bluuebunny/crossref_metadata_2025_split huggingface dataset:
BDNF Val66Met Polymorphism Is Related to Motor System Function After Stroke
Authors: Kim Dae Yul , Quinlan Erin B. , Gramer Robert , Cramer Steven C. 
Published: September 2015

BackgroundThe val66met polymorphism in brain-derived neurotrophic factor (BDNF) has been associated with poorer outcomes after stroke. The mechanism for this finding remains uncertain but might be related to the reduced motor system activation associated with this polymorphism in healthy people.ObjectiveThe current study examined whether the presence of the BDNF val66met polymorphism is associated with reduced motor system activation after stroke.Design and MethodsForty-two patients with stroke who were enrolled in 1 of 2 studies of robot-assisted arm motor therapy participated in the study. All participants were tested for the BDNF val66met polymorphism followed by functional magnetic resonance imaging during affected hand movement.ResultsParticipants averaged 12 months poststroke and had wide-ranging motor deficits (Fugl-Meyer scale scores=14–60). Brain activation in participants without the BDNF val66met polymorphism (n=26) spanned bilateral motor networks with a larger volume (total=334 cc) than that found in participants with this polymorphism (n=16) (97 cc). Regional analyses were consistent. Participants without this polymorphism showed larger ipsilesional primary sensorimotor cortex activation volume and magnitude compared with those in whom the polymorphism was present.LimitationsThe extent to which these findings generalize to other populations of people with stroke, such as those with stroke &lt;7 days prior, remains uncertain.ConclusionsFunctional magnetic resonance imaging during affected hand movement showed decreased brain activation among participants with the BDNF val66met polymorphism compared with those lacking this polymorphism, especially in the ipsilesional primary sensorimotor cortex contralateral to movement. These results echo findings in healthy people and suggest that genetic factors affecting the normal brain continue to be operative after stroke. The findings suggest a potential imaging-based endophenotype for the BDNF val66met polymorphism's effect on the motor system that may be useful in a clinical trial setting.
Assessment of image-derived risk factors for natural course of unruptured cerebral aneurysms
Authors: Ramachandran Manasi , Retarekar Rohini , Raghavan Madhavan L. , Berkowitz Benjamin , Dickerhoff Benjamin , Correa Tatiana , Lin Steve , Johnson Kevin , Hasan David , Ogilvy Christopher , Rosenwasser Robert , Torner James , Bogason Einar , Stapleton Christopher J. , Harbaugh Robert E. 
Published: September 2015

OBJECT
The goal of this prospective longitudinal study was to test whether image-derived metrics can differentiate unruptured aneurysms that will become unstable (grow and/or rupture) from those that will remain stable.

METHODS
One hundred seventy-eight patients harboring 198 unruptured cerebral aneurysms for whom clinical observation and follow-up with imaging surveillance was recommended at 4 clinical centers were prospectively recruited into this study. Imaging data (predominantly CT angiography) at initial presentation was recorded. Computational geometry was used to estimate numerous metrics of aneurysm morphology that described the size and shape of the aneurysm. The nonlinear, finite element method was used to estimate uniform pressure-induced peak wall tension. Computational fluid dynamics was used to estimate blood flow metrics. The median follow-up period was 645 days. Longitudinal outcome data on these aneurysm patients—whether their aneurysms grew or ruptured (the unstable group) or remained unchanged (the stable group)—was documented based on follow-up at 4 years after the beginning of recruitment.

RESULTS
Twenty aneurysms (10.1%) grew, but none ruptured. One hundred forty-nine aneurysms (75.3%) remained stable and 29 (14.6%) were lost to follow-up. None of the metrics—including aneurysm size, nonsphericity index, peak wall tension, and low shear stress area—differentiated the stable from unstable groups with statistical significance.

CONCLUSIONS
The findings in this highly selected group do not support the hypothesis that image-derived metrics can predict aneurysm growth in patients who have been selected for observation and imaging surveillance. If aneurysm shape is a significant determinant of invasive versus expectant management, selection bias is a key limitation of this study.
Safety and efficacy of aneurysm treatment with WEB: results of the WEBCAST study
Authors: Pierot Laurent , Costalat Vincent , Moret Jacques , Szikora Istvan , Klisch Joachim , Herbreteau Denis , Holtmannspötter Markus , Weber Werner , Januel Anne-Christine , Liebig Thomas , Sychra Vojtech , Strasilla Christoph , Cognard Christophe , Bonafé Alain , Molyneux Andrew , Byrne James V. , Spelle Laurent 
Published: September 2015

OBJECT
WEB is an innovative intrasaccular treatment for intracranial aneurysms. Preliminary series have shown good safety and efficacy. The WEB Clinical Assessment of Intrasaccular Aneurysm Therapy (WEBCAST) trial is a prospective European trial evaluating the safety and efficacy of WEB in wide-neck bifurcation aneurysms.

METHODS
Patients with wide-neck bifurcation aneurysms for which WEB treatment was indicated were included in this multicentergood clinical practices study. Clinical data including adverse events and clinical status at 1 and 6 months were collected and independently analyzed by a medical monitor. Six-month follow-up digital subtraction angiography was also performed and independently analyzed by a core laboratory. Success was defined at 6 months as complete occlusion or stable neck remnant, no worsening in angiographic appearance from postprocedure, and no retreatment performed or planned.

RESULTS
Ten European neurointerventional centers enrolled 51 patients with 51 aneurysms. Treatment with WEB was achieved in 48 of 51 aneurysms (94.1%). Adjunctive implants (coils/stents) were used in 4 of 48 aneurysms (8.3%). Thromboembolic events were observed in 9 of 51 patients (17.6%), resulting in a permanent deficit (modified Rankin Scale [mRS] Score 1) in 1 patient (2.0%). Intraoperative rupture was not observed. Morbidity (mRS score > 2) and mortality were 2.0% (1 of 51 patients, related to rupture status on entry to study) and 0.0% at 1 month, respectively. Success was achieved at 6 months in 85.4% of patients treated with WEB: 23 of 41 patients (56.1%) had complete occlusion, 12 of 41 (29.3%) had a neck remnant, and 6 of 41 (14.6%) had an aneurysm remnant.

CONCLUSIONS
The WEBCAST study showed good procedural and short-term safety of aneurysm treatment with WEB and good 6-month anatomical results.
Safety, efficacy, and life satisfaction following epilepsy surgery in patients aged 60 years and older
Authors: Dewar Sandra , Eliashiv Dawn , Walshaw Patricia D. , Engel Jerome , Fried Itzhak , Moseley Brian D. 
Published: September 2015

OBJECT
Despite its potential to offer seizure freedom, resective epilepsy surgery (RES) is seldom performed in patients 60 years of age or older. Demonstrating successful outcomes including an improved quality of life may raise awareness about the advantages of referring this underrepresented population for specialized evaluation. Accordingly, the authors investigated outcomes and life fulfillment in patients with an age ≥ 60 years who had undergone RES.

METHODS
All patients who, at the age of 60 years or older, had undergone RES for medically refractory focal onset seizures at the authors’ center were evaluated. A modified Liverpool Life Fulfillment (LLF) tool was administered postoperatively (maximum score 32). Seizure outcomes were classified according to the Engel classification system.

RESULTS
Twelve patients underwent RES. The majority of patients (9 [75%] of 12) had at least 1 medical comorbidity in addition to seizures. The mean follow-up was 3.1 ± 2.1 years. At the time of the final follow-up, 11 (91.7%) of 12 patients were documented as having a good postsurgical outcome (Engel Class I-II). Half (6 of 12 patients) were completely seizure free (Engel Class IA). Liverpool Life Fulfillment (LLF) data were available for 11 patients. Following surgery, the mean LLF score was 26.7 ± 6. Eight patients (72.7%) noted excellent satisfaction with their RES, with 5 (45.5%) noting postoperative improvements in overall health.

CONCLUSIONS
Resective epilepsy surgery is safe and effective in patients with an age ≥ 60 years. Over 90% had a good surgical outcome, with 50% becoming completely seizure free despite 1 or more medical comorbidities in the majority. The study data indicated that an advancing age should not negatively influence consideration for RES.
Cavitation-enhanced nonthermal ablation in deep brain targets: feasibility in a large animal model
Authors: Arvanitis Costas D. , Vykhodtseva Natalia , Jolesz Ferenc , Livingstone Margaret , McDannold Nathan 
Published: September 2015

OBJECT
Transcranial MRI-guided focused ultrasound (TcMRgFUS) is an emerging noninvasive alternative to surgery and radiosurgery that is undergoing testing for tumor ablation and functional neurosurgery. The method is currently limited to central brain targets due to skull heating and other factors. An alternative ablative approach combines very low intensity ultrasound bursts and an intravenously administered microbubble agent to locally destroy the vasculature. The objective of this work was to investigate whether it is feasible to use this approach at deep brain targets near the skull base in nonhuman primates.

METHODS
In 4 rhesus macaques, targets near the skull base were ablated using a clinical TcMRgFUS system operating at 220 kHz. Low-duty-cycle ultrasound exposures (sonications) were applied for 5 minutes in conjunction with the ultrasound contrast agent Definity, which was administered as a bolus injection or continuous infusion. The acoustic power level was set to be near the inertial cavitation threshold, which was measured using passive monitoring of the acoustic emissions. The resulting tissue effects were investigated with MRI and with histological analysis performed 3 hours to 1 week after sonication.

RESULTS
Thirteen targets were sonicated in regions next to the optic tract in the 4 animals. Inertial cavitation, indicated by broadband acoustic emissions, occurred at acoustic pressure amplitudes ranging from 340 to 540 kPa. MRI analysis suggested that the lesions had a central region containing red blood cell extravasations that was surrounded by edema. Blood-brain barrier disruption was observed on contrast-enhanced MRI in the lesions and in a surrounding region corresponding to the prefocal area of the FUS system. In histology, lesions consisting of tissue undergoing ischemic necrosis were found in all regions that were sonicated above the inertial cavitation threshold. Tissue damage in prefocal areas was found in several cases, suggesting that in those cases the sonication exceeded the inertial cavitation threshold in the beam path.

CONCLUSIONS
It is feasible to use a clinical TcMRgFUS system to ablate skull base targets in nonhuman primates at time-averaged acoustic power levels at least 2 orders of magnitude below what is needed for thermal ablation with this device. The results point to the risks associated with the method if the exposure levels are not carefully controlled to avoid inertial cavitation in the acoustic beam path. If methods can be developed to provide this control, this nonthermal approach could greatly expand the use of TcMRgFUS for precisely targeted ablation to locations across the entire brain.
What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?
Authors: Larson A. Noelle , Polly David W. , Ackerman Stacey J. , Ledonio Charles G. T. , Lonner Baron S. , Shah Suken A. , Emans John B. , Richards B. Stephens , _ _ 
Published: September 2015

OBJECT
There is substantial heterogeneity in the number of screws used per level fused in adolescent idiopathic scoliosis (AIS) surgery. Assuming equivalent clinical outcomes, the potential cost savings of using fewer pedicle screws were estimated using a medical decision model with sensitivity analysis.

METHODS
Descriptive analyses explored the annual costs for 5710 AIS inpatient stays using discharge data from the 2009 Kids’ Inpatient Database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), which is a national all-payer inpatient database. Patients between 10 and 17 years of age were identified using the ICD-9-CM code for idiopathic scoliosis (737.30). All inpatient stays were assumed to represent 10-level fusions with pedicle screws for AIS. High screw density was defined at 1.8 screws per level fused, and the standard screw density was defined as 1.48 screws per level fused. The surgical return for screw malposition was set at $23,762. A sensitivity analysis was performed by varying the cost per screw ($600–$1000) and the rate of surgical revisions for screw malposition (0.117%–0.483% of screws; 0.8%–4.3% of patients). The reported outcomes include estimated prevented malpositioned screws (set at 5.1%), averted revision surgeries, and annual cost savings in 2009 US dollars, assuming similar clinical outcomes (rates of complications, revision) using a standard- versus high-density pattern.

RESULTS
The total annual costs for 5710 AIS hospital stays was $278 million ($48,900 per patient). Substituting a high for a standard screw density yields 3.2 fewer screws implanted per patient, with 932 malpositioned screws prevented and 21 to 88 revision surgeries for implant malposition averted, and a potential annual cost savings of $11 million to $20 million (4%–7% reduction in the total cost of AIS hospitalizations).

CONCLUSIONS
Reducing the number of screws used in scoliosis surgery could potentially decrease national AIS hospitalization costs by up to 7%, which may improve the safety and efficiency of care. However, such a screw construct must first be proven safe and effective.
Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation
Authors: Hubbe Ulrich , Franco-Jimenez Pamela , Klingler Jan-Helge , Vasilikos Ioannis , Scholz Christoph , Kogias Evangelos 
Published: September 2015

OBJECT
The aim of the study was to investigate the safety and efficacy of minimally invasive tubular microdiscectomy for the treatment of recurrent lumbar disc herniation (LDH). As opposed to endoscopic techniques, namely microendoscopic and endoscopic transforaminal discectomy, this microscopically assisted technique has never been used for the treatment of recurrent LDH.

METHODS
Thirty consecutive patients who underwent minimally invasive tubular microdiscectomy for recurrent LDH were included in the study. The preoperative and postoperative visual analog scale (VAS) scores for pain, the clinical outcome according to modified Macnab criteria, and complications were analyzed retrospectively. The minimum follow-up was 1.5 years. Student t-test with paired samples was used for the statistical comparison of pre- and postoperative VAS scores. A p value < 0.05 was considered to be statistically significant.

RESULTS
The mean operating time was 90 ± 35 minutes. The VAS score for leg pain was significantly reduced from 5.9 ± 2.1 preoperatively to 1.7 ± 1.3 postoperatively (p < 0.001). The overall success rate (excellent or good outcome according to Macnab criteria) was 90%. Incidental durotomy occurred in 5 patients (16.7%) without neurological consequences, CSF fistula, or negative influence to the clinical outcome. Instability occurred in 2 patients (6.7%).

CONCLUSIONS
The clinical outcome of minimally invasive tubular microdiscectomy is comparable to the reported success rates of other minimally invasive techniques. The dural tear rate is not associated to higher morbidity or worse outcome. The technique is an equally effective and safe treatment option for recurrent LDH.
Treatment of cranial cruciate ligament rupture in the feline stifle
Authors: Sousa R. De. , Sutcliffe M. , Rousset N. , Holmes M. , Langley-Hobbs S.J. 
Published: September 2015

SummaryObjective: To determine whether a lateral suture placed with bone anchors between quasi-isometric points in a cat is superior to a standard fabella-tibial suture for the stabilization of cranial cruciate ligament (CrCL) rupture compared to an intact stifle joint.Study design: Biomechanical cadaveric study.Methods: Six stifle joints with intact cruciate ligaments from three skeletally mature cats were placed in a loading mounting set and tested with axial loads of 20N and 60N at three different joint angles (75°,130° and 160°). The procedure was repeated with a transected CrCL; a stabilized stifle joint after a combination of three lateral suture techniques (fabella-tibial suture technique [SFT]; femoro-tibial suture technique 1 [FTS-1] and femoro-tibial suture technique 2 [FTS-2]). Radiographic examination of the relative position of the tibia to the fixed femur was compared.Results: Stabilization of the stifle joint with lateral sutures had comparable stability to the intact specimens in the cranio-caudal direction (p = 0.2) but not in the proximo- distal direction for the SFT (p = 0.04) and FTS-2 technique (p = 0.03). There was no significant difference between the three stabilization techniques (p >0.05).Clinical significance: Lateral sutures placed with bone anchors at quasi-isometric points performed better than SFT and FTS-2 in stabilizing the feline stifle after CrCL rupture in the proximo-distal plane. Biomechanical stability in the cranio-caudal plane after placement of a lateral suture across the feline stifle was similar to the intact CrCL.
Comparison of the tibia plateau angle between small and large dogs with cranial cruciate ligament disease
Authors: Aertsens A. , Alvarez J. Rinco , Poncet C. M. , Beaufrère H. , Ragetly G. R. 
Published: September 2015

SummaryObjectives: To compare the conformation of the proximal tibia evaluated on a medio- lateral radiograph between small and large dogs with cranial cruciate ligament disease (CCLD).Methods: Retrospective clinical study with dogs having radiographic evaluation and CCLD confirmed at surgery. The first group (n = 52) was comprised of dogs weighing less than 15 kg and the second group (n = 52) of dogs weighing more than 15 kg. The tibial plateau angle (TPA), the relative tibial tube-rosity width (rTTW), and the Z angle were measured on preoperative radiographs with imaging measurement software. Linear mixed models were used to assess the effect of weight, age, sex, and neutered status on radiographic measurements and to estimate interobserver variabilities.Results: The small dog group had a greater TPA (30.1° ± 5.3; p <0.001 with a mean difference of 4.9° [95% CI: 3.8–6.0]) and Z angle (69.9° ± 5.6; p<0.001 with a mean difference of 6.1° ([95% CI: 4.9–7.4]) than the large dog group. Sex and neutered status further influenced the TPA and Z angle val -ues. No significant effect was observed on the rTTW values. A strong correlation was found between the TPA and the Z angle (r = 0.61, p <0.001). Variances were not significantly different between observers. Overall the interobserver variability was low suggesting that agreement was good.Clinical significance: Small dogs with CCLD have a steeper tibial plateau than large dogs with CCLD. Sex and neutered status also had an effect on some measured variables. This anatomical difference could influence the surgical technique, which may affect the outcome. The good interobserver agreement suggests the observer is unlikely to influence surgical planning.
False ankylosis of the temporomandibular joint in a cat
Authors: Jamet N. , Larguier L. 
Published: September 2015

SummaryObjective: To describe the use of two- dimensional computer-assisted tomography (CT) with three-dimensional (3D) reconstruction in the diagnosis and planning of surgical treatment of a case of false ankylosis of the temporomandibular joint.Case report: A young European Shorthaired cat was presented with the complaint of inability to eat and open its jaws. A CT scan with 3D reconstruction allowed visualization of the lesion which was causing extra- articular ankylosis of the temporomandibular joint. Surgery was performed to resect an osseous lesion of the zygomatic arch, thus freeing the temporomandibular joint. Postoperative physical therapy was initiated immediately following surgery, and then carried out by the owner with a one year follow-up. Clinical examination of the cat was performed during regular office visits (at 1 month and 3 months following surgery), which allowed objective assessment of postoperative recuperation. At the end of a year, the owners reported that the cat had maintained sufficient jaw opening without any signs consistent with chronic pain.Conclusion: Computed tomography scan with 3D reconstruction allowed planning of the surgical correction of extra-articular ankylosis of the temporomandibular joint, and in this case condylectomy was avoided, since temporomandibular joint range-of-motion was maintained.
Successful combined transpapillary and transmural management of a large biloma and bile duct injury: A case report and review of literature
Authors: Nayak Hemanta Kumar , Saraswat Vivek Anand , Mohindra Samir , Sharma Atul , Ghoshal Uday C. 
Published: September 2015

AbstractHere, we report a patient with bile duct injury (BDI) following open cholecystectomy, who developed a very large biloma, causing duodenal and biliary obstruction, and also had a biliary stricture at the site of BDI. We successfully managed the patient by endoscopic biloma-gastrostomy with biliary stenting that resulted in resolution of the biloma and aggressive endoscopic management of the biliary stricture with stent bundles till resolution. Pertaining this case to be the one with largest biloma in the literature (approximately 6.5 L), which developed following open cholecystectomy that resulted in biliary stricture following injury to BD. We successfully managed the patient by endoscopic biloma-gastric stenting and an aggressive endoscopic management of biliary stricture.
Influence of Education, Performance Level, and Presentation Medium on Evaluations of String Orchestra Performances
Authors: Pope David A. , Barnes Gail V. 
Published: September 2015

Abstract
The purpose of this study was to examine the effect of education level (high school orchestra students, undergraduate string music education majors, and in-service orchestra teachers), ensemble performance level (good, average, and weak), and presentation medium (audio-only and audiovisual) on the evaluations of string orchestra performances. Participants (N = 96) evaluated audio-only or audiovisual recordings of good, average, and weak string ensembles. A repeated-measures ANOVA test revealed that string education majors rated intonation more favorably than inservice teachers. All participants were able to discriminate between the good, average, and weak performances when evaluating tone, intonation, and rhythmic precision. Ratings for musical effect did not differ significantly between the good and average groups. Participants assigned significantly lower tone and intonation ratings in the audio-only presentation medium than the audiovisual. Finding evidence of when musicians learn to accurately assess music performances can be useful both for in-service music teachers and teacher educators. If this ability is apparent in high school students, they can have a larger role in the rehearsal process.