bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microsurgical Strategies for the Treatment of Compression Neuropathies Secondary to Vertebrobasilar Dolichoectasia: From Simple Decompression to Sling Transposition
Authors: Barrow Daniel L , Ellis Jason A 
Published: December 2018

Abstract

BACKGROUND
Vertebrobasilar artery dolichoectasia may result in neural element compression anywhere along its course within the cervical region, the craniocervical junction or in the posterior fossa. The clinical syndromes most often observed include cranial neuropathy, bulbar dysfunction, myelopathy and cervical radiculopathy. When indicated, the operative techniques utilized to address vertebrobasilar artery dolichoectasia must be individually tailored, can be technically challenging, and have been rarely expounded.

OBJECTIVE
To share selected cases that demonstrate the variety of pathological states caused by vertebrobasilar artery dolichoectasia as well as our experience in managing this condition.

METHODS
Here we review examples of pathological impingement of neural elements compressed by ectasia within the vertebrobasilar arterial system throughout its anatomic course. The surgical techniques we have employed to alleviate the compression, including simple decompression as well as sling-assisted arterial transposition, are described. The evolution and refinement of our transposition technique are detailed.

RESULTS
A wide range of pathological conditions may result from compression of neural structures throughout the course of the vertebrobasilar system. Compression of cervical nerve roots, the spinal cord, brainstem, and cranial nerves can be seen. Microsurgical management may be indicated in selected cases with gratifying results.

CONCLUSION
Pathological compression of neural structures throughout the course of the vertebrobasilar system should be recognized. When indicated, microsurgical decompression must be tailored to the individual symptomology and the unique anatomic relationship in each case with the potential to prevent neurological worsening and, in many cases, improve functional outcome.
“I didn’t want to be on Suboxone at first…” – Ambivalence in Perinatal Substance Use Treatment
Authors: Ostrach Bayla , Leiner Catherine 
Published: December 2018

Objectives:
The objectives of this article are to present findings from recent qualitative research with patients in a combined perinatal substance use treatment program in Central Appalachia, and to describe and analyze participants’ ambivalence about medication-assisted treatment for opioid use disorder (OUD), in the context of widespread societal stigma and judgement.

Methods:
We conducted research in a comprehensive outpatient perinatal substance use treatment program housed in a larger obstetric practice serving a large rural, Central Appalachian region. The program serves patients across the spectrum of substance use disorders but specifically offers medication-assisted treatment to perinatal patients with OUD. We purposively and opportunistically sampled patients receiving prescriptions for buprenorphine or buprenorphine-naloxone dual product, along with prenatal care and other services. Through participant-observation and semi-structured interviews, we gathered qualitative data from 27 participants, in a total of 31 interviews. We analyzed transcripts of interviews and fieldnotes using modified Grounded Theory.

Results:
Participants in a combined perinatal substance use treatment program value supportive, non-judgmental care but report ambivalence about medication, within structural and institutional contexts of criminalized, stigmatized substance use and close scrutiny of their pregnancies. Women are keenly aware of the social and public consequences for themselves and their parenting, if they begin or continue medication treatment for OUD.

Conclusions:
Substance use treatment providers should consider the social consequences of medication treatment, as well as the clinical benefits, when presenting treatment options and recommendations to patients. Patient-centered care must include an understanding of larger social and structural contexts.
Quantitative Assessment of Muscle Strength Following “Slow” Surgical Lengthening of the Medial Hamstring Muscles in Children With Cerebral Palsy
Authors: Davids Jon R. , Cung Nina Q. , Sattler Kelly , Boakes Jennette L. , Bagley Anita M. 
Published: December 2018

Background:
Classic teaching for surgical lengthening of muscle contractures in children with cerebral palsy (CP) has emphasized complete correction of the deformity acutely, with immobilization of the targeted muscles in the fully corrected position. Clinical experience has led to the impression that the muscles are invariably weakened by this approach. We have developed an alternative technique for correction of contractures called slow surgical lengthening (SSL). The goal of the study was to determine the physical examination, kinematic, and muscle strength outcomes following SSL of the medial hamstring muscles in children with CP.

Methods:
The study group included 41 children with CP who underwent SSL of the medial hamstring muscles as part of a comprehensive single-event multilevel surgery, who had preoperative and 1-year postoperative evaluations in our Motion Analysis Center, which included quantitative assessment of isometric and isokinetic muscle strength.

Results:
All subjects were Gross Motor Function Classification System I and II. Mean age at the time of surgery was 10.8 years. The mean popliteal angle improved by 16.2 degrees (P<0.001) following SSL of the medial hamstrings. Sagittal plane kinematics following SSL of the medial hamstrings showed improvement of knee extension at initial contact of 10.2 degrees (P<0.001), decrease of peak knee flexion in mid-swing of 3.6 degrees (P=0.014), improved minimum knee flexion in stance of 4.9 degrees (P=0.002), and no significant change in mean anterior pelvic tilt (P=0.123). Mean peak isometric knee flexion torque remained unchanged from preoperative to postoperative studies (P=0.154), whereas mean peak isokinetic knee flexion torque significantly increased by 0.076 Nm/kg (P=0.014) following medial hamstring SSL.

Discussion:
SSL was developed based upon clinical experience and improved understanding of the pathophysiology of skeletal muscle in children with CP. The SSL technique allows the tendinous tissue to separate spontaneously at the time of recession, but does not force further acute lengthening by intraoperative manipulation, thereby minimizing the damage to the underlying muscle. It is broadly believed that muscle weakness is inevitable following surgical lengthening. The current study shows that the SSL technique does not cause weakness.

Level of Evidence:
Level IV—therapeutic.
Pembrolizumab for metastatic adrenocortical carcinoma with high mutational burden
Authors: Mota Jose Mauricio , Sousa Luana Guimarães , Braghiroli Maria Ignez , Siqueira Luiz Tenório , Neto João Evangelista Bezerra , Chapchap Paulo , Hoff Ana A. de Oliveira , Hoff Paulo M. 
Published: December 2018

Abstract

Rationale:
In the setting of metastatic or locally advanced adrenocortical carcinoma, a limited number of therapies are available and their efficacy is generally below modest. The backbone of treatment remains surgery, even for metastatic disease, whenever it is possible, and mitotane. Chemotherapy can be used with limited results. A small subset of patients with adrenocortical carcinoma may have high mutational burden and harbor mutations in mismatch-repair genes.

Patient concerns:
We report a 40-year old and a 28-year-old female patients with metastatic adrenocortical carcinoma refractory to multiple treatments.

Diagnosis:
Next-generation sequencing detected high mutational burden (>10 mutations/megabase) in both patients, one of them with MSH2 mutation.

Interventions:
They were treated with pembrolizumab (100 to 200 mg every 3 weeks).

Outcomes:
The patient harboring a MSH2 mutation experienced a long-term complete response after pembrolizumab, while the patient with high mutational burden and absence of mismatch repair deficiency did not have any response.

Lessons:
To the best of our knowledge, this is the first report in the literature of a durable complete response after pembrolizumab in a patient with metastatic adrenocortical carcinoma. Differences in therapy sequencing, possibly abscopal effect related to multiple previous radiotherapy exposition, predictive values of high mutational burden and mutations in mismatch-repair genes are discussed.
Staged reconstructive treatment for extensive irregular cicatricial alopecia after burn
Authors: Tang Songjia , Wu Xiaoxin , Sun Zhongxin , Cheng Hanxiao , Shen Haiyan , Tang Liang , Zhou Jinghe , Jia Ming , Li Jinsheng , Zhang Jufang 
Published: December 2018

Abstract
For extensive irregular cicatricial alopecia after burn, effective and pleasing restoration of hair-bearing scalp remains challenging. In this article, the authors presented staged reconstructive treatment for extensive irregular cicatricial alopecia with the goal to achieve better and reliable results. A retrospective review of staged reconstructive treatment performed in 16 patients with extensive irregular cicatricial alopecia after burn was conducted. In stage 1, final flaps were designed at 1st. Tissue expanders were placed into the subgaleal plane and serially inflated with normal saline. In stage 2, scarring tissues were excised and the expanded hair-bearing flaps were advanced to the defect. Hair grafts were harvested from excessive hair-bearing scalps excised from the flaps and replanted. For patients with less satisfactory results, stage 3 was performed by hair transplantation. Cicatricial area, follicular unit density, survival rate of hair grafts, and patients’ satisfaction were measured before and after each stage. Thirteen patients received 3-stage treatment, and 3 received 2-stage treatment. Significant improvements in aesthetics and patient satisfaction were achieved in all the patients. No flap necrosis, implant exposure or hematoma was observed. Ideal, aesthetic, and reliable results could be obtained using staged reconstructive treatment for patients with extensive irregular cicatricial alopecia after burn.
Modified translaryngeal tracheostomy for ventilator-dependent cardiac patients
Authors: Babaee Touraj , Tabaei Ali Sadeghpour , Moludi Jalal , Alavi Seyyed Mostafa , Tabaei Sepehr Sadeghpour 
Published: December 2018

Abstract

Introduction:
A significant proportion of ventilator-dependent cardiac patients need tracheostomy during intensive care unit (ICU) stay. Three different methods including traditional (surgical), percutaneous dilatation tracheostomy, translaryngeal tracheostomy (TLT), and classical Fantoni method have been developed. In this study, modified translaryngeal tracheostomy (MTLT) has been introduced to reduce and correct the technical difficulty of classical TLT through the larynx.

Materials and methods:
The patients hospitalized because of cardiac diseases whose stay in ICU and coronary care unit lasted longer than 3 weeks, and were consulted and advised for elective tracheostomy. Afterwards, MTLT was performed for all patients (the new method).

Results:
From the 159 patients, 64.2% were women. The mean age was 65.25 ± 14.35 years. There was no considerable hemorrhage (bleeding >5–10 mL). The mean values of arterial oxygen pressure, oxygen saturation, heart rate, systolic blood pressure, and a peak airway pressure before and after MTLT had a significant improvement (P < .05), which reflects a better hemodynamic state after tracheostomy. All of the tracheostomies (MTLT) were successful and without any complications. There was no considerable bleeding despite the high international normalized ratio levels.

Conclusions:
Unlike the classical Fantoni method, this study indicates that using a new improved method of tracheostomy through larynx did not impose any difficulty on retrograde passage of guide wire and this procedure could be safely conducted on patients with coagulation disorders.
Correlation analysis between SNPs in microRNA-machinery genes and tuberculosis susceptibility in the Chinese Uygur population
Authors: Cheng Hong , Li Haixia , Feng Yangchun , Zhang Zhaoxia 
Published: December 2018

Abstract
Tuberculosis (TB) is an infectious disease caused by a mycobacterial infection, with high morbidity and mortality worldwide. The pathogenesis of TB is still unclear; however, a growing body of evidence suggests that host genetic factors may play important roles in susceptibility to TB, and different gene polymorphisms in different ethnic and genetic backgrounds may lead to different effects. In view of the above theories, our research group used bioinformatics to screen for 12 single nucleotide polymorphisms (SNPs), including rs1045481, rs1045491, rs2740349, rs10719, rs642321, rs3744741, rs7813, rs3742330, rs3757, rs14035, rs720012, and rs4961280, which are derived from 6 main genes (i.e., GEMIN4, DICER1, DROSHA, DGCR8, AGO2, and RAN) acting in the microRNA-machinery pathway. We then analyzed the correlations between TB patients of Uygur in Xinjiang China and the above SNPs using a case–control study. The results showed that the genotypic distributions of rs720012 (from gene DGCR8) and rs4961280 (from gene AGO2) were not in accordance with the Hardy–Weinberg equilibrium (P < .05), so they were deleted. Subjects carrying the rs3742330 AG/GG genotype, rs1045481 GA genotype, rs1045491 CT genotype, and rs7813 AG genotype, respectively, had an increased risk of TB than individuals carrying rs3742330 AA genotype, rs1045481 GG/AA genotype, rs1045491 CC/TT genotype, and rs7813 AA/GG genotype between different groups. Expression quantitative trait loci analysis found that rs3744741 and rs2740349 from gene GEMIN4 had a regulatory effect, while rs3742330 from gene DICER1 had a reverse regulatory effect. Finally, according to the results of Linkage Disequilibrium between SNPs, the haplotype analysis showed that the haplotype of GCTAC from gene GEMIN4 had statistical differences when compared with active and inactive TB. The current experimental results provide a direction for our future research, and the research team will conduct more in-depth studies on the correlation between miRNA and TB.
Ischemia reperfusion injury in kidney transplantation
Authors: Philipponnet Carole , Aniort Julien , Garrouste Cyril , Kemeny Jean-Louis , Heng Anne-Elisabeth 
Published: December 2018

Abstract

Rationale:
Kidney transplantation is considered the best treatment for patients with end stage renal disease. Ischemia- reperfusion injury (IRI) is an evitable event after deceased donor transplantation and influences short term and long term graft outcome. Few data on IRI's histology in the setting of kidney transplantation are available in the literature despite its frequency and its severity.

Patient concerns:
A 64-year-old patient was admitted for his 1st kidney transplantation. There were no pre-existing immunization. The surgery proceeded without complications; with cold ischemia estimated at 37 h 50 min and warm ischemia at 44 min. The immunosuppression protocol was as follows: induction by thymoglobulins, mycophelonate mofetil, corticosteroids. Few hours after transplantation, the patient remained anuric and the biological assessment highlighted in addition to renal failure, hyperlactatemia at 5 mmol/L and a high increase in lactate deshydrogenase (LDH) at 5239 U/L. An abdominopelvic angio-scanner was performed urgently to eliminate the hypothesis of thrombosis of the artery or vein of the graft. A kidney biopsy was performed the day after the transplant and revealed massive lesions of acute tubular necrosis including apoptosis, autophagy-associated cell death, and necrosis. Microvascular dysfunction with increased vascular permeability and endothelial cell inflammation were also present. Activation of coagulation is represented by thrombi in the lumens of the glomerular capillaries.

Diagnosis:
The diagnosis was ischemia reperfusion injury responsible for delayed graft function (DGF).

Interventions:
Immunosuppressive regimen was delayed use of calcineurin inhibitors, mycophenolate mofetil, and corticosteroids.

Outcomes:
At 1 year post transplant, the patient has a renal autonomy with a graft function stable and physiological proteinuria.

Lessons:
The main clinical consequences of IRI in kidney transplant are DGF, acute and chronic graft rejection, and chronic graft dysfunction. Reducing IRI is one of the most relevant challenge in kidney transplantation.
Etiologic impact on difference on clinical outcomes of patients with heart failure after cardiac resynchronization therapy
Authors: Chen Jian-Shu , Niu Xiao-Wei , Chen Fen-mei , Yao Ya-Li 
Published: December 2018

Abstract

Objective:
To compare long-term clinical outcomes between patients with heart failure due to non-ischemic cardiomyopathy (NICM) and those due to ischemic cardiomyopathy (ICM) after cardiac resynchronization therapy (CRT).

Methods and Results:
EMbase, PubMed, and Cochrane Library were searched for published studies up to December 2017. Twenty-one observational studies with 12,331 patients were enrolled in the present meta-analysis. The results demonstrated that the all-cause mortality in NICM patients was significantly lower than that in ICM patients (RR 1.37, 95% CI 1.16–1.61). In terms of echocardiographic parameters, NICM patients exhibited statistically significant improvement in left ventricular ejection fraction (LVEF) (MD 2.70, 95%CI -4.13 to -1.28), and a significant decrement in left ventricular end-systolic volume (LVESV) (MD 10.41,95% CI 2.10–18.73) and left ventricular end diastolic diameter (LVEDD) (MD 7.63, 95% CI 2.59–12.68) as compared with ICM patients. No significant difference was observed in the improvement of New York Heart Association Functional Classification (MD 0.05, 95% CI -0.05 to 0.15), pulmonary arterial systolic pressure (PASP) (MD -0.61, 95% CI -4.36 to 3.14), and severity of mitral regurgitation (MD 0.00, 95% CI -0.08 to 0.07) between the 2 groups.

Conclusions:
Our meta-analysis illustrated that patients with HF due to NICM tended to have better clinical outcomes and LV reverse remodeling as compared with those due to ICM. This finding may help clinicians select patients who respond favorably to CRT, though further research is required to clarify the potential confounding factors and underlying mechanisms for this phenomenon.
Risk factors for child maltreatment by the utilization of medical service and socioeconomic environment in Taiwan
Authors: Hsin Yi-Chen , Chang Yu-Ching , Lee En-Pei , Chiu Cheng-Hsun , Chou I.-.Jun , Hsia Shao-Hsuan , Lin Kuang-Lin , Lee Jung , Huang Jing-Long , Wang Chao-Jan , Wu Han-Ping 
Published: December 2018

Abstract
Child maltreatment is complicated by cultural, welfare, and socioeconomic factors. However, the relationship between child maltreatment and socioeconomic factors has not been completely understood. We investigated risk factors for child abuse and neglect in Taiwan.
The data in our study was obtained from Taiwan National Statistics at county level from 2004 to 2015. We included 4 areas (eastern, western, southern, northern) involving 20 cities and counties. The trends of child maltreatment rate based on different years and different areas were surveyed. In addition, panel data analysis was used to analyze the links between child maltreatment rate and socioeconomic factors.
An increasing trend of child maltreatment rate in Taiwan was observed. During the past decade, child maltreatment rate increased from 14.5 in 2004 to 23.4 cases per 10000 children in 2014. The peak, which was 43 cases per 10000 children, occurred in 2012. Significant geographical differences were observed, and the highest child maltreatment rate was seen in eastern Taiwan. Panel data analysis revealed a lag effect of the unemployment rate on child maltreatment rate at the county level: the child maltreatment rate increased by 7 percent, while the prior unemployment rate increased by one percent. In addition, the medical personnel density was related to the child maltreatment rate within the county.
Previous unemployment rate had a lag impact on child maltreatment occurrence. Unemployment rate has not only a direct impact on the economy but also sequential effects on child maltreatment.
Thrombocytopenic purpura following envenomation by the nose-horned viper (Vipera ammodytes ammodytes)
Authors: Lukšić Boris , Karabuva Svjetlana , Markić Joško , Polić Branka , Kovačević Tanja , Meštrović Julije , Križaj Igor 
Published: December 2018

Abstract

Rationale:
Two clinical cases are reported of envenomation by the nose-horned viper (Vipera ammodytes ammodytes) venom of a 9-year-old boy and of an 84-year-old woman.

Patient concerns:
Both patients had been bitten on their extremities by such a snake in August near Split, a town in southern Croatia.

Diagnoses:
Clinical manifestation of envenomation was severe in the case of the boy, being characterized by a severe coagulopathy. This was only just apparent in the case of the elderly woman, who suffered extensive local edema and hematoma at the site of the bite, together with a neurotoxic effect—bilateral ptosis. This was the first occasion of thrombocytopenic purpura being observed in patients envenomed by nose-horned viper venom. This unexpected clinical finding was characterized by an unusually profound thrombocytopenia of 5 and 10 × 109/L platelets of the respective patients on their admission to the hospital, together with purpura, observed on the face and thorax of both individuals. In the most serious cases, such pathology can be life threatening if not promptly recognized and treated.

Interventions:
The patients recovered quickly on receiving the specific antivenom along with all the usual supportive treatments.

Outcomes:
No serious sequels were noticed at the moment of discharge.

Lessons:
Our finding constitutes an important message to clinicians to consider the possibility of such complications in the case of nose-horned viper envenomation.
The efficacy and safety of thrombolytic agents for patients with cerebral infarction
Authors: Huang Shenghui , Jiang Junshi , Xu Zhiming , Lu Cuncun , Cao Fang , Sang Wengxia , Gong Ting , Li Yanyi 
Published: December 2018

Abstract

Background:
Cerebral infarction is a commonly dangerous disease also with high morbidity and mortality. Thrombolytic agent is an effective method to treat it, but their relative efficacy and safety are unclear. A network meta-analysis (NMA) will be conducted to resolve this urgent problem.

Methods:
The PubMed, Embase, and Cochrane library will be systematically search from their inception to November 2018. All randomized controlled trials (RCTs) will be included this NMA and their risk of bias will be assessed using Cochrane handbook tool. The outcomes of efficacy and safety including: Modified Rankin Scale scores, reperfusion rate, incidence of symptomatic intracerebral hemorrhage and all-cause mortality. A network meta-analysis will be performed using R x64 3.5.1 software and pairwise meta-analysis will be conducted using Stata 12.0 software (Stata Corp., College Station, Texas). Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to assess quality of outcomes.

Results:
The results of NMA will be published in a peer-reviewed journal.

Conclusion:
The NMA will provide a comprehensive evidence summary on thrombolytic agents for patients with cerebral infarction.