bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delayed Occipitocervical Instability With Cranial Settling After Far-Lateral Transcondylar Surgery for Invasive Skull Base Tumor
Authors: Mazur Marcus D , Dailey Andrew T , Shah Lubdha , Scoville Jonathan P , Couldwell William T 
Published: April 2018

Abstract

BACKGROUND
Occipitocervical instability is a rare but potentially severe complication of a far-lateral transcondylar surgical approach to the skull base.

OBJECTIVE
To investigate the incidence of clinically significant occipitocervical instability after transcondylar surgery via a far-lateral approach and to determine whether the extent of occipital condyle resection relative to the hypoglossal canal was associated with the development of occipitocervical instability.

METHODS
A retrospective review of patients undergoing far-lateral transcondylar surgery was performed at our institution to identify patients who developed postoperative occipitocervical instability.

RESULTS
Of the 61 far-lateral transcondylar operations performed, the authors identified 2 cases of delayed occipitocervical instability after surgery. In each case, the patient had tumor invading into the occipital condyle and supracondylar region and a resection extending anterior to the hypoglossal canal was performed. Both patients presented with pathological fractures and a severe occipitocervical deformity.

CONCLUSION
Patients who have tumor involvement of the occipital condyle and supracondylar region and undergo partial unilateral condylar resection are at risk for occipitocervical instability and should be considered for occipitocervical fusion.
Resection of Right Frontal Arteriovenous Malformation: 3-Dimensional Operative Video
Authors: Couldwell William T 
Published: April 2018

Abstract
The video demonstrates resection of a Grade II Spetzler-Martin unruptured, medium-sized arteriovenous malformation (AVM). A young woman presented with headaches and seizures. The right frontal lesion measured 4.5 cm in largest dimension and had superficial venous drainage. Partial Onyx embolization, primarily of the anterior cerebral feeding arteries, was performed. Bone removal for exposure allowed identification of indentation from the large superficial draining vein. The video demonstrates careful microsurgical dissection on the AVM/brain interface, with selective interruption of feeding arteries circumferentially. The lesion was removed after ligation of the large superficial draining vein. Postoperative day 1 and 1-yr angiography demonstrated complete resection. The patient's symptoms abated after resection. This case is presented with a waiver of informed consent as per the Institutional Review Board.
P-D1 Differential pathogenesis of human metapneumovirus clinical isolates in C57BL/6 mice
Authors: Zhang Yu , Tollefson Sharon , Xu Jiuyang , Williams John 
Published: April 2018

Introduction:
Human metapneumovirus (HMPV) is a member of the Pneumoviridae, formerly a subfamily of Paramyxoviridae. HMPV is a leading cause of lower respiratory infection in infants, children, and adults. The disease outcome of HMPV infection ranges from mild upper respiratory infection to severe pneumonia. Despite the clinical and economic burden, mechanisms of HMPV pathogenesis are not fully understood. In addition, no licensed vaccines or anti-viral drugs are available.

Results:
Most published HMPV studies use a few laboratory-adapted strains of the A2 lineage. Here, we tested eight HMPV clinical isolates from different genetic lineages in comparison to a laboratory reference strain in an established C57BL/6 mouse model. The clinical isolates induced variable disease severity. While mice infected by laboratory strain TN/94-49 (A2) did not lose weight, mice infected by clinical strains showed significant weight loss and greater lung histopathology. Several clinical isolates caused lethal disease, which is unusual in mouse models of HMPV. Viral replication in lungs was variable, but peak lung viral titer did not correlate with disease outcome. Higher proinflammatory cytokine production in mouse lungs was associated with more severe disease and death. Virulent clinical isolates of HMPV exhibited diminished innate immune responses and decreased antigen-presenting cells, suggesting active inhibition of innate immunity. The findings were confirmed in BALB/c and DBA/2 inbred mice.

Conclusion:
Our results indicate that severe disease caused by HMPV clinical isolates was due to exuberant immune response and immunopathology. These data suggest that distinct HMPV strains may engage host immune mediators differently.
G-107 HPV vaccines: where are we now, and where are we going?
Authors: Trimble Cornelia L. 
Published: April 2018

On a global scale, at least 20% of human malignancies are caused by known infectious pathogens. Most are viruses; of these, human papillomavirus (HPV) causes more cancers than any other. In populations which do not have herd immunity because of insufficient uptake of the preventive vaccines, HPV infections are endemic, in part, because they are asymptomatic. In the cervix, disease is clinically indolent. In immune- competent persons, a transition from the intraepithelial cancer precursor lesion, cervical intraepithelial neoplasia 3 (CIN3) or high grade squamous intraepithelial lesion (HSIL), to invasive carcinoma is thought to take on the order of 10–15 years. Moreover, not all HSILs progress to cancer; in a relatively short observational window, we and others have reported spontaneous regression of biopsy-confirmed cervical HSIL in a subset of women. The current standard of care treatment is surgical resection. In women who are HIV seropositive, less is known. Persistent infections are common, and the incidence of cervical cancer is three-fold that of immune-competent women.
HPV lesions are relatively accessible, thereby providing a clinical setting in which to better understand the immunobiology of disease, and to test proof-of-principle of potential non-surgical interventions. The infectious etiology presents an opportunity to manipulate immune responses to viral antigens. Indeed, the preventative HPV vaccines, Gardasil and Cervarix, are nearly (100%) effective in vaccinated persons. Immune-based therapies for established HPV disease would address two significant clinical settings: (1) in eradicating established cancer precursor lesions (CIN3/HSIL), and (2) in recurrent or metastatic HPV cancers. Early studies have established proof-of-principle in both. Challenges presented in eradicating HPV disease will be discussed, as well as strategies moving forward.
I-104 Cardiovascular disease in HIV and chronic hepatitis C-infected patients
Authors: Bagchi Shashwatee 
Published: April 2018

Use of antiretroviral therapy has markedly reduced morbidity and mortality associated with human immunodeficiency virus (HIV) infection. Nonetheless, all-cause mortality rates remain high in HIV-infected patients compared to the general population, with non-AIDS conditions comprising almost half of deaths. Rates of coronary artery disease (CHD) are over twice as high in HIV-infected compared to matched uninfected controls, with rates anticipated to increase as this population ages. Factors contributing to increased risk of CHD in HIV-infected patients remain to be clearly elucidated. While some studies have strongly suggested that hepatitis C (HCV) co-infection is associated with increased rates of CHD in HIV-infected patients, results in all studies have not been consistent. Since HIV, HCV, and atherosclerosis are all associated with chronic inflammation and immune activation, it can be challenging to understand relative disease pathogenesis when found concurrently in individual patients. Identifying predictors of CHD progression from overlapping pathways has the potential to suggest novel preventive and therapeutic intervention strategies to mitigate CHD progression. In addition, if HCV infection is confirmed to confer additional risk for CHD among HIV-infected patients, this would provide further justification to treat HCV early and aggressively in this population irrespective of liver fibrosis stage.
The presentation will review the data on the individual contribution of HIV and chronic hepatitis C infection on the development of cardiovascular disease and the proposed mechanisms for these observations. Finally, new research investigating the intersections of these three disease processes with potential for future preventive and therapeutic interventions will be discussed.
Differentiating Drug-related and State-related Effects of Dexmedetomidine and Propofol on the Electroencephalogram
Authors: Scheinin Annalotta , Kallionpää Roosa E. , Li Duan , Kallioinen Minna , Kaisti Kaike , Långsjö Jaakko , Maksimow Anu , Vahlberg Tero , Valli Katja , Mashour George A. , Revonsuo Antti , Scheinin Harry 
Published: April 2018

Abstract

Background
Differentiating drug-related changes and state-related changes on the electroencephalogram during anesthetic-induced unconsciousness has remained a challenge. To distinguish these, we designed a rigorous experimental protocol with two drugs known to have distinct molecular mechanisms of action. We hypothesized that drug- and state-related changes can be separated.

Methods
Forty-seven healthy participants were randomized to receive dexmedetomidine (n = 23) or propofol (n = 24) as target-controlled infusions until loss of responsiveness. Then, an attempt was made to arouse the participant to regain responsiveness while keeping the drug infusion constant. Finally, the concentration was increased 1.5-fold to achieve presumable loss of consciousness. We conducted statistical comparisons between the drugs and different states of consciousness for spectral bandwidths, and observed how drug-induced electroencephalogram patterns reversed upon awakening. Cross-frequency coupling was also analyzed between slow-wave phase and alpha power.

Results
Eighteen (78%) and 10 (42%) subjects were arousable during the constant drug infusion in the dexmedetomidine and propofol groups, respectively (P = 0.011 between the drugs). Corresponding with deepening anesthetic level, slow-wave power increased, and a state-dependent alpha anteriorization was detected with both drugs, especially with propofol. The slow-wave and frontal alpha activities were momentarily disrupted as the subjects regained responsiveness at awakening. Negative phase-amplitude coupling before and during loss of responsiveness frontally and positive coupling during the highest drug concentration posteriorly were observed in the propofol but not in the dexmedetomidine group.

Conclusions
Electroencephalogram effects of dexmedetomidine and propofol are strongly drug- and state-dependent. Changes in slow-wave and alpha activity seemed to best detect different states of consciousness.
Evidence-Based Inclusion Criteria for Cochlear Implantation in Patients With Postlingual Deafness
Authors: Snel-Bongers Jorien , Netten Anouk P. , Boermans Peter-Paul B. M. , Rotteveel Liselotte J. C. , Briaire Jeroen J. , Frijns Johan H. M. 
Published: April 2018

Objectives:
This study determined the relationship between preoperative phoneme and word scores and the gain in speech perception after cochlear implantation in a large cohort of patients. The authors aimed to define evidence-based selection criteria for cochlear implantations in adults with postlingual deafness.

Design:
This retrospective study included 364 adults with postlingual deafness who received a cochlear implant between 2000 and 2013 at the Leiden University Medical Center. The gain in speech perception observed postimplantation was compared with preoperative-aided/binaural speech perception scores, measured at 65 dB SPL in quiet. Patients who showed preoperative phoneme scores on monosyllabic words above 50% were also tested for speech perception in the presence of speech-shaped background noise, at a +5 dB signal to noise ratio.

Results:
Speech perception in quiet improved after implantation in all except 7 patients. Average scores in quiet continued to improve, up to approximately 1 year after implantation. When participants were divided into five groups, based on preoperative speech perception scores, all groups showed gains in speech perception, except for the group with aided preoperative phoneme scores above 80%. However, all patients who were tested preoperatively with the addition of background noise showed improvements in speech perception in noise after the cochlear implantation.

Conclusions:
Although the decision to implant should consider individual ear differences and other factors that might apply to a particular case, based on our data, all patients with preoperative scores of either 80% (phonemes correct) or 60% (words correct) and lower in an optimal-aided situation are potential candidates for a cochlear implant, provided that their preoperative speech perception score decreases below 50% (phonemes correct) or 20% (words correct), when background noise is added at a +5 dB signal to noise ratio.
Targeted Distraction
Authors: Mardare Mihai , Kieser David Christopher , Ahmad Adil , Subramanian Thejasvi , Haleem Shahnawaz , Thakar Chrishan , Wilson-MacDonald James , Nnadi Colin 
Published: April 2018

Study Design.
Prospective cohort study

Objective.
To understand the efficacy of a tail-gating technique (TGT) to mirror the normal spinal growth of children with early-onset scoliosis (EOS) treated with magnetically controlled growing rods (MCGR).

Summary of Background Data.
MCGR allow outpatient distraction and guided spinal growth without the need for repeat surgery. Two techniques (maximal and targeted) are currently employed to determine the distraction amount, however the efficacy of each is unknown. This study specifically assesses the ability of targeted distraction to achieve physiological growth.

Methods.
We performed a retrospective review of European children treated with MCGR using a TGT and analyzed the post-operative clinical and radiographic outcomes, including the sitting height, standing height, coronal Cobb angle, T1-T12 and T1-S1 height. Furthermore, we compared the post-operative sitting/standing height ratio every 6 months to those reported for normal age- and sex-matched European children.

Results.
Thirty-five children were included with a mean follow-up of 3.4 years (1.8–5.8 years). All clinical and radiographic parameters significantly (P < 0.05) improved immediately post-operatively and were maintained until final follow-up. The TGT mirrored the normative sitting/standing height ratios for expected spinal growth (Pearson correlation 0.95 for males and 0.90 for females). The mean difference between the reference values for the sitting/standing height ratio and our results was 0.0124 (P < 0.001) for males and 0.0068 (P = 0.010) for females.

Conclusion.
MCGR can reliably improve the coronal deformity in children with EOS while maintaining spinal growth. A TGT to determine the distraction amount at follow-up accurately mirrors the normal growth pattern of age-, sex-, and ethnicity-matched children. However, patients treated with this technique have a statistically significant, but clinically insignificant, shorter than physiologically normal spinal height.

Level of Evidence: 3
The Prognostic Significance of Pedicle Enhancement from Contrast-enhanced MRI for the Further Collapse in Osteoporotic Vertebral Compression Fractures
Authors: Hyun Sung Eun , Ko Jin Young , Lee Eugene , Ryu Ju Seok 
Published: April 2018

Study Design.
A retrospective observational study.

Objective.
The aim of this study was to investigate the prognostic significance of contrast-enhanced magnetic resonance imaging (MRI) for detecting pedicle enhancement and predicting future collapse in patients with acute benign osteoporotic vertebral compression fracture (OVCF).

Summary of Background Data.
Traditional morphological classification regarding compression versus burst fractures cannot accurately anticipate the prognosis of further collapse. Identifying subgroups with a higher risk for further collapse may be beneficial in determining the treatment modality, which should be decided immediately after the injury.

Methods.
One hundred fourteen patients with benign OVCFs who, at the onset, underwent contrast-enhanced spine MRI between 2003 and 2016 were retrospectively analyzed. Patients were recruited on the basis of predefined inclusion and exclusion criteria. The primary outcome was the compression progression rate; other potential variables included demographic and clinical characteristics, initial compression rates, and kyphotic angles. In addition, other structural abnormalities on MRI were assessed. The compression progression rates were compared according to pedicle enhancement, and the prognostic significance of pedicle enhancement for further collapse were analyzed.

Results.
Further compression progression rates were significantly higher in the pedicle-enhanced (PE) group than in the nonenhanced (NE) group. Multivariate logistic analysis revealed that pedicle enhancement may be associated with further compression progression ≥10%. The vertebral augmentation (VAG) protective effect against collapse was only significant within the PE group, while bone densitometry and patients’ mobility were significant only within the NE group. The log-rank test revealed a statistically significant difference in the rates of further collapse ≥10% during the 1 year between the groups.

Conclusion.
Sign of pedicle enhancement is a potential risk factor for further compression progression. Contrast-enhanced MRI should be performed at the onset to better determine the future risk of collapse and to choose a better treatment modality for benign OVCF patients.

Level of Evidence: 3
Activity of Daily Living After Long Level Fusion in Adult Spinal Deformity
Authors: Kim Whoan Jeang , Lee Jae Won , Hwang Seok Young , Park Kun Young , Chang Shann Haw , Song Dae Geon , Choy Won Sik 
Published: April 2018

Study Design.
Prospective single center study.

Objective.
The aim of this study was to evaluate 1) the activity of daily living (ADL) of three categorized patients group; over 60-year-old degenerative spine patients without adult spinal deformity (ASD), nonoperative ASD patients, and operative ASD patients, 2) what kinds of activities would be impaired, and 3) how the ADL changes over time after long level fusion.

Summary of Background Data.
There is still debate how surgeons could decide treatment methods for old-aged adult spinal deformity, operatively or not. There was lack of information how long level fusion impacts daily activities, especially sedentary Asian lifestyle. In Asia, impaired ADL is much more important issue because of different lifestyle.

Methods.
Patients were categorized into three groups; Group 1 was over 60-year old aged degenerative spine disease without deformity, Group 2 was ASD patients who did not have surgery, and Group 3 was ASD patients who had surgery for deformity correction. Patients were evaluated using answer Oswestry Low Back Pain Disability Questionnaire, and Assessment activities of daily living for sedentary Asian culture (ADL-SA) questionnaire.

Results.
Group 1 showed nearly full functions in every activity (ADL-SA: 41.4). ADL-SA scores of Group 2 were similar to Group 1 (P = 0.452). However, get up from bottom (P < 0.001), and pick up object (P < 0.001) were impaired. After long level fusion, ADL was impaired but gradually improved by time. From postoperative 1 year, total ADL score recovered to acceptable range. However, among ADL, activities associated sedentary lifestyle (get up from bottom, wipe floor, pick up object, and sit cross-legged) were still impaired after 2 years postoperatively.

Conclusion.
ADL was impaired after long level fusion; however it would improve as time goes by. However, among ADL, activities associated sedentary lifestyle was still impaired. Hence give enough information to patients about limited activities before deciding operation.

Level of Evidence: 3
Providing Culturally Competent Acute Care Physical Therapy for a Complex Medical Patient of Amish Heritage
Authors: Horton Roy C. , Irwin Kent E. 
Published: April 2018

Background and Purpose:
Health care providers, including physical therapists, should identify and incorporate sociocultural, educational, and environmental factors in their clinical decisions for patients of various cultural backgrounds—specifically Amish heritage as illustrated in this case report. The purpose of this case report is to describe how cultural beliefs affected acute care physical therapy (PT) and discharge planning for an older adult of Amish heritage.

Case Description:
The patient was a 65-year-old woman of Amish heritage 2 days post thoracic aortic aneurysm dissection surgery with an unexpected subsequent stroke. Due to their Amish beliefs, the patient and the family declined the physical therapist's initial postacute care discharge recommendation to an off-site skilled nursing facility. Significant discussion with multiple family members throughout the entire therapy process emphasized continued skilled services in accord with Amish cultural beliefs to promote safe reintegration into the Amish community. PT interventions primarily focused on culturally sensitive patient and family education and functional mobility to encourage safe patient resumption of activities of daily living and role in society.

Outcomes:
By the end of 2 weeks of PT (1 initial examination and 8 intervention sessions), the patient demonstrated improvements in all aspects of functional mobility and total Functional Independence Measure scores (21/126 to 86/126). On postoperative day 14, the patient transitioned to an on-site inpatient rehabilitation facility. After completing only 4 days in the inpatient rehabilitation facility, the family firmly advocated that the patient be discharged home with assistance from the family and Amish community.

Discussion:
Physical therapists may be unfamiliar with patients of Amish heritage due to the infrequency of PT services used by these individuals. This case report demonstrates a physical therapist's sensitivity to and acceptance of the Amish cultural beliefs, which ensured appropriate clinical decisions and positive patient- and family-centered outcomes. Engaging the patient's family in dialogue about realistic discharge options early in the acute care stay allowed the family time to understand the complexity of the patient's diagnoses and challenges of the health care environment as well as align decisions with their cultural beliefs.
Acute and 6-Month Outcomes in Recipients of Lung Transplantation Following Lower Extremity Strength Training: Pilot Study
Authors: Smith Barbara K. , Carter Nicole , Arteaga Angela , Dinh Amy C. , Martin A. Daniel 
Published: April 2018

Purpose:
Individuals who receive lung transplantation (LTx) have prolonged lower extremity weakness that limits exercise capacity and function. The purposes of this pilot study were to measure whether acute, intense, gym-based rehabilitation significantly increased walking distance and lower extremity strength after LTx and to identify whether gains were retained at 6-month follow-up.

Methods:
Nine men (mean age =57 years) completed 4 weeks of daily (5×/wk), gym-based acute care rehabilitation after LTx. Rehabilitation included stretching, aerobic conditioning, education, and either low- or high-volume strength training. Outcomes were assessed at baseline, 4 weeks, and 6 months post-LTx and included 1-repetition maximum (1-RM) tests, isokinetic torque, isometric torque, and 6-minute walk distance.

Results:
Patients attended an average of 17 acute rehabilitation sessions. Following acute rehabilitation, walking distance was increased and patients achieved greater 1-RM for leg press and for knee extension. Regardless of the volume of strength training, knee extension isometric torque and isokinetic torque were significantly increased (P < .05). At 6 months, subjects achieved further gains in leg press 1-RM and grip strength (P < .05), while walking and other strength measures were maintained.

Conclusions:
Intense rehabilitation produced acute lower extremity strength improvements that were retained after 6-months. Further study is needed in a larger sample.