bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality improvement
Authors: Laughner Chelsea , Sentz Ryan , Sabados Alison , Feil Danielle , Cooley Amy Seitz 
Published: April 2019

Abstract

Purpose:
This study assessed the impact of process standard work, a quality improvement tool, on staff adherence to nurse-driven unfractionated heparin (UFH) protocols in adult patients at a community teaching hospital.

Methods:
This was a retrospective quality improvement project, and statistical analysis was performed by a senior research specialist at the facility.

Results:
In total, 109 venous thromboembolism or cardiac UFH anticoagulant protocols were included in the final analysis, accounting for 445 activated partial thromboplastin time results.

Conclusion:
There was no change in adherence to a nurse-driven UFH protocol among adult patients after the implementation of process standard work.
Characterizing Social and Academic Aspects of School Anxiety in Pediatric Chronic Pain
Authors: Gibler Robert C. , Beckmann Emily A. , Lynch-Jordan Anne M. , Kashikar-Zuck Susmita , Mano Kristen E. Jastrowski 
Published: April 2019

Objective:
School anxiety is a prevalent and debilitating mental health problem among youth with chronic pain. Despite evidence that anxiety in the context of school is associated with significant school-related disability, no studies have examined specific aspects of school anxiety in a pediatric chronic pain population.

Materials and Methods:
Adolescents with chronic pain (n=30) and age-matched and sex-matched controls (n=30) and their parents completed questionnaires assessing school anxiety and functioning.

Results:
Adolescents with chronic pain reported significantly more cognitive, behavioral, and psychophysiological symptoms of school anxiety relative to healthy controls. Youth with pain also endorsed significantly greater school anxiety in situations involving negative social evaluation and peer aggression. Exploratory analyses indicated that adolescents with chronic pain reporting school refusal behaviors more strongly endorsed behavioral and psychophysiological school anxiety symptoms, and more symptoms in social-evaluative situations. Youth with pain reporting lower school functioning endorsed more cognitive school anxiety symptoms and anxiety in situations involving academic failure relative to those reporting higher functioning.

Discussion:
Present results offer a nuanced perspective into the underlying sources of school anxiety among adolescents with chronic pain. Our findings may inform future research efforts and targeted school functioning interventions. In particular, findings suggest that an individualized approach to the assessment of school anxiety which considers the unique sources of anxiety (eg, social vs. academic) may lay the groundwork for the refinement of school functioning interventions in pediatric chronic pain.
Tension Band Plate (TBP)-guided Hemiepiphysiodesis in Blount Disease: 10-Year Single-center Experience With a Systematic Review of Literature
Authors: Jain Mohit J. , Inneh Ifeoma A. , Zhu Huirong , Phillips William A. 
Published: April 2019

Background:
Primary treatment for Blount disease has changed in the last decade from osteotomies or staples to tension band plate (TBP)-guided hemiepiphysiodesis. However, implant-related issues have been frequently reported with Blount cases. The purpose of our study is to evaluate the surgical failure rates of TBP in Blount disease and characterize predictors for failure.

Methods:
We performed an Institutional Review Board–approved retrospective chart-review of pediatric patients with Blount disease to evaluate the results of TBP from 2008 to 2017 and a systematic literature review. Blount cases defined as pathologic tibia-vara with HKA (hip-knee-ankle) axis and MDA (metaphyseal-diaphyseal angle) deviations ≥11 degrees were included in the analysis. Surgical failure was categorized as mechanical and functional failure. We studied both patient and implant-related characteristics and compared our results with a systematic review.

Results:
In 61 limbs of 40 patients with mean follow-up of 38 months, we found 41% (25/61) overall surgical failure rate and 11% (7/61) mechanical failure rate corresponding to 11% to 100% (range) and 0% to 50% (range) in 8 other studies. Statistical comparison between our surgical failure and nonfailure groups showed significant differences in deformity (P=0.001), plate material (P=0.042), and obesity (P=0.044) in univariate analysis. The odds of surgical failure increased by 1.2 times with severe deformity and 5.9 times with titanium TBP in the multivariate analysis after individual risk-factor adjustment. All 7 mechanical failures involved breakage of cannulated screws on the metaphyseal side.

Conclusions:
Most of the studies have reported high failure rates of TBP in Blount cases. Besides patient-related risk factors like obesity and deformity, titanium TBP seems to be an independent risk factor for failure. Solid screws were protective for mechanical failure, but not for functional failure. In conclusion, efficacy of TBP still needs to be proven in Blount disease and implant design may warrant reassessment.

Level of Evidence:
Level III—retrospective comparative study with a systematic review.
The 5-Item Modified Frailty Index Is Predictive of Severe Adverse Events in Patients Undergoing Surgery for Adult Spinal Deformity
Authors: Yagi Mitsuru , Michikawa Takehiro , Hosogane Naobumi , Fujita Nobuyuki , Okada Eijiro , Suzuki Satoshi , Tsuji Osahiko , Nagoshi Narihito , Asazuma Takashi , Tsuji Takashi , Nakamura Masaya , Matsumoto Morio , Watanabe Kota 
Published: April 2019

Study Design.
A retrospective review of 281 consecutive cases of adult spine deformity (ASD) surgery (age 55 ± 19 yrs, 91% female, follow-up 4.3 ± 1.9 yrs) from a multicenter database.

Objective.
To compare the value and predictive ability of the 5-item modified frailty index (mFI-5) to the conventional 11-item modified frailty index (mFI-11) for severe adverse events (SAEs).

Summary of Background Data.
Several recent studies have described associations between frailty and surgical complications. However, the predictive power and usefulness of the mFI-5 have not been proven.

Methods.
SAEs were defined as: Clavien-Dindo grade >3, reoperation required, deterioration of motor function at discharge, or new motor deficit within 2 years. The patients’ frailty was categorized by the mFI-5 and mFI-11 (robust, prefrail, or frail). Spearman's rho was used to assess correlation between the mFI-5 and mFI-11. Univariate and multivariate Poisson regression analyses were conducted to analyze the relative risk of mFI-5 and mFI-11 as a predictor for SAEs in ASD surgery. Age, sex, and baseline sagittal alignment (Schwab-SRS classification subcategories) were used to adjust the baseline variance of the patients.

Results.
Of the 281 patients, 63 (22%) had developed SAE at 2 years. The weighted Kappa ratio between the mFI-5 and mFI-11 was 0.87, indicating excellent concordance across ASD surgery. Frailty was associated with increased total complications, perioperative complications, implant-related complications, and SAEs. Adjusted and unadjusted models showed similar c-statistics for mFI-5 and mFI-11 and a strong predictive ability for SAEs in ASD surgery. As the mFI-5 increased from 0 to ≥2, the rate of SAEs increased from 17% to 63% (P < 0.01), and the relative risk was 2.2 (95% CI: 1.3–3.7).

Conclusion.
The mFI-5 and the mFI-11 were equally effective predictors of SEA development in ASD surgery. The evaluation of patient frailty using mFI-5 may help surgeons optimize procedures and counsel patients.

Level of Evidence: 4
Fibroblast Growth Factor 9 Is Upregulated Upon Intervertebral Mechanical Stress-Induced Ligamentum Flavum Hypertrophy in a Rabbit Model
Authors: Hayashi Kazunori , Suzuki Akinobu , Terai Hidetomi , Ahmadi Sayed Abdullah , Rahmani Mohammad Suhrab , Maruf Mohammad Hasib , Habibi Hasibullah , Hori Yusuke , Yamada Kentaro , Hoshino Masatoshi , Toyoda Hiromitsu , Takahashi Shinji , Tamai Koji , Ohyama Shoichiro , Imai Yuuki , Nakamura Hiroaki 
Published: April 2019

Study Design.
Case-control study of an animal model.

Objective.
To investigate the factors that are upregulated and potentially related to degenerative changes in the ligamentum flavum (LF) upon mechanical stress concentration.

Summary of Background Data.
LF hypertrophy is reported to be associated with mechanical stress. However, few studies, using exhaustive analysis with control subjects, on the molecular mechanisms of LF hypertrophy have been published.

Methods.
Fourteen rabbits were used for this study. The first group underwent L2–3 and L4–5 posterolateral fusion with instrumentation and resection of the L3–4 supraspinal muscle to concentrate the mechanical stress on L3–4, whereas the other group underwent a sham operation. The deep layer of the LF from L2–3 to L4–5 in both groups was harvested after 16 weeks. Gene expression was evaluated exhaustively using DNA microarray and real-time polymerase chain reaction (RT-PCR). Fibroblast growth factor 9 (FGF9) protein expression was subsequently examined by immunohistological staining.

Results.
A total of 680 genes were found to be upregulated upon mechanical stress concentration and downregulated upon mechanical shielding compared with those in the sham group. Functional annotation analysis revealed that these genes not only included those related to the extracellular matrix but also those related to certain FGF families. On RT-PCR validation and immunohistological analysis, we identified that the FGF9 protein increases in the LF upon mechanical stress, especially in the area wherein degenerative changes were frequently identified in the previous literature.

Conclusion.
FGF9 and its pathway are suggested to contribute to the degenerative changes in the LF following mechanical stress. This finding will be helpful in further understanding the molecular mechanism of human LF degeneration.

Level of Evidence: N/A
The Effect of Intraoperative Vertebral Anesthesia on Osteoporotic Fractures Treated With Percutaneous Kyphoplasty
Authors: Mao Genwen , Alemayehu Dereje G. , Yang Yimin , Wen Tao , Ou Yiyan , Cheng Yifan , Ren Zhiwei 
Published: April 2019

Study Design:
A prospective randomized cohort study.

Objective:
The objective of this study was to investigate the effect of intraoperative vertebral anesthesia on osteoporotic vertebral compression fractures (OVCFs) when treated with percutaneous kyphoplasty (PKP).

Summary of Background Data:
Only a few studies have evaluated the intraoperative pain reducing strategies during PKP.

Materials and Methods:
A total of 64 patients with OVCFs were enrolled in the study. All of the patients were randomized into 2 groups: the traditional local anesthesia group (from the skin to the periosteum, group A) and the experimental group (from the skin to a vertebral body, group B). Visual Analogue Scale (VAS) score was used to evaluate the degree of pain at six time points, that is, VAS before surgery, VAS during balloon dilation, VAS during bone cement injection, VAS soon after surgery, and VAS 12 hours and 24 hours after surgery. In addition, we noted the patients’ willingness to undergo reoperation if necessary, and the variations in surgical complications between the 2 groups.

Results:
There was no significant difference in VAS score before surgery between the 2 groups (t=1.694, P=0.095). The VAS scores during balloon dilatation, bone cement injection and soon after surgery were significantly different between the 2 groups (t=4.405, P=0.000; t=2.481, P=0.016; t=2.992, P=0.004, respectively). The willingness to undergo reoperation was significantly different between 2 groups (χ2=6.020, P=0.049), whereas the complications showed no significant difference (χ2=0.000, P=0.754).

Conclusions:
Traditional local anesthesia combined with vertebral anesthesia was effective in alleviating perioperative pain during PKP. No serious complication was noted during the operation.

Level of Evidence:
Level I.
FARP1 Facilitates Cell Proliferation Through Modulating MAPK Signaling Pathway in Cutaneous Melanoma
Authors: Chen Zhao-Hui , Wang Li-Hua 
Published: April 2019

Purpose:
The purpose of our study was to investigate the biological functions of FARP1 gene in cutaneous melanoma.

Methods:
The mRNA expression level of FARP1 in cutaneous melanoma was analyzed based on the data obtained from ONCOMINE and The Cancer Genome Atlas database. Kaplan–Meier analysis was conducted to explore the association between FARP1 expression and the overall survival time of patients with cutaneous melanoma. The mRNA expression of FARP1 in melanoma cells was determined by qRT-PCR. A-375 cell line with silenced FARP1 was constructed to explore its biological functions. Cell proliferation, migration, and invasion abilities were determined by CCK8 assay, wound-healing assay, and transwell assays, respectively. Western blot was performed to explore the protein expression of FARP1, pMEK, MEK, pERK, and ERK.

Results:
Our results showed that the expression level of FARP1 was upregulated in cutaneous melanoma tissues and cells. Kaplan–Meier analysis revealed that high expression of FARP1 is predictive of shorter overall survival time in patients with cutaneous melanoma. Through CCK8 assay, we found that knockdown of FARP1 in A-375 cells exhibited dramatically inhibitory effect on cell proliferation. The results of wound-healing and transwell assays revealed that the motility of A-375 cells was notably suppressed after silencing FARP1. Moreover, the relative expression levels of pMEK/MEK and pERK/ERK decreased remarkably in A-375 cells following being transfected with si-FARP1.

Conclusions:
Our present results preliminary proofed that FARP1 possibly acts as a promoter in cutaneous melanoma development and possesses the potential to be a therapeutic target in patients with cutaneous melanoma.
Echogenicity Is Related to Skeletal Muscle Strength in Patients With Acute Respiratory Failure
Authors: Berry Michael J. , Files D. Clark , Campos Claudia L. , Bakhru Rita N. , Skaggs Brittany M. , Morris Peter E. 
Published: April 2019

Purpose:
Patients with acute respiratory failure (ARF) show changes in skeletal muscle structure and strength. The purpose of this study was to examine the relationship between muscle thickness, echogenicity, and strength in patients with ARF.

Methods:
Thirteen (6 females, 7 males) patients with ARF participated in the study. Knee extensor strength was measured via a handheld dynamometer and quadriceps images were obtained via ultrasonography at hospital discharge. The ultrasonograms were used to obtain muscle thickness and both mean ± SD echogenicity of the rectus femoris, vastus lateralis, and vastus medialis. Partial correlations, controlling for age, body mass index, and fluid intake were used to describe the relationships among knee extensor strength and echogenicity and muscle thickness.

Results:
Knee extensor strength and vastus lateralis SD echogenicity were significantly correlated when controlling for age, body mass index, and fluid intake (r = 0.69, P = .029). Knee extensor strength and vastus lateralis echogenicity were 19.1 ± 8.0 kg and 19.8 ± 5.4 units, respectively. No other correlations between strength and ultrasound measures were found to be significant.

Conclusion:
These results show skeletal muscle echogenicity to be significantly correlated with skeletal muscle strength in patients with ARF. As such, it may be useful in identifying muscle weakness in these patients when they are unable or unwilling to perform voluntary strength testing.
Occupational Radiation Protection Aspects of Alkaline Leach Uranium in Situ Recovery (ISR) Facilities in the United States
Authors: Brown Steven H. 
Published: April 2019

Abstract
In situ recovery or in situ leach (ISR/ISL) uranium facilities, also referred to in the past as “uranium solution mining” have operated since the late 1960s in the US and in recent years have accounted for over 70% of US production and, internationally, approximately half of worldwide uranium supplies. Note that throughout this paper, the uranium in situ recovery process, also known as in situ leach, will be abbreviated as “ISR.” This paper presents a summary of the occupational radiation protection aspects of typical ISR processes being employed in the United States today that have traditionally used alkaline-based uranium recovery solutions known as lixiviants. The paper describes the health physics and associated monitoring programs necessary to adequately measure and control radiological doses to workers based on the radiological character of these processes. Although many radiological characteristics are similar to that of conventional mills, conventional-type tailings as such are not generated. However, liquid and solid by-product materials may be generated and impounded, which can result in sources of occupational exposure. Some special monitoring considerations are required due to the manner in which 222 Rn gas is involved in the process. The major aspects of the health physics and radiation protection programs that have been developed at these facilities over many years are discussed and listed in the Conclusion section of the paper.
Assessing the Committed Effective Dose From 226Ra in Thermal Spring Water From San Diego De Alcala, Chihuahua, Mexico
Authors: Villalba Lourdes , Colmenero-Sujo Luis , Rubio-Arias Héctor , Pinales-Munguia Adán , Mireles-García Fernando , Dávila-Rangel Ignacio , Pinedo-Vega José L. , Ochoa-Rivero Jesús 
Published: April 2019

Abstract
The oral administration of mineral-rich spring water is known as hydropinic treatment and is used to treat certain ailments. Health benefits are attributed to thermal spring water containing radioactive elements such as radium; this has popularized use of such radioactive water in various parts of the world, causing those who ingest it to increase their internal radiation dose. The goal of this study was to assess the activity concentrations of 226Ra present in the thermal spring waters of San Diego de Alcala, in the state of Chihuahua, Mexico, and to estimate the health risk posed to patients by the effective dose received from ingesting this water during hydropinic treatments. Water samples were taken from different areas of the San Diego de Alcala thermal springs, and pH, temperature, electrical conductivity, and total dissolved solids were measured. The 226Ra activity concentrations were measured with a liquid scintillation counter. The activity concentrations of 226Ra in sampled water varied from 125 to 452 mBq L−1 with an average of 276 ± 40 mBq L−1. The committed effective dose from each of the 226Ra activity concentrations found in samples ranged from 9.80 × 10−5 to 4.0 × 10−3 mSv for hydropinic treatments being carried out in San Diego de Alcala thermal spring spas. Different treatments had different intake rates (200, 600, 1,000, and 1,500 mL d−1) and occurred over periods of 2 or 3 wk. According to the guidelines of the US Environmental Protection Agency, the maximum permissible amount of radium in drinking water is 185 mBq L−1; the 226Ra content in most of the collected samples exceeded this limit. The committed effective doses varied with 226Ra concentration and intake rate; none exceeded the World Health Organization’s reference dose for drinking water of 0.1 mSv y−1, which is the maximum amount to which the population should be exposed.
Randomized Controlled Trial: Split-dose and Same-day Large Volume Bowel Preparation for Afternoon Colonoscopy Have Similar Quality of Preparation
Authors: Castro Fernando J. , Al-Khairi Baker , Singh Harjinder , Mohameden Mosaab , Tandon Kanwarpreet , Lopez Rocio 
Published: April 2019

Goals:
We compare bowel cleanliness in patients taking same-day versus split-dose 4-L polyethylene glycol laxative for afternoon colonoscopy. Secondary objectives included patient satisfaction, adverse effects and patient tolerability.

Background:
Afternoon colonoscopies have been associated with inadequate bowel preparation and lower adenoma detection rates. Same-day (morning) or split-dosing of the laxative have improved preparation quality but differences between these options are unclear.

Materials and methods:
Single-center prospective randomized endoscopist blinded trial. Patients aged 18 years and above prescribed 4-L polyethylene glycol for colonoscopy were randomized into same-day or split-dose preparation. Preparation quality was assessed using the Ottawa Bowel Preparation Scale. Patient satisfaction and side effects was collected using a questionnaire. Intention-to-treat and per-protocol analysis were performed.

Results:
A total of 300 patients (158 split-dose, 142 same-day) were evaluated. No statistically significant difference was seen on total Ottawa score among the groups (P=0.47) or by individual colonic segments in intent-to-treat and per-protocol analysis. Patients in split-dose group were more likely to complete the entire preparation (P=0.01) but reported more sleep loss (P=0.001). The same-day preparation group reported higher incidence of vomiting (P=0.036). Patients ingesting bowel preparation ≥7 hours before colonoscopy had higher total Ottawa scores (P=0.001).

Conclusions:
There were no differences in quality of preparation in patients taking same-day versus split-dose preparation for afternoon colonoscopy. Those receiving same-day preparation were less likely to lose sleep but more likely to have emesis. These differences should be considered when selecting a bowel preparation regimen.
Methotrexate-associated primary hepatic lymphoma and cranial neuropathy in a patient with rheumatoid arthritis
Authors: Park Ji Eun , Lee Kyung Mi , Choi Hye Young , Ahn Sung Eun , You Myung-Won 
Published: April 2019

Abstract

Rationale:
Rheumatoid arthritis (RA) shows a variable clinical expression in patients. Articular disease is common manifestation, but patients may rarely present with extra-articular manifestation such as cranial neuropathy. Also, primary hepatic lymphoma (PHL) has rarely been reported in patient treated with immunosuppressive drug such as methotrexate (MTX) for RA. We herein describe a case of cranial neuropathy and MTX-related PHL in a woman receiving MTX for RA.

Patient concerns:
A 73-year-old women received MTX treatment for more than 5 years, presented with recurrent cranial neuropathies. During therapy of cranial neuropathies, liver enzyme levels were elevated.

Diagnoses:
The patient was diagnosed as RA by laboratory examination. A series of examinations had been launched to evaluate any possible cause of the extra-articular manifestation of the patient including ultrasound, computed tomography, magnetic resonance image (MRI) and positron emission tomography of the liver and MRI of the brain. Finally, the patient diagnosed as MTX-associated PHL and cranial neuropathy.

Interventions:
The patient underwent 4-year MTX therapy for RA at first with prednisolone. After that, she had been treated with cyclophosphamide therapy for cranial neuropathy. The liver biopsy was performed for hepatic lesion.

Outcomes:
MTX was discontinued, but no improvement of PHL and elevated liver enzyme was observed during the 3 weeks. The patient received 6 cycles of chemotherapy for 3 months and achieved complete remission including PHL and cranial neuronal lesion with symptom. No instances of relapse have occurred in 2 years of follow-up.

Lessons:
The present case is the extremely rare case in which MTX-related PHL and cranial neuropathy were involved together in the RA patient. It is necessary to examine long-term follow up hepatic and neurologic examinations that patient had a long history of receiving MTX therapy for RA.