bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stereotactic radiosurgery for brain metastases: a case-matched study comparing treatment results for patients 80 years of age or older versus patients 65–79 years of age
Authors: Watanabe Shinya , Yamamoto Masaaki , Sato Yasunori , Kawabe Takuya , Higuchi Yoshinori , Kasuya Hidetoshi , Yamamoto Tetsuya , Matsumura Akira , Barfod Bierta E. 
Published: July 2014

Object
Recently, an increasing number of patients with brain metastases, even patients over 80 years of age, have been treated with stereotactic radiosurgery (SRS). However, there is little information on SRS treatment results for patients with brain metastases 80 years of age and older. The authors undertook this study to reappraise whether SRS treatment results for patients 80 years of age or older differ from those of patients who are 65–79 years old.

Methods
This was an institutional review board–approved, retrospective cohort study. Among 2552 consecutive brain metastasis patients who underwent SRS during the 1998–2011 period, we studied 165 who were 80 years of age or older (Group A) and 1181 who were age 65–79 years old (Group B). Because of the remarkable disproportion in patient numbers between the 2 groups and considerable differences in pre-SRS clinical factors, the authors conducted a case-matched study using the propensity score matching method. Ultimately, 330 patients (165 from each group, A and B) were selected. For time-to-event outcomes, the Kaplan-Meier method was used to estimate overall survival and competing risk analysis was used to estimate other study end points, as appropriate.

Results
Although the case-matched study showed that post-SRS median survival time (MST, months) was shorter in Group A patients (5.3 months, 95% CI 3.9–7.0 months) than in Group B patients (6.9 months, 95% CI 5.0–8.1 months), this difference was not statistically significant (HR 1.147, 95% CI 0.921–1.429, p = 0.22). Incidences of neurological death and deterioration were slightly lower in Group A than in Group B patients (6.3% vs 11.8% and 8.5% vs 13.9%), but these differences did not reach statistical significance (p = 0.11 and p = 0.16). Furthermore, competing risk analyses showed that the 2 groups did not differ significantly in cumulative incidence of local recurrence (HR 0.830, 95% CI 0.268–2.573, p = 0.75), rates of repeat SRS (HR 0.738, 95% CI 0.438–1.242, p = 0.25), or incidence of SRS-related complications (HR 0.616, 95% CI 0.152–2.495, p = 0.49). Among the Group A patients, post-SRS MSTs were 11.6 months (95% CI 7.8–19.6 months), 7.9 months (95% CI 5.2–10.9 months), and 2.8 months (95% CI; 2.4–4.6 months) in patients whose disease status was modified–recursive partitioning analysis (RPA) Class(es) I+IIa, IIb, and IIc+III, respectively (p < 0.001).

Conclusions
Our results suggest that patients 80 years of age or older are not unfavorable candidates for SRS as compared with those 65–79 years old. Particularly, even among patients 80 years and older, those with modified-RPA Class I+IIa or IIb disease are considered to be favorable candidates for more aggressive treatment of brain metastases.
Patient outcomes and surgical complications in coccidioidomycosis-related hydrocephalus: an institutional review
Authors: Hardesty Douglas A. , Ramey Wyatt , Afrasiabi Mohammad , Beck Brian , Gonzalez Omar , Moran Ana , Nakaji Peter 
Published: July 2014

Object
Coccidioidomycosis is a common fungal infection in the southwestern US. Hydrocephalus is a serious complication of cranial coccidioidomycosis, and the surgical management of coccidioidomycosis-related hydrocephalus has unique challenges. The authors reviewed their institutional experience with hydrocephalus in the setting of coccidioidomycosis.

Methods
The authors retrospectively identified 44 patients diagnosed with coccidioidomycosis-related hydrocephalus at their institution since 1990, who underwent a total of 99 shunting procedures. The authors examined patient demographics, type of shunt and valve used, pressure settings, failure rates, medical treatment, ventricular response to shunting, and other variables.

Results
The majority of patients were young (average age 37 years) men (male/female ratio 28:16) with a mean follow-up of 63 months. Patients of Asian and African descent were overrepresented in the cohort compared with regional demographic data. The overall shunt failure rate during follow-up was 50%, and the average number of revisions required if the shunt failed was 2.5 (range 1–8). Low to moderate draining pressures (mean 88 mm H2O) were used in this cohort. Fourteen patients received intrathecal antifungals, and a trend of initiating intrathecal therapy after need for a shunt revision was observed (p = 0.051). The majority of shunt failures (81%) were due to mechanical blockages in the drainage system. Most patients (59%) had at least partial persistent postoperative ventriculomegaly despite successful CSF diversion. Four patients (9%) died due to coccidioidomycosis during the follow-up period.

Conclusions
Coccidioidomycosis-related hydrocephalus more often affected young males in the study's cohort, especially those of African and Asian descent. Despite the best medical therapy, there was a high rate of shunt failure due to clogged catheters or valves due to the underlying disease process. Many patients continued to have ventriculomegaly even with adequate CSF diversion. The morbidity and mortality of this chronic disease process must be recognized by the treatment team, and patients should be appropriately counseled.
Recurrence after gross-total resection of low-grade pediatric brain tumors: the frequency and timing of postoperative imaging
Authors: Kim Albert H. , Thompson Elizabeth A. , Governale Lance S. , Santa Catalina , Cahll Kevin , Kieran Mark W. , Chi Susan N. , Ullrich Nicole J. , Scott R. Michael , Goumnerova Liliana C. 
Published: July 2014

Object
Low-grade glial and glioneuronal brain tumors are frequently encountered in the pediatric population and can be effectively treated by resection. The authors aimed to use imaging to evaluate how often tumors recurred and to determine if recurrences were associated with any clinical symptoms, along with the financial costs of imaging, in patients with radiographically proven gross-total resection (GTR) at Boston Children's Hospital. These data were assessed to propose guidelines regarding postoperative surveillance.

Methods
The authors performed a retrospective cohort analysis of the Pediatric Brain Tumor Program database from 1993 to 2003 to identify patients with glial or glioneuronal tumors initially evaluated at Boston Children's Hospital. Among the 888 patients evaluated for any type of brain tumor during this period, 67 patients had WHO Grade I glial or glioneuronal lesions with radiographically proven GTR and available follow-up data. The frequency and timing of postoperative imaging was compared with the institutional protocol. Recurrence-free survival was calculated using the Kaplan-Meier method. Financial costs of imaging were available from 2001 to 2009 and were averaged to extrapolate the postoperative surveillance costs.

Results
Among the 67 patients with GTR, 13 recurrences were detected radiographically with a mean time to recurrence of 32.4 months (range 2.9–128.5 months). The mean duration of follow-up after surgery was 6.6 years. The recurrence-free survival at 2 and 5 years after GTR for all low-grade glial and glioneuronal tumors was 0.90 (95% CI 0.82–0.97) and 0.82 (95% CI 0.73–0.92), respectively. No clinical symptoms were associated with any of the recurrences, and no deaths occurred. Under the institutional protocol of surveillance imaging, the estimated cost per recurrence at 5 years was $104,094 per patient. The proposed protocol would reduce the number of MR scans in the first 5 years from 10 to 5, providing a potential cost savings of $52,047 per recurrence.

Conclusions
Given the slow-growing, clinically asymptomatic nature of low-grade glial and glioneuronal tumors coupled with the financial and psychological costs of repeated imaging, the authors propose a postoperative surveillance MRI schedule that is less intensive than current institutional practice.
Nerve growth factor promotes expression of novel genes in intervertebral disc cells that regulate tissue degradation
Authors: Kao Ting-Hsien , Peng Yi-Jen , Tsou Hsi-Kai , Salter Donald M. , Lee Herng-Sheng 
Published: July 2014

Object
Increased neurotrophin activity in degenerative intervertebral discs (IVDs) is one potential cause of chronic low-back pain (LBP). The aim of the study was to assess if nerve growth factor (NGF) might alter gene expression of IVD cells and contribute to disc degeneration by enhancing expression or activity of factors that cause breakdown of IVD matrix.

Methods
Rat-tail IVD cells were stimulated by NGF and subjected to microarray analysis. Real-time polymerase chain reaction, Western blotting, and immunocytochemistry of rat and human IVD cells and tissues treated with NGF in vitro in the absence or presence of the NGF inhibitor Ro 08-2750 were used to confirm findings of the microarray studies. Phosphorylation of mitogen-activated protein kinase (MAPK) was used to identify cell signaling pathways involved in NGF stimulation in the absence or presence of Ro 08-2750.

Results
Microarray analysis demonstrated increased expression of chitinase 3-like 1 (Chi3l1), lipocalin 2 (Lcn2), and matrix metalloproteinase–3 (Mmp3) following NGF stimulation of rat IVD cells in vitro. Increased gene expression was confirmed by real-time polymerase chain reaction with a relative increase in the Mmp/Timp ratio. Increased expression of Chi3l1, Lcn2, and Mmp3 following NGF stimulation was also demonstrated in rat cells and human tissue in vitro. Effects of NGF on protein expression were blocked by an NGF inhibitor and appear to function through the extracellular-regulation kinase 1/2 (ERK1/2) MAPK pathway.

Conclusions
Nerve growth factor has potential effects on matrix turnover activity and influences the catabolic/anabolic balance of IVD cells in an adverse way that may potentiate IVD degeneration. Anti-NGF treatment might be beneficial to ameliorate progressive tissue breakdown in IVD degeneration and may lead to pain relief.
Williams Syndrome: Ophthalmological Examination and Review of Systemic Manifestations
Authors: Weber Sarah L. P. , Souza Rodrigo B. , Ribeiro Lorena G. , Tavares Marcela F. , Goldchmit Mauro 
Published: July 2014

Purpose:
To evaluate the frequency and severity of ophthalmic manifestations and associated diseases, as well as the epidemiological data in patients with Williams syndrome.

Methods:
The authors prospectively studied 30 patients clinically diagnosed as having Williams syndrome as confirmed by the fluorescence in situ hybridization test. Patient history included gender, age, race, education level, previous illnesses, and surgeries. The ophthalmologic examination included best-corrected visual acuity, dynamic and static refraction, extraocular motility test, stereopsis test (Titmus and Lang), and direct and indirect funduscopy.

Results:
Thirty patients were included in this study. The mean age was 14.5 ± 1.38 years (range: 7 to 26 years). Fifty percent of the patients were male and 50% were female. Among the children examined, 77% had a refractive error. Hyperopia and astigmatism were noted in 67% and 20% of the patients, respectively, and myopia in 7%. Only one case of amblyopia was noted. On external examination, 23% of children had epicanthus; via biomicroscopy, 3 children with stellate patterns of the irides were observed. Eleven patients (36.6%) had measurable strabismus, 9 (82%) had esotropia, and 2 (18%) had exotropia. Binocular vision was abnormal in 43% of patients. Diffuse arteriovenous tortuosity on funduscopy was observed in 27% of patients.

Conclusions:
Williams syndrome is rare and is associated with multiple phenotypes and diseases that are susceptible to treatment. Multidisciplinary clinical management is critical and, in some cases, surgical intervention is required.

[J Pediatr Ophthalmol Strabismus 2014;51(4):209–213.]
Ophthalmologic Features of Vici Syndrome
Authors: Filloux Francis M. , Hoffman Robert O. , Viskochil David H. , Jungbluth Heinz , Creel Donnell J. 
Published: July 2014

Purpose:
To report and compile the ophthalmological features critical to diagnosis of Vici syndrome, a rare congenital disorder characterized principally by agenesis of the corpus callosum, cataracts, cardiomyopathy, immune defects, and hypopigmentation.

Methods:
A child with Vici syndrome (OMIM 242840) is reported with emphasis on the ophthalmologic evaluation. Ophthalmologic assessments including fundus examination, visual evoked potentials (VEPs), and ocular coherence tomography are presented. These findings are compared with those identified in other published cases of children with Vici syndrome.

Results:
Ophthalmologic findings included bilateral nuclear and anterior polar cataracts, bilateral optic nerve atrophy, and mild fundus hypopigmentation. Evoked potentials recorded across the mid-occipital scalp demonstrated misrouting of optic pathways typical of albinism. Optical coherence tomography exhibited a poorly defined fovea demonstrating a lesser degree of foveal depression also consistent with ocular albinism. Review of reported children with Vici syndrome identifies bilateral cataracts, nystagmus, fundus hypopigmentation, visual impairment, and optic nerve hypoplasia as common ophthalmologic features.

Conclusions:
Ophthalmologic findings are critical to the diagnosis of Vici syndrome. Most common are bilateral cataracts and relative fundus hypopigmentation. VEPs can identify misrouting of optic pathways typical of ocular albinism, thereby establishing the diagnosis in challenging cases.

[J Pediatr Ophthalmol Strabismus 2014;51(4):214–220.]
Scheimpflug Imaging for Long-Term Evaluation of Optical Components in Hungarian Children With a History of Preterm Birth
Authors: Ecsedy Mónika , Kovacs Illes , Mihaltz Kata , Recsan Zsuzsa , Szigeti Andrea , Juhasz Eva , Nemeth Janos , Nagy Zoltan Z. 
Published: July 2014

Purpose:
To determine ocular geometry and refraction in children with a history of preterm birth, and compare them to age-matched full-term children.

Methods:
In a prospective case–control study, 50 eyes of 27 premature patients 7 to 14 years of age were evaluated with Scheimpflug camera after cycloplegia. Age-matched full-term children comprised the control group (68 eyes of 34 children). All of the eligible eyes had a normal-appearing posterior pole. Anterior segment parameters such as keratometry, anterior chamber volume or thickness, and lens thickness were measured. Corneal thickness, lower- and higher-order aberrations refractive errors of the cornea (root mean square of lower- and higher-order aberrations: RMS LOA, RMS HOA) were also assessed and exported for further analysis.

Results:

In the premature eyes, anterior chamber depth was marginally smaller (
P
= .06), the lens was significantly thicker (
P
= .03), and axial length was significantly shorter (
P
< .001). Scheimpflug imaging showed a significant difference in corneal RMS (
P
= .03) and an increase in corneal RMS HOA (
P
= .002) in the premature group. Preterm birth showed significant impact on axial length (
P
< .01) and lens thickness (
P
= .05); at the same time, anterior chamber depth was more influenced by retinopathy of prematurity stage (
P
= .01). Laser treatment showed marginally significant impact (
P
= .06) on anterior chamber depth.

Conclusions:
In premature eyes with or without mild retinopathy of prematurity, anterior segment anatomy is slightly different and they have more higher-order corneal aberrations compared to the eyes of term-born children.

[J Pediatr Ophthalmol Strabismus 2014;51(4):235–241.]
Laparoscopic Hysterectomy:Revisited
Authors: Yadav Poonam 
Published: July 2014

ABSTRACT
Laparoscopic hysterectomy is an alternative to abdominal hysterectomy. Different techniques are described and illustrated. Most laparotomies for hysterectomies can be avoided by using the laparoscopic approach including cases of adhesions, adnexal masses and endometriosis. According to the expertise of the surgeon the time to perform the laparoscopic surgery can be reduced. There are many advantages of laparoscopic hysterectomy for the patient including the length of hospital stay and convalescence. Most hysterectomies currently requiring an abdominal route may be performed with laparoscopic dissection in part followed by removal of uterus vaginally.

How to cite this article
Garg R, Singh R, Yadav P, Malhotra N. Laparoscopic Hysterectomy: Revisited. J South Asian Feder Obst Gynae 2014;6(1):1-4.
Oxidative Stress and Antioxidant Enzymes in Pre-eclampsia
Authors: Arshad Zakia , Noor Nasreen , Parveen Shazia , Moin Shagufta , Banu Naheed 
Published: July 2014

ABSTRACT

Objective
To estimate the levels of lipid peroxidation product and free radical metabolizing enzymes in normotensive pregnant women and women with pre-eclampsia.

Materials and methods
The study has been conducted on 50 women between the age group of 20 and 35 years. The women were divided into two groups, i.e. group A — normotensive pregnant women between 20 and 36 weeks of gestation and group B — Pregnant women with pre-eclampsia between 20 and 36 weeks of gestation. Lipid peroxidation product malondialdehyde (MDA) and antioxidant enzymes SOD, GSH and GST were estimated.

Results
Mean circulating levels of MDA were higher in women with pre-eclampsia as compared to normotensive pregnant women and mean circulating levels of free radical metabolizing enzymes SOD, GSH and GST were decreased in women with pre-eclampsia.

Conclusion
Pre-eclampsia is a state of pregnancy in which there is increased oxidative stress an depicted by increased level of free radical MDA and decreased levels of antioxidant enzyme to counter act that oxidative stress.

How to cite this article
Parveen S, Noor N, Moin S, Arshad Z, Banu N. Oxidative Stress and Antioxidant Enzymes in Preeclampsia. J South Asian Feder Obst Gynae 2014;6(1):5-7.
Malondialdehyde and Homocysteine Levels in Patients with Unexplained Female Infertility
Authors: Chari Suresh , Gupta Madhur Mahesh 
Published: July 2014

ABSTRACTObjectivesTo assess association in between malondialdehyde and homocysteine in females with unexplained infertility.MethodsA case control study.SettingHospital based.PatientsFifty females diagnosed with unexplained infertility were matched with fifty normal healthy controls.InterventionBlood samples for malondialdehyde, a lipid peroxidation product and homocysteine measurements.ResultsOur study suggests that females with unexplained infertility have increase in malondialdehyde along with hyperhomocysteinemia when compared with normal healthy controls.ConclusionDetermination of levels of malondialdehyde and homocysteine should be incorporated as one of the factors for ascertaining the cause of female unexplained infertility.How to cite this articleGupta MM, Chari S. Malondialdehyde and Homocysteine Levels in Patients with Unexplained Female Infertility. J South Asian Feder Obst Gynae 2014;6(1):18-20.
Doppler Cerebroplacental Ratio and Adverse Perinatal Outcome
Authors: Singh Anita , LNU Shaheen , Bano Imam , Ahmad Ibne 
Published: July 2014

ABSTRACT

Objective
This study was done to assess the Doppler cerebroplacental ratio (CPR) in the prediction of adverse perinatal outcome especially in growth restricted pregnancies.

Materials and methods
In this study, 62 antenatal women were subjected to Doppler studies at 34 to 42 weeks of gestations. CPR was calculated and less than 1 was taken as predictor of adverse perinatal outcome. Adverse perinatal outcomes was evaluated by mode of delivery, meconium staining, 1 and 5-minute Apgar scores, birth weight, admission to NICU and other neonatal complications.

Results
Of 62 antenatal women, with an abnormal CPR had higher incidence of meconium, clinical fetal distress, operative delivery, low Apgar score (5 mins), NICU admission and neonatal death, 42.88, 47.62, 26.57, 76.19, 66.17 and 66.67% respectively as compared to women with normal CPR who had 4.88, 2.88, 2.88. 2.88, 12.19, 17.07 and 0% respectively. With the use of an abnormal CPR, the sensitivity, specificity, and positive and negative predictive values for predicting an adverse outcome were 62, 80, 62 and 80%, respectively, with an odds ratio (95% confidence interval).

Conclusion
An abnormal CPR is associated with adverse perinatal outcomes, especially in growth-restricted fetuses.

How to cite this article
Shaheen S, Bano I, Ahmad I, Singh A. Doppler Cerebroplacental Ratio and Adverse Perinatal Outcome. J South Asian Feder Obst Gynae 2014;6(1):25-27.
Mole in the Hole: A Rare Case of Recurrent Invasive Vesicular Mole in an Ectopic Pregnancy at Scar Site with Bladder Invasion
Authors: Lewis Preeti , Biswas Som Subhro 
Published: July 2014

ABSTRACT

Background
Cesarean scar pregnancy is a rare form of ectopic pregnancy with an incidence of 1:1800 to 1:2200 pregnancies. There is currently no consensus as to the most effective management of cesarean-scar ectopic pregnancy, and little is known about the outcome of subsequent pregnancies.

Case Report
We report here a very rare case of recurrent vesicular mole in an ectopic pregnancy at scar site with bladder invasion and its management.

Conclusion
There is currently no consensus as to the most effective management of cesarean-scar ectopic pregnancy, and little is known about the outcome of subsequent pregnancies. We show that medical management was effective in this patient but further studies are needed to decide ideal management in such cases.

How to cite this article
Lewis P, Biswas SS. Mole in the Hole: A Rare Case of Recurrent Invasive Vesicular Mole in an Ectopic Pregnancy at Scar Site with Bladder Invasion. J South Asian Feder Obst Gynae 2014;6(1):35-38.
An Unusual Presentation of an Endometriotic Chocolate Cyst
Authors: Desai Shyam V , Desai Gaurav S 
Published: July 2014

ABSTRACT

Background
Pelvic inflammatory disease is usually associated with gonococcal sexually transmitted infection. Its association with endometriosis has not been well documented.

Case Report
The authors report an unusual case of an endometriotic cyst in a 29-year-old nulliparous patient with clinical features of pelvic inflammatory disease. On treatment with antibiotics, the symptomatology subsided and signs of infection diminished. But subsequent imaging revealed a persistent right adnexal mass. A right chocolate cyst was found on laparoscopy and was treated with drainage and enucleation. Patient was administered three doses of GnRH analogs thereafter and is awaiting treatment for infertility.

Conclusion
Endometriotic cysts commonly manifest with dyspareunia and dysmenorrhea. The patient in this report presented with signs and symptoms suggestive of pelvic inflammatory disease which was secondary to a slow leak from a chocolate cyst.

How to cite this article
Desai GS, Desai SV. An Unusual Presentation of an Endometriotic Chocolate Cyst. J South Asian Feder Obst Gynae 2014;6(1):46-48.