bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anatomic Investigation of the Trajectory for Stereotactic Laser Amygdalohippocampectomy
Authors: Holanda Vanessa M , Gungor Abuzer , Baydin Serhat , Middlebrooks Erik H , Danish Shabbar F 
Published: November 2017

Abstract

BACKGROUND
Magnetic resonance imaging-guided laser interstitial thermal therapy (LITT) has emerged as a promising treatment for mesial temporal lobe epilepsy. Surgeons must understand the relevant anatomy that is traversed by the catheter and affected by ablation.

OBJECTIVE
To study the anatomic structures crossed by the LITT catheter until it reaches the amygdala.

METHODS
Three human cadaveric heads were implanted with catheters using a frameless stereotactic technique. The Visualase® system (Medtronic, Dublin, Ireland) was utilized to ablate along the trajectory. Coronal and oblique axial slices were created. Fiber tract dissections were performed in a lateral-medial and inferior-superior scheme. Magnetic resonance tractography was acquired to illustrate the tracts dissected.

RESULTS
Entry points occurred within 4 cm of the transverse and sagittal sinus, inferior to the lambdoid suture. The cortex of the inferior occipital gyrus was crossed in the region of the transverse occipital sulcus. The vertical occipital fasciculus was crossed en route to passing through the optic radiations. The catheter crossed through or inferior to the optic radiations before piercing the parahippocampal gyrus at about 4 cm from the skull. The catheter entered the hippocampus as it pierced the superior margin of the parahippocampus at 6 cm. The catheter entered the head of the hippocampus to lie inferolateral to the amygdala in the last centimeter of the trajectory.

CONCLUSION
Understanding the anatomic principles of LITT catheter trajectories will improve the ability to perform this procedure. The current study is the first to examine the anatomy of this trajectory and will serve as the basis for future studies.
Sequential Coiling-Assisted Deployment of Flow Diverter for Treatment of Fusiform Middle Cerebral Artery Aneurysms
Authors: Alturki Abdulrahman Y , Schmalz Philip G R , Ogilvy Christopher S , Thomas Ajith J 
Published: November 2017

Abstract

BACKGROUND AND IMPORTANCE
Fusiform intracranial aneurysms remain challenging lesions to treat. These aneurysms have historically required bypass procedures or clip remodeling constructs for cure. Recently, endovascular specialists have reported experience with flow diversion for complex fusiform aneurysms of the vertebrobasilar system, with mixed results. Vascular anatomy for anterior circulation fusiform aneurysms may make these lesions more amenable to flow diversion and embolization procedures; however, published experience with these techniques is lacking. In this report, we describe a sequential coiling-assisted deployment of flow diverter for the treatment of fusiform middle cerebral artery (MCA-M1) aneurysms in 2 cases, 1 presenting acutely with subarachnoid hemorrhage and another with progressive aneurysm enlargement.

CLINICAL PRESENTATION
Two patients, a 36-yr-old male presenting with subarachnoid hemorrhage and a 60-yr-old female presenting with aneurysm enlargement were treated for fusiform aneurysms of the M1 segment of the MCA using a sequential, partial deployment of coils and flow diverter through 2 microcatheters to facilitate mutual mechanical support for both coil and flow diverter (Pipeline Embolization Device; Medtronic Inc, Dublin, Ireland). Both patients achieved favorable outcomes and follow-up angiography demonstrated complete vessel reconstruction in both cases.

CONCLUSION
The treatment of complex, fusiform, large vessel aneurysms remains challenging. As experience with new endovascular technologies and techniques grows, these lesions may be treated safely with interventional methods. The technique of partial flow diverter deployment and stabilization with coils with sequential delivery of both devices using dual microcatheter was both safe and effective.
Asthma versus chronic obstructive pulmonary disease, the Dutch versus British hypothesis, and role of interleukin-5
Authors: Chambliss Jeffrey M. , Sur Sanjiv , Tripple Julia W. 
Published: November 2017

Purpose of review
Asthma and COPD represent heterogeneous disorders with broad ranging impact on patients and health systems. This review focuses on evidence for early attempts at understanding their pathogenesis by the British and Dutch hypotheses. It also addresses the role of eosinophils, IL-5, and biologics targeting these pathways in asthma and COPD.

Recent findings
Among asthma and COPD patients, clusters exist based on phenotypic and biologic markers allowing for further understanding of endotypes. Recent studies suggest the role of eosinophils and optimal therapies for each condition may be different.

Summary
Although patients with ACOS or overlap symptoms may be an exception, overall there appears to be more evidence supporting that asthma and COPD are distinct processes. Targeting eosinophils with anti-IL-5 therapy appears to be an exciting pathway in the properly selected patient with asthma and recent data also supports its use in COPD.
Patient blood management strategies in total hip and knee arthroplasty
Authors: Newman Christopher , Tran Phong , McGregor Susan , Bramley David 
Published: November 2017

Background:
Patient blood management in total hip and knee arthroplasty involves a three-pillar approach of optimizing red blood cell mass, minimizing blood loss, and managing anemia. We describe the effect of implementation of various strategies over a 7-year period.

Methods:
We prospectively collected blood transfusion data over a yearly quarter in the years of 2009, 2012, 2014, and 2015 with patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), primary and revision procedures. Evidence-based patient blood management strategies were introduced, including a tranexamic acid (TXA) protocol. The data were retrospectively analyzed, with observations of rates and appropriateness of blood transfusions in the context of changes in Australian National Blood Authority guidelines.

Results:
There was a significant reduction in transfusion rates from 2009 to 2015 in both THA (38.5%, 24.4%, 8.5%, and 12.5% for 2009, 2012, 2014, and 2015, χ2=17.9, P<0.05), and TKA (12.4%, 6.1%, 7.8%, and 2.1% for 2009, 2012, 2014, and 2015, χ2=4.2, P<0.05). This coincided with an increased adherence to national blood management guidelines in both THA and TKA (χ2=7.19, P=0.027).

Conclusions:
Patient blood management is multifaceted, and significant reductions in transfusion can be achieved in adherence to perioperative patient blood management guidelines. Tranexamic acid also is an important contributor in the improvement of transfusion rates in THA and TKA.
Maturity Indicators and Adolescent Idiopathic Scoliosis
Authors: Neal Kevin M. , Shirley Eric D. , Kiebzak Gary M. 
Published: November 2017

Study Design.
Retrospective review.

Objective.
To determine the correlation between the Sanders Maturity Scale (SMS) and Risser stages, between both systems and menarche, and whether Risser can be used to predict SMS.

Summary of Background Data.
Predicting curve progression is critical to understanding adolescent idiopathic scoliosis and making treatment recommendations. The SMS is a better predictor of the curve acceleration phase of growth than the Risser stage. However, Scoliosis Research Society bracing criteria utilize the Risser stage and menarche.

Methods.
Consecutive female patients, 8 to 16 years old, evaluated for idiopathic scoliosis or spinal asymmetry over a 31-month period were included. Main curve size, Risser stage, menarchal status, and SMS stage were recorded for each encounter, and analyzed using Spearman rank correlation and regression models.

Results.
Six hundred fifty-six encounters (452 patients) were included with SMS staging, including 402 encounters that included menarchal data. The correlation between the Risser stage and the SMS stage was 0.9031 (P < 0.0001). However, ranges for the SMS at each Risser stage were large. Correlation between Risser stage and menarche was 0.7327 (P < 0.0001), and between SMS and menarche was 0.8355 (P < 0.0001). Eighty-five percent of SMS 3 patients were Risser 0, with or without open triradiate cartilages. Eighty-one percent of Risser 1 patients were SMS 4 or greater.

Conclusion.
When assessing maturity in idiopathic scoliosis, SMS correlates strongly with Risser stages, and both SMS and Risser correlate with menarche. However, Risser stage is a poor predictor of the exact SMS stage for individual patients due to the large ranges. The majority of patients who are ≥Risser 1 have passed the curve acceleration phase of growth. Developing brace criteria based upon the SMS stage may allow more accurate predictions regarding which patients will benefit from bracing.

Level of Evidence: 2
An Analysis of the Incidence and Outcomes of Major Versus Minor Neurological Decline After Complex Adult Spinal Deformity Surgery
Authors: Kato So , Fehlings Michael G. , Lewis Stephen J. , Lenke Lawrence G. , Shaffrey Christopher I. , Cheung Kenneth M.C. , Carreon Leah Y. , Dekutoski Mark B. , Schwab Frank J. , Boachie-Adjei Oheneba , Kebaish Khaled M. , Ames Christopher P. , Qiu Yong , Matsuyama Yukihiro , Dahl Benny T. , Mehdian Hossein , Pellisé Ferran , Berven Sigurd H. 
Published: November 2017

Study Design.
A subanalysis from a prospective, multicenter, international cohort study in 15 sites (Scoli-RISK-1).

Objective.
To report detailed information regarding the severity of neurological decline related to complex adult spine deformity (ASD) surgery and to examine outcomes based on severity.

Summary of Background Data.
Postoperative neurological decline after ASD surgeries can occur due to nerve root(s) or spinal cord dysfunction. The impact of decline and the pattern of recovery may be related to the anatomic location and the severity of the injury.

Methods.
An investigation of 272 prospectively enrolled complex ASD surgical patients with neurological status measured by American Spinal Injury Association Lower Extremity Motor Scores (LEMS) was undertaken. Postoperative neurological decline was categorized into “major” (≥5 points loss) versus “minor” (<5 points loss) deficits. Timing and extent of recovery in LEMS were investigated for each group.

Results.
Among the 265 patients with LEMS available at discharge, 61 patients (23%) had neurological decline, with 20 (33%) experiencing major decline. Of note, 90% of the patients with major decline had deficits in three or more myotomes. Full recovery was seen in 24% at 6 weeks and increased to 65% at 6 months. However, 34% continued to experience some neurological decline at 24 months, with 6% demonstrating no improvement. Of 41 patients (67%) with minor decline, 73% had deficits in one or two myotomes. Full recovery was seen in 49% at 6 weeks and increased to 70% at 6 months. Of note, 26% had persistence of some neurological deficit at 24 months, with 18% demonstrating no recovery.

Conclusion.
In patients undergoing complex ASD correction, a rate of postoperative neurological decline of 23% was noted with 33% of these being “major.” Although most patients showed substantial recovery by 6 months, approximately one-third continued to experience neurological dysfunction.

Level of Evidence: 2
Temperature Variability in a Modern Targeted Temperature Management Trial
Authors: Abu-Arafeh Ahmad , Rodriguez Aryelly , Paterson Ross L. , Andrews Peter J. D. 
Published: November 2017

Objectives:
The Eurotherm3235 trial showed that therapeutic hypothermia was deleterious in patients with raised intracranial pressure following traumatic brain injury. We sought to ascertain if increased temperature variability within the first 48 hours, or for 7 days post randomization, were modifiable risk factors associated with poorer outcome.

Design:
Eurotherm3235 was a multicenter randomized controlled trial. Patients were randomized to receive either therapeutic hypothermia in addition to standard care or the later only. Mean moving range (mr) was used to stratify subjects into tertiles by the variability present in their core temperature within the first 48 hours post randomization and within 7 days post randomization. The primary outcome measure was a collapsed Glasgow Outcome Scale-Extended at 6 months post randomization. The temperature variability effect was estimated with ordinal logistic regression adjusted for baseline covariates and treatment effect.

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

Patients:
Patients enrolled in the Eurotherm3235 trial to either therapeutic hypothermia or control treatments only.

Measurements and Main Results:
Three hundred eighty-six patients were included in our study. High level of temperature variability during the first 48 hours was associated with poorer collapsed Glasgow Outcome Scale-Extended. This effect remained statistically significant when only the control arm of the study was analyzed. No statistically significant effect was seen within the first 48 hours in the hypothermia group or within 7 days in either group.

Conclusions:
When targeting normothermia, temperature variability may be a statistically significant variable in an ordinal analysis adjusted for baseline covariates.
Association of Driving Pressure With Mortality Among Ventilated Patients With Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis*
Authors: Aoyama Hiroko , Pettenuzzo Tommaso , Aoyama Kazuyoshi , Pinto Ruxandra , Englesakis Marina , Fan Eddy 
Published: November 2017

Objectives:
A recent post hoc analysis suggested that driving pressure may be more important than traditional ventilatory variables in determining outcome in mechanically ventilated patients with acute respiratory distress syndrome. We conducted a systematic review and meta-analysis to summarize the risk of mortality for higher versus lower driving pressure.

Data Sources:
MEDLINE, EMBASE, PubMed, CINAHL, and Cochrane CENTRAL from inception to February 10, 2017.

Study Selection:
Studies including mechanically ventilated adult patients with acute respiratory distress syndrome, reporting driving pressure and mortality.

Data Extraction:
Seven studies including five secondary analysis of previous randomized controlled trials and two observational studies (6,062 patients) were eligible for study. All studies were judged as having a low risk of bias. Median (interquartile range) driving pressure between higher and lower driving pressure groups was 15 cm H2O (14–16 cm H2O). Median (interquartile range) mortality of all included studies was 34% (32–38%).

Data Synthesis:
In the meta-analyses of four studies (3,252 patients), higher driving pressure was associated with a significantly higher mortality (pooled risk ratio, 1.44; 95% [CI], 1.11–1.88; I
2 = 85%). A sensitivity analysis restricted to the three studies with similar driving pressure cutoffs (13–15 cm H2O) demonstrated similar results (pooled risk ratio, 1.28; 95% CI, 1.14–1.43; I
2 = 0%).

Conclusions:
Our study confirmed an association between higher driving pressure and higher mortality in mechanically ventilated patients with acute respiratory distress syndrome. These findings suggest a possible range of driving pressure to be evaluated in clinical trials. Future research is needed to ascertain the benefit of ventilatory strategies targeting driving pressure in patients with acute respiratory distress syndrome.
Impact of Sex on Long-term Clinical Outcomes After Percutaneous Coronary Intervention
Authors: Ghoreyshi-Hefzabad Seyed-Mohammad , Kassaian Seyed-Ebrahim , Kheirkhah-Sabetghadam Shahrbanoo , Jalali Arash , Poorhosseini Hamidreza , Movahed Mohammad Reza , Nematipour Ebrahim , Salarifar Mojtaba , Alidoosti Mohammad , Ghoreyshi- Hefzabad Seyedeharezoo , Alaeddini Farshid , Sadeghian Saeed , Lotfi-Tokaldany Masoumeh 
Published: November 2017

Aims:
To evaluate the impact of sex on long-term clinical outcomes after percutaneous coronary intervention (PCI).

Methods:
In a large prospective cohort, 5664 patients (1716 women and 3948 men) who underwent PCI in a tertiary cardiac center between March 2007 and March 2010 were enrolled. Patients were followed up for median of 74.3 months. We compared the occurrence of long-term mortality, myocardial infarction (MI), and repeated revascularization between 2 sexes. Major adverse cardiac events were defined as a composite end point consisting of occurrence of all-cause mortality, nonfatal MI, or target vessel revascularization during follow-up period.

Results:
Women were older and had more conventional coronary artery disease risk factors, had smaller vessel diameter, and received drug-eluting stents more frequently than men. On the contrary, men were much more smokers and had higher frequency of acute coronary syndrome, multivessel disease, total coronary occlusion, and lower ejection fraction. After >6 years of follow-up, the all-cause mortality, nonfatal MI, target vessel revascularization, major adverse cardiac events, patient-oriented composite end point, and total repeat PCI were similar between 2 sexes. After adjusting for potential confounders, the total repeat PCI was the only observed difference that was significantly lower in women [11.2% in women vs. 12.4% in men, adjusted subdistributional hazard ratio=0.73 (95% confidence interval, 0.6–0.88); P = 0.001).

Conclusions:
During >6 years of follow-up, no significant difference was observed in major clinical outcomes between 2 sexes.
Patient Ethnicity Predicts Poor Health Access and Gaps in Perception of Personal Cardiovascular Risk Factors
Authors: Kim Yeunjung , Hogan Kathryn , D’Onofrio Gail , Chekijian Sharon , Safdar Basmah 
Published: November 2017

Background:
Focus of health literacy campaigns has centered around raising awareness. It is unknown whether awareness of coronary artery disease risk factors accurately reflects personalization of one’s own cardiovascular risk.

Methods:
A cross-sectional survey was performed in consecutive patients presenting with chest pain admitted to an observation unit of a tertiary care hospital. A 32-item questionnaire in English or Spanish examined knowledge of coronary artery disease risk factors. Separately, the personalization of coronary risk factors was determined by having patients list their individual risk factors for having a heart attack. Primary outcome was the evaluation of ethnic disparities in awareness of cardiovascular risk factors and the patient’s misperceptions on personal risk factors. Secondary outcome was the assessment of access to information in the same population by gender and ethnicity.

Results:
Between October 2006 and April 2008, 1584 consecutive patients were screened, and 1051 patients were enrolled. Participants were 57.5% female and 62.8% self-identified White, 22.5% Black, and 11.5% Hispanic. Misperception about personal risk was significantly higher in non-White compared with the White participants for diabetes (in Blacks [odds ratio (OR), 2.22; 95% confidence interval (CI), 1.08–5.57] and Hispanics [OR, 3.50; 95% CI, 1.49–8.20]) and for hyperlipidemia (in Hispanics [OR, 2.21; 95% CI, 1.19–4.10]). Although the majority (85%) had a primary care physician, Blacks and Hispanics were less likely to have access to information (OR, 0.25; 95% CI, 0.10–0.49; and OR, 0.71; 95% CI, 0.37–1.04, respectively).

Conclusions:
There are major gaps between awareness and personalization of risk in major modifiable coronary artery disease risk factors in different ethnic groups.
Efficacy of Implementation of a Chest Pain Center at a Community Hospital
Authors: Davis Alexandra , Chiu Jason , Lau Stanley K. , Kok Yih Jen , Wu Jonathan Y. H. 
Published: November 2017

Introduction:
Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, <20% of the patients have acute coronary syndrome that require immediate attention. The HEART score is designed for rapid risk stratification of ED chest pain patients using the following criteria: history, electrocardiogram, age, risk factors, and troponin. It has been shown to be superior in identifying patients with low (HEART score 0–3) and high (7–10) risk of major adverse cardiac events, who can then be rapidly discharged or admitted for intervention.

Objective:
This retrospective review and assessment sought to evaluate the efficacy of implementation of a Chest Pain Center (CPC) at a predominantly Asian-based community hospital in the United States. Additionally, this assessment sought to evaluate the effectiveness and safety of a HEART protocol in the first 4 months after its adoption.

Materials and Methods:
The facility implemented the CPC, an observation unit, in October 2016. ED physicians risk stratified patients using the HEART score. The guidelines allow ED physicians to stratify patients into 3 categories: to discharge low-risk patients, observe moderate-risk patients in the CPC, and admit high-risk patients. Patients in the CPC received additional diagnostic work-up under the care of ED physicians and cardiologists for less than 24 hours. In addition, CPC patients were followed-up 2 and 30 days after discharge.

Results:
A total of 172 patients presented at the ED with a chief complaint of chest pain. The majority of the patients were classified into the moderate-risk group (n = 101). Low-risk patients spent significantly less hours in the hospital than the moderate- and high-risk groups, and the high-risk group spent more time in the hospital than the moderate-risk group. The staff followed-up with 74 CPC patients through telephone calls to assess if patients were still experiencing chest pain and if they had followed-up with a cardiologist or primary care physician. The 2- and 30-day survival rates were 100% and 97%, respectively.

Discussion:
The data showed a significant reduction in total length of stay for all chest pain patients. This retrospective program evaluation demonstrated some evidence in using HEART score to safely risk stratify chest pain patients to the appropriate level of care. As healthcare moves from a fee-for-service environment to value-based purchasing, hospitals need to devise and implement innovative strategies to provide efficient, beneficial, and safe care for the patients.
Safety of a 1-hour Rule-out High-sensitive Troponin T Protocol in Patients With Chest Pain at the Emergency Department
Authors: Röttger E. , de Vries – Spithoven S. , Reitsma J. B. , Limburg A. , van Ofwegen – Hanekamp C. E. E. , Hoes A. W. , Poldervaart J. M. 
Published: November 2017

Background:
The 1-hour rule-out high-sensitive cardiac troponin T protocol (hs-cTnT), in which a serial troponin measurement is performed 1 hour after the first to assess the possibility of acute coronary syndrome (ACS), has been implemented in the European guidelines in 2015. Our aim was to assess the safety of this protocol in low-risk patients in the Emergency Department (ED) when implemented in daily practice.

Methods:
Patients with acute chest pain presenting to the ED of our hospital and younger than 75 years were included (May 2013 to October 2014, The Netherlands). Hs-cTnT was measured at presentation (T0) and 1–1.5 hours after T0 (T1). Patients with a first troponin (T0) ≥ 0.012 ug/l were excluded. Primary endpoint was the 6-week occurrence of major adverse cardiac events (MACEs), defined as unstable angina, acute myocardial infarction (AMI), percutaneous coronary intervention, significant stenosis managed conservatively, coronary artery bypass grafting, and death.

Results:
Of the 374 analyzed patients, 16 patients (4.3%) developed 35 MACE. Of these 16 patients with endpoints, 3 were primarily discharged with noncardiac chest pain but returned within 6 weeks with unstable angina. Importantly, no patients experienced an AMI or died during follow-up.

Conclusion:
No AMIs or deaths occurred after introducing the 1-hour hs-cTnT protocol to rule-out ACS in chest pain patients, but other MACE such as unstable angina occurred. Our results suggest the protocol is safe to implement in the ED in The Netherlands.