bluuebunny/crossref_metadata_2025_split huggingface dataset:
Altered distribution and enhanced osteoclastogenesis of mucosal-associated invariant T cells in gouty arthritis
Authors: Cho Young-Nan , Jeong Hae-Seong , Park Ki-Jeong , Kim Hyung-Seok , Kim Eun-Hee , Jin Hye-Mi , Jung Hyun-Ju , Ju Jae Kyun , Choi Sung-Eun , Kang Ji-Hyoun , Park Dong-Jin , Kim Tae-Jong , Lee Shin-Seok , Kee Seung-Jung , Park Yong-Wook 
Published: January 2020

Abstract

Objective
This study was designed to investigate the role of mucosal-associated invariant T (MAIT) cells in gouty arthritis (GA) and their effects on osteoclastogenesis.

Methods
Patients with GA (n = 61), subjects with hyperuricaemia (n = 11) and healthy controls (n = 30) were enrolled in this study. MAIT cells, cytokines, CD69, programmed death-1 (PD-1) and lymphocyte-activation gene 3 (LAG-3) levels were measured by flow cytometry. In vitro osteoclastogenesis experiments were performed using peripheral blood mononuclear cells in the presence of M-CSF and RANK ligand.

Results
Circulating MAIT cell levels were significantly reduced in GA patients. However, their capacities for IFN-γ, IL-17 and TNF-α production were preserved. Expression levels of CD69, PD-1 and LAG-3 in MAIT cells were found to be elevated in GA patients. In particular, CD69 expression in circulating MAIT cells was increased by stimulation with MSU crystals, suggesting that deposition of MSU crystals might contribute to MAIT cell activation. Interestingly, MAIT cells were found to be accumulated in synovial fluid and infiltrated into gouty tophus tissues within joints. Furthermore, activated MAIT cells secreted pro-resorptive cytokines (i.e. IL-6, IL-17 and TNF-α) and facilitated osteoclastogenesis.

Conclusion
This study demonstrates that circulating MAIT cells are activated and numerically deficient in GA patients. In addition, MAIT cells have the potential to migrate to inflamed tissues and induce osteoclastogenesis. These findings provide an important role of MAIT cells in the pathogenesis of inflammation and bone destruction in GA patients.
The mentalizing network and theory of mind mediate adjustment after childhood traumatic brain injury
Authors: Hoskinson Kristen R , Bigler Erin D , Abildskov Tracy J , Dennis Maureen , Taylor H Gerry , Rubin Kenneth , Gerhardt Cynthia A , Vannatta Kathryn , Stancin Terry , Yeates Keith Owen 
Published: January 2020

Abstract
Childhood traumatic brain injury (TBI) affects over 600 000 children per year in the United States. Following TBI, children are vulnerable to deficits in psychosocial adjustment and neurocognition, including social cognition, which persist long-term. They are also susceptible to direct and secondary damage to related brain networks. In this study, we examine whether brain morphometry of the mentalizing network (MN) and theory of mind (ToM; one component of social cognition) mediates the effects of TBI on adjustment. Children with severe TBI (n = 15, Mage = 10.32), complicated mild/moderate TBI (n = 30, Mage = 10.81) and orthopedic injury (OI; n = 42, Mage = 10.65) completed measures of ToM and executive function and underwent MRI; parents rated children’s psychosocial adjustment. Children with severe TBI demonstrated reduced right-hemisphere MN volume, and poorer ToM, vs children with OI. Ordinary least-squares path analysis indicated that right-hemisphere MN volume and ToM mediated the association between severe TBI and adjustment. Parallel analyses substituting the central executive network and executive function were not significant, suggesting some model specificity. Children at greatest risk of poor adjustment after TBI could be identified based in part on neuroimaging of social brain networks and assessment of social cognition and thereby more effectively allocate limited intervention resources.
Cost-Effectiveness of Operative Versus Nonoperative Management of Patients With Intra-articular Calcaneal Fractures
Authors: Albin Stephanie R. , Bellows Brandon K. , Van Boerum Drew H. , Hunter Stephen , Koppenhaver Shane L. , Nelson Richard E. , Marcus Robin , Dibble Lee , Cornwall Mark , Fritz Julie M. 
Published: January 2020

Objective:
To assess the costs, health gains, and cost-effectiveness of operative versus nonoperative treatment of calcaneal fractures over a 5-year time horizon from both US societal and payer perspectives.

Methods:
The societal perspective analysis included both direct medical costs and costs for missed work, whereas the health care payer perspective analysis included only direct medical costs associated with treatment and complications. A decision tree simulation model was developed to estimate the direct medical and indirect costs (2018 US$) and quality-adjusted life-years (QALYs) for treatment of patients sustaining intra-articular calcaneal fractures fixed with an extensile lateral approach. Direct medical costs were obtained from a large US health care system in Utah, Intermountain Healthcare, and indirect costs from the literature. Utility and probability parameters were also derived from the literature. Parameter uncertainty was explored using both one-way and probabilistic sensitivity analysis.

Results:
From a US societal perspective, operative treatment costs less ($35,110 vs. $39,870) and yielded more QALYs (3.89 vs. 3.51) over 5 years compared with nonoperative treatment. At a willingness-to-pay threshold of $50,000 per QALY, operative fixation had an 89% probability of being cost-effective. From a health care payer perspective, operative management remained cost-effective as the incremental cost-effectiveness ratio is below the willingness-to-pay threshold of $50,000/QALY.

Conclusion:
From both US societal and health care payer perspectives, operative treatment of displaced intra-articular calcaneal fractures utilizing an extensile lateral approach is cost-effective at commonly accepted willingness-to-pay thresholds compared with nonoperative treatment over a 5-year time horizon. Patient variability may impact cost-effectiveness and should be explored in future research.

Level of Evidence:
Economic Level III. See Instructions for Authors for a complete description of levels of evidence.
When to Raise Our White Flag—A Discussion of Scope of Practice in a Resource Scarce World
Authors: Barnhardt Elizabeth , Baum Rebecca , Winerman Mark , Vandana Pankhuree , Tabern Karen B. , Augustyn Marilyn 
Published: January 2020

CASE:
Thomas is a 13-year-old boy with autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder, separation anxiety disorder, and major depressive disorder who presented for a follow-up to his developmental and behavioral pediatrician (DBP). His mother describes an increase in symptoms of anxiety and depression for the last 6 weeks, accompanied by suicidal ideation and thoughts of self-mutilation.
Before this increase in symptoms, he had been doing well for the last several months with the exception of increasing weight gain, and Abilify was decreased from 5 mg to 2.5 mg at his last visit. Other medications at that time included Zoloft 100 mg twice daily, Focalin XR 40 mg every morning, and Focalin 5 mg every night. Without seeking the guidance of our developmental and behavioral pediatrics clinic, his mother increased his intake of Zoloft to 150 mg each morning and continued 100 mg each evening because of worsening anxiety and depression.
Religion is very important to Thomas and his family. He acknowledges that he does not want to die and feels badly because “suicide is against our religion.”
Helping Thomas receive appropriate care has been a challenge. He was diagnosed with ADHD and Asperger disorder at the age of 5. Thomas is homeschooled and is very attached to his mother. His parents have very different parenting styles, with his mother being more permissive and his father more authoritarian. At the time of initial diagnosis, the behavioral health services (BHS) in Thomas' community, which is about an hour away from the DBP, were limited to older children, and he was followed by a DBP for ADHD medication management. At the age of 11, he expressed passive suicidal ideation and described that he imagined his mother as “the devil with fire coming out of her eyes” when she corrected him. He was evaluated by BHS, diagnosed with anxiety disorder, and started on Lexapro. BHS linked to the DBP were out of network for his insurance. The family was unable to pay out of pocket, so care was subsequently transferred to a DBP clinic that was in network. Soon after, Thomas developed auditory hallucinations, and Abilify was added after consultation with BHS.
Over the last few years, Thomas' symptoms have waxed and waned. He did well for a short time and then again developed auditory hallucinations, worsening symptoms of anxiety and depression, and increasing somatic symptoms including vomiting and penile pain. Medications were adjusted with input from BHS, and further attempts were made to link him to local BHS but were unsuccessful. With his current concerns of suicidal ideation and self-mutilation, what would be your next steps?
Impact of opioid dose escalation on pain intensity: a retrospective cohort study
Authors: Hayes Corey J. , Krebs Erin E. , Hudson Teresa , Brown Joshua , Li Chenghui , Martin Bradley C. 
Published: January 2020

Abstract
Prescribers are often confronted with the decision to escalate opioid doses to achieve adequate analgesia. Understanding the impact of dose escalation on pain intensity is warranted. Using a retrospective cohort study design, Veterans with chronic pain and chronic opioid therapy were identified. Opioid dose escalators (>20% increase in average morphine milligram equivalent daily dose) were compared with dose maintainers (±20% change in average morphine milligram equivalent daily dose) assessed over 2 consecutive 6-month windows. Pain intensity was measured by the Numeric Rating Scale. The primary analyses used linear repeated-measures models among a 1:1 matched sample of escalators and maintainers matched on propensity score and within ±180 days of the index date. Sensitivity analyses were conducted using adjusted linear repeated-measures models with and without incorporating stabilized inverse probability of treatment weighting. There were 32,420 dose maintainers and 20,767 dose escalators identified with 19,358 (93%) matched pairs. Pain scores were persistently higher among dose escalators at each 90-day period after the index date (0-90 days after index date: dose escalators: 4.68, 95% confidence interval [CI]: 4.64-4.72 dose maintainers: 4.32, 95% CI: 4.28-4.36, P < 0.0001; 91-180 days after index date: dose escalators: 4.53, 95% CI: 4.49-4.57; dose maintainers: 4.25, 95% CI: 4.22-4.29, P < 0.0001) but were not different in the 90 days before the index date (dose escalators: 4.64, 95% CI: 4.61-4.68; dose maintainers: 4.59, 95% CI: 4.55-4.63, P = 0.0551). Sensitivity analyses provided similar results as the primary analyses. Opioid dose escalation among patients with chronic pain is not associated with improvements in Numeric Rating Scale pain scores.
Marked sexual dimorphism in neuroendocrine mechanisms for the exacerbation of paclitaxel-induced painful peripheral neuropathy by stress
Authors: Ferrari Luiz F. , Araldi Dioneia , Green Paul G. , Levine Jon D. 
Published: January 2020

Abstract
Chemotherapy-induced neuropathic pain is a serious adverse effect of chemotherapeutic agents. Clinical evidence suggests that stress is a risk factor for development and/or worsening of chemotherapy-induced peripheral neuropathy (CIPN). We evaluated the impact of stress and stress axis mediators on paclitaxel CIPN in male and female rats. Paclitaxel produced mechanical hyperalgesia, over the 4-day course of administration, peaking by day 7, and still present by day 28, with no significant difference between male and female rats. Paclitaxel hyperalgesia was enhanced in male and female rats previously exposed to unpredictable sound stress, but not in rats that were exposed to sound stress after developing paclitaxel CIPN. We evaluated the role of the neuroendocrine stress axes: in adrenalectomized rats, paclitaxel did not produce hyperalgesia. Intrathecal administration of antisense oligodeoxynucleotides (ODN) reduced expression of β₂-adrenergic receptors on nociceptors, and paclitaxel-induced hyperalgesia was slightly attenuated in males, but markedly attenuated in females. By contrast, after intrathecal administration of antisense ODN to decrease expression of glucocorticoid receptors, hyperalgesia was markedly attenuated in males, but unaffected in females. Both ODNs together markedly attenuated paclitaxel-induced hyperalgesia in both males and females. We evaluated paclitaxel-induced CIPN in stress-resilient (produced by neonatal handling) and stress-sensitive (produced by neonatal limited bedding). Neonatal handling significantly attenuated paclitaxel-induced CIPN in adult male, but not in adult female rats. Neonatal limited bedding did not affect the magnitude of paclitaxel-induced CIPN in either male or female. This study provides evidence that neuroendocrine stress axis activity has a marked, sexually dimorphic, effect on paclitaxel-induced painful CIPN.
A “dyadic dance”: pain catastrophizing moderates the daily relationships between parent mood and protective responses and child chronic pain
Authors: Neville Alexandra , Griep Yannick , Palermo Tonya M. , Vervoort Tine , Schulte Fiona , Yeates Keith Owen , Sumpton Janice E. , Mychasiuk Richelle , Noel Melanie 
Published: January 2020

Abstract
Children's experience of chronic pain is influenced by the psychological and behavioural responses of their parents. However, the majority of research has been cross-sectional, precluding examination of how these dynamic relationships unfold over time. This study used a microlongitudinal design to examine the daily relationships between parent mood and protective responses and child chronic pain. We also examined the moderating roles of child and parent pain catastrophizing to determine how the affective-motivational context may alter the influence of parent factors. Participants included 95 youth with idiopathic chronic pain (Mage = 14.08; 71.6% female) and their parents. At baseline, parents and youth reported on their catastrophic thinking about child pain. For 7 consecutive days, parents completed daily assessments of their mood and protective responses, while youth completed assessments of their pain intensity, unpleasantness, and interference. Multilevel path analyses were conducted. At a daily level, greater parent protectiveness significantly predicted higher youth pain unpleasantness, interference, and intensity; more negative parent mood significantly predicted higher youth pain intensity and unpleasantness. Higher baseline youth pain catastrophizing predicted a stronger daily association between parent mood and youth pain unpleasantness and intensity. Higher baseline parent pain catastrophizing predicted a weaker daily association between parent protectiveness and youth pain interference. Findings suggest that parent mood and protective responses are dynamic, daily predictors of child pain. Findings also underscore the importance of addressing parents' daily mental health and protectiveness, among youth with chronic pain, and suggest different intervention targets depending on levels of child and parent catastrophizing.
Implementation of a Novel Near Visual Acuity Chart in an Emergency Department Setting
Authors: Wu James F. , Visotcky Alexis , Szabo Aniko , Eyler Stephen , Siegmann Peter , Griepentrog Gregory J. , Warren Clinton C. , Han Dennis P. 
Published: January 2020

ABSTRACT

Purpose:
The quality of visual acuity (VA) measurement in emergency department (ED) settings can be affected by patient immobility and lack of standardized testing conditions. We implemented a previously validated, novel VA chart, the Runge Sloan letter near card, in a hospital ED and evaluated its impact on frequency and consistency of VA testing.

Methods:
Two hundred seventeen hospital ED ophthalmology consult records from December 1, 2016, to November 15, 2017, were evaluated in an IRB-approved protocol. Frequency of VA measurement and agreement between nonophthalmic ED technicians and ophthalmology physicians-in-training were assessed.

Results:
Implementation of the Runge card saw missed technician VA evaluations decrease from 36% (43/120) to 21% (20/97) of ophthalmic consults (p = .01), without significant change in agreement of VA measurements. After implementation, the proportion of VA measurements differing between technicians and residents by ≤2 lines was 51%; with pinhole testing, it improved to 64% (p < .05). In patients with good VA of >20/80, pinhole increased agreement from 58% to 73% (p < .05).

Conclusions:
Implementation of the Runge card was associated with improved frequency of VA measurement and, when combined with pinhole testing, increased agreement rates. Our findings suggest utility of training in the use of the Runge card in ED settings.
Predictive Value of Preoperative and Intraoperative Neurophysiology in Evaluating Long-term Facial Function Outcome in Acoustic Neuroma Surgery
Authors: Frigeni Barbara , Bivona Rachele , Foresti Camillo , Guazzo Emily , Danesi Giovanni 
Published: January 2020

Objective:
To determine the role of neurophysiological preoperative and intraoperative parameters in providing prognostic information regarding facial nerve (FN) function at 1 year after translabyrinthine acoustic neuroma (AN) resection surgery.

Study Design:
Prospective observational study in a tertiary referral center. Patients treated via translabyrinthine surgical approach for sporadic AN microresection between December 2015 and 2018.

Methods:
Patients underwent preoperative (electroneurography-ENG, electromyography-EMG, and Blink Reflex-BR) and intraoperative (FN motor action potential–MAP and continuous EMG traces) neurophysiological studies. FN function was graded postoperatively at 1 year using House–Brackmann Scoring System.

Results:
Sixty-two patients were included in the analysis. Mean age was 53±10 years and average tumor diameter was 23 ± 9 mm. At 1 year a normal facial function was observed in 68% of patients. In the univariate analysis a pathologic BR, low FN MAP values and ratios, and the presence of pathological neurotonic tracing (A-trains) on continuous EMG were associated with a poor facial nerve function outcome at 1 year postoperatively. Pathological preoperative BR testing and intraoperative A-trains showed a statistical significance also in the multivariable analysis, regardless of tumor size.

Conclusions:
Preoperative pathological BR testing and A-train activity on intraoperative EMG are correlated with poor FN outcomes at 1 year postoperative. This may provide important prognostic information to both patients and treating neuro-otologists. In the future this may guide preoperative and postoperative patient counselling and possibly optimize timing of facial nerve reanimation in selected patients.
Use of an Electronic Feeds Calorie Calculator in the Pediatric Intensive Care Unit
Authors: Sng Qian Wen , Ong Chengsi , Ang Su Ling Linda , Kirk Angela Hui Ping , Lee Jan Hau 
Published: January 2020

Introduction:
Strategies to improve nutritional management are associated with better outcomes in pediatric intensive care units. We implemented a calorie-based protocol that integrated an electronic feeds calculator and stepwise feeds increment algorithm.

Methods:
Using a pretest–posttest design, we compared the effectiveness of the calorie-based protocol with an existing fluid-based protocol in a quality improvement project. The main outcome measure was the proportion of patients prescribed with the appropriate amount of calories (defined as 90%−110% of calculated energy requirements). Nurses were surveyed on their satisfaction with the new calorie-based protocol. We compared consecutive patients enrolled in the calorie-based protocol over 21 months with retrospective data of patients in the fluid-based protocol. χ
2 and Mann–Whitney U tests were used to compare categorical and continuous variables, respectively.

Results:
We enrolled 75 and 92 patients in the fluid-based (pre) and calorie-based (post) protocols, respectively. Both groups did not differ in their age, reasons for pediatric intensive care units admissions, length of stay, duration of mechanical ventilation, and risks of mortality. The frequency of appropriate feeds prescription increased (16.0% versus 33.7%, P = 0.002). The new protocol significantly reduced the time from protocol initiation to full feeds (median: 18.0 hours, interquartile range = 18.0−27.5 versus median: 12.8 hours, interquartile range = 12.0−16.0, P < 0.001). The satisfaction surveys (n = 63) revealed favorable nursing perceptions.

Conclusions:
The use of a calorie-based protocol with an electronic calculator led to an improvement in the accuracy of the prescribed feeds and the time required to attain full enteral feeding. Nursing perceptions regarding the protocol were positive.
Direct-to-Implant, Prepectoral Breast Reconstruction: A Single-Surgeon Experience with 201 Consecutive Patients
Authors: Safran Tyler , Al-Halabi Becher , Viezel-Mathieu Alex , Boileau Jean-François , Dionisopoulos Tassos 
Published: January 2020

Background:
The resurgence of prepectoral breast reconstruction has brought strict patient inclusion and exclusion criteria by numerous authors. This article provides an overview of a single surgeon’s experience with 201 patients, 313 breasts using immediate, direct-to-implant prepectoral breast reconstruction. The article compares surgical outcomes of different patient cohorts to elucidate risk factors that may predispose patients toward developing complications.

Methods:
A retrospective chart review was performed, identifying all patients who underwent prepectoral, direct-to-implant breast reconstruction from June of 2016 to June of 2018.

Results:
A total of 201 patients representing 313 breasts were included. A midlateral incision was used in 157 breasts (50.2 percent), followed by a skin-reducing, Wise-pattern in 90 breasts (28.8 percent). Acellular dermal matrix was used in 243 breasts (77.6 percent), free nipple grafts were used in 39 breasts (12.5 percent), and postmastectomy radiation therapy was used in 58 breasts (18.5 percent). Complications requiring operative intervention occurred in 24 breasts (7.7 percent), and minor complications occurred in 23 breasts (7.3 percent). There were no significant differences in complication rates for (1) acellular dermal matrix use versus non–acellular dermal matrix use, (2) Wise-pattern versus other incision, or (3) postmastectomy radiotherapy (p > 0.05).

Conclusions:
This represents the largest single-surgeon, direct-to-implant prepectoral cohort in the literature. Surgical complications did not differ with acellular dermal matrix use, incision selection, and the use of postmastectomy radiation therapy. There may be an association between acellular dermal matrix use and major complications and radiotherapy with minor complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.