bluuebunny/crossref_metadata_2025 huggingface dataset:
Timing of Cholecystectomy after Biliary Pancreatitis
Authors: Catanzaro Michael P. , Kwon Rachel J.
Published: October 2017

This chapter provides a summary of a landmark historical study in surgery related to timing of cholecystectomy after biliary pancreatitis. It describes the history of the disease, a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: systematic reviews. This study was the first prospective randomized study to show that early removal of impacted gallstones did not prevent the progression of pancreatitis but did put patients at increased risk for other complications. Current guidelines, informed by this and subsequent studies, recommend that surgery be performed after pancreatic inflammation has subsided but ideally during the same hospital admission.
Child-Pugh Score for Mortality in Cirrhosis
Authors: Kwon Rachel J.
Published: October 2017

This chapter provides a summary of a landmark historical study in surgery deriving the Child-Pugh score for mortality in cirrhosis. It describes the history of the disease, gives a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: prognosis studies. There is a critical need for prognostic tools for selecting appropriate patients with liver cirrhosis and portal hypertension for surgical intervention. The development of the Child-Pugh score, and now the Model for End-Stage Liver Disease (MELD) score, has provided surgeons with an evidence-based objective tool for informing these decisions.
Hinchey Classification of Acute Diverticulitis
Authors: Catanzaro Michael P. , Kwon Rachel J.
Published: October 2017

This chapter provides a summary of a landmark historical study in surgery: the Hinchey classification of acute diverticulitis. It describes the history of the disease, gives a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: validation of scoring systems. Hinchey’s classification of diverticulitis has become the most widespread system and while the Hinchey score may currently have less clinical relevance as it did in his time, its publication and eventual adoption marked a practice-changing paradigm shift in the way diverticulitis is viewed and managed today.
Acute Appendicitis
Authors: Catanzaro Michael P. , Kwon Rachel J.
Published: October 2017

This chapter provides a summary of a landmark historical study in surgery involving management and treatment of acute appendicitis. It describes the history of the disease, gives a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: observational studies in study design. Reginald H. Fitz’s insights over a century ago in a seminal case series regarding the nature of appendicitis, its potential sequelae, and the value of urgent surgical intervention changed the disease from a deadly one into one that can be easily cured by surgery. However, with the advent of modern broad spectrum antibiotic therapy, Fitz’s assertion that immediate surgical therapy is always mandated has recently come under question.
Antifungals
Authors: Török M. Estée , Cooke Fiona J. , Moran Ed
Published: October 2017

This chapter provides a systematic summary of antifungal agents, grouped by class and mechanism of action. Each summary provides information on the mode of action, mechanisms of resistance, pharmacology, and clinical use.
Cardiovascular infections
Authors: Török M. Estée , Cooke Fiona J. , Moran Ed
Published: October 2017

This chapter covers infective endocarditis characterized by infections of the endocardial surface of the heart, intravascular catheter-related infections, endovascular infections, myocarditis (which is an inflammatory disease of the myocardium), pericarditis (which is an inflammation of the pericardium), and mediastinitis (which is an infection involving the mediastinal structures).
Skin and soft tissue infections
Authors: Török M. Estée , Cooke Fiona J. , Moran Ed
Published: October 2017

This chapter covers impetigo (with lesions commonly affecting children in tropical and subtropical regions), folliculitis affecting hair follicles, cutaneous abscesses involving collections of pus within the dermis and deeper skin structures, furuncles (boils which are deep inflammatory nodules), carbuncles (which are deeper lesions), ecthyma (punched-out ulcers caused by Staphylococcus aureus or group A streptococci), erysipelas with lymphatic involvement, and cellulitis which extends into the subcutaneous tissue.
Immunodeficiency and HIV
Authors: Török M. Estée , Cooke Fiona J. , Moran Ed
Published: October 2017

This chapter covers primary and secondary immunodeficiency, antibody deficiency syndromes, selective T-cell deficiency, infections in asplenic patients and transplant recipients, neutropenic sepsis, HIV epidemiology, natural history, and classification, initial evaluation of the HIV patient, skin, oral, cardiovascular, neurological, and pulmonary complications, HIV gastrointestinal, liver, and kidney disease, HIV infection and malignancy, as well as HIV prevention.
Diagnosis of Borderline Personality Disorder
Authors: Stanley Barbara , Singh Tanya
Published: October 2017

The diagnosis of borderline personality disorder (BPD) can be devastating. BPD is characterized by instability on several domains: affect regulation, impulse control, interpersonal relationships, and self-image, and it affects about 1–2% of the general population—up to 10% of psychiatric outpatients, and 20% of inpatients. In addition to meeting the criteria set forth in DSM-5, BPD, like all personality disorders, is characterized by a pervasive and persistent pattern of behavior that begins in early childhood and is stable across contexts. Affective dysregulation (inappropriate, intense anger or difficulty controlling anger; affective instability due to a marked reactivity of mood), is one of the core domains associated with BPD and is characterized by erratic, easily aroused mood changes and disproportionate emotional responses. Affect dysregulation differs in BPD and mood disorders because in BPD it can shift rapidly and is affected by environmental triggers.
Pharmacological Interventions for Borderline Personality Disorder
Authors: Silk Kenneth R.
Published: October 2017

Although no medication is indicated to specifically treat symptoms of borderline personality disorder (BPD), medications are used frequently in the treatment of patients with BPD. This chapter reviews a number of reasons why medications are frequently prescribed in this patient population, then goes on to discuss eight systematic reviews or meta-analyses of 23 double-blind placebo-controlled randomized trials of the psychopharmacologic treatment of patients with BPD. The author attempts to make some sense of these reviews, which at times come to different conclusions despite examining essentially the same dataset. The chapter also addresses how to proceed with and manage the psychopharmacologic treatment of patients with BPD.
Transference-Focused Psychotherapy
Authors: Yeomans Frank E. , Delaney Jill C.
Published: October 2017

This chapter details the theoretical and clinical underpinnings of transference-focused psychotherapy (TFP), a psychodynamic treatment modified from essential psychoanalytic principles and intended to treat patients with borderline personality disorder (BPD). TFP has its roots in object relations theory, which focuses on the developmental achievement of an integrated and stable sense of self in interaction and relationship to equally whole and stable others. The theory posits a progression of psychological development on a continuum toward object constancy, tolerance of ambivalence (positive and negative affects in self and others), and achievement of an integrated identity. Our understanding of the core pathology of BPD and the systematic application of essential techniques and strategies of TFP are described.
The Relation of Self-Regulation to Children’s Externalizing and Internalizing Problems
Authors: Eisenberg Nancy , Hernández Maciel M. , Spinrad Tracy L.
Published: October 2017

Chapter 2 investigates the relation between self-regulation and both internalizing and externalizing problems in children and adolescents. Although the association between children’s self-regulation and externalizing and internalizing symptoms has been established, research on co-morbidity is scarce; moreover, causal models delineating underlying regulatory mechanisms involved in the development and propagation of psychopathology via self-regulatory processes are lacking. Thus, further research is needed to explore potential mediating and moderating variables impacting this association. Intervention research indicates multi-level system-based approaches targeting various aspects of the child’s ecosystem (child-, parent-, peer, and/or school-level elements) elicit tangible changes in emotion regulation competencies and adjustment. Moreover, culture may play a crucial role in the degree to which self-regulation is valued and the extent to which internalizing or externalizing symptoms are viewed as problematic, which in turn, impacts the relation between self-regulation and maladaptive behavior.
Research Domain Criteria (RDoC) and Emotion Regulation
Authors: Sun Michael , Vinograd Meghan , Miller Gregory A. , Craske Michelle G.
Published: October 2017

Chapter 5 describes the Research Domain Criteria (RDoC) framework as it pertains to emotion regulation, an in-progress research framework mapping psychological constructs onto discrete units of analysis (genes, molecules, cells, brain circuits, physiology, behavior, and self-report). It accommodates contemporary and developing emotion frameworks such as the Bradley-Lang Model and Gross-Ochsner Extended Process Model (EPM), while supplementing the clinically valuable, categorical account of psychological disorders featured in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The RDoC has three objectives: Describing how psychological constructs are implemented mechanistically (biologically), increasing the explanatory ability as to why a biological system or neurobiological structure works, and increasing the predictive validity of pathological phenomena. This multi-componential research framework involves interdisciplinary collaboration to uncover new avenues for exploring the etiology, maintenance, and intervention to address one of the field’s greatest challenges: the effective treatment of emotion dysregulation.
Emotion Regulation and Attention Deficit Hyperactivity Disorder
Authors: Fernandes Blossom , Tan-Mansukhani Roseann , Essau Cecilia A.
Published: October 2017

Chapter 6 describes emotion dysregulation features which are associated with children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). In ADHD adaptive emotion regulation processes are impaired; this negatively impacts the individual’s ability to flexibly select, attend, and appraise emotionally evocative stimuli. This is identified as emotion dysregulation, which occurs when individuals fail to alter emotional states that affect behaviours necessary for achieving one’s goals. This review also examines the relationship between executive functions and emotion dysregulation in ADHD. Successful modulation of emotion occurs as a result of intact executive functions; however, ADHD is characterized by poor executive functions as a result of deficits in the prefrontal cortical networks. Along with describing neural mechanisms associated with ADHD, this review also focuses on the development of emotion dysregulation, clinical implications and current interventions.
Emotion Regulation and Depression
Authors: Rice Frances , Davidovich Shiri , Dunsmuir Sandra
Published: October 2017

Chapter 9 delineates the symptomology, epidemiology and risk factors associated with depression in children and adolescents. Youth depression involves an assemblage of co-occurring symptoms causing impairment and dysfunction across school, interpersonal relationships, and extracurricular activities. Core diagnostic features of depressive disorders include: depressed mood, loss of interest or pleasure in activities and decreased energy. Depressed youth demonstrate deficits in processing emotional material, which deleteriously impacts regulatory efforts. These impairments include low levels of bias for positive information. Until recently CBT was considered the gold-standard treatment for depression; however, research demonstrates there is limited quality evidence to suggest one treatment modality offers a preferred approach. Thus, interventions should consider the child’s age, cognitive competency, and educational experience when determining treatment options. A novel intervention with auspicious, preliminary findings is Thinking about Reward in Young People (TRY), which incorporates CBT and behavioral activation, with an emphasis on increasing reward-processing.
Adolescents who Engage in Nonsuicidal Self-Injury (NSSI)
Authors: Voon David , Hasking Penelope
Published: October 2017

Nonsuicidal self-injury (NSSI) refers to intentional damage to the body without fatal intent. While distal factors such as genetic predisposition, emotional sensitivity, emotional reactivity and invalidating childhood environments may serve as risk factors, NSSI is primarily maintained by alleviation of intense negative emotional states, in the absence of alternative emotion regulation strategies. Currently, no specific NSSI intervention for adolescents exists; however, extant self-harm interventions have demonstrated promising, preliminary findings. Of note, the salient role of emotion regulation in the initiation and maintenance of NSSI suggests this may be a viable treatment target. While empirical evidence supports this in adult samples, replication in large-scale, randomized controlled trials with adolescent samples is required to inform best practice in treating NSSI among adolescents.
The moral economies of market societies: popular attitudes towards market competition, redistribution and reciprocity in comparative perspective
Authors: Koos Sebastian , Sachweh Patrick
Published: October 2017

In a classical typology, Polanyi distinguishes three basic modes of economic integration: competitive market exchange, redistribution and reciprocity. While markets are dominant in modern capitalism, redistribution and reciprocity are—to varying extent—also part of its institutional architecture. Asking whether such institutional differences are mirrored in distinct ‘moral economies’, we investigate ordinary citizens’ support for market competition, redistribution and reciprocity across 14 capitalist economies. Combining data from three comparative surveys, we analyze, first, the extent to which these principles are supported by citizens and whether they cluster into distinct ‘moral economies’; second, whether these norms are anchored in formal institutional settings; and finally, how privileged and disadvantaged groups differ in their support. While support for market competition is strong across countries, it is to varying degrees complemented by support for redistribution and reciprocity. We identify a competition-dominated, an embedded and a strongly embedded moral economy. The interplay of formal institutions and people’s social–structural position partly explains differences in popular support.
Molecular Typing of Bois Noir Phytoplasma Strains in the Chianti Classico Area (Tuscany, Central Italy) and Their Association with Symptom Severity inVitis vinifera‘Sangiovese’
Authors: Pierro R. , Passera A. , Panattoni A. , Casati P. , Luvisi A. , Rizzo D. , Bianco P. A. , Quaglino F. , Materazzi A.
Published: October 2017

Bois noir (BN) is the most widespread disease of the grapevine yellows complex in the Euro-Mediterranean area. BN is caused by ‘Candidatus Phytoplasma solani’ (BNp), transmitted from herbaceous plants to grapevine by polyphagous insect vectors. In this study, genetic diversity among BNp strains and their prevalence and possible association with grapevine symptom severity were investigated in a Sangiovese clone organic vineyard in the Chianti Classico area (Tuscany). Field surveys over 2 years revealed a range of symptom severity on grapevine and an increase of BN incidence. A TaqMan allelic discrimination assay detected only tufB type b among BNp strains, suggesting the prevalence of the bindweed-related ecology. Nucleotide sequence analyses of vmp1 and stamp genes identified 12 vmp1 and 16 stamp sequence variants, showing an overall positive selection for such genes. The prevalent genotype was Vm43/St10, reported for the first time in this study and closely related to strains identified only in the French Eastern Pyrenees. BNp strains identified in the examined vineyard and mostly grouped in separate bindweed-related phylogenetic clusters showed statistically significant differences in their distribution in grapevines exhibiting distinct symptom severity. These results suggest the possible occurrence of a range of virulence within BNp strain populations in the Chianti Classico area.
Sex Chromosome Aneuploidy Detection by Noninvasive Prenatal Testing: Helpful or Hazardous?
Authors: Reiss Rosemary E. , Discenza Marie , Foster Judith , Dobson Lori , Wilkins-Haug Louise
Published: October 2017

(Abstracted from Prenat Diagn 2017;37:515–520)

Noninvasive prenatal testing (NIPT) using cell-free DNA (cfDNA) technology has been shown to accurately detect trisomy 21, as well as fetal sex in the first trimester. The predictive values of NIPT for other aneuploidies such as sex chromosome aneuploidy (SCA) are not as well understood.
Are We on the Same Page? Shared Mental Models to Support Clinical Teamwork Among Health Professions Learners: A Scoping Review
Authors: Floren Leslie Carstensen , Donesky DorAnne , Whitaker Evans , Irby David M. , ten Cate Olle , O’Brien Bridget C.
Published: October 2017

Purpose

To conduct a scoping review to explore the construct of shared mental models (SMMs) in the context of clinical teamwork among health professions learners.

Method

The authors searched the PubMed, ERIC, CINAHL, Scopus, Web of Science, PsychINFO, and EMBASE databases for English-language articles published between 2000 and 2016. Eligible articles mentioned SMMs in relation to clinical teamwork and included health professions learners. Two reviewers screened studies for eligibility and extracted data to determine the depth and breadth of the literature on SMMs. The authors examined definitions of the SMM construct in the context of clinical teams, educational interventions using SMMs, and the measurement of SMMs.

Results

Of the 1,273 articles retrieved, 23 met the inclusion criteria. SMMs were defined in less than two-fifths of the articles (9/23). All articles applied the construct to improvements in hospital-based patient safety, often in high-intensity settings (14/23). Most articles included graduate-level physicians (21/23) within clinical teams (18/23). Interventions designed to foster SMMs (6/23) included teamwork curricula/training and teamwork supportive tools. Measurements of SMMs (7/23) included a qualitative task analysis, quantitative analyses of speech, a concept mapping, and Likert-type surveys.

Conclusions

In health professions education, the SMM construct lacks clear definition. Few studies described educational interventions aimed at SMM development, and few attempted to measure the construct. The authors propose an operational definition of SMMs in health care and illustrate how interventions intended to foster SMMs, such as team trainings or planning exercises and communication tools, could be developed, implemented, and assessed.
Comparison of Direct Patient Care Costs and Quality Outcomes of the Teaching and Nonteaching Hospitalist Services at a Large Academic Medical Center
Authors: Perez Jose A. , Awar Melina , Nezamabadi Aryan , Ogunti Richard , Puppala Mamta , Colton Lara , Clewing Johanna M. , Ketkar Sayali , Wong Stephen T. C. , Robbins Richard J.
Published: October 2017

Purpose

To compare costs of care and quality outcomes between teaching and nonteaching hospitalist services, while testing the assumption that resident-driven care is more expensive.

Method

Records of inpatients with the top 20 Medicare Severity Diagnosis-Related Groups admitted to the University Teaching Service (UTS) and nonteaching hospitalist service (NTHS) at Houston Methodist Hospital from 2014–2015 were analyzed retrospectively. Direct costs of care, length of stay (LOS), in-hospital mortality (IHM), 30-day readmission rate (30DRR), and consultant utilization were compared between the UTS and NTHS. Propensity score matching and case mix index (CMI) were used to mitigate differences in baseline characteristics. To compare outcomes between matched groups, the Wilcoxon rank sum test and chi-square test were used. A sensitivity analysis was conducted using multivariable regression analysis.

Results

From the overall study population of 8,457 patients, 1,041 UTS and 3,123 NTHS patients were matched. CMI was 1.07 for each group. The UTS had lower direct costs of care per case ($5,028 vs. $5,502, P = .006), lower LOS (4.7 vs. 5.2 days, P = .0002), and lower consultant utilization (1.0 vs. 1.6, P ≤ .0001) versus the NTHS. The UTS and NTHS 30DRR (17.2% vs. 19.3%, P = .110) and IHM (2.9% vs. 3.7%, P = .206) were comparable. The multivariable regression analysis validated the matched data and identified an incremental cost savings of $333/UTS patient.

Conclusions

Patients of an academic hospitalist service had significantly shorter LOS, fewer consultants, and lower direct care costs than comparable patients of a nonteaching service.
A single surgeon’s experience of metal-on-metal hip resurfacing arthroplasty in a district general hospital: 9-year clinical results using the Conserve Plus resurfacing system
Authors: Henderson Fraser , Smith Innes , Baird Karene , Holt Graeme , Khan Aman
Published: October 2017

Background:

A number of hip resurfacing arthroplasty implants have been found to have satisfactory clinical outcomes, suggesting implant design has a significant role. The aim of our study was to report the radiographic and clinical outcomes of a series of Conserve Plus hip resurfacing arthroplasty performed by a single surgeon.

Methods:

Our series included 51 consecutive resurfacings at mean follow-up of 7.61 yr performed through a modified Hardinge approach. Postoperatively, functional scores, ion levels, and hip radiographs were obtained at 6-8 wk, 6 mo, 1 yr, and yearly thereafter.

Results:

There were statistically significant improvements in University of California, Los Angeles Activity Score (UCLA), Oxford Hip Score (OHS), and Harris Hip Score (HHS), at 1 yr, with no further significant changes in functional scores identified at time of last review. Initial median postoperative cobalt and chromium levels were 1.06 and 1.77 μgl−1, with no significant increases at the time of last review. There were no significant differences in radiographic outcomes at the time of last review compared with early postoperative radiographs. Two implants required revision to THA. Kaplan-Meier analysis with revision as an endpoint found survivorship of 96% at up to 9.5 yr.

Conclusions:

This study found satisfactory survivorship and clinical outcomes with the Conserve Plus, and to our knowledge this is the largest series to date using the modified Hardinge approach.
Extracellular vesicles in cartilage homeostasis and osteoarthritis
Authors: Miyaki Shigeru , Lotz Martin K.
Published: October 2017

Purpose of review

Extracellular vesicles carry bioactive molecules that can be transferred between cells and tissues. The purpose of this review is to describe how extracellular vesicles regulate functions of cells in cartilage and other joint tissues. The potential application of extracellular vesicles in the treatment of osteoarthritis and as biomarkers will also be discussed.

Recent findings

Extracellular vesicles are found in synovial fluid, in articular cartilage and in the supernatants of synoviocytes and chondrocytes. Extracellular vesicles in cartilage have been proposed to be involved in cross talk between cells in joint tissues and to affect extracellular matrix turnover and inflammation. Extracellular vesicles from arthritic joints can promote abnormal gene expression and changes in cartilage extracellular matrix, including abnormal mineralization. Promising results were obtained in the therapeutic application of mesenchymal stem cell-derived extracellular vesicles for cartilage repair and experimental osteoarthritis.

Extracellular vesicles have emerged as vehicles for the exchange of bioactive signaling molecules within cartilage and between joint tissues to promote joint homeostasis and arthritis pathogenesis. As the molecular content of extracellular vesicles can be customized, they offer utility in therapeutic applications.
Usefulness of PET in recognizing and managing vasculitides
Authors: Pipitone Nicolò A.M. , Versari Annibale , Salvarani Carlo
Published: October 2017

Purpose of review

The aim of this article was to review the recent contributions to the scoring methods of PET in vasculitis as well as to its role in the diagnostic work-up.

Recent findings

Both visual and semiquantitative scoring methods can be used to interpret PET scans. PET has been shown to be both sensitive and specific in the diagnosis of large-vessel vasculitis. In addition, it also has a role in predicting vascular complications.

There is a need to better standardize the scoring methods used to interpret PET scans. In clinical practice, PET is useful to diagnose untreated individuals with suspected large-vessel vasculitis and contributes to identify patients at risk for vascular complications.
The Prognostic Value of MRI in Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis
Authors: Haghbayan Hourmazd , Boutin Amélie , Laflamme Mathieu , Lauzier François , Shemilt Michèle , Moore Lynne , Zarychanski Ryan , Douville Vincent , Fergusson Dean , Turgeon Alexis F.
Published: October 2017

Objectives:

Traumatic brain injury is a major cause of death and disability, yet many predictors of outcome are not precise enough to guide initial clinical decision-making. Although increasingly used in the early phase following traumatic brain injury, the prognostic utility of MRI remains uncertain. We thus undertook a systematic review and meta-analysis of studies evaluating the predictive value of acute MRI lesion patterns for discriminating clinical outcome in traumatic brain injury.

Data Sources:

MEDLINE, EMBASE, BIOSIS, and CENTRAL from inception to November 2015.

Study Selection:

Studies of adults who had MRI in the acute phase following moderate or severe traumatic brain injury. Our primary outcomes were all-cause mortality and the Glasgow Outcome Scale.

Data Extraction:

Two authors independently performed study selection and data extraction. We calculated pooled effect estimates with a random effects model, evaluated the risk of bias using a modified version of Quality in Prognostic Studies and determined the strength of evidence with the Grading of Recommendations, Assessment, Development, and Evaluation.

Data Synthesis:

We included 58 eligible studies, of which 27 (n = 1,652) contributed data to meta-analysis. Brainstem lesions were associated with all-cause mortality (risk ratio, 1.78; 95% CI, 1.01–3.15; I
2 = 43%) and unfavorable Glasgow Outcome Scale (risk ratio, 2.49; 95% CI, 1.72–3.58; I
2 = 81%) at greater than or equal to 6 months. Diffuse axonal injury patterns were associated with an increased risk of unfavorable Glasgow Outcome Scale (risk ratio, 2.46; 95% CI, 1.06–5.69; I
2 = 74%). MRI scores based on lesion depth demonstrated increasing risk of unfavorable neurologic outcome as more caudal structures were affected. Most studies were at high risk of methodological bias.

Conclusions:

MRI following traumatic brain injury yields important prognostic information, with several lesion patterns significantly associated with long-term survival and neurologic outcome. Given the high risk of bias in the current body of literature, large well-controlled studies are necessary to better quantify the prognostic role of early MRI in moderate and severe traumatic brain injury.
Dopaminergic mechanisms in periaqueductal gray-mediated antinociception
Authors: Tobaldini Glaucia , Reis Rafael A. , Sardi Natalia F. , Lazzarim Mayla K. , Tomim Dabna H. , Lima Marcelo M.S. , Fischer Luana
Published: October 2017

As important as perceiving pain is the ability to modulate this perception in some contextual salient situations. The periaqueductal gray (PAG) is perhaps the most important site of endogenous pain modulation; however, little is known about dopaminergic mechanisms underlying PAG-mediated antinociception. In this study, we used a pharmacological approach to evaluate this subject. We found that µ-opioid receptor-induced antinociception (DAMGO, 0.3 μg) from PAG was blocked by the coadministration of either D1-like or D2-like dopaminergic antagonists (SCH23390, 2, 4, and 6 μg or raclopride, 2 and 4 μg, respectively) both in the tail-flick and in the mechanical paw-withdrawal test. A selective D2-like receptor agonist (piribedil, 6 and 12 μg into the PAG) induced antinociception in the mechanical paw-withdrawal test, but not in the tail-flick test. This effect was blocked by the coadministration of its selective antagonist (raclopride 4 μg), as well as by either a GABAA agonist (muscimol, 0.1 μg) or an opioid receptor antagonist (naloxone, 0.5 μg). A selective D1-like receptor agonist (SKF38393, 1, 5, and 10 μg into the PAG) induced a poor and transient antinociceptive effect, but when combined with piribedil, a potentiated antinociceptive effect emerged. None of these treatments affected locomotion in the open-field test. These findings suggest that µ-opioid antinociception from the PAG depends on dopamine acting on both D1-like and D2-like receptors. Selective activation of PAG D2-like receptors induces antinociception mediated by supraspinal mechanisms dependent on inhibition of GABAA and activation of opioid neurotransmission.
Decreases in smoking during treatment for methamphetamine-use disorders: preliminary evidence
Authors: McPherson Sterling , Orr Michael , Lederhos Crystal , McDonell Michael , Leickly Emily , Hirchak Katherine , Oluwoye Oladunni A. , Murphy Sean M. , Layton Matthew , Roll John M.
Published: October 2017

Despite high rates of smoking (70–90%) and the severely negative impact of smoking on physical and mental health, only 12% of individuals receiving stimulant-use disorder treatment also receive smoking-cessation treatment. The aim of this investigation was to examine the effect of a contingency management (CM) intervention targeting methamphetamine (MA) use on cigarette smoking. Sixty-one adults with MA-use disorders who were smokers were assigned to CM or standard psychosocial treatment. Rates of smoking-negative breath samples (carbon monoxide <3 ppm) were compared between the two groups while controlling for baseline carbon monoxide level, marijuana use, MA use, and time. This subgroup of mostly male (59%) participants included 44 participants in the CM group and 17 participants in the standard psychosocial treatment. Tobacco smoking participants who received CM targeting MA use were 140% (odds ratio: 2.395; 95% confidence interval: 1.073–5.346) more likely to submit a smoking-negative breath sample relative to standard psychosocial treatment during the treatment period, holding constant several other prespecified covariates. This study provides evidence that a behavioral treatment for MA use results in reductions in cigarette smoking in adults with MA-use disorder.
The antidepressant-like effects of sinomenine in mice: a behavioral and neurobiological characterization
Authors: Li Xiuqin , Liu Chao , Jiang Bo , Chen Kai , Li Wenjuan , Wang Hongze
Published: October 2017

Sinomenine is a bioactive alkaloid extracted from Sinomenium acutum. Here, we investigated the antidepressant effects of sinomenine in mice. The antidepressant actions of sinomenine were first examined in the forced-swim test and the tail-suspension test, and then assessed in the chronic social defeat stress (CSDS) model of depression. Changes in the brain-derived neurotrophic factor (BDNF) signaling pathway after CSDS and sinomenine treatment were also investigated. A tryptophan hydroxylase inhibitor and a BDNF signaling inhibitor were also used to determine the pharmacological mechanisms of sinomenine. It was found that sinomenine induced antidepressant-like effects in the forced-swim test and tail-suspension test without affecting the locomotor activity of mice. Sinomenine also prevented the CSDS-induced depressive-like symptoms. Moreover, sinomenine fully restored the CSDS-induced decrease in the hippocampal BDNF signaling pathway, whereas a BDNF signaling inhibitor, but not a tryptophan hydroxylase inhibitor, blocked the antidepressant effects of sinomenine. In conclusion, sinomenine exerts antidepressant effects in mice by promoting the hippocampal BDNF signaling pathway.
An Investigation of the Use of Traditional Chinese Medicine and Complementary and Alternative Medicine in Stroke Patients
Authors: Yeh Mei-Ling , Chiu Wei-Ling , Wang Yu-Jen , Lo Chyi
Published: October 2017

This study aimed to investigate the use of traditional Chinese medicine and complementary and alternative medicine in stroke patients in Taiwan. Chinese herbal medicine, massage, acupuncture, natural products, and exercise were widely used among stroke patients. Integrating safe and effective traditional Chinese medicine and complementary and alternative medicine into conventional therapies is suggested.
Novel Dry-Lab Training Method for Totally Endoscopic Coronary Anastomosis
Authors: Ujihira Kosuke , Yamada Akira
Published: October 2017

Objective

We describe our original dry-lab training system for nonrobotic and beating heart endoscopic coronary artery anastomosis.

Methods

All the materials used for this training were commercially available. We selected a boxed machine, which can produce pulsatile movements of artificial vessels, and on its roof, we installed a two-dimensional home video camera and a monitor. A multiple-holed plate was placed in front of the machine, and through these holes, a trainee inserted endoscopic surgical instruments and anastomosed the artificial vessels by running fashion while watching the monitor. This training program has four stages. During the first stage, a trainee has to demonstrate mastery in conducting a conventional off-pump coronary artery anastomosis without assistance. The second stage is the “nonbeating” version, and the third stage is the “beating” version with the model mentioned previously. After a trainee gets accustomed to the third stage, the original artificial vessel is replaced with an extremely fragile one, and this is the fourth stage. Our trainee conducted one hundred fourth-stage anastomoses and each procedure was recorded with the video camera. We analyzed several factors from the videos and evaluated the efficacy of the training method. We compared the outcomes of the first 50 consecutive anastomoses with the following 50 ones and described the learning curves.

Results

The comparison showed a significant decrease in anastomotic time and vessel injury. We considered the quality of anastomosis acceptable after 47 anastomoses, and anastomotic time fell below 15 minutes at the 81st training at the fourth stage.

Conclusions

Our dry-lab system might be an effective training method for endoscopic coronary anastomosis.
Endoscopic Conduit Harvest in Coronary Artery Bypass Grafting Surgery
Authors: Ferdinand Francis D. , MacDonald John K. , Balkhy Husam H. , Bisleri Gianluigi , Young Hwang Ho , Northrup Patricia , Trimlett Richard H. J. , Wei Lai , Kiaii Bob B.
Published: October 2017

Objective

The purpose of this consensus conference was to develop and update evidence-informed consensus statements and recommendations on harvesting saphenous vein and radial artery via an open as compared with endoscopic technique by systematically reviewing and performing a meta-analysis of randomized and nonrandomized clinical trials.

Methods

All randomized controlled trials and nonrandomized controlled trials included in the first the International Society for Minimally Invasive Cardiothoracic Surgery Consensus Conference and Statements,1,2 in 2005 up to November 30, 2015, were included in a systematic review and meta-analysis. Based on the resultant, 76 studies (23 randomized controlled trials and 53 nonrandomized controlled trials) on 281,459 patients analyzed, consensus statements, and recommendations were generated comparing the risks and benefits of endoscopic versus open conduit harvesting for patients undergoing coronary artery bypass grafting.

Results

Compared with open vein harvest, it is reasonable to perform endoscopic vein harvest of saphenous vein to reduce wound-related complications, postoperative length of stay, and outpatient wound management resources and to increase patient satisfaction (class I, level A). Based on the quality of the conduit and major adverse cardiac events as well as 6-month angiographic patency, endoscopic vein harvest was noninferior to open harvest. It is reasonable to perform endoscopic radial artery harvest to reduce wound-related complication and to increase patient satisfaction (class I, level B-R and B-NR, respectively) with reduction in major adverse cardiac events and noninferior patency rate at 1 and 3 to 5 years (class III, level B-R).

Conclusions

Based on the consensus statements, the consensus panel recommends (class I, level B) that endoscopic saphenous vein and radial artery harvesting should be the standard of care for patients who require these conduits for coronary revascularization.
An Artificial Cadaveric Leg Blood Flow System for Endoscopic Vein Harvesting Simulation
Authors: Karras Constantine L. , DeDonato Emily A. , DiBartola Kaitlin K. , Zhao Jin-Cheng
Published: October 2017

Despite being the most common training model for endoscopic vein harvesting, cadaveric legs are limited by their absence of blood flow, resulting in a faded vascular appearance. Because the saphenous vein and the surrounding tissue seem less distinguishable, dissection of the saphenous vein and bipolar coagulation of its branches becomes increasingly inefficient and difficult. An inexpensive artificial blood flow system was developed to overcome this limitation. A cadaveric leg was thawed to a soft and yielding degree, and the saphenous vein was dissected medial and proximal to the medial malleolus. An artificial blood solution was prepared by dissolving 4% protein powder, red dye, and a contrast agent—for x-ray visualization—in saline. The solution was perfused through the saphenous vein and artery. The open ends of the vessels were temporarily clamped after the perfusion had been completed. Blood flow within the vessels was confirmed via angiography and endoscopic visualization of the leg's vessels. A bleeding effect was observed when the saphenous vein was perforated or when a vascular branch was transected. Conversely, a tight seal indicated successful bipolar coagulation of a branch, providing an objective, quantifiable assessment parameter. The artificial blood flow system helps overcome the limitations of the cadaveric leg, creating a more realistic and inexpensive model for endoscopic vein harvesting simulation training.
Injury Pattern in Icelandic Elite Male Handball Players
Authors: Rafnsson Elis Thor , Valdimarsson Örnólfur , Sveinsson Thorarinn , Árnason Árni
Published: October 2017

Objective:

To examine the incidence, type, location, and severity of injuries in Icelandic elite male handball players and compare across factors like physical characteristics and playing position.

Design:

Prospective cohort study.

Setting:

The latter part of the preseason and the competitive season of Icelandic male handball.

Participants:

Eleven handball teams (185 players) from the 2 highest divisions in Iceland participated in the study. Six teams (109 players) completed the study.

Variables Measured:

Injuries were recorded by the players under supervision from their team physiotherapists or coaches. Coaches recorded training exposure, and match exposure was obtained from the Icelandic and European Handball Federations. The players directly recorded potential risk factors, such as age, height, weight, previous injuries, and player position.

Main Outcome Measures:

Injury incidence and injury location and number of injury days.

Results:

Recorded time-loss injuries were 86, of which 53 (62%) were acute and 33 (38%) were due to overuse. The incidence of acute injuries was 15.0 injuries/1000 hours during games and 1.1 injuries/1000 hours during training sessions. No significant difference was found in injury incidence between teams, but number of injury days did differ between teams (P = 0.0006). Acute injuries were most common in knees (26%), ankles (19%), and feet/toes (17%), but overuse injuries occurred in low back/pelvic region (39%), shoulders (21%), and knees (21%). Previous knee injuries were the only potential risk factor found for knee injury.

Conclusions:

The results indicate a higher rate of overuse injuries in low back/pelvic region and shoulders than in comparable studies.
Comparison of the Effect of 5 Different Treatment Options for Managing Patellar Tendinopathy: A Secondary Analysis
Authors: van Rijn Dafne , van den Akker-Scheek Inge , Steunebrink Mirjam , Diercks Ron L. , Zwerver Johannes , van der Worp Henk
Published: October 2017

Objective:

Currently, no treatments exist for patellar tendinopathy (PT) that guarantee quick and full recovery. Our objective was to assess which treatment option provides the best chance of clinical improvement and to assess the influence of patient and injury characteristics on the clinical effect of these treatments.

Design:

A secondary analysis was performed on the combined databases of 3 previously performed double-blind randomized controlled trials.

Patients:

In total, 138 patients with PT were included in the analysis.

Interventions:

Participants were divided into 5 groups, based on the treatment they received: Extracorporeal shockwave therapy (ESWT) (n = 31), ESWT plus eccentric training (n = 43), eccentric training (n = 17), topical glyceryl trinitrate patch plus eccentric training (n = 16), and placebo treatment (n = 31).

Main Outcome Measures:

Clinical improvement (increase of ≥13 points on the Victorian Institute of Sport Assessment-Patella score) after 3 months of treatment.

Results:

Fifty-two patients (37.7%) improved clinically after 3 months of treatment. Odds ratios (ORs) for clinical improvement were significantly higher in the eccentric training group (OR 6.68, P = 0.009) and the ESWT plus eccentric training group (OR 5.42, P = 0.015) compared with the other groups. We found evidence that a high training volume, a longer duration of symptoms, and older age negatively influence a treatment's clinical outcome (trend toward significance).

Conclusions:

Our study confirmed the importance of exercise, and eccentric training in particular, in the management of PT. The role of ESWT remains uncertain. Further research focusing on the identified prognostic factors is needed to be able to design patient-specific treatment protocols for the management of PT.
Risk Factors for Lower-Extremity Injuries Among Contemporary Dance Students
Authors: van Seters Christine , van Rijn Rogier M. , van Middelkoop Marienke , Stubbe Janine H.
Published: October 2017

Objective:

To determine whether student characteristics, lower-extremity kinematics, and strength are risk factors for sustaining lower-extremity injuries in preprofessional contemporary dancers.

Design:

Prospective cohort study.

Setting:

Codarts University of the Arts.

Patients:

Forty-five first-year students of Bachelor Dance and Bachelor Dance Teacher.

Assessment of Risk Factors:

At the beginning of the academic year, the injury history (only lower-extremity) and student characteristics (age, sex, educational program) were assessed using a questionnaire. Besides, lower-extremity kinematics [single-leg squat (SLS)], strength (countermovement jump) and height and weight (body mass index) were measured during a physical performance test.

Main Outcome Measures:

Substantial lower-extremity injuries during the academic year were defined as any problems leading to moderate or severe reductions in training volume or in performance, or complete inability to participate in dance at least once during follow-up as measured with the Oslo Sports Trauma Research Center (OSTRC) Questionnaire on Health Problems. Injuries were recorded on a monthly basis using a questionnaire. Analyses on leg-level were performed using generalized estimating equations to test the associations between substantial lower-extremity injuries and potential risk factors.

Results:

The 1-year incidence of lower-extremity injuries was 82.2%. Of these, 51.4% was a substantial lower-extremity injury. Multivariate analyses identified that ankle dorsiflexion during the SLS (OR 1.25; 95% confidence interval, 1.03-1.52) was a risk factor for a substantial lower-extremity injury.

Conclusions:

The findings indicate that contemporary dance students are at high risk for lower-extremity injuries. Therefore, the identified risk factor (ankle dorsiflexion) should be considered for prevention purposes.
Evaluating the Impact of Prescription Fill Rates on Risk Stratification Model Performance
Authors: Chang Hsien-Yen , Richards Thomas M. , Shermock Kenneth M. , Elder Dalpoas Stacy , J. Kan Hong , Alexander G. Caleb , Weiner Jonathan P. , Kharrazi Hadi
Published: October 2017

Background:

Risk adjustment models are traditionally derived from administrative claims. Prescription fill rates—extracted by comparing electronic health record prescriptions and pharmacy claims fills—represent a novel measure of medication adherence and may improve the performance of risk adjustment models.

Objective:

We evaluated the impact of prescription fill rates on claims-based risk adjustment models in predicting both concurrent and prospective costs and utilization.

Methods:

We conducted a retrospective cohort study of 43,097 primary care patients from HealthPartners network between 2011 and 2012. Diagnosis and/or pharmacy claims of 2011 were used to build 3 base models using the Johns Hopkins ACG system, in addition to demographics. Model performances were compared before and after adding 3 types of prescription fill rates: primary 0–7 days, primary 0–30 days, and overall. Overall fill rates utilized all ordered prescriptions from electronic health record while primary fill rates excluded refill orders.

Results:

The overall, primary 0–7, and 0–30 days fill rates were 72.30%, 59.82%, and 67.33%. The fill rates were similar between sexes but varied across different medication classifications, whereas the youngest had the highest rate. Adding fill rates modestly improved the performance of all models in explaining medical costs (improving concurrent R
2 by 1.15% to 2.07%), followed by total costs (0.58% to 1.43%), and pharmacy costs (0.07% to 0.65%). The impact was greater for concurrent costs compared with prospective costs. Base models without diagnosis information showed the highest improvement using prescription fill rates.

Conclusions:

Prescription fill rates can modestly enhance claims-based risk prediction models; however, population-level improvements in predicting utilization are limited.