bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations Between Polysubstance Use Patterns and Receipt of Medications for Opioid Use Disorder Among Adults in Treatment for Opioid Use Disorder
Authors: Ford Becky R. , Bart Gavin , Grahan Brian , Shearer Riley D. , Winkelman Tyler N.A. 
Published: August 2020

Objective:
To examine trends in polysubstance use among adults in treatment for opioid use disorder (OUD) and estimate associations between polysubstance use patterns and receipt of medications for OUD (MOUD).

Methods:
We conducted a cross-sectional longitudinal analysis of treatment admissions for opioid use from 1992 to 2017 using the Treatment Episodes Data Set-Admissions (N = 9,440,157). We used multiple logistic regression to examine co-use patterns and estimate associations between receipt of MOUD and polysubstance use categories (opioid only, any methamphetamine, any cocaine, any alcohol, any benzodiazepine).

Results:
Between 1992 and 2017, treatment admissions involving opioid/cocaine (−17.2 percentage points [PP]) and opioid/alcohol co-use (−12.5 PP) decreased while opioid/methamphetamine (10.1 PP) and opioid/benzodiazepine co-use (5.6 PP) increased. In 2016 to 2017, receipt of medications for OUD was significantly higher for those who used opioids only (38.5%; 95% confidence interval [CI] 38.4–38.6) compared with individuals who used opioids with cocaine (35.7%; 95% CI 35.6–35.9), methamphetamine (23.9%; 95% CI 23.7–24.2), alcohol (25.0%; 95% CI 24.8–25.2), or benzodiazepines (34.6%; 95% CI 34.3–34.9). If those who co-used opioids with other substances received MOUD at the same rate as those who used opioids only, 47,400 additional people would have received MOUD between 2016 and 2017.

Conclusions:
Opioid/methamphetamine and opioid/benzodiazepine increased substantially between 1992 and 2017. Co-use of other substances with opioids was associated with significantly lower receipt of MOUD. Treatment facilities should increase access to MOUD for individuals who co-use opioids with other substances. This change would extend evidence-based treatment to thousands of individuals and save lives.
Safely Reducing the Incidence of Contralateral Slipped Capital Femoral Epiphysis: Results of a Prospectively Implemented Prophylactic Fixation Protocol Using the Posterior Sloping Angle
Authors: St George Justine , Genon Michel , Little David G. 
Published: August 2020

Background:
Bilateral slipped capital femoral epiphysis (SCFE) is common. The management of the contralateral hip in unilateral SCFE remains controversial. The aim of this study was to report on the clinical outcomes using a posterior sloping angle (PSA) threshold of 14.5 degrees for prophylactic fixation in preventing contralateral SCFE.

Methods:
Having previously established through a retrospective study that PSA was predictive of future slip, the authors put in place a protocol where patients with unilateral SCFE who had a PSA ≥14.5 degrees on the contralateral side were offered prophylactic fixation. Those with unilateral SCFE presenting between January 2008 and December 2018 with a minimum of 12-month follow-up were included. Patients with renal or endocrine disorders were excluded. Primary outcomes were the number of slips prevented, the number needed to treat, and the complication rate.

Results:
Of the 219 patients who were included, 114 (52.1%) underwent prophylactic fixation.
A PSA threshold of 14.5 degrees prevented 77% of subsequent slips with a number needed to treat of 2.4 in our population. There were no cases of chondrolysis, avascular necrosis, or periprosthetic fracture associated with prophylactic pinning.

Conclusions:
Prophylactic fixation using a PSA of 14.5 degrees is safe, decreases unnecessary intervention, and reduces 77% of subsequent SCFE. The PSA can increase over time and the authors recommend that the protocol be applied for the duration of follow-up.

Level of Evidence:
Level III
Evaluation of Radiation Doses in Pediatric Patients Undergoing Conventional Chest X-ray Examination
Authors: Lahham Adnan , Issa Ahlam 
Published: August 2020

Abstract
This work deals with the evaluation of radiation doses from chest x rays for 240 male and female pediatric patients selected randomly from four Palestinian hospitals. The patient population was divided into five age groups: Newborn, 1, 5, 10, and 15 y old. Doses were theoretically calculated by using Monte Carlo based codes: CALDOSE-X5 and PCXMC-2.0. Patients’ data and type of radiographic systems used as well as exposure factors were provided by the administrations of the selected hospitals. Absorbed organ doses from AP and PA projections were evaluated for 76 pediatric patients selected from one hospital in East Jerusalem. The highest mean organ dose for these patients was 0.085 mGy to the breast in AP projection. Effective doses were estimated for the five age groups for all patients. The highest average effective dose was found for patients in the age group of 10 y and was about 0.13 mSv, while the lowest average effective dose was found for the 5-y age group, about 0.06 mSv. The mean effective dose for all investigated patients in the five age categories was about 0.08 mSv. Variations in effective doses for the same age group and x-ray examination among involved hospitals are remarkable.
A Potential Role for Excess Tissue Iron in Development of Cardiovascular Delayed Effects of Acute Radiation Exposure
Authors: Miller Steven J. , Chittajallu Supriya , Sampson Carol , Fisher Alexa , Unthank Joseph L. , Orschell Christie M. 
Published: August 2020

Abstract
Murine hematopoietic-acute radiation syndrome (H-ARS) survivors of total body radiation (TBI) have a significant loss of heart vessel endothelial cells, along with increased tissue iron, as early as 4 mo post-TBI. The goal of the current study was to determine the possible role for excess tissue iron in the loss of coronary artery endothelial cells. Experiments used the H-ARS mouse model with gamma radiation exposure of 853 cGy (LD50/30) and time points from 1 to 12 wk post-TBI. Serum iron was elevated at 1 wk post-TBI, peaked at 2 wk post-TBI, and returned to non-irradiated control values by 4 wk post-TBI. A similar trend was seen for transferrin saturation, and both results correlated inversely with red blood cell number. Perls’ Prussian Blue staining, used to detect iron deposition in heart tissue sections, showed myocardial iron was present as early as 2 wk following irradiation. Pretreatment of mice with the iron chelator deferiprone decreased tissue iron but not serum iron at 2 wk. Coronary artery endothelial cell density was significantly decreased as early as 2 wk vs. non-irradiated controls (P<0.05), and the reduced density persisted to 12 wk after irradiation. Deferiprone treatment of irradiated mice prevented the decrease in endothelial cell density at 2 and 4 wk post-TBI compared to irradiated, non-treated mice (P<0.03). Taken together, the results suggest excess tissue iron contributes to endothelial cell loss early following TBI and may be a significant event impacting the development of delayed effects of acute radiation exposure.
Shovel and Cut Technique: Beveled Vitrectomy Probes to Address Diabetic Tractional Retinal Detachments
Authors: Gerardo González-Saldivar , Chow David R. 
Published: September 2020

Purpose:
To describe a surgical technique using the structural advantages of beveled tip cutters.

Methods:
The introduction of beveled tips has been one of the few modifications that have been performed to vitrectomy probes since first described by Machemer in 1972. Shovel and cut technique uses this incredible modification to access tighter planes and remove broad diabetic membranes.

Description of Technique:
The shovel and cut technique can be used with any gauge probe to which the bevel tip is applied. The beveled tip of the cutter is used in a shovel manner to create a tissue plane between the diabetic plaque and the retina. As the beveled tip of the cutter moves parallel to the underlying retina, scar tissue naturally feeds into the cutting port where it is cut and aspirated with low flow rates.

Conclusion:
Shovel and cut technique takes advantage of beveled tip technological innovation to allow easy access and tissue dissection of the most difficult plaques in diabetic membranes. This technique allows us to remove these plaques in a safer, more controlled manner than previous described techniques.
Effects of Localized Heating on Pain, Skin Perfusion, and Wound Healing After Lumbar Decompression
Authors: Kim Jeoung Hee , Shin Yong Soon 
Published: August 2020

ABSTRACT

BACKGROUND: Current evidence regarding the effectiveness and safety of localized heating after spinal surgery for pain, peripheral tissue perfusion, and wound healing is conflicting. METHODS: This study was a prospective, single-blind, randomized controlled trial; 58 adult patients were randomized to an experimental group or a control group after spinal decompression surgery. All participants received localized cooling on postoperative days 1 and 2. The experimental group received localized heating at the surgical wound on postoperative days 3 and 4, and the control group kept normothermia without localized heating. Outcome variables were evaluated 1 hour after surgery and on day 4. RESULTS: Postoperative pain was significantly lower in the experimental versus control group (13.8 vs 23.0, P = .01). Skin perfusion was better in the experimental versus control group (4.7 vs 2.8, P = .001). There was no statistically significant difference in the wound healing status between the groups. CONCLUSION: Localized heating can effectively relieve postoperative pain and improve skin perfusion. These results suggest that localized heating tailored to the wound healing process may be beneficial for patients undergoing spinal surgery.
Information Needs and Preferences of Family Caregivers of Patients With Amyotrophic Lateral Sclerosis
Authors: Chu Hyeon Sik , Oh Juyeon 
Published: August 2020

ABSTRACTOBJECTIVE:The aim of this study was to explore the information needs and preferred sources of information of Korean family caregivers of patients with amyotrophic lateral sclerosis (ALS).METHODS:Family caregivers of patients with ALS (n = 108) completed a structured questionnaire to assess their information needs and preferred sources of information.RESULTS:Most of the caregivers obtained health information from Internet searches (89.8%) and healthcare professionals (85.2%). The source rated most helpful was healthcare professionals, and that rated least helpful was broadcast media. Family caregivers who were younger than 50 years and well educated and caregivers of bulbar-onset ALS patients had higher scores of information needs.CONCLUSION:Providing information through healthcare professionals and self-support groups could enhance family caregiver satisfaction. Family caregivers who are older and less educated need to be more empowered to be involved in information-based caring, and caregivers of patients with bulbar-onset ALS have substantial information needs.
Additive Manufacturing of Ankle-Foot Orthosis with Predefined Ankle Stiffness—A Case Report
Authors: Vasiliauskaite Egle , Van Paepegem Wim , Deckers Jan Patrick , Vermandel Miguel , Forward Malcolm , Plasschaert Frank 
Published: August 2020

ABSTRACT

Introduction
The success of orthotic interventions depends on how well an individual patient's needs are identified and addressed. In this prospective study, we addressed the following question: Is it possible to additively manufacture an ankle-foot orthosis (AFO) with predefined ankle stiffness that would decrease excessive plantarflexion in the dropfoot gait?

Materials and Methods
A child with unilateral drop foot was recruited for this study and took part in three gait assessments. In the first gait assessment, the “optimal” AFO stiffness was determined using a hinged AFO with adjustable ankle stiffness. A leaf-spring-type AFO with predefined optimal ankle stiffness was then virtually designed and additively manufactured. The impact of this orthosis on the patient's gait before and after 6 weeks of acclimatization period was evaluated in the second and the third gait assessments, respectively.

Results
A hinged orthosis with an ankle stiffness of 0.009 N·m·deg−1·kg−1 was deemed to be the optimal for the study patient. The ankle stiffness of the additively manufactured AFO was 0.008 N·m·deg−1·kg−1. This orthosis decreased patient's excessive plantarflexion, but its impact was moderately inferior compared with that of the optimal hinged orthosis.

Conclusions
Despite having the same ankle stiffness, hinged AFO and leaf-spring AFO did not produce the same gait pattern. Therefore, to prescribe an optimal AFO, a better understanding of subject-AFO interaction in walking is needed.
Gut microbial dysbiosis as a limiting factor in the management of primary and secondary sarcopenia: an Asian Indian perspective
Authors: Bhattacharya Shinjini , Bhadra Rohini , Schols Annemie M.W.J. , Sambashivaiah Sucharita 
Published: August 2020

Purpose of review
The article summarizes recent research advances on the role of gut microbiome in primary and secondary sarcopenia. This article also explores the potential contribution of gut dysbiosis to suboptimal sarcopenia management with special focus on factors contributing to gut dysbiosis among Asian Indians.

Recent findings
Aging and chronic diseases contribute to gut dysbiosis and intestinal barrier dysfunction allowing enhanced microbial translocation that may negatively affect muscle strength, physical function, and frailty. Gut microbiome of Asian Indians has shown a unique composition that is affected by multiple factors, such as socioeconomic status, poor hygiene, high rate of infection and infestations, antibiotic overuse and transition towards a westernized eating pattern. Current management approach for sarcopenia (exercise and/or protein supplementation) fails to address gut dysbiosis and intestinal barrier dysfunction. Incorporating a prebiotic or probiotic element to the intervention strategy may improve gut dysbiosis, inflammation and muscle function.

Summary
Gut dysbiosis and intestinal barrier dysfunction appear to be a significant limitation in sarcopenia management, thus gut centric intervention may be perceived as a (co)intervention strategy to be tested in appropriate clinical trials.
Intermittent fasting as a nutrition approach against obesity and metabolic disease
Authors: Zhu Shengjie , Surampudi Prasanth , Rosharavan Baback , Chondronikola Maria 
Published: August 2020

Purpose of review
Intermittent fasting has been proposed as a potential nutrition approach against obesity and metabolic disease. Although data from studies in rodents convincingly support the antiobesity and cardiometabolic benefits of intermittent fasting, its effects in human health are still debatable.

Recent findings
Recent studies have examined the effect of two intermittent fasting approaches, that is, alternate day fasting (ADF) and time-restricted eating (TRE), on weight loss and cardiometabolic risk factors. ADF seems to be an equally effective weight loss approach to caloric restriction, but adherence to ADF is more challenging. ADF improves cardiometabolic risk factors, whereas it may have superior metabolic benefits compared to caloric restriction in people with insulin resistance. TRE with ad libitum food intake is well tolerated and induces 2–4% weight loss in approximatively 3 months. Additionally, TRE may have metabolic benefits particularly in people with metabolically abnormal obesity even without weight loss.

Summary
Intermittent fasting is a promising nutritional approach against obesity and its related metabolic diseases. Further research is needed to: i) establish the long-term effectiveness of TRE in weight loss and metabolic health, ii) improve the long-term adherence to ADF and investigate its weight loss independent effects in metabolic health, and iii) determine the mechanisms underlying the potential cardiometabolic benefits of intermittent fasting in humans.
Coronavirus disease 2019 associated with aggressive neurological and mental abnormalities confirmed based on cerebrospinal fluid antibodies
Authors: Wang Maomao , Li Ting , Qiao Fan , Wang Laixing , Li Chunlin , Gong Yanping 
Published: September 2020

AbstractIntroduction:Coronavirus disease (COVID-19) is spreading worldwide. The reported possible neurological symptoms are varied and range from subtle neurologic deficits to unconsciousness. Knowledge regarding the detection, diagnosis, treatment, and follow-up of COVID-19-associated neurological damage is still limited. We report a case of serious neurological damage and mental abnormalities in a patient who was finally confirmed to have COVID-19 based on IgM and IgG antibodies in the cerebrospinal fluid (CSF).Patient concerns:A 68-year-old man had slight flu-like symptoms and transient loss of consciousness in early February. Exaggerated unconsciousness and deteriorating mental abnormalities occurred over the next month without severe respiratory symptoms. Craniocerebral computed tomography showed normal results, but antibodies against severe acute respiratory syndrome coronavirus 2 were 100 times higher in the CSF than in the serum; tests for viral ribonucleic acid showed negative results with both a nasopharyngeal swab and CSF sample.Diagnosis:COVID-19 pneumonia was diagnosed based on symptoms and positive results for IgM and IgG in the CSF.Interventions:Antiviral, fluid, and nutritional support were administered for 30 days before admission without obvious improvement. A further 18 days of routine antiviral therapy, immunoglobulin therapy (10 g per day for 5 days), and antipsychotic drug treatment were administered.Outcomes:The patient's neurological and mental abnormalities were greatly ameliorated. He was discharged with mild irritability, slight shaking of the hands, and walking fatigue. These symptoms have persisted up to our last follow-up (May 4, 2020).Conclusion:We believe this is the first case involving neural system injury in a patient who confirmed COVID-19 based on CSF antibody test results. Negative ribonucleic acid test results, strong positivity for antibodies, and high protein levels in the CSF suggest the possibility of autoimmune encephalitis secondary to COVID-19. This case highlights additional novel symptoms of COVID-19, and these data are important for the assessment and follow-up of COVID-19 patients.
Radiofrequency catheter ablation in a patient with dextrocardia, persistent left superior vena cava, and atrioventricular nodal reentrant tachycardia
Authors: Zheng Zhipeng , Zeng Zhihuan , Zhou Yuliang , Li Chichang , Zhang Wei 
Published: September 2020

Abstract

Rationale:
Dextrocardia is a rare congenital heart disease, while the persistent left superior vena cava (PLSVC) is an uncommon congenital vascular malformation. It is extremely rare for a person to have dextrocardia and PLSVC. A case with a combination of dextrocardia, PLSVC, and atrioventricular nodal reentrant tachycardia has not been reported.

Patient concerns:
A 51-year-old woman was admitted to the hospital with palpitations. The physical examination revealed a heart rate of patient increased significantly, and that apex beating was found in the right fifth intercostal space approximately 0.5 cm from the midclavicular line.

Diagnosis:
We used different techniques, including electrocardiography, esophagus heart electrophysiology, chest radiograph, and cardiac color Doppler echocardiography to reveal the presence of the combination of dextrocardia, PLSVC, and supraventricular tachycardia.

Interventions:
We terminated tachycardia by esophageal pacing and cured patients with radiofrequency catheter ablation (RFCA).

Outcomes:
The complex structural anomalies presented great technical challenges for interventional treatments. After consulting the literature, thorough examination and understanding of the structural anatomy and anomalies of the vena cava and cardiac chambers, we successfully treated this patient by RFCA. After half a year of follow-up, the patient did not have palpitations, and no arrhythmia was seen on the electrocardiography.

Lessons:
Physicians need to be aware that the key to the success of RFCA, in this case, is to clarify the complexity of the morphological and anatomical structures of dextrocardia accompanying PLSVC and to consult and understand the experience of access vessels reported in relevant cases before the operation.
Long-term survival prediction for transjugular intrahepatic portosystemic shunt in severe cirrhotic ascites: assessment of ten prognostic models
Authors: Li Jing , Tang Shihao , Zhao Jianbo , Zhang Chunqing , Jiang Zaibo , Xue Hui , Sun Junhui , Zhu Xuan , Ren Weixin , Zhu Xiaoli , Wang Qiuhe , Wang Enxin , Lv Yong , Guo Shuai , Wang Zhexuan , Yang Qiaoyi , Wang Zhengyu , Niu Jing , Yin Zhanxin , Xia Jielai , Fan Daiming , Han Guohong 
Published: August 2020

Objectives
Patients with severe cirrhotic ascites have poor prognosis, yet individual patient survival varies greatly. Therefore, suitable prognostic models can be helpful in clinical decision making. The aim of this study was to evaluate and compare the performance of 10 scores in predicting transplant-free survival (TFS) after transjugular intrahepatic portosystemic shunt (TIPS) in severe cirrhotic ascites.

Methods
Two hundred eighty consecutive cirrhotic patients with severe ascites undergoing TIPS between March 2006 and December 2017 were retrospectively screened and included from nine tertiary Chinese centers, consisting of 123 patients with refractory ascites and 157 with recurrent ascites. Discriminatory ability of these models was further assessed in the whole cohort and subgroups.

Results
TFS rates of all 280 patients were 75.4, 65.7, and 53.6% at 6-month, 1-year, and 2-year follow-up, respectively. Compared with other prognostic systems, the integrated model for end-stage liver disease (iMELD, incorporating serum sodium and age) showed optimal performance in predicting 6-month, 1-year, and 2-year TFS. Cutoffs were determined according to c-index and were used to stratify patients into three strata presenting significantly different TFS for short-term and long-term: iMELD < 32, ≥32 but <38 and ≥38 (log-rank P < 0.001).

Conclusions
The iMELD score proved to be the best prognostic model in predicting TFS in patients with severe cirrhotic ascites receiving TIPS. Meanwhile, the model could stratify patients in three strata to help guiding clinical practice.