bluuebunny/crossref_metadata_2025_split huggingface dataset:
Referral to Treatment After Positive Screens for Unhealthy Drug Use in an Outpatient Veterans Administration Setting
Authors: Hodgkin Dominic , Gao Wenwu , Larson Mary Jo , Drebing Charles E. , Merrick Elizabeth L. , Pugatch Marianne , Horgan Constance M. , Zolotusky Galina , Petry Nancy M. , Saitz Richard 
Published: October 2019

Objectives:To measure the rates and predictors of clinician recommendation for follow-up after a positive screen for unhealthy drug use, in a context of mandatory routine screening. To measure response to clinician recommendations and identification of new drug use diagnoses.Methods:Data are from a Veterans Health Administration (VHA) medical center that introduced mandatory routine screening for unhealthy drug use in outpatient primary care and mental health settings, using a validated single question. This study analyzed VHA electronic health records data for patients who screened positive for unhealthy drug use (n = 570) and estimated logistic regression models to identify the predictors of receiving a recommendation for any follow-up and for specialty substance use disorder (SUD) treatment. Bivariate tests were used for other analyses.Results:Among patients who screened positive for unhealthy drug use, 66% received no recommendation to return to primary care or another setting from the screening clinician. Further, among the 23% of patients who received a recommendation to visit specialty SUD treatment, only 25% completed the visit within 60 days. Six percent of all positive screens both received a referral to specialty SUD treatment and acted upon it.Conclusions:In the context of mandatory drug use screening using a single item, rates of clinician action and patient receipt of care appeared low. Improved follow-up will require health systems to provide more supports for clinicians and patients at each of the stages from positive screen to attending the follow-up appointment.
Observations of Distortion Product Otoacoustic Emission Components in Adults With Hearing Loss
Authors: Prieve Beth A. , Thomas Lisa , Long Glenis , Talmadge Carrick 
Published: October 2019

Objectives:
Distortion product otoacoustic emissions (DPOAEs) measured in the ear canal are composed of OAEs generated by at least two mechanisms coming from different places in the cochlea. Otoacoustic emission (OAE) models hypothesize that reduction of cochlear gain will differentially impact the components. The purpose of the current experiment was to provide preliminary data about DPOAE components in adults with hearing loss in relation to OAE models and explore whether evaluation of the relative amplitudes of generator and reflection components can enhance identification of hearing loss.

Design:
DPOAEs were measured from 45 adult ears; 21 had normal hearing (≤15 dB HL) and 24 with mild-to-severe sensorineural hearing loss (>15 dB HL). The higher frequency primary (f

2
) was swept logarithmically between 1500 and 6000 Hz, and f

2
/f

1
was 1.22. The two equal-level primaries varied from 55 to 75 dB SPL in 5 dB steps. The swept primary procedure permitted the measurement of the amplitude and phase of the DPOAE fine structure and the extraction of the two major components (generator and reflection) by varying the predicted delays of the analysis windows.

Results:
DPOAE fine structure was reduced or absent in ears with hearing loss. DPOAE generator and reflection components were lower in ears with hearing loss than those with normal hearing, especially for the reflection component. Significant correlations were found between the generator component and hearing threshold but not between reflection levels and hearing threshold. Most ears with normal hearing had both components, but only a small number of ears with hearing loss had both components.

Conclusions:
The reflection component is not recordable or low in level in ears with hearing loss, explaining the reduced or absent DPOAE fine structure. DPOAE generator components are also lower in level in ears with hearing loss than in ears without hearing loss. In ears that had both measurable generator and reflection components, the relationship between the two did not depend on the presence or absence of hearing loss. Because reflection components are not measurable in many ears with hearing thresholds >15 dB HL, stimuli that evoke other types of reflection emissions, such as stimulus-frequency or long-latency transient-evoked emissions, should be explored in conjunction with DPOAE generator components.
Perioperative Outcome of Severe Idiopathic Scoliosis (Cobb Angle ≥ 90°)
Authors: Mihara Yuki , Chung Weng Hong , Chiu Chee Kidd , Hasan Mohd Shahnaz , Lee Sin Ying , Ch’ng Pei Ying , Chan Chris Yin Wei , Kwan Mun Keong 
Published: October 2019

Study Design.
Retrospective study from a prospectively collected database.

Objective.
To compare the perioperative outcome between after-hours and daytime surgery carried out by a dedicated spinal deformity team for severe Idiopathic Scoliosis (IS) patients with Cobb angle ≥ 90°.

Summary of Background Data.
There were concerns that after-hours corrective surgeries in severe IS have higher morbidity compared to daytime surgeries.

Methods.
Seventy-one severe IS patients who underwent single-staged Posterior Spinal Fusion (PSF) were included. Surgeries performed between 08:00H and 16:59H were classified as “daytime” group and surgeries performed between 17:00H and 06:00H were classified as “after-hours” group. Perioperative outcome parameters were average operation start time and end time, operation duration, intraoperative blood loss, intraoperative hemodynamic parameters, preoperative and postoperative hemoglobin, blood transfusion rate, total patient-controlled anesthesia (PCA) morphine usage, length of postoperative hospitalization, and complications. Radiological variables assessed were preoperative and postoperative Cobb angle, side bending flexibility, number of fusion levels, number of screws used, Correction Rate, and Side Bending Correction Index.

Results.
Thirty patients were operated during daytime and 41 patients were operated after-hours. The mean age was 16.1 ± 5.8 years old. The mean operation start time for daytime group was 11:31 ± 2:45H versus 19:10 ± 1:24H for after-hours group. There were no significant differences between both groups in the operation duration, intraoperative blood loss, intraoperative hemodynamic parameters, postoperative hemoglobin, hemoglobin drift, transfusion rate, length of postoperative hospitalization, postoperative Cobb angle, Correction Rate, and Side Bending Correction Index. There were four complications (1 SSEP loss, 1 massive blood loss, and 2 superficial wound infections) with no difference between daytime and after-hours group.

Conclusion.
After-hours elective spine deformity corrective surgeries in healthy ambulatory patients with severe IS performed by a dedicated spinal deformity team using dual attending surgeon strategy were as safe as those performed during daytime.

Level of Evidence: 4
The Relation of Birth Weight and Adiposity Across the Life Course to Semen Quality in Middle Age
Authors: Kahn Linda G. , Widen Elizabeth M. , Janevic Teresa , Straka Nadine , Liu Xinhua , Cirillo Piera M. , Cohn Barbara A. , Buck Louis Germaine M. , Factor-Litvak Pam 
Published: October 2019

Background:Studies of body mass index and semen quality have reported mixed results, but almost all were cross-sectional and many were conducted in selected populations. Longitudinal studies in population-based cohorts are necessary to identify how timing and duration of excess adiposity may affect semen quality.Methods:In 193 members of the Child Health and Development Studies birth cohort, we examined associations of birth weight and adiposity at six time points spanning early childhood and adulthood with sperm concentration, motility, and morphology at mean age 44 years, as well as with corresponding 2010 World Health Organization (WHO) subfertility reference levels.Results:Birth weight for gestational age percentile was positively associated with square-root sperm concentration (regression coefficientB[95% confidence interval] = 0.02 × 103 sperm/ml [0.004, 0.04]). Overweight/obesity in men’s 20s was associated with lower percent progressive motility (B=−5.2 [−9.9, −0.63]), higher odds of low motility (odds ratio (OR) = 2.4 [1.3, 4.4]), and higher odds of poor morphology (OR = 1.9 [0.94, 3.8]). Those who were overweight/obese in their 20s were also more likely to meet two or three WHO subfertility criteria (OR = 3.9 [1.6, 9.4]) compared with normal-weight men. Each additional adult decade in which a participant was overweight/obese was associated with higher odds of low motility (OR = 1.3 [0.96, 1.6]) and higher odds of meeting two or three WHO subfertility criteria (OR = 1.5 [1.0, 2.2]).Conclusions:In our data, associations among adiposity and sperm concentration, motility, and morphology varied according to timing and duration of exposure, potentially reflecting different biological mechanisms that influence these semen parameters.
Volumetric Symmetry after Unilateral Autologous Breast Reconstruction: A Reasonable Goal
Authors: Glener Adam D. , Suresh Visakha , Shammas Ronnie L. , Broadwater Gloria , Sergesketter Amanda , Taskindoust Mahsa , Guo Xiaoshuang , Hollenbeck Scott T. 
Published: October 2019

Background:
With growing concerns about the overuse of contralateral prophylactic mastectomy, optimizing unilateral mastectomy reconstruction outcomes becomes a priority. However, there remains a paucity of objective data that describe volumetric symmetry between a natural and autologous-reconstructed breast.

Methods:
We evaluated patients who underwent unilateral mastectomy reconstruction with free-flap abdominal tissue transfer from 04/2006 to 01/2015, and had at least 2 postoperative magnetic resonance images (MRIs; n = 28). Using these MRI data, volumetric measurements of the reconstructed and natural breast were performed at the first postoperative MRI (after all revisions were complete) and the most recent MRI. Relationships were analyzed using Spearman correlation coefficients. A symmetry score (SS) was calculated such that values closer to 1.0 reflected volumetric symmetry.

Results:
The mean age (years) and BMI of the patients was 44.8 and 26.8, respectively. The mean interval time between the MRIs was 3.03 years (range 0.43–6.6). After surgical revisions were complete, volumetric symmetry between reconstructed and nonreconstructed breasts was typically achieved (mean SS 0.92). This symmetry was also retained at the end of follow-up (mean SS 0.96), despite a mean change in BMI of 3.9% (range 1.1–7.7). Additionally, the mean number of flap revisions was 0.75 (range 0–2), and 39% of patients had a procedure performed on the natural breast.

Conclusion:
In patients undergoing unilateral abdominal-based breast reconstruction, volumetric symmetry is attainable; however, it can require flap revisions and procedures to natural breast. Interestingly, this study does show that initial symmetry is retained postoperatively, regardless of changes in BMI.
A Simple and Low-cost Method of Sleeve to Insert Silicone Gel Breast Implants
Authors: Panczel Georg , Munhoz Alexandre Mendonça 
Published: October 2019

Summary:
Contact between silicone implants and skin/breast parenchyma has been described as an agent of implant contamination and biofilm formation, resulting in implant complications. The no-touch technique was introduced to avoid implant contact and reduce skin/breast contamination. The authors propose an easily available sleeve option using a saline sterile plastic container that provides elastic and transparent protection for inserting silicone implants. These sterile containers can be easily converted into a sleeve by cutting off the narrow end of the container, which then easily fits into the small inframammary, periareolar, and transaxillary incisions. The authors have performed this technique in 10 patients (20 implants) undergoing primary breast augmentation or revision breast surgery, with microtexturized implants ranging in size from 255 to 500 ml (mean, 325 ml) and obtained satisfactory results with no cases of complications. Our clinical outcome shows that this new sleeve does not interact with the implant or the patient’s skin and soft tissues and has the added advantage of low cost compared with similar available devices, but further randomized and controlled studies are required to corroborate this effect.
Discovery of Novel Small Molecules that Block Myofibroblast Formation: Implications for Capsular Contracture Treatment
Authors: Park Rachel H. , Pollock Stephen J. , Phipps Richard P. , Langstein Howard N. , Woeller Collynn F. 
Published: October 2019

Background:
Capsular contracture is a devastating complication that occurs in patients undergoing implant-based breast reconstruction. Ionizing radiation drives and exacerbates capsular contracture in part by activating cytokines, including transforming growth factor-beta (TGF-β). TGF-β promotes myofibroblast differentiation and proliferation, leading to excessive contractile scar formation. Therefore, targeting the TGF-β pathway may attenuate capsular contracture.

Methods:
A 20,000 small molecule library was screened for anti-TGF-β activity. Structurally diverse anti-TGF-β agents were identified and then tested on primary human capsular fibroblasts. Fibroblasts were irradiated or not, and then treated with both TGF-β and candidate molecules. Resulting cells were then analyzed for myofibroblast activity using myofibroblast markers including alpha-smooth muscle actin, collagen I, Thy1, and periostin, using Western Blot, quantitative real-time polymerase chain reaction, and immunofluorescence.

Results:
Human capsular fibroblasts treated with TGF-β showed a significant increase in alpha-smooth muscle actin, collagen I, and periostin levels (protein and/or mRNA). Interestingly, fibroblasts treated with latent TGF-β and 10 Gy radiation also showed significantly increased levels of myofibroblast markers. Cells that were treated with the novel small molecules showed a significant reduction in myofibroblast activation, even in the presence of radiation.

Conclusions:
Several novel small molecules with anti-TGF-β activity can effectively prevent human capsular fibroblast to myofibroblast differentiation in vitro, even in the presence of radiation. These results highlight novel therapeutic options that may be utilized in the future to prevent radiation-induced capsular contracture.
Human Papilloma Virus Vaccination After Pediatric Sexual Abuse Evaluations in the Outpatient Child Sexual Abuse Subspecialty Clinic: A Quality Improvement Project
Authors: Goodman Elizabeth A. , Goodpasture Meggan 
Published: October 2019

ABSTRACT
The nonavalent human papilloma virus (HPV) vaccination prophylactically contributes to the prevention of nine types of HPV-associated oral and genital cancers. HPV vaccination rates remain lower than the national Healthy People 2020 goal of 80%. Victims of pediatric sexual abuse are at a higher risk for acquiring and developing HPV-related outcomes. Current research supports vaccination after sexual abuse as soon as eligible and suggests utilizing multiple types of medical encounters to increase vaccination rates.
An institutional-review-board-approved quality improvement project was developed to determine the impact of promoting and providing HPV vaccination during the medical encounter after pediatric sexual abuse in a child protection team (CPT) clinic. Twenty percent of the 111 total clinic patients evaluated in the preintervention period and 21% of the 99 patients evaluated in the postintervention period were HPV vaccine eligible, illustrating a significant opportunity for impact. During the intervention period, 62% of patients who were vaccine eligible and presented for their CPT clinic visit received HPV vaccine. Barriers to vaccination in the outpatient CPT clinic setting included high appointment no-show rates, high social and medical visit complexity, and absence of an appropriate consenting caretaker. Implications for forensic nursing practice are discussed.
Effect of physical fitness on colorectal tumor development in patients with familial adenomatous polyposis
Authors: Nakamura Tomiyo , Ishikawa Hideki , Sakai Toshiyuki , Ayabe Makoto , Wakabayashi Keiji , Mutoh Michihiro , Matsuura Nariaki 
Published: October 2019

Abstract
Although accumulated epidemiological evidence indicates that a good physical fitness level may prevent the development of sporadic colorectal cancer (CRC), few studies have examined the effect of physical fitness level on familial adenomatous polyposis (FAP). This cross-sectional study aimed to examine the relationship between physical fitness and CRC development in patients with FAP.
A total of 119 patients (54 male; 65 female) with FAP, aged 17 to 73 years, underwent a step test to induce exercise stress. Predicted maximal oxygen uptake (VO2max) was calculated for each patient by using heart rate as an index of physical fitness. The association of VO2max with the presence or absence of CRC and polyp diameter was examined. Patients with FAP were divided into 3 categories according to their VO2max (high, medium, and low). The association between maximum polyp size and VO2max among the patients with FAP without a history of colectomy was examined.
The risk of CRC was significantly higher in the low VO2max group than in the high VO2max group (odds ratio = 4.07; 95% confidence interval, 1.02–16.26). The maximum polyp diameter was significantly negatively correlated with the VO2max among the patients with FAP without a history of colectomy (r = −.44, P = .01). In the multiple linear regression analysis, maximum polyp diameter was independently correlated with VO2max.
Our results suggest a preventive association between physical fitness and CRC development or colorectal adenoma growth exists in patients with FAP.
Efficacy of methylprednisolone for treatment of persistent vertigo
Authors: Ding Guo-rong , Ni Jian-ming , Zhang Shan-jing , Xie Yan-zhong , Feng Jun-fei 
Published: October 2019

Abstract

Background:
This study will systematically investigate the efficacy and safety of methylprednisolone for treatment of persistent vertigo (PV).

Methods:
All following electronic databases will be searched from inception to the June 30, 2019 without language restrictions: MEDILINE, EMBASE, Cochrane Library, Web of Science, and Chinese Biomedical Literature Database. All randomized controlled trials focusing on assessing the efficacy and safety of methylprednisolone for patients with PV will be fully considered for inclusion. Cochrane risk of bias tool will be used for assessing methodological quality, and RevMan 5.3 software (Cochrane Community, London, UK) will be utilized for statistical analysis.

Results:
This study will assess the efficacy and safety of methylprednisolone for PV via assessing primary outcome of vertigo, and secondary outcomes of somatization, depression, anxiety, health-related quality of life, and adverse events.

Conclusion:
This study will provide a high-quality evidence to judge whether methylprednisolone is an effective and safety therapy for patients with PV.

Dissemination and ethics:
No individual data will be utilized in this study, thus, it does not need ethical approval. The results of this study will be published at peer-reviewed journals.

Systematic review registration:
PROSPERO CRD42019138890.
Prognostic value of radiologically determined sarcopenia prior to treatment in urologic tumors
Authors: Li Jialin , Deng Yinan , Zhang Menghui , Cheng Yusheng , Zhao Xin , Ji Zhigang 
Published: October 2019

Abstract

Objective:
Increasing evidence suggests that radiologically determined sarcopenia prior to treatment can serve as a prognostic marker in various tumors. However, there are conflicting conclusions about the prognostic role of sarcopenia in urological tumors. We performed a meta-analysis to assess the association between radiologically determined sarcopenia before treatment and survival outcomes in urological tumors.

Methods:
A systematically literature search in PubMed, Cochrane databases, and EMBASE was performed. We estimated hazard ratios (HRs) for overall survival (OS) and cancer-specific survival (CSS). Hazard ratios (HR) with 95% confidence interval (CI) were calculated using STATA 12.0 software.

Results:
A total of 16 studies enrolling 2264 patients with urologic tumors were included in our meta-analysis. Among these studies, 13 studies with 1941 patients explored the association between sarcopenia and OS, and 10 studies with 1790 patients investigated the relationship between sarcopenia and OS. The synthesized result suggested that sarcopenia was significantly associated with poor OS (Fixed-effect model, HR 1.73, 95% CI: 1.48–2.01, P <.05; heterogeneity: P = .064; I2 = 40.5%), and poor CSS (Fixed-effect model, HR: 1.85, 95% CI: 1.51–2.28, P <.05, heterogeneity: P = .053; I2 = 46.2%).

Conclusion:
This meta-analysis showed that sarcopenia was associated with poor OS and CSS, suggesting that sarcopenia may serve as a promising prognostic marker in urologic cancer patients. Considering several limitations in our study, in the future more high-quality studies on this topic should be conducted to confirm our findings.
Management of postpartum pulmonary embolism combined with retained placenta accreta
Authors: Tong An , Zhao Fumin , Liu Ping , Zhao Xia , Qi Xiaorong 
Published: October 2019

Abstract

Rationale:
Retained placenta accreta is an increasing obstetric problem in recent years, and pulmonary embolism (PE) during pregnancy and the postpartum period is a vital condition, but lack of standard therapy guidelines. This report describes a case of postpartum PE combined with retained placenta accreta.

Patient concerns:
A 27-year-old woman presenting with fever and dyspnea after delivery was admitted to our hospital with retained placenta accreta.

Diagnoses:
The patient was diagnosed with the infection, postpartum PE, and residual placenta.

Interventions:
The antibiotics and low molecular weight heparin were initially started to cure the infection and control PE. Mifepristone was then used to promote the necrosis of residual placenta while long-term use of warfarin was served as continuous anticoagulant therapy. Hysteroscopic resection of retained placenta was not performed until thrombi had been almost disappeared after more than 2 months of anticoagulation therapy.

Outcomes:
The patient's menstruation returned to normal within several weeks after hysteroscopic resection and she completely recovered from PE after 3 months of anticoagulant therapy.

Lessons:
Treatment of retained placenta accreta can be postponed when encountering complicated cases, such as postpartum PE. PE in perinatal stage can be managed referring to nonmaternal PE.