bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seizure response to temozolomide chemotherapy in patients with WHO grade II oligodendroglioma: a single-institution descriptive study
Authors: Haggiagi Aya , Avila Edward K 
Published: August 2018

Abstract

Background
Tumor-related epilepsy (TRE) is common in patients with low-grade oligodendrogliomas. TRE is difficult to control despite multiple antiepileptic drugs (AEDs) in up to 30% of patients. Chemotherapy has been used for treatment to avoid potential radiotherapy-related neurotoxicity. This study evaluates the effect of temozolomide on seizure frequency in a homogeneous group with World Health Organization (WHO) grade II oligodendrogliomas.

Methods
A retrospective analysis was conducted of adult patients with WHO grade II oligodendrogliomas and TRE followed at Memorial Sloan Kettering between 2005 and 2015 who were treated with temozolomide alone either as initial treatment or for disease progression. All had seizures 3 months prior to starting temozolomide. Seizure frequency was reviewed every 2 cycles and at the end of temozolomide treatment. Seizure reduction of ≥50% compared to baseline was defined as improvement.

Results
Thirty-nine individuals met inclusion criteria. Median follow-up since starting temozolomide was 6 years (0.8-13 years). Reduction in seizure frequency occurred in 35 patients (89.7%). Improvement was independent of AED regimen adjustments or prior antitumor treatment in 16 (41%); of these, AED dosage was successfully reduced or completely eliminated in 10 (25.6%). Twenty-five patients (64.1%) remained on a stable AED regimen. The majority (n = 32, 82%) had radiographically stable disease, 5 (12.8%) had objective radiographic response, and 2 (5.2%) had disease progression.

Conclusions
Temozolomide may result in reduced seizure frequency, and permit discontinuation of AEDs in patients with WHO II oligodendroglioma. Improvement was observed irrespective of objective tumor response on MRI, emphasizing the importance of incorporating seizure control in assessing response to tumor-directed therapy.
Outpatient Parenteral Antimicrobial Therapy Among People Who Inject Drugs: A Review of the Literature
Authors: Suzuki Joji , Johnson Jennifer , Montgomery Mary , Hayden Margaret , Price Christin 
Published: August 2018

AbstractHospitalizations for people who inject drugs (PWID) with infectious complications requiring prolonged antibiotic therapy are increasing in the context of the opioid epidemic. Although outpatient parenteral antimicrobial therapy (OPAT) is routinely offered to patients without a history of injection drug use (IDU), PWID are often excluded from consideration of OPAT. To better assess the evidence base for the safety and effectiveness of OPAT for PWID, we conducted a review of the published literature. Results suggest that OPAT may be safe and effective for PWID, with rates of OPAT completion, mortality, and catheter-related complications comparable to rates among patients without a history of IDU. Rates of hospital readmissions may be higher among PWID, but instances of misuse of the venous catheter were rarely reported. More research is needed to study the safety and effectiveness of OPAT among PWID, as well as studying the combination of OPAT and addiction treatment.
On surface brightness and flux calibration for point and compact extended sources in the AKARI Far-IR All-Sky Survey (AFASS) maps
Authors: Ueta Toshiya , Szczerba Ryszard , Fullard Andrew G , Takita Satoshi 
Published: August 2018

Abstract
The AKARI infrared astronomical satellite produced all-sky survey (AFASS) maps in the far-infrared at roughly arcminute spatial resolution, enabling us to investigate the whole sky in the far-infrared for objects having surface brightnesses greater than a few to a couple of dozen MJy sr−1. While the AFASS maps are absolutely calibrated against large-scale diffuse emission, it was uncertain whether or not an additional flux correction for point sources was necessary. Here, we verify that calibration for point-source photometry in the AFASS maps is proper. With the aperture correction method based on the empirical point spread function templates derived directly from the AFASS maps, fluxes in the AKARI bright source catalogue (BSC) are reproduced. The AKARI BSC fluxes are also satisfactorily recovered with the 1 σ aperture, which is the empirical equivalent of an infinite aperture. These results confirm that in the AFASS maps far-infrared photometry can be properly performed by using the aperture correction method for point sources and by summing all pixel values within an appropriately defined aperture of the intended target (i.e., the aperture photometry method) for extended sources.
Interaction between plasma homocysteine and the MTHFR C.677C > T polymorphism is associated with site‐specific changes in DNA methylation in humans
Authors: Nash Alexander J. , Mandaviya Pooja R. , Dib Marie-Joe , Uitterlinden André G. , van Meurs Joyce , Heil Sandra G. , Andrew Toby , Ahmadi Kourosh R. 
Published: August 2018

ABSTRACTOne‐carbon metabolism provides a direct link among dietary folate/vitamin B12 exposure, the activity of the enzyme methylenetetrahydrofolate reductase (MTHFR), and epigenetic regulation of the genome via DNA methylation. Previously, it has been shown that the common C.677C > T polymorphism in MTHFR influences global DNA methylation status through a direct interaction with folate status and (indirectly) with total homocysteine (tHcy) levels. To build on that and other more recent observations that have further highlighted associations among MTHFR C.677C > T, tHcy, and aberrations in DNA methylation, we investigated whether the interaction between mildly elevated plasma tHcy and the C.677C > T polymorphism is associated with site‐specific changes in DNA methylation in humans. We used data on plasma tHcy levels, c.677C> T polymorphism, and site‐specific DNA methylation levels for a total of 915 white women and 335 men from the TwinsUK registry (n = 610) and the Rotterdam study (n = 670). We performed methylome‐wide association analyses in each cohort to model the interaction between levels of tHcy and C.677C > T genotypes on DNA methylation β values. Our meta‐analysis identified 13 probes significantly associated with rs1801133 × tHcy levels [false‐discovery rate (FDR) < 0.05]. The most significant associations were with a cluster of probes at the AGTRAP–MTHFR–NPPA/B gene locus on chromosome 1 (FDR = 1.3E–04), with additional probes on chromosomes 2, 3, 4, 7, 12, 16, and 19. Our top 2 hits on chromosome 1 were functionally associated with variability in expression of the TNF receptor superfamily member 8 (TNFRSF8) gene/locus on that chromosome. This is the first study, to our knowledge, to provide a direct link between perturbations in 1‐carbon metabolism, through an interaction of tHcy and the activity of MTHFR enzyme on epigenetic regulation of the genome via DNA methylation.—Nash, A. J., Mandaviya, P. R., Dib, M.‐J., Uitterlinden, A. G., van Meurs, J., Heil, S. G., Andrew, T., Ahmadi, K. R. Interaction between plasma homocysteine and the MTHFR c.677C>T polymorphism is associated with site‐specific changes in DNA methylation in humans. FASEB J. 33, 833–843 (2019). www.fasebj.org
How to Prevent K-Wire Bounce in Oblique Supracondylar Humerus Fractures
Authors: Iobst Christopher , Thompson R. Gil , Grauer Jordan , Wheeler Peter 
Published: August 2018

Summary:
Supracondylar humerus fractures with an obliquely oriented fracture pattern can pose a clinical challenge in obtaining adequate fixation. Traditionally, 1.6-mm Kirchner wires are used for fracture fixation when pinning pediatric supracondylar humerus fractures. However, when pinning across obliquely oriented fractures, the angle of pin inclination may increase to the point where the 1.6-mm k-wire cannot penetrate the far cortex. We have found that, when pinning oblique supracondylar humerus fractures, utilization of a 2.0-mm k-wire can assist the surgeon in obtaining bicortical purchase. We present a cadaveric study demonstrating the maximal angles at which both 1.6-mm and 2.0-mm k-wires will penetrate the far cortex. This technical trick can give surgeons a relatively simple solution to treat these difficult fractures.
Pulseless Supracondylar Humerus Fracture With Anterior Interosseous Nerve or Median Nerve Injury—An Absolute Indication for Open Reduction?
Authors: Harris Liam R. , Arkader Alexandre , Broom Alexander , Flynn John , Yellin Joseph , Whitlock Patrick , Miller Ashley , Sawyer Jeffrey , Roaten John , Skaggs David L. , Choi Paul D. 
Published: August 2018

Background:
Optimal management for a pulseless supracondylar humerus fracture associated with anterior interosseous nerve (AIN) or median nerve injury is unclear. The purpose of this study was to determine the incidence of pulseless supracondylar humerus fractures associated with AIN or median nerve injury, to assess open versus closed surgical management, to determine factors associated with the need for neurovascular intervention, and to report the outcome.

Methods:
A retrospective review was performed at 4 pediatric trauma hospitals on all patients who sustained a Gartland III or IV supracondylar humerus fracture with the combination of absent distal palpable pulses and AIN or median nerve injury between 2000 and 2014. Choice of treatment, details regarding preoperative and postoperative exam findings, follow-up course, and outcome were recorded.

Results:
A total of 71 patients met inclusion criteria; 52 patients (73%) underwent closed reduction (CR); 19 patients (27%) underwent open reduction (OR) and early antecubital fossa exploration. The index procedure of CR plus percutaneous pinning was sufficient treatment in 50 (of 52, 96%) patients with only 2 requiring reoperation. One patient developed compartment syndrome approximately 9 hours after CRPP (13.5 h after time of injury) and underwent emergent fasciotomies. Of the 19 patients who underwent OR and early exploration, 6 needed vascular procedures, 5 required detethering of entrapped surrounding fibrous tissues. Forty patients were diagnosed with median nerve palsy versus 31 diagnosed with AIN palsy. There was no significant difference between patients presenting with median nerve versus AIN palsy, with similar rates of need for OR (10/40; 25% vs. 9/31; 29%), rate of compartment syndrome (3/40; 7.5% vs. 3/31; 9.7%), need for reoperation (4/40; 10% vs. 6.5%), and ultimate resolution of nerve palsy (4/36; 20.1% vs. 3/30; 10%). Compartment syndrome developed in 6 (of 71, 8.5%) patients and was associated with poor perfusion status on presentation and delayed time from injury to surgery. In patients with at least 3-month neurological follow-up, 59 (of 61, 97%) patients had complete resolution of nerve palsy.

Conclusions:
Although previous authors have suggested a pulseless SCH fx with an associated AIN or median nerve injury should be treated with exploration and OR, 70% (50/71) of the patients in this series were treated with a CR. In this series, both AIN and median nerve palsies among patients presenting with pulseless extremity and Gartland III or IV SCH fracture, offer similar rates of OR, risk of compartment syndrome, and resolution of nerve palsy.

Level of Evidence:
Level IV.
Risk Factors Associated With Pouch Adenomas in Patients With Familial Adenomatous Polyposis
Authors: Ganschow Petra , Trauth Silke , Hinz Ulf , Schaible Anja , Büchler Markus W. , Kadmon Martina 
Published: August 2018

BACKGROUND:
Restorative proctocolectomy with ileal pouch-anal reconstruction is the standard prophylactic surgical procedure for patients with familial adenomatous polyposis. However, several groups have reported the development of adenomas and even carcinomas within the ileal pouch. The predisposing factor was the time interval after pouch surgery in some studies, but it was the severity of the initial colonic disease and duodenal adenomatosis in others.

OBJECTIVE:
The aim of this study was to further clarify the prevalence of pouch adenomas, clinical risk factors, and a possible phenotype–genotype relation in a large population of patients with familial adenomatous polyposis, as well as to analyze pouch adenoma-free survival.

DESIGN:
This study was designed as a cohort study.

SETTINGS:
This study was conducted in a specialized outpatient clinic at the University of Heidelberg.

PATIENTS:
A total of 192 patients with familial adenomatous polyposis were included, and all of the available endoscopy reports after pouch surgery were screened for pouch adenomas. Additional clinical information was retrieved from the Heidelberg Polyposis Register.

MAIN OUTCOME MEASURES:
This present study revealed 3 main independent risk factors for the development of pouch adenomas: age <18 years at the time of IPAA, male sex, and the presence of gastric adenomas. Secondary outcome measures were adenoma progression and overall pouch adenoma-free survival.

RESULTS:
Pouch adenomas were detected in 46.9% of patients. Median follow-up was 12.8 years (interquartile range, 9.0–17.0 y) for patients with pouch adenomas and 7.3 years (interquartile range, 2.5–12.2 y) for those without them. Patients underwent pouch surgery at a median age of 27.5 years (range, 10.2–58.5 y), and pouch adenomas occurred a median of 8.5 years (range, 0.9–25.1 y) after surgery. Also detected were gastric adenomas in 37.2%, duodenal adenomas in 80.3%, and desmoid tumors in 24.5% of patients. Estimation of pouch adenoma-free survival revealed that, after 20 years, only ≈22% of patients would be free of pouch adenomas. Male sex, age ≦18 years at the time of pouch surgery, and gastric adenomas were found to be independent risk factors for the development of pouch adenomas in a multivariate Cox regression analysis (p = 0.0002, p = 0.0059, and p = 0.0020). No predisposing germline mutation for pouch adenoma development was detected.

LIMITATIONS:
Detailed information on the initial preoperative findings was not fully available, and the study was only carried out as a single-center study.

CONCLUSIONS:
A severe upper intestinal phenotype, male sex, and age <18 years at the time of IPAA all increase the risk for development of pouch adenomas. See Video Abstract at http://links.lww.com/DCR/A675.
Video Super-microsurgery Amplified using Close-up Lens Filter on the Operative Field Camera: Preliminary Report
Authors: Kato Motoi , Watanabe Shoji , Watanabe Azusa , Utsunomiya Hiroki , Yokoyama Takayuki , Watanabe Taro 
Published: August 2018

Background:
Super-microsurgery has widely spread due to the improvement of high magnification microscopes. The cost of multiple microscopes is high. Furthermore, the microscope heads are too large to fit in multiple surgical fields for pediatric patients. We adapted a 2-dimensional magnification system for performing lymphatic venous anastomosis on pediatric lymphedema cases.

Methods:
We attached a close-up lens filter to the suspended camera (CHZ-1,360-PTR camera, Carina system, Tokyo, Japan) in the operative field. This was done to achieve 26× magnification using a small camera head, making it possible to perform super-micro anastomoses. Anastomoses time, scar length, and lymph vessel diameters were measured, and the outcomes were statistically analyzed and compared with the contralateral side.

Results:
Four pediatric lymphedema patients underwent the aforementioned technique, using the multisite microscopic approach. All anastomoses were completed within 20 minutes. The results were not significantly different from the conventional microscopic lymphatic venous anastomosis.

Conclusion:
This system is advantageous because (1) it has less costly initial investments; (2) it requires a small camera head, which provides available space for the multisite microscopic approach even for pediatric patients; and (3) it allows for a wider surgical working space.
An Overlooked but Effective Wound Care Methodology: Hydromechanical Therapy Revisited
Authors: Desjardins Haley , Guo Lifei 
Published: August 2018

Summary:
Chronic wounds are frequently difficult, expensive to treat, and pose a significant burden on both the patient’s quality of life and health care system. Their recalcitrance to treatment stems from multiple factors, particularly the presence of bacterial biofilms within the wound bed. However, a commonly overlooked modality in the field of wound care, pressurized irrigation, offers an inexpensive mechanical debridement force capable of dislodging these biofilms that contribute to delayed healing of chronic wounds. We present here a single clinical case of a difficult nonhealing wound that had previously failed 3 months of negative-pressure wound therapy, a much more expensive modality. This chronic plantar foot wound was treated with daily application of hydromechanical therapy using tap water at home. It achieved a stable granulation surface, and with a small skin graft, healing with no recurrence seen at 15-month follow-up. We speculate that a combination of tissue stimulation and disruption of the wound surface biofilm contribute to improved healing, supporting a reevaluation for the use of pressurized irrigation in the treatment of chronic wounds.
The impact of accountable care organization participation on hospital patient experience
Authors: Diana Mark L. , Zhang Yongkang , Yeager Valerie A. , Stoecker Charles , Counts Catherine R. 
Published: August 2018

Background:
Accountable care organizations (ACOs) are being implemented rapidly across the Unites States. Previous studies indicated an increasing number of hospitals have participated in ACOs. However, little is known about how ACO participation could influence hospitals’ performance.

Purpose:
This study aims to examine the impact of Medicare ACO participation on hospitals’ patient experience.

Methodology/Approach:
Difference-in-difference analyses were conducted to compare 10 patient experience measures between hospitals participating in Medicare ACOs and those not participating.

Results:
In general, hospitals participating in Pioneer ACOs had significantly improved scores on nursing communication and doctor communication. Shared Savings Program (SSP) ACO participation did not show significant improvement of patient experience. Subgroup analyses indicate that, for hospitals in the middle and top tertile groups in terms of baseline experience, Pioneer ACO and SSP ACO participation was associated with better patient experience. For hospitals in the bottom tertile, Pioneer ACO and SSP ACO participation had no association with patient experience.

Conclusion:
ACO participation improved some aspects of patient experience among hospitals with prior good performance. However, hospitals with historically poor performance did not benefit from ACO participation.

Practice Implications:
Prior care coordination and quality improvement experience position Medicare ACOs for greater success in terms of patient experience. Hospital leaders need to consider the potential negative consequences of ACO participation and the hospital’s preparedness for care coordination.
An Exploratory Study of Mild Cognitive Impairment of Retired Professional Contact Sport Athletes
Authors: Baker John G. , Leddy John J. , Hinds Andrea L. , Haider Mohammad N. , Shucard Jennifer , Sharma Tania , Hernandez Sergio , Durinka Joel , Zivadinov Robert , Willer Barry S. 
Published: August 2018

Objective:
To test the hypothesis that mild cognitive impairment (MCI) rates are higher among retired professional contact sport athletes than in noncontact athlete controls and compare history of contact sports with other MCI risk factors.

Setting:
University Concussion Management Clinic.

Participants:
Twenty-one retired National Football League and National Hockey League players and 21 aged-matched noncontact athlete controls.

Designs:
Case-control.

Main Measures:
Comprehensive criteria were used to assess MCI based on the following: Wisconsin Card Sorting Test, Delis-Kaplan Executive Function System; Trail Making Parts A and B; Wechsler Adult Intelligence Scale–Third Edition subtests; Neuropsychological Assessment Battery Memory Module List Learning, Story Learning, and Naming subtests; and Controlled Oral Word Association Test. The Wide Range Achievement Test was used as a proxy measure for IQ. Atherosclerotic cardiovascular disease risk factors were self-reported and blood cholesterol was measured. Depression was measured by the Beck Depression Inventory-II (BDI).

Results:
Eight contact sport athletes (38%) and 3 noncontact athletes (14%) met MCI criteria (P = .083). Contact sport athletes' scores were significantly worse on Letter Fluency and List B Immediate Recall. Contact athletes were more obese, had more vascular risk factors, and had higher scores on the BDI than controls.

Conclusion:
Athletes with a history of playing professional contact sports had more vascular risk factors and higher depression scores. MCI rates were somewhat higher, though not significant.
Informing the Revolution: A Needs Assessment of Ultrasound Knowledge and Skills Among Graduating Physician Assistant Students
Authors: Barnett Melissa , Pillow M. Tyson , Carnell Jennifer , Rohra Anita , DeSandro Stephanie , Gardner Aimee K. 
Published: August 2018

Purpose
We performed a needs assessment to understand how existing physician assistant (PA) program curricula and clinical training affect students' ultrasound knowledge, skills, and competence and prepare students for performing ultrasound techniques in clinical practice.

Methods
Students graduating from a PA program completed a 23-item questionnaire examining their ultrasound training experiences, their self-assessment of competency, and their demographics. Students also completed a 15-item ultrasound knowledge assessment.

Results
Thirty-eight of 39 students (97%) completed the survey. Students received little hands-on ultrasound training, with the most hands-on training being offered during emergency medicine (44.7%), obstetrics and gynecology (42.1%), and inpatient internal medicine (39.5%) rotations. This lack of preparedness was reflected in a mean score of 47.1% (±16.4%) on the ultrasound knowledge assessment. Most students (84.2%) indicated that the ultrasound instruction they received during clinical rotations was insufficient to prepare them for clinical practice, and 84.2% desired a formal ultrasound training program in the PA program curriculum.

Conclusions
Existing PA program curricula are insufficient for developing critical skills related to ultrasonography.
Normal Variant Occipital Pneumatization
Authors: Tomblinson Courtney M. , Deep Nicholas L. , Fletcher Geoffrey P. , Nelson Kent D. , Patel Ameet C. , Weindling Steven M. , Lane John I. , Hoxworth Joseph M. 
Published: August 2018

Objective:
Evaluate prevalence and pattern of occipital pneumatization (OP).

Patients:
Individuals with imaging evidence of OP on computed tomography (CT).

Intervention(s):
High resolution CT scans of the temporal bone.

Main Outcome Measure:
The prevalence and pattern of OP on 1000 CT scans performed at a large academic healthcare system.

Results:
OP had a prevalence of 11.8% (n = 118) while occipital condyle pneumatization occurred in only 0.3%. Occipital air cells were right-sided in 27.1% (n = 32), left-sided in 51.7% (n = 61), and bilateral in 21.2% (n = 25), and OP was contiguous with the occipitomastoid suture. In cases of unilateral OP, the contralateral jugular foramen demonstrated relative enlargement (p = 0.006), but a direct association could not be established.

Conclusions:
The occipital bone is an accessory site of skull base pneumatization in 11.8% of the population undergoing temporal bone CT, while air cell extension into the occipital condyle occurs more rarely. These occipital air cells have a left-sided predilection and are always in direct proximity to the occipitomastoid suture, suggesting developmental egress from the mastoid. OP is a normal variant and lacks features of craniocervical pneumatization, which is a rare disorder.