bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction
Authors: Liu Yen-Wen , Su Chi-Ting , Sung Junne-Ming , Wang Saprina P.H. , Su Yu-Ru , Yang Chun-Shin , Tsai Liang-Miin , Chen Jyh-Hong , Tsai Wei-Chuan 
Published: May 2013

Summary

Background and objectives
Little is known about the optimal echocardiographic parameters for risk stratification in stable dialysis patients with preserved left ventricular ejection fraction (LVEF) (ejection fraction ≥50%). Left ventricular (LV) global peak systolic longitudinal strain (GLS) is the ratio of the maximal change in myocardial longitudinal length in systole to the original length and reliably and accurately assesses LV function. During systole, LV myocardium in the longitudinal direction shortens and GLS is represented by a negative value. The more negative value of GLS, the better the LV function is. This study hypothesized that subtle abnormalities of GLS are associated with an adverse prognosis.

Design, setting, participants, & measurements
This prospective study collected clinical and echocardiographic data (including GLS) from 88 stable hemodialysis patients (mean age 67.0±11.2 years; 35% men) with preserved LVEF. These patients were enrolled from December 2008 to January 2009 and were followed-up for 25.6±9.9 months. The primary outcome was all-cause mortality. Multivariate Cox regression analysis was used to investigate risk factors for mortality.

Results
The mortality group (n=24) had lower albumin levels, less negative GLS, and higher prevalence of coronary artery disease and diabetes mellitus than the survival group. Using a GLS cutoff value of −15%, the less negative GLS group (GLS ≥−15%) had a higher mortality rate. Cox regression analyses revealed that lower albumin level (hazard ratio, 0.16; 95% confidence interval, 0.05 to 0.53; P=0.003) and less negative GLS (hazard ratio, 3.57; 95% confidence interval, 1.41 to 9.04; P=0.01) were independent predictors of all-cause mortality. Furthermore, less negative GLS was associated with a higher cardiovascular death rate.

Conclusions
Less negative GLS is predictive of poor prognosis among stable hemodialysis patients with preserved LVEF.
Orthodontic pain: an interaction between age and sex in early and middle adolescence
Authors: Sandhu Satpal S , Sandhu Jasleen 
Published: May 2013

ABSTRACT

Objective:
To investigate the age and sex interaction effect on orthodontic pain in adolescence during the initial phase of fixed orthodontic treatment.

Materials and Methods:
Three hundred participants (mean age 13.85 ± 1.98 years; 152 female, 148 male) met all inclusion criteria and enrolled in the study designed as 2 × 2 factorial trial with two levels each for age (11–14 years; 14–17 years) and sex (male; female). A 0.16-inch superelastic NiTi wire was used in a 0.022-inch slot (Roth's prescription) preadjusted edgewise appliance for initial leveling and alignment of mandibular anterior dentition. The follow-up period was 7 days. Pain was assessed by using 100 mm visual analog scale for one baseline and nine follow-up repeated measurements at prespecified time points. Data were analyzed by using generalized linear mixed effect model analysis.

Results:
Three participants were lost to follow-up, and 17 participants were not considered for analysis due to incomplete or improperly completed questionnaire. Therefore, 280 participants (mean age 13.96 ± 2.01 years; 138 female, 142 male) were analyzed for results. Results showed that age and sex interaction had statistically significant effect on pain (F  =  3.56; P  =  .0151; df 3/218). In the 11–14 year age group, there was no significant difference for pain between male and female. In the 14–17 year age group, girls reported significantly greater pain compared to 14- to 17 year-old boys (t  =  2.76; P  =  .0209). Pain reported by 14- to 17-year-old girls was also significantly greater compared to 11- to 14-year-old boys (t  =  2.91; P  =  .0206).

Conclusions:
Age and sex interaction has significant effect on orthodontic pain during adolescence, and 14- to 17-year-old girls experienced maximum pain.
Outcome Measures for Individuals With Stroke: Process and Recommendations From the American Physical Therapy Association Neurology Section Task Force
Authors: Sullivan Jane E. , Crowner Beth E. , Kluding Patricia M. , Nichols Diane , Rose Dorian K. , Yoshida Rie , Pinto Zipp Genevieve 
Published: May 2013

Background and PurposeThe use of standardized outcome measures (OMs) can support clinicians’ development of appropriate care plans, guide educators in curricular decisions, and enhance the methodological quality and generalizability of clinical trials. The purposes of this case report are: (1) to describe a framework and process for assessing psychometrics and clinical utility of OMs used poststroke; (2) to describe a consensus process used to develop recommendations for stroke-related OMs in clinical practice, research, and professional (entry-level) physical therapist education; (3) to present examples demonstrating how the recommendations have been utilized to date; and (4) to make suggestions for future efforts.Case DescriptionA task force of 7 physical therapists with diverse clinical and research expertise in stroke rehabilitation used a 3-stage, modified Delphi consensus process to develop recommendations on OM use. An evidence-based systematic review template and a 4-point rating scheme were used to make recommendations on OM use by care setting and patient acuity, for research, and for inclusion in professional education.OutcomesAn initial list of 77 OMs was developed based on input from numerous professional sources. Screening measures and duplicate measures were eliminated. Fifty-six OMs received full review. Measures spanned the constructs of body structure/function (21), activity (28), and participation (14). Fourteen measures received a rating of “highly recommend.”DiscussionUse of highly recommended OMs may provide a common set of tools enabling comparisons across patients, interventions, settings, and studies. The use of a clearly defined, comprehensive assessment template may facilitate the pooling of data on OMs and contribute to best practice guidelines. Educational recommendations may inform curricular decisions.
Effective treatment of refractory intracranial hypertension after traumatic brain injury with repeated boluses of 14.6% hypertonic saline
Authors: Eskandari Ramin , Filtz Michael R. , Davis Gary E. , Hoesch Robert E. 
Published: May 2013

Object
Normal intracranial pressure (ICP) and cerebral perfusion pressure (CPP) have been identified as favorable prognostic factors in the outcome of patients with traumatic brain injuries (TBIs). Osmotic diuretics and hypertonic saline (HTS) are commonly used to treat elevated ICP in patients with TBI; however, sustained effects of repeated high-concentration HTS boluses for severely refractory ICP elevation have not been studied. The authors' goal in this study was to determine whether repeated 14.6% HTS boluses were efficacious in treating severely refractory intracranial hypertension in patients with TBI.

Methods
In a prospective cohort study in a neurocritical care unit, adult TBI patients with sustained ICP > 30 mm Hg for more than 30 minutes after exhaustive medical and/or surgical therapy received repeated 15-minute boluses of 14.6% HTS over 12 hours through central venous access.

Results
Response to treatment was evaluated in 11 patients. Within 5 minutes of bolus administration, mean ICP decreased from 40 to 33 mm Hg (30% reduction, p < 0.05). Intracranial pressure–lowering effects were sustained for 12 hours (41% reduction, p < 0.05) with multiple boluses (mean number of boluses 7 ± 5.5). The mean CPP increased 22% and 32% from baseline at 15 and 30 minutes, respectively (p < 0.05). The mean serum sodium level (SNa) at baseline was 155 ± 7.1 mEq/L, and after multiple boluses of 14.6% HTS, SNa at 12 hours was 154 ± 7.1 mEq/L. The mean heart rate, systolic blood pressure, blood urea nitrogen, and creatinine demonstrated no significant change throughout the study.

Conclusions
The subset of TBI patients with intracranial hypertension that is completely refractory to all other medical therapies can be treated effectively and safely with repeated boluses of 14.6% HTS rather than a one-time dose.
Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control
Authors: Elliott Robert E. , Bollo Robert J. , Berliner Jonathan L. , Silverberg Alyson , Carlson Chad , Geller Eric B. , Barr William B. , Devinsky Orrin , Doyle Werner K. 
Published: May 2013

Object
In this paper the authors' goal was to identify preoperative variables that predict long-term seizure freedom among patients with mesial temporal sclerosis (MTS) after single-stage anterior temporal lobectomy and amygdalohippocampectomy (ATL-AH).

Methods
The authors retrospectively reviewed 116 consecutive patients (66 females, mean age at surgery 40.7 years) with refractory seizures and pathologically confirmed MTS who underwent ATL-AH with at least 2 years of follow-up. All patients underwent preoperative MRI and video-electroencephalography (EEG); 106 patients (91.4%) underwent Wada testing and 107 patients (92.2%) had neuropsychological evaluations. The authors assessed the concordance of these 4 studies (defined as test consistent with the side of eventual surgery) and analyzed the impact of preoperative variables on seizure freedom.

Results
The median follow-up after surgery was 6.7 years (mean 6.9 years). Overall, 103 patients (89%) were seizure free, and 109 patients (94%) had Engel Class I or II outcome. Concordant findings were highest for video-EEG (100%), PET (100%), MRI (99.0%), and Wada testing (90.4%) and lowest for SPECT (84.6%) and neuropsychological testing (82.5%). Using binary logistic regression analysis (seizure free or not) and Cox proportional hazard analysis (seizure-free survival), less disparity in the Wada memory scores between the ipsilateral and contralateral sides was associated with persistent seizures.

Conclusions
Seizure freedom of nearly 90% can be achieved with ATL-AH in properly selected patients with MTS and concordant preoperative studies. The low number of poor outcomes and exclusion of multistage patients limit the statistical power to determine preoperative variables that predict failure. Strong Wada memory lateralization was associated with excellent long-term outcome and adds important localization information to structural and neurophysiological data in predicting outcome after ATL-AH for MTS.
The relationship between the superior petrosal sinus and the porus trigeminus: an anatomical study
Authors: Tubbs R. Shane , Mortazavi Martin M. , Krishnamurthy Sanjay , Verma Ketan , Griessenauer Christoph J. , Cohen-Gadol Aaron A. 
Published: May 2013

Object
During intracranial approaches to the skull base, vascular relationships are important. One relationship that has received scant attention in the literature is that between the superior petrosal sinus (SPS) and the opening of the Meckel cave (that is, the porus trigeminus).

Methods
Cadaver dissections were performed in 25 latex-injected adult cadaveric heads (50 sides). Specifically, the relationship between the SPS and the opening of the Meckel cave was observed. The goal was to enhance knowledge of the relationship between the SPS and the opening of the Meckel cave.

Results
Of the 50 sides, 68%, 18%, and 16% of SPSs traveled superior to, inferior to, and around the opening to the Meckel cave, respectively. In the latter cases, a venous ring was formed around the proximal trigeminal nerve. No sinus entered the Meckel cave. In general, the porus trigeminus was narrowed on sides found to have an SPS that encircled this region. Sinuses that traveled only inferior to the porus were in general smaller than sinuses that traveled superior or encircled this opening. No statistically significant differences were noted between the various sinus relationships and sex, age, or side of the head.

Conclusions
Knowledge of the relationship between the SPS and the opening of the Meckel cave may be useful to the skull base surgeon. Based on this study, some individuals may retain the early embryonic position of their SPS in relation to the trigeminal nerve.
Gamma Knife surgery for large vestibular schwannomas: a single-center retrospective case-matched comparison assessing the effect of lesion size
Authors: Williams Brian J. , Xu Zhiyuan , Salvetti David J. , McNeill Ian T. , Larner James , Sheehan Jason P. 
Published: May 2013

Object
Gamma Knife surgery (GKS) is a safe and effective treatment for patients with small to moderately sized vestibular schwannomas (VSs). Reports of stereotactic radiosurgery for large VSs have demonstrated worse tumor control and preservation of neurological function. The authors endeavored to assess the effect of size of VSs treated using GKS.

Methods
This study was a retrospective comparison of 24 patients with large VSs (> 3 cm in maximum diameter) treated with GKS compared with 49 small VSs (≤ 3 cm) matched for age, sex, radiosurgical margin and maximal doses, length of follow-up, and indication.

Results
Actuarial tumor progression-free survival (PFS) for the large VS cohort was 95.2% and 81.8% at 3 and 5 years, respectively, compared with 97% and 90% for small VSs (p = 0.009). Overall clinical outcome was better in small VSs compared with large VSs (p < 0.001). Patients with small VSs presenting with House-Brackmann Grade I (good facial function) had better neurological outcomes compared with patients with large VSs (p = 0.003). Treatment failure occurred in 6 patients with large VSs; 3 each were treated with resection or repeat GKS. Treatment failure did not occur in the small VS group. Two patients in the large VS group required ventriculoperitoneal shunt placement. Univariate analysis did not identify any predictors of treatment failure among the large VS cohort.

Conclusions
Patients with large VSs treated using GKS had shorter PFS and worse clinical outcomes compared with age-, sex-, and indication-matched patients with small VSs. Nevertheless, GKS has efficacy for some patients with large VSs and represents a reasonable treatment option for selected patients.
Use of the intrathoracic pressure regulator to lower intracranial pressure in patients with altered intracranial elastance: a pilot study
Authors: Kiehna Erin N. , Huffmyer Julie L. , Thiele Robert H. , Scalzo David C. , Nemergut Edward C. 
Published: May 2013

Object
The intrathoracic pressure regulator (ITPR) is a novel noninvasive device designed to increase circulation and blood pressure. By applying negative pressure during the expiratory phase of ventilation it decreases intrathoracic pressure and enhances venous return, which increases cardiac output. It is possible that the ITPR may both decrease intracranial pressure (ICP) and increase cerebral perfusion pressure (CPP) in brain-injured patients by decreasing cerebral venous blood volume and increasing cardiac output. The authors conducted an open-label, “first-in-humans” study of the ITPR in patients with an ICP monitor or external ventricular drain and altered intracranial elastance.

Methods
This prospective randomized trial commenced July 2009. Baseline hemodynamic variables and ICP were recorded prior to inserting one of the two ITPRs into the ventilator circuit based on a randomization scheme. Depending on the device selected, activation provided either −5 or −9 mm Hg endotracheal tube pressure. Hemodynamic and ICP data were recorded sequentially every 2 minutes for 10 minutes. The first device was turned off for 10 minutes, then it was removed and the second device was applied, and then the procedure was repeated for the second device.

Results
Ten patients with elevated ICP secondary to intracranial hemorrhage (n = 4), trauma (n = 2), obstructive hydrocephalus (n = 2), or diffuse cerebral processes (n = 2) were enrolled. Baseline ICP ranged from 12 to 38 mm Hg. With device application, a decrease in ICP was observed in 16 of 20 applications. During treatment with the −5 mm Hg device, there was a mean maximal decrease of 3.3 mm Hg in ICP (21.7 vs 18.4 mm Hg, p = 0.003), which was associated with an increase in CPP of 6.5 mm Hg (58.2 vs 64.7 mm Hg, p = 0.019). During treatment with the −9 mm Hg device, there was a mean maximal decrease of 2.4 mm Hg in ICP (21.1 vs 18.7 mm Hg, p = 0.044), which was associated with an increase in CPP of 6.5 mm Hg (59.2 vs 65.7 mm Hg, p = 0.001).

Conclusions
This pilot study demonstrates that use of the ITPR in patients with altered intracranial elastance is feasible. Although this study was not powered to demonstrate efficacy, these data strongly suggest that the ITPR may be used to rapidly lower ICP and increase CPP without apparent adverse effects. Additional studies will be needed to assess longitudinal changes in ICP when the device is in use and to delineate treatment parameters.
Suboccipital decompression during posterior cranial vault remodeling for selected cases of Chiari malformations associated with craniosynostosis
Authors: Scott William W. , Fearon Jeffrey A. , Swift Dale M. , Sacco David J. 
Published: May 2013

Object
The optimal management of Chiari malformations in the setting of craniosynostosis is not well established. In this report the authors describe their outcomes with the combined technique of simultaneous suboccipital decompression (SOD) during posterior cranial vault remodeling (PCVR).

Methods
A retrospective review was performed of all patients undergoing PCVR and simultaneous SOD. Demographic data, diagnosis, imaging studies, operative intervention, and clinical follow-up were evaluated.

Results
Thirty-four patients were identified as having undergone a simultaneous PCVR/SOD for Chiari malformation associated with craniosynostosis. Eighty-eight percent of these patients had syndromic, multisutural craniosynostosis, and the remaining patients had unilateral lambdoid craniosynostosis. There were no postoperative complications as a direct result from this combined procedure. Two patients required a subsequent direct approach for decompression of the Chiari malformation. The interval between these subsequent surgeries was 3 years and 19 months.

Conclusions
Chiari malformations are commonly associated with syndromic, complex craniosynostosis and isolated lambdoid craniosynostosis. In appropriately selected patients, a combined posterior cranial vault enlargement and SOD of the foramen magnum is associated with a low complication rate and appears to be an effective procedure.
Design of a synthetic simulator for pediatric lumbar spine pathologies
Authors: Mattei Tobias A. , Frank Christopher , Bailey Joshua , Lesle Edna , Macuk Alyssa , Lesniak Matthew , Patel Ankit , Morris Martin J. , Nair Kalyani , Lin Julian J. 
Published: May 2013

Object
Simulation has become an important tool in neurosurgical education as part of the complex process of improving residents' technical expertise while preserving patient safety. Although different simulators have already been designed for a variety of neurosurgical procedures, spine simulators are still in their infancy and, at present, there is no available simulator for lumbar spine pathologies in pediatric neurosurgery. In this paper the authors describe the peculiarities and challenges involved in developing a synthetic simulator for pediatric lumbar spine pathologies, including tethered spinal cord syndrome and open neural tube defects.

Methods
The Department of Neurosurgery of the University of Illinois at Peoria, in a joint program with the Mechanical Engineering Department of Bradley University, designed and developed a general synthetic model for simulating pediatric neurosurgical interventions on the lumbar spine. The model was designed to be composed of several sequential layers, so that each layer might closely mimic the tensile properties of the natural tissues under simulation. Additionally, a system for pressure monitoring was developed to enable precise measurements of the degree of manipulation of the spinal cord.

Results
The designed prototype successfully simulated several scenarios commonly found in pediatric neurosurgery, such as tethered spinal cord, retethered spinal cord, and fatty terminal filum, as well as meningocele, myelomeningocele, and lipomyelomeningocele. Additionally, the formulated grading system was able to account for several variables involved in the qualitative evaluation of the technical performance during the training sessions and, in association with an expert qualitative analysis of the recorded sessions, proved to be a useful feedback tool for the trainees.

Conclusions
Designing and building a synthetic simulator for pediatric lumbar spine pathologies poses a wide variety of unique challenges. According to the authors' experience, a modular system composed of separable layers that can be independently replaced significantly enhances the applicability of such a model, enabling its individualization to distinctive but interrelated pathologies. Moreover, the design of a system for pressure monitoring (as well as a general score that may be able to account for the overall technical quality of the trainee's performance) may further enhance the educational applications of a simulator of this kind so that it can be further incorporated into the neurosurgical residency curriculum for training and evaluation purposes.
Persistent cough associated with osteophyte formation and vagus nerve impingement following cervical spinal surgery
Authors: Orhan Kadir Serkan , Acar Şenol , Ulusan Murat , Aydoseli Aydın , Güldiken Yahya 
Published: May 2013

Persistent cough due to irritation of the vagus nerve by osteophytes resulting from cervical spinal surgery is a very rare condition. The authors report the case of a 49-year-old woman who presented with a persistent cough subsequent to cervical spinal surgery. One year after the initial operation, the patient underwent surgery to free the larynx from the prevertebral fascia and cut the pharyngeal plexus, but her symptoms persisted. In order to control the cough, she used a soft cervical collar with padding inserted in the left side so that the larynx would be pushed to the right, a solution she discovered on her own. Without the collar, she coughed uncontrollably.
A CT scan was performed and showed an osteophyte that had developed at the level of the prosthesis. Based on these findings, the authors hypothesized that the cough was caused by vagus nerve irritation due to the osteophyte. The osteophyte was resected and the vagus nerve was moved to a position anterior to the carotid artery and was isolated by means of an autogenous tensor fascia lata graft. The patient's symptom disappeared immediately after the surgery. At the most recent follow-up visit, 18 months after surgery, the patient was symptom free and was pursuing regular daily activities without using a cervical collar.