bluuebunny/crossref_metadata_2025_split huggingface dataset:
Balloon-Assisted Coiling of the Cavernous Sinus to Treat Direct Carotid Cavernous Fistula
Authors: De Renzis Alioscia , Nappini Sergio , Consoli Arturo , Renieri Leonardo , Limbucci Nicola , Rosi Andrea , Vignoli Chiara , Pellicanò Giannantonio , Mangiafico Salvatore 
Published: January 2017

This study evaluated clinical and neuroradiological results in 13 consecutive patients with spontaneous and traumatic direct carotid cavernous fistulas treated at our center between January 2006 and September 2012. All patients were treated by coiling of the cavernous sinus. Coiling was always performed while a semi-compliant non-detachable balloon was temporarily inflated in the internal carotid artery. This technique (balloon-assisted coiling) permitted a clear visualization of the fistula, facilitated coil positioning and protected the patency of the artery. All patients' clinical data and radiological examinations were reviewed; nine patients underwent radiological and clinical follow-up, with a mean duration of 3.8 years (range: six months-six years). Overall results at discharge showed a complete occlusion of the fistula in seven patients (7/13, 54%) and a resolution of symptoms in eight patients (8/12, 67%). Radiological follow-up showed complete occlusion of the fistula in all patients (9/9, 100%) and clinical follow-up showed a resolution of symptoms in eight patients (8/9, 89%) and persistent symptoms in one (1/9, 11%). No procedure-related complications occurred. Balloon-assisted coiling of the cavernous sinus for the treatment of direct carotid cavernous fistulas proved an effective and safe technique, both in angiographic and clinical terms, and may be considered a technical improvement.
Percutaneous Microballoon Compression for Trigeminal Neuralgia Using Dyna-CT
Authors: Xiaochuan Huo , Xiaoyun S. , Junsheng Luo , Ning Guan , Wenshi Guo , Zhenxing Zhang 
Published: January 2017

Percutaneous microballoon compression (PMC) is a well-established technique for treatment of trigeminal neuralgia (TN). However, direct puncture of the foramen ovale (FO) is sometimes difficult and there have been well-reported complications from cannulating the FO. We describe our experiences in using Dyna-CT for cannulating the FO and determining balloon position and volume. Dyna-CT was used to perform image reconstruction in 21 cases. The optimal working projection was generated and further fluoroscopic data were used to determine the needle's relationship to the foramen during puncture. Furthermore, the balloon position and three-dimensional shape were verified by Dyna-CT during balloon compression. The balloon volume and puncture angle were further calculated. Patients' prognosis was further discussed. Dyna-CT allowed quick, safe, and easy cannulation of the FO. It provided three-dimensional images which were more elaborate than the classic ‘pear-shaped’ images for determining correct positioning in 21 cases. The volume of the flattened balloon ranged from 568.2 mm3 to 891.4 mm3 with an average of 775.9 mm3. The angle of introducing the cannula ranged from 15.17°–35.48° rotation to the midline with an average of 26.24° and 38.47°–51.89° angulation to the Reid line with an average of 46.09°. All the patients were pain free after PMC. Four patients had resolvable masseter weakness and fine touch loss. There was no recurrence of TN during follow-up. Dyna-CT demonstrated three advantages in assisting PMC. Firstly, the FO can be better visualized irrespective of the patient's position. Secondly, needle correction or insertion can be performed much more easily because of the direct fluoroscopic control. Thirdly, the needle position, balloon position, balloon configuration and the volume of the inflated balloon are more reliably determined. The use of dyna-CT provided an assisted method to PMC with a low incidence of complications and good prognosis.
Preoperative Embolization of Hypervascular Thoracic, Lumbar, and Sacral Spinal Column Tumors: Technique and Outcomes from a Single Center
Authors: Nair Sreejit , Gobin Y. Pierre , Leng Lewis Z. , Marcus Joshua D. , Bilsky Mark , Laufer Ilya , Patsalides Athos 
Published: January 2017

The existing literature on preoperative spine tumor embolization is limited in size of patient cohorts and diversity of tumor histologies. This report presents our experience with preoperative embolization of hypervascular thoracic, lumbar, and sacral spinal column tumors in the largest series to date. We conducted a retrospective review of 228 angiograms and 188 pre-operative embolizations for tumors involving thoracic, lumbar and sacral spinal column. Tumor vascularity was evaluated with conventional spinal angiography and was graded from 0 (same as normal adjacent vertebral body) to 3 (severe tumor blush with arteriovenous shunting). Embolic materials included poly vinyl alcohol (PVA) particles and detachable platinum coils and rarely, liquid embolics. The degree of embolization was graded as complete, near-complete, or partial. Anesthesia records were reviewed to document blood loss during surgery. Renal cell carcinoma (44.2%), thyroid carcinoma (9.2%), and leiomyosarcoma (6.6%) were the most common tumors out of a total of 40 tumor histologies. Hemangiopericytoma had the highest mean vascularity (2.6) of all tumor types with at least five representative cases followed by renal cell carcinoma (2.0) and thyroid carcinoma (2.0). PVA particles were used in 100% of cases. Detachable platinum coils were used in 51.6% of cases. Complete, near-complete, and partial embolizations were achieved in 86.1%, 12.7%, and 1.2% of all cases, respectively. There were no new post-procedure neurologic deficits or other complications with long-term morbidity. The mean intra-operative blood loss for the hypervascular tumors treated with pre-operative embolization was 1745 cc. Preoperative embolization of hypervascular thoracic, lumbar, and sacral spine tumors can be performed with high success rates and a high degree of safety at high volume centers.
Endovascular Management of Complete Vertebral Artery Dissection Presenting with Subarachnoid Haemorrhage
Authors: Lenthall R.K. , White B.D. , McConachie N.S. 
Published: January 2017

Spontaneous vertebral artery (VA) dissection may involve the intradural segment of the VA and result in subarachnoid haemorrhage (SAH). These lesions are frequently associated with recurrent SAH, and have a high mortality. Prior to the development of endovascular techniques the majority of these lesions were treated surgically. In cases where the dissection involved the posterior inferior cerebellar artery (PICA) origin surgery was associated with significant complications including recurrent SAH from retrograde VA flow into the dissected segment above the surgical clip. We describe two cases of complete VA dissection in which the entire intradural VA was sacrificed to prevent recurrent SAH. The first case tolerated planned left PICA occlusion without developing a significant neurological deficit. The second case had infarcted the right PICA territory at presentation.
Heme Oxigenase-1 (HO-1) and Oxidative Stress in Rat Heart
Authors: Grilli A. , De Lutiis M.A. , Patruno A. , Speranza L. , Gizzi F. , Di Giulio C. , Conti P. , Felaco M. 
Published: January 2017

Low oxygen tension (hypoxia) is a potent regulator of diverse biological processes. Mammalian cells respond to hypoxia in part by increased expression of several genes that encode for tissue-specific and ubiquitous proteins. The aim of this study was to evaluate the effects of chronic exposure to low tension of oxygen (hypoxia) on the induction of heme-oxygenase-1 (HO-1) as an oxidative stress model. Adult male Wistar rats were used and subdivided randomly in two groups: A:(n=10) maintained in normoxic conditions and B: (n=10) maintained in hypoxic conditions. The animal of both groups were sacrificed after 14 days. Group A showed an evident non-specific reaction. Group B presented an increased positively of HO-1 immunoreaction. This data was confirmed by western blot analysis of protein and by the study of mRNA through rtPCR. These results suggest that myocardial adaptive response to hypoxia involves up-regulation of HO-1 in cardiac cells, indicating that this enzyme may participate in regulating vascular tone via CO and thereby contributing to the pathophysiologically important defense mechanism of the heart.
Treatment and Prophylaxis of Pityriasis Versicolor with Oral Fluconazole
Authors: Cassano N. , D'Argento V. , Loconsole F. , Vena G.A. 
Published: January 2017

Treatment with oral antifungals is usually preferred when pityriasis versicolor (PV) affects large body surface areas, especially in chronic or recurrent cases. In this study, we evaluated the effectiveness of fluconazole in the treatment and prophylaxis of patients with chronic or recurrent, mostly extensive, PV. Treatment regimen consisted of fluconazole 100mg once daily for 10 consecutive days; 3–4 weeks after the end of treatment, patients were evaluated for clinical and mycological response (visit T1). Patients with mycological eradication received fluconazole 200mg/day (100mg twice a day) for two consecutive days per month for 5 months. Clinical and mycological evaluations were performed after 2 months (T2) and 5 months (T3) from visit T1. Mycological efficacy was assessed using microscopic examination and represented the primary efficacy parameter; therefore, positive microscopy at any visit was reason for withdrawal from the study. At visit T1 60 subjects were evaluated; most patients (94 %) were clinically cured or improved. Similar clinical response rates were observed at visits T2 and T3. The proportion of patients with eradication of Malassezia was 92 % at T1 visit, 88 % at T2 visit, and 91 % at T3 visit. No relevant adverse events occurred. The results of this open preliminary study suggest that an oral treatment with fluconazole 100mg/day for 10 days is effective in PV. A maintenance monthly treatment with fluconazole 200mg/day for two consecutive days can be very useful to prevent recurrence of PV.
Comparison of pancreatic histology specimens obtained by EUS 19G versus 22G core biopsy needles: A prospective multicentre study among experienced pathologists
Authors: Petrone Maria Chiara , Poley Jan‐Werner , Bonzini Matteo , Abdulkader Ihab , Biermann Katharina , Monges Genevieve , Rindi Guido , Doglioni Claudio , Bruno Marco J , Giovannini Marc , Iglesias‐Garcia Julio , Larghi Alberto , Arcidiacono Paolo Giorgio 
Published: January 2017

Background and aimScanty data about inter‐observer agreement (IOA) among pathologists in the evaluation of pancreatic samples acquired with EUS histology needle are available. The aim of this study was to determine IOA on adequacy of pancreatic histology specimens obtained with a 22G needle by a panel of experienced pathologist, in comparison with the 19G needle.MethodsThis multicentre prospective study involved 73 pancreatic specimens prepared using histology needles of different calibres. Five pathologists independently reviewed all the samples, assessing the presence of a core, specimen adequacy and the possibility to perform additional analyses. IOA determined by Fleiss’ Kappa statistic was used as the primary outcome measure. Secondary outcome was to compare 22G versus 19G needle results.ResultsA core was present in 57% of pancreatic specimens obtained by 22G needle. The specimens were considered adequate in 72% of cases, with poor agreement among pathologists (p  = 0.02, Fleiss’ κ = 0.26). The possibility to perform further analyses was rated as ‘positive’ in 66% of cases without significant difference among observers (p  = 0.80). When comparing the results, the presence of a core and the adequacy of tissue slides were significantly better for the 19G needle (57% vs. 84% p  = 0.002; 72% vs. 83% p  = 0.004, respectively). Reproducibility in the assessment of pancreatic sample adequacy was significantly better with the 19G needle (κ = 0.26 for 22G samples vs. κ = 0.81 for 19G samples).ConclusionsOur results suggest that histology sampling of pancreatic masses should be performed with a 19G histology needle, since is able to provide a core in the majority of cases, with 83% of adequate specimens and excellent results in term of reproducibility among pathologists.
Acute Gastrocnemius-Soleus Complex Injuries in National Football League Athletes
Authors: Werner Brian C. , Belkin Nicole S. , Kennelly Steve , Weiss Leigh , Barnes Ronnie P. , Potter Hollis G. , Warren Russell F. , Rodeo Scott A. 
Published: January 2017

Background: Lower extremity muscle injuries are common in professional football. Although less common than hamstring or quadriceps injuries in National Football League (NFL) athletes, calf injuries occur with relative frequency and have not previously been studied. Purpose: To evaluate gastrocnemius-soleus complex muscle injuries over the past 13 years from a single NFL team to determine the incidence of such injuries, their imaging characteristics, and return to play after such injuries and any correlation between imaging findings and prolonged return to play. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of all acute calf muscle injuries on a single NFL team from 2003 to 2015 was performed. Player demographics and return-to-play data were obtained from the medical records. All available magnetic resonance images (MRIs) were reviewed by a musculoskeletal radiologist for specific imaging findings that correlated with return to play. Results: A total of 27 calf injuries in 24 NFL players were reviewed, yielding an incidence of 2.3 acute calf injuries per year on a single NFL team. Of these 27 injuries, 20 (74%) were isolated injuries to the gastrocnemius muscle, 4 (15%) were isolated injuries to the soleus muscle, and the remaining 3 injuries (11%) involved both. Defensive players were more likely to sustain injuries ( P = .043). The mean time to return to play for all 27 players was 17.4 ± 14.6 days (range, 3-62 days). MRIs were available in 14 of the 27 injuries. The average size of the fascial defect ( P = .032) and the presence of a fluid collection ( P = .031) both correlated with return to play of longer than 2 weeks. Conclusion: Although less common than hamstring or quadriceps muscle injuries, calf muscle injuries occur with relative frequency in the NFL, and more so in defensive players. The majority of these injuries occur in the gastrocnemius and result in significant disability, with at least 2 weeks of missed playing time on average. MRI may have an important role in the evaluation of calf injuries in NFL players, as certain injury imaging characteristics, including the anteroposterior size of any fascial tear and the presence of a fluid collection, are associated with longer return-to-play times after injury.
A novel humanized mouse model with significant improvement of class-switched, antigen-specific antibody production
Authors: Yu Hua , Borsotti Chiara , Schickel Jean-Nicolas , Zhu Shu , Strowig Till , Eynon Elizabeth E. , Frleta Davor , Gurer Cagan , Murphy Andrew J. , Yancopoulos George D. , Meffre Eric , Manz Markus G. , Flavell Richard A. 
Published: January 2017

Key PointsHuman IL-6 improves T-cell engraftment and serum IgG production in humanized mice. IgG-switched memory B cells in IL-6 knock-in mice displayed a diverse antibody repertoire and high specificity against immunized antigen.
A Predictive Model for Extended Postanesthesia Care Unit Length of Stay in Outpatient Surgeries
Authors: Gabriel Rodney A. , Waterman Ruth S. , Kim Jihoon , Ohno-Machado Lucila 
Published: January 2017

BACKGROUND:
A predictive model that can identify patients who are at an increased risk for prolonged postanesthesia care unit (PACU) stay could help optimize resource utilization and case sequencing. Although previous studies identified some predictors, there is not a model that only utilizes various patients demographic and comorbidities, that are already known preoperatively, and that may affect PACU length of stay for outpatient procedures requiring the care of an anesthesiologist.

METHODS:
We collected data from 4151 patients at a single institution from 2014 to 2015. The data set was split into a training set (cases before 2015) and a test set (cases during 2015). Bootstrap samples were chosen (R = 1000 replicates) and a logistic regression model was built on the samples using a combined method of forward selection and backward elimination based on the Akaike Information Criterion. The trained model was applied to the test set. Model performance was evaluated with the area under the receiver operating characteristic (ROC) Curve (AUC) for discrimination and the Hosmer-Lemeshow (HL) test for goodness-of-fit.

RESULTS:
The final model had 5 predictor variables for prolonged PACU length of stay, which included the following: morbid obesity, hypertension, surgical specialty, primary anesthesia type, and scheduled case duration. The model had an AUC value of 0.754 (95% confidence interval 0.733–0.774) on the training set and 0.722 (95% confidence interval 0.698–0.747) on the test set, with no difference between the 2 ROC curves (P = .06). The model had good calibration for the data in both the training and test data set indicated by nonsignificant P values from the HL test (P = .211 and .719 for the training and test set, respectively).

CONCLUSIONS:
We developed a predictive model with excellent discrimination and goodness-of-fit that can help identify those at higher odds for extended PACU length of stay. This information may help optimize case-sequencing methodologies.
Synthesis of δ-Lactone and Amino Acid Frameworks Utilizing the Umpoled Reactivity of β,γ-Alkenyl α-Iminoester
Authors: Kawanishi Mami , Mizota Isao , Aratake Kana , Tanaka Hirotaka , Nakahama Kenta , Shimizu Makoto 
Published: January 2017

Abstract
An umpolung N-alkylation reaction of β,γ-alkenyl α-iminoesters was studied, and various tandem reactions were found utilizing this N-alkylation. A useful synthesis of δ-lactones and dienamines was developed by tandem N-alkylation/vinylogous aldol-type reaction. The synthesis of α-quaternary alkenyl amino esters was also developed via the tandem N-alkylation/bromination/C-alkylation. These methods using β,γ-alkenyl α-iminoesters are operationally simple and useful, and exhibit broad substrate generality.
Problems Facing Vascular Surgery in 2004
Authors: Berguer Ramon 
Published: January 2017

The most pressing challenges we face in the immediate future are endovascular training for those already in practice and a new educational paradigm for our residents. A number of avenues for training those in practice have been implemented, and newer methods, including computer simulation, are being explored. Vascular training programs should be 3 years in length, include vascular navigation and interventional skills, and follow 3 years of basic general surgical training. These changes in our resident training paradigm can take place only through two avenues: a successful reapplication to the American Board of Medical Specialties for an independent American Board of Vascular Surgery or a full reconfiguration of the training programs for general and vascular surgeons that would have to be spearheaded by the American Board of Surgery. There is skepticism that the latter could take place in the limited time we have left to make the vascular surgery residency attractive to candidates and sufficient in experiential and knowledge content.
The Status of Vascular Surgery as an Independent Specialty in Europe: Are the Relationships with General and Cardiothoracic Surgery a Problem?
Authors: Paaske William P. 
Published: January 2017

Vascular surgery has established a clear clinical and scientific profile in Europe over the last decade, but it presents a highly complex, disorganized, and unplanned pattern. It is a specialty in the majority of the present member states of the European Union (EU), but in the United Kingdom, Germany, the Netherlands, and Sweden this is not the case. With the current expansion of the EU with 13 countries, mainly from the former Eastern Bloc, it will be even more necessary to ensure at least some level of convergence in the standards of training, certification, quality assured practice, continuing medical education, recertification, access to and quality of care, etc, because free migration of doctors, and patients, is a derivative of the cornerstones of the EU treaties, namely free movement of the citizens (and capital). The profession has been successful in creating a simple and coherent system for organization within the European Union of Medical Specialists with a board of vascular surgery, for a (voluntary) European proficiency test for specialists (the EBSQ-Vasc), and for European continuing medical education, all in close collaboration with the premier scientific society, the European Society for Vascular Surgery. The fantastic reductions in working hours for young doctors in the EU represent a serious threat to standards of training and, ultimately, to the patients. This, in connection with increased litigation and compensation demands for incompetence and negligence, makes it even more necessary to establish European minimum standards for training, professional competence, and an obligatory European specialist examination. A key element in this difficult process is the establishment of vascular surgery as a specialty in all member states. Day-to-day collaboration with radiologic interventionalists has developed pragmatically at the local level in most places, but only when the administrative structures mature and vascular surgery becomes a specialty in all countries will the necessary tools be available for the avoidance of professional conflicts with colleagues from other specialties.
Feasibility evaluation of diffusion-weighted imaging using an integrated MRI-radiotherapy system for response assessment to neoadjuvant therapy in rectal cancer
Authors: Shaverdian Narek , Yang Yingli , Hu Peng , Hart Steven , Sheng Ke , Lamb James , Cao Minsong , Agazaryan Nzhde , Thomas David , Steinberg Michael , Low Daniel A , Lee Percy 
Published: January 2017

Objective:
To evaluate the feasibility of on-board diffusion-weighted imaging (DWI) with an integrated low-field MRI radiotherapy system to assess responses to neoadjuvant chemoradiation (NAC) in rectal cancer.

Methods:
A spin echo-based planar imaging diffusion sequence on a 0.35-T MRI radiotherapy system was acquired over the course of NAC. The apparent diffusion coefficients (ADCs) from the tumour regions of interest (ROIs) were calculated. A functional diffusion map (fDM) was created showing a pixelwise ADC analysis of the ROI over the course of treatment. Surgical pathology was correlated with ADC data.

Results:
Consecutive patients treated on a 0.35-T MRI radiotherapy system were evaluated. Patient A had the worst pathological response to NAC with a tumour regression score of 1 and was the only patient with a negative slope in the change of ADC values over the entire course of NAC, and during both the first and second half of NAC. The fDM from the first half of NAC for Patient A showed discrete dark areas in the tumour ROI, reflecting subregions with decreasing ADC values during NAC. Patient C had the most favourable pathological response to NAC with a Grade 3 response and was the only patient who had an increase in the slope in the change of ADC values from the first to the second half of NAC.

Conclusion:
DWI using a low-field MRI radiotherapy system for evaluating the responses to NAC is feasible.

Advances in knowledge:
ADC values obtained using a 0.35-T MRI radiotherapy system over the course of NAC for rectal cancer correlate with pathological responses.