bluuebunny/crossref_metadata_2025_split huggingface dataset:
After 9 Years of 3-Column Osteotomies, Are We Doing Better? Performance Curve Analysis of 573 Surgeries With 2-Year Follow-up
Authors: Diebo Bassel G , Lafage Virginie , Varghese Jeffrey J , Gupta Munish , Kim Han Jo , Ames Christopher , Kebaish Khaled , Shaffrey Christopher , Hostin Richard , Obeid Ibrahim , Burton Doug , Hart Robert A , Lafage Renaud , Schwab Frank J ,   International Spine Study Group (ISSG) of Denver, Colorado
Published: May 2017

Abstract

BACKGROUND
In spinal deformity treatment, the increased utilization of 3-column (3CO) osteotomies reflects greater comfort and better training among surgeons. This study aims to evaluate the longitudinal performance and adverse events (complications or revisions) for a multicenter group following a decade of 3CO.

OBJECTIVE
To investigate if performance of 3CO surgeries improves with years of practice.

METHODS
Patients who underwent 3CO for spinal deformity with intra/postoperative and revision data collected up to 2 yr were included. Patients were chronologically divided into 4 even groups. Demographics, baseline deformity/correction, and surgical metrics were compared using Student t-test. Postoperative and revision rates were compared using Chi-square analysis.

RESULTS
Five hundred seventy-three patients were stratified into: G1 (n = 143, 2004-2008), G2 (n = 142, 2008-2009), G3 (n = 144, 2009-2010), G4 (n = 144 2010-2013). The most recent patients were more disabled by Oswestry disability index (G4 = 49.2 vs G1 = 38.3, P = .001), and received a larger osteotomy resection (G4 = 26° vs G1 = 20°, P = .011) than the earliest group. There was a decrease in revision rate (45%, 35%, 33%, 30%, P = .039), notably in revisions for pseudarthrosis (16.7% G1 vs 6.9% G4, P = .007). Major complication rates also decreased (57%, 50%, 46%, 39%, P = .023) as did excessive blood loss (>4 L, 27.2 vs 16.7%, P = .023) and bladder/bowel deficit (4.2% vs 0.7% P = .002). Successful outcomes (no complications or revision) significantly increased (P = .001).

CONCLUSION
Over 9 yr, 3COs are being performed on an increasingly disabled population while gaining a greater correction at the osteotomy site. Revisions and complication rate decreased while success rate improved during the 2-yr follow-up period.
Transsylvian Transuncal Approach for an Anterior Midbrain Cavernous Malformation Resection: A Case Report
Authors: Delaunois Julien , Vaz Géraldo , Raftopoulos Christian 
Published: May 2017

Abstract

BACKGROUND AND IMPORTANCE
Cavernous malformations (CMs) are vascular abnormalities with a hemorrhage risk of 0.2% to 5% per year, according to their location. Brainstem CMs seem to have a greater hemorrhagic risk and represent a neurosurgical challenge. We report here the first transsylvian transuncal (TS-TU) approach for an anteromedial mesencephalic CM resection.

CLINICAL PRESENTATION
A 29-yr-old female suddenly presented a left hemiparesis and central facial paresis with a diplopia in the upward gaze. A cerebral imagery revealed an 18-mm right cerebral peduncle CM with signs of acute hemorrhage. Two months later, she rebleed while pregnant. The pregnancy was interrupted. Five months later, a 3.0 Tesla magnetic resonance imaging (MRI) with diffusion tensor imaging sequences was realized for preoperative planning followed by a gross total resection of the CM through a TS-TU approach to avoid the perforating arteries of the anterior perforated substance. The patient presented postoperatively again a left hemiparesis and central facial paresis with a right oculomotor nerve paresis. On the tenth postsurgical day, she developed a Holmes’ tremor of the left upper limb, for which a Levodopa treatment was initiated. Three months postoperative, MRI showed a gross total resection of the mesencephalic CM without complications. A complete clinical recovery was observed 1 yr later.

CONCLUSION
We describe here the first performance of a TS-TU approach for an anterior mesencephalic CM resection. This surgical approach allowed direct access to the CM, avoiding the vascularization of the anterior perforated substance.
PPARγ Agonists Attenuate Trigeminal Neuropathic Pain
Authors: Lyons Danielle N. , Zhang Liping , Danaher Robert J. , Miller Craig S. , Westlund Karin N. 
Published: May 2017

Objectives:
The aim of this study is to investigate the role of peroxisome proliferator-activated receptor-gamma isoform (PPARγ), in trigeminal neuropathic pain utilizing a novel mouse trigeminal inflammatory compression (TIC) injury model.

Results:
The study determined that the PPARγ nuclear receptor plays a significant role in trigeminal nociception transmission, evidenced by: 1) Intense PPARγ immunoreactivity is expressed 3 weeks after TIC nerve injury in the spinal trigeminal caudalis, the termination site of trigeminal nociceptive nerve fibers. 2) Systemic administration of a PPARγ agonist, pioglitazone (PIO), attenuates whisker pad mechanical allodynia at doses of 300 mg/kg i.p. and 600 mg/kg p.o. 3) Administration of a PPARγ antagonist, GW9662 (30 mg/kg i.p.), prior to providing the optimal dose of PIO (300 mg/kg i.p.) blocked the analgesic effect of PIO.

Discussion:
This is the first study localizing PPARγ immunoreactivity throughout the brainstem trigeminal sensory spinal nucleus (spV) and its increase three weeks after TIC nerve injury. This is also the first study to demonstrate that activation of PPARγ attenuates trigeminal hypersensitivity in the mouse TIC nerve injury model. The findings presented here suggest the possibility of utilizing the FDA approved diabetic treatment drug, PIO, as a new therapeutic that targets PPARγ for treatment of patients suffering from orofacial neuropathic pain.
Educational Gaps in Molecular Diagnostics, Genomics, and Personalized Medicine in Dermatopathology Training: A Survey of U.S. Dermatopathology Fellowship Program Directors
Authors: Torre Kristin , Russomanno Kristen , Ferringer Tammie , Elston Dirk , Murphy Michael J. 
Published: May 2017

Background:
Molecular technologies offer clinicians the tools to provide high-quality, cost-effective patient care. We evaluated education focused on molecular diagnostics, genomics, and personalized medicine in dermatopathology fellowship training.

Design:
A 20-question online survey was emailed to all (n = 53) Accreditation Council for Graduate Medical Education (ACGME)-accredited dermatopathology training programs in the United States.

Results:
Thirty-one of 53 program directors responded (response rate = 58%). Molecular training is undertaken in 74% of responding dermatopathology fellowships, with levels of instruction varying among dermatology-based and pathology-based programs. Education differed for dermatology- and pathology-trained fellows in approximately one-fifth (19%) of programs. Almost half (48%) of responding program directors believe that fellows are not currently receiving adequate molecular education, although the majority (97%) expect to incorporate additional instruction in the next 2–5 years. Factors influencing the incorporation of relevant education include perceived clinical utility and Accreditation Council for Graduate Medical Education/residency review committee (RRC) requirements. Potential benefits of molecular education include increased medical knowledge, improved patient care, and promotion of effective communication with other healthcare professionals. More than two-thirds (68%) of responding program directors believe that instruction in molecular technologies should be required in dermatopathology fellowship training.

Conclusions:
Although all responding dermatopathology fellowship program directors agreed that molecular education is important, only a little over half of survey participants believe that their fellows receive adequate instruction. This represents an important educational gap. Discussion among those who oversee fellow education is necessary to best integrate and evaluate teaching of molecular dermatopathology.
Development of glucose-responsive ‘smart’ insulin systems
Authors: Rege Nischay K. , Phillips Nelson F.B. , Weiss Michael A. 
Published: May 2017

Purpose of review
The complexity of modern insulin-based therapy for type I and type II diabetes mellitus and the risks associated with excursions in blood–glucose concentration (hyperglycemia and hypoglycemia) have motivated the development of ‘smart insulin’ technologies (glucose-responsive insulin, GRI). Such analogs or delivery systems are entities that provide insulin activity proportional to the glycemic state of the patient without external monitoring by the patient or healthcare provider. The present review describes the relevant historical background to modern GRI technologies and highlights three distinct approaches: coupling of continuous glucose monitoring (CGM) to deliver devices (algorithm-based ‘closed-loop’ systems), glucose-responsive polymer encapsulation of insulin, and molecular modification of insulin itself.

Recent findings
Recent advances in GRI research utilizing each of the three approaches are illustrated; these include newly developed algorithms for CGM-based insulin delivery systems, glucose-sensitive modifications of existing clinical analogs, newly developed hypoxia-sensitive polymer matrices, and polymer-encapsulated, stem-cell-derived pancreatic β cells.

Summary
Although GRI technologies have yet to be perfected, the recent advances across several scientific disciplines that are described in this review have provided a path towards their clinical implementation.
Short article: Stool cytomegalovirus polymerase chain reaction for the diagnosis of cytomegalovirus-related gastrointestinal disease
Authors: Prachasitthisak Noparat , Tanpowpong Pornthep , Lertudomphonwanit Chatmanee , Treepongkaruna Suporn , Boonsathorn Sophida , Angkathunyakul Napat , Sornmayura Pattana , Chantratita Wasun 
Published: May 2017

Objectives
The diagnosis of cytomegalovirus-related gastrointestinal disease (CMV-GI disease) still requires histopathology, but biopsy is considered invasive. Stool CMV PCR has been reported in adults as an alternative method to diagnose this condition; hence, the results between studies are discrepant. Moreover, no pediatric studies on stool CMV real-time PCR in CMV-GI disease have been carried out. Here, we evaluate the value of stool CMV real-time PCR in detecting CMV-GI disease among immunocompromised children.

Methods
We enrolled immunocompromised patients aged younger than 20 years who presented with gastrointestinal symptoms at a teaching hospital during January 2015–March 2016. Stool samples were analyzed for CMV real-time PCR. All patients underwent esophagogastroduodenoscopy and colonoscopy with mucosal biopsy.

Results
We performed stool CMV real-time PCR in 31 patients, but two could not undergo endoscopy. Therefore, 29 patients were analyzed. Two additional stool samples showed inhibitors that interfere with the PCR testing and were precluded from the final analysis. Among 27 patients, we found CMV-GI disease in seven (26%) patients. The sensitivity, specificity, and accuracy of stool CMV real-time PCR were 71, 85, and 82%, respectively. We also found that all patients with CMV-GI disease had positive plasma CMV real-time PCR (>150 copies/ml). A significant association between stool and plasma CMV real-time PCR was also noted (P<0.001).

Conclusion
Stool CMV real-time PCR may be used as a noninvasive tool in the diagnosis of CMV-GI disease. Plasma CMV real-time PCR shows a significant correlation with stool CMV real-time PCR and also represents high diagnostic values.
Utility of SOFA and Δ-SOFA scores for predicting outcome in critically ill patients from the emergency department
Authors: García-Gigorro Renata , Sáez-de la Fuente Ignacio , Marín Mateos Helena , Andrés-Esteban Eva M. , Sanchez-Izquierdo Jose A. , Montejo-González Juan C. 
Published: May 2017

ObjectiveThe condition of critically ill patients in the emergency department (ED) varies from moment to moment. The aims of this study are to quantify sequential organ failure assessment (SOFA) and changes in SOFA scores over time and determine its prognostic impact.Patients and methodsThis is a prospective observational cohort study. We included 269 patients consecutively admitted to the ICU from the ED over 18 months. The SOFA scores at ED admission (ED-SOFA) and ICU admission (ICU-SOFA) were obtained. Relative changes in SOFA scores were calculated as follows: Δ-SOFA=ICU-SOFA−ED-SOFA. Patients were divided into two groups depending on the Δ-SOFA score: (a) Δ-SOFA=0–1; and (b) Δ-SOFA more than or equal to 2.ResultsThe median ED-SOFA score was two points (interquartile range: 1–4.5) and the Δ-SOFA score was 2 points (interquartile range: 0–3). The Δ-SOFA score was more powerful (area under the curve: 0.81) than the ED-SOFA score (area under the curve: 0.75) in predicting hospital mortality. Sixteen (6%) patients had a Δ-SOFA score less than 0, 116 (43%) patients had a Δ-SOFA=0–1, and 137 (51%) patients had a Δ-SOFA of at least 2 points. The probability of being alive at hospital discharge was 51 and 86.5% in Δ-SOFA of at least 2 and Δ-SOFA=0–1 groups, respectively (P<0.001). Risk factors for an increase of two or more SOFA points were age, cirrhosis, a diagnosis of sepsis, and a prolonged ED stay.ConclusionSOFA and changes in the SOFA score over time are potentially useful tools for risk stratification when applied to critically ill patients admitted to ICUs from the ED.
Celiac Disease Symptom Resolution
Authors: Sansotta Naire , Amirikian Karine , Guandalini Stefano , Jericho Hilary 
Published: May 2017

ABSTRACTObjective:The aim of the study was to evaluate the efficacy of the gluten‐free diet (GFD) on gastrointestinal (GI) and extra‐intestinal (EI) symptom resolution and identify predictors for persistence of symptoms in all celiac patients at the University of Chicago.Methods:We conducted a retrospective chart review from 2002 to 2015. GI symptoms included abdominal pain, bloating, constipation, diarrhea, failure to thrive/weight loss, nausea, reflux, and vomiting. EI symptoms included abnormal liver enzymes, arthralgia/arthritis, dermatitis herpetiformis, alopecia, fatigue, headache, anemia, stomatitis, myalgia, psychiatric disorders, rashes, seizures, neuropathy, short stature, delayed puberty, osteoporosis, and infertility.Results:A total of 554 patients (227 children) with celiac disease (CeD) were included. Abdominal pain, diarrhea and failure to thrive were the most common GI symptoms in children whereas diarrhea, bloating, and abdominal pain were most common in adults. Short stature, fatigue, and headache were the most common EI symptoms in children whereas iron deficiency anemia, fatigue, and headache/psychiatric disorders were most common in adults. Children had significantly higher rates of EI and GI symptom resolution as compared to adults, with greater rates of improvements in GI versus EI symptoms at more than 24 months. Long duration of symptoms, female sex, and non‐adherence to a GFD were the most important significant predictors of failure to clinically improve.Conclusions:On a strict GFD, children report greater rates of both GI and EI symptom resolution as compared to adults with greater rates of improvement in GI over EI symptoms. Early recognition of CeD and close attention to diet adherence may help in symptom resolution.
Psychotherapy Technique Related to Changes in Anxiety Symptoms With a Transdiagnostic Sample
Authors: Pitman Seth R. , Hilsenroth Mark J. , Weinberger Joel , Conway Francine , Owen Jesse 
Published: May 2017

Abstract
The current study examined how techniques in a psychodynamic model of therapy (Blagys and Hilsenroth, Clin Psychol Sci Pract. 7, 167–188, 2000) were related to changes in anxiety symptoms across early treatment process among a transdiagnostic sample of patients with primary anxiety disorder, subclinical anxiety disorder, and no anxiety disorder. Secondary analyses examined the use of specific psychodynamic techniques in relation to symptom change. Results revealed that therapists' use of psychodynamic-interpersonal (PI) techniques were significantly and directly related to changes in anxiety symptoms, in line with previous findings (Pitman, Slavin-Mulford, and Hilsenroth, J Nerv Ment Dis. 202, 391–396, 2014). In addition, patients with co-occurring axis I and II disorders demonstrated positive changes in anxiety symptoms regardless of level of PI technique used, whereas patients without co-occurring disorders experienced greater improvement with more PI. Implications for transdiagnostic treatment protocols for anxiety, notably Leichsenring and Salzer's (Psychotherapy 51, 224, 2104) Unified Psychodynamic Protocol for Anxiety Disorders, are discussed in relation to the current findings.
The Safety of Soft Contact Lenses in Children
Authors: Bullimore Mark A. 
Published: May 2017

ABSTRACT

Purpose
There is increasing interest in fitting children with soft contact lenses. This review collates data from a range of studies to estimate the incidence of complications, specifically corneal infiltrative events and microbial keratitis, in patients under the age of 18 years.

Methods
Peer-review papers were identified using PubMed and the Web of Science. A broad range of studies are summarized including large-scale epidemiological studies of contact lens–related complications, hospital-based case series, long- and short-term prospective studies, and multicenter retrospective studies.

Results
Nine prospective studies representing 1800 patient years of wear in 7- to 19-year-olds include safety outcomes. In three large prospective studies representing between 159 and 723 patient years of soft contact lens wear in patients 8 to 14 years, the incidence of corneal infiltrative events is up to 136 per 10,000 years. Data from a large retrospective study show similar rates of corneal infiltrative events: 97 per 10,000 years in 8- to 12-year-olds (based on 411 patient years of wear) and 335 per 10,000 years in 13- to 17-year-olds (based on 1372 patient years of wear). None of the prospective studies report any cases of microbial keratitis. Five clinical studies where safety data are not reported constitute a further 493 patient years. One retrospective study found no cases of microbial keratitis occurred in 8- to 12-year-olds (411 patient years) and an incidence of 15 per 10,000 patient years in 13- to 17-year-olds (1372 patient years)—no higher than the incidence of microbial keratitis in adults wearing soft contact lenses on an overnight basis.

Conclusions
The overall picture is that the incidence of corneal infiltrative events in children is no higher than in adults, and in the youngest age range of 8 to 11 years, it may be markedly lower.
Penis Transplantation
Authors: Cetrulo Curtis L. , Li Kai , Salinas Harry M. , Treiser Matthew D. , Schol Ilse , Barrisford Glen W. , McGovern Francis J. , Feldman Adam S. , Grant Michael T. , Tanrikut Cigdem , Lee Jeffrey H. , Ehrlichman Richard J. , Holzer Paul W. , Choy Garry M. , Liu Raymond W. , Ng Zhi Yang , Lellouch Alexandre G. , Kurtz Josef M. , Austen William G. , Winograd Jonathan M. , Bojovic Branko , Eberlin Kyle R. , Rosales Ivy A. , Colvin Robert B. , Ko Dicken S. C. 
Published: May 2017

Objective:
We describe the first successful penis transplant in the United States in a patient with a history of subtotal penectomy for penile cancer.

Background:
Penis transplantation represents a new paradigm in restoring anatomic appearance, urine conduit, and sexual function after genitourinary tissue loss. To date, only 2 penis transplants have been performed worldwide.

Methods:
After institutional review board approval, extensive medical, surgical, and radiological evaluations of the patient were performed. His candidacy was reviewed by a multidisciplinary team of surgeons, physicians, psychiatrists, social workers, and nurse coordinators. After appropriate donor identification and recipient induction with antithymocyte globulin, allograft procurement and recipient preparation took place concurrently. Anastomoses of the urethra, corpora, cavernosal and dorsal arteries, dorsal vein, and dorsal nerves were performed, and also inclusion of a donor skin pedicle as the composite allograft. Maintenance immunosuppression consisted of mycophenolate mofetil, tacrolimus, and methylprednisolone.

Results:
Intraoperative, the allograft had excellent capillary refill and strong Doppler signals after revascularization. Operative reinterventions on postoperative days (PODs) 2 and 13 were required for hematoma evacuation and skin eschar debridement. At 3 weeks, no anastomotic leaks were detected on urethrogram, and the catheter was removed. Steroid resistant-rejection developed on POD 28 (Banff I), progressed by POD 32 (Banff III), and required a repeat course of methylprednisolone and antithymocyte globulin. At 7 months, the patient has recovered partial sensation of the penile shaft and has spontaneous penile tumescence. Our patient reports increased overall health satisfaction, dramatic improvement of self-image, and optimism for the future.

Conclusions:
We have shown that it is feasible to perform penile transplantation with excellent results. Furthermore, this experience demonstrates that penile transplantation can be successfully performed with conventional immunosuppression. We propose that our successful penile transplantation pilot experience represents a proof of concept for an evolution in reconstructive transplantation.
Neuroimaging as a tool to study the sources of phenotypic heterogeneity in Huntington's disease
Authors: Garcia-Gorro Clara , Camara Estela , de Diego-Balaguer Ruth 
Published: May 2017

Purpose of review
Huntington's disease is a neurodegenerative disorder characterized by a triad of motor, cognitive and psychiatric disturbances. There is great variability regarding the prominence and evolution of each type of clinical sign. One possible source of phenotypic heterogeneity could be the more prominent degeneration of specific brain circuits. The scope of this review is to highlight the most recent neuroimaging studies that have analysed the relationship between brain changes and motor, cognitive and psychiatric alterations in Huntington's disease.

Recent findings
The results from recent neuroimaging studies are heterogeneous. Although there is a great overlap between the different regions associated with each symptomatic domain, there is some degree of differentiation. For example, the motor network is associated with motor impairment, whereas the ventral striatum is especially involved in emotional deficits related with psychiatric problems.

Summary
Motor, cognitive and psychiatric impairments are associated with structural and functional brain biomarkers. However, the specificity of the regions involved remains unknown, because these studies focused on specific regions and symptoms. In order to tease apart the neural substrates that underlie the phenotypic heterogeneity in Huntington's disease, multivariate approaches combining brain and behavioural measures related to all symptomatic domains should be considered in the future.
Spread of competing viruses on heterogeneous networks
Authors: Chen Shanshan , Wang Kaihua , Sun Mengfeng , Fu Xinchu 
Published: May 2017

In this paper, we propose a model where two strains compete with each other at the expense of common susceptible individuals on heterogeneous networks by using pair-wise approximation closed by the probability-generating function (PGF). All of the strains obey the susceptible–infected–recovered (SIR) mechanism. From a special perspective, we first study the dynamical behaviour of an SIR model closed by the PGF, and obtain the basic reproduction number via two methods. Then we build a model to study the spreading dynamics of competing viruses and discuss the conditions for the local stability of equilibria, which is different from the condition obtained by using the heterogeneous mean-field approach. Finally, we perform numerical simulations on Barabási–Albert networks to complement our theoretical research, and show some dynamical properties of the model with competing viruses.This article is part of the themed issue ‘Mathematical methods in medicine: neuroscience, cardiology and pathology’.