bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgery for Brainstem Cavernous Malformations: Association between Preoperative Grade and Postoperative Quality of Life
Authors: Lashkarivand Aslan , Ringstad Geir , Eide Per Kristian 
Published: November 2019

Abstract

BACKGROUND
Brainstem cavernous malformations (BSCMs) are associated with substantial neurologic morbidity, but the literature on quality of life (QoL) after surgical treatment is limited. There is a need for validating the clinical utility of current grading scales for cavernous malformations.

OBJECTIVE
To assess outcome of surgery for BSCMs and validate how outcome is associated with current grading scales for cavernous malformations.

METHODS
We retrospectively reviewed a single-surgeon series of patients with BSCM treated surgically during a 10-yr period. Outcome was categorized according to modified Rankin Scale (mRS), and QoL was assessed by interviewing patients using Short Form 36 (SF-36) Health Survey and comparing results with the normative population. The mRS and QoL were correlated with the Lawton BSCM grading scale and with the Zabramski classification of cavernous malformations.

RESULTS
The study included 22 patients (12 males and 10 females; median age 58 yr). No mortality related to the BSCM surgery occurred, and none were in vegetative state. In SF-36, 70% of patients reported a physical and mental functioning noninferior compared to the general population of comparative age and gender group. There was a significant positive correlation between the Lawton BSCM grading and the postoperative mRS score and QoL.

CONCLUSION
Outcome of surgery for BSCM was good, as assessed by mRS and QoL. The Lawton grading scale for BSCMs correlated significantly with the postoperative mRS score and QoL, suggesting this grading scale may become a useful clinical tool for treatment prognostication at the individual level.
Pain Management Telementoring, Long-term Opioid Prescribing, and Patient-Reported Outcomes
Authors: Flynn Diane , Doorenbos Ardith Z , Steffen Alana , McQuinn Honor , Langford Dale J 
Published: November 2019

Abstract

Objective
Benefits of primary care provider (PCP) participation in pain management telementoring have been reported; however, no studies have examined within-patient changes in dose or discontinuation of long-term opioid therapy (LOT). The objectives of this nonrandomized study were to evaluate the relationship between telementoring participation and 1) LOT dose reduction and 2) LOT discontinuation and to 3) explore the relationship between LOT dose changes and patient-reported outcomes.

Methods
PCPs were recruited from a US Army medical center. Intervention group PCPs (N = 12) attended telementoring sessions; control group providers (N = 13) did not. Morphine equivalent daily doses (MEDD) for patients of study providers (N = 396) were extracted from the study site’s opioid database. The intervention group was subdivided based on number of sessions attended (i.e., active and low participation). Intent-to-treat and as-treated analyses were conducted using generalized estimating equations. Separate analyses evaluated the association between within-patient changes in MEDD and pain impact, depression, and anxiety (N = 40).

Results
Intent-to-treat analysis revealed no significant difference in MEDD reduction; however, a higher proportion of patients of intervention PCPs discontinued LOT (25% ± 3.6%) compared with control PCPs (16% ± 3.6%, P &lt; 0.05). As-treated analyses revealed differences in MEDD reduction between active (13.2 ± 3.0) and low-participating (2.6 ± 3.0) PCPs (P &lt; 0.01). Further, a higher proportion of patients of actively participating PCPs discontinued LOT (29% ± 4.9%) compared with control PCPs (16% ± 3.6%, P = 0.01). We found no evidence that decreased MEDD was associated with poorer self-reported outcomes within patients.

Conclusions
Pain management telementoring supports PCPs’ efforts to reduce reliance on LOT for chronic pain management and highlights the need for actively engaged PCP pain champions.
MEASUREMENT OF EXTREMITY DOSES OF NUCLEAR ENERGY WORKER BY USING RING DOSIMETER
Authors: Islam M Tahidul , Ferdous J , Haque M M 
Published: November 2019

Abstract
Finger doses can serve as a guide to suggest any needed modification in work practice to minimise radiation doses to the extremities. In the present study, radiation doses at the base of the middle finger of both hands of 20 nuclear energy workers handling 99mTc-labelled compounds,125I and131I during various diagnostic and therapeutic procedures in nuclear medicine were measured. The laboratory assessments were carried out by means of thermoluminescence ring dosimetry in Health Physics Division, Atomic Energy Center, Dhaka. The recorded extremity doses were then compared to their routinely monitored whole-body doses. The average annual finger doses recorded in this study were found to be 10.7 ± 8.2 and 12.7 ± 12.9 mSv, respectively, for the left- and right-hand fingers, which are at least 12-fold higher than the average whole-body dose. There was, however, no extreme case found of health hazard to the workers’ hand, which exceeds maximum dose limit 500 mSv/year given by the International Commission on Radiological Protection. On comparing the average annual finger doses at different labs, significantly higher average dose was recorded at isotope-dispensing lab (19.6 ± 12.6 mSv/year) and then followed by gamma camera lab (13.2 ± 12.1 mSv/year) and radioimmunoassay lab (7.0 ± 5.5 mSv/year). These observations are fairly in good agreement with the reported results. The observations of the present study, therefore, may be implemented for the betterment of safety for the occupational workers in nuclear medicine facilities.
226Ra AND 228Ra CONCENTRATIONS IN SOILS WITH INTENSE GROUNDWATER IRRIGATION IN AN ARID ENVIRONMENT
Authors: Ebaid Y Y 
Published: November 2019

Abstract
The enhancing effect due to long-time irrigation with radium-containing groundwater on soil was investigated in this work. Samples from the Al-Qassim and Hail areas in Saudi Arabia were studied for their 226Ra and 228Ra inventories. Groundwater and soil samples were collected from 32 farms where agricultural activities are intensively irrigated with radium-containing groundwater. A noticeably good correlation was observed between radium isotopes inventories in the groundwater used for irrigation with those in the associated soils. It was concluded that there are enhanced levels of radium isotopes in the soils due to the existence of radium isotopes in irrigated groundwater. The additional annual effective dose values ranged between 0.00 and 0.412 with an average of 0.09 mSv y−1.
The dynamics of ‘Moralized Markets’: a field perspective
Authors: Balsiger Philip 
Published: November 2019

AbstractThis article describes the distinctive features and structural properties of ‘moralized markets’, that is, markets in which producers set higher moral standards than those governing conventional market practices, and consumers buy products that respect those higher moral standards. Starting from a critical discussion of existing theoretical conceptualizations in terms of conventionalization/co-optation, quality conventions and resource partitioning, this article conceptualizes moralized markets as fields where actors are in strategic interaction. Using illustrations from several empirical studies, it suggests that all moralized markets are composed of a plurality of actors whose understanding of and commitments to moral principles vary. It reveals the main dimensions of the field, characterizes typical positions, and identifies and describes the core strategies used in struggles around field boundaries and the issues of policing and regulation of field settlements. The article concludes by offering six propositions regarding different possible outcome scenarios for the dynamics of moralized market fields, highlighting the role of the state for the stabilization of field settlements.
Professionalisation and Professionalism: Diphtheria and Medical Practice in Minnesota 1850–1910
Authors: Rushton Alan R 
Published: November 2019

Summary
The evolution of professionalism in Minnesota began when allopathic and homeopathic physician leaders organised medical societies and colleges to define and perpetuate their styles of practice. The epidemics of diphtheria that ravaged the state demanded prompt public health measures of quarantine to reduce the spread of the disease. Then the successful utilization of diphtheria antitoxin in Europe encouraged its local production in Minnesota and the re-education of all physicians there to convince them that they were no longer helpless to treat this infection that killed so many children. Their professionalisation was completed when they implemented the cure for diphtheria that laboratory science had produced. Homeopathic and allopathic practices converged as Minnesota physicians transformed their occupation from merely caring and comforting to actively treating and curing a serious infection.
Breakthrough spikes in rapid eye movement sleep from the epilepsy monitoring unit are associated with peak seizure frequency
Authors: McKenzie Marna B , Jones Michelle-Lee , O’Carroll Aoife , Serletis Demitre , Shafer Leigh Anne , Ng Marcus C 
Published: November 2019

Abstract

Study Objectives
Rapid eye movement sleep (REM) usually suppresses interictal epileptiform discharges (IED) and seizures. However, breakthrough IEDs in REM sometimes continue. We aimed to determine if the amount of IED and seizures in REM, or REM duration, is associated with clinical trajectories.

Methods
Continuous electroencephalogram (EEG) recordings from the epilepsy monitoring unit (EMU) were clipped to at least 3 h of concatenated salient findings per day including all identified REM. Concatenated EEG files were analyzed for nightly REM duration and the “REM spike burden” (RSB), defined as the proportion of REM occupied by IED or seizures. Patient charts were reviewed for clinical data, including patient-reported peak seizure frequency. Logistic and linear regressions were performed, as appropriate, to explore associations between two explanatory measures (duration of REM and RSB) and six indicators of seizure activity (clinical trajectory outcomes).

Results
The median duration of REM sleep was 43.3 (IQR 20.9–73.2) min per patient per night. 59/63 (93.7%) patients achieved REM during EMU admission. 39/59 (66.1%) patients had breakthrough IEDs or seizures in REM with the median RSB at 0.7% (IQR 0%–8.4%). Every 1% increase in RSB was associated with 1.69 (95% CI = 0.47–2.92) more seizures per month during the peak seizure period of one’s epilepsy (p = 0.007).

Conclusions
Increased epileptiform activity during REM is associated with increased peak seizure frequency, suggesting an overall poorer epilepsy trajectory. Our findings suggest that RSB in the EMU is a useful biomarker to help guide about what to expect over the course of one’s epilepsy.
Phenotypic characterization of Slc26a2 mutant mice reveals a multifactorial etiology of spondylolysis
Authors: Zheng Chao , Lin Xisheng , Liu He , Lu Weiguang , Xu Xiaolong , Wang Di , Gao Bo , Wang Cheng , Zhou Jinru , Fan Jing , Hu Yaqian , Jie Qiang , Chen Di , Yang Liu , Luo Zhuojing 
Published: November 2019

AbstractConfusion persists over pathogenesis of spondylolysis. To confirm pathogenicity of the previously identified causative mutation of spondylolysis and investigate the genetic etiology, we generate a new mouse line harboring D673V mutation in the Slc26a2 gene. D673V mutation induces delayed endochondral ossification characterized by transiently reduced chondrocyte proliferation in mice at the early postnatal stage. Adult D673V homozygotes exhibit dysplastic isthmus and reduced bone volume of the dorsal vertebra resembling the detached vertebral bony structure when spondylolysis occurs, including the postzygopophysis, vertebral arch, and spinous process, which causes biomechanical alterations around the isthmic region of L4‐5 vertebrae indicated by finite element analysis. Consistently, partial ablation of Slc26a2 in vertebral skeletal cells using Col1a1‐Cre; Slc26a2 fl/fl mouse line recapitulates a similar but worsened vertebral phenotype featured by lamellar isthmus. In addition, when reaching late adulthood, D673V homozygotes develop an evident bone‐loss phenotype and show impaired osteogenesis. These findings support a multifactorial etiology, involving congenitally predisposed isthmic conditions, altered biomechanics, and age‐dependent bone loss, which leads to SLC26A2‐related spondylolysis.
Insulin receptor preserves mitochondrial function by binding VDAC1 in insulin insensitive mucosal epithelial cells
Authors: Titone Rossella , Robertson Danielle M. 
Published: November 2019

AbstractUnlike many epithelial tissues, the corneal epithelium is insulin insensitive, meaning it does not require insulin for glucose uptake. In this study, we show that insulin differentially regulates mitochondrial respiration in two human mucosal epithelial cell types: insulin‐insensitive corneal epithelial cells and insulin‐sensitive bronchial epithelial cells. In both cell types, insulin blocks glycogen synthase kinase beta (GSK3β) activity. In the corneal epithelium however, insulin selectively regulates PTEN‐induced kinase 1 (PINK‐1)‐mediated mitophagy and mitochondrial accumulation of insulin receptor (INSR). While insulin blocked basal levels of PINK‐1‐mediated mitophagy in bronchial epithelial cells, mitochondrial trafficking of INSR was not detectable. We further show that in corneal epithelia, INSR interacts with the voltage‐dependent anion channel‐1 (VDAC1) in mitochondria and that INSR knockdown triggers robust mitochondrial fragmentation, alterations in mitochondrial polarization, and blocks the induction of PINK‐1‐mediated mitophagy. Collectively, these data demonstrate that INSR interacts with VDAC1 to mediate mitochondrial stability. We also demonstrate unique interactions between VDAC1 and other receptor tyrosine kinases, indicating a novel role for this family of receptors in mitochondria.
Deceptive and Nondeceptive Placebos to Reduce Pain
Authors: Kube Tobias , Rief Winfried , Vivell Maj-Britt , Schäfer N. Leonora , Vermillion Teresa , Körfer Karoline , Glombiewski Julia A. 
Published: November 2019

Objectives:
Recent research has shown that placebos can be effective even if they are openly prescribed to participants. Yet, it is unclear how such “open-label placebos” (OLPs) compare to deceptive placebo (DP) and what the mechanisms of actions are. In this study, we therefore compared 2 versions of OLP to DP and no treatment (NT).

Materials and Methods:
Using a standard heat pain paradigm, 117 healthy volunteers underwent a baseline and a posttreatment pain assessment. With the exception of NT, all groups received an inert placebo cream after the first assessment. OLP was administered by either evoking positive expectancies or by raising hope for placebo analgesia, thus distinguishing for the first time conceptually between expectancy and hope in experimental pain research. The primary outcome was pre-post change in pain tolerance.

Results:
Increase in pain tolerance was larger in the 3 treatment groups compared with NT, whereas the treatment groups did not differ from each other. Further results showed that participants receiving DP reported a large reduction of subjective pain intensity and unpleasantness, whereas no such reduction was found for the 2 OLP groups. The 2 OLP versions did not differ in terms of their analgesic effects.

Discussion:
The study provided evidence for traditional placebo analgesia on the basis of deception. For OLP, we found that OLP indeed increased pain tolerance; however, participants receiving OLP were reluctant to report any subjective analgesic effects. Combined with previous studies, the present findings suggest that the effects of OLP are weaker in healthy volunteers than in clinical samples.
Chronic Spinal Pain and Financial Worries in the US Adult Population
Authors: Yang Haiou , Haldeman Scott 
Published: November 2019

Study Design.
Epidemiological study based on cross-sectional data of a representative sample.

Objective.
To determine whether financial worries are associated with chronic spinal pain in the US adult population.

Summary of Background Data.
This study used data from the US 2015 National Health Interview Survey. The sample size was 33,672 and the study population is defined as aged 18 to 85 years.

Methods.
To account for the complex sampling design, the Taylor linearized variance estimation method was used. Spinal pain was defined in two ways: chronic low back pain and neck pain, chronic low back pain and/or neck pain. Eight types of financial worries were assessed: paying monthly bills, maintaining standard of living, credit card payments, paying rent/mortgage/housing costs, medical costs for healthcare, money for retirement, medical costs of illness/accident, and paying for children's college.

Results.
Different types of financial worries were significantly associated with chronic spinal pain, controlling for demographic characteristics and socioeconomic status. These worries included paying monthly bills (odds ratio [OR] 2.5), maintaining standard of living (OR 2.5), credit card payments (OR 2.2), paying rent/mortgage/housing costs (OR 2.2), medical costs for healthcare (OR 2.2), money for retirement, (OR 2.3), medical costs of illness/accident (OR 2.2), and paying for children's college (OR 1.4).

Conclusion.
This study shows that financial worries were significantly associated with chronic spinal pain. Financial worries may be important to be taken into consideration by clinicians managing patients with spinal pain. More future research is needed to explore the association between financial worries and spinal pain.

Level of Evidence: 3
Multimodal Pain Management and Postoperative Outcomes in Lumbar Spine Fusion Surgery
Authors: Cozowicz Crispiana , Bekeris Janis , Poeran Jashvant , Zubizarreta Nicole , Schwenk Eric , Girardi Federico , Memtsoudis Stavros G. 
Published: November 2019

Study Design.
Retrospective population-based cohort analysis.

Objective.
Given the lack of large-scale data on the use and efficacy of multimodal analgesia in spine fusion surgery, we conducted a population-based analysis utilizing the nationwide claims-based Premier Healthcare database.

Summary of Background Data.
Multimodal analgesia, combining different pain signaling pathways to achieve additive and synergistic effects, is increasingly emerging as the standard of care.

Methods.
Cases of posterior lumbar fusion surgery were extracted (2006–2016). Opioid-only analgesia was compared to multimodal analgesia, that is, systemic opioid analgesia + either acetaminophen, steroids, gabapentinoids, ketamine, nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, or neuraxial anesthesia (categorized into 1, 2, or >2 additional analgesic modes). Mixed-effects models measured associations between multimodal analgesia categories and outcomes, including opioid prescription dose, cost/length of hospitalization, and opioid-related complications. Odds ratios (ORs, or % change) and 95% confidence intervals (CIs) are reported.

Results.
Among 265,538 patients the incidence of multimodal analgesia was 61.1% (162,156); multimodal pain management—specifically when adding NSAIDs/COX-2 inhibitors to opioids—was associated with reduced opioid prescription (−13.3% CI −16.7 to −9.7%), cost (−2.9% CI −3.9 to −1.8%) and length of hospitalization (−7.3% CI −8.5 to −6.1%). Multimodal analgesia in general was associated with stepwise decreased odds for gastrointestinal complications (OR 0.95, 95% CI 0.88–1.04; OR 0.84, CI 0.75–0.95; OR 0.78, 95% CI 0.64–0.96), whereas odds were increased for postoperative delirium (OR 1.14, 95% CI 1.00–1.32; OR 1.33, 95% CI 1.11–1.59; OR 1.31, 95% CI 0.99–1.74), and counterintuitively- naloxone administration (OR 1.25, 95% CI 1.13–1.38; OR 1.56, 95% CI 1.37–1.77; OR 1.84, 95% CI 1.52–2.23) with increasing analgesic modes used: one, two, or more additional analgesic modes, respectively. Post-hoc analysis revealed that specifically gabapentinoid use increased odds of naloxone requirement by about 50%, regardless of concurrent opioid dose (P < 0.001).

Conclusion.
Although multimodal analgesia was not consistently implemented in spine fusion surgery, particularly NSAIDs and COX-2 inhibitors demonstrated opioid sparing effects. Moreover, results suggest a synergistic interaction between gabapentinoids and opioids, the former potentiating opioid effects resulting in greater naloxone requirement.

Level of Evidence: 3
Osteoporosis-related Vertebral Fragility Fractures
Authors: Robinson William A. , Carlson Bayard C. , Poppendeck Heidi , Wanderman Nathan R. , Bunta Andrew D. , Murphy Sarah , Sietsema Debra L. , Daffner Scott D. , Edwards Beatrice J. , Watts Nelson B. , Tosi Laura L. , Anderson Paul A. , Freedman Brett A. 
Published: November 2019

Study Design.
Retrospective cohort study of the Own the Bone database which is a fracture liaison service designed to improve recognition and treatment of osteoporosis.

Objective.
To use the Own the Bone (OTB) database to 1) examine the specific demographics of patients presenting with a low-energy clinical vertebral fracture (VFX) and 2) compare demographic and fracture-specific risk factors between patients with clinical VFX versus patients with nonvertebral low-energy fracture (NVFX).

Summary of Background Data.
Large database studies have described risk factors for developing VFX. It is well described that a history of previous VFX portends an increased risk of future VFX. Few studies have reported cohorts from a fracture liaison service such as the OTB initiative.

Methods.
35,039 unique cases of fragility fracture occurred between 2009 and 2016 and were included in analysis. VFX accounted for 3395 (9.9%) of the presenting fractures at OTB enrollment. The demographics, lifestyle factors, medication use, and fracture-specific data for patients in the OTB registry with vertebral fractures were summarized and then statistically compared to those with nonvertebral fragility fractures.

Results.
The majority of VFX patients were Caucasian, postmenopausal women (74.4%). There was an increased likelihood of presenting with a vertebral fracture in patients who sustained a previous VFX after the age of 50, while patients who sustained a prior nonvertebral fracture (NVFX) were more likely to present with a subsequent NVFX. After controlling for patients with a history of fracture after the age of 50, VFX patients (vs. NVFX) were more likely to be age 70–79, class 1 obesity, with a history of taking anti-osteoporotic prescription medications.

Conclusions.
Multiple factors were associated with a significantly increased risk of VFX compared with NVFX. Understanding the risk factors unique to fragility VFX is a critical component for targeting “at-risk” patients and preventing future osteoporosis-related fractures and their consequences.

Level of Evidence: 4