bluuebunny/crossref_metadata_2025_split huggingface dataset:
The strengths and limitations of meta-analyses based on aggregate data
Authors: Lyman Gary H , Kuderer Nicole M 
Published: April 2005

Abstract

Background
Properly performed systematic reviews and meta-analyses are thought by many to represent among the highest level of evidence addressing important clinical issues. Few would disagree that meta-analyses based on individual patient data (IPD) offer several advantages and represent the standard to which all other systematic reviews should be compared.

Methods
All cancer-related meta-analyses cited in Medline were classified as based on aggregate or individual patient data. A review was then undertaken of all reports comparing the comparative strengths and limitations of meta-analyses using either aggregate or individual patient data.

Results
The majority of published meta-analyses are based on summary or aggregate patient data (APD). Reasons suggested for this include the considerable resources, years of study and often, broad international cooperation required for IPD meta-analyses. Many of the most important features of systematic reviews including formal meta-analyses are addressed by both IPD and APD meta-analyses. The need for defining an explicit and relevant clinical question, exhaustively searching for the totality of evidence, meticulous and unbiased data transfer or extraction, assessment of between study heterogeneity and the use of appropriate statistical methods for estimating summary effect measures are essentially the same for the two approaches.

Conclusion
IPD offers advantages and, when feasible, should be considered the best opportunity to summarize the results of multiple studies. However, the resources, time and cooperation required for such studies will continue to limit their use in many important areas of clinical medicine which can be meaningfully and cost-effectively approached by properly performed APD meta-analyses. APD meta-analyses continue to be the mainstay of systematic reviews utilized by the US Preventive Services Task Force, the Cochrane Collaboration and many professional societies to support clinical practice guidelines.
The prognostic value of the hypoxia markers CA IX and GLUT 1 and the cytokines VEGF and IL 6 in head and neck squamous cell carcinoma treated by radiotherapy ± chemotherapy
Authors: De Schutter Harlinde , Landuyt Willy , Verbeken Erik , Goethals Laurence , Hermans Robert , Nuyts Sandra 
Published: April 2005

Abstract
Background
Several parameters of the tumor microenvironment, such as hypoxia, inflammation and angiogenesis, play a critical role in tumor aggressiveness and treatment response. A major question remains if these markers can be used to stratify patients to certain treatment protocols.
The purpose of this study was to investigate the inter-relationship and the prognostic significance of several biological and clinicopathological parameters in patients with head and neck squamous cell carcinoma (HNSCC) treated by radiotherapy ± chemotherapy.

Methods
We used two subgroups of a retrospective series for which CT-determined tumoral perfusion correlated with local control. In the first subgroup (n = 67), immunohistochemistry for carbonic anhydrase IX (CA IX) and glucose transporter-1 (GLUT-1) was performed on the pretreatment tumor biopsy. In the second subgroup (n = 34), enzyme linked immunosorbent assay (ELISA) was used to determine pretreatment levels of the cytokines vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) in serum. Correlation was investigated between tumoral perfusion and each of these biological markers, as well as between the markers mutually. The prognostic value of these microenvironmental parameters was also evaluated.

Results
For CA IX and GLUT-1, the combined assessment of patients with both markers expressed above the median showed an independent correlation with local control (p = 0.02) and disease-free survival (p = 0.04) with a trend for regional control (p = 0.06).
In the second subgroup, IL-6 pretreatment serum level above the median was the only independent predictor of local control (p = 0.009), disease-free survival (p = 0.02) and overall survival (p = 0.005).

Conclusion
To our knowledge, we are the first to report a link in HNSCC between IL-6 pretreatment serum levels and radioresistance in vivo. This link is supported by the strong prognostic association of pretreatment IL-6 with local control, known to be the most important parameter to judge radiotherapy responses.
Furthermore, the combined assessment of CA IX and GLUT-1 correlated independently with prognosis. This is a valuable indication that a combined approach is important in the investigation of prognostic markers.
Posttraumatic stress disorder: An exploratory study examining rates of trauma and PTSD and its effect on client outcomes in community mental health
Authors: Howgego Irene M , Owen Cathy , Meldrum Lenore , Yellowlees Peter , Dark Frances , Parslow Ruth 
Published: April 2005

Abstract
Background
Rates of trauma and Posttraumatic Stress Disorder (PTSD) were examined in order to compare the profile in clients of an Australian Public Mental Health Service with that reported in the international literature for clients with major mental illness and to explore the effect of this on client health outcomes. Potential factors contributing to increased levels of trauma/PTSD in this group of clients and the issue of causality between PTSD and subsequent mental illness was also explored.

Methods
A convenience sample of 29 clients was screened for trauma and PTSD using the Posttraumatic Stress Diagnostic Scale™ (PDS) and selected outcome measures. Paired and independent samples t-test and ANOVA were applied to the data.

Results
High levels of undocumented trauma and PTSD were found. Twenty clients, (74%) reported exposure to multiple traumatic events; 33.3% (9) met DSM IV diagnostic criteria for PTSD. Significant difference was found for PTSD symptomatology, severity and impairment and for client and clinician-rated scores of Quality of Life (QOL) outcomes in the PTSD group. No effect for PTSD symptomatology on the Working Alliance (WA) was found. Factors that may influence higher rates of PTSD in this group were identified and included issues associated with the population studied, the predominance of assaultive violence found, and vulnerability and risks factors associated with re-traumatisation within the social and treating environments.

Conclusion
A similar trauma and PTSD profile to that reported in the international literature, including greater levels of trauma and PTSD and a poorer QOL, was found in this small sample of clients. It is postulated that the increased levels of trauma/PTSD as reported for persons with major mental illness, including those found in the current study, are primarily related to the characteristics of the population that access public mainstream psychiatric services and that these factors have specific implications for service delivery, and raise issues of efficiency and effectiveness of resource use in achieving successful outcomes in public mental health services for clients with co-morbid PTSD. Further research with a more rigorous design is needed to test these preliminary findings within Australian Community Mental Health Services.
Introducing the National Library for Health Skin Conditions Specialist Library
Authors: Grindlay Douglas , Boulos Maged N Kamel , Williams Hywel C 
Published: April 2005

Abstract

Background
This paper introduces the new National Library for Health Skin Conditions Specialist Library http://www.library.nhs.uk/skin.

Description
The aims, scope and audience of the new NLH Skin Conditions Specialist Library, and the composition and functions of its core Project Team, Editorial Team and Stakeholders Group are described. The Library's collection building strategy, resource and information types, editorial policies, quality checklist, taxonomy for content indexing, organisation and navigation, and user interface are all presented in detail. The paper also explores the expected impact and utility of the new Library, as well as some possible future directions for further development.

Conclusion
The Skin Conditions Specialist Library is not just another new Web site that dermatologists might want to add to their Internet favourites then forget about it. It is intended to be a practical, "one-stop shop" dermatology information service for everyday practical use, offering high quality, up-to-date resources, and adopting robust evidence-based and knowledge management approaches.
Human T-cell leukemia virus type I (HTLV-I) infection and the onset of adult T-cell leukemia (ATL)
Authors: Matsuoka Masao 
Published: April 2005

Abstract
The clinical entity of adult T-cell leukemia (ATL) was established around 1977, and human T-cell leukemia virus type 1 (HTLV-I) was subsequently identified in 1980. In the 25 years since the discovery of HTLV-I, HTLV-I infection and its associated diseases have been extensively studied, and many of their aspects have been clarified. However, the detailed mechanism of leukemogenesis remains unsolved yet, and the prognosis of ATL patients still poor because of its resistance to chemotherapy and immunodeficiency. In this review, I highlight the recent progress and remaining enigmas in HTLV-I infection and its associated diseases, especially ATL.
Pharmacokinetics of 5-Azacitidine Administered With Phenylbutyrate in Patients With Refractory Solid Tumors or Hematologic Malignancies
Authors: Rudek Michelle A. , Zhao Ming , He Ping , Hartke Carol , Gilbert Jill , Gore Steven D. , Carducci Michael A. , Baker Sharyn D. 
Published: April 2005

Purpose To characterize the pharmacokinetic behavior of 5-azacitidine (5-AC), a cytidine nucleoside analog, when given with phenylbutyrate, a histone deaceytlase inhibitor. Patients and Methods Pharmacokinetic data were obtained from two trials involving patients with solid tumor and hematologic malignancies. 5-AC at doses ranging from 10 to 75 mg/m2/d was administered once daily as a subcutaneous injection for 5 to 21 days in combination with phenylbutyrate administered as a continuous intravenous infusion for varying dose and duration every 28 or 35 days. Serial plasma samples were collected up to 24 hours after 5-AC administration. 5-AC was quantitated using a validated liquid chromatograph/tandem mass spectrometry method. Results 5-AC was rapidly absorbed with the mean Tmax occurring at 0.47 hour. Average maximum concentration (Cmax) and area under the curve (AUC0-∞) values increased in a dose-proportionate manner with increasing dose from 10 to 75 mg/m2/d; the mean ± SD Cmax and AUC0-∞ at 10 mg/m2/d were 776 ± 459 nM and 1,355 ± 1,125 h*nM, respectively, and at 75 mg/m2/d were 4,871 ± 1,398 nM and 6,582 ± 2,560 h*nM, respectively. Despite a short terminal half-life of 1.5 ± 2.3 hours, inhibition of DNA methyl transferase activity in tumors of patients receiving 5-AC has been documented. Conclusion 5-AC is rapidly absorbed and eliminated when administered subcutaneously. Sufficient 5-AC exposure is achieved to produce pharmacodynamic effects in tumors.
The Microsurgical Nuances of Resecting Tuberculum Sellae Meningiomas
Authors: Benjamin Vallo , Russell Stephen M. 
Published: April 2005

Abstract
In a recent article, our experience and knowledge of the clinical picture, microsurgical anatomy, and long-term surgical outcome of resecting tuberculum sellae meningiomas was described in detail. We now present our surgical technique in a pictorial and video format for the benefit of neurosurgeons in training, as well as for general critique. Attention is given to the details of surgery: patient positioning, surgical approaches, technique of tumor removal, and postoperative care.
Anatomic Landmarks for Nerves of the Neck: A Vade Mecum for Neurosurgeons
Authors: Tubbs R. Shane , Salter E. George , Oakes W. Jerry 
Published: April 2005

Abstract
ANATOMIC LANDMARKS ARE often quite useful in localizing structures within the human body, especially in the surgical realm. We have reviewed the medical literature and multiple texts of surgery and anatomy and culled together many anatomic landmarks regarding important nerves of the neck. This region is complicated by formidable anatomy, and a single collection of the relationships of the nerves in this region is lacking in the literature. It is our hope that this collection will serve to assist the surgeon who operates in this region of the body.
Quantitative Anatomic Study of Three Surgical Approaches to the Anterior Communicating Artery Complex
Authors: Figueiredo Eberval Gadelha , Deshmukh Pushpa , Zabramski Joseph M. , Preul Mark C. , Crawford Neil R. , Siwanuwatn Rungsak , Spetzler Robert F. 
Published: April 2005

Abstract

OBJECTIVE:
To compare the angles of approach and area of exposure to the anterior communicating artery (AComA) complex associated with pterional (PT), orbitopterional (OPT), and orbitozygomatic (OZ) craniotomies before and after gyrus rectus resection.

METHODS:
PT, OPT, and OZ craniotomies were performed on both sides of four heads, and the angles of approach and area of exposure to the AComA complex were measured before and after resection of the gyrus rectus.

RESULTS:
The vertical angle of approach increased significantly among the PT and OPT (P = 0.001), PT and OZ (P = 0.001), and OPT and OZ approaches (P = 0.005). The horizontal angle of approach was significantly larger between the PT to OPT (P = 0.001) and PT to OZ (P = 0.001) approaches but not between the OPT and OZ approaches (P = 0.757). After gyrus rectus resection, the vertical and horizontal angles of approach increased significantly for the PT approach but not for the OPT and OZ approaches. The area of exposure to the AComA complex increased progressively from the PT to OPT to OZ approach but did not reach statistical significance (P = 0.124). Resection of the gyrus rectus resulted in significant relative gains in the area of exposure for the PT (P = 0.01) and OPT (P = 0.04) approaches but not for the OZ approach (P = 0.88).

CONCLUSION:
The vertical and horizontal angles of approach to the AComA complex are significantly larger for the OPT and OZ approaches compared with the PT approach. Use of the OZ approach may decrease the need for frontal lobe retraction and resection of the gyrus rectus.
Lateral Transsulcal Approach to Asymptomatic Trigonal Meningiomas with Correlative Microsurgical Anatomy: Technical Case Report
Authors: Nagata Shinji , Sasaki Tomio 
Published: April 2005

Abstract

OBJECTIVE:
We introduce the lateral transsulcal approach to asymptomatic trigonal meningiomas.

METHODS:
The approach was studied in two cadaver brains and three asymptomatic patients with trigonal meningiomas. The posterior part of the sylvian fissure, or superior temporal sulcus, is opened to the bottom. Through a small horizontal cortical incision, the trigone of the lateral ventricle is exposed in the shortest distance. The trigonal meningiomas are detached from the choroid plexus and removed.

RESULTS:
In patients with meningiomas on the nondominant side, the transsylvian approach was adopted. In patients with meningiomas on the dominant side, the transsylvian approach was adopted for patients with a wide sylvian cistern, and the approach through the superior temporal sulcus was adopted for patients with a narrow sylvian cistern. The transverse gyrus of Heschl was a good anatomic landmark in the operative field of the transsylvian approach. Patients with meningiomas on the dominant side exhibited transient amnestic aphasia and dyscalculia, but the symptoms disappeared in a few days or weeks. These patients were discharged without any neurological deficits. Although there are potential risks of damaging association fibers, optic radiation, the transverse gyrus of Heschl, and the parietal lobe, a thorough understanding of the topographical anatomy and careful dissection techniques can avoid morbidity. Wide opening of the sylvian fissure and debulking of the tumor are other important factors to reduce the retraction of the parietal and temporal lobes.

CONCLUSION:
The lateral transsulcal approach is applicable for small asymptomatic trigonal meningiomas with an acceptable risk of morbidity, even in the dominant hemisphere.
Intraoperative Motor Mapping of the Cerebral Peduncle during Resection of a Midbrain Cavernous Malformation: Technical Case Report
Authors: Quiñones-Hinojosa Alfredo , Lyon Russ , Du Rose , Lawton Michael T. 
Published: April 2005

Abstract

OBJECTIVE AND IMPORTANCE:
Brainstem cavernous malformations that seem to come to a pial or ependymal surface on preoperative magnetic resonance imaging studies may, in fact, be covered by an intact layer of neural tissue. For cavernous malformations in the cerebral peduncle, intraoperative stimulation mapping with a miniaturized probe can determine whether this overlying tissue harbors fibers in the corticospinal tract. In addition, intermittent monitoring with transcranial motor evoked potentials (TcMEPs) helps to protect this vital pathway during resection of the lesion.

CLINICAL PRESENTATION:
A 20-year-old woman collapsed after a cavernous malformation in the left cerebral peduncle hemorrhaged into the pons, midbrain, and thalamus. She presented with right hemiparesis and left oculomotor palsy.

INTERVENTION:
The cavernous malformation was completely resected through a left orbitozygomatic craniotomy and transsylvian approach. Stimulation mapping of the cerebral peduncle with a Kartush probe (Medtronic Xomed, Inc., Jacksonville, FL) identified the corticospinal tract lateral to the lesion, and a layer of tissue over the lesion harbored no motor fibers. TcMEP monitoring helped to guide the resection, with increased voltage thresholds and altered waveform morphologies indicating transient impaired motor conduction. All TcMEP changes returned to baseline by the end of the procedure, and the patient's hemiparesis improved after surgery.

CONCLUSION:
Stimulation mapping of the corticospinal tract and intermittent TcMEPs is a safe and simple surgical adjunct. Expanded monitoring of the motor pathway during the resection of cerebral peduncle cavernous malformations may improve the safety of these operations.
Surgical Clipping of Complex Basilar Apex Aneurysms: A Strategy for Successful Outcome Using the Pretemporal Transzygomatic Transcavernous Approach
Authors: Krisht Ali F. , Kadri Paulo A.S. 
Published: April 2005

Abstract

OBJECTIVE:
Complex basilar apex aneurysms (large size, wide and complex neck, tortuous parent vessels) continue to pose a challenge in treatment. Endovascular treatment has a high risk of recanalization, and surgical treatment is limited by the space and time necessary to achieve safe clipping. To overcome these obstacles, a modification of previously reported approaches was developed. The pretemporal transzygomatic transcavernous approach and a clipping strategy were used in the treatment of 21 high-complexity basilar apex aneurysms.

METHODS:
By use of the pretemporal route, the zygomatic notch was widened, the anterior clinoid was removed, the cavernous sinus was partially exposed, and the oculomotor nerve was mobilized. The depth of the field was widened by further cavernous exposure and the removal of the posterior clinoid. Temporary clips were applied to the basilar trunk perforator-free zone to preserve visualization of the aneurysm neck and perforators and to maintain collateral flow to the brainstem.

RESULTS:
Twenty-one high-complexity basilar apex aneurysms, 11 of which caused subarachnoid hemorrhage, were treated. Twenty (95%) were successfully clipped (Glasgow Outcome Scale scores, 4 or 5 in 90.5% at discharge; Rankin Disability Score, 1 in 90.5% at 1-yr follow-up). Complications were transient oculomotor palsy in all patients, small thalamic infarct in one patient, and cerebrospinal fluid leak in another. There was no surgical mortality. Delayed follow-up angiography in 19 of the 21 patients showed no residual aneurysm.

CONCLUSION:
We report the largest series of a unique, challenging group of complex basilar apex aneurysms treated with the pretemporal transzygomatic transcavernous approach, which provided improved safety of clipping by 1) increased visualization of the basilar apex and perforator arteries, 2) improved maneuverability of clip application, 3) a safer perforator-free location, and 4) preservation of brainstem collateral flow.
The Triangle of the Vertebral Artery
Authors: Tubbs R. Shane , Salter E. George , Wellons John C. , Blount Jeffrey P. , Oakes W. Jerry 
Published: April 2005

Abstract

OBJECTIVE:
Neurosurgical procedures such as proximal brachial plexus repair, scalenotomy, and direct isolation of the proximal vertebral artery require a good working knowledge of the triangle of the vertebral artery. This deep triangle of the neck is bound by the subclavian artery and the anterior scalene and longus cervicis muscles. In addition to the vertebral artery, many important structures are found in this area, such as the ganglionated sympathetic chain and certain cervical spinal nerves.

METHODS:
Twenty formalin-fixed cadavers were used for this study. Dissection of this triangle was performed, and measurements were made not only of parts of its borders, but also distances from these borders to neurologically important structures within its confines, such as the C8 spinal nerve.

RESULTS:
In all specimens, the middle scalene muscle was noted to form part of the posterior wall of the triangle. The mean height of the triangle was found to be 3.2 cm, and the mean width of its base was 1.3 cm. We observed that the C8 spinal nerve had a mean distance of 1.2 cm inferior to the apex of the triangle and that the C7 spinal nerve was found inside the triangle in 5% of sides. If the phrenic nerve entered the triangle, it was never found more than 6 mm medial to the anterior scalene muscle. The vertebral artery always traveled intimately along the lateral border of the longus cervicis muscle, and its lateral edge ranged 5 to 8 mm medial to the medial edge of the anterior scalene muscle.

CONCLUSION:
The C7 spinal nerve was observed in the triangle of the vertebral artery. In addition, the posterior border of the triangle of the vertebral artery was clearly defined in this study, and the middle scalene muscle could be used as a landmark. These data, coupled with our quantitation of parts and structures within the triangle, may assist neurosurgeons who operate on this area of the neck.