bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing an Algorithm for Optimizing Care of Elderly Patients With Glioblastoma
Authors: Flanigan Patrick M , Jahangiri Arman , Kuang Ruby , Truong Albert , Choi Sarah , Chou Alvin , Molinaro Annette M , McDermott Michael W , Berger Mitchel S , Aghi Manish K 
Published: March 2017

Abstract

BACKGROUND
Elderly patients with glioblastoma have an especially poor prognosis; optimizing their medical and surgical care remains of paramount importance.

OBJECTIVE
To investigate patient and treatment characteristics of elderly vs nonelderly patients and develop an algorithm to predict elderly patients’ survival.

METHODS
Retrospective analysis of 554 patients (mean age = 60.8; 42.0% female) undergoing first glioblastoma resection or biopsy at our institution (2005-2011).

RESULTS
Of the 554 patients, 218 (39%) were elderly (≥65 yr). Compared with nonelderly, elderly patients were more likely to receive biopsy only (26% vs 16%), have ≥1 medical comorbidity (40% vs 20%), and develop postresection morbidity (eg, seizure, delirium; 25% vs 14%), and were less likely to receive temozolomide (TMZ) (78% vs 90%) and gross total resection (31% vs 45%). To predict benefit of resection in elderly patients (n = 161), we identified 5 factors known in the preoperative period that predicted survival in a multivariate analysis. We then assigned points to each (1 point: Charlson comorbidity score >0, subtotal resection, tumor >3 cm; 2 points: preoperative weakness, Charlson comorbidity score >1, tumor >5 cm, age >75 yr; 4 points: age >85 yr). Having 3 to 5 points (n = 78, 56%) was associated with decreased survival compared to 0 to 2 points (n = 41, 29%, 8.5 vs 16.9 mo; P = .001) and increased survival compared to 6 to 9 points (n = 20, 14%, 8.5 vs 4.5 mo; P < .001). Patients with 6 to 9 points did not survive significantly longer than elderly patients receiving biopsy only (n = 57, 4.5 vs 2.7 mo; P = .58).

CONCLUSION
Further optimization of the medical and surgical care of elderly glioblastoma patients may be achieved by providing more beneficial therapies while avoiding unnecessary resection in those not likely to receive benefit from this intervention.
Stent Placement for Disabling Pulsatile Tinnitus Caused by a Lateral Sinus Stenosis: A Retrospective Study
Authors: Lenck Stéphanie , Labeyrie Marc-Antoine , Vallee Fabrice , Saint-Maurice Jean-Pierre , Guillonnet Antoine , Bernat Anne-Laure , Vironneau Pierre , Houdart Emmanuel 
Published: March 2017

Abstract

BACKGROUND: Lateral sinus stenosis is a little-known cause for pulsatile tinnitus (PT). In several small series, stenting has been described as an effective treatment for disabling PT linked with this type of stenosis.

OBJECTIVES: To describe the clinical, radiological, and manometric characteristics of patients treated for disabling PT by lateral sinus stenosis. Assessment of the efficacy of stenting for this indication.

METHODS: Retrospective study of patients treated for isolated PT by stenting of a lateral sinus stenosis in our institution, between 2009 and 2015.

RESULTS: Fourteen patients were included in our study. All of them were women. The median age at the onset of symptoms was 39.0 (21.0) years. The median body mass index was 28.5 (7.0) kg/m2. Stenting of the lateral sinus led to the disappearance of PT without recurrence in 13 patients. In one patient, stenting did not modify the noise. In this case, another cause of PT was diagnosed after stent placement.

CONCLUSION: Lateral sinus stenosis is a curable cause of venous PT. Other causes of PT must be ruled out before an endovascular treatment is undertaken, due to the frequent asymptomatic nature of Pacchioni granulations in the lateral sinus. Treatment by stenting is effective in all cases, provided that stenosis underlies the PT.
Association of Maternal Obesity With Maternal and Neonatal Outcomes in Cases of Uterine Rupture
Authors: Yao Ruofan , Goetzinger Katherine R. , Crimmins Sarah D. , Kopelman Jerome N. , Contag Stephen A. 
Published: March 2017

OBJECTIVE:
To describe the risk of adverse outcomes associated with uterine rupture in the setting of maternal obesity.

METHODS:
This was a retrospective cohort analysis of singleton nonanomalous neonates born after uterine rupture between 34 and 42 weeks of gestation. We derived data from the U.S. Natality Database from 2011 to 2014. Maternal prepregnancy body mass index (BMI) was categorized according to the World Health Organization classification. The rates of neonatal and maternal complications were calculated for each BMI class. Multivariable logistic regression analysis was used to estimate the risks of these complications among obese pregnancies compared with normal-weight pregnancies.

RESULTS:
There were 3,942 cases of uterine rupture identified among 15,860,954 births (0.02%) between 2011 and 2014. Of these, 2,917 (74%) met inclusion criteria for analysis. There was an increased risk of low 5-minute Apgar score (22.9% compared with 15.9%; adjusted odds ratio [OR] 1.49 [1.19–1.87]), neonatal intensive care unit admission (31% compared with 24.6%; adjusted OR 1.51 [1.23–1.85]), and seizure (3.7% compared with 1.9%; adjusted OR 1.80 [1.05–3.10]) in obese compared with normal-weight pregnancies. The rate of prolonged assisted ventilation was 8.5% compared with 6.2% (P=.13), which, after adjustment for confounders, was a statistically significant difference (adjusted OR 1.47 [1.05–2.07]). The rate of neonatal death was similar (12.4 compared with 6.5/1,000 births; adjusted OR 2.03 [0.81–5.05]). The rates of various maternal complications were similar between groups.

CONCLUSION:
In the setting of uterine rupture, maternal obesity moderately increases the risks of low Apgar score, neonatal intensive care unit admission, prolonged ventilation, and seizure. Risk of maternal complications and the risk of neonatal death, however, are similar to risks in patients of normal BMI.
Uptake of a Guideline for the Administration of a Rescue Course of Antenatal Corticosteroids
Authors: Datkhaeva Ilina , Dray Danielle , Has Phinnara , Stifani Bianca , Hughes Brenna L. , Rouse Dwight J. 
Published: March 2017

OBJECTIVE:
To evaluate use (both appropriate and inappropriate) of rescue corticosteroids before and after the implementation of a guideline for their use.

METHODS:
We conducted a retrospective cohort study using a pharmacy log to identify women who received an initial course of antenatal corticosteroids in the year before (2008) and in the 4 years (2009–2012) after implementation of the guideline. The charts were then reviewed to determine eligibility and assess receipt of rescue corticosteroids according to the guideline. Our primary study outcome was a temporal change in the percentage of appropriate rescue corticosteroid administration.

RESULTS:
Of 2,528 women who received a first course of corticosteroids, 142 (5.6%) were eligible for a rescue course, of whom 103 (73%) received it. The rate of appropriate administration increased from 18.2% (95% confidence interval [CI] 5–40%) in 2008 to 65.4% (95% CI 44–83%) in 2009, 93.5% (95% CI 79–99%) in 2010, 96.1% (95% CI 80–99%) in 2011, and 75.7% (95% CI 59–88%) in 2012 (P for test of trend <.001). Only 25 of these 103 eligible women (24.3%) delivered within 2–7 days of receipt of the rescue course. The rate of inappropriate administration among women who were not eligible for a rescue course (n=2,381) also rose from 0.4% (95% CI 0.04–1.4%) in 2008 to 1.9% (95% CI 0.9–3.5%) in 2009, 1.8% (95% CI 0.8–3.6%) in 2010, 2.4% (95% CI 1.2–4.3%) in 2011, and 2.2% (95% CI 1.1–4.0%) in 2012 (P for test of trend=.03). Among all recipients of rescue corticosteroids, 28% (41/144) were ineligible according to the guideline.

CONCLUSION:
Implementation of an institutional guideline for rescue corticosteroids was associated with a high rate of use among eligible women.
Early Results of Surgical Management of Camptodactyly
Authors: Evans Brady T. , Waters Peter M. , Bae Donald S. 
Published: March 2017

Background:
We hypothesize that surgery for moderate-to-severe camptodactyly (>50 degrees) results in modest gains in range of motion and improved digital position.

Methods:
A retrospective analysis of patients undergoing surgery for camptodactyly at a tertiary children’s hospital between 2000 and 2014 was performed. Surgery was indicated for patients with persistent, functionally limiting flexion contractures despite observation, therapy, and splinting. Data were collected on demographics, clinical history and presentation, nonoperative management, surgery, and clinical follow-up, focusing on range of motion at the involved joint. Total passive motion (TPM) and total active motion (TAM) at the proximal interphalangeal (PIP) joint was calculated at presentation, preoperative visit, first postoperative visit out of the cast, and last follow-up visit. Average postoperative follow-up was 1.4 years.

Results:
In total, 31 digits in 22 patients were reviewed. There were 13 males; average age at surgery was 9.6 years. There were 7 type I (infantile), 8 type II (adolescent), and 7 type III (syndromic) patients. All cases involved the PIP joint; 55% involved the small finger. All patients underwent sequential release of contracted structures until maximal extension without compromising vascularity or joint stability was obtained. Z-plasty of the volar skin was performed in 68% of digits, flexor digitorum superficialis tenotomy in 77%, volar plate release in 58%, and collateral ligament release in 48%. All patients were casted postoperatively for an average of 31 days, and 71% of digits had temporary transarticular pin fixation. At initial presentation, mean TPM and TAM were 34 and 24 degrees, respectively. TPM and TAM were 32 and 19 degrees immediately preoperatively, 30 and 13 at the first postoperative visit, and 35 and 25 at the final follow-up. Furthermore, the position of PIP arc of motion was in a more extended position postoperatively. Average TPM arc of motion was from 50 to 82 degrees preoperatively and 28 to 63 degrees at final follow-up; average TAM arc of motion was 62 to 81 degrees preoperatively and 30 to 55 degrees at final follow-up. There were no clinically meaningful differences in results based on camptodactyly type, preoperative motion, or age at surgery. There were no cases of wound infection or dehiscence. Two patients with recurrent contractures opted for subsequent PIP arthrodesis.

Conclusions:
Total motion of the PIP joint was similar both preoperatively and postoperatively following surgical release of camptodactyly. However postoperatively, the digit was in a more extended position over this arc of motion. For patients with functionally limiting flexion contractures, surgical release may be beneficial by providing a more extended position, for improved digital release, hygiene, and esthetics.

Level of Evidence:
Level IV.
Mortality Risk Stratification After Traumatic Brain Injury and Hazard of Death With Titrated Hypothermia in the Eurotherm3235Trial
Authors: Andrews Peter J. D. , Rodriguez Aryelly , Suter Peter , Battison Claire G. , Rhodes Jonathan K. J. , Puddu Irene , Harris Bridget A. 
Published: March 2017

Objectives:
Hypothermia reduces intracranial hypertension in patients with traumatic brain injury but was associated with harm in the Eurotherm3235Trial. We stratified trial patients by International Mission for Prognosis and Analysis of Clinical Trials in [Traumatic Brain Injury] (IMPACT) extended model sum scores to determine where the balance of risks lay with the intervention.

Design:
The Eurotherm3235Trial was a randomized controlled trial, with standardized and blinded outcome assessment. Patients in the trial were split into risk tertiles by IMPACT extended model sum scores. A proportional hazard analysis for death between randomization and 6 months was performed by intervention and IMPACT extended model sum scores tertiles in both the intention-to-treat and the per-protocol populations of the Eurotherm3235Trial.

Setting:
Forty-seven neurologic critical care units in 18 countries.

Patients:
Adult traumatic brain injury patients admitted to intensive care who had suffered a primary, closed traumatic brain injury; increased intracranial pressure; an initial head injury less than 10 days earlier; a core temperature at least 36°C; and an abnormal brain CT.

Intervention:
Titrated Hypothermia in the range 32-35°C as the primary intervention to reduce raised intracranial pressure.

Measurements and Main Results:
Three hundred eighty-six patients were available for analysis in the intention-to-treat and 257 in the per-protocol population. The proportional hazard analysis (intention-to-treat and per-protocol populations) showed that the treatment effect behaves similarly across all risk stratums. However, there is a trend that indicates that patients in the low-risk group could be at greater risk of suffering harm due to hypothermia.

Conclusions:
Hypothermia as a first line measure to reduce intracranial pressure to less than 20 mm Hg is harmful in patients with a lower severity of injury and no clear benefit exists in patients with more severe injuries.
Improved Outcomes with Pedicled Nipple-sparing Mastectomies Using a New Surgical Delay: Mastectomy through Wise Incisions
Authors: Schwartz Jean-Claude D. , Skowronksi Piotr P. 
Published: March 2017

Summary:
Nipple-sparing mastectomy (NSM) is challenging in patients with significant ptosis and skin excess. We previously described the first use of a surgical delay (a supraareolar incision with undermining off the breast mound) to facilitate a second-stage pedicled NSM and reconstruction. Here, we present an improvement in our surgical delay technique—a total skin and NSM through Wise incisions. This technique obviates concerns regarding delays in cancer care and more aggressively delays the nipple, allowing for more reliable and extreme NAC transpositions. This strategy also delays the Wise pattern flaps resulting in better wound healing, which is critical in implant-based reconstructions.
ABNORMAL VASCULAR COMPLEX WITHIN AN IDIOPATHIC EPIRETINAL MEMBRANE IMAGED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Gueunoun Sacha , Nazim Gabriela , Bruyère Elsa , Sieiro André , Souied Eric H. , Miere Alexandra 
Published: March 2017

Purpose:
To report the case 70-year-old patient presenting with preretinal, abnormal vascularization accompanying an idiopathic epiretinal membrane (ERM), identified by optical coherence tomography angiography.

Methods:
Observational case report of one patient.

Results:
The authors describe the case of a patient presenting with an ERM on the right eye since March 2011, diagnosed by fundus biomicroscopy and spectral domain optical coherence tomography (Spectralis; Heidelberg Engineering, Heidelberg, Germany). At the last follow-up visit, the patient had a Snellen best-corrected visual acuity of 20/32 in her right eye and 20/20 in her left eye. Although on spectral domain optical coherence tomography the aspect on the right eye was unchanged since prior examination, optical coherence tomography angiography (Angiovue; Optovue, Fremont, CA) was able to reveal a high-flow, abnormal vascular network in the preretinal manual segmentation corresponding to the ERM.

Conclusion:
Spectral domain optical coherence tomography, routinely performed in these patients, may underestimate the presence of abnormal vascularization, as both preretinal neovascular complexes and thick ERMs appear as hyperreflective structures. Optical coherence tomography angiography allows a fast and depth-resolved visualization of these abnormal vascular complexes inside idiopathic ERMs. Diagnosis of a vascularized epiretinal structure could be noteworthy before decision of retinal surgery.
Intracranial Pressure Values Are Highly Variable After Cerebral Spinal Fluid Drainage
Authors: Rogers Michael , Stutzman Sonja E. , Atem Folefac D. , Sengupta Samarpita , Welch Babu , Olson DaiWai M. 
Published: March 2017

ABSTRACT
Intracranial pressure (ICP) is often obtained via external ventricular drain (EVD) placement and is discussed as a key vital sign in neuroscience. Nurses are most often delegated the task of observing, adjudicating, and documenting ICP. Cerebrospinal fluid drainage requires that the transducer connected to the EVD is open to drain, prohibiting ICP monitoring. There are no recent data to support an evidence-based standard for the period an ICP waveform should be observed, after the EVD is clamped, to be able to adjudicate a value that represents the patient’s status. Therefore, the purpose of this study is to determine the optimal period for which an EVD should be closed to obtain an accurate ICP value. In a sample of 30 subjects who received continuous ICP monitoring for 15 minutes, there was no universal pattern to ICP after clamping an EVD. The conditional probability of observing a patient’s highest ICP, if ICP is observed for 5 minutes, is 0.0181. The conditional probability increased to 0.0402 if ICP is observed for 10 minutes. There were no instances of ICP elevation requiring intervention. The results suggest that at least 5 minutes of ICP monitoring is safe and is required to provide an ICP value that reflects true ICP.
Risk Factors for Poststroke Depression: An Integrative Review
Authors: Babkair Lisa A. 
Published: March 2017

ABSTRACT

Background: Poststroke depression (PSD) is the most common stroke-related emotional disorder and affecting one-third of stroke survivors at any time up to 5 years after stroke. Poststroke depression affects rehabilitation after stroke and may delay recovery. The purpose of this integrative review is to analyze the state of the science in regard to risk factors for PSD. Methods: The electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo were searched. Inclusion criteria included (1) peer-reviewed primary observational Western studies, (2) PSD as the primary outcome, (3) included adult stroke survivors, and (4) and published after 2004. The integrative review guidelines were used for analysis. Results: From an original of 406 articles identified, 18 met the inclusion criteria and were reviewed: 3 cross-sectional, 14 prospective cohort, and 1 case control. The most common risk factors associated with PSD are stroke severity, cognitive impairment, physical disability, and functional dependency. Others factors including demographic and social factors and medical history were not consistent across studies. Conclusions: Overall, quality of the research was limited by small sample sizes, selection bias, number of selected variables, and lack of multivariate analyses. Nurses should identify patients at risk for PSD through early depression screening and provide interventions to enhance rehabilitation and improve recovery.
Clinical Predictors for KRAS Codon 13 Mutations in Patients With Colorectal Cancer
Authors: Kwak Min S. , Cha Jae M. , Cho Young H. , Kim Sang H. , Yoon Jin Y. , Jeon Jung W. , Shin Hyun P. , Joo Kwang R. , Lee Joung I. 
Published: March 2017

Goals:
This study sought to clarify sex differences in KRAS mutations and clinical predictors of KRAS 13 codon mutations.

Background:
Sex differences in KRAS mutations and predictors for KRAS codon 13 mutations in colorectal cancer (CRC) are unclear.

Study:
Between October 2007 and May 2016, 328 patients underwent surgery for CRCs that were analyzed for KRAS mutations at a referral university hospital. Sex differences in the rates and distributions of KRAS mutations, and factors predictive of overall KRAS and KRAS codon 13 mutations were analyzed.

Results:
KRAS mutations were significantly more common in women than men patients (46.0% vs. 34.4%, P<0.033). However, no sex differences were detected for KRAS mutations by codon subtypes (P=0.592). The Gly13Asp (GGC>GAC) point mutation was identified only within codon 13 in both sexes. For right-sided CRC, KRAS mutations were twice as frequent in men as in women (univariate analysis; P=0.016, multivariate analysis; P=0.019). High-plasma cholesterol level was an independent predictive factor of KRAS codon 13 mutations by univariate (odds ratio, 1.013; 95% confidence interval, 1.003-1.023) and multivariate analysis (odds ratio, 1.011; 95% confidence interval, 1.001-1.021).

Conclusions:
Sex differences may affect the presentation of KRAS mutations, as they were more frequently detected in women and in right-sided CRC in men. KRAS codon 13 mutations were significantly associated with high-plasma cholesterol. Further studies are needed on the clinical implications of this finding.
Functional neuroimaging in obesity
Authors: Patriarca Laura , Magerowski Greta , Alonso-Alonso Miguel 
Published: March 2017

Purpose of review
This review examines recent advances in the use of functional neuroimaging to study human obesity, a field that is rapidly expanding and continues to be of paramount importance for a better understanding of the pathogenesis of this condition. With rising levels of obesity worldwide and limited therapeutic options, there is a great need for the development of new solutions that can benefit patients.

Recent findings
Studies that utilize functional neuroimaging are beginning to shed light on the nature of behavioral and neurocognitive dysfunctions previously identified in individuals with obesity. Significant progress has occurred in the study of reward-related processes, cognition–reward interactions, mechanisms of weight loss, genetic influences and the case of obesity in children and adolescents. Research findings confirm that obesity and its related overeating behaviors are strongly associated with the brain, both at a regional level and a large-scale network level.

Summary
Functional neuroimaging studies bring unprecedented levels of detail to examine the brain basis of obesity and show promise for the development of future brain-based biomarkers and interventions in this condition.
Managing dysphagia in trachesotomized patients: where are we now?
Authors: Goff Diane 
Published: March 2017

Purpose of review
Tracheostomized patients are medically complex and vulnerable. International attention is now focused on improving the safety and quality of their care. This review summarizes recent evidence in hot-topic areas pertinent to speech and language therapy (SLT) intervention for dysphagia management in tracheostomized patients.

Recent findings
The management of tracheostomized patients requires a truly multidisciplinary team (MDT) approach. Without this, patients remain tracheostomized and hospitalized for longer and have slower access to MDT members. Patterns of SLT intervention are variable across the United Kingdom, and further work to achieve consensus on best practice is required. Instrumental evaluation of swallowing provides vital information and can facilitate well tolerated oral feeding even prior to cuff deflation. A systematic review suggests that sensitivity of blue-dye testing is poor, but studies are methodologically flawed. The need for tracheostomy-specific quality of life measures is being addressed by the development of a questionnaire.

Summary
In this review, the main research themes relevant to speech and language therapists (SLTs) working with tracheostomized patients are discussed. This patient group poses significant challenges to robust study design. However, recent advances in uniting MDT members globally to improve standards of care are encouraging.