bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Recent Cannabis Consumption and Withdrawal-Related Symptoms During Early Abstinence Among Females With Smoked Cocaine Use Disorder
Authors: Viola Thiago Wendt , Sanvicente-Vieira Breno , Kluwe-Schiavon Bruno , Rothmann Leonardo Melo , Mélo-Pereira João Vítor Nóbrega e , Bicca Carla , Ottolia Niederauer João Paulo , Schmitz Joy , Grassi-Oliveira Rodrigo 
Published: January 2020

Background:
The effects of cannabis on clinical outcomes of treatment services for other drug use disorders remains unclear. The primary aim of the current study was to investigate the effects of recent cannabis consumption on the severity of cocaine withdrawal and depressive symptoms during a 3-week inpatient treatment program for women with cocaine use disorder. The second goal of this study was to test the effect of recent alcohol or tobacco use on the aforementioned outcomes.

Methods:
This was a longitudinal study with 2 assessment time points: at enrollment and upon discharge from a medically managed intensive inpatient unit. The sample was composed of 214 early abstinence females with cocaine use disorder. Cocaine withdrawal and depressive symptoms were measured using the Cocaine Selective Severity Assessment (CSSA) and the Beck Depressive Inventory (BDI-II). Recent substance use was evaluated using the Addiction Severity Index (ASI-6).

Results:
Patients with cocaine use disorder and with frequent recent cannabis use reported higher severity of cocaine withdrawal and depressive symptoms after 3 weeks of inpatient treatment. Neither recent alcohol nor tobacco use was associated with increased CSSA or BDI outcomes, suggesting these substances play a minor role compared to recent cannabis use in affecting withdrawal-related symptoms.

Conclusions:
The assessment of recent cannabis use may help identify patients in need of additional treatment to manage severe cocaine withdrawal symptoms and depressive symptoms during early abstinence.
Plate-Assisted Intramedullary Nailing of Gustilo Type IIIB Open Tibial Diaphyseal Fractures: Does Adjunctive Plate Retention Affect Complication Rate?
Authors: Stoddart Michael T. , Al-Hourani Khalid , Fowler Tim , Khan Umraz , Kelly Michael B. 
Published: January 2020

Objectives:
To investigate the complication rates after use of retained adjunctive plate (RAP) fixation with intramedullary nailing of Gustilo–Anderson type IIIB open tibia fractures, as part of a 2-stage orthoplastic approach.

Design:
Consecutive cohort study.

Patients/Participants:
One hundred and thirty-seven consecutive patients with a Gustilo–Anderson type IIIB open diaphyseal tibia fracture (OTA/AO 42) treated between May 2014 and January 2018. Ninety-eight patients (RAP = 67; non-RAP = 31) met the inclusion criteria and underwent 2-stage reconstruction. All patients were treated using a small fragment adjunctive plate to hold the fracture reduced before intramedullary nailing.

Intervention:
At stage 2, the temporary small fragment (in-fix) plate was removed and the site further thoroughly debrided. After this, the fracture is reduced and held with a new small fragment plate to facilitate the definitive intramedullary nailing. This new plate was either retained (RAP) as part of the definitive fixation at second stage or removed before wound coverage.

Main Outcome Measurement:
The main outcome measures were reoperation rate, deep infection, nonunion, and flap-related complication.

Results:
Six patients (6/98, 6.1%) proceeded to nonunion (RAP 5/67, non-RAP 1/31). This was not significant (P = 0.416). Two hundred twelve operations were undertaken, and the median was 2. Sixteen (16/212, 7.5%) complication-related reoperations were undertaken, affecting 8 patients (8/67, 11.9%) in the RAP group. Eight patients (8/98, 8.2%) developed a deep infection (RAP 6/67, non-RAP 2/31). This was not significant (P = 0.674).

Conclusions:
In the context of an orthoplastic approach, the use of a RAP with definitive intramedullary nailing does not seem to significantly increase the rate of deep infection or nonunion in patients with type IIIB open tibial shaft fractures.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Plantar Pressures Following Surgical Release in Children With Clubfoot: Comparison of Posterior Release, Posteromedial Release, and Nonoperative Correction
Authors: Erdman Ashley L. , Jeans Kelly A. , Karol Lori A. 
Published: January 2020

Background:
Functional deficits observed at long-term follow-up in surgically released clubfeet have led to the adoption of a nonoperative approach. Gait results reported at age 5 years found ankle motion was limited in clubfeet treated by posteromedial release (PMR), compared with those that required posterior release (PR) or remained nonoperative. The purpose of this study was to assess plantar pressures in clubfeet that required surgical correction by 5 years of age.

Methods:
Pedobarograph data were collected at age 5 years on patients with clubfeet that underwent surgical correction due to residual deformity or recurrence. Plantar pressures were assessed by subdividing the foot into the medial/lateral hindfoot, midfoot, and forefoot regions. Variables included maximum force, contact area%, contact time% (CT%), the hindfoot-forefoot angle, and displacement of the center of pressure line. Surgical feet were divided into those that underwent an isolated PR versus PMR. A group of 72 clubfeet that remained nonoperative were matched by initial severity and used for comparison.

Results:
Pedobarograph data from 53 patients (72 clubfeet; 25 PR and 47 PMR) showed minimal differences between the PR and PMR feet. Compared with the nonoperative group, both surgical groups had increased CT% in the medial hindfoot and medial midfoot regions. An increase in lateral hindfoot CT% was observed in the PMR group. In addition, CT% in the first metatarsal region in the PMR group was reduced compared with the nonoperative group. Lateralization is present across both surgical groups in the center of pressure line and hindfoot-forefoot angle.

Conclusion:
While there were minimal differences between surgical groups, patients who underwent PR exhibited pressure variables that were more comparable to the nonoperative group while the PMR group had greater deviations.

Level of Evidence:
Level II—therapeutic.
Factors Associated With Attendance at a 1-yr Post–Cardiac Rehabilitation Risk Factor Check
Authors: Giannoccaro Justin D. , Aggarwal Sandeep , Grace Sherry L. , Campbell Tavis S. , Hauer Trina , Arena Ross , Rouleau Codie R. 
Published: January 2020

Purpose:
Patients with coronary artery disease (CAD) often fail to maintain secondary prevention gains after completing cardiac rehabilitation (CR). Follow-up appointments aimed at assessing cardiac status and encouraging maintenance of health behaviors after CR completion are generally offered but not well-attended. This study explored patient characteristics and barriers associated with nonattendance at a 1-yr follow-up visit following CR completion.

Methods:
Forty-five patients with CAD who completed a 12-wk outpatient CR program but did not attend the 1-yr follow-up appointment were included. Participants responded to a survey consisting of open-ended questions about follow-up attendance, a modified version of the Cardiac Rehabilitation Barriers Scale, and self-report items regarding current health practices and perceived strength of recommendation to attend. Thematic analysis was used to derive categories from open-ended questionnaire responses. Linear regression was used to assess characteristics associated with appointment attendance barriers.

Results:
Barrier themes were as follows: (1) lack of awareness; (2) perception of appointment as unnecessary; (3) practical or scheduling issues; (4) comorbid health issues; and (5) anticipated an unpleasant experience at the appointment. Greater self-reported barriers (mean ± SD = 1.97/5.00 ± 0.57) were significantly associated with lower perceived strength of recommendation to attend the follow-up appointment (2.82/5.00 ± 1.45), P = .005.

Conclusions:
Providing a stronger recommendation to attend, enhancing patient awareness, highlighting potential benefits, and supporting self-efficacy might increase 1-yr follow-up appointment attendance and, in turn, support long-term adherence to cardiovascular risk reduction behaviors.
Validity of the Past-day Adults' Sedentary Time Questionnaire in a Cardiac Rehabilitation Population
Authors: Freene Nicole , McManus Margaret , Mair Tarryn , Tan Ren , Clark Bronwyn , Davey Rachel 
Published: January 2020

Purpose:
Self-report measures of sedentary behavior are easier to use in a clinical setting; yet, no self-report measures of sedentary behavior appear to be validated in cardiac rehabilitation over time. The aim of this study was to assess the validity of the Past-day Adults' Sedentary Time (PAST) questionnaire in a cardiac rehabilitation population over 12 mo.

Methods:
Seventy-two cardiac rehabilitation participants were recruited to a prospective cohort study. Participants wore an ActiGraph ActiSleep accelerometer (sedentary time <100 counts/min) for 7 consecutive days and completed the self-administered PAST questionnaire at baseline, 6 wk, and 6 and 12 mo. Total daily sedentary time from both methods were compared using Bland-Altman plots and Spearman rank-order correlations.

Results:
Agreement between the 2 measures of sedentary time improved over 12 mo. At 6 and 12 mo, there was a good level of agreement between measures (mean difference between accelerometer and PAST 57 and −0.7 min, respectively), although the dispersion of the differences was wide (95% limits of agreement −428 to 541 and −500 to 498 min, respectively). There were weak correlations between the PAST questionnaire and average accelerometer measured sedentary time at all time points (α = −0.249 to 0.188).

Conclusions:
Following repeated assessments, the PAST questionnaire may be useful to determine sedentary time in cardiac rehabilitation participants at a group level, with participants appearing to more accurately recall their time spent in sedentary behavior. Further research is indicated to assess the validity of sedentary behavior questionnaires in cardiac rehabilitation, with a combination of objective and self-reported measures currently recommended.
A Radon Background-subtraction Algorithm for Electronic Personal Dosimeters
Authors: Fabian R. , Bell J. , Brandl A. 
Published: January 2020

Abstract
Many first responders are outfitted with electronic personal dosimeters to recognize and be alerted to radiological hazards during their response operations. These dosimeters provide invaluable measurement data for force protection, allowing the first responder to assess a response situation and take protective measures for themselves and other individuals involved based on instrument readings of dose rate or cumulative dose. However, capabilities of common electronic personal dosimeters to identify and distinguish various contributions to the instrument reading, in particular from natural radiological sources, are rather limited. An algorithm has been developed for two-channel electronic personal dosimeters that quantifies the signal contribution from radon progeny and allows for background subtraction from radon and radon progeny in the instrument reading. This algorithm will be particularly useful in operational scenarios where first responders may be subject to rapidly changing levels of natural background radiation, which could mimic the presence of anthropogenic sources of ionizing radiation.
HIGH-POWERED BLUE-LIGHT LASER-INDUCED MACULOPATHY IN AN ADOLESCENT: MULTI-MODAL IMAGING, EVOLUTION, AND MANAGEMENT
Authors: Botsford Benjamin W. , Williams Andrew M. , Martel Joseph N. 
Published: January 2020

Purpose:
To characterize evolution of macular injury from a high-powered blue handheld laser using multimodal imaging and describe successful surgical treatment.

Methods:
Observational clinical case report.

Results:
A 17-year-old boy presented with unilateral acute loss of vision with discrete white macular lesions, full-thickness disruption of retinal layers, and hyperreflective material at the fovea on optical coherence tomography caused by exposure to a 445 nm blue-light handheld laser with power up to 2,000 mW characterized as a Class IV laser. The injury evolved into an approximately 950-μm full-thickness macular hole 3 weeks later with visual acuity of 20/400. Vitrectomy and internal limiting membrane peel resulted in anatomic success and final vision at 4 months of 20/25.

Conclusion:
High-powered lasers can induce significant disruption of retinal layers, inflammatory debris, and full-thickness macular holes with momentary exposure that, despite poor anatomic prognostic factors, can have successful surgical outcomes.
Reframing the Care of Children With Epidermolysis Bullosa Through the Lens of Medical Trauma
Authors: Bodán Rebecca Cross 
Published: January 2020

ABSTRACT
Epidermolysis bullosa (EB) is a group of rare inherited genetic connective tissue disorders causing blisters and skin erosions, in addition to a number of other extracutaneous complications. There is currently no Food and Drug Administration-approved treatment for EB, and the current mainstay of disease management involves frequent, prolonged, and extensive wound care, which is often traumatic for the child and caregivers alike. Because of the potential for extensive wounds and other complications, children with moderate to severe forms of EB experience significant amounts of medical trauma related to their condition, both in a medical setting and in the community. Exposure to pediatric medical trauma has been linked to poor health outcomes and increased psychosocial sequelae. Thus, this article seeks to provide an in-depth discussion of the potential sources of trauma children with EB face on a daily basis, along with some practical trauma-informed interventions that healthcare providers may consider implementing in an attempt to alleviate some of the suffering and build resilience among those affected by this potentially devastating and life-limiting condition.
Impact of lack of surgery on outcomes in elderly women with nonmetastatic breast cancer—A surveillance, epidemiology, and end results 18 population based study
Authors: Yin Ming , Verschraegen Claire , Vincent Vinh-Hung , Patel Sandipkumar M. , George Tiffany , Truica Cristina I. 
Published: January 2020

Abstract
Elderly women with early-stage, nonmetastatic breast cancer do not always receive recommendations for definitive surgical treatment. The reasons vary and include patient and provider-related reasons.
We queried the surveillance, epidemiology, and end results database from 2010 to 2013 for women age 60 and older with stage I/II/III invasive breast cancer for whom local treatment was known. We divided the patients into 3 groups: patients for whom surgery was performed; patients for whom surgery was recommended but not performed; patients for whom surgery was not recommended and not performed. We used Kaplan–Meier method to generate OS curves and the Cox proportional hazard test to compare survival outcomes.
A total of 119,404 patients were eligible for study with a median age between 70 and 74 years old. Compared with patients who received breast surgery, patients who did not receive surgery had a worse overall survival (OS) (hazard ratio [HR], 7.39; 95% confidence interval [CI], 6.98–7.83, P < .001). Patients who were recommended but ultimately did not undergo surgery had better OS than those who were recommended against surgery (adjusted HR, 0.60; 95% CI, 0.53–0.69). However, their survival was significantly inferior to patients who underwent surgery (adjusted HR, 2.81; 95% CI 2.48–3.19). Similar results were found regardless of age, tumor stage, estrogen receptor, or human epidermal growth factor receptor 2 status and were recapitulated in analyses of cancer-specific survival.
Upfront definitive breast surgery should be performed in medically-fit elderly patients with early-stage, nonmetastatic breast cancer given significant survival benefit.
Cystic intraductal papillary neoplasms with infiltrating carcinoma of the intrahepatic bile duct
Authors: Ma Zhoupeng , Zhao Fang , Pan Jiangfeng , Lin Guansheng , Chen Bingye , Fu Wenbing 
Published: January 2020

Abstract

Introduction:
Intraductal papillary neoplasms of the bile duct (IPNB) is a kind of rare disorder with low incidence but high misdiagnosis due to untypical symptoms and non-specific laboratory indicators. Herein, we report a case of cystic type IPNB with infiltrating carcinoma of the intrahepatic bile duct presented as a single giant cystic mass of the liver.

Patient concerns:
A 51-year-old woman was admitted due to right upper abdominal discomfort for 10 months. Physical examination indicated no specific finding. Laboratory tests showed that serum total bilirubin and carcinoembryonic antigen level was mildly elevated. Ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) of abdomen indicated a giant lobulated cystic lesion involving the left, right and the caudate lobes of liver. There were multiple small nodules of different sizes with papillary or coral reef-like pattern protruding into the cystic lumen from the inner wall.

Diagnosis:
The patient was diagnosed as malignant tumors of intrahepatic bile duct.

Interventions:
She received radical resection of the lesion by hepatectomy.

Outcomes:
The postoperative pathological examination revealed an IPNB with infiltrating carcinoma of the intrahepatic bile duct. This patient had an uneventful postoperative recovery and was discharged on day 21 post-surgery. Until 35 months after surgery, there is no recurrence or metastasis.

Conclusion:
The CT and MRI can show certain morphologic features including the segmental cystic dilatation of intrahepatic bile ducts and the pathological details of papillary tumors inside the lesion. Cystic IPNB with infiltrating carcinoma of the intrahepatic bile duct can be treated with surgery.
Neoadjuvant apatinib plus S-1 in locally advanced pulmonary adenocarcinoma
Authors: Zhang Chu , Wang Xiang , Zhang Miao , Liu Dong , Yang Dun-Peng 
Published: January 2020

Abstract

Rationale:
About one-third of the lung tumors are staged as locally advanced at the time of initial diagnosis; however, the optimal induction treatment before curative resection has not been elucidated. To date, the evidence regarding the preoperative apatinib plus S-1 for locally advanced pulmonary adenocarcinoma is scarce.

Patient concerns:
A 29-year-old female was admitted because of persistent cough, sputum, and chest distress for 2 months.

Diagnoses:
Primary pulmonary adenocarcinoma (cT3N2M0, IIIB) with unknown driver gene mutation status.

Interventions:
The patient had received 4 months of neoadjuvant therapy using oral apatinib (425 mg daily) plus S-1 (60 mg, twice daily for 4 weeks with a 2-week drug-free interval), followed by anatomical lobectomy with curative intent. Adjuvant apatinib (425 mg daily for a month, and 250 mg daily for another month) plus S-1 at the same dosage were administered for 2 months. Thereafter, maintenance of low-dose S-1 monotherapy (40 mg, twice daily for 4 weeks with a 2-week drug-free interval) was continued for 6 months.

Outcomes:
The adverse events were tolerable and well-controlled. A postoperative recurrence-free survival for 2 years and a half up to now was indicated.

Lessons:
Preoperative apatinib plus S-1 showed efficacy in locally advanced pulmonary adenocarcinoma. However, high-quality trials are warranted before the recommendation of this therapeutic regimen.
Deontological examination as a criterion for the assessment of personal healthcare professional quality
Authors: Mazeikiene Sandra , Stasiuniene Jurgita , Vasiljevaite Diana , Laima Sigitas , Chmieliauskas Sigitas , Fomin Dmitrij , Simakauskas Rokas , Jasulaitis Algimantas 
Published: January 2020

Abstract
Discrepancies between clinical and autopsy diagnoses range from 30% to 37%. The significance of deontological examinations remains high. In the pursuit of proper evaluation of diagnostic discrepancies, the establishment of pathogenesis, the mechanism of death, and a correct diagnosis are of particular importance.
A retrospective study of deontological examinations, aimed at the detection of medical errors and carried out by the State Forensic Medicine Service during the period 1989 to 2016, was performed. The clinical and autopsy data from 1007 cases were collected in compliance with the research protocol.
The number of deontological examinations tends to increase. In 60% of cases, the deceased were men. Most cases were in the age group of 50 to 59 years. Most examinations were carried out in relation to improperly provided healthcare services and the patient's death in surgery, admission, intensive care and obstetrics-gynecology departments. In 13% of cases, the diagnosis did not coincide and, in 79% of cases, the diagnoses fully coincided. In 68% of cases, the medical error was disproved.
The number of deontological examinations is increasing. In most cases, clinical and autopsy diagnoses fully matched. Incorrectly clinically diagnosed intracranial injuries were the most common diagnostic mistakes. The data are similar to the results of research in other countries and would be relevant to ensuring the prevention of medical mistakes and the improvement of healthcare quality.
Using personalized 3D printed Titanium sleeve-prosthetic composite for reconstruction of severe segmental bone loss of proximal femur in revision total hip arthroplasty
Authors: Wang Xingshan , Xu Hui , Zhang Ji 
Published: January 2020

Abstract

Rationale:
Allograft-prosthetic composites (APCs) and proximal femoral replacement have been applied for reconstruction of severe segmental femoral bone loss in revision total hip arthroplasty. The outcomes are encouraging but the complication rate is relatively high. Considering the high complication rates and mixed results of APCs and megaprosthesis, we presented a case using personalized 3D printed Titanium sleeve-prosthetic composite for reconstruction of segmental bone defect.

Patient concerns:
A 73-year-old woman presented to the emergency department on account of acute severe pain of the left hip without history of trauma. She had undergone a cemented total hip arthroplasty for osteonecrosis of femoral head at the left side in 2000. In 2013 she underwent a cemented revision total hip arthroplasty as a result of aseptic loosening of hip prosthesis. She denied obvious discomfort prior to this episode since the revision surgery in 2013.

Diagnosis:
According to the clinical history, imaging and physical examination, we confirmed the diagnosis of severe segmental bone loss of proximal femur and fracture of prosthetic stem. The femoral bone defect was evaluated using the Paprosky classification system and rated as Type 3B, and the acetabular bone defect was rated as Type 2C.

Interventions:
In this study, we present the first case of severe segmental bone loss of proximal femur in revision total hip arthroplasty that was successfully treated using personalized 3D printed Titanium sleeve-prosthetic composite

Outcomes:
At the 2-year follow-up, the patient was symptom free with a Harris Hip Score of 91. Radiographs showed excellent osteointegration between the interface of sleeve-prosthetic composite and the host bone, with no signs of implant loosening or subsidence.

Lessons:
Despite the absence of long term results of 3D printed Titanium sleeve-prosthetic composite reconstruction, the good clinical and radiological outcome at 2 years follow up implied its potential role for reconstruction of segmental femoral bone defect in revision THA.