bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combining National Early Warning Score With Soluble Urokinase Plasminogen Activator Receptor (suPAR) Improves Risk Prediction in Acute Medical Patients: A Registry-Based Cohort Study*
Authors: Rasmussen Line J. H. , Ladelund Steen , Haupt Thomas H. , Ellekilde Gertrude E. , Eugen-Olsen Jesper , Andersen Ove 
Published: October 2018

Objectives:
Soluble urokinase plasminogen activator receptor is a prognostic biomarker associated with critical illness, disease progression, and risk of mortality. We aimed to evaluate whether soluble urokinase plasminogen activator receptor adds prognostic value to a vital sign-based score for clinical monitoring of patient risk (National Early Warning Score) in acute medical patients.

Design:
Registry-based observational cohort study of consecutively admitted acute medical patients.

Setting:
The Acute Medical Unit, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark.

Patients:
Acute medical patients admitted between November 18, 2013, and September 30, 2015.

Interventions:
None.

Measurements and Main Results:
Of 17,312 included patients, admission National Early Warning Score was available for 16,244 (93.8%). During follow-up, 587 patients (3.4%) died in-hospital, 859 (5.0%) within 30 days, and 1,367 (7.9%) within 90 days. High soluble urokinase plasminogen activator receptor was significantly associated with in-hospital-, 30-day-, and 90-day mortality within all National Early Warning Score groups, in particular in patients with a low National Early Warning Score; for 30-day mortality, mortality rate ratios ranged from 3.45 (95% CI, 2.91–4.10) for patients with National Early Warning Score 0–1, to 1.86 (95% CI, 1.47–2.34) for patients with National Early Warning Score greater than or equal to 9 for every doubling in soluble urokinase plasminogen activator receptor (log2-transformed). Combining National Early Warning Score, age, and sex with soluble urokinase plasminogen activator receptor improved prediction of in-hospital-, 30-day-, and 90-day mortality, increasing the area under the curve (95% CI) for 30-day mortality from 0.86 (0.85–0.87) to 0.90 (0.89–0.91), p value of less than 0.0001, with a negative predictive value of 99.0%.

Conclusions:
The addition of soluble urokinase plasminogen activator receptor to National Early Warning Score significantly improved risk prediction of both low- and high-risk acute medical patients. Patients with low National Early Warning Score but elevated soluble urokinase plasminogen activator receptor had mortality risks comparable to that of patients with higher National Early Warning Score.
Adenosine Triphosphate Release is Required for Toll-Like Receptor-Induced Monocyte/Macrophage Activation, Inflammasome Signaling, Interleukin-1β Production, and the Host Immune Response to Infection
Authors: Lee Albert H. , Ledderose Carola , Li Xiaoou , Slubowski Christian J. , Sueyoshi Koichiro , Staudenmaier Laura , Bao Yi , Zhang Jingping , Junger Wolfgang G. 
Published: October 2018

Objectives:
Monocytes and macrophages produce interleukin-1β by inflammasome activation which involves adenosine triphosphate release, pannexin-1 channels, and P2X7 receptors. However, interleukin-1β can also be produced in an inflammasome-independent fashion. Here we studied if this mechanism also involves adenosine triphosphate signaling and how it contributes to inflammasome activation.

Design:
In vitro studies with human cells and randomized animal experiments.

Setting:
Preclinical academic research laboratory.

Subjects:
Wild-type C57BL/6 and pannexin-1 knockout mice, healthy human subjects for cell isolation.

Interventions:
Human monocytes and U937 macrophages were treated with different inhibitors to study how purinergic signaling contributes to toll-like receptor-induced cell activation and interleukin-1β production. Wild-type and pannexin-1 knockout mice were subjected to cecal ligation and puncture to study the role of purinergic signaling in interleukin-1β production and host immune defense.

Measurements and Main Results:
Toll-like receptor agonists triggered mitochondrial adenosine triphosphate production and adenosine triphosphate release within seconds. Inhibition of mitochondria, adenosine triphosphate release, or P2 receptors blocked p38 mitogen-activated protein kinase and caspase-1 activation and interleukin-1β secretion. Mice lacking pannexin-1 failed to activate monocytes, to produce interleukin-1β, and to effectively clear bacteria following cecal ligation and puncture.

Conclusions:
Purinergic signaling has two separate roles in monocyte/macrophage activation, namely to facilitate the initial detection of danger signals via toll-like receptors and subsequently to regulate nucleotide-binding oligomerization domain, leucine rich repeat and pyrin domain containing 3 inflammasome activation. Further dissection of these mechanisms may reveal novel therapeutic targets for immunomodulation in critical care patients.
Parental Distress and Stress in Association with Health-Related Quality of Life in Youth with Spina Bifida: A Longitudinal Study
Authors: Driscoll Colleen F. Bechtel , Buscemi Joanna , Holmbeck Grayson N. 
Published: October 2018

Abstract

Objective:
This study examined associations between 3 distinct parent factors (parent personal distress, parenting stress, and spina bifida (SB)-specific parenting stress) and youth and parent proxy reports of youth health-related quality of life (HRQOL) over time.

Method:
Participants were recruited as part of a longitudinal study, and data were collected at 3 time points, spaced 2 years apart. Parents and youth completed questionnaires, and youth completed neuropsychological assessment tasks to determine youth intelligence quotient during home visits.

Results:
Analyses revealed that higher levels of maternal SB-specific parenting stress were related to lower levels of youth-reported HRQOL at time 1. Other parent factors were not associated with youth report of HRQOL at the earlier time points, although higher levels of maternal SB-specific parenting stress and paternal parenting stress were associated with lower levels of youth HRQOL at time 3. For mothers and fathers, increased parent personal distress, parenting stress, and SB-specific parenting stress were associated with decreased proxy report of youth HRQOL. Of these three parent factors, SB-specific parenting stress was consistently the most strongly associated with parent proxy-report of youth HRQOL.

Conclusion:
Parenting stress and distress are important targets for interventions, and these interventions may improve youth outcomes, especially as youth age. Future research is needed to identify other factors influencing youth HRQOL over time.
A Young Man with Trisomy 21 and Sudden Behavioral Changes
Authors: Cormier DePorres , Jean Davidson Emily , Young Amy , Augustyn Marilyn 
Published: October 2018

CASE:
Grant is a 13-year-old boy with trisomy 21 who presents with his mother for concerns regarding the emergence of several new disruptive behaviors. While he is verbal, he also communicates through an augmentative communication device. He currently attends a residential school. Over the past 2 months, he has begun spitting at the staff, engaging in self-injurious behaviors, placing his hands in his pants, and frequently talking about “pee and poop.” Notably, Grant has undergone several changes to his educational placement and medical health over the past several months. He recently transferred to his current residential school from another placement to be closer to his family, although this has meant that Grant was unable to work with his long-time aide. Additionally, most of the students at Grant's current school are significantly lower functioning than him, such that Grant is one of the few verbal children.
Approximately 3 months ago, Grant underwent significant dental work under anesthesia. Grant had previously taken an alpha-agonist for behavioral management, although he was weaned off this 4 months ago because of increasing somnolence increasing somnolence. Grant's recent behavioral challenges make performing community and home activities more challenging.
Grant's behavioral history is notable for a previous episode of behavioral and emotional challenges 18 months ago. This occurred in the setting of transitioning to a new classroom with higher academic and behavioral expectations and decreased time spent with his family. These behaviors had consisted of self-injurious behaviors and tantrums consisting of crying and social withdrawal. This was managed by increased behavioral and academic supports via trained teachers and aides, medication management, and optimizing his augmentative communication. After these interventions, Grant's behavioral and emotional functioning improved and remained stable until this current episode.
Grant's mother is concerned about what may be causing these emerging behaviors and wondering if any of the recent educational and medical stressors could be contributing. What do you do next?
Age and leptinemia association with anxiety and depression symptoms in overweight middle-aged women
Authors: Naufel Maria Fernanda , Boldarine Valter Tadeu , Oyama Lila Missae , do Nascimento Cláudia Maria Oller , Silva dos Santos Gianni Mara , Hachul Helena , Ribeiro Eliane Beraldi 
Published: October 2018

Abstract

Objective:
The aim of the study was to investigate the effect of menopause and of postmenopausal stages on depression and anxiety symptoms, and whether these symptoms associate with anthropometric, metabolic, and hormonal parameters in midlife women.

Methods:
Postmenopausal women (age 50-65), either at early (EPM, n=33) or late (LPM, n = 23) postmenopause, and 23 premenopausal controls (PreM, age 40-50), matched for BMI with the PM groups, were studied. Blood biochemical and hormonal determinations, bioimpedance anthropometry, and depression and anxiety symptoms (Beck's depression [BDI] and anxiety [BAI] inventories) were conducted.

Results:
The BAI score was higher in both PM groups than in the PreM group. In contrast, only the LPM group showed a significantly elevated BDI score. All groups presented overweight and abdominal obesity, having similar BMI and waist/hip ratio values. Both PM groups showed insulin resistance, whereas only the LPM group presented decreased skeletal muscle mass and basal metabolic rate. Correlation analysis, including all 79 middle-aged women, showed age, percentage body fat, waist/hip ratio, and leptinemia to correlate positively with the anxiety and depression scores. Multivariate regression showed leptin and age to associate positively with depressive- and anxious-like symptoms.

Conclusions:
Postmenopausal women presented impaired body composition, energy expenditure, insulin sensitivity, and mental symptoms, in comparison to similarly overweight premenopausal women. Among all the overweight midlife women, these symptoms were more strongly associated with age and leptin levels than with reproductive aging itself. The data indicate that, among overweight middle-aged women with abdominal obesity, the aging process and the development of leptin resistance are associated with impairment of mental health.
Telehealth in Plastic Surgery: A Veterans Affairs Hospital Perspective
Authors: Douglas Stephanie , Geiger Erik , McGregor Andrew , Norwich Amanda , Abbate Deena , Hsia Henry , Narayan Deepak 
Published: October 2018

Background:
Telemedicine is a rapidly growing tool since its invention in the 1950s. Recently, it has expanded to the field of plastic surgery. In the Connecticut VA System, there is 1 plastic surgeon at a central location for the state of Connecticut and southern Massachusetts. Our aim was to pilot a telehealth program for plastic surgery consultation within the VA to improve access to subspecialty care. We intend to discuss the value of telehealth as part of consultation services, and assess patient attitudes toward telemedicine.

Methods:
Patients in the Connecticut VA System referred for plastic surgery consultation for evaluation of nonurgent diagnoses, such as skin lesions, carpal tunnel syndrome, and chronic wounds, were invited to participate. After being appropriately consented according to Connecticut state law, patients completed a postvisit questionnaire rating their overall satisfaction, quality of interaction, and ability to communicate using a modified 10-point Likert scale. Means were calculated for numerical responses. Preference for future telehealth visits was reported as a percentage.

Results:
Forty-one of 44 eligible patients elected to participate. Of those patients, 83% (n = 34) stated they prefer telemedicine services for future visits. Patients rated overall satisfaction 9.2/10, overall quality of interaction 9.2/10, ability to communicate 9.3/10, and sound and video quality 8.6/10 and 9.0/10, respectively.

Conclusion:
Remote video telemedicine is a feasible method of plastic surgery consultation and results in high patient satisfaction. Further studies should focus on cost-effectiveness and ways to broaden the use of telehealth services in plastic surgery.
Contact Dermatitis Caused by Dermabond Advanced Use
Authors: Nakagawa Shiho , Uda Hirokazu , Sarukawa Shunji , Sunaga Ataru , Asahi Rintaro , Chi Daekwan , Yoshimura Kotaro 
Published: October 2018

Background:
Dermabond Advanced (DBA) has been widely used globally; however, severe contact dermatitis (CD) can be a serious adverse effect of DBA use. In this study, we investigated the characterization and incidence rate of CD after using DBA and the safe use of DBA.

Methods:
One hundred consecutive patients who underwent skin closure with DBA were investigated. All patients were women undergoing breast reconstruction. DBA was applied to their trunk and limbs following reconstruction.

Results:
Seven patients (7%) presented with CD. Of these, 4 patients exhibited CD after the second DBA use; sensitization influence by the first DBA use was considered. One of 3 patients presenting with CD after the first DBA use was allergic to cosmetic glue, and the influence of immunological cross-reaction of acrylates was suggested.

Conclusion:
We consider that DBA use is inadequate for wounds with an improper margin and in dry and low-skin barrier areas such as the trunk and limbs because it may induce irritant CD and sensitization of DBA and subsequent allergic CD. Frequent use can also induce sensitization. If patients have a history of acrylate allergies, DBA use should be avoided because immunological cross-reaction from acetylates could result.
The Role of Antibiotics in Breast Pocket Irrigation and Implant Immersion: A Systematic Review
Authors: Frois Ashley O. , Harbour Patrick O. , Azimi Farhad , Young Jane , Chan Belinda , Mak Cindy , Warrier Sanjay 
Published: October 2018

Background:
The usage of antibiotics and antiseptics to washout the breast pocket, or to soak the breast implant during surgery, has come under scrutiny in recent times. Guidelines from the Centers for Disease Control and Prevention give no recommendation for or against the usage of antibiotics in this regard. They do however offer a weak recommendation for washing tissues with iodophor. This systematic review aims to investigate the efficacy and impact of such topical antibiotic or antiseptic usage in reducing infection rates.

Methods:
A systematic electronic search was performed on the PreMEDLINE, MEDLINE, EMBASE, and CENTRAL (Cochrane) databases from inception to April 2017. Reference search was performed manually through Scopus. Results of the searches were independently screened by 2 reviewers (A.F. and P.H.). Studies involving an implant or tissue expander, with appropriate controls were included. Meta-analyses were performed where possible and data summarized when not.

Results:
Three retrospective cohort studies were found to fit the review requirements. No randomized control trials were found. These studies covered a period of 1996–2010 for a total of 3,768 women undergoing augmentative surgery. The usage of antibiotics in pocket washout or implant immersion resulted in lower infection rates (RR = 0.52; P = 0.004; 95% CI = 0.34–0.81).

Conclusions:
There is a clinical benefit in using antibiotics for breast pocket irrigation and implant immersion. However, the quality of the evidence obtained in this review is low; hence, we recommend a randomized control trial for a higher level of evidence on this important issue.
Geospatial Analysis of Risk Factors Contributing to Loss to Follow-up in Cleft Lip/Palate Care
Authors: Sharif-Askary Banafsheh , Bittar Peter G. , Farjat Alfredo E. , Liu Beiyu , Vissoci Joao Ricardo Nickenig , Allori Alexander C. 
Published: October 2018

Background:
Multidisciplinary cleft care depends on follow-up at specified time points to monitor and address functional or aesthetic concerns that may arise during a child's development. However, loss to follow-up (LTFU) is common and can lead to missed opportunities for therapeutic and surgical intervention. This study explores clinical, demographic, and geographic determinants of LTFU in cleft care.

Methods:
Medical records were retrospectively evaluated for 558 pediatric patients of a single mid-volume cleft team. The primary outcome was LTFU. Spatial dependency was evaluated using variograms. The probability of LTFU was assessed using a generalized linear geostatistical model within a Bayesian framework. Risk maps were plotted to identify vulnerable communities within our state at higher risk of LTFU.

Results:
Younger age at last encounter was a strong predictor of LTFU (P < 0.0001), even when ignoring spatial dependency among observations. When accounting for spatial dependency, lower socioeconomic status [OR = 0.98; 95% CI = (0.97–0.99)] and cleft phenotype [OR = 0.55; 95% CI = (0.36, 0.81)] were significant predictors of LTFU. Distance from the cleft team and rural/urban designation were not statistically significant predictors. Cartographic representation of predicted probability of LTFU revealed vulnerable communities across our state, including in the immediate vicinity of our cleft center.

Conclusions:
Geostatistical methods are able to identify risk factors missed by traditional statistical analysis. Knowledge of vulnerable populations allow a cleft team to allocate more resources toward high-risk areas to rectify or prevent deficiencies in care.
Reconstruction and Recovery After Massive Burn
Authors: Furnas David W. , Furnas Heather J. 
Published: October 2018

Background:
Forty years ago, a 33-year-old female suffered a 35% total body surface area burn after the car in which she was a passenger caught fire in a rear-end collision. She experienced second- and third-degree burns of her face, head, back, arms, and hands.

Methods:
After immediate burn resuscitation, the patient underwent approximately 40 reconstructive procedures over the course of the first 17 years after her burns.

Results:
While finding social situations difficult to endure, the patient developed tools to help her face the public.

Conclusions:
These tools included confident body language, verbal responses, and makeup application. This case report details surgical procedures the patient underwent and her own lasting contribution through establishing the first hospital-based Image Enhancement and Behavioral Skills program along with her extensive work with the Phoenix Society for Burn Survivors.
Functional Temporomandibular Joint Reconstruction in Costochondral Grafting of Micrognathia
Authors: Hirota Yuka , Ueda Koichi , Katayama Misato , Otsuki Yuki 
Published: October 2018

Summary:
Rib bone and costochondral complex grafting has been used to treat micrognathia classified as Pruzansky type III. To acquire more physiological joint movement, we reconstructed a temporomandibular joint with the glenoid fossa in addition to the mandibular ramus. The patient underwent a tracheostomy to correct her airway obstruction at 2 months of age. After that, no further surgical treatments were performed on the micrognathia. When she was 6 years of age and during consultation at our department, micrognathia caused by Goldenhar syndrome was confirmed. A head and neck computed tomography scan showed hypoplasia and deficit of the mandible, severe glossoptosis and airway constriction. Initially, a bilateral mandibular body distraction was performed at 6 years of age, and 15 mm of elongation was obtained. Subsequently, reconstruction of the right ramus and right temporomandibular joint fossa was performed at 8 years of age to achieve extubation. Part of her sixth rib and costochondral complex graft was used for the ramus, and costochondral graft was used for the joint fossa. Some new ideas for temporomandibular joint reconstruction were added. Postoperatively, the open mouth range was increased and improvement of the airway space narrowing was observed in a computed tomography scan. The main points of this new method are prevention of ankylosis, skull cortex thinning, and reconstructed ramus’ dislocation. This method may become an effective new treatment for cases of micrognathia with a ramus classified as Pruzansky type III.
Scratch Collapse Test for Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis
Authors: Huynh Minh N. Q. , Karir Aneesh , Bennett Alexandria 
Published: October 2018

Background:
Despite the fact that carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, the diagnostic accuracy of clinical screening examinations for CTS is controversial. The scratch collapse test (SCT) is a novel test that may be of diagnostic advantage. The purpose of our study was to determine the diagnostic accuracy of the SCT for CTS.

Methods:
A literature search was performed using PubMed (1966 to April 2018); Ovid MEDLINE (1966 to April 2018); EMBASE (1988 to April 2018); and Cochrane Central Register of Controlled Trials (The Cochrane Library, to April 2018). We examined the studies for the pooled sensitivity, specificity, and likelihood ratios of the SCT. This review has been registered with PROSPERO (CRD42018077115).

Results:
The literature search generated 13 unique articles. Seven articles were included for full text screening and 3 articles met our inclusion criteria, all of which were level II evidence with low risk of bias (165 patients). Pooled sensitivities, specificities, positive likelihood ratio, and negative likelihood ratios were 0.32 [95% CI (0.24–0.41)], 0.62 [95% CI (0.45–0.78)], 0.75 [95% CI (0.33–1.67)], and 1.03 [95% CI (0.61–1.74)], respectively. The calculated area under the summary receiver operating characteristic (AUSROC) curve was 0.25, indicating a low diagnostic accuracy.

Conclusion:
The SCT has poor sensitivity; however, it is moderately specific. Based on the current literature and their variable quality of the evidence, we conclude that the SCT is not an adequate screening test for detecting CTS.