bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved Postoperative Metrics with Modified Myofascial Closure in Fetal Myelomeningocele Repair
Authors: Flanders Tracy M , Madsen Peter J , Pisapia Jared M , Hudgins Eric D , Mackell Catherine M , Alexander Erin E , Moldenhauer Julie S , Zarnow Deborah M , Flake Alan W , Adzick N Scott , Heuer Gregory G 
Published: June 2019

Abstract

BACKGROUND
The effect of modifications in fetal myelomeningocele (fMMC) closure techniques has not been extensively studied.

OBJECTIVE
To study the effect of a modified closure technique on fMMC postnatal patient outcomes: hydrocephalus, hindbrain herniation, and cyst development.

METHODS
We performed single-center retrospective study of a subset of post-MOMS (Management of Myelomeningocele Study) trial patients who underwent fMMC closure. After January 2015, the fetal myofascial closure technique was modified. Needlepoint monopolar cautery was used to raise dural lined myofascial flaps to create a more robust closure. Outcomes between the pre- and postmodification groups were compared with regard to hindbrain herniation, hydrocephalus, and cyst development. Families who transitioned care to local institutions were contacted via telephone for outcome information.

RESULTS
From January 2011 to May 2016, data were reviewed from 119 fMMC closure patients. Patients without full follow-up data were excluded from the final analysis. Cerebrospinal fluid diversion was seen in 32 of 74 patients with the standard technique compared to 14 of 45 with the modified closure and was significantly decreased in postmodification when compared to that of the MOMS trial (P = .01). Hindbrain herniation resolution was significantly decreased in both the pre- and postmodification groups compared to that of the MOMS trial (P < .01). Prior to January 2015 with standard closure, 23 cysts required resection whereas no cysts required resection in the modified repair group (P < .01).

CONCLUSION
Modified myofascial closure for fMMC closure is safe and feasible. The new approach reflects a decreased rate of cyst development requiring surgical resection, and a trend for improved rates of hindbrain herniation and hydrocephalus.
Protecting Against Postoperative Dyspnea and Dysphagia After Occipitocervical Fusion
Authors: Gonda David D , Huang Meng , Briceño Valentina , Lam Sandi K , Luerssen Thomas G , Jea Andrew 
Published: June 2019

Abstract

BACKGROUND
Upper airway obstruction leading to dyspnea and dysphagia after occipitocervical fusion is a rare complication that has significant morbidity.

OBJECTIVE
To estimate the frequency of postoperative dyspnea and dysphagia in children after occipitocervical fusion and to identify variables associated with its occurrence.

METHODS
We retrospectively reviewed outcomes from all pediatric occipitocervical fusions at our institution between 2007 and 2014. Pre- and postoperative computed tomography (CT) scans were compared to determine differences in the clivoaxial (OC2) angles.

RESULTS
Sixty-seven pediatric patients underwent occipitocervical fusions. Median age was 9.6 yr (range 6 mo-18 yr). Fifty-six of 62 patients (90.3%) with at least 1 yr of follow-up had successful fusions. Eleven had pre-existing symptoms or otherwise compromised examination (eg, severe traumatic brain injury). None of 15 patients placed in extension (>2 degrees) relative to preoperative CT in Situ position developed new dyspnea or dysphagia. Nine of forty patients (23%) kept in Situ or flexed position developed new symptoms of dyspnea or dysphagia. Dysphagia in patients fused in the in Situ position was milder and resolved within a few weeks. No patient under age 5 (n = 20) developed symptoms of dyspnea or dysphagia regardless of head position. There were 3 cases of infection, 1 clinically silent vertebral artery injury, and 3 deaths at last follow-up.

CONCLUSION
Positioning of the child's head prior to occipitocervical fusion has considerable impact on outcomes, especially in older children. Careful measurements of the OC2 angle during surgery to ensure optimal head positioning in Situ or slightly extended position may prevent postoperative dysphagia or dyspnea.
Posterior Inferior Cerebellar Artery (PICA) Reanastomosis After Excision of a Ruptured p2-PICA Aneurysm: 2-Dimensional Operative Video
Authors: Cavallo Claudio , Labib Mohamed , Gandhi Sirin , Moreira Leandro Borba , Mascitelli Justin , Lawton Michael T 
Published: June 2019

Abstract
Posterior inferior cerebellar artery (PICA) aneurysms have an increased tendency towards a fusiform morphology precluding primary clip reconstruction. The management of these complex aneurysms might require cerebral revascularization to preserve flow in a distal PICA territory. This video illustrates a case of a ruptured p2-PICA aneurysm excision followed by a PICA reanastomosis. A 54-yr-old male presented with a sudden-onset severe headache, diplopia, and complete left cranial nerve six (CN VI) palsy. Neuroimaging demonstrated diffuse subarachnoid hemorrhage in basal cisterns. A catheter angiogram shows a ruptured small fusiform aneurysm in the p2-PICA segment. After obtaining consent for surgery, the patient was placed in a three-quarter prone position. After a hockey stick skin incision and C1 laminectomy, a lateral suboccipital craniotomy was performed. The aneurysm was identified within the vagoaccessory triangle. Cerebral protection consisted of propofol-induced electroencephalography burst suppression during the clamp time for the bypass, without hypothermia or hypertension. After trapping the aneurysm and excising the diseased arterial segment, the distal end of the p2-PICA was reanastomosed to the proximal parent vessel in an end-to-end fashion. Indocyanine green angiography confirmed patency of the anastomosis. Postoperatively, the patient was neurologically at his baseline. The CN VI palsy had completely resolved at a follow-up visit. Reanastomosis is an effective modality for reconstructing PICA following the excision of the fusiform aneurysm. The redundancy of the tonsillomedullary segment of PICA allows for easier distal segment reapproximation in the inferior hypoglossal triangle. An intracranial-intracranial revascularization technique eliminates the need for harvesting the occipital artery. Additionally, it prevents iatrogenic ischemic injury to contralateral PICA, if used for a PICA-PICA bypass.
1
© Barrow Neurological Institute, used with permission.
Microsurgical Resection of a Left Cerebral Peduncle Cavernous Malformation: 3-Dimensional Operative Video
Authors: Ceccato Guilherme H W , Rassi Marcio S , Borba Luis A B 
Published: June 2019

Abstract
Brainstem cavernous malformations are challenging lesions considering the numerous eloquent structures frequently related. Surgical resection is the preferred treatment if the patient is symptomatic and the lesion can be safely resected. We present the case of a right-handed 38-yr-old female, presenting with progressive impairment of her handwriting. Physical examination showed a right-sided grade 4/5 hemiparesis. Preoperative imaging was suggestive of a left cerebral peduncle cavernous malformation with a recent area of hemorrhage. The most superficial portion of the lesion was on the surface of the brainstem in the supratrigeminal safe entry zone of the pons. A frontotemporal craniotomy was performed, followed by a pretemporal transtentorial approach. Prior to performing brainstem incision, the area was stimulated, and no motor evoked potential was recorded. The hematoma was then evacuated, and the cavernous malformation was dissected and removed. The capsule was also dissected and removed, using neurophysiological monitoring to guide this procedure. The lesion was completely resected, and the patient was discharged on postoperative day 7 with a right-sided hemiparesis grade 3/5, which improved to grade 5/5 after 4 mo. The patient presented an improvement of her symptoms, with no new neurological deficits. Brainstem cavernomas can be safely removed in selected cases, using the adequate safe entry zone and the appropriate surgical approach. The pretemporal route can be used to reach the anterolateral aspect of the upper part of the brainstem, as it combines the advantages of both transsylvian and subtemporal approaches. An informed consent was obtained from the patient for publication of this operative video.
Absence of Ischemic Injury after Sacrificing the Superior Petrosal Vein during Microvascular Decompression
Authors: Xia Yuanxuan , Kim Timothy Y , Mashouf Leila A , Patel Kisha K , Xu Risheng , Casaos Joshua , Choi John , Kim Eileen S , Hung Alice L , Wu Adela , Garzon-Muvdi Tomas , Bender Matthew T , Jackson Christopher M , Bettegowda Chetan , Lim Michael 
Published: June 2019

Abstract

BACKGROUND
Sacrificing the superior petrosal vein (SPV) is controversial during a microvascular decompression (MVD). There have been multiple reports of complications including life-threatening brainstem infarction and cerebellar edema.

OBJECTIVE
To analyze the potential for vascular complications when the SPV is sacrificed during an MVD.

METHODS
Retrospective chart review was performed to identify all MVDs for trigeminal neuralgia and hemifacial spasm from 2007 to 2018 at 1 institution. Cases with ≥1 mo of follow-up were included and SPV sacrifice was noted. The primary outcome was complications related to SPV sacrifice including sinus thrombosis, cerebellar edema, and midbrain or pontine infarction. Imaging was used to confirm all potential vascular complications noted in medical records. Fisher's exact test and unpaired t-tests were used to compare between groups.

RESULTS
A total of 732 MVD cases were identified and 592 met inclusion criteria with an average follow-up of 11.8 ± 16.4 mo and a male-to-female ratio of 1:2.2. The SPV was sacrificed in 217 cases and retained in 375 cases. No SPV-related vascular complications were found in this study. Two unrelated cases of vascular complications were identified and both were in the nonsacrificed group. One case involved cerebellar bleeding while the other was an ipsilateral transverse sinus thrombosis that was present preoperatively.

CONCLUSION
In MVDs, there is no difference in the rate of vascular complications when the SPV is sacrificed compared to preserved. To best visualize a cranial nerve and optimize safe decompression, surgeons should feel free to sacrifice the SPV.
Obesity prevalence in large US cities: association with socioeconomic indicators, race/ethnicity and physical activity
Authors: Benusic Michael , Cheskin Lawrence J 
Published: June 2019

AbstractBackgroundObesity has a complex association with socioeconomic factors. Further clarification of this association could guide population interventions.MethodsTo determine the relationship between obesity prevalence, socioeconomic indicators, race/ethnicity, and physical activity, we performed a cross-sectional, multivariable linear regression, with data from large US cities participating in the Big Cities Health Inventory.ResultsIncreased household income was significantly associated with decreased obesity prevalence, for White (−1.97% per 10 000USD), and Black (−3.02% per 10 000USD) populations, but not Hispanic. These associations remained significant when controlling for the proportion of the population meeting physical activity guidelines. Educational attainment had a co-linear relationship with income, and only a bachelor’s degree or higher was associated with a lower prevalence of obesity in White (−0.30% per percentage) and Black (−0.69% per percentage) populations. No association was found between obesity prevalence and the proportion of the population meeting physical activity guidelines for any race/ethnicity grouping.ConclusionAt the population level of large US cities, obesity prevalence is inversely associated with median household income in White and Black populations. Strategies to increase socioeconomic status may also decrease obesity. Targeting attainment of physical activity guidelines as an obesity intervention needs further appraisal.
Feeding differing direct-fed microbials and its influence on growth and haematological parameters of growing lambs1
Authors: Antwi Christopher , Mensa Patience A , Arthur Fareed K N , Frimpong Yaw O , Baah John 
Published: June 2019

Abstract
A 4 mo feeding trial was conducted to ascertain the effect of direct-fed microbial (DFM) and their products, namely rumen enhancer three (RE3), Paenibacillus polymyxa (P3), and a fermentation product of RE3—RE3 Plus on the growth and haematological profile of lambs at different stages of growth (suckling, weaner, and grower phases). The lambs weighing 2.5 ± 2 kg were blocked by their weights and allotted to four dietary treatments, namely Control, RE3, RE3 Plus, and P3 in a randomized complete block design. Blood sampling of lambs to investigate the effect of the treatments on the haematological and blood biochemistry variables was done on monthly basis and analysis of variance in a repeated measures design was done using the Statistical Analysis System. Feed intake (FI) by lambs was not significantly (P &gt; 0.05) influenced by DFM supplementation for all the phases of growth. However, feed conversion ratio (FCR) for the grower phase of the lamb was higher for T2. Similar (P &gt; 0.05) hemoglobin (Hb), red blood cell (RBC), pack cell volume (PCV), mean corpuscular volume, mean corpuscular hemoglobin concentration (MCHC), eosinophil, lymphocyte, and basophil composition were recorded for lambs on the different experimental diets. Neutrophil and monocytes levels were, however, different (P &lt; 0.05) for lambs fed the varying dietary treatments with lambs on RE3 Plus diets recording the lowest (P &lt; 0.05) neutrophil levels. Monocytes levels were highest (P &lt; 0.05) in lambs fed diets fortified with RE3. Sampling period influenced (P &lt; 0.05) the Hb, RBC, PCV, MCHC, eosinophil, monocyte, and lymphocyte levels. The trial revealed a significant treatment × sampling period interaction (P &lt; 0.0001) for the blood parameters examined. The inclusion of the different DFM products had no influence on the growth characteristics and blood profile of growing lambs.
New insights into the evolution of lateral compound eyes in Palaeozoic horseshoe crabs
Authors: Bicknell Russell D C , Amati Lisa , Ortega-Hernández Javier 
Published: June 2019

AbstractVision allows animals to interact with their environment. Aquatic chelicerates dominate the early record of lateral compound eyes among non-biomineralizing crown-group euarthropods. Although the conservative morphology of lateral eyes in Xiphosura is potentially plesiomorphic for Euarthropoda, synziphosurine eye organization has received little attention despite their early diverging phylogenetic position. Here, we re-evaluate the fossil evidence for lateral compound eyes in the synziphosurines Bunodes sp., Cyamocephalus loganensis, Legrandella lombardii, Limuloides limuloides, Pseudoniscus clarkei, Pseudoniscus falcatus and Pseudoniscus roosevelti. We compare these data with lateral eyes in the euchelicerates Houia yueya, Kasibelinurus amicorum and Lunataspis aurora. We find no convincing evidence for lateral eyes in most studied taxa, and Pseudoniscus roosevelti and Legrandella lombardii are the only synziphosurines with this feature. Our findings support two scenarios for euchelicerate lateral eye evolution. The elongate-crescentic lateral eyes of Legrandella lombardii might represent the ancestral organization, as suggested by the phylogenetic position of this taxon in stem-group Euchelicerata. Alternatively, the widespread occurrence of kidney-shaped lateral eyes in stem-group Xiphosura and stem-group Arachnida could represent the plesiomorphic condition; Legrandella lombardii eyes would therefore be derived. Both evolutionary scenarios support the interpretation that kidney-shaped lateral eyes are ancestral for crown-group Euchelicerata and morphologically conserved in extant Limulus polyphemus.
Community turnover by composition and climatic affinity across scales in an alpine system
Authors: Smithers Brian V. , Oldfather Meagan F. , Koontz Michael J. , Bishop Jim , Bishop Catie , Nachlinger Jan , Sheth Seema N. 
Published: June 2019

ABSTRACTPremise of the studyExamining community turnover across climate gradients at multiple scales is vital to understanding biogeographic response to climate change. This approach is especially important for alpine plants in which the relative roles of topographic complexity and non-climatic or stochastic factors vary across spatial scales.MethodsWe examined the structure of alpine plant communities across elevation gradients in the White Mountains, California. Using community climatic niche means (CCNMs) and measures of community dissimilarity, we explored the relationship between community composition and elevation gradients at three scales: the mountain range, individual peaks, and within elevation contours.Key ResultsAt the mountain range scale, community turnover and CCNMs showed strongly significant relationships with elevation, with an increase in the abundance of cooler and wetter-adapted species at higher elevations. At the scale of a single peaks, we found weak and inconsistent relationships between CCNMs and elevation, but variation in community composition explained by elevation increased. Within the elevation contours, the range of CCNMs was weakly positively correlated with turnover in species identity, likely driven by microclimate and other site-specific factors.ConclusionsOur results suggest that there is strong environmental sorting of alpine plant communities at broad scales, but microclimatic and site-specific, non-climatic factors together shape community turnover at finer scales. In the context of climate change, our results imply that community-climate relationships are scale-dependent, and predictions of local alpine plant range shifts are limited by a lack of topoclimatic and habitat information.
Endothelial-derived exosomes demonstrate a link between endothelial innate inflammation and brain dysfunction and injury in aging
Authors: Elahi F.M. , Harvey D. , Altendahl M. , Casaletto K.B. , Fernandes N. , Staffaroni A.M. , Maillard P. , Hinman J.D. , Miller B.L. , DeCarli C. , Kramer J.H. , Goetzl E.J. 
Published: June 2019

ABSTRACTWe test the hypothesis that endothelial cells take on an inflammatory phenotype in functionally intact human subjects with radiographic evidence of white matter injury. Markers within all three complement effector pathways and regulatory proteins were quantified from endothelial-derived exosomes (EDE) of subjects (age 70-82) with (n=11) and without (n=16) evidence of white matter hyperintensity on MRI. Group differences and associations with systemic markers of immune activation (IL6, ICAM1), cognition and neuroimaging were calculated via regression modelling.EDE complement factors within the alternative and classical pathways were found to be higher and regulatory proteins lower in subjects with WMH. EDE levels of several factors demonstrated significant associations with cognitive slowing and systolic blood pressure. The inhibitor of the membrane attack complex, CD46, showed a significant positive association with cerebral grey matter volume. Systemic inflammatory markers, IL6 and ICAM1, were positively associated with EDE levels of several factors.These findings provide the first in vivo evidence of the association of endothelial cell inflammation with white matter injury, cognition, and brain degeneration in functionally normal older individuals, and form the basis for future biomarker development in early or preclinical stages of vascular cognitive impairment and dementia.
Impact of herbivore preference on the benefit of plant trait variability
Authors: Thiel Tatjana , Gaschler Sarah , Mody Karsten , Blüthgen Nico , Drossel Barbara 
Published: June 2019

AbstractWe explore the hypothesis that intraspecific trait variability can beper sebeneficial for the plant when the curvature of the herbivore response to this trait is concave downwards. This hypothesis is based on a mathematical relation for non-linear averaging (Jensen’s inequality), leading to reduced herbivory when the trait distribution becomes broader. Our study introduces and investigates a model for plants and their insect herbivores that includes an unequal distribution of nutrient content between leaves. In contrast to earlier publications, we take into account the ability of herbivores to choose leaves, and the associated costs. By performing computer simulations and analytic calculations, we find that this herbivore preference can considerably alter the conclusion cited above. In particular, we demonstrate that herbivore populations that show preference for leaves on which they grow well can benefit from large nutrient level variability independently of the curvature of the herbivore response function, and despite the cost for preference.
A novel Mendelian randomization method identifies causal relationships between gene expression and low-density lipoprotein cholesterol levels
Authors: van der Graaf Adriaan , Claringbould Annique , Rimbert Antoine ,   BIOS consortium, Westra Harm-Jan , Li Yang , Wijmenga Cisca , Sanna Serena 
Published: June 2019

AbstractRobust inference of causal relationships between gene expression and complex traits using Mendelian Randomization (MR) approaches is confounded by pleiotropy and linkage disequilibrium (LD) between gene expression quantitative loci (eQTLs). Here we propose a new MR method, MR-link, that accounts for unobserved pleiotropy and LD by leveraging information from individual-level data. In simulations, MR-link shows false positive rates close to expectation (median 0.05) and high power (up to 0.89), outperforming all other MR methods we tested, even when only one eQTL variant is present. Application of MR-link to low-density lipoprotein cholesterol (LDL-C) measurements in 12,449 individuals and eQTLs summary statistics from whole blood and liver identified 19 genes causally linked to LDL-C. These include the previously functionally validatedSORT1gene, and thePVRL2gene, located in theAPOElocus, for which a causal role in liver was yet unknown. Our results showcase the strength of MR-link for transcriptome-wide causal inferences.
The histopathological staging of tau, but not amyloid, corresponds to antemortem cognitive status, dementia stage, functional abilities, and neuropsychiatric symptoms
Authors: Malpas Charles B , Sharmin Sifat , Kalincik Tomas 
Published: June 2019

AbstractObjectiveAlzheimer’s disease (AD) is characterised by two cardinal pathologies, namely the extracellular accumulation amyloid-related aggregates, and the intracellular formation of taurelated neurofibrillary tangles (NFTs). While both pathologies disrupt cognitive function, a large body of evidence suggests that tau-pathology has a stronger relationship with the clinical manifestation of the disease compared to amyloid. Given the ordinal nature of histopathological staging systems, however, it is possible that the effect of amyloid pathology has been underestimated in clinicopathological studies.MethodWe investigated this possibility using data from the National Alzheimer’s Coordinating Center (NACC) database. Bayesian ordinal models were used to directly investigate the relative contribution of Braak NFT, diffuse plaque, and neuritic plaque staging to the severity of antemortem clinical impairment.ResultsData from 144 participants were included in the final analysis. Bayesian ordinal models revealed that Braak NFT stage was the only predictor of global cognitive status, clinical dementia stage, functional abilities, and neuropsychiatric symptoms. When compared directly, Braak NFT stage was a stronger predictor than diffuse or neuritic plaques across these domains.ConclusionsThese findings confirm that tau-related pathology is more strongly related to clinical status than amyloid pathology. This suggests that conventional clinical markers of disease progression might be insensitive to amyloid-pathology, and hence might be inappropriate for use as outcome measures in therapeutic trials that directly target amyloid.