bluuebunny/crossref_metadata_2025_split huggingface dataset:
Precision of VerifyNow P2Y12 Assessment of Clopidogrel Response in Patients Undergoing Cerebral Aneurysm Flow Diversion
Authors: Bender Matthew T , Zarrin David A , Campos Jessica K , Jiang Bowen , Chandra Arun , Vo Chau D , Caplan Justin M , Huang Judy , Tamargo Rafael J , Lin Li-Mei , Colby Geoffrey P , Coon Alexander L 
Published: July 2018

Abstract

Background
Dual antiplatelet therapy (DAT), most commonly with aspirin and Clopidogrel, is the standard of care for intracranial stenting, including flow diversion. Clopidogrel response varies by individual.

Objective
To investigate the real-world precision of VerifyNow P2Y12 assessment (Accumetrics, San Diego, California) of Clopidogrel response.

Methods
Using a prospectively-collected, IRB-approved cerebral aneurysm database 643 patients were identified who were treated with the Pipeline embolization device from 2011 to 2017. Patients with multiple P2Y12 assays drawn within a 24-h window were identified. A single patient could contribute multiple, independent sets. Levels drawn before a 5-d course of DAT and patients who received alternative antiplatelet agents were excluded. Therapeutic range was defined as platelet reaction units (PRU) 60–200.

Results
A total of 1586 P2Y12 measurements were recorded; 293 (46%) patients had more than one assay. One hundred forty (22%) patients had multiple P2Y12 measurements within 24 h. These patients accounted for 230 independent 24-h sets. The average P2Y12 fluctuation across all sets was 35 points; the 25th, 50th, and 75th percentiles were 12, 26, and 48 points, respectively. Of the 230 24-h sets of P2Y12 assays, 76% remained within their original therapeutic category: 100 (43%) all therapeutic, 54 (23%) all hypo-responsive, and 21 (9%) all hyper-responsive. Twenty-four percent of patients fluctuated between therapeutic categories when multiple P2Y12 assessments were drawn within a 24-h period: 29 (13%) between hypo-response and therapeutic, 23 (10%) between hyper-response and therapeutic, and 3 (1%) between hypo-response and hyper-response.

CONCLUSION
Our experience suggests P2Y12 is an often-imprecise measure, and this should be considered when utilizing P2Y12 levels for clinical decisions.
Comparison of Health-related Quality of Life Between Double-door Laminoplasty and Selective Laminoplasty for Degenerative Cervical Myelopathy, With a Minimum Follow-up of 5 Years
Authors: Hirota Ryosuke , Miyakoshi Naohisa , Yoshimoto Mitsunori , Hongo Michio , Hamada Shuto , Kasukawa Yuji , Oshigiri Tsutomu , Ishikawa Yoshinori , Iesato Noriyuki , Kudo Daisuke , Tanimoto Katsumasa , Terashima Yoshinori , Takebayashi Tsuneo , Shimada Yoichi , Yamashita Toshihiko 
Published: July 2018

Study Design.
A retrospective analysis of prospectively collected multicenter observational data.

Objective.
The aim of this study was to compare the health-related quality of life (HR-QOL) of double-door laminoplasty (DDL) and selective laminoplasty (SL) in patients with degenerative cervical myelopathy (DCM) in two institutions, with a minimum follow-up of 5 years.

Summary of Background Data.
No study has compared DDL and SL regarding postoperative HR-QOL with a follow-up of more than 5 years.

Methods.
One-hundred ninety patients who underwent DDL (n = 77) or SL (n = 113) participated in this study. Short-form 36 (SF-36), Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), Neck Disability Index (NDI), and visual analog scale (VAS) values were compared between the groups.

Results.
Thirty-seven DDL and 52 SL patients were evaluated. The mean follow-up period was 8 years and the follow-up rate was 46.8%. No significant differences were found regarding age and JOA score at baseline. At the follow-up, there were no significant differences in SF-36, JOACMEQ, and VAS score, while the NDI score for headache and sleeping were higher in the SL group. After dividing the SL group into short and long SL subgroups, the long SL subgroup showed a significantly lower score in bodily pain in SF-36, lower and bladder function in JOACMEQ, and pain intensity, personal care, headaches, and sleeping in NDI compared with the other groups.

Conclusion.
No significant differences were found in SF-36, JOA score, and NDI, except for the NDI subscale of headache and sleeping. The subgroup analysis showed that the long SL group showed a decreased QOL compared with the short SL and DDL groups.

Level of Evidence: 3
Development and Validation of a Novel Survival Prediction Model in Patients With Spinal Metastasis From Non-small Cell Lung Cancer
Authors: Yang Minglei , Xu Wei , Liu Tielong , Yang Xinghai , Wang Peng , Wu Sujia , Wei Haifeng , Zhao Jian , Yang Cheng , Xiao Jianru 
Published: July 2018

Study Design.
Retrospective study.

Objective.
The aim of this study was to develop a model for predicting survival of patients with non-small cell lung cancer (NSCLC) spinal metastasis and compare its accuracy with the existing scoring systems.

Summary of Background Data.
Spinal metastasis is commonly seen in advanced NSCLC and usually associated with poor survival prognosis.

Methods.
A total of 376 patients with NSCLC spinal metastases admitted to our institution from January 2010 to October 2016 were enrolled. They were randomly assigned at a 3:1 ratio to a training cohort (n = 282) and a validation cohort (n = 94). A nomogram for survival prediction was established by identifying and integrating significant prognostic factors, and then subjected to bootstrap validation in both training and validation cohorts. The discrimination was measured by concordance index (C-index). Predictive accuracy was compared with three existing models by the receiver-operating characteristic curve (ROC) and area under ROC in both training and validation cohorts.

Results.
Six independent prognostic factors including sex (P = 0.008), the presence of visceral metastasis (P = 0.008), the number of metastases in the vertebral body (P = 0.011), Frankel score (P < 0.001), d-dimer (P = 0.002), and sensitive epidermal growth factor receptor mutation (p < 0.001) were identified and entered into the nomogram. The calibration curves for probability of 3-, 6-, 12- and, 24-month overall survival showed good agreement between the predictive risk and the actual risk. The C-index of the nomogram was 0.708 (95% confidence interval [CI], 0.674–0.742) in the training cohort and 0.683 (95% CI, 0.619–0.747) in the validation cohort. Model comparison showed that this nomogram had better predictive accuracy than the Tomita et al, Tokuhashi et al, and Schwab et al scoring systems (P < 0.05 in the training cohort).

Conclusion.
We established and validated a novel nomogram that could be used to predict the survival outcome of patients with NSCLC spinal metastasis, thus helping clinicians in decision making and individualized care planning of such patients.

Level of Evidence: 4
Incidence and Predictors of 30-Day Readmission Among Patients Hospitalized for Chronic Pancreatitis
Authors: Garg Sushil K. , Sarvepalli Shashank , Campbell James P. , Anugwom Chimaobi , Singh Dupinder , Wadhwa Vaibhav , Singh Rajeshwar , Sanaka Madhusudhan R. 
Published: July 2018

Objectives
Chronic pancreatitis (CP) hospitalizations along with associated morbidity and costs are increasing. The goal of this study was to use the National Readmission Database to identify the incidence and risk factors for 30-day readmissions among patients with CP.

Methods
We performed a retrospective analysis of National Readmission Database from January 2013 to December 2013 to determine patient demographic and clinical characteristics predictive of 30-day hospital readmission for adult patients (aged >18 years) discharged with a principle diagnosis of CP. A survey logistic regression model was used to determine the predictive value of selected variables for 30-day readmission.

Results
In 2013, 12,545 admissions with primary diagnosis of CP were noted, and 30.4% were readmitted within 30 days. Cholecystectomy (odds ratio [OR], 0.53; P = 0.0024) or endoscopic retrograde cholangiopancreatography (OR, 0.70; P = 0.01) during index admission was associated with decreased all-cause readmissions. Pancreatectomy during index admission was associated with reduced (OR, 0.2; P = 0.0005) pancreatitis-related readmissions.

Conclusions
Hospital readmissions for CP are frequent and pose a significant healthcare burden. Performing cholecystectomy, endoscopic retrograde cholangiopancreatography, or pancreatectomy during index admission was associated with reduced odds of readmission.
Managing the Social Determinants of Health: Part II
Authors: Fink-Samnick Ellen 
Published: July 2018

Behavioral Learning Objectives:
This article will:

Explore health care industry considerations for the social determinants of health (SDH).Identify industry initiatives and reimbursement strategies.Discuss SDH-focused assessment tools for professional case managers.Present and apply the Comprehensive Case Management Path.

Primary Practice Settings(s):
Applicable to health and behavioral health settings where case management is practiced.

Findings/Conclusions:
When professional case managers use comprehensive assessments to inform their work with populations impacted by the SDH, barriers to care access can be more readily addressed (e.g., poverty, employment, housing insufficiency, health literacy, migration, and medication adherence). Initiatives, programming, and treatment plans can be advanced to provide target populations with individualized and appropriate intervention. Case management involvement can also be leveraged to coordinate and facilitate successful interprofessional team efforts (Casteneda, Holmes, Madrigal, DeTrinidad, Beyeler, & Quesada, 2015
;
Davis, 2016).

Implications for Case Management Practice:
Case managers must engage clients from a wholistic lens that reflects their standards of practice and accounts for all domains of assessment: medical, cognitive and behavioral, functional, and social. Comprehensive tools to guide a robust and exhaustive screening of issues and opportunities ensure more successful outcomes.
Elevated 68Ga-DOTATATE Activity in IgG4-Related Lymphadenopathy
Authors: Cheng Zhaoting , Song Shuang , Han Yunfeng , Zou Sijuan , Zhu Xiaohua 
Published: July 2018

Abstract

68Ga-DOTATATE PET/CT was performed in a 60-year-old man to detect culprit tumor responsible for tumor-induced osteomalacia (TIO). The images revealed multiple foci of abnormal activity in soft tissue lesion, which were not typical of tumor causing TIO in 68Ga-DOTATATE PET/CT. Considering other neoplastic processes, FDG PET/CT were subsequently performed, which showed all same lesions, although the lesions with highest activity were different between the scans. Pathological examination demonstrated that the patient experienced TIO caused by 1 lesion, but other lesions were due to IgG4-related lymphadenopathy.
Persistent Opioid Use Among Children, Adolescents, and Young Adults After Common Cleft Operations
Authors: Bennett Katelyn G. , Harbaugh Calista M. , Hu Hsou Mei , Vercler Christian J. , Buchman Steven R. , Brummett Chad M. , Waljee Jennifer F. 
Published: July 2018

Background:
Surgical care represents an important source of opioid prescribing and chronic use, but rates of prolonged opioid use following pediatric procedures remain unclear. The authors describe the rates and risk factors for new persistent opioid use in patients after common cleft operations.

Methods:
The authors examined claims from the Truven Marketscan databases from January 1, 2010 to December 31, 2014. The authors included opioid-naive patients ages 8 to 25, who underwent 1 of 10 cleft-related procedures. Patients were considered opioid-naïve if they had no opioid prescription fills in the 11 months prior to the perioperative period. The authors obtained a random sample of age-matched, nonsurgical patients from the same dataset to be used as a control group. Included cleft patients had no procedural codes in the 6 months following surgery. All included patients filled an opioid prescription during the perioperative period, defined as 30 days before and 14 days after surgery. The primary outcome was new persistent opioid use, which is defined as continued opioid prescription fills between 90 and 180 days after the procedure.

Results:
This cohort included 2039 cleft patients and 2100 control patients. The incidence of new persistent opioid use following surgery was 4.4% and 0.1% in the control group. Higher odds of opioid use 3 months beyond surgery were associated with distractor placement (OR 5.34, CI 2.00–14.24, P = 0.001). Increasing age (OR 1.11, CI 1.04–1.17, P = 0.001) and presence of a gastrointestinal comorbidity (OR 7.37, CI 1.49–36.54, P = 0.014) were also associated with new persistent use.

Conclusions:
New persistent opioid use occurs after cleft-related procedures and could lead to chronic use in children, adolescents, and young adults.
The Double Thread Buried Nonincisional Blepharoplasty Technique
Authors: Jung Gyu Sik , Park Min Hyung 
Published: July 2018

Abstract
The nonincisional blepharoplasty technique is widely practiced because it is relatively simple, causes less scarring than the incisional technique, provides a quick recovery, and allows easy correction. Although various modified nonincisional techniques have been used to create a more natural appearance, complications such as loosening of the double fold and regression of the double fold line may still occur. So the authors introduce the double thread buried nonincisional blepharoplasty technique to reduce such complications. This study included 300 patients who underwent upper eyelid blepharoplasty between January 2016 and June 2017. Most patients displayed satisfactory aesthetic results, and no significant complications occurred, such as loosening of the double fold. There was no obvious regression of the double fold; however, of the patients who underwent surgery early, 1 patient required reoperation to correct loosening of the fold on one side during the follow-up period. One patient presented with a subcutaneous suture knot, and the knot was removed in the clinic. The double thread buried nonincisional blepharoplasty technique is a simple and less time-consuming method for a durable double fold and provides satisfactory aesthetic results.
Monocular Diplopia and Nondisplaced Inferior Rectus Muscle on Computed Tomography in a Pediatric Pure Orbital-Floor Fracture
Authors: Joganathan Varajini , Gupta Deepak , Beigi Bijan 
Published: July 2018

Abstract
Trapdoor fractures are common in children because of elastic nature of the pediatric bone. Clinical signs and radiological evidence in these cases may be minimal.
This study involves a 14-year-old girl who sustained blunt trauma to her left eye. Initial investigation, for pure orbital floor fracture included computerized tomography (CT scan) of the orbit, did not show any evidence of incarcerated rectus muscle. She had no limitation of extraocular movements nor enophthalmos. Following conservative treatment, she had a left persistent orbital pain and left monocular diplopia. This prompted a magnetic resonance imaging (MRI) of the orbit investigating soft tissue, which found fine partial muscle herniation through the self-sealed fracture needing surgical intervention.
Although an orbital CT imaging is preferrd, in this acute setting, magnetic resonance imaging should be considered to delineate the soft tissue anatomy in relation to a trapdoor fracture, especially when there are not cardinal associated physical symptoms with a trap door fracture such as restricted eye movement and enophthalmos. Mono-ocular diplopia can be noted as an associated symptom to prompt early surgical repair.
Citrated kaolin thrombelastography (TEG) thresholds for goal-directed therapy in injured patients receiving massive transfusion
Authors: Stettler Gregory R. , Sumislawski Joshua J. , Moore Ernest E. , Nunns Geoffrey R. , Kornblith Lucy Z. , Conroy Amanda S. , Callcut Rachael A. , Silliman Christopher C. , Banerjee Anirban , Cohen Mitchell J. , Sauaia Angela 
Published: July 2018

INTRODUCTION
Goal-directed hemostatic resuscitation based on thrombelastography (TEG) has a survival benefit compared with conventional coagulation assays such as international normalized ratio, activated partial thromboplastin time, fibrinogen level, and platelet count. While TEG-based transfusion thresholds for patients at risk for massive transfusion (MT) have been defined using rapid TEG, cutoffs have not been defined for TEG using other activators such as kaolin. The purpose of this study was to develop thresholds for blood product transfusion using citrated kaolin TEG (CK-TEG) in patients at risk for MT.

METHODS
CK-TEG was assessed in trauma activation patients at two Level 1 trauma centers admitted between 2010 and 2017. Receiver operating characteristic (ROC) curve analyses were performed to test the predictive performance of CK-TEG measurements in patients requiring MT, defined as >10 units of red blood cells or death within the first 6 hours. The Youden Index defined optimal thresholds for CK-TEG-based resuscitation.

RESULTS
Of the 825 trauma activations, 671 (81.3%) were men, 419 (50.8%) suffered a blunt injury, and 62 (7.5%) received a MT. Patients who had a MT were more severely injured, had signs of more pronounced shock, and more abnormal coagulation assays. CK-TEG R-time was longer (4.9 vs. 4.4 min, p = 0.0084), angle was lower (66.2 vs. 70.3 degrees, p < 0.0001), maximum amplitude was lower in MT (57 vs. 65.5 mm, p < 0.0001), and LY30 was greater (1.8% vs. 1.2%, p = 0.0012) in patients with MT compared with non-MT. To predict MT, R-time yielded an area under the ROC curve (AUROC) = 0.6002 and a cut point of >4.45 min. Angle had an AUROC = 0.6931 and a cut point of <67 degrees. CMA had an AUROC = 0.7425, and a cut point of <60 mm. LY30 had an AUROC = 0.623 with a cut point of >4.55%.

CONCLUSION
We have identified CK-TEG thresholds that can guide MT in trauma. We propose plasma transfusion for R-time >4.45 min, fibrinogen products for an angle <67 degrees, platelet transfusion for MA <60 mm, and antifibrinolytics for LY30 >4.55%.

LEVEL OF EVIDENCE
Therapeutic study, level V.
Perceptual consciousness and cognitive access: an introduction
Authors: Fazekas Peter , Overgaard Morten 
Published: July 2018

The problem of perceptual consciousness—the question of how our subjective experiences (colours as we see them; sounds as we hear them; tastes, etc., as we feel them) could be accounted for in terms of brain processes—is often regarded as the greatest unsolved mystery of our times. In recent literature, one of the most pressing questions in this regard is whether the neural basis of perceptual consciousness is independent of the neural basis of cognitive access mechanisms that make reporting and reflecting on conscious experiences possible. The Theme Issue focuses on this central problem of consciousness research and aims to contribute to the field by critically discussing state-of-the-art empirical findings, identifying methodological problems and proposing novel approaches.
This article is part of the theme issue ‘Perceptual consciousness and cognitive access’.
If perception is probabilistic, why does it not seem probabilistic?
Authors: Block Ned 
Published: July 2018

The success of the Bayesian perspective in explaining perceptual phenomena has motivated the view that perceptual representation is probabilistic. But if perceptual representation is probabilistic, why does normal conscious perception not reflect the full probability functions that the probabilistic point of view endorses? For example, neurons in cortical area MT that respond to the direction of motion are broadly tuned: a patch of cortex that is tuned to vertical motion also responds to horizontal motion, but when we see vertical motion, foveally, in good conditions, it does not look at all horizontal. The standard solution in terms of sampling runs into the problem that sampling is an account of perceptual decision rather than perception. This paper argues that the best Bayesian approach to this problem does not require probabilistic representation.
This article is part of the theme issue ‘Perceptual consciousness and cognitive access'.
The relationship between attention and consciousness: an expanded taxonomy and implications for ‘no-report’ paradigms
Authors: Pitts Michael A. , Lutsyshyna Lydia A. , Hillyard Steven A. 
Published: July 2018

Tensions between global neuronal workspace theory and recurrent processing theory have sparked much debate in the field of consciousness research. Here, we focus on one of the key distinctions between these theories: the proposed relationship between attention and consciousness. By reviewing recent empirical evidence, we argue that both theories contain key insights and that certain aspects of each theory can be reconciled into a novel framework that may help guide future research. Alternative theories are also considered, including attended intermediate-level representations theory, integrated information theory and higher order thought theory. With the aim of offering a fresh and nuanced perspective to current theoretical debates, an updated taxonomy of conscious and non-conscious states is proposed. This framework maps a wider spectrum of conscious states by incorporating contemporary views from cognitive neuroscience regarding the variety of attentional mechanisms that are known to interact with sensory processing. Whether certain types of attention are necessary for phenomenal and access consciousness is considered and incorporated into this extended taxonomy. To navigate this expanded space, we review recent ‘no-report’ paradigms and address several methodological misunderstandings in order to pave a clear path forward for identifying the neural basis of perceptual awareness.This article is part of the theme issue ‘Perceptual consciousness and cognitive access'.
Dream experiences and the neural correlates of perceptual consciousness and cognitive access
Authors: Fazekas Peter , Nemeth Georgina 
Published: July 2018

This paper approaches the debate whether perceptual consciousness requires cognitive access from the perspective of dream studies, and investigates what kind of findings could support the opposing views of this debate. Two kinds of arguments are discussed, one that claims that the hypoactivity of the dorsolateral prefrontal cortex in rapid eye movement sleep is directly relevant, and another that proposes that locating the neural correlates of dream experiences can indirectly inform the debate. It is argued that under closer reflection, neither the classical claim about dorsolateral prefrontal cortex hypoactivity nor the more recent emphasis on general posterior hot zone activity during dreaming stand up to scrutiny. White dreaming is identified as the phenomenon that, nevertheless, holds the most promise to have an impact on the debate. Going beyond the topic if studying dreams can contribute to this debate, it is argued that cognitive access is not a monolithic phenomenon, and its neural correlates are not well understood. There seems to be a relevant form of cognitive access that can operate in the absence of activity in the dorsolateral prefrontal cortex, and maybe also in the whole frontal region. If so, then exclusive posterior activation during conscious experiences might very well be compatible with the hypothesis that perceptual consciousness requires cognitive access.This article is part of the theme issue ‘Perceptual consciousness and cognitive access'.