bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comprehensive preclinical assessment of late-term imaging markers of radiation-induced brain injury
Authors: Tang Tien T , Zawaski Janice A , Kesler Shelli R , Beamish Christine A , Reddick Wilburn E , Glass John O , Carney Darrell H , Sabek Omaima M , Grosshans David R , Gaber M Waleed 
Published: July 2019

Abstract

Background
Cranial radiotherapy (CRT) is an important part of brain tumor treatment, and although highly effective, survivors suffer from long-term cognitive side effects. In this study we aim to establish late-term imaging markers of CRT-induced brain injury and identify functional markers indicative of cognitive performance. Specifically, we aim to identify changes in executive function, brain metabolism, and neuronal organization.

Methods
Male Sprague Dawley rats were fractionally irradiated at 28 days of age to a total dose of 30 Gy to establish a radiation-induced brain injury model. Animals were trained at 3 months after CRT using the 5-choice serial reaction time task. At 12 months after CRT, animals were evaluated for cognitive and imaging changes, which included positron emission tomography (PET) and magnetic resonance imaging (MRI).

Results
Cognitive deficit with signs of neuroinflammation were found at 12 months after CRT in irradiated animals. CRT resulted in significant volumetric changes in 38% of brain regions as well as overall decrease in brain volume and reduced gray matter volume. PET imaging showed higher brain glucose uptake in CRT animals. Using MRI, irradiated brains had an overall decrease in fractional anisotropy, lower global efficiency, increased transitivity, and altered regional connectivity. Cognitive measurements were found to be significantly correlated with six image features that included myelin integrity and local organization of the neural network.

Conclusions
These results demonstrate that CRT leads to late-term morphological changes, reorganization of neural connections, and metabolic dysfunction. The correlation between imaging markers and cognitive deficits can be used to assess late-term side effects of brain tumor treatment and evaluate efficacy of new interventions.
Sporadic Peutz–Jeghers syndrome: a rare cause of intussusception in a toddler with no medical history
Authors: Nassif Mhmmad , Gawrieh Bardisan , Abdo Aras , Alshehabi Zuheir , Ali Wajih 
Published: July 2019

AbstractPeutz–Jeghers syndrome (PJS) is an unusual hamartomatous polyposis of the gastrointestinal tract associated with melanocytic mucocutaneous hyperpigmentation. This research paper examines the case of an 18-month-old Syrian female who had been diagnosed with intussusception. The patient underwent laparotomy, and multiple small bowel polyps were found to act as the lead point. For this reason, small bowel resection (~15 cm), with end-to-end anastomosis, were performed. Although PJS diagnosis was histopathologically confirmed, the patient had no pigmented lesions on the face, the lower lip or the buccal mucosa and neither had any history of hospitalization or family history of the disease. This case was examined and is reported in the present study because PJS is rarely present at this early age when significant medical history is lacking.
Parotid swelling due to external carotid artery thrombus—a rare manifestation in antiphospholipid syndrome
Authors: Basu Rajdeep , De Hazra Omkarr , Mondal Sumantro , Ghosh Srabani , Ghosh Soumitra 
Published: July 2019

Abstract
Vascular complications in forms of venous and arterial thrombi are common scenario in antiphospholipid syndrome with raised titer of antibodies. Here we describe an 18 years old female who was admitted with right parotid swelling due to external carotid artery thrombi within gland parenchyma in antiphospholipid syndrome, with past history of right lower leg arterial occlusion and digital gangrene.
Opioid- and Motor-sparing with Proximal, Mid-, and Distal Locations for Adductor Canal Block in Anterior Cruciate Ligament Reconstruction
Authors: Abdallah Faraj W. , Mejia Jorge , Prasad Govindarajulu A. , Moga Rebecca , Chahal Jaskarandip , Theodoropulos John , Dwyer Tim , Brull Richard 
Published: July 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
The ideal location for single-injection adductor canal block that maximizes analgesia while minimizing quadriceps weakness after painful knee surgery is unclear. This triple-blind trial compares ultrasound-guided adductor canal block injection locations with the femoral artery positioned medial (proximal adductor canal), inferior (mid-adductor canal), and lateral (distal adductor canal) to the sartorius muscle to determine the location that optimizes postoperative analgesia and motor function. The hypothesis was that distal adductor block has (1) a superior opioid-sparing effect and (2) preserved quadriceps strength, compared with proximal and mid-locations for anterior cruciate ligament reconstruction.

Methods
For the study, 108 patients were randomized to proximal, mid-, or distal adductor canal injection locations for adductor canal block. Cumulative 24-h oral morphine equivalent consumption and percentage quadriceps strength decrease (maximum voluntary isometric contraction) at 30 min postinjection were coprimary outcomes. The time to first analgesic request, pain scores, postoperative nausea/vomiting at least once within the first 24 h, and block-related complications at 2 weeks were also evaluated.

Results
All patients completed the study. Contrary to the hypothesis, proximal adductor canal block decreased 24-h morphine consumption to a mean ± SD of 34.3 ± 19.1 mg, (P < 0.0001) compared to 64.0 ± 33.6 and 65.7 ± 22.9 mg for the mid- and distal locations, respectively, with differences [95% CI] of 29.7 mg [17.2, 42.2] and 31.4 mg [21.5, 41.3], respectively, mostly in the postanesthesia care unit. Quadriceps strength was similar, with 16.7%:13.4%:15.3% decreases for proximal:mid:distal adductor canal blocks. The nausea/vomiting risk was also lower with proximal adductor canal block (10 of 34, 29.4%) compared to distal location (23 of 36, 63.9%; P = 0.005). The time to first analgesic request was longer, and postoperative pain was improved up to 6 h for proximal adductor canal block, compared to mid- and distal locations.

Conclusions
A proximal adductor canal injection location decreases opioid consumption and opioid-related side effects without compromising quadriceps strength compared to mid- and distal locations for adductor canal block in patients undergoing anterior cruciate ligament reconstruction.
Oxidants Regulated Diaphragm Proteolysis during Mechanical Ventilation in Rats
Authors: Moroz Nikolay , Maes Karen , Leduc-Gaudet Jean-Philippe , Goldberg Peter , Petrof Basil J. , Mayaki Dominique , Vassilakopoulos Theodoros , Rassier Dilson , Gayan-Ramirez Ghislaine , Hussain Sabah N. 
Published: July 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Diaphragm dysfunction and atrophy develop during prolonged controlled mechanical ventilation. Fiber atrophy has been attributed to activation of the proteasome and autophagy proteolytic pathways. Oxidative stress activates the proteasome during controlled mechanical ventilation, but it is unclear whether it also activates autophagy. This study investigated whether pretreatment with the antioxidant N-acetylcysteine affects controlled mechanical ventilation–induced diaphragm contractile dysfunction, fiber atrophy, and proteasomal and autophagic pathway activation. The study also explored whether proteolytic pathway activity during controlled mechanical ventilation is mediated by microRNAs that negatively regulate ubiquitin E3 ligases and autophagy-related genes.

Methods
Three groups of adult male rats were studied (n = 10 per group). The animals in the first group were anesthetized and allowed to spontaneously breathe. Animals in the second group were pretreated with saline before undergoing controlled mechanical ventilation for 24 h. The animals in the third group were pretreated with N-acetylcysteine (150 mg/kg) before undergoing controlled mechanical ventilation for 24 h. Diaphragm contractility and activation of the proteasome and autophagy pathways were measured. Expressions of microRNAs that negatively regulate ubiquitin E3 ligases and autophagy-related genes were measured with quantitative polymerase chain reaction.

Results
Controlled mechanical ventilation decreased diaphragm twitch force from 428 ± 104 g/cm2 (mean ± SD) to 313 ± 50 g/cm2 and tetanic force from 2,491 ± 411 g/cm2 to 1,618 ± 177 g/cm2. Controlled mechanical ventilation also decreased diaphragm fiber size, increased expression of several autophagy genes, and augmented Atrogin-1, MuRF1, and Nedd4 expressions by 36-, 41-, and 8-fold, respectively. Controlled mechanical ventilation decreased the expressions of six microRNAs (miR-20a, miR-106b, miR-376, miR-101a, miR-204, and miR-93) that regulate autophagy genes. Pretreatment with N-acetylcysteine prevented diaphragm contractile dysfunction, attenuated protein ubiquitination, and downregulated E3 ligase and autophagy gene expression. It also reversed controlled mechanical ventilation–induced microRNA expression decreases. N-Acetylcysteine pretreatment had no affect on fiber atrophy.

Conclusions
Prolonged controlled mechanical ventilation activates the proteasome and autophagy pathways in the diaphragm through oxidative stress. Pathway activation is accomplished, in part, through inhibition of microRNAs that negatively regulate autophagy-related genes.
Human Frequency Following Responses to Vocoded Speech: Amplitude Modulation Versus Amplitude Plus Frequency Modulation
Authors: Suresh Chandan H. , Krishnan Ananthanarayan , Luo Xin 
Published: July 2019

Objectives:
The most commonly employed speech processing strategies in cochlear implants (CIs) only extract and encode amplitude modulation (AM) in a limited number of frequency channels. Zeng et al. (2005) proposed a novel speech processing strategy that encodes both frequency modulation (FM) and AM to improve CI performance. Using behavioral tests, they reported better speech, speaker, and tone recognition with this novel strategy than with the AM-alone strategy. Here, we used the scalp-recorded human frequency following responses (FFRs) to examine the differences in the neural representation of vocoded speech sounds with AM alone and AM + FM as the spectral and temporal cues were varied. Specifically, we were interested in determining whether the addition of FM to AM improved the neural representation of envelope periodicity (FFRENV) and temporal fine structure (FFRTFS), as reflected in the temporal pattern of the phase-locked neural activity generating the FFR.

Design:
FFRs were recorded from 13 normal-hearing, adult listeners in response to the original unprocessed stimulus (a synthetic diphthong /au/ with a 110-Hz fundamental frequency or F0 and a 250-msec duration) and the 2-, 4-, 8- and 16-channel sine vocoded versions of /au/ with AM alone and AM + FM. Temporal waveforms, autocorrelation analyses, fast Fourier Transform, and stimulus-response spectral correlations were used to analyze both the strength and fidelity of the neural representation of envelope periodicity (F0) and TFS (formant structure).

Results:
The periodicity strength in the FFRENV decreased more for the AM stimuli than for the relatively resilient AM + FM stimuli as the number of channels was increased. Regardless of the number of channels, a clear spectral peak of FFRENV was consistently observed at the stimulus F0 for all the AM + FM stimuli but not for the AM stimuli. Neural representation as revealed by the spectral correlation of FFRTFS was better for the AM + FM stimuli when compared to the AM stimuli. Neural representation of the time-varying formant-related harmonics as revealed by the spectral correlation was also better for the AM + FM stimuli as compared to the AM stimuli.

Conclusions:
These results are consistent with previously reported behavioral results and suggest that the AM + FM processing strategy elicited brainstem neural activity that better preserved periodicity, temporal fine structure, and time-varying spectral information than the AM processing strategy. The relatively more robust neural representation of AM + FM stimuli observed here likely contributes to the superior performance on speech, speaker, and tone recognition with the AM + FM processing strategy. Taken together, these results suggest that neural information preserved in the FFR may be used to evaluate signal processing strategies considered for CIs.
Non-mobile Adjacent Level Cervical Spondylolisthesis Does Not Always Require Fusion in Patients Undergoing ACDF
Authors: Segar Anand H. , Divi Srikanth N. , Tarazona Daniel , Fried Tristan , Sandhu Hanna , Kaye Ian D. , Kepler Christopher K. , Kurd Mark F. , Woods Barrett I. , Hilibrand Alan S. , Radcliff Kristen E. , Rihn Jeffrey A. , Anderson D. Greg , Vaccaro Alexander R. , Schroeder Gregory D. 
Published: July 2019

Study Design.
Retrospective review of a prospectively maintained database.

Objective.
Compare outcomes following anterior cervical decompression and fusion (ACDF) between patients with no adjacent level spondylolisthesis (NAS) and adjacent level spondylolisthesis (AS).

Summary of Background Data.
There are no prior studies evaluating the effect of preoperative adjacent-level cervical spondylolisthesis on outcomes following anterior cervical discectomy and fusion (ACDF).

Methods.
A retrospective review of consecutive patients who underwent ACDF for degenerative cervical disease was performed. Adjacent level spondylolisthesis was defined on radiographs as anterior displacement (> 1 mm) of the vertebra in relation to an adjacent “to be fused” level. Patients were categorized as either AS or NAS. Preoperative and 1-year postoperative outcomes including Short Form-12 Physical and Mental Component Scores, Neck Disability Index, Visual Analog Score for arm and neck pain, and rate of revision surgery were compared between the two groups. Radiographic changes were also analyzed for patients with AS.

Results.
A total of 264 patients met the inclusion criteria. There were 53 patients (20.1%) with AS and 211 patients (79.9%) with NAS. Both groups improved significantly from baseline with respect to all patient outcomes and there were no significant differences between the two groups. After accounting for confounding variables, the presence of an AS was not a predictor of any postoperative outcome. Revision rates did not differ between the two groups.

Conclusion.
Patients with an AS had similar postoperative clinical outcomes compared with NAS. Furthermore, the presence of an AS was not a predictor of poorer clinical outcomes. This is the first study to investigate the effect of AS in patients undergoing ACDF and suggests that an adjacent-level spondylolisthesis does not need to be included in a fusion construct if it is not part of the primary symptom generating pathology.

Level of Evidence: 3
Risk, Recovery, and Clinical Impact of Neurological Complications in Adult Spinal Deformity Surgery
Authors: Yagi Mitsuru , Michikawa Takehiro , Hosogane Naobumi , Fujita Nobuyuki , Okada Eijiro , Suzuki Satoshi , Tsuji Osahiko , Nagoshi Narihito , Asazuma Takashi , Tsuji Takashi , Nakamura Masaya , Matsumoto Morio , Watanabe Kota 
Published: July 2019

Study Design.
Multicenter retrospective case series.

Objective.
To report the risks, recovery, and clinical impact of neurological complications (NCs) in adult spinal deformity (ASD) surgery.

Summary of Background Data.
Although recent studies have reported the incidence of NCs in ASD surgery, few have addressed the recovery from and clinical impacts of NC.

Methods.
We reviewed records from a multicenter database for 285 consecutive surgically treated ASD patients who had reached a 2-year follow-up. NCs were categorized as sensory only or motor deficit (MD). Recovery was noted as none, partial, or complete, during hospitalization and at every postoperation visit. Uni- and multivariate risk analyses were performed to identify risk factors for MD.

Results.
NC developed in 29 (10%) patients within 30 days of surgery, of which 11 were permanent deficits (seven no recovery, and four partial recovery). MD developed in 14 (5%) patients, including one spinal cord injury. Seven MD patients required physical assistance at the latest follow-up. While NC patients experienced significant improvements in health-related quality of life at the 2-year follow-up, the health-related quality of life was significantly worse for the NC versus no-NC group at this time point. Univariate analyses revealed that Schwab-SRS types N and L, pelvic tilt, modified frailty index physical function, and an inferior SRS22 function domain at baseline were risk factors for MD. Among them, modified frailty index physical function, which represented a preoperative decline in activities of daily living, was identified as an independent risk factor for MD (OR: 4.0, 95% CI: 1.2–13.5, P = 0.03).

Conclusions.
NC developed in 10% of ASD surgery patients, with permanent deficits occurring in 4%. Half of the patients who developed MD required physical assistance, which contributed to the inferior clinical outcomes. Surgical intervention should be considered before severe activities of daily living decline to prevent NCs.

Level of Evidence: 4
Low-Pressure Lumbar Provocation Discography According to Spine Intervention Society/International Association for the Study of Pain Standards Does Not Cause Acceleration of Disc Degeneration in Patients With Symptomatic Low Back Pain
Authors: McCormick Zachary L. , Lehman Vance T. , Plastaras Christopher T. , Walega David R. , Huddleston Paul , Moussallem Charbel , Geske Jennifer R. , Verdoorn Jared T. , Kennedy David J. , Maus Timothy P. , Carr Carrie M. 
Published: July 2019

Study Design.
Retrospective matched cohort study.

Objective.
To determine if low-pressure lumbar provocation discography (PD) results in long-term accelerated disc degeneration, internal disc disruption, or disc herniation in patients with symptomatic low back pain (LBP).

Summary of Background Data.
Study of subjects without clinically-significant LBP suggests that high-pressure PD may accelerate disc degeneration.

Methods.
Consecutive patients with symptomatic LBP who underwent magnetic resonance imaging (MRI), PD, and repeat MRI more than 7 years later, but did not undergo subsequent spinal fusion surgery, were included. Punctured discs were matched (1:2 to 1:4) to corresponding discs in a control cohort by age, BMI, Pfirrmann score (±2), and presence of disc herniation; control cohort inclusion required MRIs for symptomatic LBP, separated by more than 7 years. The primary outcome of the study was a progression in Pfirrmann score category (I–II, III–IV, V). MRI disc-to-CSF T2 signal-intensity ratio, disc height, disc herniations, high intensity zones (HIZs), and Modic changes were assessed.

Results.
Baseline and follow-up MRIs were available for 77 discs exposed to PD, and for 260 discs in the matched control cohort. There was no difference in the proportion of punctured discs that advanced in Pfirrmann score category in the PD group (17%, 95% CI 9–27%) compared with corresponding discs in the Control group (21%, 95% CI 17–27%), P = 0.3578, or in non-punctured discs in the PD group (35%, 95% CI 21–51%) compared with corresponding discs in the Control group (34%, 95% CI 27–42%), P = 0.1169. There were no differences in disc-to-CSF T2 signal-intensity ratio, presence of disc herniations, HIZs, or Modic changes following puncture in the PD versus matched cohort discs or in the non-punctured PD cohort discs versus corresponding control cohort discs (P > 0.05).

Conclusion.
Patients with symptomatic LBP who underwent low-pressure PD, but who did not undergo a subsequent spinal fusion surgery, developed disc degeneration and new disc herniations at a similar rate to corresponding discs in matched control patients.

Level of Evidence: 3
Improving Tracheostomy Decannulation Rate in Trauma Patients
Authors: Farrell Michael S. , Gillin Thomas M. , Emberger John S. , Getchell John , Caplan Richard J. , Cipolle Mark D. , Bradley Kevin M. 
Published: July 2019

Objectives:
Identify the effect of a multidisciplinary tracheostomy decannulation protocol in the trauma population.

Design:
Single-center retrospective review.

Setting:
American College of Surgeons level 1 trauma center; large academic associated community hospital.

Patients:
Adult trauma patients who required a tracheostomy.

Interventions:
A tracheostomy decannulation protocol empowering respiratory therapists to move patients toward tracheostomy decannulation.

Measurements Main Results:
Tracheostomy decannulation rate, time to tracheostomy decannulation, length of stay, and reintubation and recannulation rates. A total of 252 patients met inclusion criteria during the study period with 134 presenting after the tracheostomy decannulation protocol was available. Since the tracheostomy decannulation protocol was implemented, patients managed by the tracheostomy decannulation protocol had a 50% higher chance of tracheostomy decannulation during the hospital stay (p < 0.001). The time to tracheostomy decannulation was 1 day shorter with the tracheostomy decannulation protocol (p = 0.54). There was no difference in time to discharge after ventilator liberation (p = 0.91) or in discharge disposition (p = 0.66). When comparing all patients, the development of a tracheostomy decannulation protocol, regardless if a patient was managed by the tracheostomy decannulation protocol, resulted in an 18% higher chance of tracheostomy decannulation (p = 0.003). Time to tracheostomy decannulation was 5 days shorter in the postintervention period (p = 0.07). There was no difference in discharge disposition (p = 0.88) but the time to discharge after ventilator liberation was shorter post protocol initiation (p = 0.04).

Conclusions:
In a trauma population, implementation of a tracheostomy decannulation protocol significantly improves tracheostomy decannulation rates during the same hospital stay. A larger population will be required to identify patient predictive factors for earlier successful tracheostomy decannulation.
Thymic malignancies: emerging systemic therapies
Authors: Girard Nicolas 
Published: July 2019

Purpose of review
The management of thymic malignancies is based on multidisciplinary collaboration. Systemic agents may be administered as an exclusive treatment if local treatment is not achievable. Novel and innovative agents are needed. Integrated genomic analyses reported the activation of targetable signaling pathways in thymomas and thymic carcinomas.

Recent findings
Phase II trials reported the antitumor activity of phosphatidylinositol 3-kinase/mechanistic target of rapamycin kinase inhibitors, cyclin dependent kinase inhibitors, and antiangiogenic agents in advanced, refractory thymic malignancies. Meanwhile, a major challenge is the use of immune checkpoint inhibitors, given the frequent association of those tumors with autoimmune disorders.

Summary
Although those innovative agents were assessed in phase II trials reporting on variable antitumor efficacy in terms of response and survival, in selected and limited cohorts of patients, a better understanding of systemic treatment sequences in a real-life setting is mandatory to analyze the actual efficacy of each line of treatment one after another, define the best clinical–pathological selection of patients for the administration of chemotherapy, targeted agents, and immunotherapy, and develop individualized decision-making to optimize the survival of patients with advanced thymic malignancies.