bluuebunny/crossref_metadata_2025_split huggingface dataset:
Office-Based Transperineal Laser Ablation for Benign Prostatic Hyperplasia Under Local Anesthesia: 2-Year Results from a Dose Range Confirmatory Trial
Authors: Bianco Fernando J. , Luna Eusebio , Lopez-Prieto Alberto , González Pedro , Gheiler Edward L. , Kaufman Ariel M. , Avila Luis , Maiolino Giuseppe 
Published: February 2024

Purpose:
To evaluate the safety and tolerability profile of transperineal laser ablation (TPLA) for patients with benign prostatic hyperplasia in an office setting under sedative-free anesthesia, including the functional outcome results at 24 months.

Materials and Methods:
This is a prospective, single-center, dose range confirmatory trial involving 20 male patients. TPLA was performed by urologists in an office setting, using nonsedative local anesthesia. Self-administered nitrous oxide/oxygen dissociating gas was optional. Tolerability was assessed using a visual analog scale. Safety was evaluated by recording Grade 3 or worse adverse events within 30 days after the procedure. International Prostate Symptom Score, Sexual Health Inventory for Men, ejaculation function, and uroflowmetry parameters were assessed at 6, 12, and 24 months.

Results:
All 20 procedures were performed as intended without request of cessation from any patient, who tolerated them very well, recording a median pain score of 2 (range 1-4). It is important to note that there was a rapid escalation of dose, and the last 18 consecutive patients were initiated at the maximal energy dose of 7 watts. No hospital transfers were recorded, and no urgent hospital admissions within 30 days post-procedure occurred. There was 1 Grade 3 complication registered during the 24-month study interval. We observed a statistically significant and sustained reduction in the median International Prostate Symptom Score at 6 months (6, 3-8), 12 months (3, 5-2), and 24 months (3, 2-4) when compared with baseline values (14, 12-17). Uroflowmetry parameters showed a similar trend. The median Sexual Health Inventory for Men values did not change significantly, and only approximately 10% of patients reported absence of anterograde ejaculation at 12 and 24 months.

Conclusions:
TPLA for benign prostatic hyperplasia is a safe and well-tolerated office-based procedure, with durable benefits on functional outcomes over 2 years of follow-up. Further studies are required to confirm these results.

NCT:
NCT04760483.
Management of Fallopian Canal Spontaneous CSF Leaks, Implications of Elevated Intracranial Pressure: Case Report and Systematic Review of the Literature
Authors: Saltagi Abdul K. , Saltagi Mohamad Z. , Kedo Mahmood , Shah Mitesh V. , Nelson Rick F. 
Published: February 2024

ObjectivesDescribe the diagnosis and management of a spontaneous cerebrospinal fluid leak (sCSF-L) through the facial nerve fallopian canal and determine the role of intracranial hypertension (IH).Study DesignRetrospective case study and systematic review of the literature.MethodsReviewed patient characteristics, radiographic findings, and management of the facial nerve canal CSF leak and postoperative IH. Conducted systematic literature review according to the PRISMA guidelines for surgical management and rates of IH.ResultsA 50-year-old female with bilateral tegmen defects and temporal encephaloceles underwent left middle cranial fossa (MCF) repair. Intraoperative CSF egressed from the temporal bone tegmen defects. Facial nerve decompression revealed CSF leak from the labyrinthine segment. A nonocclusive temporalis muscle plug was placed in the fallopian canal, and tegmen repair was completed with bone cement. A ventriculoperitoneal shunt was placed for IH. Postoperative facial nerve function and hearing were normal. A total of 20 studies met inclusion criteria with a total of 25 unique patients. Of 13 total adult cases of fallopian canal CSF leak, there is a 46% recurrence rate, and 86% of patients had documented IH when tested.ConclusionsFallopian canal CSF leaks are rare and challenging to manage. Assessment of intracranial hypertension and CSF diversion is recommended along with MCF skull base repair to preserve facial nerve function and conductive hearing.
The Role of Lumbar Drains in the Perioperative Management of Primary Spontaneous Temporal Lobe Encephaloceles and Cerebrospinal Fluid Leaks
Authors: Schwam Zachary G. , Mavrommatis Maria , Gidumal Sunder , Carrasquilla Alejandro , Shrivastava Raj , Perez Enrique R. , Cosetti Maura K. , Wanna George B. 
Published: February 2024

Objective
To examine the role of lumbar drains (LDs) in the success of spontaneous temporal cerebrospinal fluid (CSF) leak and encephalocele repair.

Study design
Retrospective cohort study.

Setting
Tertiary academic health system.

Patients
Patients undergoing repair of spontaneous temporal lobe encephaloceles or middle fossa CSF leaks during years 2017 to 2023.

Interventions
Transmastoid, middle fossa craniotomy, or combination approaches to CSF leak repair.

Outcome measures
Failure rate, complication rate, length of stay (LOS), readmission.

Results
Sixty-nine patients were included, with a combination approach performed in 78.3%, transmastoid in 17.4%, and isolated middle fossa craniotomy in 4.3%. Mean body mass index was 33.2, mean bony defect size width was 6.51 mm, and defect locations included the epitympanum, antrum, mastoid, and petrous apex. Multilayer closure with three or more layers was performed in 87.0%. LD was used in 73.9% of cases for a mean duration 2.27 days and was associated with longer LOS (3.27 vs. 1.56 d, p = 0.006) but not with failure rate, complications, discharge destination, or readmission. Only one major complication occurred as a result of the drain, but low-pressure headache was anecdotally common.

Conclusions
Use of LD in the repair of spontaneous CSF leaks and temporal lobe encephaloceles is associated with longer LOS but not failure rates or other admission-level outcomes.
Intermediate Cervical Plexus Block in the Management of Refractory Somatosensory Tinnitus Following Whiplash: Prospective Series in 30 Patients
Authors: Kukreja Yuvraj , Lee Hayun , Morsy Mohamed , Niraj G 
Published: February 2024

Objective
Whiplash-associated disorder comprises of a constellation of persistent symptoms after neck trauma. Tinnitus that develops postwhiplash is termed somatosensory tinnitus. The objective is to assess the role of intermediate cervical plexus block (iCPB) in patients with somatosensory tinnitus secondary to whiplash.

Methods
Prospective service evaluation in adults with whiplash-associated disorder and concomitant somatosensory tinnitus. Patients underwent specialist otorhinolaryngology review before pain clinic referral. Patients were offered ultrasound-guided iCPB with steroids. Intensity of tinnitus was recorded on a numerical rating scale at baseline, 3 and 6 months posttreatment. Brief Pain Inventory Short Form and Hospital Anxiety Depression Scale questionnaires were also completed.

Results
Over a 36-month period, 32 patients with refractory somatosensory tinnitus following whiplash were offered iCPB(s). Two patients refused because of needle phobia. iCPB(s) was performed in 30 patients as an outpatient procedure. One patient (1/30, 3.3%) was lost to follow-up. Twenty-three patients (23/30, 77%) reported clinically significant reduction in intensity of tinnitus at 3 months postprocedure. Nineteen patients (19/30, 63%) reported ongoing benefit at 6-month follow-up. Six patients failed to report any benefit (6/30, 20%).

Conclusion
The cervical plexus could play a significant role in the development of somatosensory tinnitus after whiplash. iCPB may have a role in the management of somatosensory tinnitus in this cohort.
Variability in Manual Segmentation of Temporal Bone Structures in Cone Beam CT Images
Authors: Lee Julian W. , Andersen Steven Arild Wuyts , Hittle Bradley , Powell Kimerly A. , Al-Fartoussi Hagar , Banks Laura , Brannen Zachary , Lahchich Mariam , Wiet Gregory J. 
Published: February 2024

Purpose
Manual segmentation of anatomical structures is the accepted “gold standard” for labeling structures in clinical images. However, the variability in manual segmentation of temporal bone structures in CBCT images of the temporal bone has not been systematically evaluated using multiple reviewers. Therefore, we evaluated the intravariability and intervariability of manual segmentation of inner ear structures in CBCT images of the temporal bone.

Methods
Preoperative CBCTs scans of the inner ear were obtained from 10 patients who had undergone cochlear implant surgery. The cochlea, facial nerve, chorda tympani, mid-modiolar (MM) axis, and round window (RW) were manually segmented by five reviewers in two separate sessions that were at least 1 month apart. Interreviewer and intrareviewer variabilities were assessed using the Dice coefficient (DICE), volume similarity, mean Hausdorff Distance metrics, and visual review.

Results
Manual segmentation of the cochlea was the most consistent within and across reviewers with a mean DICE of 0.91 (SD = 0.02) and 0.89 (SD = 0.01) respectively, followed by the facial nerve with a mean DICE of 0.83 (SD = 0.02) and 0.80 (SD = 0.03), respectively. The chorda tympani had the greatest amount of reviewer variability due to its thin size, and the location of the centroid of the RW and the MM axis were also quite variable between and within reviewers.

Conclusions
We observed significant variability in manual segmentation of some of the temporal bone structures across reviewers. This variability needs to be considered when interpreting the results in studies using one manual reviewer.
In Vivo Thickness of the Healthy Tympanic Membrane Determined by Optical Coherence Tomography
Authors: Morgenstern Joseph , Kreusch Theodor , Golde Jonas , Steuer Svea , Ossmann Steffen , Kirsten Lars , Walther Julia , Zahnert Thomas , Koch Edmund , Neudert Marcus 
Published: February 2024

Objective
Tympanic membrane (TM) thickness is an important parameter for differentiation between a healthy and a pathologic TM. Furthermore, it is needed for modeling the middle ear function. Endoscopic optical coherence tomography (eOCT) provides the opportunity to measure the TM thickness of the entire TM in vivo.

Materials and methods
A total of 27 healthy ears were examined by eOCT. The system uses a light source with a central wavelength of 1,300 nm. The endoscope with an outer diameter of 3.5 mm provides a field of view of 10 mm and a working distance of 10 mm. Thickness measurements were carried out at 8 points on the TM. Additionally, the existing literature was analyzed, and a mean TM thickness value was determined.

Results
The mean thickness of the TM over all measurement points of the pars tensa was 120.2 μm, and the pars flaccida was significantly thicker with a mean thickness of 177.9 μm. Beyond that, there were no significant differences between the single quadrants. The mean TM thickness in the literature was 88.8 μm.

Discussion
EOCT provides the possibility for in vivo thickness determination of the TM. The mean thickness seems to be higher than in the previous studies, which were mostly carried out ex vivo. Our study takes the three-dimensional refraction into account and provides a method for the refraction correction.
Serum Carbohydrate Antigen 19-9 and Metabolite Hypotaurine Are Predictive Markers for Early Recurrence of Pancreatic Ductal Adenocarcinoma
Authors: Nagao Mina , Oshima Minoru , Suto Hironobu , Sugimoto Masahiro , Enomoto Ayame , Murakami Tomomasa , Shimomura Ayaka , Wada Yukiko , Matsukawa Hiroyuki , Ando Yasuhisa , Kishino Takayoshi , Kumamoto Kensuke , Kobara Hideki , Kamada Hideki , Masaki Tsutomu , Soga Tomoyoshi , Okano Keiichi 
Published: February 2024

Objective
A significant number of patients experience early recurrence after surgical resection for pancreatic ductal adenocarcinoma (PDAC), negating the benefit of surgery. The present study conducted clinicopathologic and metabolomic analyses to explore the factors associated with the early recurrence of PDAC.

Materials and Methods
Patients who underwent pancreatectomy for PDAC at Kagawa University Hospital between 2011 and 2020 were enrolled. Tissue samples of PDAC and nonneoplastic pancreas were collected and frozen immediately after resection. Charged metabolites were quantified by capillary electrophoresis-mass spectrometry. Patients who relapsed within 1 year were defined as the early recurrence group.

Results
Frozen tumor tissue and nonneoplastic pancreas were collected from 79 patients. The clinicopathologic analysis identified 11 predictive factors, including preoperative carbohydrate antigen 19-9 levels. The metabolomic analysis revealed that only hypotaurine was a significant risk factor for early recurrence. A multivariate analysis, including clinical and metabolic factors, showed that carbohydrate antigen 19-9 and hypotaurine were independent risk factors for early recurrence (P = 0.045 and P = 0.049, respectively). The recurrence-free survival rate 1 year after surgery with both risk factors was only 25%.

Conclusions
Our results suggested that tumor hypotaurine is a potential metabolite associated with early recurrence. Carbohydrate antigen 19-9 and hypotaurine showed a vital utility for predicting early recurrence.
Ki-67 Proliferation Index Is Associated With Tumor Grade and Survival in Pleural Epithelioid Mesotheliomas
Authors: Galeano Belinda , Smith Caleb J. , Yi Eunhee S. , Roden Anja C. , Jenkins Sarah , Capelle Jenna , Kittle-Francis Mary , Mansfield Aaron S. , Aubry Marie Christine 
Published: February 2024

Pleural epithelioid mesothelioma (PEM) is divided into low and high grades based on nuclear atypia, mitoses, and necrosis in the tumor. Assessing mitoses and nuclear atypia tend to be labor-intensive with limited reproducibility. Ki-67 proliferation index was shown to be a prognostic factor in PEM, but its performance has not been directly correlated with tumor grade or mitotic score. This study evaluated the potential of Ki-67 index as a surrogate of tumor grade. We also compared the predictability of mitoses and Ki-67 index for overall survival (OS). Ninety-six PEM samples from 85 patients were identified from the surgical pathology file during 2000-2021 at our institution, and all glass slides were reviewed by 2 pulmonary pathologists to confirm the diagnosis and assign the tumor grade. Digital image analysis (DIA) was done for Ki-67 index. The agreement on tumor grading between 2 reviewers was moderate (kappa value = 0.47). The correlation between mitotic count (average count by 2 reviewers) and Ki-67 index was 0.65. The areas under the curve for predicting tumor grade by mitotic score and Ki-67 index were 0.84 and 0.74 (reviewer 1) and 0.85 and 0.81 (reviewer 2), respectively. High Ki-67 index and mitoses were significantly associated with poor OS (P=0.03 and 0.0005, using 30% and 10/2 mm2 as cutoffs, respectively). In conclusion, Ki-67 index by DIA was associated with tumor grade as well as mitotic count, and its predictability for OS was comparable to that of mitotic score, thus being a potential surrogate for tumor grade.
Combining Transcranial Direct Current Stimulation With Hand Robotic Rehabilitation in Chronic Stroke Patients
Authors: Bernal-Jiménez Juan J. , Dileone Michele , Mordillo-Mateos Laura , Martín-Conty José L. , Durantez-Fernández Carlos , Viñuela Antonio , Martín-Rodríguez Francisco , Lerin-Calvo Alfredo , Alcántara-Porcuna Vanesa , Polonio-López Begoña 
Published: February 2024

Objective
This study aimed to assess the impact of combining transcranial direct current stimulation with end-effector robot-assisted treatment on upper limb function, spasticity, and hand dexterity in chronic stroke patients.

Design
This was a prospective, double-blind randomized trial with 20 equally allocated stroke patients. The experimental group received dual transcranial direct current stimulation (anode over affected M1, cathode over contralateral M1) alongside robot-assisted treatment, while the control group received sham transcranial direct current stimulation with the same electrode placement + robot-assisted treatment. Each patient underwent 20 combined transcranial direct current stimulation and robot-assisted treatment sessions. The primary outcome measure was the Fugl-Meyer Upper Limb motor score, with secondary outcomes including AMADEO kinematic measures, Action Research Arm Test, and Functional Independence Measure. Assessments were conducted at baseline, after rehabilitation, and 3 mos later.

Results
Combining bilateral transcranial direct current stimulation with robot-assisted treatment did not yield additional improvements in Fugl-Meyer Upper Limb motor score, Functional Independence Measure, or Action Research Arm Test scores among stroke patients. However, the real transcranial direct current stimulation group showed enhanced finger flexion in the affected hand based on AMADEO kinematic measures.

Conclusions
The addition of transcranial direct current stimulation to robot-assisted treatment did not result in significant overall functional improvements in chronic stroke patients. However, a benefit was observed in finger flexion of the affected hand.
Chronic Use of Prescription Pain Medication and Outcomes in Patients With Burn Injury
Authors: Vu Kevin , Deng Huan , Kelter Brian , Shepler Lauren , Stewart Barclay , Wolf Steven , Mandell Samuel , Bamer Alyssa , Mehta Anupam , Kazis Lewis , Ryan Colleen , Schneider Jeffrey 
Published: February 2024

Objective
This study attempts to examine long-term pain medication usage after burn injury and its association with functional and psychosocial outcomes.

Design
This is a multicenter retrospective cohort study utilizing the Burn Model System National Longitudinal Database. Participants injured from 2015 to 2021 were divided into two groups, those taking and not taking prescription pain medication at 12 mos after injury. Regression analyses examined associations between pain medication use and outcomes at 12 mos, adjusting for demographics, burn size, length of hospital stay, and preinjury pain medication use and employment status. Outcomes included VR-12 Physical and Mental Component Summary scores Patient-Reported Outcomes Measurement Information System Anxiety and Depression scores, Satisfaction with Life Scale, and employment status.

Results
Of 358 participants analyzed, prescription pain medication use was associated with worse outcomes at 12 mos: Physical Component Summary (β = −7.11, P < 0.001), Mental Component Summary (β = −6.01, P < 0.001), and Patient-Reported Outcomes Measurement Information System Depression (β = 4.88, P < 0.001) and Anxiety (β = 6.16, P < 0.001). Satisfaction with Life Scale was not significantly associated with pain medication use (P = 0.069) and those taking pain medication were 52% less likely to be employed at 12 mos (P = 0.035).

Conclusions
There is a significant association between prescription pain medication use and worse physical, mental, and employment outcomes at 12 mos after burn injury.
Application and accuracy of the EAPC/IASP diagnostic algorithm for neuropathic cancer pain and quantitative sensory testing profile in patients with pain due to cancer
Authors: Shkodra Morena , Mulvey Matthew , Fallon Marie , Brunelli Cinzia , Zecca Ernesto , Bracchi Paola , Caputo Mariangela , Massa Giacomo , Lo Dico Silvia , Rolke Roman , Kaasa Stein , Caraceni Augusto 
Published: February 2024

Abstract

Introduction:
Better diagnosis and treatment of neuropathic cancer pain (NcP) remains an unmet clinical need. The EAPC/IASP algorithm was specifically designed for NcP diagnosis; yet, to date, there is no information on its application and accuracy.

Objectives:
Our aim was to determine the accuracy of the EAPC/IASP algorithm compared with the Neuropathic Special Interest Group grading system (gold standard) and to describe patients' sensory profile with quantitative sensory testing (QST).

Methods:
This is a cross-sectional observational study conducted in a palliative care and pain outpatient clinic. Patients with cancer pain intensity ≥3 (numerical rating scale 0–10) were eligible. The palliative care physician applied the EAPC/IASP algorithm as a grading system to diagnose probable or definite NcP, and an independent investigator applied the gold standard and performed the QST. Sensitivity and specificity of the EAPC/IASP algorithm were measured in comparison with the gold standard results. Kruskal–Wallis and unequal variance independent-samples t tests were used to compare the QST parameters in patients with and without NcP.

Results:
Ninety-eight patients were enrolled from August 2020 to March 2023. Sensitivity and specificity for the EAPC/IASP algorithm were 85% (95% CI 70.2–94.3) and 98.3% (95% CI 90.8–100), respectively. Patients with NcP in contrast to patients without NcP showed cold hypoesthesia (P = 0.0032), warm hypoesthesia (P = 0.0018), pressure hyperalgesia (P = 0.02), and the presence of allodynia (P = 0.0001).

Conclusion:
The results indicate a good performance of the EAPC/IASP algorithm in diagnosing NcP and the QST discriminated well between patients with and without NcP.
Pharmacokinetics of Single-Dose Versus Double-Dose Dolutegravir After Switching From a Failing Efavirenz-Based Regimen
Authors: Griesel Rulan , Banda Clifford G. , Zhao Ying , Omar Zaayid , Wiesner Lubbe , Meintjes Graeme , Sinxadi Phumla , Maartens Gary 
Published: February 2024

Background:
Dolutegravir exposure is reduced after switching from efavirenz, which could select for dolutegravir resistance if switching occurs during virologic failure.

Methods:
We measured serial dolutegravir trough concentrations after switching from efavirenz in a clinical trial, which randomized some participants to a supplemental dolutegravir dose or placebo for the first 14 days. Changes in dolutegravir trough concentrations between days 3, 7, 14, and 28 were evaluated. The primary outcome was the geometric mean ratio of dolutegravir trough concentrations on day 7 versus day 28.

Results:
Twenty-four participants received double-dose dolutegravir (50 mg twice daily) and 11 standard dose for the first 14 days. Baseline characteristics were 77% female, median age 36 years, CD4 cell count 254 cells/mm3, and HIV-1 RNA 4.0 log10 copies/mL. The geometric mean ratio (90% CI) of dolutegravir trough concentrations on day 7 versus day 28 was 0.637 (0.485 to 0.837) in the standard-dose group and 1.654 (1.404 to 1.948) in the double-dose group. There was a prolonged induction effect at day 28 in participants with efavirenz slow metaboliser genotypes. One participant in the double-dose group had a dolutegravir trough concentration below the protein-binding adjusted concentration needed to inhibit 90% of HIV-1 (PA-IC90) at day 3.

Conclusions:
No participants on standard-dose dolutegravir had dolutegravir trough concentrations below the PA-IC90. Slow efavirenz metaboliser genotypes had higher baseline efavirenz concentrations and more pronounced and longer period of induction postswitch. These findings suggest that a 14-day lead-in supplemental dolutegravir dose may not be necessary when switching from a failing efavirenz-based first-line regimen.