwent endonasal transsphenoidal fenestration and drainage with no major complications. Over mean follow-up of 38.4 mo, 2/2 patients with vision loss reported improvement, and 2/5 patients with headaches reported improvement. Although all women resumed menses, patients with preoperative hypopituitarism did not experience pituitary axis improvement. Follow-up magnetic resonance imaging showed no instances of RCC recurrence with a mean imaging follow-up of 38.6 mo.

CONCLUSION
RCCs occasionally present with hemorrhage and clinical symptoms that may be confused with apoplexy. Outcomes following hemorrhagic RCC treatment are excellent when treated at tertiary pituitary centers. Although hyperprolactinemia often improves following surgery, other pituitary axis deficits typically do not.
Between Diversity, Representation and ‘Best Evidence’: Rethinking Select Committee Evidence-Gathering Practices
Authors: Beswick Danielle , Elstub Stephen 
Published: August 2019

AbstractSelect committees play an important role in scrutinising government policy. They have come under increasing pressure to seek evidence for their inquiries—including both formal and informal evidence—from a wider range of stakeholders. Two particular pressures can be observed within this trend. First, committees are expected to show commitment to hearing from a more diverse set of stakeholders. The second pressure relates to the representativeness of those providing evidence. Consequently, they have been urged to increase public engagement. The recent Citizens’ Assembly into adult social care points to one mechanism for engaging a ‘mini-public’ in committee inquiries. Due to their use of random and stratified sampling to recruit participants, mini-publics could diversify the evidence base and facilitate public scrutiny of the committees. However, we know little of what committee members and staffs think about these issues. In this article, we draw insights from over 60 interviews with select committee chairs, members and staff to gain insight into their perspectives on evidence diversity and the potential of mini-publics to promote this. We find that traditional approaches to inquiries are still favoured. While mini-publics are seen as a solution to the failings of current approaches to public engagement, this is for instrumental reasons, meaning that they are only valued in particular circumstances. Ultimately, further culture change is required if committee inquiries are to move substantially beyond the traditional approach.
Newly discovered associations between peritrich ciliates (Ciliophora: Peritrichia) and scale polychaetes (Annelida: Polynoidae and Sigalionidae) with a review of polychaete–peritrich epibiosis
Authors: Mikac Barbara , Semprucci Federica , Guidi Loretta , Ponti Massimo , Abbiati Marco , Balsamo Maria , Dovgal Igor 
Published: August 2019

AbstractIn this research, we report the presence of two ciliate protozoans of the subclass Peritrichia, Cothurnia amphicteis and C. peloscolicis, as epibionts on the chaetae of scaled polychaetes Malmgrenia lilianae, M. andreapolis (fam. Polynoidae) and Sthenelais boa (fam. Sigalionidae), from the north Adriatic (Mediterranean Sea). Both ciliate species are herein found for the first time after their original description and are redescribed, based on light and scanning electron microscopy analyses. This is the first record of an association between ciliates and polychaetes of the family Sigalionidae. Our results suggest that these host–epibiont relationships might be highly specific. We also present the first review of epibiosis between polychaetes and peritrich ciliates, indicating that this relationship is more diverse than previously thought. Forty taxa of peritrich ciliates from 12 genera and seven families are recorded as epibionts on polychaetes, while 48 polychaete taxa are known as their hosts. The relationship can be considered ectocommensalism, where the ciliates have the advantages of increased food availability. This association might be a more widespread phenomenon than currently known, because it could be easily overlooked or misinterpreted. It, therefore, deserves careful attention and further investigation.
A Retrospective Observational Study of the Neuroendocrine Stress Response in Patients Undergoing Endoscopic Transsphenoidal Surgery for Removal of Pituitary Adenomas: Total Intravenous Versus Balanced Anesthesia
Authors: Yhim Hyung-Been , Oh Hyung-Min , Yoon Hyun-Kyu , Kim Yong Hwy , Park Hee-Pyoung 
Published: August 2019

Background:
Anesthetic technique affects the neuroendocrine stress response to surgery. In this retrospective study, we compared the neuroendocrine stress response in patients undergoing endoscopic transsphenoidal pituitary adenoma surgery (ETSPAS) with total intravenous anesthesia (TIVA) with propofol-remifentanil or balanced anesthesia (BAL) with sevoflurane-remifentanil.

Materials and Methods:
Eighty-nine patients undergoing ETSPAS were anesthetized with either propofol-remifentanil (TIVA group, n=62) or sevoflurane-remifentanil (BAL group, n=27). Data were retrospectively collected regarding preoperative and immediate postoperative serum levels of adrenocorticotropic hormone (ACTH) and cortisol (primary outcome measures), as well as other pituitary hormones and their target organ hormones (secondary outcome measures).

Results:
There were no significant differences in preoperative pituitary hormone levels between the 2 groups. The immediate postoperative ACTH (89.5 [62.1 to 162.6] vs. 256.0 [92.0 to 570.7] pg/mL; P<0.001) level was lower in the TIVA group than in the BAL group, whereas immediate postoperative cortisol levels were similar between the 2 groups. The immediate postoperative thyroid-stimulating hormone (1.85 [1.21 to 2.98] vs. 1.21 [0.44 to 1.71] μIU/mL; P=0.003), triiodothyronine (91.0 [82.0 to 103.0] vs. 69.1 [64.6 to 76.2] ng/dL; P<0.001), luteinizing hormone (2.2 [1.2 to 4.0] vs. 1.0 [0.5 to 2.3] mIU/mL; P=0.005), and prolactin (22.6±15.8 vs. 12.8±10.2 ng/mL; P=0.005) levels were higher in the TIVA group compared with the BAL group. In both groups, none of the patients who had sufficient preoperative ACTH without hydrocortisone supplementation (n=15) showed hypocortisolism in the immediate postoperative measurement.

Conclusions:
Compared with BAL, TIVA resulted in reduced release of ACTH and increased release of thyroid-stimulating hormone, triiodothyronine, luteinizing hormone, and prolactin in patients undergoing ETSPAS.
Postoperative Complications Associated With Metabolic Syndrome Following Adult Spinal Deformity Surgery
Authors: Ye Ivan B. , Tang Ray , Schwartz John T. , Cheung Zoe B. , Cho Samuel K. 
Published: August 2019

Study Design:
A retrospective cohort study.

Objective:
The objective of this study was to examine the effect of metabolic syndrome on 30-day postoperative complications following corrective surgery for the adult spinal deformity (ASD).

Summary of Background Data:
Metabolic syndrome has been shown to increase the risk of cardiovascular morbidity and mortality. Few studies have examined the effect of metabolic syndrome on patients with ASD undergoing surgery.

Materials and Methods:
We performed a retrospective cohort study of patients who underwent spinal fusion for ASD. Patients were divided into 2 groups based on the presence or absence of metabolic syndrome, which was defined as a combination of hypertension, diabetes mellitus, and obesity. Baseline patient characteristics and operative variables were compared between the 2 groups. We also compared the incidence of 30-day postoperative complications between the 2 groups. A multivariable regression analysis was then performed to identify 30-day postoperative complications that were independently associated with metabolic syndrome.

Results:
A total of 6696 patients were included with 8.3% (n=553) having metabolic syndrome. Patients with metabolic syndrome were more likely to have renal comorbidity (P=0.042), bleeding disorder (P=0.011), American Society of Anesthesiology classification ≥3 (P<0.001), and undergo a long fusion (P=0.009). Patients with metabolic syndrome had higher rates of 30-day mortality (P=0.042), superficial surgical site infection (P=0.006), sepsis (P=0.003), cardiac complications (P<0.001), pulmonary complications (P=0.003), pulmonary embolism (P=0.050), prolonged hospitalization (P=0.010), nonhome discharge (P=0.007), and reoperation (P=0.003). Metabolic syndrome was an independent risk factor for cardiac complications [odds ratio (OR)=4.2; 95% confidence interval (CI): 1.7–10.2; P=0.001], superficial surgical site infection (OR=2.8; 95% CI: 1.4–5.7; P=0.004), sepsis (OR=2.2, 95% CI: 1.2–3.9; P=0.009), reoperation (OR=1.7; 95% CI: 1.2–2.5; P=0.006), pulmonary complications (OR=1.7; 95% CI: 1.1–2.5; P=0.017), and prolonged hospitalization (OR=1.4; 95% CI: 1.0–1.9; P=0.039).

Conclusions:
Recognition and awareness of the relationship between metabolic syndrome and postoperative complications following ASD surgery is important for preoperative optimization and perioperative care.
The Variability of Lumbar Facet Joint Synovial Cyst Recurrence Requiring Revision Surgery After Decompression-only and Decompression/Fusion
Authors: Wun Kelly , Hashmi Sohaib Z. , Maslak Joseph , Schneider Andrew D. , Katchko Karina M. , Singh Gurmit , Patel Alpesh A. , Hsu Wellington K. 
Published: August 2019

Study Design:
This is a retrospective study.

Objective:
The objective of this study was to evaluate lumbar spine synovial cyst recurrence rates of decompression-alone versus decompression/fusion procedures.

Background:
Improvements in imaging modalities allow for increased diagnosis and surgical treatment of symptomatic spinal juxtafacet synovial cysts. Conservative management may be used as a first-line management strategy, however rarely provides durable, effective relief of symptoms. Surgical treatment of spinal synovial cysts ranges from decompression and cyst excision to decompression with fusion procedures. Decompression procedures alone have a higher risk of recurrence of spinal synovial cysts.

Methods:
We retrospectively reviewed 87 patients undergoing surgical treatment of lumbar spinal juxtafacet synovial cysts as a single institution over 20 years. Surgical treatment consisted of either decompression versus decompression/fusion procedures. Preoperative symptoms included back pain, radiculopathy, motor deficits, or sensory deficits. The incidence of recurrence of spinal synovial cysts at the same-site or differing sites was compared between 2 categories of surgical treatment. Revision surgical procedure rates were also evaluated.

Results:
A total of 55 (63%) patients were treated with an index decompression-only procedure for the lumbar spinal synovial cyst compared with 32 (37%) patients treated with an index decompression and fusion procedure. Fifty-eight (68%) of the lumbar spinal cysts occurred at the L4–L5 level. There were 10 (11.5%) spinal synovial cyst recurrences in the decompression-only group, and 0 recurrences in the decompression/fusion group. Revision decompression procedures were performed in 4 of the 10 (4.6%) recurrences, and 6 of 10 (6.9%) recurrences had subsequent decompression and fusion surgery. The mean time to recurrence was 23.9±17.3 months. The mean length of follow-up was 65.1±48.6 months. Both recurrence and nonrecurrence cohorts had significant symptomatic improvement using Odom criteria.

Conclusions:
Decompression and cyst excision was the more common surgical treatment of lumbar spinal synovial cysts compared with decompression/fusion procedure in our study. The rate of synovial cyst recurrence and revision surgery in patients undergoing index decompression was relatively low and comparable to current literature. Symptomatic improvement of patients undergoing decompression versus decompression/fusion was similar in our study. Although the fusion may be required for the extent of pathology or coexisting instability, decompression and excision of spinal synovial cysts provide durable, effective treatment with a known, appropriate risk of recurrence and subsequent revision surgery.
Novel MFN2 Missense Mutation Induces Hereditary Axonal Motor and Sensory Neuropathy in a Saudi Arabian Family
Authors: Al-Harbi Talal M. , Abdulmana Sameeh O. , Bashir Shahid , Dridi Walid 
Published: August 2019

Abstract
Hereditary axonal motor and sensory neuropathy or Charcot–Marie–Tooth type 2 (CMT2) is a common inherited peripheral neuropathy. Major symptomatologic signs vary from minimal to significant weakness and loss of sensation, feet usually affected more than hands. It may also cause visual acuity impairment, hearing loss, and skeletal deformity. CMT2 classification is based on the clinical, electrophysiological, and genetic inheritance pattern. Dominant CMT2 is classified from CMT2A to CMT2N and recessive CMT2 into CMT2B1 and CMT2B2. CMT2A is the most frequent subtype of CMT2 and caused by mutations in the mitofusin 2 (MFN2) gene. We hereby report a Saudi Arabian CMT2A patient with a variant c.58C>T of the MFN2 gene mutation.
Favorable Response in Statin-Naive Paraneoplastic Anti-HMGCR Antibody–Associated Myopathy to Single Dose of Rituximab and Persistent Remission With Management of Underlying Lung Cancer
Authors: Waheed Waqar , Jones Christine , Gentchos George , DeWitt John , Tandan Rup 
Published: August 2019

Abstract
Anti-HMGCR myopathy is a subtype of immune-mediated necrotizing myopathy, typically associated with exposure to statins, although a sizable minority in some cohorts are statin-naive. Although the clinical features of acute- or subacute-onset symmetrical proximal muscle weakness mimic those of other idiopathic inflammatory myopathies, necrotizing myopathy is distinguished by the histopathological findings of muscle fiber necrosis and regeneration with little to no accompanying inflammation. Several recent studies of patients with anti-HMGCR myopathy have identified a slightly increased risk of cancer. Most patients require aggressive immunotherapy, usually as a combination of 2 or 3 immunosuppressant drugs. We report a case of a statin-naive paraneoplastic anti-HMGCR myopathy, who unlike other reported cases, responded to a single dose of 1000 mg of intravenous rituximab and subsequent chemoradiation therapy for an underlying lung cancer, despite failing to completely respond to prior high-dose oral prednisone and methotrexate.
Phenotypes of Late-Onset Transthyretin Amyloid Neuropathy: A Diagnostic Challenge
Authors: Živković Saša A. , Mnatsakanova Diana , Lacomis David 
Published: August 2019

Abstract
Hereditary transthyretin amyloidosis (hATTR) is a rare cause of severe neuropathy, typically with progressive sensorimotor and autonomic manifestations. The clinical course is marked by progressive worsening with typical survival of 7–11 years following the onset of symptoms. The phenotype may resemble other types of neuropathy, and dysautonomia may be absent at onset delaying the diagnosis. Two medications were recently approved for treatment of hATTR neuropathy in the United States and more may follow. Three major phenotypes of hATTR include neuropathic, cardiac, and mixed. Diagnostic clues include “red-flag” symptoms reflecting typical multisystem involvement, often presenting with cardiomyopathy, gastrointestinal dysmotility, or kidney insufficiency. We present a case series of 4 patients with late-onset hATTR neuropathy who were initially diagnosed with vasculitic neuropathy and chronic inflammatory demyelinating polyneuropathy to illustrate diagnostic challenges encountered with hATTR. Early diagnosis is even more urgent now given the availability of disease modifying treatments.
Depression and Non-modifiable Patient Factors Associated with Patient Satisfaction in an Academic Orthopaedic Outpatient Clinic: Is it More Than a Provider Issue?
Authors: Tisano Breann K. , Nakonezny Paul A. , Gross Bruno S. , Martinez J. Riley , Wells Joel E. 
Published: August 2019

Abstract

Background
Patient satisfaction surveys play an increasingly important role in United States healthcare policy and serve as a marker of provided physician services. In attempts to improve the patient’s clinical experience, focus is often placed on components of the healthcare system such as provider interaction and other experiential factors. Patient factors are often written off as “non-modifiable”; however, by identifying and understanding these risk factors for dissatisfaction, another area for improvement and intervention becomes available.

Questions/purposes
(1) Do patients in the orthopaedic clinic with a preexisting diagnosis of depression report lower satisfaction scores than those without a preexisting diagnosis of depression? (2) What other non-modifiable patient factors influence patient-reported satisfaction?

Methods
We reviewed Press Ganey Survey scores, which assess patient experiential satisfaction with a single clinical encounter, from 3044 clinic visits (2527 patients) in adult reconstructive, sports, and general orthopaedic clinics at a single academic medical center between November 2010 and May 2017, during which time approximately 19,000 encounters occurred. Multiple patient factors including patient age, gender, race, health insurance status, number of previous clinic visits with their physician, BMI, and a diagnosis of depression were recorded. Patient satisfaction was operationalized as a binary outcome as satisfied or less satisfied, and a multiple logistic regression analysis was used to estimate the odds of being satisfied.

Results
After adjusting for all other covariates in the model, we found that patients with a diagnosis of depression were less likely to be satisfied than patients without this diagnosis (odds ratio 0.749 [95% confidence interval, 0.600-0.940]; p = 0.01). Medicare-insured patients were more likely to be satisfied than non-Medicare patients (OR 1.257 [95% CI, 1.020-1.549]; p = 0.03), patients in the sports medicine clinic were more likely to be satisfied than those seen in the general orthopaedic clinic (OR 1.397 [95% CI, 1.096-1.775]; p = 0.007), and established patients were more likely to be satisfied than new patients (OR 0.763 [95% CI, 0.646-0.902]; p = 0.002).

Conclusions
Given the association of depression with lower satisfaction with a single visit at the orthopaedic clinic, providers should screen for depression and address the issue during the outpatient encounter. The impact of such comprehensive care or subsequent treatment of depression on improving patient-reported satisfaction offers areas of future study.

Level of Evidence
Level III, therapeutic study.
Menopausal hot flashing and endothelial function in two vascular beds: findings from a cross-sectional study of postmenopausal women
Authors: Iliodromiti Stamatina , Sattar Naveed , Delles Christian , Nelson Scott M. , Gill Jason M.R. , Lumsden MaryAnn 
Published: August 2019

Abstract

Objective:
We sought to examine the association of menopausal hot flashing with vascular reactivity in two different vascular beds in the same cohort of postmenopausal women and explore the relationship between hot flashing and cardiovascular disease (CVD) risk profile.

Methods:
A cross-sectional study of 79 healthy postmenopausal women, 23 of whom have never had menopausal hot flashes and 56 of whom have reported hot flashes. Endothelial function at a microvascular level was measured with Laser Doppler Imaging with Iontophoresis which assesses the response to both acetylcholine (Ach, endothelium dependent) and sodium-nitroprusside (SNP, endothelium independent). Reactive Hyperemia Index (RHI) was measured with peripheral arterial tonometry as a marker of endothelial function mainly at a macrovascular level. Metabolic biomarkers including insulin sensitivity were assessed.

Results:
Women with hot flashes had enhanced microvascular response to Ach by ∼30% (P = 0.04) and to SNP by ∼31% (P = 0.02), but lower RHI by ∼13% (P = 0.05) compared with women without flashes. Hot flashing was associated with enhanced response to SNP and lower RHI after adjustment for confounders and conventional CVD risk factors. Women with hot flashes were more insulin resistant than nonflashers (HOMAIR: 1.9 (1.2-2.6) vs 1.4 (0.8-1.9), P = 0.03).

Conclusions:
Our data support the association of hot flashing with greater insulin resistance and lower macrovascular response. The paradoxical enhanced microvascular response in hot flashers could be the result of the net effect of thermoregulatory and nonnitric oxide-related pathways rather than of endothelial integrity.
Glaucoma After Corneal Trauma or Surgery—A Rapid, Inflammatory, IOP-Independent Pathway
Authors: Dohlman Claes H. , Zhou Chengxin , Lei Fengyang , Cade Fabiano , Regatieri Caio V. , Črnej Alja , Dohlman Jan G. , Shen Lucy Q. , Paschalis Eleftherios I. 
Published: August 2019

Purpose:
To review clinical aspects and cellular and molecular steps in the development of long-term glaucoma after corneal surgery or acute trauma—especially the pivotal role of tumor necrosis factor alpha (TNF-α), the rapidity of the secondary damage to the retinal ganglion cells, and the clinical promise of early antiinflammatory intervention.

Methods:
A series of laboratory studies on post-injury and post-surgery glaucoma have been compared to clinical outcome studies on the subject, focusing particularly on the vulnerability of the retinal ganglion cells. Alkali burn to the cornea of mice and rabbits served as the main experimental model. TNF-α titer, ganglion cell apoptosis, and depletion of optic nerve axons have been examined. Anti-TNF-α antibodies or corticosteroids have been used to protect the retinal ganglion cells. Intraocular pressure (IOP) postburn was recorded by manometric methods.

Results:
In animals with alkali burn to the cornea, damage to the retina can occur within 24 to 72 hours. This is not because of a direct pH change posteriorly—the alkali is effectively buffered at the iris–lens level. Rather, TNF-α (and other inflammatory cytokines), generated anteriorly, rapidly diffuses posteriorly to cause apoptosis of the ganglion cells. During this time, the IOP remains much lower than the reported values required to cause ganglion cell damage. The TNF-α antibody infliximab or corticosteroids, if administered promptly, are markedly protective of the ganglion cells.

Conclusions:
A rapidly initiated, inflammatory (TNF-α mediated), IOP-independent pathway to glaucoma, resulting from acute anterior segment trauma or surgery, has been identified in laboratory studies. Prompt prophylactic treatment with antiinflammatory agents has been shown to be markedly neuroprotective of retinal ganglion cells, presumably capable of reducing the risk of late glaucoma.