bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative Spinal Navigation for the Removal of Intradural Tumors: Technical Notes
Authors: Stefini Roberto , Peron Stefano , Mandelli Jaime , Bianchini Elena , Roccucci Paolo 
Published: August 2017

Abstract

BACKGROUND
In recent years, spinal surgery has incorporated the many advantages of navigation techniques to facilitate the placement of pedicle screws during osteosynthesis, mainly for degenerative diseases. However, spinal intradural tumors are not clearly visible by intraoperative fluoroscopy or computed tomography scans, thereby making navigation necessary.

OBJECTIVE
To evaluate the use of spinal navigation for the removal of intradural and spinal cord tumors using spinal magnetic resonance imaging (MRI) merged with intraoperative 3-dimensional (3-D) fluoro images.

METHODS
After fixing the patient reference frame on the spinous process, the 3-D fluoro images were obtained in the surgical room. Using this image as the reference, the preoperative volumetric MRI images and intraoperative 3-D fluoro images were merged using automated software or manually.

RESULTS
From January to July 2016, we performed 10 navigated procedures for intradural spinal tumors by merging MRI and 3-D fluoro images. Nine patients had an intradural extramedullary tumor, 6 had neurinomas, and 3 had meningiomas; 1 patient had an intramedullary spinal cord metastasis.

CONCLUSION
The surgically demonstrated benefits of spinal navigation for the removal of intradural tumors include the decreased risk of surgery at the wrong spinal level, a minimal length of skin incision and muscle strip, and a reduction in bone removal extension. Furthermore, this technique offers the advantage of opening the dura as much as is necessary and, in the case of intrinsic spinal cord tumors, it allows the tumor to be centered. Otherwise, this would not be visible, thus enabling the precise level and the posterior midline sulcus to be determined when performing a mielotomy.
Infertility
Authors: Cunningham Jill 
Published: August 2017

ABSTRACT
Infertility is a potentially life-changing diagnosis for couples who are trying to conceive. A diagnosis of infertility and the associated management plan can lead to psychological stress, anxiety, and depression for one or both partners. Infertility affects 6% of married women of reproductive age in the United States. Once a couple is determined to be infertile, prompt referral to a specialist is indicated. Treatment varies according to the cause and may include medication, surgical intervention, or assisted reproductive technology.
Exploring Hearing Aid Problems: Perspectives of Hearing Aid Owners and Clinicians
Authors: Bennett Rebecca J. , Laplante-Lévesque Ariane , Meyer Carly J. , Eikelboom Robert H. 
Published: August 2017

Objectives:
To gather perspectives of hearing aid owners and hearing healthcare clinicians with regard to problems that arise after hearing aid fitting and use these perspectives to generate a conceptual framework to gain a better understanding of these problems.

Design:
Participants included a group of 17 hearing aid owners and a group of 21 hearing healthcare clinicians; data collection occurred separately for each group. Participants each attended two group sessions in Perth, Western Australia, wherein they: (1) generated statements describing the problems associated with hearing aids and (2) grouped and rated the statements to identify key themes. Concept mapping was used to generate a conceptual framework.

Results:
Participants identified four concepts regarding hearing aid problems as follows: (1) hearing aid management; (2) hearing aid sound quality and performance; (3) feelings, thoughts, and behaviors; and (4) information and training. While hearing aid owners and clinicians generated similar results regarding the concepts derived, the clinicians reported that the problems identified had a greater negative impact on hearing aid success than did hearing aid owners.

Conclusions:
The magnitude and diversity of hearing aid problems identified in this study highlight the ongoing challenges that hearing aid owners face and suggest that current processes for hearing aid fitting can be improved. Problems relating to hearing aid management were most often deemed to have the greatest impact on hearing aid success and be the most preventable/solvable, and thus are a good starting point when addressing hearing aid–related problems.
Use of a Defined Surgical Approach for the Debridement of Open Tibia Fractures
Authors: Marecek Geoffrey S. , Nicholson Luke T. , Auran Richard T. , Lee Jackson 
Published: August 2017

Objectives:
To determine whether a defined approach for debridement of open tibia fractures would result in no change in reoperation rate, but reduce the need for flap coverage.

Design:
Prospective cohort study.

Setting:
Academic Level 1 trauma center.

Patients:
A total of 66 patients with 68 open diaphyseal tibia fractures were included. Patients under the age of 18 and with orthopaedic trauma association open fracture classification (OTA-OFC) skin score of 3 were excluded.

Intervention:
Debridement of the open fracture through direct extension of the traumatic wound or through a defined surgical interval.

Main Outcome Measurements:
Number of operations. Need for soft-tissue transfer.

Results:
A total of 47 patients had direct extension of the traumatic wound and 21 patients had a defined surgical approach. The groups had similar proportions of Gustilo–Anderson and OTA-OFC subtypes. The average number of surgeries, including index procedure, per patient was 1.96 in the direct extension group and 1.29 in the defined approach group (P = 0.026). Flap coverage was needed in 9 patients in the direct extension group and no patients in the defined approach group (P = 0.048).

Conclusions:
A defined surgical approach to the debridement of open tibia fractures is safe and may reduce the need for flap coverage in select patients.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Long-Term Survival in Adult Patients With Severe Acute Lung Failure Receiving Veno-Venous Extracorporeal Membrane Oxygenation
Authors: Enger Tone Bull , Philipp Alois , Lubnow Matthias , Fischer Marcus , Camboni Daniele , Lunz Dirk , Bein Thomas , Müller Thomas 
Published: August 2017

Objectives:
To assess long-term survival in adult patients with severe acute lung failure receiving veno-venous extracorporeal membrane oxygenation and explore risk factors for long-term mortality.

Design:
Single-center prospective cohort study.

Setting:
University Hospital Regensburg, Germany.

Patients:
All primary cases supported with veno-venous extracorporeal membrane oxygenation from 2007 to 2016 (n = 553).

Interventions:
None.

Measurements and Main Results:
Patients were followed until January 2017. Long-term survival and predictors of long-term mortality were assessed using Kaplan-Meier survival analyses and Cox proportional hazards modeling, respectively. Two hundred eighty-six patients (52%) died during follow-up (mean follow-up 4.8 yr). Two hundred seventeen patients (39%) died during hospitalization, whereas another 69 patients (12%) died during later follow-up. Among hospital survivors, the 1-month, 3-month, 1-year, and 5-year survival rates were 99%, 95%, 86%, and 76%, respectively. Higher age, immunocompromised status, and higher Sequential Organ Failure Assessment scores were associated with long-term mortality, whereas patients with out-of-center cannulation showed improved long-term survival. Due to nonproportional hazards over time, the analysis was repeated for hospital survivors only (n = 336). Only age and immunocompromised state remained significant predictors of late mortality among hospital survivors. Lower Glasgow Outcome Scale at hospital discharge and the University Hospital Regensburg pre–extracorporeal membrane oxygenation score for predicting hospital mortality in veno-venous extracorporeal membrane oxygenation patients before extracorporeal membrane oxygenation initiation were associated with late mortality in hospital survivors (p < 0.001).

Conclusions:
Whereas acute illness factors may be important in prediction of hospital outcomes in veno-venous extracorporeal membrane oxygenation patients, they do not determine late mortality in hospital survivors. Preexisting morbidity and functional ability at hospital discharge may be important determinants of long-term survival in veno-venous extracorporeal membrane oxygenation patients.
Novel therapeutic agents in the management of brain metastases
Authors: Venur Vyshak A. , Ahluwalia Manmeet S. 
Published: August 2017

Purpose of review
This review aims to highlight the novel therapeutic agents in the management of brain metastases which are in various stages of clinical development. We review the results from recent clinical trials, publications and presentations at recent national and international conferences.

Recent findings
Several new systemic treatment options for brain metastases are in early or advanced clinical trials. These drugs have good intracranial and extracranial activities. As lung cancer, breast cancer, and melanoma are the three most common causes of brain metastases, most agents in clinical development are focused on these tumor types. Several of these therapies are small molecule tyrosine kinase inhibitors or monoclonal antibodies against the tyrosine kinase receptors. Another exciting development in brain metastases management is the use of immunotherapy agents. The anti-CTLA-4 and\or anti-PD-1 antibodies have shown promising intracranial activity in melanoma and nonsmall cell lung cancer patients with brain metastases.

Summary
Contemporary clinical trials have shown encouraging intracranial activity of newer tyrosine kinase inhibitors, monoclonal antibodies against tyrosine kinase receptors and immunotherapy agents in select group of patients with brain metastases. Further studies are needed to develop therapeutic strategies, in order to improve survival in patients with brain metastases.
Efficacy of Pharmacologic Therapy for Eosinophilic Esophagitis
Authors: Tomizawa Yutaka , Melek John , Komaki Yuga , Kavitt Robert T. , Sakuraba Atsushi 
Published: August 2017

Goals:
In order to provide a comparative evaluation of available pharmacologic treatments for eosinophilic esophagitis (EoE), we conducted a network meta-analysis.

Background:
A variety of pharmacologic treatments for EoE have been reported, however there exists a paucity of direct comparisons.

Study:
We searched randomized controlled trials using MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials database through December 2014. Studies were analyzed using a random-effects network meta-analysis to identify the most effective therapy. Subgroup analysis was performed among studies that excluded gastroesophageal reflux disease or proton-pump inhibitor responsive esophageal eosinophilia, and also among pediatric and adult populations. The ranking probability for the efficacy of each treatment was analyzed. Consistency of the included randomized controlled trials was checked by applying inconsistency and node-splitting models.

Results:
Eleven studies of a total of 456 patients were identified. Six pharmacologic treatments (budesonide suspension and viscous, fluticasone, prednisone, esomeprazole, and mepolizumab) and placebo were included in our analysis. Meta-analysis showed superiority of budesonide viscous, budesonide suspension, and fluticasone over placebo. Network meta-analysis demonstrated the rank order of efficacy as budesonide viscous, esomeprazole, prednisone, budesonide suspension, fluticasone, mepolizumab, and placebo. The results were consistent from the inconsistency model analysis and node-splitting analysis. Subgroup analysis demonstrated prednisone, budesonide suspension, and esomeprazole were the most effective when network meta-analyses were performed among studies that excluded gastroesophageal reflux disease or proton-pump inhibitor responsive esophageal eosinophilia, and among pediatric and adult populations, respectively.

Conclusions:
On the basis of this network meta-analysis, viscous budesonide was shown to be the most effective pharmacologic therapy for EoE among the reported pharmacologic treatments.
Irritable Bowel Syndrome on the US Mexico Border
Authors: Zuckerman Marc J. , Schmulson Max J. , Bashashati Mohammad , Jia Yi , Dwivedi Alok , Ortiz Melchor , Casner Nancy , Byrd Theresa , Shokar Navkiran 
Published: August 2017

Goals:
To investigate the prevalence of irritable bowel syndrome (IBS), and its association with health perception and health care–seeking behavior in this Mexican American population.

Background:
The prevalence of IBS ranges from 3% to 20.4% in the United States and 4.4% to 16% in Mexico, based on Rome III and II criteria. However, its epidemiological profile in the US Mexico border is unknown.

Study:
We conducted a survey in a randomly selected indigent population (N=521) recruited into a colon cancer screening program (ACCION). The prevalence of IBS was estimated and a multivariable logistic regression was carried out to determine the associated risk factors. Results are summarized using odds ratio and 95% confidence interval (CI).

Results:
A total of 464 (89%) completed the survey (mean age, 56.7 y; female, 74.8%). Country of birth was Mexico in 90.5% and the United States in 8.2% and acculturation was more Spanish (94.8%) than English (5.2%). Overall, 5.6% (95% CI, 3.7-8.1) fulfilled criteria for IBS with a predominance among women (6.9%) versus men (1.7%) (P=0.03). On the basis of multivariable analysis, lower number of bowel movements/week (odds ratio, 0.89; 95% CI, 0.80-1.00), having a primary care physician: 4.09 (1.51-11.12), using herbal treatments: 2.76 (1.08-7.06) and a previous IBS diagnosis: 23.11 (3.44-155.45), were significantly associated with the presence of IBS.

Conclusions:
The prevalence of IBS on the US Mexico border is comparable with data obtained from studies in both countries. Consulting a primary care physician as an associated factor may reveal the high rate of health-care seeking in IBS patients, while herbal treatments may reflect a cultural influence.
Computed Tomography Features Predictive of Lymph Node Involvement in Patients With a Nonfunctioning Pancreatic Neuroendocrine Tumor
Authors: Choi Sang Hyun , Kim Hyoung Jung , Kim So Yeon , Byun Jae Ho , Kim Kyung Won , Song Ki Byung , Kim Song Cheol , Kim Myung-Hwan 
Published: August 2017

Objectives
This study aims to identify the computed tomography (CT) features that may differentiate nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs) with lymph node (LN) metastasis from NF-PanNETs without lymph node metastasis.

Methods
We retrospectively analyzed 166 NF-PanNETs in 166 patients who had undergone surgical resection (median age, 53). Two radiologists evaluated the qualitative and quantitative CT findings. Through univariate and multivariate logistic regression analyses, we determined independent significant findings for differentiating NF-PanNETs with LN metastasis from NF-PanNETs without LN metastasis. Recurrence-free survival (RFS) and overall survival (OS) were compared between the 2 groups using Kaplan-Meier analysis and log-rank testing.

Results
Of the 166 NF-PanNETs, 24 (14.5%) tumors demonstrated LN metastasis. Three CT findings, radiologic LN enlargement (adjusted odds ratio [OR], 11.76; P = 0.001), liver metastasis (OR, 10.31; P = 0.027), and portal enhancement ratio of <1.238 (OR, 3.58; P = 0.033), were independently significant for differentiating NF-PanNETs with LN metastasis from NF-PanNETs without LN metastasis. Tumor size greater than 2 cm also showed a statistically marginal significance (OR, 8.47; P = 0.050). The median RFS and OS in NF-PanNETs with LN metastasis were significantly shorter than NF-PanNETs without LN metastasis (23.7 months vs 33.2 months, P < 0.001; 33.7 months vs 54.8 months, P < 0.001).

Conclusions
Four CT findings can be useful to differentiate NF-PanNETs with LN metastasis and NF-PanNETs without LN metastasis.
Thromboembolisms in Advanced Pancreatic Cancer
Authors: Ishigaki Kazunaga , Nakai Yousuke , Isayama Hiroyuki , Saito Kei , Hamada Tsuyoshi , Takahara Naminatsu , Mizuno Suguru , Mohri Dai , Kogure Hirofumi , Matsubara Saburo , Yamamoto Natsuyo , Tada Minoru , Koike Kazuhiko 
Published: August 2017

Objectives
Pancreatic cancer is reported to be highly associated with thromboembolism (TE). The aim of this analysis is to clarify risk factors for TE and its clinical impact in Japanese patients with pancreatic cancer.

Methods
Data on consecutive pancreatic cancer patients receiving systemic chemotherapy between August 1999 and July 2015 were retrospectively studied. Both symptomatic and asymptomatic, arterial and venous TEs were included in the analysis. Risk factors for TE development were analyzed using a proportional hazards model with death without TE as a competing risk. The impact of TE on survival was also evaluated using a time-dependent covariate multiple Cox model.

Results
A total of 475 patients were included in the analysis, and 57 TEs (12%) were identified: 45 venous TEs and 12 arterial TEs. The median time to TE was 169 days and the median survival from TE was 65 days. Liver metastasis was the only significant risk factor for TE (subdistribution hazards ratio, 2.15; P = 0.01), and TE was significantly associated with poor prognosis (hazards ratio, 3.31; P < 0.01).

Conclusions
Thromboembolism was not uncommon in Japanese patients receiving chemotherapy for advanced pancreatic cancer and was associated with poor prognosis. Liver metastasis was the risk factor for TE.
Comparison of Clinical Data and Scores of Quality of Life, Anxiety, and Depression in Patients With Different Types of Intraductal Papillary Mucinous Neoplasms
Authors: Pezzilli Raffaele , Cucchetti Alessandro , Calculli Lucia 
Published: August 2017

Objectives
This study aims to evaluate the well-being of patients with main duct intraductal papillary mucinous neoplasms (MD-IPMNs) or mixed type IPMNs (mixed-IPMNs) of the pancreas.

Methods
Twenty-two patients with MD/mixed-IPMNs of the pancreas were studied, and an equal number of patients having branch duct IPMNs (BD-IPMNs) were used as controls. The short form (SF) -12 Health Survey, State Trait Anxiety Inventory Y-1 and Y-2, General Health Questionnaire, and Beck Depression Inventory II were used to evaluate the quality of life once a year for 2 consecutive years.

Results
At basal evaluation, the SF-12 Health Survey questionnaire administered to the 44 patients showed that the values of the physical component and mental component scores were similar between the 2 groups of patients studied. The State Trait Anxiety Inventory Y-1 and Y-2, General Health Questionnaire, and Beck Depression Inventory II scores were also similar in the 2 groups at basal evaluation. No differences were found between MD/mixed-IPMNs and BD-IPMNs at the 1-year and the 2-year evaluations.

Conclusions
The well-being of patients with MD/mixed-IPMNs did not differ as compared with patients with BD-IPMNs.
Does Pancreaticogastrostomy Decrease the Occurrence of Delayed Gastric Emptying After Pancreatoduodenectomy?
Authors: Vandermeeren Chloé , Loi Patrizia , Closset Jean 
Published: August 2017

Objectives
This study investigates the factors that could influence the development of delayed gastric emptying (DGE) after pancreatoduodenectomy (PD). Delayed gastric emptying is a common complication after PD. The postoperative course is affected by a lengthened hospital stay, a decrease of the patients' quality of life, and a delayed adjuvant treatment.

Methods
From January 2000 to December 2012, 257 patients underwent PD in the same center. Forty-six variables were retrospectively extracted from medical records. Delayed gastric emptying (grades A, B, and C) was defined by the International Study Group of Pancreatic Surgery classification. Univariate and multivariate analyses were performed to identify factors associated with DGE.

Results
Delayed gastric emptying occurred in 133 patients (51.8%), 89 grade A (66.9%), 27 grade B (20.3%), and 17 grade C (12.8%). Biliary fistula (odds ratio [OR], 8.87; 95% confidence interval [CI], 2.07–37.99, P = 0.003), sepsis (OR, 8.02; 95% CI, 3.22–19.99; P < 0.0001), and intra-abdominal collection (OR, 3.43; 95% CI, 1.06–11.06; P = 0.039) were identified as independent risk factors for DGE, whereas pancreaticogastrostomy (OR, 0.32; 95% CI, 0.16–0.64; P < 0.001) decreased the occurrence of DGE.

Conclusions
Delayed gastric emptying was linked to the occurrence of postoperative intra-abdominal complications, and reconstruction by pancreaticogastrostomy was beneficial by decreasing its incidence.
Prenatal Stress, Methylation in Inflammation-Related Genes, and Adiposity Measures in Early Childhood: the Programming Research in Obesity, Growth Environment and Social Stress Cohort Study
Authors: Wu Shaowei , Gennings Chris , Wright Rosalind J. , Wilson Ander , Burris Heather H. , Just Allan C. , Braun Joseph M. , Svensson Katherine , Zhong Jia , Brennan Kasey J.M. , Dereix Alexandra , Cantoral Alejandra , Schnaas Lourdes , Téllez-Rojo Martha Maria , Wright Robert O. , Baccarelli Andrea A. 
Published: August 2017

ABSTRACT

Objective
Maternal stress during pregnancy may influence childhood growth and adiposity, possibly through immune/inflammatory programming. We investigated whether exposure to prenatal stress and methylation in inflammation-related genes were associated with childhood adiposity in 424 mother-child pairs in Mexico City, Mexico.

Methods
A stress index was created based on four prenatally administered stress-related scales (Exposure to Violence, Crisis in Family Systems, State-Trait Anxiety Inventory, and Edinburgh Postnatal Depression Scale). We measured weight, height, body fat mass (BFM), percentage body fat (PBF), and waist circumference in early childhood (age range, 4–6 years). Body mass index (BMI) z scores were calculated according to World Health Organization standards. DNA methylation in gene promoters of tumor necrosis factor α, interleukin 8, and interleukin 6 (IL6) in umbilical cord blood were determined by pyrosequencing.

Results
An interquartile range increase in stress index (27.3) was associated with decreases of 0.14 unit in BMI z score (95% confidence interval [CI] = −0.28 to −0.005), 5.6% in BFM (95% CI = −9.7 to −1.4), 3.5% in PBF (95% CI = −6.3 to −0.5), and 1.2% in waist circumference (95% CI = −2.4 to −0.04) in multivariable-adjusted models. An interquartile range increase in IL6 methylation (3.9%) was associated with increases of 0.23 unit in BMI z score (95% CI = 0.06–0.40), 8.1% (95% CI = 2.3–14.3) in BFM, 5.5% (95% CI = 1.7–9.5) in PBF, and 1.7% (95% CI = 0.2–3.3) in waist circumference.

Conclusions
Prenatal stress was associated with decreased childhood adiposity, whereas cord blood IL6 methylation was associated with increased childhood adiposity in Mexican children.
Gain-of-function Shh mutants activate Smoin cisindependent of Ptch1/2 function
Authors: Casillas Catalina , Roelink Henk 
Published: August 2017

AbstractSonic Hedgehog (Shh) signaling is characterized by strict non-cell autonomy; cells expressing Shh do not respond to their ligand. Here, we identify several Shh mutations that gain the ability to activate the Hedgehog (Hh) pathwayin cis. This activation requires the extracellular cysteine rich domain of Smoothened, but is otherwise independent of Ptch1/2. Many of the identified mutations disrupt either a highly conserved catalytic motif found in peptidases or an a-helix domain frequently mutated in holoprosencephaly-causingSHHalleles. The expression of gain-of-function mutants often results in the accumulation of unprocessed Shh pro-peptide, a form of Shh we demonstrate is sufficient to activate the Hh response cell-autonomously. Our results demonstrate that Shh is capable of activating the Hh pathway via Smo independently of Ptch1/2, and that it harbors an intrinsic mechanism that prevents cell-autonomous activation of the pathway to favor non-cell autonomous signaling.