bluuebunny/crossref_metadata_2025_split huggingface dataset:
Activation of the NF-κB Pathway and Heterozygous Deletion of TNFAIP3 (A20) Confer Superior Survival in Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type
Authors: Liu Fang , Zheng Jun-Ping , Wang Lu , Zhao Dan-Hui , Li Ming-Yang , Wang Ying-Mei , Liu Yang , Ma Jing , Zeng Nai-Yan , Liu Hong-Xiang , Liang Rong , Guo Shuang-Ping , Wang Zhe , Yan Qing-Guo 
Published: March 2019

ABSTRACT

Objectives
To investigate the role of TNFAIP3 deletions and NF-κB activation in extranodal natural killer/T-cell lymphoma (ENKTCL), nasal type.

Methods
In total, 138 patients with ENKTCL were included. Activation of NF-κB pathway and expression of TNFAIP3 (A20) were examined by immunohistochemistry. TNFAIP3 was analyzed for deletions using FICTION (fluorescence immunophenotyping and interphase cytogenetics as a tool for investigating neoplasms), for mutations using Sanger sequencing, and for promoter methylation using methylation-specific sequencing.

Results
NF-κB pathway activation was observed in 31.2% of cases (43/138), TNFAIP3 expression was negative in 15.2% of cases (21/138), and heterozygous TNFAIP3 deletion was observed in 35% of cases (35/100). TNFAIP3 exons 2 to 9 mutations and promoter methylation were not observed. Kaplan-Meier analysis showed patients with NF-κB pathway activation or TNFAIP3 heterozygous deletion to have a longer overall survival.

Conclusions
Our study demonstrated that NF-κB activation and TNFAIP3 heterozygous deletion confer superior survival in patients with ENKTCL.
Counterpoint: Keeping the Demons at Bay When Handling Time-Varying Exposures—Beyond Avoiding Immortal Person-Time
Authors: Edwards Jessie K , Htoo Phyo T , Stürmer Til 
Published: March 2019

Abstract
The potential for immortal time bias is pervasive in epidemiologic studies with left truncation or time-varying exposures. Unlike other biases in epidemiologic research (e.g., measurement bias, confounding due to unmeasured factors, and selection based on unmeasured predictors of the outcome), immortal time bias can and should be avoided by the correct assignment of person-time during follow up. However, even when handing person-time correctly, allowing late entry into a study or into an exposure group can open the door to more insidious sources of bias, some of which we explore here. Clear articulation of the study question, including the treatment plans of interest, can provide navigation around these sources of bias and elucidate the assumptions needed for inference given the available data. Here, we use simulated data to illustrate the assumptions required under various approaches to estimate the effect of a time-varying treatment and describe how these assumptions relate to the assumptions necessary to estimate single sample rates and risks in settings with censoring and truncation.
Surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis vs total colectomy with ileorectal anastomosis for intractable slow-transit constipation
Authors: Xie Xiao-Yu , Sun Kong-Liang , Chen Wen-Hao , Zhou Yan , Chen Bao-Xiang , Ding Zhao , Yu Xue-Qiao , Wu Yun-Hua , Qian Qun , Jiang Cong-Qing , Liu Wei-Cheng 
Published: March 2019

Abstract

Background
Few studies have compared the surgical outcomes of different surgical procedures currently used to treat refractory colonic slow-transit constipation (STC), despite the increase in the number of cases. This study aimed to analyse the long-term surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis (SC-ACRA) vs total colectomy with ileorectal anastomosis (TC-IRA) for severe STC.

Methods
Between January 2005 and January 2015, we retrospectively collected clinical data of 55 patients who underwent TC-IRA (n = 35) or SC-ACRA (n = 20) for severe STC at our institution. The post-operative functional outcomes between the two groups were compared.

Results
There were no significant differences in age (P = 0.655), sex (P = 0.234), period of constipation (P = 0.105) and defecation frequency (P = 0.698) between the TC-IRA and SC-ACRA groups. During a median follow-up period of 72 months (range, 12–120 months), there were no significant differences between the TC-IRA and SC-ACRA groups regarding the median number of bowel movements per day [3 (1/6–7) vs 3 (1/6–5), P = 0.578], Cleveland Clinic Florida Constipation Score [2 (0–20) vs 2 (0–19), P = 0.454], Cleveland Clinic Incontinence Score [0 (0–5) vs 0 (0–2), P = 0.333] and Gastrointestinal Quality of Life Index [122 (81–132) vs 120 (80–132), P = 0.661]. Moreover, there was no significant difference in the incidence of post-operative complications between the two groups (37.1% vs 25.0%, P = 0.285).

Conclusions
Our findings indicate that both TC-IRA and SC-ACRA are effective treatments for severe STC, with similar long-term outcomes.
On the Success of the Hadal Snailfishes
Authors: Gerringer M E 
Published: March 2019

SynopsisDeep-sea trenches, depths 6000–11,000 m, are characterized by high pressures, low temperatures, and absence of sunlight. These features make up the majority of the deepest marine habitat—the hadal zone—home to distinct communities from those in the surrounding abyssal plains. The snailfishes, family Liparidae (Scorpaeniformes), have found notable success in the hadal zone from ∼6000 to 8200 m, comprising the dominant ichthyofauna in at least six trenches worldwide. The hadal fish community is distinct from the abyssal community where elongate, scavenging fishes such as rattails (Macrouridae), cutthroat eels (Synaphobranchidae), tripodfishes (Ipnopidae), eelpouts (Zoarcidae), and cusk eels (Ophidiidae) are most common. Until recently, little was known about the biology of these deepest-living fishes, or the factors that drive their success at hadal depths. Here, I review recent investigations spanning the abyssal–hadal boundary and discuss the factors structuring these communities, including the roles of pressure adaptation, feeding ecology, and life history. Hadal fishes show specialized adaptation to hydrostatic pressure both in accumulation of the pressure-counteractant trimethylamine n-oxide and in intrinsic changes to enzymes. Stomach content and amino acid isotope analyses, and jaw morphology suggest that suction-feeding predatory fishes like hadal liparids may find an advantage to descending into the trench where amphipods are increasingly abundant. Analysis of otolith growth zones suggest that snailfishes may be adapted to a seismically active, high-disturbance hadal environment by having relatively short life-spans. This review synthesizes the known literature on the planet’s deepest-living fishes and informs new understanding of adaptations to life in the trenches.
Electronic health record (EHR) training program identifies a new tool to quantify the EHR time burden and improves providers’ perceived control over their workload in the EHR
Authors: DiAngi Yumi T , Stevens Lindsay A , Halpern – Felsher Bonnie , Pageler Natalie M , Lee Tzielan C 
Published: March 2019

AbstractObjectiveTo understand if providers who had additional electronic health record (EHR) training improved their satisfaction, decreased personal EHR-use time, and decreased turnaround time on tasks.Materials and MethodsThis pre-post study with no controls evaluated the impact of a supplemental EHR training program on a group of academic and community practice clinicians that previously had go-live group EHR training and 20 months experience using this EHR on self-reported data, calculated EHR time, and vendor-reported metrics.ResultsProviders self-reported significant improvements in their knowledge of efficiency tools in the EHR after training and doubled (significant) their preference list entries (mean pre = 38.1 [65.88], post = 63.5 [90.47], P &lt; .01). Of the 7 EHR satisfaction variables, only 1 self-reported variable significantly improved after training: Control over my workload in the EHR (mean pre = 2.7 [0.96], post = 3.0 [1.04], P &lt; .01). There was no significant decrease in their calculated EHR usage outside of clinic (mean pre = 0.39 [0.77] to post = 0.37 [0.48], P = .73). No significant difference was seen in turnaround time for patient calls (mean pre = 2.3 [2.06] days, post = 1.9 [1.76] days, P = .08) and results (mean before = 4.0 [2.79] days, after = 3.2 [2.33] days, P = .03).DiscussionMultiple sources of data provide a holistic view of the provider experience in the EHR. This study suggests that individualized EHR training can improve the knowledge of EHR tools and satisfaction with their perceived control of EHR workload, however this did not translate into less Clinician Logged-In Outside Clinic (CLOC) time, a calculated metric, nor quicker turnaround on in box tasks. CLOC time emerged as a potential less-costly surrogate metric for provider satisfaction in EHR work than surveying clinicians. Further study is required to understand the cost-benefit of various interventions to decrease CLOC time.ConclusionsThis supplemental EHR training session, 20 months post go-live, where most participants elected to receive 2 or fewer sessions did significantly improve provider satisfaction with perceived control over their workload in the EHR, but it was not effective in decreasing EHR-use time outside of clinic. CLOC time, a calculated metric, could be a practical trackable surrogate for provider satisfaction (inverse correlation) with after-hours time spent in the EHR. Further study into interventions that decrease CLOC time and improve turnaround time to respond to inbox tasks are suggested next steps.
Mapping Modern Rejuvenation: An Introduction
Authors: Alexander Kristine , Honeck Mischa , Richter Isabel 
Published: March 2019

Abstract
The desire to conquer old age is as old as humanity itself, yet the pursuit of youthfulness acquired a fiercer urgency with the rise of post-Enlightenment conceptions of youth as a redemptive social force. This introductory essay widens the circle of what constitutes modern rejuvenation by moving beyond the standard focus on anti-aging medicine and lays out the historiographical and methodological stakes of conceptualizing rejuvenation more broadly. Its main contention is that rejuvenation can serve as an analytical linchpin to reveal unrecognized connections between various historically specific projects of regeneration and repair that were comprised in individual flesh-and-blood as well as in imagined collective bodies such as nations and empires.
Posterior Fossa Decompression With or Without Duraplasty in the Treatment of Paediatric Chiari Malformation Type I: A Literature Review and Meta-Analysis
Authors: Honeyman Susan I , Warr William 
Published: March 2019

Abstract

INTRODUCTION
Chiari malformation I (CM-1) is a posterior fossa structural abnormality, characterized by caudal displacement of cerebellar tonsils, through the foramen magnum.
Posterior fossa decompression (PFD), involving a suboccipital craniectomy and C1 laminectomy, remains the definitive treatment. Both PFD alone (PFDO) and PFD with additional duraplasty (PFDD) are used in surgical practices. This review evaluates the current literature comparing outcomes of CM-1 treatment using PFDO and PFDD.

METHODS
A literature search of EMBASE and MEDLINE was conducted. References from January 1980 to January 2018 were retrieved. Only papers containing original data, comparing the use of PFDD and PFDO in paediatric CM-1 patients, were included.

RESULTS
Eighteen relevant papers were identified, with a resulting cohort of 4030 patients, 46.1% underwent PFDD and 53.9% PFDO. PFDD was associated with 60 min longer mean operation duration, and longer mean hospital stays by 0.7 d. PFDD provided greater symptomatic improvement (OR: 2.13; 95% CI: 1.31-3.45; P = .002). However, PFDD was also associated with increased postoperative complications (OR: 1.71, 95% CI: 1.41-2.08; P = .0001), in particular CSF leak and meningitis. PFDD was not significantly associated with incidence of syrinx improvement or revision surgery, relative to PFDO.

CONCLUSION
From the current literature, PFDD is associated with greater clinical improvement but higher risk of postsurgical complications, in comparison to PFDO for the treatment of paediatric CM-1. The requirement for a large cohort prospective study, adjusting for case-mix, which evaluates the relative efficacy of these 2 techniques have been identified. Current evidence is low quality, with limited statistical power.
Predicting Non-Routine Discharge After Elective Spine Surgery: External Validation of Machine Learning Algorithms Using Institutional Data
Authors: Stopa Brittany M , Robertson Faith C , Karhade Aditya , Chua Melissa , Broekman Marike L D , Schwab Joseph H , Smith Timothy R , Gormley William B 
Published: March 2019

Abstract

INTRODUCTION
Non-routine discharge after elective spine surgery negatively impacts patient outcomes and increases healthcare costs. Preoperative prediction in this population could improve discharge planning. We previously developed an algorithm that predicts non-home discharge after elective spine surgery. Here, we validate our algorithm in an institutional population of neurosurgical spine patients from a Transitional Care Program (TCP) at an academic, tertiary care center.

METHODS
Medical records from elective inpatient surgery for lumbar disc herniation or degeneration in the TCP program (2013–2015) were retrospectively reviewed. Variables included age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) class, preoperative functional status, number of fusion levels and discharge disposition. The discrimination and calibration of the previous algorithm was assessed in the independent sample, using Python 3.0 software.

RESULTS
A total of 144 patients underwent elective inpatient surgery for lumbar disc disorders with a non-home discharge rate of 10 (7%). The algorithm generalized well to the institutional data with c-statistic 0.89, calibration slope 1.09 and calibration intercept −0.08. This was comparable to performance in the derivation cohort and substantiates initial use of this algorithm in clinical practice. Prospective validation of this algorithm and comparison to other existing discharge prediction models is ongoing.

CONCLUSION
This institutional external validation of a previously developed machine learning algorithm suggests a reliable method for identifying lumbar disc disorder patients at risk for non-routine discharge. This tool can be used by multidisciplinary teams of case management and spine surgeons to strategically invest additional time and resources into postoperative plans for this population.
Thirty-Day Mortality and Survival in Elderly Patients Undergoing Neurosurgery
Authors: Bligh Emily Rose , Al-Tamimi Yahia , Sinha Priyank , Smith Daisy 
Published: March 2019

Abstract

INTRODUCTION
With an ageing population and advances in neuroanaesthesia and critical care, there is an increasing subgroup of patients greater than 70 yr of age presenting to neurosurgical departments and undergoing surgery. We are now moving towards the idea of a frailty index. The aim of the current study is to investigate 30-d mortality and survival in this cohort following emergency and elective neurosurgery.

METHODS
Retrospective cohort study. All patients aged 70 yr and above, who had undergone a neurosurgical procedure from April 2015 to April 2017 were identified. Online patient electronic records were retrieved to gather information related to procedure type, co-morbidities, days in hospital, discharge destination, complications and mortality. Logistic regression analysis was used to identify predictors of mortality.

RESULTS
A total of 798 patients in total of whom 623 were <80 yr (group A) and 175 were >80 yr (group B). Male : Female = 3 : 1. Mean age of the study was 76 yr. There were 390 elective and 408 emergency admissions. Overall 30-d mortality = 5.6% (8% in group B). Overall survival was 86.5% in group A and 79.4% in group B. There was a significant difference in 30-d mortality between elective (0.8%) and emergency (10.3%) patients. About 84.5% of patients were discharged back to their usual place of residence in group A but this figure was 68.9% for group B. Logistic regression found emergency surgery (P > .001) and degenerative spine diagnosis to be independent predictors of mortality (P = .05).

CONCLUSION
The current model for accepting elderly patients is associated with a good overall outcome. The elderly should not be refused neurosurgery on their age per se. We have applied fairly strict and stringent criteria particularly in SAH and TBI.
Establishment of the European Medical Students' Neurosurgery Society–A Proposal
Authors: Stumpo Vittorio 
Published: March 2019

Abstract

INTRODUCTION
Recent years have witnessed the birth in the United States of Neurosurgery Medical Students Chapters aimed at fostering the interest toward neurosurgery and at supporting students willing to pursue a career in academic neurosurgery by making available research and mentoring opportunities. The American Association of Neurological Surgeons has pioneered the support of these programs and medical chapters are currently active in most US medical schools where they receive support from local Neurosurgery Departments and Research Centers. On the contrary, the European network of medical students' neurosurgical interest groups is fragmented and this opportunity is largely unexploited.

METHODS
The present abstract is intended to propose the establishment of the European Medical Students' Neurosurgery Society which would represent a tremendous opportunity to build a collaborative network and promote students' interest toward neurosurgery with the aim of increasing learning, research and mentoring opportunities.

RESULTS
The Italian Medical Student Neurosurgery Interest Group is currently underway and will be launched soon. Other medical students' societies active in European countries are invited to join this project to establish a proactive European Neurosurgical Student Network and to advocate the birth of other groups.

CONCLUSION
The establishment of this society under EANS support would represent the ideal platform for leadership positions in the medical student community at local and national level that will be important to acquire experience and promote a virtuous circle of knowledge and service while also providing the basis for scientific production on the current state of medical students' recruiting in neurosurgery around Europe.
Quantitative Diffusion Tensor Imaging (DTI) Analysis Reveals Different Infiltrative Patterns of Oligodendrogliomas and Astrocytomas in Peri-Tumour White Matter
Authors: Murphy Christopher , Agushi Erjon , Su Zhangjie , Hinz Rainer , Roncaroli Federico , Coope David 
Published: March 2019

Abstract

INTRODUCTION
Gliomas are highly infiltrative primary brain tumours. Glioma infiltration is difficult to identify clinically using conventional diagnostic imaging. We used diffusion tensor imaging (DTI) to identify glioma infiltration in peritumour white matter (WM) and characterized differences between histological subtypes.

METHODS
We recruited 8 patients with a histological diagnosis of grade II or III glioma and 10 healthy controls. We compared fractional anisotropy (FA) maps of each patient against the control group using SPM8 (Matlab 2014a) to identify regions of glioma infiltration. The FA and mean diffusivity (MD) of formerly WM matter tumour regions, infiltrated WM and normal appearing WM were compared with a 2-sample t-test and characterized with respect to normal control data.

RESULTS
Our results have identified radiological evidence of infiltration in the peri-tumour WM of glioma patients. The infiltrated region of oligodendrogliomas extended further than that of astrocytomas. Oligodendrogliomas preferentially infiltrated larger WM tracts, whereas astrocytomas infiltrated more peripheral WM. In all grades, the 3 regions had significantly different diffusion parameters and there were significant differences between oligodendrogliomas and astrocytomas.

CONCLUSION
We identified previously unrecognized study wide significant changes in the peri-tumour WM of gliomas. Despite the known propensity of these tumours to infiltrate WM we found no significant DTI changes distant to the tumour. Our DTI results suggest oligodendrogliomas and astrocytomas demonstrate different infiltrative patterns, which highlights the need for astrocytomas and oligodendrogliomas to be studied separately.
PET Imaging and Glioblastoma
Authors: Weigel Katharina 
Published: March 2019

Abstract

INTRODUCTION
Patients who present with Glioblastoma have a median survival of around 15 mo, even when treated with the most aggressive methods available. Imaging of glial cell tumours is faced with multiple challenges, including the accurate delineation of abnormal tissue and the identification of low-grade gliomas.
PET imaging depicts aspects of tissue activity in Vivo and thus, helps us improve our understanding of the tumor's size and behavior. While functional imaging is already an established modality in other fields of oncology, the appropriate tracer for the imaging of glial cancers remains under investigation since FDG, the traditional oncological tracer, proves suboptimal due to the high physiological glucose uptake of the cerebral grey matter.

METHODS
In this literature review, I discuss the physiological characteristics as well as the opportunities for clinical application of the tracers FDG, C-MET, FET, FDOPA and FLT.

RESULTS
Although PET imaging remains expensive and availability of tracers is limited by their mode of production and decaying nature, integration of PET scanning into the treatment pathway offers clear patient benefits. While sensitivity of the PET tracers C-MET and FET exceeds that of traditional imaging modalities, application in screening is limited by associated expenses. Combining amino-acid PET tracers with traditional modalities has shown significant benefits in biopsy and radiotherapy planning.

CONCLUSION
All amino acid tracers show good results in distinguishing treatment response from early recurrence, a task where MRI, the current gold standard, is lacking in reliability. FET shows especially good results in monitoring residual tumour mass.
Prognosticating Traumatic Brain Injury (TBI): Analysis of CRASH, IMPACT Models and Patient Age in a Cohort of TBI Patients
Authors: Gillespie Conor , McMahon Catherine 
Published: March 2019

Abstract

INTRODUCTION
Both CRASH and IMPACT models have been developed in recent years to predict the outcome of Traumatic Brain Injury (TBI). However, there is no clear evidence as to how these models perform in a modern cohort of UK-patients. There is also predictive uncertainty with regards to survival rates and functional outcome in elderly (>65 yr) patients.

METHODS
Patients referred to a tertiary neuroscience center from December 2014 to January 2016 with a suspected TBI were retrospectively examined. For each model, the predicted survival and overall outcome were compared to the actual outcome on admission and at 6 mo post injury, stratified by patient age (>65 yr vs ≤65 yr).

RESULTS
A total of 161 patients met the initial criteria; mean age 65 yr (SD = 21) and 110 male. Both CRASH and IMPACT correctly predicted 6-mo mortality rates and functional outcomes in most patients (range 61.7%-82.4%), with better predictive performance for patients not accepted to the center (range 84%-98%). There was no significant difference in the initial survival of elderly patients if accepted (78% [95% CI 50.6-104.0] vs 81% [95% CI 67.8-94.8] but were lower for those not accepted (24% [95% CI 4.2-43.7] vs 76% [95% CI 63.5-88.5], P = .027).

CONCLUSION
Patients >65 yr admitted to tertiary neuroscience center had good survival rates on admission and at 6 mo. The lesser ability of CRASH and IMPACT models to predict poorer outcomes when accepted suggests that acceptance to specialist centers may be able to improve outcome and suggests more optimistic treatment and acceptance of appropriate over 65 yr should be considered.