bluuebunny/crossref_metadata_2025_split huggingface dataset:
Histopathological Insights on Imaging Results of Intraoperative Magnetic Resonance Imaging, 5-Aminolevulinic Acid, and Intraoperative Ultrasound in Glioblastoma Surgery
Authors: Coburger Jan , Scheuerle Angelika , Pala Andrej , Thal Dietmar , Wirtz Christian Rainer , König Ralph 
Published: February 2017

Abstract

BACKGROUND: For appropriate use of available intraoperative imaging techniques in glioblastoma (GB) surgery, it is crucial to know the potential of the respective techniques in tumor detection.

OBJECTIVE: To assess histopathological basis of imaging results of intraoperative magnetic resonance imaging (iMRI), 5-aminolevulinic acid (5-ALA), and linear array intraoperative ultrasound (lioUS).

METHODS: We prospectively compared the imaging findings of iMRI, 5-ALA, and lioUS at 99 intraoperative biopsy sites in 33 GB patients during resection control. Histological classification of specimens, tumor load, presence of necrosis, presence of vascular malformations, and O6-methylguanin-DNA methyltransferase (MGMT) promoter state was correlated with imaging findings.

RESULTS: Solid tumor was found in 57%, infiltration zone in 42%, and no tumor in 1% of specimens. However, imaging was negative in iMRI in 49%, using 5-ALA in 17%, and in lioUS in 21%. In positive imaging results, share of solid tumor was highest in 5-ALA (65%) followed by lioUS (60%) and lowest in iMRI (55%). In comparison to 5-ALA, iMRI had a high share of solid tumor in specimens when showing intermediate results. Sensitivity for invasive tumor was higher in 5-ALA (84%) and lioUS (80%) than in iMRI (50%). We found a significant correlation of 5-ALA with classification of specimen, presence of necrosis, and microproliferations. Methylated MGMT promoter correlated with positive findings in 5-ALA. lioUS and iMRI showed no correlations with histopathological findings.

CONCLUSION: All of the assessed established imaging techniques detect infiltrating tumor only to a certain extent. Only 5-ALA showed a significant correlation with histopathological findings. Interestingly, tumor remnants in an MGMT-methylated tumor are more likely to be visible using 5-ALA as in unmethylated tumors.
A New Classification for Pathologies of Spinal Meninges—Part 2: Primary and Secondary Intradural Arachnoid Cysts
Authors: Klekamp Jörg 
Published: February 2017

Abstract

BACKGROUND: Spinal intradural arachnoid cysts are rare causes of radiculopathy or myelopathy. Treatment options include resection, fenestration, or cyst drainage.

OBJECTIVE: To classify intradural spinal arachnoid cysts and present results of their treatment.

METHODS: Among 1519 patients with spinal space occupying lesions, 130 patients demonstrated intradural arachnoid cysts. Neuroradiological and surgical features were reviewed and clinical data analyzed.

RESULTS: Twenty-one patients presented arachnoid cysts as a result of an inflammatory leptomeningeal reaction related to meningitis, subarachnoid hemorrhage, intrathecal injections, intradural surgery, or trauma, ie, secondary cysts. For the remaining 109 patients, no such history could be elucidated, ie, primary cysts. Forty-six percent of primary and 86% of secondary cysts were associated with syringomyelia. Patients presented after an average history of 53 ± 88 months. There were 122 thoracic and 7 lumbar cysts plus 1 cervical cyst. Fifty-nine patients with primary and 15 patients with secondary cysts underwent laminotomies with complete or partial cyst resection and duraplasty. Mean follow-up was 57 ± 52 months. In the first postoperative year, profound improvements for primary cysts were noted, in contrast to marginal changes for secondary cysts. Progression-free survival for 10 years following surgery was determined as 83% for primary compared to 15% for secondary cysts. Despite differences in clinical presentation, progression-free survival was almost identical for patients with or without syringomyelia.

CONCLUSIONS: Complete or partial resection leads to favorable short- and long-term results for primary arachnoid cysts. For secondary cysts, surgery can only provide clinical stabilization for a limited time due to the often extensive arachnoiditis.
A Prospective Study of Interbody Fat Graft Application With the Anterior Contralateral Cervical Microdiscectomy to Preserve Segmental Mobility
Authors: Aydın Yunus , Çavuşoğlu Halit , Yüce İsmail , Özdilmaç Ahmet , Kahyaoğlu Okan 
Published: February 2017

Abstract

BACKGROUND
Any surgical procedure aims at protecting mobile segments at the operated level, and the sagittal balance of the columna vertebralis. Interbody fusion has become an often applied technique in anterior cervical discectomy.

OBJECTIVE
To indicate that a minimally invasive technique in which we use interbody fat graft placement showed great results and effectiveness, especially in patients who were suffering from cervical paramedian disc herniation.

METHODS
In this study, 432 patients were observed from 2000 to 2013. All these consecutive patients had paramedian disc herniation. The initial 239 patients (group 1) underwent microdiscectomy without graft placement, whereas the remaining 193 patients (group 2) had a microdiscectomy with interbody fat graft insertion. The Neck Disability Index (NDI) and Short Form-36 (SF-36) were used to evaluate clinical outcomes. They were followed up for 5.3 years (range 2-13 years).

RESULTS
Spontaneous radiological fusion was noticed in 12% of group 1 patients and none of the group 2 patients. It has been observed that the mean overall cervical curvature (C2-7) angles and segmental lordosis did not change significantly in late follow-up findings. During both early and late follow-ups, all patients indicated a decreasing NDI score, but in late follow-up, an improving SF-36 score.

CONCLUSION
This surgical technique provides good direct decompression and preserves mobility at the treated level, while preventing disc collapse.
Proposal for the Rapid Reversal of Coagulopathy in Patients with Nonoperative Head Injuries on Anticoagulants and/or Antiplatelet Agents: A Case Study and Literature Review
Authors: Watson Victoria L , Louis Nundia , Seminara Brittany V , Muizelaar J Paul , Alberico Anthony 
Published: February 2017

Abstract

BACKGROUND
Emergency room physicians, trauma teams, and neurosurgeons are seeing increasing numbers of head-injured patients on anticoagulants, many of whom are nonoperative. Head injury and anticoagulation can lead to devastating consequences. These patients need immediate evaluation and often reversal of anticoagulation in order to decrease their high rates of morbidity and mortality.

OBJECTIVE
To review data on the prevalence, risks, treatment, and complications of head-injured anticoagulated patients and provide a proposal for their anticoagulant management, and imaging requirements.

METHODS
A PubMed database search was performed for articles on the prevalence, risks, treatment, and complications of patients who have sustained a head injury while on anticoagulant or antiplatelet agents.

RESULTS
A total of 1877 articles were found, of which 64 were selected for use based on direct relevance, information quality, and contribution of the article to the current understanding of anticoagulated head injury patients.

CONCLUSION
There are very few guidelines for the management of nonoperative head-injured patients. Rapid reversal guided by international normalized ratio values, Platelet Function Assays, computed tomography imaging of the head, and physical exam is suggested. The proposal presented in this paper enables patient management to begin quickly in a systematic approach, with the goal of achieving a significant decrease in the morbidity and mortality for the anticoagulated head-injured patient. Rapid reversal can potentially decrease mortality by as much as 38%.
Morphological and Hemodynamic Differences Between Aneurysmal Middle Cerebral Artery Bifurcation and Contralateral Nonaneurysmal Anatomy
Authors: Song Jianping , Zhu Fengping , Qian Yi , Ou Chubin , Cai Jiajun , Zou Xiang , Wu Zehan , Zhu Wei , Chen Liang , Mao Ying 
Published: February 2017

Abstract

BACKGROUND
The morphological and hemodynamic features differ between middle cerebral artery (MCA) bifurcations with and without aneurysms.

OBJECTIVE
To investigate the morphological and hemodynamic differences between aneurysmal MCA bifurcation and contralateral nonaneurysmal anatomy.

METHODS
Computed tomography angiography of 36 patients with unilateral small saccular MCA bifurcation aneurysms was evaluated. The parent–daughter angles (φ1 for larger branch and φ2 for smaller branch), bifurcation angle (φ = φ1 + φ2), inclination angle (γ angle), and their relationships with the MCA bifurcation locations were analyzed. Computational fluid dynamics simulation was performed in 6 cases to explore the hemodynamics influenced by the bifurcation morphology.

RESULTS
The φ angle was significantly higher in aneurysmal than contralateral nonaneurysmal bifurcations (160.8° ± 31.0° vs 99.0° ± 19.2°, respectively; P = .000); the φ1, φ2, and γ angles were also higher. However, by regression analysis combined with MCA bifurcation locations, only the φ angle might be associated with the aneurysm presence (odds ratio = 1.120, 95% confidence interval = 1.059-1.185) and a φ angle cut-off of 124.8° was established. Computational fluid dynamics simulation demonstrated that flow resistance of the wider aneurysmal MCA bifurcation was significantly higher than that on the contralateral side.

CONCLUSION
A larger φ angle was more prevalent in aneurysmal than nonaneurysmal MCA bifurcations, and the higher flow resistance caused by the larger φ angle might be a potential hemodynamic factor associated with MCA aneurysm presence.
Interactive iBook-Based Patient Education in a NeuroTrauma Clinic
Authors: Sahyouni Ronald , Mahmoodi Amin , Mahmoodi Amir , Rajaii Ramin R , Hasjim Bima J , Bustillo David , Huang Melissa , Tran Diem Kieu , Chen Jefferson W 
Published: February 2017

Abstract

BACKGROUND
Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Educational interventions may alleviate the burden of TBI for patients and their families. Interactive modalities that involve engagement with the educational material may enhance patient knowledge acquisition when compared to static text-based educational material.

OBJECTIVE
To determine the effects of educational interventions in the outpatient setting on self-reported patient knowledge, with a focus on iPad-based (Apple, Cupertino, California) interactive modules.

METHODS
Patients and family members presenting to a NeuroTrauma clinic at a tertiary care academic medical center completed a presurvey assessing baseline knowledge of TBI or concussion, depending on the diagnosis. Subjects then received either an interactive iBook (Apple) on TBI or concussion, or an informative pamphlet with identical information in text format. Subjects then completed a postsurvey prior to seeing the neurosurgeon.

RESULTS
All subjects (n = 152) significantly improved on self-reported knowledge measures following administration of either an iBook (Apple) or pamphlet (P < .01, 95% confidence interval [CI]). Subjects receiving the iBook (n = 122) performed significantly better on the postsurvey (P < .01, 95% CI), despite equivalent presurvey scores, when compared to those receiving pamphlets (n = 30). Lastly, patients preferred the iBook to pamphlets (P < .01, 95% CI).

CONCLUSION
Educational interventions in the outpatient NeuroTrauma setting led to significant improvement in self-reported measures of patient and family knowledge. This improved understanding may increase compliance with the neurosurgeon's recommendations and may help reduce the potential anxiety and complications that arise following a TBI.
Variation in Tularemia Clinical Manifestations—Arkansas, 2009–2013
Authors: Lester Rothfeldt Laura K. , Jacobs Richard F. , Wheeler J. Gary , Weinstein Susan , Haselow Dirk T. 
Published: February 2017

Abstract

Background
Francisella tularensis, although naturally occurring in Arkansas, is also a Tier 1 select agent and potential bioterrorism threat. As such, tularemia is nationally notifiable and mandatorily reported to the Arkansas Department of Health. We examined demographic and clinical characteristics among reported cases and outcomes to improve understanding of the epidemiology of tularemia in Arkansas.

Methods
Surveillance records on all tularemia cases investigated during 2009–2013 were reviewed.

Results
The analytic dataset was assembled from 284 tularemia reports, yielding 138 probable and confirmed tularemia cases during 2009–2013. Arthropod bite was identified in 77% of cases. Of 7 recognized tularemia manifestations, the typhoidal form was reported in 47% of cases, approximately double the proportion of the more classic manifestation, lymphadenopathy. Overall, 41% of patients were hospitalized; 3% died. The typhoidal form appeared to be more severe, accounting for the majority of sepsis and meningitis cases, hospitalizations, and deaths. Among patients with available antibiotic data, 88% received doxycycline and 12% received gentamicin.

Conclusions
Contrary to expectation, lymphadenopathy was not the most common manifestation observed in our registry. Instead, our patients were more likely to report only generalized typhoidal symptoms. Using lymphadenopathy as a primary symptom to initiate tularemia testing may be an insensitive diagnostic strategy and result in unrecognized cases. In endemic areas such as Arkansas, suspicion of tularemia should be high, especially during tick season. Outreach to clinicians describing the full range of presenting symptoms may help address misperceptions about tularemia.
Sequential Extradural Release of the V3 Vertebral Artery to Facilitate Intradural V4 Vertebral Artery Reanastomosis: Feasibility of a Novel Revascularization Technique
Authors: Meybodi Ali Tayebi , Lawton Michael T. , Benet Arnau 
Published: February 2017

Abstract

BACKGROUND: Revascularization of the intradural vertebral artery (VA) usually involves V3-V4 bypass using an interposition graft. The interposition of a graft increases surgical time, adds risks, and requires 2 suture lines.

OBJECTIVE: To assess the feasibility of an excision-reanastomosis of V4 by sequentially releasing V3.

METHODS: Twenty specimens were prepared for surgical simulation of a far-lateral approach. The third and fourth segments of the VA were exposed through the far-lateral approach bilaterally. The V3 segment was divided into three subsegments: (1) V3f: from entry to C1 transverse foramen to the point of exit from C1 transverse foramen; (2) V3s: from V3f to the distal point of V3 within the sulcus arteriosus; and (3) V3d: from point V3 leaves the sulcus arteriosus to its dural entrance. After transecting the VA 2 mm proximal to the posterior inferior cerebellar artery origin, each subsegment was released sequentially. We measured the lengths obtained before and after releasing each segment by pulling the VA along its main axis to recreate a V3-V4 excision-reanastomosis.

RESULTS: The V3 could not be effectively mobilized without release. When totally released, an average length of 13.15 mm was available for completing V3-V4 reanastomosis.

CONCLUSION: Complete release of V3 from all its adhesions in its extracranial course can provide an average length of 13.15 mm for excision-reanastomosis. The present study shows the anatomic feasibility of the use of V3 segment in primary anastomosis after excision of a diseased segment of the intradural VA, laying the basis for future clinical application.
Low Risk of Producing an Opioid Use Disorder in Primary Care by Prescribing Opioids to Prescreened Patients with Chronic Noncancer Pain
Authors: Cheatle Martin D , Gallagher Rollin M , O’Brien Charles P 
Published: February 2017

AbstractObjectiveTo examine the risk of developing aberrant behaviors that might lead to a substance use disorder (addiction) when prescribing opioids for the relief of chronic noncancer pain in primary care settings.DesignLongitudinal, prospective, descriptive design with repeated measures.SettingPrivate community-based internal medicine and family medicine clinics.SubjectsPatients with chronic musculoskeletal pain.MethodsStandardized measures of patient status (pain, functional impairment, psychiatric disorders, family history) and treatments provided, urine drug monitoring, and medical chart audits (presence of aberrant drug-related behaviors) were obtained in a cohort of 180 patients at the time of initiating opioids for chronic noncancer pain and at three, six, and 12 months thereafter.ResultsOver the 12-month follow-up period, subjects demonstrated stable, mild to moderate levels of depression (PHQ-9 scores ranging from 9.43 to 10.92), mild anxiety (BAI scores ranging from 11.80 to 14.67), minimal aberrant drug-related behaviors as assessed by chart reviews, and a low percentage of illicit drug use as revealed by results of urine drug monitoring. Less than 5% of our study population revealed any evidence of substance use disorder.ConclusionsThis prospective study suggests that patients without a recent or prior history of substance use disorder who were prescribed primarily short-acting opioids in low doses for chronic noncancer pain have a low risk for developing a substance use disorder. This finding supports the importance of prescreening patients being considered for opioid therapy and that prescription of opioids for noncancer pain may carry a lower risk of abuse in selected populations such as in private, community-based practices.
Lumbar Neuraxial Ultrasound for Spinal and Epidural Anesthesia: A Systematic Review and Meta-Analysis
Authors: Perlas Anahi , Chaparro Luis E. , Chin Ki Jinn 
Published: February 2017

(Reg Anesth Pain Med. 2016;41:251–260)
Spinal anesthesia and lumbar epidural anesthesia are safe and effective anesthetic techniques. However, neuraxial blocks can sometimes be difficult to perform especially when the spinal anatomy is altered. This technical challenge poses a potential risk of procedural failure and consequent complications including postdural puncture headache and backache, epidural hematoma, and spinal cord injury. A neuraxial ultrasound of the spine delineates its anatomy precisely, thus facilitating successful insertion of a spinal or epidural needle. This study aimed to assess the evidence favoring the use of preprocedural neuraxial ultrasound for spinal or lumbar epidural anesthesia and to put forward recommendations for practice.
Restriction of Oral Intake During Labor: Whither are We Bound?
Authors: Sperling Jeffrey D. , Dahlke Joshua D. , Sibai Baha M. 
Published: February 2017

(Am J Obstet Gynecol. 2016;214(5):592–596)
Oral intake during labor is encouraged in some settings while being restricted in others. Dr Curtis Mendelson in 1946 suggested that aspiration during general anesthesia in obstetrics could be avoided with oral restriction during labor. The American Congress of Obstetricians and Gynecologists (ACOG) and the American Society of Anesthesiologists (ASA) in 2013 reiterated that oral intake of small amounts of clear liquids but not solids may be allowed in uncomplicated cases. Contradictory to this, the World Health Organization (WHO) suggested that healthcare providers should not prevent a woman from oral intake during labor as the energy demands are huge and replenishment could ensure maternal and fetal well-being. Patients at greater risk for aspiration are those who have gastrointestinal and neurological disorders, and other obstetric conditions. This commentary aimed to assess the evidence of restricting oral intake in low-risk patients and to inquire into the role of this general practice in modern obstetrics.
Pregnancy Outcomes in Women With Sickle-Cell Disease in Low and High Income Countries: A Systematic Review and Meta-Analysis
Authors: Boafor T.K. , Olayemi E. , Galadanci N. , Hayfron-Benjamin C. , Dei-Adomakoh Y. , Segbefia C. , Kassim A.A. , Aliyu M.H. , Galadanci H. , Tuuli M.G. , Rodeghier M. , DeBaun Michael R. , Oppong S.A. 
Published: February 2017

(BJOG. 2016;123:691–698)
Pregnant women with sickle-cell disease (SCD) are generally considered to have a high risk of developing maternal and fetal complications. However, data from well-designed studies are limited regarding this topic. Therefore, this meta-analysis aimed to determine whether women with and without SCD have similar risks of pregnancy complications, and whether these outcomes differ based on residence in low-income or high-income countries.
Does Ondansetron Modify Sympathectomy Due to Subarachnoid Anesthesia?: Meta-Analysis, Meta-Regression, and Trial Sequential Analysis
Authors: Terkawi Abdullah S. , Mavridis Dimitris , Flood Pamela , Wetterslev Jørn , Terkawi Rayan S. , Bin Abdulhak Aref A. , Nunemaker Megan S. , Tiouririne Mohamed 
Published: February 2017

(Anesthesiology. 2016;124:846–869)
Subarachnoid anesthesia, used in abdominal and lower extremity surgeries, has side effects including hypotension and bradycardia. Ondansetron, a potent 5-HT3 receptor antagonist, was found to prevent the consequences of sympathectomy in earlier studies but these were underpowered and presented variable results. This study evaluated the existing data on the efficacy of ondansetron in preventing hypotension and bradycardia due to subarachnoid anesthesia. A literature search was performed from the MEDLINE databases using PubMed, Cochrane Library, and Web of Science. The primary outcomes were the incidence of hypotension and bradycardia after subarachnoid anesthesia, and secondary outcomes were vasopressor (phenylephrine and ephedrine) consumption. Random-effects models were used to determine the ondansetron effect a priori. Data were analyzed by standard meta-analysis and recently developed statistical techniques such as small trial bias assessments, selection models, trial sequential analyses (TSAs) to estimate adjusted confidence intervals (CIs), and the Grading of Recommendations on Assessment, Development, and Evaluation system.
How Long is Safe? Setting the Cutoff for Uncomplicated Third Stage Length: A Retrospective Case-Control Study
Authors: Shinar Shiri , Schwartz Anat , Maslovitz Sharon , Many Ariel 
Published: February 2017

(Birth. 2016;43(1):36–41)
Postpartum hemorrhage (PPH) is one of the main risk factors of a prolonged third stage of labor, which is usually 5 to 20 minutes; only 8% of placentae remain undelivered by 20 minutes. The incidence of PPH worldwide is about 6% for >500 mL of blood loss and 1.86% for >1000 mL of blood loss despite active management of the third stage. The objective of this study was to determine the optimal time until undertaking manual placental removal in an uncomplicated third stage while taking into consideration the risk for blood transfusion.
Epidural Volume Extension During Combined Spinal-Epidural Labor Analgesia Does Not Increase Sensory Block
Authors: Zaphiratos Valerie , George Ronald B. , Macaulay Bruce , Bolleddula Prasad , McKeen Dolores M. 
Published: February 2017

(Anesth Analg. 2016;123:684–689)
Combined spinal-epidural (CSE) provides faster and better first-stage analgesia and fewer epidural top-up boluses than traditional epidural methods. Deliberate injection into the epidural space can increase anesthetic level. This mechanism, referred to as epidural volume extension (EVE), is not fully understood; the fluid in the epidural space may be compressing the dural sac. The current authors thus tested 2 hypotheses. First, an epidural injection of 10 mL normal saline while initiating CSE would increase the initial anesthetic sensory block height by 15 minutes. Second, compared with CSE alone, CSE with EVE would result in a higher sensory block at 30 minutes while decreasing pain scores, analgesia onset time, and motor block.