bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of early nutrition on deaths due to severe traumatic brain injury
Authors: Härtl Roger , Gerber Linda M. , Ni Quanhong , Ghajar Jamshid 
Published: June 2008

Object
Traumatic brain injury (TBI) remains a serious public health crisis requiring continuous improvement in pre-hospital and inhospital care. This condition results in a hypermetabolic state that increases systemic and cerebral energy requirements, but achieving adequate nutrition to meet this demand has not been a priority in reducing death due to TBI. The effect of timing and quantity of nutrition on death within the first 2 weeks of injury was analyzed in a large prospective database of adult patients with severe TBI in New York State.

Methods
The study is based on 797 patients with severe TBI (Glasgow Coma Scale [GCS] score < 9) treated at 22 trauma centers enrolled in a New York State quality improvement program between 2000 and 2006. The inhospital section of the prospectively collected database includes information on age, initial GCS score, weight and height, results of CT scanning, and daily parameters such as pupillary status, arterial hypotension, GCS score, and number of calories fed per day.

Results
Patients who were not fed within 5 and 7 days after TBI had a 2- and 4-fold increased likelihood of death, respectively. The amount of nutrition in the first 5 days was related to death; every 10-kcal/kg decrease in caloric intake was associated with a 30–40% increase in mortality rates. This held up even after controlling for factors known to affect mortality, including arterial hypotension, age, pupillary status, initial GCS score, and CT scan findings.

Conclusions
Nutrition is a significant predictor of death due to TBI. Together with prevention of arterial hypotension, hypoxia, and intracranial hypertension it is one of the few therapeutic interventions that can directly affect TBI outcome.
Hearing preservation in medial vestibular schwannomas
Authors: Strauss Christian , Bischoff Barbara , Romstöck Johann , Rachinger Jens , Rampp Stefan , Prell Julian 
Published: June 2008

Object
Vestibular schwannomas (VSs) with no or little extension into the internal auditory canal have been addressed as a clinical subentity carrying a poor prognosis regarding hearing preservation, which is attributed to the initially asymptomatic intracisternal growth pattern. The goal in this study was to assess hearing preservation in patients who underwent surgery for medial VSs.

Methods
A consecutive series of 31 cases in 30 patients with medial VSs (mean size 31 mm) who underwent surgery between 1997 and 2005 via a suboccipitolateral route was evaluated with respect to pre- and postoperative cochlear nerve function, extent of tumor removal, and radiological findings. Intraoperative monitoring of brainstem auditory evoked potentials was performed in all patients with hearing. Patients were reevaluated at a mean of 30 months following surgery.

Results
Preoperative hearing function revealed American Academy of Otolaryngology–Head and Neck Surgery Foundation Classes A and B in 7 patients each, Class C in 4, and D in 9. Four patients presented with deafness. Hearing preservation was achieved in 10 patients (Classes A–C in 2 patients each, and Class D in 4 patients). Tumor removal was complete in all patients with hearing preservation, except for 2 patients with neurofibromatosis. In 4 patients a planned subtotal excision was performed due to the individual's age or underlying disease. In 1 patient a recurrent tumor was completely removed 3 years after the initial procedure.

Conclusions
The cochlear nerve in medial VSs requires special attention due to the atypical intracisternal growth pattern. Even in large tumors, hearing could be preserved in 37% of cases, since the cochlear nerve in medial schwannomas may not exhibit the adherence to the tumor capsule seen in tumors with comparable size involving the internal auditory canal.
Expression of hypoxia-inducible angiogenic proteins (hypoxia-inducible factor–1α, vascular endothelial growth factor, and E26 transformation-specific–1) and plaque hemorrhage in human carotid atherosclerosis
Authors: Higashida Tetsuhiro , Kanno Hiroshi , Nakano Masato , Funakoshi Kengo , Yamamoto Isao 
Published: June 2008

Object
Plaque hemorrhage in carotid atherosclerosis promotes plaque progression, resulting in cerebrovascular disease. Hypoxia inducible factor–1α (HIF-1α) induces angiogenesis via the expression of vascular endothelial growth factor (VEGF) and E26 transformation-specific–1 (Ets-1). The authors investigated human carotid plaques to determine whether these hypoxia-inducible angiogenic proteins play a major role in intraplaque angiogenesis and hemorrhage.

Methods
The expression of HIF-1α, VEGF, and Ets-1 was analyzed using immunohistochemistry and Western blotting in 29 human carotid plaques obtained at carotid endarterectomy. The authors investigated the relationship between plaque characteristics and clinical symptoms.

Results
A higher incidence of plaque hemorrhage was observed in plaques associated with symptoms than in those without symptoms (p = 0.03). Hypoxia-inducible factor–1α, VEGF, and Ets-1 coexisted in the deep layer of plaque, where angiogenesis was remarkably developed; the expression levels of HIF-1α, VEGF, and Ets-1 were significantly enhanced in the main lesion of the plaque (p < 0.01). Symptomatic plaques showed higher expression of VEGF (p = 0.04) than asymptomatic plaques. Plaques with hemorrhage showed a higher incidence of plaque ulcer (p = 0.001) and higher expression of Ets-1 (p = 0.03) than those without hemorrhage. Moreover, significantly increased expressions of VEGF (p = 0.01) and Ets-1 (p = 0.006) were observed in plaques with not only hemorrhages but also ulcers and severe stenosis.

Conclusions
The findings in this study suggest that hypoxia-inducible angiogenic proteins in human carotid atherosclerosis promote intraplaque angiogenesis, which can induce plaque hemorrhage and progression.
Upregulation of estrogen receptor α and mediation of 17β-estradiol vasoprotective effects via estrogen receptor α in basilar arteries in rats after experimental subarachnoid hemorrhage
Authors: Shih Huei-Chuan , Lin Chih-Lung , Wu Shu-Chuan , Kwan Aij-Lie , Hong Yi-Ren , Howng Shen-Long 
Published: June 2008

Object
The authors previously demonstrated that 17β-estradiol benzoate (E2) treatment prevents subarachnoid hemorrhage (SAH)–induced cerebral vasospasm and preserves endothelial nitric oxide synthase (eNOS) in male rats. Changes in the expression of estrogen receptor (ER) subtypes ERα and -β and their roles in the E2-mediated preservation of eNOS in SAH remain unknown. In the present study the effects of SAH on the expression of ERα and -β in the cerebral arteries were clarified, and the receptor roles in the E2-mediated preservation of eNOS expression in SAH were differentiated.

Methods
A 2-hemorrhage SAH model was induced by 2 autologous blood injections into the cisterna magna of adult male rats. The effect of SAH on ERα and -β expression was evaluated. Other rats subcutaneously received implanted Silastic tubes containing corn oil with E2 and daily injections of various doses of an ERα- (methyl-piperidinopyrazole [MPP]) or ERβ-selective antagonist (R,R-tetrahydrochrysene) after the first hemorrhage. The protein levels of ERα, ERβ, eNOS, and inducible nitric oxide synthase (iNOS) from basilar arteries were examined using Western blot analysis, and their mRNAs were evaluated by reverse transcription–polymerase chain reaction.

Results
The ERα but not the ERβ was upregulated in the basilar artery after SAH. Treatment with MPP eliminated E2-mediated effects in SAH, relieved cerebral vasospasm, preserved eNOS expression, and suppressed iNOS expression.

Conclusions
Estrogen receptor α is upregulated in the basilar artery after SAH. Note that E2 exerts its protective effects through ERα-dependent pathways to relieve cerebral vasospasm and preserve eNOS expression. A selective ERα agonist may be the drug of choice for the treatment of patients with SAH.
Nonlinear poroplastic model of ventricular dilation in hydrocephalus
Authors: Momjian Shahan , Bichsel Denis 
Published: June 2008

Object
The mechanism of ventricular dilation in normal-pressure hydrocephalus remains unclear. Numerical finite-element (FE) models of hydrocephalus have been developed to investigate the biomechanics of ventricular enlargement. However, previous linear poroelastic models have failed to reproduce the relatively larger dilation of the horns of the lateral ventricles. In this paper the authors instead elaborated on a nonlinear poroplastic FE model of the brain parenchyma and studied the influence of the introduction of these potentially more realistic mechanical behaviors on the prediction of the ventricular shape.

Methods
In the proposed model the elasticity modulus varies as a function of the distension of the porous matrix, and the internal mechanical stresses are relaxed after each iteration, thereby simulating the probable plastic behavior of the brain tissue. The initial geometry used to build the model was extracted from CT scans of patients developing hydrocephalus, and the results of the simulations using this model were compared with the real evolution of the ventricular size and shape in the patients.

Results
The authors' model predicted correctly the magnitude and shape of the ventricular dilation in real cases of acute and chronic hydrocephalus. In particular, the dilation of the frontal and occipital horns was much more realistic.

Conclusions
This finding suggests that the nonlinear and plastic mechanical behaviors implemented in the present numerical model probably occur in reality. Moreover, the availability of such a valid FE model, whose mechanical parameters approach real mechanical properties of the brain tissue, might be useful in the further modeling of ventricular dilation at a normal pressure.
Pharmacological modulation of cortical plasticity following kainic acid lesion in rat barrel cortex
Authors: Darbar Aneela , Stevens Richard T. , Siddiqui Adnan H. , McCasland James S. , Hodge Charles J. 
Published: June 2008

Object
The brain shows remarkable capacity for plasticity in response to injury. To maximize the benefits of current neurological treatment and to minimize the impact of injury, the authors examined the ability of commonly administered drugs, dextroamphetamine (D-amphetamine) and phenytoin, to positively or negatively affect the functional recovery of the cerebral cortex following excitotoxic injury.

Methods
Previous work from the same laboratory has demonstrated reorganization of whisker functional responses (WFRs) in the rat barrel cortex after excitotoxic lesions were created with kainic acid (KA). In the present study, WFRs were mapped using intrinsic optical signal imaging before and 9 days after creation of the KA lesions. During the post-lesion survival period, animals were either treated with intraperitoneal D-amphetamine, phenytoin, or saline or received no treatment. Following the survival period, WFRs were again measured and compared with prelesion data.

Results
The findings suggest that KA lesions cause increases in WFR areas when compared with controls. Treatment with D-amphetamine further increased the WFR area (p < 0.05) while phenytoin-treated rats showed decreases in WFR areas. There was also a statistically significant difference (p < 0.05) between the D-amphetamine and phenytoin groups.

Conclusions
These results show that 2 commonly used drugs, D-amphetamine and phenytoin, have opposite effects in the functional recovery/plasticity of injured cerebral cortex. The authors' findings emphasize the complex nature of the cortical response to injury and have implications for understanding the biology of the effects of different medications on eventual functional brain recovery.
Identification of a human leukocyte antigen-A24–restricted T-cell epitope derived from interleukin-13 receptor α2 chain, a glioma-associated antigen
Authors: Shimato Shinji , Natsume Atsushi , Wakabayashi Toshihiko , Tsujimura Kunio , Nakahara Norimoto , Ishii Jun , Ito Motokazu , Akatsuka Yoshiki , Kuzushima Kiyotaka , Yoshida Jun 
Published: June 2008

Object
The human leukocyte antigen-A24 (HLA-A24) allele is highly expressed in Asians. This allele is expressed in 60% of the Japanese population and in a significant number of people of other ethnicities. The interleukin-13 type α2 receptor (IL-13Rα2) has been shown to be a glioma-specific antigen, and is abundantly expressed in a majority of high-grade astrocytomas. In this study, the authors first investigated the suitability of IL-13Rα2 as a target antigen of malignant glioma cells, and then identified a potential HLA-A24–restricted peptide derived from IL-13Rα2.

Methods
The expression of IL-13Rα2 in glioma tissues was examined by reverse transcription–polymerase chain reaction analysis. To identify the desired epitope, the authors selected 5 candidate peptides from IL-13Rα2 that were predicted to bind to HLA-A24. The lytic activity of cytotoxic T lymphocytes (CTLs) induced by peptide-pulsed dendritic cells was analyzed against various glioma cell lines and freshly isolated human glioma cells.

Results
In a series of glioma tissues obtained in 29 patients, the authors found that > 50% of high-grade gliomas expressed IL-13Rα2. Of the 5 peptides tested, P174 (WYEGLDHAL) was found to be the most useful for the induction of HLA-A24–restricted and IL-13Rα2–specific CTLs. A CTL line induced by P174 also showed antigen-specific cytotoxicity to surgically removed glioma cells depending on their level of expression of IL-13Rα2 and HLA-A24.

Conclusions
Interleukin-13Rα2 is a glioma-specific antigen, and the immunogenic peptide P174 may contribute to a peptide-based immunotherapy against malignant glioma cells expressing HLA-A24.
Motor cortex stimulation in patients with Parkinson disease: 12-month follow-up in 4 patients
Authors: Arle Jeffrey E. , Apetauerova Diana , Zani Janet , Deletis D. Vedran , Penney Dana L. , Hoit Daniel , Gould Christine , Shils Jay L. 
Published: June 2008

Object
Since the initial 1991 report by Tsubokawa et al., stimulation of the M1 region of cortex has been used to treat chronic pain conditions and a variety of movement disorders.

Methods
A Medline search of the literature published between 1991 and the beginning of 2007 revealed 459 cases in which motor cortex stimulation (MCS) was used. Of these, 72 were related to a movement disorder. More recently, up to 16 patients specifically with Parkinson disease were treated with MCS, and a variety of results were reported. In this report the authors describe 4 patients who were treated with extradural MCS.

Results
Although there were benefits seen within the first 6 months in Unified Parkinson's Disease Rating Scale Part III scores (decreased by 60%), tremor was only modestly managed with MCS in this group, and most benefits seen initially were lost by the end of 12 months.

Conclusions
Although there have been some positive findings using MCS for Parkinson disease, a larger study may be needed to better determine if it should be pursued as an alternative surgical treatment to DBS.
Concurrent use of a lumboperitoneal shunt with programmable valve and ventricular access device in the treatment of pseudotumor cerebri: review of 40 cases
Authors: Nadkarni Trimurti D. , Rekate Harold L. , Wallace Donna 
Published: June 2008

Object
The authors evaluated the efficacy of treating patients with pseudotumor cerebri (PTC) and headaches due to increased intracranial pressure (ICP) by using a lumboperitoneal (LP) shunt with a programmable valve and ventricular access device (VAD).

Methods
Forty patients in whom PTC was diagnosed were treated using LP shunts with programmable valves and wand-guided placement of a VAD. All patients had papilledema and high opening pressure during spinal tap. The mean follow-up was 18 months (range 3–72 months). When patients complained of headaches that suggested shunt malfunction, the ventricular reservoir was tapped at bedside to assess ICP. The programmable valve was adjusted based on the patient's headache and ICP.

Results
The VAD was tapped in 21 patients, and the LP valve was redialed in 14. Shunt malfunction was diagnosed accurately. The 10 patients undergoing revision were all found to have shunt obstruction except 1 whose valve was replaced because it could not be reprogrammed. No patient treated with a shunt developed a Chiari malformation. The VAD was exposed in 4 patients with infection or wound breakdown. The LP shunt was revised in 2 patients who developed a pseudomeningocele. In 1 patient, a small bowel obstruction responded to conservative management. Seven patients had headaches despite documented normal ICP. That is, the headaches were unrelated to shunt function, and these patients were referred to a pain management clinic.

Conclusions
Lumboperitoneal shunts with programmable valves effectively controlled the outflow of lumbar cerebrospinal fluid to ameliorate the symptoms of PTC. The VAD permitted assessment of ICP and thus, indirectly, LP shunt function, and benefits outweighed risks. The programmable valve permitted cerebrospinal fluid flow to be adjusted based on patients' clinical status and ICP to be measured by the VAD.
Efficacy of intraoperative wound irrigation for preventing shunt infection
Authors: Hayashi Toshiaki , Shirane Reizo , Kato Takahiro , Tominaga Teiji 
Published: June 2008

Object
Although a cerebrospinal fluid shunt procedure is one of the most frequently performed operations in pediatric neurosurgery, the infection rate due to the procedure is not low. The authors have hypothesized that the key to reducing surgical shunt infections is to reduce bacteria from the operating field and wound. This hypothesis has been tested in a prospective nonrandomized controlled study at the authors' department.

Methods
Beginning in August 2006, during shunt procedures the authors began routinely irrigating the operating field and wound with amikacin containing saline, using a jet of fluid from a syringe. Prior to this new routine no irrigation techniques were used, providing an adequate control group for comparing the effect of the irrigation technique. Data obtained in all patients undergoing shunt insertions or revisions for hydrocephalus performed between October 1, 2003, and November 30, 2007, were reviewed.

Results
A total of 101 shunt procedures were performed in 63 patients (34 females and 29 males) during the study period. The mean age of all patients was 48.2 ± 61.8 months. A total of 61 shunt procedures were performed before August 2006, and 40 were performed after August 2006. There was no statistical difference between the ages of patients in the 2 groups (p = 0.64). Eight total infections occurred during the 90 days of the postoperative period (7.9% overall infection rate). All 8 infections occurred before implementation of the irrigation technique (13.1% infection rate), but no infections were noted after beginning use of the irrigation procedure (0% infection rate). There was a statistically significant difference in the infection rate between the 2 groups (p = 0.021).

Conclusions
Use of an irrigation strategy aimed at reducing bacteria from the operating field and wound can be considered an effective procedure for preventing shunt infection.
Changing the paradigm of 1-stage total callosotomy for the treatment of pediatric generalized epilepsy
Authors: Shim Kyu-Won , Lee Young-Mok , Kim Heung-Dong , Lee Jun-Soo , Choi Joong-Uhn , Kim Dong-Seok 
Published: June 2008

Object
The authors propose that anterior callosotomy—thought to have some advantages over total callosotomy—is not superior to total callosotomy for prevention of seizure propagation or other complications.

Methods
The study comprised 34 patients in whom generalized epilepsy syndrome or frontal lobe seizures with a secondary generalization were diagnosed. Preoperatively, all patients suffered from disabling drop attacks or intense head-drop seizures, and some patients also experienced other types of seizures. The male/female ratio was 22:12, and patients ranged in age between 1 to 19 years (mean 8.7 years). The follow-up period ranged from 1.08 to 5.0 years (mean 2.58 years). Seizure outcome, parental assessment of daily function, and parental satisfaction with the outcome was assessed postoperatively.

Results
After undergoing 1-stage total callosotomy, drop attacks disappeared completely in 25 patients during the follow-up period, and in 6 patients the frequency of drop attacks decreased to < 10% of baseline. With regard to other types of seizures, seizures resolved completely in 12 patients, and in another 18 seizure frequency decreased. Two patients experienced a transient disconnection syndrome for 2 and 4 weeks. One patient experienced ataxic hemiparesis for 3 weeks before it completely abated. The overall daily function of the patients improved, and all parents were satisfied with the surgical outcome.

Conclusions
For pediatric generalized epilepsy syndrome, 1-stage total callosotomy will be the first choice in treatment for controlling generalized seizures.
Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis
Authors: Durham Susan R. , Fjeld-Olenec Kristina 
Published: June 2008

Object
Surgery for Chiari malformation Type I (CM-I) is one of the most common neurosurgical procedures performed in children, although there is clearly no consensus among practitioners about which surgical method is preferred. The objective of this meta-analysis was to compare the outcome of posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) for the treatment of CM-I in children.

Methods
The authors searched Medline–Ovid, The Cochrane Library, and the conference proceedings of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons (2000–2007) for studies meeting the following inclusion criteria: 1) surgical treatment of CM-I; 2) surgical techniques of PFD and PFDD being reported in a single cohort; and 3) patient age < 18 years.

Results
Five retrospective and 2 prospective cohort studies involving a total of 582 patients met the criteria for inclusion in the meta-analysis. Of the 582 patients, 316 were treated with PFDD and 266 were treated with PFD alone. Patient age ranged from 6 months to 18 years. Patients undergoing PFDD had a significantly lower reoperation rate (2.1 vs 12.6%, risk ratio [RR] 0.23, 95% confidence interval [CI] 0.08–0.69) and a higher rate of cerebrospinal fluid–related complications (18.5 vs 1.8%, RR 7.64, 95% CI 2.53–23.09) than those undergoing PFD. No significant differences in either clinical improvement (78.6 vs 64.6%, RR 1.23, 95% CI 0.95–1.59) or syringomyelia decrease (87.0 vs 56.3%, RR 1.43, 95% CI 0.91–2.25) were noted between PFDD and PFD.

Conclusions
Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation than PFD but a greater risk for cerebrospinal fluid–related complications. There was no significant difference between the 2 operative techniques with respect to clinical improvement or decrease in syringomyelia.