bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early development of tendinopathy in humans: Sequence of pathological changes in structure and tissue turnover signaling
Authors: Tran Peter H. T. , Malmgaard‐Clausen Nikolaj M. , Puggaard Rikke S. , Svensson René B. , Nybing Janus D. , Hansen Philip , Schjerling Peter , Zinglersen Amanda H. , Couppé Christian , Boesen Mikael , Magnusson S. Peter , Kjaer Michael 
Published: November 2019

AbstractOverloading of tendon tissue with resulting chronic pain (tendinopathy) is a common disorder in occupational‐, leisure‐ and sports‐activity, but its pathogenesis remains poorly understood. To investigate the very early phase of tendinopathy, Achilles and patellar tendons were investigated in 200 physically active patients and 50 healthy control persons. Patients were divided into three groups: symptoms for 0‐1 months (T1), 1‐2 months (T2) or 2‐3 months (T3). Tendinopathic Achilles tendon cross‐sectional area determined by ultrasonography (US) was ~25% larger than in healthy control persons. Both Achilles and patellar anterior‐posterior diameter were elevated in tendinopathy, and only later in Achilles was the width increased. Increased tendon size was accompanied by an increase in hypervascularization (US Doppler flow) without any change in mRNA for angiogenic factors. From patellar biopsies taken bilaterally, mRNA for most growth factors and tendon components remained unchanged (except for TGF‐beta1 and substance‐P) in early tendinopathy. Tendon stiffness remained unaltered over the first three months of tendinopathy and was similar to the asymptomatic contra‐lateral tendon. In conclusion, this suggests that tendinopathy pathogenesis represents a disturbed tissue homeostasis with fluid accumulation. The disturbance is likely induced by repeated mechanical overloading rather than a partial rupture of the tendon.
PAs are a solution to the growing need for clinicians to treat an aging population
Authors: Smith Benjamin J. , McCall Timothy C. , Slaven Elaine M. , Smith Noël 
Published: November 2019

ABSTRACT

Objective:
To elucidate the types of patients cared for by physician assistants (PAs), specifically older adults and those with complex medical conditions.

Methods:
A nationwide survey was sent to PAs asking about their practice demographics, including the complexity of their patients and the types of treatment they provide; 676 responded.

Results:
Less than 2% of PAs specialize in geriatrics but 92.1% of PAs see patients over age 65 years. Most PAs see patients with conditions associated with aging, including hypertension (85.8%) and osteoarthritis (82.1%) as well as those with three or more comorbidities (54.8%) or who are medically complex (52.8%).

Conclusions:
Although few PAs work exclusively in geriatrics, most PAs are providing medical care for older adults and patients with complex healthcare needs. PAs should be considered to fill healthcare needs that will continue to exist when caring for this patient population.
Intraoperative Oxidative Damage and Delirium after Cardiac Surgery
Authors: Lopez Marcos G. , Hughes Christopher G. , DeMatteo Anthony , O’Neal Jason B. , McNeil J. Brennan , Shotwell Matthew S. , Morse Jennifer , Petracek Michael R. , Shah Ashish S. , Brown Nancy J. , Billings Frederic T. 
Published: November 2019

Abstract

Background
Mechanisms of postoperative delirium remain poorly understood, limiting development of effective treatments. We tested the hypothesis that intraoperative oxidative damage is associated with delirium and neuronal injury and that disruption of the blood–brain barrier modifies these associations.

Methods
In a prespecified cohort study of 400 cardiac surgery patients enrolled in a clinical trial of atorvastatin to reduce kidney injury and delirium, we measured plasma concentrations of F2-isoprostanes and isofurans using gas chromatography-mass spectrometry to quantify oxidative damage, ubiquitin carboxyl-terminal hydrolase isozyme L1 to quantify neuronal injury, and S100 calcium-binding protein B using enzyme-linked immunosorbent assays to quantify blood–brain barrier disruption before, during, and after surgery. We performed the Confusion Assessment Method for the Intensive Care Unit twice daily to diagnose delirium. We measured the independent associations between intraoperative F2-isoprostanes and isofurans and delirium (primary outcome) and postoperative ubiquitin carboxyl-terminal hydrolase isozyme L1 (secondary outcome), and we assessed if S100 calcium-binding protein B modified these associations.

Results
Delirium occurred in 109 of 400 (27.3%) patients for a median (10th, 90th percentile) of 1.0 (0.5, 3.0) days. In the total cohort, plasma ubiquitin carboxyl-terminal hydrolase isozyme L1 concentration was 6.3 ng/ml (2.7, 14.9) at baseline and 12.4 ng/ml (7.9, 31.2) on postoperative day 1. F2-isoprostanes and isofurans increased throughout surgery, and the log-transformed sum of intraoperative F2-isoprostanes and isofurans was independently associated with increased odds of postoperative delirium (odds ratio, 3.70 [95% CI, 1.41 to 9.70]; P = 0.008) and with increased postoperative ubiquitin carboxyl-terminal hydrolase isozyme L1 (ratio of geometric means, 1.42 [1.11 to 1.81]; P = 0.005). The association between increased intraoperative F2-isoprostanes and isofurans and increased postoperative ubiquitin carboxyl-terminal hydrolase isozyme L1 was amplified in patients with elevated S100 calcium-binding protein B (P = 0.049).

Conclusions
Intraoperative oxidative damage was associated with increased postoperative delirium and neuronal injury, and the association between oxidative damage and neuronal injury was stronger among patients with increased blood–brain barrier disruption.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Static and Dynamic Transpulmonary Driving Pressures Affect Lung and Diaphragm Injury during Pressure-controlled versus Pressure-support Ventilation in Experimental Mild Lung Injury in Rats
Authors: Pinto Eliete F. , Santos Raquel S. , Antunes Mariana A. , Maia Ligia A. , Padilha Gisele A. , de A. Machado Joana , Carvalho Anna C. F. , Fernandes Marcos V. S. , Capelozzi Vera L. , de Abreu Marcelo Gama , Pelosi Paolo , Rocco Patricia R. M. , Silva Pedro L. 
Published: November 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Pressure-support ventilation may worsen lung damage due to increased dynamic transpulmonary driving pressure. The authors hypothesized that, at the same tidal volume (VT) and dynamic transpulmonary driving pressure, pressure-support and pressure-controlled ventilation would yield comparable lung damage in mild lung injury.

Methods
Male Wistar rats received endotoxin intratracheally and, after 24 h, were ventilated in pressure-support mode. Rats were then randomized to 2 h of pressure-controlled ventilation with VT, dynamic transpulmonary driving pressure, dynamic transpulmonary driving pressure, and inspiratory time similar to those of pressure-support ventilation. The primary outcome was the difference in dynamic transpulmonary driving pressure between pressure-support and pressure-controlled ventilation at similar VT; secondary outcomes were lung and diaphragm damage.

Results
At VT = 6 ml/kg, dynamic transpulmonary driving pressure was higher in pressure-support than pressure-controlled ventilation (12.0 ± 2.2 vs. 8.0 ± 1.8 cm H2O), whereas static transpulmonary driving pressure did not differ (6.7 ± 0.6 vs. 7.0 ± 0.3 cm H2O). Diffuse alveolar damage score and gene expression of markers associated with lung inflammation (interleukin-6), alveolar-stretch (amphiregulin), epithelial cell damage (club cell protein 16), and fibrogenesis (metalloproteinase-9 and type III procollagen), as well as diaphragm inflammation (tumor necrosis factor-α) and proteolysis (muscle RING-finger-1) were comparable between groups. At similar dynamic transpulmonary driving pressure, as well as dynamic transpulmonary driving pressure and inspiratory time, pressure-controlled ventilation increased VT, static transpulmonary driving pressure, diffuse alveolar damage score, and gene expression of markers of lung inflammation, alveolar stretch, fibrogenesis, diaphragm inflammation, and proteolysis compared to pressure-support ventilation.

Conclusions
In the mild lung injury model use herein, at the same VT, pressure-support compared to pressure-controlled ventilation did not affect biologic markers. However, pressure-support ventilation was associated with a major difference between static and dynamic transpulmonary driving pressure; when the same dynamic transpulmonary driving pressure and inspiratory time were used for pressure-controlled ventilation, greater lung and diaphragm injury occurred compared to pressure-support ventilation.
Titanium Elastic Nails Are a Safe and Effective Treatment for Length Unstable Pediatric Femur Fractures
Authors: Siddiqui Ali A. , Abousamra Oussama , Compton Edward , Meisel Erin , Illingworth Kenneth D. 
Published: November 2019

Background:
Controversy exists regarding the treatment of length unstable pediatric femoral shaft fractures. The purpose of this study was to investigate the outcomes of skeletally immature children with length unstable femur fractures treated with titanium elastic nails (TENs).

Methods:
A retrospective review was conducted on all patients with femoral shaft fractures at a tertiary care pediatric hospital from April 2006 to January 2018. Patients with femoral shaft fractures treated with TEN and minimum 6 months follow-up were included. Exclusion criteria were age 11 years or above, weight >50 kg, pathologic fracture, and neuromuscular disorders. Femur fractures were categorized into 2 groups: length unstable (spiral, comminuted, or long oblique fractures) versus length stable (transverse and short oblique). Complications and reoperations were compared between the groups.

Results:
A total of 57 patients with 58 femoral shaft fractures were included. The mean age was 5±2 (1 to 11) years and mean follow-up was 20.4±18.1 (6.0 to 81.2) months. The mean weight was 22.9±7.7 (11.0 to 40.5) kg. There was no difference in age (P=0.32), weight (P=0.28) or follow-up length (P=0.57) between patients with length unstable fractures and those with length stable fractures. A total of 32/58 (55%) fractures were length unstable and 26/58 (45%) were length stable. Mean time to union was 4.6 months, and there was no significant difference in mean time to union between the 2 groups (P=0.71). Thirty-one complications occurred in 27 patients. There was no difference between groups in the incidence of major complications requiring revision surgery (P=0.68) and minor complications that did not require revision surgery (P>0.99).

Conclusions:
In children with femoral shaft fractures treated with TEN, there was no difference in the incidence of complications or reoperations between those with length unstable fractures and those with length stable fractures. TEN are a safe and effective choice for operative fixation of length unstable femoral shaft fractures in children.

Level of Evidence:
Level III—retrospective comparative study.
Importance of Early Improvement in the Treatment of Low Back Pain With Physical Therapy
Authors: Walston Zachary , McLester Cherilyn 
Published: November 2019

Study Design. .
A retrospective observational study.

Objective.
Assess the time course of functional outcome improvements during a physical therapy (PT) episode of care for patients with low back pain. In addition, assess the impact of patient variables, such as symptom duration, on the time course of functional outcome improvements.

Summary of Background Data.
Early improvement in patient-reported symptoms and functional limitations may play an important role in the eventual success of an intervention. Early improvements in pain are associated with greater improvement in disability and depression in patients with low back pain.

Methods.
A total 11,945 patients were included. Intake functional status (FS), FS change at discharge, predicted FS change at discharge, FS change at first progress report (FS1), duration of symptoms before treatment, and duration of PT episode of care were assessed. Pearson correlation analysis was used to assess correlation between collected variables and FS change.

Results.
The mean FS change was 16.995 units, mean FS1 was 12.024 units, total duration was 63.591 days, and duration at FS1 was 28.969 days, indicating 70.72% of FS change occurred in the first 45.45% of the episode of care. Similar results occurred in all symptom duration categories, ranging from “0 to 7 days" to “greater than 6 months" duration. Correlation analysis demonstrated that FS1 had the greatest correlation to FS. A strong correlation (r > 0.7) was demonstrated in all symptom duration categories ranging from 0.741 to 0.805.

Conclusion.
The results of this study yield further support for the importance of rapid functional improvements during a PT episode of care. In addition, patients demonstrated roughly two-thirds of their improvement in the first 40% of visits regardless of their symptom duration. This study may help clinicians identify a need to modify a plan of care if insufficient early improvement is observed.

Level of Evidence: 3
Circulating miR-155-5p as a Novel Biomarker of Lumbar Degenerative Disc Disease
Authors: Divi Srikanth N. , Markova Dessislava Z. , Fang Taolin , Guzek Ryan , Kurd Mark F. , Rihn Jeffrey A. , Hilibrand Alan S. , Anderson David Greg , Vaccaro Alexander R. , Schroeder Gregory D. , Kepler Christopher K. 
Published: November 2019

Mini
Circulating microRNAs provide an insight into current disease states. Comparing patients with degenerative disc disease to healthy controls, patients with disc disease were found to have significantly downregulated levels of miR-155-5p. This marker was found to be an accurate diagnostic predictor for the presence of degeneration (P = 0.006).

Study Design.
Case-control study measuring differential gene expression of circulating microRNA (miRNA) in patients with degenerative disc disease (DDD).

Objective.
To identify miRNA dysregulation in serum samples of patients with DDD compared to healthy controls (HC).

Summary of Background Data.
Early DDD can be a difficult diagnosis to make clinically, with lack of positive and specific findings on physical exam or advanced imaging. miRNAs are a class of molecules that act as gene regulators and have been shown to be dysregulated in local degenerative disc tissue. However, to date no studies have identified dysregulation of serum miRNA in patients with DDD.

Methods.
Whole blood samples were obtained from 69 patients with DDD and 16 HC. Patient-reported outcomes were collected preoperatively and degree of DDD was classified using Pfirrmann grade on preoperative imaging. Differential gene expression analysis using a screening assay for several hundred miRNAs and further characterization for five specific miRNAs (miR-16-5p, miR-21-5p, miR-142-3p, miR-146a-5p, and miR-155-5p) was performed. In addition, a pro-inflammatory cytokine multiplex assay and bioinformatics analysis were done.

Results.
The initial screening assay showed 13 miRNA molecules that were significantly dysregulated in DDD patients, with miR-155-5p showing significant downregulation (p = 0.027) and direct interactions with the pro-inflammatory cytokine IL-1β, and the tumor suppressor genes p53 and BRAF. Analyzing the whole cohort, miR-155 showed an almost four-fold downregulation in DDD patients (−3.94-fold, P < 0.001) and was the sole miRNA that accurately predicted the presence of disc degeneration (P = 0.006). Downregulation of miR-155 also correlated with increased leg pain (P = 0.018), DDD (P = 0.006), and higher Pfirrmann grade (P = 0.039). On cytokine analysis, TNF-α (0.025) and IL-6 (P < 0.001) were significantly higher in DDD patients.

Conclusion.
Serum miR-155-5p is significantly downregulated in patients with DDD and may be a diagnostic marker for degenerative spinal disease.

Level of Evidence: N/A
Paraspinous Muscle Flaps for the Treatment of Complex Spinal Wounds
Authors: Inglesby Dani C. , Young Zachary T. , Alshareef Mohammed , Ritter Alexandra , Gunasekaran Arunprasad , Kalhorn Stephen P. , Lance Tavana M. 
Published: November 2019

Mini
This retrospective case series investigated paraspinous flaps for coverage of complex spinal wounds. 6.90% of patients developed postoperative wound infections and 0.00% of patients required instrumentation removal for infection. This suggests that these flaps may offer a long-term solution in wound management for patients with repeated spinal operations.

Study Design.
Retrospective case series.

Objective.
To investigate the efficacy and complication profile of the use of paraspinous muscle flaps for closure of complex spinal wounds.

Summary of Background Data.
Paraspinous muscle flap closure offers an innovative option in difficult-to-manage post-spinal surgery wounds. Current literature reports are mixed in terms of success and complication rates of these flap procedures, with most sources citing a wound complication rate of 20%.

Methods.
This case series investigated the hospital course of 58 patients undergoing paraspinous flap closure after spinal surgery between the years 2014 and 2018. Information gathered includes: demographics, surgery indication, location, and length of incision on the spine, nutrition labs, previous spinal surgeries, preoperative wound class, operative times, length of hospital stay, and complication rates including reoperation, wound infection, and other postoperative complications.

Results.
Of the 58 patients undergoing spinal muscle flap closure, 51 (87.93%) had undergone previous spinal surgery with an average of 2.12 previous surgeries in these patients. Mean albumin and prealbumin were 2.62 and 13.75, respectively. 4/58 (6.90%) developed a wound infection or experienced a continuation of their chronic osteomyelitis. Of the 57 patients that had spinal instrumentation, three (5.26%) had spinal implants removed at the time of surgery and two (3.51%) had it removed or replaced later for mechanical complications. No patients had instrumentation removed for chronic infections. One (1.72%) experienced reoperation for wound-related complications. These rates are lower than most complication rates in the current literature.

Conclusion.
The plastic and reconstructive paraspinous muscle flap has promising results as a closure option for complex spinal wounds following neurosurgical cases. Further investigation is called for to determine the applicability of these results to the general population.

Level of Evidence: 4
Prevalence and Risk Factors for Thrombotic Complications Following Venovenous Extracorporeal Membrane Oxygenation: A CT Scan Study*
Authors: Parzy Gabriel , Daviet Florence , Persico Nicolas , Rambaud Romain , Scemama Ugo , Adda Mélanie , Guervilly Christophe , Hraiech Sami , Chaumoitre Kathia , Roch Antoine , Papazian Laurent , Forel Jean-Marie 
Published: November 2019

Objectives:
The aims of this study were to: 1) analyze the cannula-associated deep vein thrombosis frequency after venovenous extracorporeal membrane oxygenation using a CT scan and 2) identify the associated risk factors for cannula-associated deep vein thrombosis.

Design:
Retrospective observational analysis at a single center.

Setting:
Tertiary referral university teaching hospital.

Patients:
Patients under venovenous extracorporeal membrane oxygenation with a femorofemoral or femorojugular cannulation admitted for acute respiratory distress syndrome or primary graft dysfunction after pulmonary transplantation. CT scan was performed within 4 days after decannulation.

Interventions:
None.

Measurements and Main Results:
We included 105 of 228 patients screened. Bacterial pneumonia was the main indication of venovenous extracorporeal membrane oxygenation (46.7%). CT scans were performed at a median of 2 days (1–3 d) after decannulation. Cannula-associated deep vein thrombosis was found in 75 patients (71.4%) despite it having a mean activated partial thromboplastin time ratio of 1.60 ± 0.31. Femorofemoral cannulation induced femoral cannula-associated deep vein thrombosis more frequently than femorojugular cannulation (69.2% vs 63.1%, respectively; p = 0.04). Seventeen of the 105 patients (16.2%) had a pulmonary embolism. Multivariate logistic regression analysis showed that higher the percentage of thrombocytopenia less than 100 G/L during extracorporeal membrane oxygenation period, lower the risk for developing cannula-associated deep vein thrombosis (hazard ratio, 0.98; 95% CI, 0.98–1.00; p = 0.02).

Conclusions:
Cannula-associated deep vein thrombosis after venovenous extracorporeal membrane oxygenation is a frequent complication. This plead for a systematic vascular axis imaging after venovenous extracorporeal membrane oxygenation. Thrombocytopenia is associated with a reduction in the occurrence of thrombotic events.
Discovery of Radiocesium-bearing Particles in Masks Worn by Members of the Public in Fukushima in Spring 2013
Authors: Higaki Shogo , Kurihara Yuichi , Takahashi Yoshio 
Published: November 2019

Abstract
To investigate the publics’ internal exposure by inhalation of radiocesium from the Fukushima Daiichi nuclear disaster in 2011, we examined the activity of radiocesium and radiocesium-bearing particles adhering to nonwoven fabric masks worn daily by members of the public in spring 2013 and 2014. We found a maximum cumulative 137Cs activity of 4.58 ± 0.15 Bq in 4 wk of spring 2013, which is 20.8% of the activity measured for the same subject in spring 2012 using the same method. This decrease was faster than the physical decay of radiocesium. Radiocesium was detected in 21 of 722 masks in 2013; three of these included type A radiocesium-bearing particles. The activity ratio of the radiocesium-bearing particles on the mask to the total radiocesium was at most approximately 20%. The two radiocesium sources, radiocesium-bearing particles and fugitive dust, are both insoluble particles. The largest internal dose from inhalation was 7.6 μSv in spring 2013, which is negligible compared to the dose limit recommended for members of the public by the International Commission on Radiological Protection.
Acute Unilateral Ptosis and Myositis Following the H1N1 Influenza Vaccine
Authors: Basilious Alfred , Jivraj Imran , DeAngelis Dan 
Published: November 2019

The authors present a rare case of sudden onset unilateral complete ptosis occurring hours after administration of the H1N1 influenza vaccine. A complete workup for autoimmune and neurological disease was negative. MRI of the orbits demonstrated unilateral orbital myositis involving the left superior rectus/levator complex, superior oblique, and medial rectus muscles. Ptosis resolved spontaneously over 2 months without intervention. An autoimmune mechanism may explain rare cases of orbital myositis following administration of the H1N1 influenza vaccination.
A case of acute onset and spontaneous resolution of complete unilateral ptosis and orbital myositis post H1N1 influenza vaccination.
Colectomy Averted
Authors: Brothers Todd N. , Charpentier Margaret M. , Shah Shivani , Tandon Richa 
Published: November 2019

Abstract

Clostridioides difficile infection is considered an urgent public health threat by the Centers for Disease Control and Prevention. Recent practice guidelines recommend either vancomycin or fidaxomicin for an initial episode of C. difficile infection and further recommend a subtotal colectomy in severe cases. There are limited data discussing novel approaches for fidaxomicin administration in severe C. difficile infection to avert colectomy. We describe an off-label route of fidaxomicin administration through a loop ileostomy twice daily with successful outcome.