bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic Endonasal Surgery for Cranial Base Chondrosarcomas
Authors: Vaz-Guimaraes Francisco , Fernandez-Miranda Juan C. , Koutourousiou Maria , Hamilton Ronald L. , Wang Eric W. , Snyderman Carl H. , Gardner Paul A. 
Published: March 2017

Abstract

BACKGROUND: Microsurgical resection via open approaches is considered the main treatment modality for cranial base chondrosarcomas (CBCs). The use of endoscopic endonasal approaches (EEAs) has been rarely reported.

OBJECTIVE: To present the endoscopic endonasal experience with CBCs at our institution.

METHODS: Retrospective review of the medical records of 35 consecutive patients who underwent EEA for CBC resection between January 2004 and April 2013. Surgical outcomes and variables that might affect extent of resection, complications, and recurrence were analyzed.

RESULTS: Forty-eight operations were performed (42 EEAs and 6 open approaches). Gross-total resection was achieved in 22 patients (62.9%), near total (≥90% tumor resection) in 11 (31.4%). Larger tumors were associated with incomplete resection in univariate and multivariate analysis (P = .004, .015, respectively). In univariate analysis, tumors involving the lower clivus and cerebellopontine angle were associated with increased number of complications, especially postoperative cerebrospinal fluid leak (P = .015) and new cranial neuropathy (P = .037), respectively. Other major complications included 2 cases of meningitis and deep venous thrombosis, and 1 case of hydrocephalus and carotid injury. Involvement of the lower clivus, parapharyngeal space, and cervical spine required a combination of approaches to maximize tumor resection (P = .017, .044, .017, respectively). No predictors were significantly associated with increased risk of recurrence. The average follow-up time was 44.6 ± 31 months.

CONCLUSIONS: EEAs may be considered a good option for managing CBCs without significant posterolateral extension beyond the basal foramina and can be used in conjunction with open approaches for maximal resection with acceptable morbidity.
Indocyanine Green Videoangiography for Surgery of a Ruptured Dissecting Aneurysm in the Precommunicating Anterior Cerebral Artery: A Technical Case Report
Authors: Nagai Yasunori , Goto Masanori , Toda Hiroki , Nishida Namiko , Yoshimoto Naoya , Iwasaki Koichi 
Published: March 2017

Abstract

BACKGROUND AND IMPORTANCE: Indocyanine green videoangiography (ICG-VA) is an important intraoperative adjunct for saccular aneurysm surgery, but its efficacy in surgery for dissecting aneurysms has rarely been reported. The authors describe the usefulness of preclipping ICG-VA in a rare case of a ruptured dissecting aneurysm located at the precommunicating (A1) segment of the anterior cerebral artery.

CLINICAL PRESENTATION: A 52-year-old woman, with no history of connective tissue diseases or vascular disorders, presented with sudden headache and convulsion. The CT scan showed that the patient had subarachnoid hemorrhage. Angiography showed a dissecting aneurysm in the left A1 segment of the anterior cerebral artery. Thus, the patient underwent trapping of the dissecting aneurysm. ICG-VA was used as an intraoperative adjunct before and after clipping. The preclipping ICG-VA showed the heterogeneously bright dissecting aneurysm and branching arteries even in the presence of hematoma.

CONCLUSION: Preclipping ICG-VA may enhance the advantage of direct surgery for dissecting aneurysm by allowing visualization of the extent of the dissected vascular wall and the related branching arteries. ICG-VA can be an indispensable adjunct to minimize the compromise from the surgical treatment for intracranial dissecting aneurysms.
Activity Restriction Recommendations and Outcomes After Reconstructive Pelvic Surgery
Authors: Mueller Margaret G. , Lewicky-Gaupp Christina , Collins Sarah A. , Abernethy Melinda G. , Alverdy Alex , Kenton Kimberly 
Published: March 2017

OBJECTIVE:
To assess the relationship between prescribed postoperative activity recommendations (liberal compared with restricted) after reconstructive prolapse surgery and patient satisfaction and pelvic floor symptoms.

METHODS:
In our multicenter, randomized, double-blind clinical trial, women undergoing reconstructive prolapse surgery were randomized to liberal compared with restricted postoperative activity recommendations. Liberal recommendations instructed women to resume postoperative activity at the woman's own pace with no restrictions on lifting or high-impact activities. Conversely, restricted recommendations instructed women to avoid heavy lifting or strenuous exercise for 3 months. The primary outcome, patient satisfaction, was assessed on a 5-point Likert scale at 3 months postoperatively with the question, “How satisfied are you with the result of your prolapse surgery?” Secondary outcomes included anatomic outcomes and pelvic floor symptoms.

RESULTS:
From September 2014 to December 2015, 130 women were screened and 108 were randomized. Ultimately, 95 were allocated to study intervention (n=45 liberal, n=50 restricted) and completed the primary outcome. Baseline characteristics (including pelvic organ prolapse quantification stage and demographics) and surgical intervention did not differ between groups. Most women underwent a minimally invasive sacrocolpopexy (58) followed by vaginal suspension (27) or vaginal closure procedures (nine). Rates of satisfaction were similarly high in the liberal and restricted recommendations groups (98% compared with 94%, odds ratio 0.36 [0.036–3.55], P=.619). Anatomic outcomes did not differ between groups; however, fewer pelvic floor symptoms were reported in the liberal group.

CONCLUSION:
Satisfaction was equally high 3 months after prolapse surgery in women who were instructed to liberally resume activities compared with those instructed to restrict postoperative activities. Women who liberally resumed their activities reported fewer prolapse and urinary symptoms and had similar short-term anatomic outcomes suggesting that allowing women to resume their normal activities postoperatively may result in improved pelvic floor outcomes.

CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov, www.clinicaltrials.gov, NCT02138487.
Postabortion Contraceptive Use and Continuation When Long-Acting Reversible Contraception Is Free
Authors: Goyal Vinita , Canfield Caitlin , Aiken Abigail R. A. , Dermish Amna , Potter Joseph E. 
Published: March 2017

OBJECTIVE:
To compare preference for long-acting contraception (LARC) and subsequent use, year-long continuation, and pregnancy among women after induced abortion who were and were not eligible to participate in a specialized funding program that provided LARC at no cost.

METHODS:
Between October 2014 and March 2016, we conducted a prospective study of abortion patients at Planned Parenthood in Austin, Texas (located in Travis County). We compared our primary outcome of interest, postabortion LARC use, among women who were eligible for the specialized funding program (low-income, uninsured, Travis County residents) and two groups who were ineligible (low-income, uninsured, non–Travis County residents, and higher income or insured women). Secondary outcomes of interest included preabortion preference for LARC and 1-year continuation and pregnancy rates among the three groups.

RESULTS:
Among 518 women, preabortion preference for LARC was high among all three groups (low-income eligible: 64% [91/143]; low-income ineligible: 44% [49/112]; and higher income 55% [146/263]). However, low-income eligible participants were more likely to receive LARC (65% [93/143] compared with 5% [6/112] and 24% [62/263], respectively, P<.05). Specifically, after adjusting for age, race–ethnicity, and education, low-income eligible participants had a 10-fold greater incidence of receiving postabortion LARC compared with low-income ineligible participants (incidence rate ratio 10.13, 95% confidence interval [CI] 4.68–21.91). Among low-income eligible and higher income women who received postabortion LARC, 1-year continuation was 90% (95% CI 82–97%) and 86% (95% CI 76–97%), respectively. One-year pregnancy risk was higher among low-income ineligible than low-income eligible women (hazard ratio 3.28, 95% CI 1.15–9.31).

CONCLUSION:
Preference for postabortion LARC was high among all three eligibility groups, yet women with access to no-cost LARC were more likely to use and continue these methods. Low-income ineligible women were far more likely to use less effective contraception and become pregnant. Specialized funding programs can play an important role in immediate postabortion contraceptive provision, particularly in settings where state funding is limited.
Vaginal Delivery After Dührssen Incisions in a Patient With Bladder Exstrophy and Uterine Prolapse
Authors: Lachica Ruben , Chan Yen , Uquillas Kristen R. , Lee Richard H. 
Published: March 2017

BACKGROUND:
Bladder exstrophy is a rare congenital anomaly affecting the lower abdominal wall, pelvis, and genitourinary structures. Pregnant women with bladder exstrophy present a unique challenge to the obstetrician.

CASE:
The patient is a 35-year old pregnant woman with bladder exstrophy, an extensive surgical history, and uterine prolapse with an abnormal, rubbery consistency to her cervix. Prenatally, she was counseled on the potential use of Dührssen incisions to facilitate vaginal delivery. Labor was induced at 36 4/7 weeks of gestation after her pregnancy was complicated by recurrent pyelonephritis. Vaginal delivery was achieved 8 minutes after the creation of Dührssen incisions.

CONCLUSION:
The care of pregnant women with bladder exstrophy requires multidisciplinary management and careful delivery planning. Successful vaginal delivery can be attained in these patients.
How to evaluate and assess quality of life issues in head and neck cancer patients
Authors: Vartanian Jose G. , Rogers Simon N. , Kowalski Luiz P. 
Published: March 2017

Purpose of reviewReview quality of life (QOL) concepts and most common instruments to be used in patients with head and neck cancer, as well as the potential benefits and limitations of information derived from QOL studies.Recent findingsInformation from QOL studies can be clinical predictors of prognosis, serve as potential screening and planning tools for clinical care and rehabilitation efforts. Enhancements in computer technology and the advent of tools like head and neck cancer-specific item prompt list will allow for QOL data to be used more easily.SummaryPatients with malignant head and neck neoplasms can present changes in important vital functions related to the disease and its treatment, usually resulting in a negative impact on their QOL. The application of specific questionnaires can be used to measure such impact and the information derived from QOL studies has the potential to be incorporated in the clinical practice to improve the quality of care.
Successful Arthroplasty Using Cadaveric Meniscus for Osteochondral Defects in the Wrist and Hand Joints
Authors: Hoang Don , Chen Vivi W. , Gould Daniel J. , Cohen Myles J. , Kulber David A. 
Published: March 2017

Background:
Osteochondral defects of the radiocarpal, metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints often necessitate joint arthrodesis or mechanical arthroplasty, which has a limited lifespan. In severely arthritic wrist and finger joints, we propose a novel adjunct for joint salvage using cadaveric meniscus for joint resurfacing as an off-the-shelf alternative to address osteochondral defects and restore normal intraarticular contact stress.

Methods:
A total of 14 patients with osteochondral defects in 5 radiocapitate, 5 MCP, 3 PIP, and 1 carpometacarpal joints received cadaveric meniscus to facilitate arthroplasty. Patient demographic, perioperative pain, range of motion, and complications were examined.

Results:
Patients aged 17 to 73 years old (average, 54.6 years old) underwent joint reconstruction for scaphoid nonunion (n = 1), scaphoid-lunate advanced collapse (n = 4), or osteoarthritis of MCP/carpometacarpal (n = 6) or PIP (n = 3) joints. Successful arthroplasty with joint space preservation occurred in all joints. Patients had a significant reduction in average pain scale score (P < 0.01) and improved average range of active motion degrees of flexion (P < 0.01) and degrees of extension (P < 0.05). No complications resulted; only a revision tenolysis and capsulotomy were required for PIP and MCP arthroplasties. Postoperative films reveal preservation of arthroplasty joint space after an average 19.7-month follow-up (range, 8–54).

Conclusions:
We believe that meniscus is a viable joint salvage option or adjunct to preserve pain-free motion and avoid total joint arthrodesis. In this series of 14 patients, we demonstrate the successful use of cadaver meniscus in hand joint arthroplasty, such that it advantageously maintains a low metabolic demand, is biointegratable, and is surgically malleable.
Factors Associated With Levels of Risky Drinking in Adolescent Alcohol Users in Taiwan: A Secondary Data Analysis
Authors: Hung Chao-Chia , Chang Hsin-Yi , Chiang Yi-Chen , Wu Wen-Chi , Yen Lee-Lan 
Published: March 2017

ABSTRACT

Background:
Drinking is largely viewed as a socialized behavior; however, our understanding of factors associated with levels of risky drinking is limited in cultures where underage drinking is relatively unacceptable.

Purpose:
The aims of this study were to define the different levels associated with risky drinking and to examine the factors that are associated with these levels.

Methods:
We used data from the Child and Adolescent Behavior in Long-Term Evolution project. Of the 2184 students who participated in the 2006 Child & Adolescent Behavior in Long-Term Evolution survey, 1591 self-reported prior use of alcohol and had complete questionnaire data that could be used in secondary data analysis. The main study variables that were used in this study to assess levels of risky drinking included frequency of drinking, amount of drinking, and frequency of intoxication. We used ordinal logistic regression to analyze the relationships between levels of risky drinking and associated factors.

Results:
In the study sample, 9.55% were classified with high-risk drinking behavior, 22.51% were classified with medium-risk drinking behavior, and 67.94% were classified with low-risk drinking behavior. Having a mother or peers who used alcohol, being encouraged to consume alcohol by older adults or peers, high alcohol availability, high positive alcohol expectancies, low negative alcohol expectancies, and low alcohol refusal efficacy were all associated with higher levels of risky drinking.

Conclusions/Implications for Practice:
Decreasing the availability of alcohol, developing appropriate alcohol expectancies, and increasing alcohol refusal skills may help decrease the development of high-risk drinking behavior in adolescents. Our study furthers the understanding of underage alcohol use in societies with low alcohol consumption.
Update on adrenocortical carcinoma management and future directions
Authors: Varghese Jeena , Habra Mouhammed Amir 
Published: March 2017

Purpose of review
To present an update on the management of and future directions in adrenocortical carcinoma (ACC).

Recent findings
ACC is a rare malignancy with high morbidity and mortality. Surgery remains the mainstay treatment for localized disease, but it is often not feasible in more advanced cases. There is an ongoing controversy about the routine use of adjuvant treatments after surgery. Hormonal overproduction can complicate the management and worsen the prognosis of the disease. Systemic therapy with multiple cytotoxic drugs is often combined with the adrenolytic agent mitotane. Genomic analyses of ACC revealed numerous signal transduction pathway aberrations (insulin-like growth factor 2 overexpression, TP53 mutations and Wnt/β-catenin pathway activation), but so far, there has been no clinically meaningful breakthrough in targeting these genes. Immunotherapy offers hope for altering the orthodox management of cancer, and its role in ACC is being explored in multiple ongoing trials.

Summary
Surgery by experienced team is the key treatment for localized ACC, whereas currently used chemotherapy has limited efficacy in advanced ACC. The improved understanding of the molecular pathways involved in ACC has not been translated into effective therapy. The development of new therapies requires collaborative effort to fight this disease.
Testing for Urinary Tract Infection in the Influenza/Respiratory Syncytial Virus–Positive Febrile Infant Aged 2 to 12 Months
Authors: Schlechter Salinas Anna Kathleen , Hains David S. , Jones Tamekia , Harrell Camden , Meredith Mark 
Published: March 2017

Objective
Infants 12 months or younger with influenza and respiratory syncytial virus (RSV) commonly present to the emergency department (ED) with fever. Previous publications have recommended that these patients have a urinalysis and urine culture performed. We aimed to assess the prevalence of urinary tract infection (UTI) in febrile RSV/influenza positive infants aged 2 to 12 months presenting to the ED. We also examined whether the 2011 American Academy of Pediatrics (AAP) UTI clinical practice guidelines could be used to identify patients at lower risk of UTI.

Methods
This was a retrospective chart review examining all infants aged 2 to 12 months with a documented fever of higher than 38°C who presented to our ED from 2009 to 2013 and tested positive for influenza and/or RSV.

Results
One thousand seven hundred twenty-four patients were found to meet our inclusion criteria. Of these, 98 were excluded because of known urinary tract anomaly or systemic antibiotic use in the 24 hours preceding evaluation. Of those patients remaining, 10 (0.62%) of 1626 had positive urine cultures (95% confidence interval, 0.3%–1.1%), and 8 (0.49%) of 1626 (95% confidence interval, 0.2%–0.97%) had positive urine cultures with positive urinalyses as defined in the 2011 AAP UTI clinical practice guidelines. All subjects with positive urine cultures as defined by the AAP had risk factors for UTI that placed their risk for UTI above 1%.

Conclusions
Our population of 2- to 12-month-old febrile infants with positive influenza/RSV testing, who did not have risk factors to make their risk of UTI higher than 1%, may not have required evaluation with urinalysis or urine culture.
Clinical Utility of Hemoglobin Testing After Minimally Invasive Sacrocolpopexy
Authors: Lavelle Erin Seifert , Giugale Lauren , Sears Sarah , Carter-Brooks Charelle M. , Shepherd Jonathan P. 
Published: March 2017

Objective
To determine the clinical utility of routine postoperative hemoglobin screening after minimally invasive sacrocolpopexy.

Methods
This is a retrospective chart review of women undergoing minimally invasive sacrocolpopexy between 2009 and 2015 at a large academic center where postoperative hemoglobin assessment is performed as routine practice. Demographic and perioperative data, pre- and postoperative hemoglobin values, and clinical signs and symptoms of potential postoperative anemia were extracted. Hemoglobin parameters were compared between women with and without clinical evidence of potential postoperative anemia. Linear and logistic regression analyses were used to identify predictors of postoperative anemia and magnitude of hemoglobin decrease.

Results
Among 800 women, postoperative hemoglobin was obtained for 99.6% and prompted further testing among 23.8%. Mean postoperative hemoglobin was 11.78 ± 1.11 g/dL, and mean decrease was 1.76 ± 0.95 g/dL. More than half (56.9%) had clinical evidence of potential anemia, but few (5%) had postoperative hemoglobin of 10 g/dL or less and none required transfusion. Women with clinical evidence of potential anemia had lower postoperative hemoglobin (11.57 vs 12.19; P < 0.001) and larger mean hemoglobin decrease (1.91 vs 1.49; P < 0.001). On regression analyses, only lower body mass index was associated with larger hemoglobin decrease (β = −0.030, P < 0.001) and no factor significantly predicted postoperative hemoglobin of 10 g/dL or less.

Conclusions
Routine hemoglobin testing rarely benefited clinical care but lead to further testing for nearly 1 in 4 patients. Although many women demonstrated clinical evidence potentially suggestive of anemia, significant anemia was rare and no women required transfusion. Neither estimated blood loss nor other risk factors consistently predicted presence of postoperative anemia or significant postoperative decrease in hemoglobin.
Sugarcoated Perineuronal Nets Regulate “GABAergic” Transmission: Bittersweet Hypothesis in Autism Spectrum Disorder
Authors: Burket Jessica A. , Urbano Maria R. , Deutsch Stephen I. 
Published: March 2017

Abstract
Fast-spiking, parvalbumin-expressing “GABAergic” interneurons regulate synchronous oscillatory output of pyramidal neurons. Metabolic demands of these GABAergic projections are great because local ion concentrations must be optimally maintained; in addition, high rates of mitochondrial respiration necessitate exquisite redox regulation. Interestingly, only fast-spiking, parvalbumin-expressing basket cells coexpressing 3 metalloproteinases seem to be preferentially enwrapped in perineuronal nets (PNNs), a specialized lattice-like structure of the extracellular matrix. The PNNs maintain optimal local concentrations of ions, protect against oxidative stress, and concentrate transcription factors and chemorepulsive axon guidance cues. The PNNs mediate opening and closing of periods of heightened plasticity. Therapeutic strategies in autism spectrum disorders include promoting both maintenance and deliberate disruption of PNNs to promote new learning and cognitive flexibility.
Epigenetic Regulation of Gene Expression in Cancer: Techniques, Resources, and Analysis
Authors: Kagohara Luciane T , Stein-O’Brien Genevieve , Kelley Dylan , Flam Emily , Wick Heather C , Danilova Ludmila V , Easwaran Hariharan , Favorov Alexander V , Qian Jiang , Gaykalova Daria A , Fertig Elana J 
Published: March 2017

ABSTRACTCancer is a complex disease, driven by aberrant activity in numerous signaling pathways in even individual malignant cells. Epigenetic changes are critical mediators of these functional changes that drive and maintain the malignant phenotype. Changes in DNA methylation, histone acetylation and methylation, non-coding RNAs, post-translational modifications are all epigenetic drivers in cancer, independent of changes in the DNA sequence. These epigenetic alterations, once thought to be crucial only for the malignant phenotype maintenance, are now recognized as critical also for disrupting essential pathways that protect the cells from uncontrolled growth, longer survival and establishment in distant sites from the original tissue. In this review, we focus on DNA methylation and chromatin structure in cancer. While associated with cancer, the precise functional role of these alterations is an area of active research using emerging high-throughput approaches and bioinformatics analysis tools. Therefore, this review describes these high-throughput measurement technologies, public domain databases for high-throughput epigenetic data in tumors and model systems, and bioinformatics algorithms for their analysis. Advances in bioinformatics data integration techniques that combine these epigenetic data with genomics data are essential to infer the function of specific epigenetic alterations in cancer, and are therefore also a focus of this review. Future studies using these emerging technologies will elucidate how alterations in the cancer epigenome cooperate with genetic aberrations to cause tumorigenesis initiation and progression. This deeper understanding is essential to future studies that will precisely infer patients’ prognosis and select patients who will be responsive to emerging epigenetic therapies.