bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Validation of Finite Element Analysis Model (FEM) of Craniovertebral Junction
Authors: Gupta Deepak , Zubair Mohd , Lalwani Sanjeev , Gamanagatti Shiva , Roy Tara Sankar , Mukherjee Sudipto , Kale Shashank Sharad 
Published: March 2020

Study Design.
Experimental Cadaveric Biomechanical Study.

Objective.
To establish an experimental procedure in cadavers to estimate joint stiffness/stability at craniovertebral junction (CVJ) region with various implant systems and to develop/validate an indigenous cost effective 3D—FEM (three-dimensional finite element model) of CVJ region.

Summary of Background Data.
Finite element analysis (FEM) tools can provide estimates of internal stress and strain in response to external loading of various implant systems used in CVJ fixations.

Methods.
Experimental setup for conducting biomechanical movements on CVJ region of cadaver was developed using cost effective innovative tools. A manually actuated seven- degrees of freedom parallel manipulator motion testing system (MA7DPM) was designed and developed to impart designed trajectories and to conduct various biomechanical motion studies at CVJ region for the present study.

Results.
FEM model of CVJ region was developed and subsequently validated with CVJ morphometry data of 15 human subjects of Asian origin. Validated FEM was subjected to force motion studies at the CVJ region. The force-motion maps obtained from the FEM studies were subsequently validated against biomechanical experiment results from cadaveric experiment results obtained with three different implant fixations.

Conclusions.
A cost effective biomechanical tool (which did not require decapitation of cadaveric head) and a customised chair (to place cadaver in sitting position during conduct of biomechanical movements simulating real-life scenario) was indigenously designed and developed. Developed biomechanical tool (MA7DPM) for this study is likely to be useful for stress-testing analysis of various implant systems for individual patients undergoing surgery at CVJ region in near future.

Level of Evidence: 5
Enhanced Recovery Implementation and Perioperative Outcomes in Posterior Fusion Patients
Authors: Fiasconaro Megan , Wilson Lauren A. , Bekeris Janis , Liu Jiabin , Poeran Jashvant , Soffin Ellen M. , Memtsoudis Stavros G. 
Published: March 2020

Study Design.
Retrospective cohort study.

Objective.
We sought to determine if there was an association between enhanced recovery after surgery (ERAS) implementation level and complication risk, length of stay, and cost of hospitalization.

Summary of Background Data.
ERAS protocols aim to minimize the stress response of surgery by promoting early mobilization, oral intake, as well as improvement of analgesia. Implementation of ERAS protocols in spine surgeries has been limited to mostly single-institution studies, and no population-based data exist on the impact of the level of implementation of various ERAS components on outcomes.

Methods.
In this study we identified 265,576 posterior lumbar fusion surgeries from 2006 to 2016. The main effect was the application of eight ERAS-related practices: (1) multimodal analgesia, (2) tranexamic acid, (3) antiemetics, (4) steroids, (5) early physical therapy, (6) avoidance of urinary catheters, (7) avoidance of patient-controlled analgesia, (8) avoidance of wound drains. Patients were classified by levels of ERAS implementation: “High,” “Medium,” and “Low” ERAS implementation if they received more than five, three to five, or less than three ERAS components, respectively. Mixed-effects models measured associations between ERAS implementation categories and complications, length and cost of hospitalization; odds ratios (OR, or average ratios for continuous outcomes), and 99.4% confidence intervals (CI) were reported.

Results.
Overall, 13.3%, 62.8%, and 24.4% of cases were categorized as “High,” “Medium,” and “Low” ERAS implementation, respectively. After adjusting for study variables, “Medium” and “High” (compared with “Low”) ERAS implementation levels were significantly associated with incrementally improved outcomes regarding “any complication” (OR 0.84 CI 0.80–0.88 and OR 0.77 CI 0.71–0.84), cardiopulmonary complications (OR 0.75 CI 0.68–0.73 and OR 0.69 CI 0.59–0.80), length of stay (average ratio 0. 94 CI 0.93–0.94 and average ratio 0.91 CI 0.90–0.91), and hospitalization cost (average ratio 0.99 CI 0.98–0.99 and average ratio OR 0.95 0.95–0.96).

Conclusion.
In a cohort undergoing posterior lumbar spine fusion the level of utilization of ERAS protocol components was independently associated with incrementally improved complication odds as well as reduced length of stay and a small decrease in overall hospitalization cost.

Level of Evidence: 3
Hyperdiluted Calcium Hydroxylapatite 1:2 for Mid and Lower Facial Skin Rejuvenation: Efficacy and Safety
Authors: Rovatti Pier Paolo , Pellacani Giovanni , Guida Stefania 
Published: March 2020

BACKGROUND
Diluted/hyperdiluted calcium hydroxylapatite (CaHA) represents an emerging biostimulatory treatment. However, limited data concerning the effects of this agent on the face have been provided so far.

OBJECTIVE
To investigate the efficacy and safety of hyperdiluted CaHA 1:2 treatment for mid and lower face rejuvenation.

PATIENTS AND METHODS
A retrospective study of 40 patients seeking skin rejuvenation for mid and lower face, treated with hyperdiluted CaHA 1:2 technique at baseline (T0), was performed. Patients were classified according to validated scales of aging in the mid to lower face at T0 and efficacy was established with scales calculated again at 4-month post-treatment (T1). In addition, efficacy was assessed by blinded evaluation of T0/T1 clinical pictures, non-invasive skin imaging and patient satisfaction. Safety was assessed through pain scale and minor/major adverse events.

RESULTS
Hyperdiluted CaHA 1:2 successfully decreased aging severity scores of the mid and lower face. Variations of collagen morphology and increased vessel density at T1 were observed with noninvasive skin imaging. Most patients were very satisfied. Mean pain score was low and only minor adverse events were reported.

CONCLUSION
Hyperdiluted CaHA 1:2 technique seems to be effective and safe for mid and lower face skin rejuvenation.
SUPPORT-1 (Subjects Undergoing PCI and Perioperative Reperfusion Treatment): A Prospective, Randomized Trial of CMX-2043 in Patients Undergoing Elective Percutaneous Coronary Intervention
Authors: Tcheng James E. , Gibson Michael , Krucoff Mitchell W. , Patel Manesh R. , Ajit Mullasari , Hiremath Jagdish , Ponde Chandrashekhar , Ramsaran Eddison , Clark Geoffrey , Lader Alan S. , Beeuwkes Reinier ,   on behalf of the SUPPORT-1 Investigators
Published: March 2020

Objective:
The natural molecule α-lipoic acid has been shown to be partially cytoprotective through antioxidant and antiapoptotic mechanisms. To obtain an initial assessment of the safety and potential efficacy of a synthetic derivative, CMX-2043, in preventing ischemic complications of percutaneous coronary intervention (PCI) we conducted the Subjects Undergoing PCI and Perioperative Reperfusion Treatment (SUPPORT-1) trial, the first patient experience with this agent.

Methods and Results:
SUPPORT-1 was a phase 2a, 6-center, international, placebo-controlled, randomized, double-blind trial. A total of 142 patients were randomized to receive a single intravenous bolus dose of drug or placebo administered 15–60 minutes before PCI. Cardiac biomarker assessments included serial measurements of creatine kinase myocardial band (CK-MB) at 6, 12, 18, and 24 hours after PCI and a single measurement of troponin T (TnT) at 24 hours. Peak concentrations of CK-MB and TnT were significantly reduced in the 2.4 mg/kg group compared with placebo (P = 0.05 and 0.03, respectively). No subject administered 2.4 mg/kg of CMX-2043 had an increase of CK-MB to ≥3X upper limit of normal versus 16% for placebo (P = 0.02); 16% of the 2.4-mg/kg dose group developed an elevation of TnT to ≥3X upper limit of normal versus 39% in the placebo group (P = 0.05). No drug-related serious adverse events were observed in any group.

Conclusion:
These data suggest that CMX-2043 may reduce PCI periprocedural myonecrosis and support further clinical evaluation of this novel agent for its potential cytoprotective effects.
Exposure Variability and Target Attainment of Vancomycin: A Systematic Review Comparing Intermittent and Continuous Infusion
Authors: van Maarseveen Erik M. , Gipmans Suzan G. H. , van Zanten Arthur R. H. 
Published: March 2020

Background:Studies comparing the clinical outcomes between vancomycin intermittent infusion (InI) and continuous infusion (CoI) treated patients are generally underpowered. Moreover, due to large differences in the design and efficacy end points in these studies, a meta-analysis of the currently available data is not feasible. Therefore, this systematic review aimed to compare the exposure variability and target attainment with vancomycin during InI and CoI.Patients and methods:A literature search was performed, and clinical studies reporting on vancomycin-treated populations were selected. After exclusion of reviews, case reports, and articles not published in the English language, 505 articles were screened for reported data on vancomycin serum concentrations. A total of 34 studies were included in the review. Relative standard deviations reported in the included studies were assessed, and vancomycin serum concentration variability and target attainment were compared between vancomycin InI and CoI.Results:The variability in serum concentrations was significantly larger for InI than for CoI (relative standard deviations 46.5% and 32.1%, respectively;P= 0.001). Notably, variability appeared to be independent of the study population or design. Studies directly comparing target attainment between both modes of administration denoted higher and faster target attainment with CoI in all instances.Conclusions:In conclusion, CoI was associated with lower variabilities in the serum concentration and favorable target attainment rates compared with InI. These findings are important because vancomycin exposure is considered a major predictor of the patients' clinical outcomes. However, the role of lower serum concentration variability and higher target attainment rates in achieving better clinical outcomes needs to be evaluated in patients treated with vancomycin CoI compared with InI.
Midline catheters: an underutilized means of decreasing central venous catheter use
Authors: Shanja-Grabarz Xhesika , Santoriello Lisa , Ritter Gary , Nicastro Jeffrey , Patel Vihas , Coppa Gene , Barrera Rafael 
Published: March 2020

Background:
Central line–associated blood stream infections (CLABSI) remain a substantial source of morbidity and increased health care costs in hospitalized patients. Our aim was to show that by having a dedicated team of physician assistants for the placement of midlines central venous catheters (CVCs), the number of the more typical CVCs placed could be decreased. Patients with difficult peripheral access who were given midlines had a decrease in central line days as well as the number of CVC-associated infections.

Methods:
A retrospective review of data regarding central line days and CLABSI collected from 2009 to 2017 was performed. In that time period, system changes including initiating CVC monitoring and teams who placed these midline venous catheters. Data from January 2016 through December 2017 pertaining to patients in the intensive care unit (ICU) and surgical wards were reviewed, comparing the overall number of CVC and midline catheters placed. Our primary endpoint was decrease in the number of central line days and consequently the number of associated complications in ICU and ward settings.

Results:
Midline catheters were used more often than CVCs and in both the ICU and floor setting. There was a decrease in the number of central-line days and CLABSI that corresponded to hospital system changes, including utilizing a team of trained, designated house staff and physician assistants to monitor central lines and place midline catheters sterilely in patients with difficult peripheral access.

Conclusion:
Our data show that with the implementation of teams to monitor CVCs and to place the midline catheters, the number of midline catheters placed increased, and patients have fewer central line days and fewer central line–associated complications.
Tocol Prophylaxis for Total-body Irradiation: A Proteomic Analysis in Murine Model
Authors: Rosen Elliot , Fatanmi Oluseyi O. , Wise Stephen Y. , Rao V. Ashutosh , Singh Vijay K. 
Published: March 2020

Abstract
The aim of this study was to analyze the changes in mouse jejunum protein expression in response to prophylactic administration of two promising tocols, γ-tocotrienol (GT3) and α-tocopherol succinate (TS), as radiation countermeasures before irradiation to elucidate the molecular mechanism(s) of their radioprotective efficacy. Mice were administered GT3 or TS (200 mg kg−1) subcutaneously 24 h prior to exposure to 11 Gy 60Co γ-radiation, a supralethal dose for mice. Jejunum was harvested 24 h post-irradiation. Results of the two-dimensional differential in-gel electrophoresis (2D-DIGE), coupled with mass spectrometry, and advanced bioinformatics tools suggest that the tocols have a corresponding impact on expression of 13 proteins as identified by mass spectrometry. Ingenuity Pathway Analysis (IPA) reveals a network of associated proteins involved in inflammatory response, organismal injury and abnormalities, and cellular development. Relevant signaling pathways including actin cytoskeleton signaling, RhoA signaling, and Rho family GTPase were identified. This study reveals the major proteins, pathways, and networks involved in preventing the radiation-induced injury in gut that may be contributing to enhanced survival.
Effect of Radiation Dose Rate on Circulatory Disease Mortality among Nuclear Workers: Reanalysis of Hanford Data
Authors: Sasaki Michiya , Kudo Shin’ichi , Furuta Hiroshige 
Published: March 2020

Abstract
The excess relative risk (ERR) of mortality for circulatory disease among nuclear workers was reanalyzed by taking into consideration the annual dose as the dose rate using publicly available epidemiological data of the Hanford site dedicated to the cohort study of nuclear workers in the US, the UK, and Canada. Values of the dose rate (cut-points) were chosen at 2 mSv y−1 intervals from 2 to 40 mSv y−1, and risk estimates were made for 32,988 workers, considering the doses accumulated below and above each cut-point to have different effects. Similarly to that in the previous study for cancer by Sasaki et al., examinations of sensitivity analysis were also carried out for different risk models, lag periods, and impacts of adjusting the monitoring period to find the effect of the dose rate. As a result, emergence of a statistically significant difference between βL1, which is the ERR for the doses accumulated below the specified cut-point, and βH1, which is the ERR for that above the specified cut-point, was observed for cut-point of the dose rate of 4, 6, 34, 36, and 38 mSv y−1. While statistically negative values were estimated for βL1 (4 and 6 mSv y−1) and for βH1 (34, 36, and 38 mSv y−1), the overall relationship between the ERR and the cut-point of the dose rate was found to be similar to that obtained by the analysis of the mortality for all cancers excluding leukemia.
Correlation and Agreement Between Water Drinking Test and Modified Diurnal Tension Curve in Untreated Glaucoma Patients in Nigeria
Authors: Olatunji Olayemi P. , Olawoye Olusola , Ajayi BGK 
Published: March 2020

Purpose:
To determine the correlation and agreement between intraocular pressure (IOP) parameters evaluated by the modified diurnal tension curve (mDTC) and the water drinking test (WDT) in primary open-angle glaucoma (POAG) in an indigenous African population.

Materials and Methods:
This was a prospective, interventional, comparative study of 50 newly diagnosed, previously untreated primary open-angle glaucoma patients at the out-patient clinic of the Eleta Eye Institute, Ibadan. A series of IOP measurements were taken 2 hourly (from 7:00 am to 3:00 pm) for the mDTC, using Goldmann applanation tonometer. The WDT was performed thereafter. The patients drank 800 mL of water within 5 minutes, and another series of IOP measurements were taken every 15 minutes for a duration of 1 hour from the moment water was fully ingested. Both the mDTC and the WDT were performed on the same day. IOP peak, mean, and IOP fluctuations were estimated from the data collected. Comparison between the mDTC and the WDT was performed using the paired Student T test for means, Pearson correlation analysis for correlation, and Bland-Altman analysis for agreement.

Results:
Estimated IOP parameters were significantly higher for the WDT than for the mDTC. The average peak IOP was 27.8±4.0 mm Hg during the WDT and 24.9±3.1 mm Hg during the mDTC (P<0.001). The average mean IOP was 25.8±3.6 mm Hg during the WDT and 22.3±2.4 mm Hg during the mDTC (P<0.001). The average IOP fluctuation was higher (6.6±2.9 mm Hg) during the WDT compared with 4.7±2.0 mm Hg during the mDTC. The mean and peak IOPs were strongly correlated between the mDTC (r=0.729, P<0.001) and the WDT (r=0.658, P<0.001). IOP fluctuation, however, showed weak correlation between the mDTC and the WDT (r=0.258, P=0.709).

Conclusions:
There is a strong positive correlation between IOP parameters (peak and mean IOP) estimated from the WDT and the mDTC. The peak and mean IOP can be estimated from the WDT, which is quicker, compared with the mDTC. This is more relevant in low resource settings with limited personnel, time, and resource constraints. In addition, higher IOP values were obtained from the WDT compared with the mDTC, and therefore could serve as a useful practical way to determine target peak in order to optimize IOP control in glaucoma patients.
A Novel Use of Two Prosthetic Concepts for Prosthetic Fitting of a Patient with Charcot-Marie-Tooth-Disease and Multiple Medical Problems
Authors: Baars Erwin C.T. , Olsman Jeroen , Kreulen Anja J. 
Published: March 2020

ABSTRACT

Introduction
This case report describes prosthetic fitting problems in a patient with a short residual limb after a left-sided transtibial amputation as a result of a foot deformity caused by Charcot-Marie-Tooth disease and ipsilateral knee osteoarthrosis.

Materials and Methods
A Kondylen Bettung Munster prosthesis was prescribed with a liner and pin-locking system. Residual limb atrophy and day-to-day volume changes resulted in diminished socket fit, whereas ipsilateral knee osteoarthrosis caused pain during patellar tendon loading resulting in diminished prosthetic use.

Results
A conventional-type prosthesis with thigh corset was prescribed to unload and stabilize the knee. A suction socket system with Seal-In liner and inner slip socket was applied to improve fit and suspension. With this prosthesis, the patient could walk comfortably without walking aids and ride a bicycle.

Conclusion
Prescription of a conventional-type prosthesis with suction socket suspension and inner slip socket demonstrates that combining prosthetic concepts can result in a new prosthetic design fulfilling individual patient needs.
Clinicopathologic Diagnostic Criteria for Vulvar Lichen Planus
Authors: Day Tania , Wilkinson Edward , Rowan Darion , Scurry James 
Published: March 2020

Objective
The aim of the study was to describe the clinical and histopathologic features required for a clinicopathologic diagnosis of vulvar lichen planus (LP), which is divided into 3 types: erosive, classic, and hypertrophic.

Materials and Methods
The International Society of the Study of Vulvovaginal Diseases tasked the Difficult Pathologic Diagnoses committee with development of a consensus document for the clinicopathologic diagnosis of vulvar LP, lichen sclerosus, and differentiated vulvar intraepithelial neoplasia. The LP subgroup reviewed the literature and formulated diagnostic criteria, then approved by the International Society of the Study of Vulvovaginal Diseases membership.

Results
The clinicopathologic diagnosis of erosive LP incorporates 5 criteria: (a) a well-demarcated, glazed red macule or patch at labia minora, vestibule, and/or vagina, (b) disease affects hairless skin, mucocutaneous junction, and/or nonkeratinized squamous epithelium, (c) evidence of basal layer damage, categorized as degenerative or regenerative, (d) a closely applied band-like lymphocytic infiltrate, and (e) absent subepithelial sclerosis. The clinicopathologic diagnoses of classic and hypertrophic LP each require a characteristic clinical appearance accompanied by hyperkeratosis, hypergranulosis, acanthosis, basal layer degeneration, a closely applied lymphocytic infiltrate, and absent dermal sclerosis, with hypertrophic LP showing marked epithelial abnormality compared with classic LP.

Conclusions
Clinicopathological correlation yields the most reliable diagnosis of vulvar LP. Disease appearance overlaps with other physiologic, dermatologic, infectious, and neoplastic entities; a low threshold for biopsy at all morphologically distinct areas is recommended. Use of the histopathologic criteria described in this document may reduce the nondiagnostic biopsy rate for clinically diagnosed LP.
Carcinoma in situ of the bladder: why is it underdetected?
Authors: Subiela José D. , Rodríguez Faba Óscar , Guerrero-Ramos Félix , Aumatell Julia , Breda Alberto , Palou Joan 
Published: March 2020

Purpose of review
The standard diagnosis of carcinoma in situ (CIS) of the bladder, based on white light cystoscopy and urine cytology, is limited because CIS can vary from normal-appearing mucosa to a lesion indistinguishable from an inflammatory process. Intravesical instillation of Bacillus Calmette–Guerin (BCG) remains first-line therapy; however, a significant proportion of cases persist or recur after BCG treatment. This review summarizes recent improvements in the detection and treatment of CIS.

Recent findings
The new optical technologies improve CIS detection, with a potential positive impact on oncological outcomes. The usefulness of MRI-photodynamic diagnosis fusion transurethral resection in CIS detection is unclear and further studies are needed. BCG instillation remains the first-line therapy in CIS patients and seems to improve recurrence and progression rates, especially with the use of maintenance. Intravesical device-assisted therapies could be effective in both BCG-naïve and BCG-unresponsive CIS patients, but further studies are ongoing to clarify their clinical benefit. A phase II clinical trial with pembrolizumab has shown the potential effectiveness of immune checkpoint inhibitors in BCG-unresponsive CIS patients and further trials are ongoing.

Summary
New optical techniques increase the CIS detection rate. BCG instillation remains the first-line treatment. Immune checkpoint inhibitors could be a future alternative in BCG-naïve and BCG-unresponsive CIS patients.