bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations
Authors: Zada Gabriel , Cavallo Luigi M. , Esposito Felice , Fernandez-Jimenez Julio Cesar , Tasiou Anastasia , De Angelis Michelangelo , Cafiero Tullio , Cappabianca Paolo , Laws Edward R. 
Published: October 2010

Object
In addition to difficulties with anesthetic and medical management, transsphenoidal operations in patients with longstanding acromegaly are associated with inherent intraoperative challenges because of anatomical variations that occur frequently in these patients. The object of this study was to review the overall safety profile and anatomical/technical challenges associated with transsphenoidal surgery in patients with acromegaly.

Methods
The authors performed a retrospective analysis of 169 patients who underwent endoscopic transsphenoidal operations for growth hormone–secreting adenomas to assess the incidence of surgical complications. A review of frequently occurring anatomical challenges and operative strategies employed during each phase of the operation to address these particular issues was performed.

Results
Of 169 cases reviewed, there was no perioperative mortality. Internal carotid artery injury occurred in 1 patient (0.6%) with complex sinus anatomy, who remained neurologically intact following endovascular unilateral carotid artery occlusion. Other complications included: significant postoperative epistaxis (5 patients [3%]), transient diabetes insipidus (5 patients [3%]), delayed symptomatic hyponatremia (4 patients [2%]), CSF leak (2 patients [1%]), and pancreatitis (1 patient [0.6%]). Preoperative considerations in patients with acromegaly should include a cardiopulmonary evaluation and planning regarding intubation and other aspects of the anesthetic technique. During the nasal phase of the transsphenoidal operation, primary challenges include maintaining adequate visualization and hemostasis, which is frequently compromised by redundant, edematous nasal mucosa and bony hypertrophy of the septum and the nasal turbinates. During the sphenoid phase, adequate bony removal, optimization of working space, and correlation of imaging studies to intraoperative anatomy are major priorities. The sellar phase is frequently challenged by increased sellar floor thickness, distinct patterns of tumor extension and bony invasion, and anatomical variations in the caliber and course of the internal carotid artery. Specific operative techniques for addressing each of these intraoperative challenges are discussed.

Conclusions
Transsphenoidal surgery in patients with longstanding acromegaly frequently poses greater challenges than operations for other types of sellar lesions, yet these challenges may be safely and effectively overcome with the anticipation of specific issues and implementation of various intraoperative techniques.
Stereotactic radiosurgery as primary and salvage treatment for brain metastases from breast cancer
Authors: Kondziolka Douglas , Kano Hideyuki , Harrison Gillian L. , Yang Huai-che , Liew Donald N. , Niranjan Ajay , Brufsky Adam M. , Flickinger John C. , Lunsford L. Dade 
Published: October 2010

Object
To evaluate the role of stereotactic radiosurgery (SRS) in the management of brain metastases from breast cancer, the authors assessed clinical outcomes and prognostic factors for survival.

Methods
The records from 350 consecutive female patients who underwent SRS for 1535 brain metastases from breast cancer were reviewed. The median patient age was 54 years (range 19–84 years), and the median number of tumors per patient was 2 (range 1–18 lesions). One hundred seventeen patients (33%) had a single metastasis to the brain, and 233 patients (67%) had multiple brain metastases. The median tumor volume was 0.7 cm3 (range 0.01–48.9 cm3), and the median total tumor volume for each patient was 4.9 cm3 (range 0.09–74.1 cm3).

Results
Overall survival after SRS was 69%, 49%, and 26% at 6, 12, and 24 months, respectively, with a median survival of 11.2 months. Factors associated with a longer survival included controlled extracranial disease, a lower recursive partitioning analysis (RPA) class, a higher Karnofsky Performance Scale score, a smaller number of brain metastases, a smaller total tumor volume per patient, the presence of deep cerebral or brainstem metastases, and HER2/neu overexpression. Sustained local tumor control was achieved in 90% of the patients. Factors associated with longer progression-free survival included a better RPA class, fewer brain metastases, a smaller total tumor volume per patient, and a higher tumor margin dose. Symptomatic adverse radiation effects occurred in 6% of patients. Overall, the condition of 82% of patients improved or remained neurologically stable.

Conclusions
Stereotactic radiosurgery was safe and effective in patients with brain metastases from breast cancer and should be considered for initial treatment.
Surgical outcomes for older patients with glioblastoma multiforme: preoperative factors associated with decreased survival
Authors: Chaichana Kaisorn L. , Chaichana Khan K. , Olivi Alessandro , Weingart Jon D. , Bennett Richard , Brem Henry , Quiñones-Hinojosa Alfredo 
Published: October 2010

Object
As the population ages, the incidence of glioblastoma multiforme (GBM) among older patients (age > 65 years) will increase. Older patients, unlike their younger counterparts, are not often offered aggressive surgery because of their age, comorbidities, and potential inability to tolerate surgery. The goal of this study was to identify preoperative factors associated with decreased survival for older patients who underwent resection of a GBM. The identification of these factors may provide insight into which patients would benefit most from aggressive surgery.

Methods
All patients older than 65 years who underwent nonbiopsy resection of an intracranial GBM at a single institution between 1997 and 2007 were retrospectively reviewed. Factors associated with overall survival were assessed using multivariate proportional hazards regression analysis after controlling for peri- and postoperative factors known to be associated with outcome (extent of resection, carmustine wafer implantation, temozolomide chemotherapy, and radiation therapy). Variables with p < 0.05 were considered statistically significant.

Results
A total of 129 patients with an average age of 73 ± 5 years met the inclusion/exclusion criteria. At last follow-up, all 129 patients had died, with a median survival of 7.9 months. The preoperative factors that were independently associated with decreased survival were Karnofsky Performance Scale (KPS) score less than 80 (p = 0.001), chronic obstructive pulmonary disease (p = 0.01), motor deficit (p = 0.01), language deficit (p = 0.005), cognitive deficit (p = 0.02), and tumor size larger than 4 cm (p = 0.002). Patients with 0–1 (Group 1), 2–3 (Group 2), and 4–6 (Group 3) of these factors had statistically different survival times, where the median survival was 9.2, 5.5, and 4.4 months, respectively. In log-rank analysis, the median survival for Group 1 was significantly longer than that for Group 2 (p = 0.004) and Group 3 (p < 0.0001), while Group 2 had longer survival than Group 3 (p = 0.02).

Conclusions
Older patients with an increasing number of these factors may not benefit as much from aggressive surgery as patients with fewer factors. This may provide insight into identifying which patients older than 65 years of age may benefit from aggressive surgery.
Meningoencephalocele: a late complication of Le Fort III midfacial advancement in a patient with Crouzon syndrome
Authors: Ridgway Emily B. , Ropper Alexander E. , Mulliken John B. , Padwa Bonnie L. , Goumnerova Liliana C. 
Published: October 2010

Complications of Le Fort III midfacial advancement include CSF rhinorrhea, meningitis, and ocular and cerebral injury. This report reviews the anatomy of the Le Fort III osteotomies and their relevance to the unusual complication of meningoencephalocele.
In this report, a young male patient with Crouzon syndrome underwent subcranial midfacial advancement at the age of 10 years for obstructive sleep apnea and ocular exposure. He presented 4 years later complaining of nasal obstruction. On physical examination, a mucous-covered mass was noted in the left upper nasal vault medial to the turbinates. Computed tomography scanning and MR imaging confirmed the diagnosis of frontoethmoidal meningoencephalocele. Repair of the meningoencephalocele was accomplished using a combined neurosurgery and plastic surgery approach.
Meningoencephalocele is a rare complication of subcranial midfacial advancement. The abnormal anatomy of the anterior cranial base in patients with syndromic craniosynostosis places them at greater risk for fracture of the cribriform plate and dural tears during this procedure. Unrecognized dural injury is the etiology of this complication in this young patient; however, elevated intracranial pressure may have been a confounding factor. Attention to the anatomy of the anterior cranial base, as seen on sagittal CT images, will aid in preventing this complication.
Impact of 5,10-methylenetetrahydrofolate reductase gene polymorphism on neural tube defects
Authors: Harisha Poomagame Narasimhamurthy , Devi B. Indira , Christopher Rita , Kruthika-Vinod Tumkur Puttasiddhappa 
Published: October 2010

Object
Neural tube defects (NTDs) are among the most common congenital malformations worldwide. Their etiology and exact mechanisms of development are incompletely understood. Many enzymes involved in folate metabolism and the genes encoding these enzymes have been studied as candidates in their etiology. A mutation in the methylenetetrahydrofolate reductase (MTHFR) gene—a C→T transition at nucleotide 677—is one among them. The mutation results in substitution of alanine by valine at a functionally important site in the enzyme. It has been shown to be a risk factor for development of NTDs in certain populations. The present study was conducted to evaluate the role of MTHFR 677 C→T mutation as a risk factor for NTD in the South Indian population and to determine the relative importance of the genotypes in the affected child and its mother.

Methods
Blood samples were collected from the test and the control groups. The test group consisted of children with NTDs and their mothers, while the control group consisted of apparently healthy controls. MTHFR C677T polymorphism in the 3 groups was determined by polymerase chain reaction and restriction fragment length polymorphism studies. Comparison of polymorphism in the 3 groups was using the chi-square test.

Results
There was a significant difference in the prevalence of MTHFR 677 C→T mutation among the 3 groups (p = 0.002). The risk conferred by the TT genotype in the child was statistically significant (OR 12.625, 95% CI 1.430–111.465). In the mothers, however, although there was an increased prevalence of the mutation compared with the control individuals, the difference was not statistically significant (p = 0.152).

Conclusions
The MTHFR 677TT genotype is considered to be a definite risk factor for development of NTDs. It is the TT genotype status of the developing embryo, rather than the TT genotype status of its mother, that is the critical genetic determinant of MTHFR-related NTD risk.
Increased Risk of Autoimmune Disease in Families with Wegener’s Granulomatosis
Authors: KNIGHT ANN , SANDIN SVEN , ASKLING JOHAN 
Published: October 2010

Objective.The etiology of Wegener’s granulomatosis (WG) is unknown. Susceptibility genes for WG that also affect the risks of other autoimmune/inflammatory diseases have been identified, indicating the existence of shared interdisease genetic susceptibilities. To determine the effect, on a population level, of shared susceptibility on disease risk, we assessed the occurrence of autoimmune/inflammatory disease in first-degree relatives of patients with WG.Methods.In the Swedish Hospital Discharge Register we identified 2288 individuals discharged with the diagnosis of WG between 1970 and 2003. Through linkage to the Swedish Multi-generation Register we identified 787 parents, 1212 siblings, and 3650 children of these patients. From the Register of Total Population we identified 10 controls for each patient with WG, and 65,000 of their first-degree relatives. Through linkage to the nationwide Outpatients Register, we identified autoimmune/inflammatory disease among all relatives. Relative risks were estimated as hazard ratio (HR) using Cox regression. The study period was 2001–2006.Results.Biological first-degree relatives of patients with WG were at a moderately increased risk of any autoimmune/inflammatory disease (HR 1.32, 95% CI 1.18–1.49), including specific associations with, for example, multiple sclerosis (HR 1.92, 95% CI 1.16–3.16), Sjögren’s syndrome (HR 2.00, 95% CI 1.07–3.73), and seropositive rheumatoid arthritis (HR 1.54, 95% CI 1.09–2.19).Conclusion.Relatives of patients with WG are at increased risk of being diagnosed with other autoimmune/inflammatory diseases, indicating shared susceptibility between WG and other auto-immune/inflammatory disease.
Disease Activity, Physical Function, and Radiographic Progression After Longterm Therapy with Adalimumab Plus Methotrexate: 5-Year Results of PREMIER
Authors: van der HEIJDE DÉSIRÉE , BREEDVELD FERDINAND C. , KAVANAUGH ARTHUR , KEYSTONE EDWARD C. , LANDEWÉ ROBERT , PATRA KAUSHIK , PANGAN AILEEN L. 
Published: October 2010

Objective.To evaluate the efficacy and safety of initial combination treatment with adalimumab (ADA) and methotrexate (MTX) versus monotherapy with ADA or MTX during an open-label extension of PREMIER.Methods.Patients with early rheumatoid arthritis (RA) received blinded ADA plus MTX, ADA alone, or MTX alone for 2 years in PREMIER. At Year 2, patients could enroll in an open-label extension and receive ADA monotherapy; MTX could be added at the investigator’s discretion. Longterm efficacy results are presented as observed data.Results.In the open-label period, 497 of the original 799 randomized patients had ≥ 1 dose of ADA (by original randomization: ADA plus MTX, n = 183; ADA, n = 159; MTX, n = 155). In the completers cohort [patients with available Year-5 ACR responses and modified total Sharp scores (mTSS)], the Year-5 mean change from baseline in mTSS for the ADA+MTX arm (n = 124) was 2.9, compared with 8.7 and 9.7 in the ADA (n = 115) and MTX (n = 115) arms. Comprehensive disease remission, defined as the combination of DAS28 remission, normal function (Health Assessment Questionnaire ≤ 0.5), and radiographic nonprogression (ΔmTSS ≤ 0.5), was achieved by more patients in the initial ADA+MTX arm (35%) than in the ADA (13%) or MTX (14%) arms.Conclusion.Initial combination treatment with ADA plus MTX, followed by open-label ADA, led to better longterm clinical, functional, and radiographic outcomes than either initial ADA or MTX monotherapy during 5 years of treatment.
Summer and Winter Spatial Habitat Use by the Lake Erie Watersnake
Authors: Stanford Kristin M. , King Richard B. , Wynn Doug 
Published: October 2010

Abstract
In an effort to provide information to guide habitat management for the Lake Erie watersnake Nerodia sipedon insularum, a federally threatened and Ohio state endangered species, we used radiotelemetry to obtain spatial habitat data for adult snakes during the summer active season and during winter hibernation. During the summer active season, terrestrial habitat use was limited to a narrow band of shoreline. Among individuals, maximum distance inland from shore ranged from 1 to 50 m (mean  =  8 m) and linear extent of shoreline ranged from 30 to 1,360 m (mean  =  261 m). Winter hibernation occurred at varying distances inland with individual hibernation sites ranging from 1 to 580 m (mean  =  29 m) from shore. Habitat use did not differ between males and females. Existing U.S. Fish and Wildlife Service habitat management guidelines suggest that ground-disturbing activities within potential hibernation areas (defined as terrestrial habitat within 161 m of shore) should be avoided in winter to prevent harm to hibernating snakes. They suggest further that excavation and removal of shrubs, standing or downed trees, root masses, animal burrows, piled rocks, cliffs, or bedrock within 21 m of shore should be avoided in summer to prevent harm to active snakes. Given that Lake Erie watersnakes have recovered to the point where delisting is being proposed, these habitat guidelines appear to be sufficient. However, maintaining voluntary compliance with habitat guidelines and meeting the need for continued public outreach will be vital to ensure long-term persistence.
Relationships Between Handwriting and Keyboarding Performance of Sixth-Grade Students
Authors: Rogers Janet , Case-Smith Jane 
Published: October 2010

Abstract
OBJECTIVES. This study examined the relationships between sixth-grade students’ handwriting speed and legibility and their keyboarding speed and error rate. A second purpose was to examine how well handwriting performance discriminates students as slow or fast in computer keyboarding.
METHOD. After participation in a school-required keyboarding class, 40 sixth-grade students were asked to copy a familiar poem using handwriting and keyboarding. Handwriting legibility and speed and keyboarding speed and errors were measured. Relationships among these variables were analyzed using Pearson product-moment correlations and discriminant analysis.
RESULTS. Keyboarding speed correlated with handwriting legibility (n = 38, r = .361, p = .026), suggesting that handwriting performance accounts for 12% to 13% of the variance in keyboarding performance. Handwriting speed and legibility together accurately categorized 71% of students as slow or fast in keyboarding. On average, students were able to keyboard faster than handwrite. Of the 20 slowest handwriters, 75% achieved more text production with keyboarding than with handwriting.
CONCLUSION. Keyboarding performance demonstrated low to moderate correlation with handwriting performance, suggesting that these forms of written expression require distinctly different skills. Most students who were slow at handwriting or had poor legibility increased the quantity and overall legibility of text they produced with a keyboard. These results suggest that keyboarding has the potential to increase and improve a student’s written output.
Development of a Standardized Instrument To Assess Computer Task Performance
Authors: Dumont Claire , Vincent Claude , Mazer Barbara 
Published: October 2010

Abstract
OBJECTIVE. The purpose of this study was to determine the psychometric properties of the Assessment of Computer Task Performance, specifically, the test–retest reliability, internal consistency, construct validity, and ability to discriminate between known groups.
METHOD. This assessment comprises 14 standardized and timed tasks. It was administered to 24 persons with upper-extremity impairments and 30 with no impairments by a trained occupational therapist. To assess the test–retest reliability, participants in the impaired group were retested within 2 to 7 days. Intraclass correlation coefficients were calculated to determine test–retest reliability. Internal consistency was assessed with Cronbach’s alpha, and factor analysis was conducted to examine construct validity. The Mann Whitney U Test was used to assess the test’s ability to discriminate between the groups.
RESULTS. Results indicated that the tool has excellent reliability and internal consistency, can discriminate between groups, and has appropriate construct validity.
CONCLUSION. The Assessment of Computer Task Performance provides occupational therapists with an accurate test to measure computer performance and can assist them in providing computer access services.
Sensory Processing Issues Associated With Asperger Syndrome: A Preliminary Investigation
Authors: Dunn Winnie , Myles Brenda Smith , Orr Stephany 
Published: October 2010

Abstract
OBJECTIVE. The purpose of this study was to identify the sensory processing patterns of children with Asperger syndrome.
METHOD. Researchers compared the performance of 42 children with Asperger syndrome and 42 children without disabilities on section and factor scores of the Sensory Profile.
RESULTS. As reported by parents on the Sensory Profile, the children with Asperger syndrome were significantly different from children without disabilities on 22 of 23 items. This result was obtained with good power estimates (.997–1.00) and large effect sizes (O2 = .267–.732). Both groups of children performed the same on modulation of visual input affecting emotional responses and activity level.
CONCLUSION. This study provides initial evidence that clear differences exist in the sensory processing patterns of children with Asperger syndrome when compared with peers without disabilities.
The Adolescent Role Assessment: Psychometric Properties and Theoretical Usefulness
Authors: Huebner Ruth A. , Emery Lynnda J. , Shordike Anne 
Published: October 2010

Abstract
OBJECTIVE. Fostering career adaptability may improve vocational outcomes for adolescents. This study examined the responses of adolescents on the Adolescent Role Assessment (ARA) to explore its usefulness as a measure of career adaptability.
METHOD. The ARA was administered to 101 adolescents 12 to 17 years of age. Descriptive statistics, reliability analysis, and factor analysis were generated from the ARA scores. Dominant narrative themes were coded into the six domains of the ARA and into the domains identified in the factor analysis.
RESULTS. The internal consistency of the ARA was low with few differences in findings across age. The identified factors—developing aspirations, self-efficacy, interpersonal competencies, and autonomy—are consistent with constructs of career adaptability found in the literature and differentiated low and high scorers.
CONCLUSION. Major changes to the ARA content and scaling or development of a new assessment of career adaptability using the factor structure are recommended for clinical and research applications.
Aspects of Emic and Etic Measurement: Lessons From Mary Poppins
Authors: Lee Christopher J. 
Published: October 2010

Abstract
This article describes emic and etic approaches to measurement in terms of a process of associating indicators and constructs. In this process, it is important to establish evidence of an adequate range of indicators and a relevant association of indicators and constructs and to recognize that such evidence places bounds on the interpretation of measurement outcomes. A passage from one of P. L. Travers’s Mary Poppins stories provides a counterpoint for this article’s discussion of these key aspects of emic and etic methods of measuring human individuality.
A Synthesis of the Effects of Occupational Therapy for Persons With Stroke, Part I: Restoration of Roles, Tasks, and Activities
Authors: Trombly Catherine A. , Ma Hui-ing 
Published: October 2010

Abstract
This article synthesizes research findings regarding the effects of occupational therapy on the restoration of role, task, and activity performance for persons who have had a stroke, with the purpose of guiding practice and research. It is the first of a two-part review of studies. Part II synthesizes research findings regarding the effects of occupational therapy on remediating impairments. Part I includes 15 studies involving 895 participants (mean age = 70.3 years). Of these studies, 11 (7 randomized controlled trials) found that role participation and instrumental and basic activities of daily living performance improved significantly more with training than with the control conditions. We conclude that occupational therapy effectively improves participation and activity after stroke and recommend that therapists use structured instruction in specific, client-identified activities, appropriate adaptations to enable performance, practice within a familiar context, and feedback to improve client performance. Empirical research to verify these findings and to characterize the key therapeutic mechanisms associated with desired outcomes is needed.