bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a Perfusion-Based Cadaveric Simulation Model Integrated into Neurosurgical Training: Feasibility Based On Reconstitution of Vascular and Cerebrospinal Fluid Systems
Authors: Zada Gabriel , Bakhsheshian Joshua , Pham Martin , Minneti Mike , Christian Eisha , Winer Jesse , Robison Aaron , Wrobel Bozena , Russin Jonathan , Mack William J , Giannotta Steven 
Published: May 2017

Abstract

BACKGROUND
Novel methodologies providing realistic simulation of the neurosurgical operating room environment are currently needed, particularly for highly subspecialized operations with steep learning curves, high-risk profiles, and demands for advanced psychomotor skills.

OBJECTIVE
To describe the development of a curriculum for using perfusion-based cadaveric simulation models in a “Mock Operating Room” for neurosurgical procedures.

METHODS
At the USC Keck School of Medicine Fresh Tissue Dissection Laboratory between 2012 and 2016, 43 cadaveric specimens underwent cannulation of the femoral or carotid artery and artificial perfusion of the arterial system, and/or cannulation of the intradural cervical spine for intrathecal reconstitution of the cerebrospinal fluid (CSF) system. Models were used to train neurosurgical residents in various procedures. Self-assessment of pre- and postprocedure trainee confidence (Likert) scores was compared for each module.

RESULTS
The following novel procedural training methodologies were successfully established: management of an injury to the carotid artery during an endoscopic endonasal approach (n = 12), endoscopic endonasal CSF leak repair (n = 6) with fluorescein perfusion, carotid endarterectomy (n = 4), extracranial-to-intracranial bypass (n = 2), insertion of ventriculostomy catheter (n = 7), spinal laminectomy with durotomy repair (n = 9), and intraventricular neuro-endoscopy with septum pellucidotomy and third ventriculostomy (n = 12). In all instances, trainees reported improvement in their postprocedural confidence scores, with mean pre- and postprocedural Likert scores being 2.85 ± 1.09 and 4.14 ± 0.93 (P < .05).

CONCLUSION
Augmentation of fresh cadaveric specimens via reconstitution of vascular and CSF pathways is a feasible methodology for complimenting surgical training in numerous neurosurgical procedures, and may hold implications in the future of neurosurgical resident education.
Congenital Deafness Alters Sensory Weighting for Postural Control
Authors: Maheu Maxime , Sharp Andréanne , Pagé Sara , Champoux François 
Published: May 2017

Objectives:
The aim of this study was to examine sensory reweighting for postural control in congenitally deaf individuals.

Design:
We studied 14 controls and 14 deaf age-matched individuals using a force platform and the modified clinical test of sensory interaction and balance protocol. Both groups performed the postural tasks without auditory cues (with hearing protectors for controls or without hearing devices for the deaf).

Results:
The results confirmed poorer postural stability in the deaf. More importantly, the data suggest that congenitally deaf individuals rely more on somatosensory information for postural control than controls.

Conclusions:
This increased somatosensory reliance may increase postural sway when it comes to more challenging postural conditions.
What Is the Actual 3D Representation of the Rib Vertebra Angle Difference (Mehta Angle)?
Authors: Brink Rob C. , Schlösser Tom P.C. , van Stralen Marijn , Vincken Koen L. , Kruyt Moyo C. , Chu Winnie C.W. , Cheng Jack C.Y. , Castelein René M. 
Published: May 2017

Study Design.
Cross-sectional study.

Objective.
To establish the relevance of the conventional two-dimensional (2D) rib vertebra angle difference (RVAD) and the relationship with the complex three-dimensional (3D) apical morphology in scoliosis.

Summary of Background Data.
The RVAD, also known as Mehta angle, describes apical rib asymmetry on conventional radiographs and was introduced as a prognostic factor for curve severity in early onset scoliosis, and later applied to other types of scoliosis as well.

Methods.
An existing idiopathic scoliosis database of high-resolution computed tomography scans used in previous work, acquired for spinal navigation, was used. Eighty-eight patients (Cobb angle 46°–109°) were included. Cobb angle and 2D RVAD, as described by Mehta, were measured on the conventional radiographs and coronal digitally reconstructed radiographs (DRR) of the prone computed tomography scans. A previously validated, semiautomatic image processing technique was used to acquire complete 3D spinal reconstructions for the measurement of the 3D RVAD in a reconstructed true coronal plane, axial rotation, and sagittal morphology.

Results.
The 2D RVAD on the x-ray was on average 25.3° ± 11.0° and 25.6° ± 12.8° on the DRR (P = 0.990), but in the true 3D coronal view of the apex, hardly any asymmetry remained (3D RVAD: 3.1° ± 12.5°; 2D RVAD on x-ray and DRR vs. 3D RVAD: P < 0.001). 2D apical rib asymmetry in the anatomical coronal plane did not correlate with the same RVAD measurements in the 3D reconstructed coronal plane of the rotated apex (r = 0.155; P = 0.149). A larger 2D RVAD was found to correlate linearly with increased axial rotation (r = 0.542; P < 0.001) and apical lordosis (r = 0.522; P < 0.001).

Conclusion.
The 2D RVAD represents a projection-based composite radiographic index reflecting the severity of the complex 3D apical morphology including axial rotation and apical lordosis. It indicates a difference in severity of the apical deformation.

Level of Evidence: 4
Hyperchloremia Is Associated With Acute Kidney Injury in Patients With Subarachnoid Hemorrhage
Authors: Sadan Ofer , Singbartl Kai , Kandiah Prem A. , Martin Kathleen S. , Samuels Owen B. 
Published: May 2017

Objective:
To assess the prevalence of acute kidney injury in patients with subarachnoid hemorrhage patients.

Design:
Retrospective analysis of all subarachnoid hemorrhage admissions.

Settings:
Neurocritical care unit.

Patients:
All patients with a diagnosis of subarachnoid hemorrhage between 2009 and 2014.

Interventions:
None.

Measurements and Main Results:
Of 1,267 patients included in this cohort, 16.7% developed acute kidney injury, as defined by Kidney Disease Improving Global Outcome criteria (changes in creatinine only). Compared to patients without acute kidney injury, patients with acute kidney injury had a higher prevalence of diabetes mellitus (21.2% vs 9.8%; p < 0.001) and hypertension (70.3% vs 50.5%; p < 0.001) and presented with higher admission creatinine concentrations (1.21 ± 0.09 vs 0.81 ± 0.01 mg/dL [mean ± sd], respectively; p < 0.001). Patients with acute kidney injury also had higher mean serum chloride and sodium concentrations during their ICU stay (113.4 ± 0.6 vs 107.1 ± 0.2 mmol/L and 143.3 ± 0.4 vs 138.8 ± 0.1 mmol/L, respectively; p < 0.001 for both), but similar chloride exposure. The mortality rate was also significantly higher in patients with acute kidney injury (28.3% vs 6.1% in the non-acute kidney injury group [p < 0.001]). Logistic regression analysis revealed that only male gender (odds ratio, 1.82; 95% CI, 1.28–2.59), hypertension (odds ratio, 1.64; 95% CI, 1.11–2.43), diabetes mellitus (odds ratio, 1.88; 95% CI, 1.19–2.99), abnormal baseline creatinine (odds ratio, 2.48; 95% CI, 1.59–3.88), and increase in mean serum chloride concentration (per 10 mmol/L; odds ratio, 7.39; 95% CI, 3.44–18.23), but not sodium, were associated with development of acute kidney injury. Kidney recovery was noted in 78.8% of the cases. Recovery reduced mortality compared to non-recovering subgroup (18.6% and 64.4%, respectively; p < 0.001).

Conclusions:
Critically ill patients with subarachnoid hemorrhage show a strong association between hyperchloremia and acute kidney injury as well as acute kidney injury and mortality.
Tackling immunomonitoring in gastrointestinal cancer
Authors: Anciaux Maëlle , Vandeputte Caroline , Hendlisz Alain 
Published: May 2017

Purpose of review
The growing awareness that the immune system is a key player in the antitumoral response and the excellent clinical results achieved in some settings with anti-programmed cell death 1 (PD1)/programmed death ligand 1 (PDL1) and anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA4) drugs has led to the rise of immunotherapy as a supplement or an alternative to conventional cancer treatment. The high costs associated with these therapies, their significant toxicity and the need to understand and circumvent immune escape mechanisms raise the urgent need for immunological assessment of therapy response. The study of the immunological parameters before, during and after treatment is referred to as immunomonitoring. This review discusses the current knowledge of immunomonitoring markers in gastrointestinal cancers.

Recent findings
The last decade has seen a collaborative effort to standardize the assays performed in clinical trials to assess response to immunotherapy. Since then, multiple studies have been conducted on blood samples, biopsies and surgical specimens to determine their immunological profiles leading to the identification of several immunological markers possessing a predictive value of response to treatment.

Summary
Future research will focus on detangling the predictive value of immune markers in different therapeutic models, and also to develop new noninvasive means to monitor the immune response of patients.

Video abstract

http://links.lww.com/COON/A20.
DISEASE EXPRESSION IN NONEXUDATIVE AGE-RELATED MACULAR DEGENERATION VARIES WITH CHOROIDAL THICKNESS
Authors: Spaide Richard F. 
Published: May 2017

Purpose:
To investigate the relationship between subfoveal choroidal thickness and disease manifestation in a series of eyes with nonexudative age-related macular degeneration (AMD).

Methods:
Retrospective study of eyes with nonexudative AMD. The extracellular deposits present, drusen and subretinal drusenoid deposits (SDD, pseudodrusen) along with a newly recognized form of drusen, pachydrusen, were graded and compared with choroidal thickness as determined by optical coherence tomography. Demographic and imaging information was evaluated with descriptive statistics and generalized estimating equations.

Results:
There were 94 eyes of 71 patients, who had a mean age of 78.1 years. Soft drusen alone were found in 45 eyes (47.9%) and subretinal drusenoid deposit with or without drusen in 38 (40.4%). Pachydrusen, which were typically larger than 125 μm, often had an irregular outer contour, showed a scattered distribution over the posterior pole and occurred in isolation or in groups of only a few drusen were found in 11 (11.7%). The mean subfoveal choroidal thickness in the soft drusen group was 227.9 μm, in the subretinal drusenoid deposit group 167.3 μm, and in the pachydrusen group 419 μm. The differences between the groups were highly significant.

Conclusion:
Extracellular deposits, subretinal drusenoid deposits and drusen, which are on either side of the retinal pigment epithelium, respectively, are common in nonexudative AMD. A new form of drusen presentation could be differentiated from typical soft drusen and was associated with thicker choroids. Disease manifestation in nonexudative AMD seems to be associated with choroidal thickness. Each of these has potential to lead to specific forms of late AMD.
Impact of Higher Vancomycin Troughs on Vancomycin-Induced Nephrotoxicity
Authors: Bulloch Marilyn Novell , Paumen Lyndsi , Eure Stephen , Stewart Joseph Grier 
Published: May 2017

Background
Guidelines published in 2009 by the Infectious Diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists recommended targeting vancomycin troughs of 15 to 20 mg/L. No previous studies exist examining the effect of implementing these guidelines on kidney function. The objective of this study was to evaluate the effect of a dosing nomogram that incorporated recommendations for higher vancomycin goal trough vancomycin-induced nephrotoxicity (VIN).

Methods
This study evaluated 300 adult inpatients with a pharmacokinetics consultation for vancomycin dosing. Two periods were evaluated: phase I (2008) assessed practice preguideline vancomycin dosing nomogram change, and phase II (2012) assessed practice postguideline vancomycin dosing nomogram change reflecting the higher trough targets. Groups were compared using χ2 or Fisher exact tests for categorical variables and Mann-Whitney U tests for continuous variables. The a priori level of significance was set at 0.05.

Results
A total of 300 inpatients (150 in 2008 and 150 in 2012) were included in the analysis. More patients from the 2012 group experienced VIN, according to the guideline definition (P = 0.03), but not per the 2007 Acute Kidney Injury Network definition (P = 0.88). There was no change in other adverse outcomes, including dialysis initiation (2 vs 0; P = 0.16), discharge on dialysis (1 vs 0; P = 0.32), transfer to another hospital for higher level of care (33 vs 34; P = 0.89), or death (15 vs 11; P = 0.41).

Conclusions
Targeting higher vancomycin troughs resulted in transient VIN but did not cause adverse sequelae.
Secondary reconstruction of maxillofacial trauma
Authors: Castro-Núñez Jaime , Van Sickels Joseph E. 
Published: May 2017

Purpose of review
Craniomaxillofacial trauma is one of the most complex clinical conditions in contemporary maxillofacial surgery. Vital structures and possible functional and esthetic sequelae are important considerations following this type of trauma and intervention. Despite the best efforts of the primary surgery, there are a group of patients that will have poor outcomes requiring secondary reconstruction to restore form and function. The purpose of this study is to review current concepts on secondary reconstruction to the maxillofacial complex.

Recent findings
The evaluation of a posttraumatic patient for a secondary reconstruction must include an assessment of the different subunits of the upper face, middle face, and lower face. Virtual surgical planning and surgical guides represent the most important innovations in secondary reconstruction over the past few years. Intraoperative navigational surgery/computed-assisted navigation is used in complex cases. Facial asymmetry can be corrected or significantly improved by segmentation of the computerized tomography dataset and mirroring of the unaffected side by means of virtual surgical planning. Navigational surgery/computed-assisted navigation allows for a more precise surgical correction when secondary reconstruction involves the replacement of extensive anatomical areas. The use of technology can result in custom-made replacements and prebent plates, which are more stable and resistant to fracture because of metal fatigue.

Summary
Careful perioperative evaluation is the key to positive outcomes of secondary reconstruction after trauma. The advent of technological tools has played a capital role in helping the surgical team perform a given treatment plan in a more precise and predictable manner.
Current opinion in otolaryngology and head and neck surgery: frontal sinus fractures
Authors: Chouake Robert J. , Miles Brett A. 
Published: May 2017

Purpose of review
The purpose of this manuscript is to review the current literature regarding the management of frontal sinus fractures and offer the authors opinion on the current management of these traumatic injuries. We evaluate recently proposed management algorithms as well as novel surgical approaches reported within the last few years.

Recent findings
Patient selection for sinus sparing treatment modalities is balanced between fracture severity, involved structures, and reliable patient surveillance. Minimally invasive, aesthetically favorable approaches grow in diversity for anterior table fractures. For fractures of the posterior sinus wall and nasofrontal outflow tract, the literature focuses on sinus sparing surgery, as well as better defining the patients in which obliteration and/or cranialization is appropriate.

Summary
Lack of large patient cohorts and follow-up limits generalizability of frontal sinus fracture research, and the ability to develop national guidelines of management. Evidence-based literature shows growing support for conservative management and sinus preservation. Improvements in frontal sinus fracture classification schemes, surgical technique, and patient selection direct this treatment paradigm shift.
Complications in facial Mohs defect reconstruction
Authors: Berens Angelique M. , Akkina Sarah R. , Patel Sapna A. 
Published: May 2017

Purpose of review
To review the recent literature in regards to complications after reconstruction of Mohs defects, outline common pitfalls and to discuss the literature on avoiding complications as outlined per aesthetic subunit.

Recent findings
Complications in facial Mohs reconstruction commonly consist of infection, wound necrosis and dehiscence, hematoma and suboptimal scarring. However, site-specific complications such as hairline or eyebrow distortion, eyelid retraction or ectropion, nasal contour abnormality, alar retraction, nasal valve compromise, significant facial asymmetry or even oral incompetence must also be considered.

Summary
A successful reconstruction mimics the premorbid state and maintains function. The use of perioperative antibiotics, sterile technique, meticulous hemostasis, subcutaneous dissection and deep sutures to minimize wound tension should be considered for all Mohs reconstructions. Cartilage grafting can minimize nasal deformity and obstruction. Reconstruction near the lower eyelid should employ periosteal suspension sutures to minimize downward tension and lid retraction. Perioral complications, such as microstomia and oral incompetence, typically improve with time and therapy. Always consider secondary procedures such as dermabrasion, steroid injection, scar revision and laser resurfacing to help optimize aesthetic outcome.
Effects of Preoperative Psychological Interventions on Catecholamine and Cortisol Levels After Surgery in Coronary Artery Bypass Graft Patients: The Randomized Controlled PSY-HEART Trial
Authors: Salzmann Stefan , Euteneuer Frank , Laferton Johannes A.C. , Auer Charlotte J. , Shedden-Mora Meike C. , Schedlowski Manfred , Moosdorf Rainer , Rief Winfried 
Published: May 2017

ABSTRACT

Objective
The aim of the study was to examine whether preoperative psychological interventions targeting patients' expectations are capable of influencing the biological stress response after coronary artery bypass graft (CABG) surgery and could thus improve recovery after heart surgery.

Methods
Randomized controlled trial with assessments 10 days before surgery, after psychological intervention (day of hospital admission, but before surgery), postoperative (6–8 days later), and at follow-up (6 months after surgery). Eligible patients (N = 124) scheduled for elective on-pump CABG or CABG with valve replacement surgery were approached before hospital admission. Standard medical care (SMC) was compared with two additional preoperative psychological interventions: (a) an expectation manipulation intervention to optimize patients' expectations about course and outcomes or (b) supportive therapy, containing the same amount of therapeutic attention, but without specifically focusing on expectations. Postoperative plasma adrenaline, noradrenaline, and cortisol levels were a secondary outcome of our study (primary outcome patients' disability 6 months after surgery and other secondary patient-reported or clinical outcomes were reported elsewhere).

Results
Expectation manipulation intervention (3.68 ln pg/mL, 95% confidence interval = 3.38–3.98, p = .015) and supportive therapy (3.70 ln pg/mL, 95% confidence interval = 3.38–4.01, p = .026) led to significantly lower postoperative adrenaline levels compared with SMC (4.26 ln pg/mL, 95% confidence interval = 3.99–4.53) only. There were no treatment effects of the preoperative intervention for noradrenaline (p = .90) or cortisol (p = .30). Higher postoperative adrenaline levels predicted disability 6 months after surgery (r = .258, p = .018).

Conclusions
In addition to SMC, preoperative psychological interventions seem to buffer psychobiological stress responses and could thus facilitate recovery from CABG surgery. Patients' postoperative stress responses could be an important factor for explaining trajectories of long-term outcomes.

Clinical Trial Registration

www.clinicaltrials.gov (NCT01407055).
Influence of Uncertain Anticipation on Brain Responses to Aversive Rectal Distension in Patients With Irritable Bowel Syndrome
Authors: Kano Michiko , Muratsubaki Tomohiko , Morishita Joe , Kono Keiji , Mugikura Shunji , Takase Kei , Ly Huynh Giao , Dupont Patrick , Van Oudenhove Lukas , Fukudo Shin 
Published: May 2017

ABSTRACT

Objective
We investigated whether certainty and uncertainty of impending aversive visceral sensation differently modulate regional brain activity, both during anticipation and visceral sensation in irritable bowel syndrome (IBS) patients compared with healthy controls.

Methods
Twenty-six IBS patients (14 women) and 29 healthy controls (15 women) were enrolled in a functional magnetic resonance imaging study. Participants received rectal distention at an individually titrated severe discomfort level that was preceded by visual cues to induce certain (100% chance of distention), uncertain (50% chance), and safe (0% chance) anticipation.

Results
Subjective ratings of anticipatory fear before and discomfort during distention were similar between IBS and control participants under cued certainty and uncertainty (p > .05). Uncertain anticipation compared with certain anticipation induced greater activation of anterior midcingulate cortex, thalamus, and visual processing areas in IBS patients compared with controls. Rectal distention after the uncertain, but not certain, cue induced higher activity in the posterior- and midcingulate cortices and the precuneus in IBS compared with controls. Controls exhibited bilateral insula activation during the nondistention period after the uncertain cue compared with the safe cue. IBS patients failed to produce this response, which was possibly due to elevated bilateral insular responses during nondistention after the safe cue. Brain data were significant at a voxel-level threshold of p
uncorrected value of less than .005 combined with a cluster-level threshold of p
FWE-corrected value of less than .05.

Conclusions
Preceding uncertainty differentially modulates the brain processing of physiologically identical rectal stimulation in IBS patients. Cue-dependent alterations in brain responses may underlie hypervigilance to visceral sensations in IBS patients.