bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Patient Reported Outcomes Measurement Information System Scores Assist in Predicting Early Postoperative Success in Lumbar Discectomy
Authors: Rubery Paul T. , Houck Jeff , Mesfin Addisu , Molinari Robert , Papuga Mark O. 
Published: August 2018

Study Design.
Retrospective review of prospective data.

Objective.
Determine whether patient reported outcome (PRO) data collected prior to lumbar discectomy predicts achievement of a minimal important difference (MID) after surgery. Compare ability of PRO and clinical information to predict achievement of MID in short term follow-up after discectomy.

Summary of Background Data.
We investigated the ability of patient reported outcomes measurement information system (PROMIS) and clinical factors at the preoperative time point to determine patients achieving MID after surgery.

Methods.
PROMIS physical function (PF), pain interference (PI), and depression (D) scores were assessed at evaluation and follow-up for consecutive visits between February, 2015 and September, 2017. Patients with preoperative scores within 30 days prior to surgery and with scores 40 days or more after surgery who completed all PROMIS domains were included yielding 78 patients. MIDs were calculated using a distribution-based method. A multivariate logistic regression model was created, and the ability to predict achieving MID for each of the PROMIS domains was assessed. Cut-off values and prognostic probabilities were determined for this model and models combining preoperative PROMIS with clinical data.

Results.
Preoperative PROMIS scores modestly predict reaching MID after discectomy (areas under the curve [AUC] of 0.62, 0.68, and 0.76 for PF, PI, and D, respectively). Preoperative cut-off scores show patients who have PF and PI scores more than 2 standard deviations, and D more than 1.5 standard deviations worse-off than population mean are likely to achieve MID. The combination of PROMIS with clinical data was the most powerful predictor of reaching MID with AUCs of 0.87, 0.84, and 0.83 for PF, PI, and D.

Conclusion.
PROMIS scores before discectomy modestly predict improvement after surgery. Preoperative PROMIS combined with clinical factors was more predictive of achieving MID than either clinical factors or PROMIS alone.

Level of Evidence: 3
The Impact of Metabolic Syndrome on 30-Day Outcomes Following Elective Anterior Cervical Discectomy and Fusions
Authors: Malik Azeem Tariq , Jain Nikhil , Kim Jeffery , Yu Elizabeth , Khan Safdar N. 
Published: August 2018

Study Design.
Retrospective review of prospective registry

Objective.
To analyze the impact of metabolic syndrome (MetS) on 30-day outcomes following elective anterior cervical discectomy and fusions (ACDFs).

Summary of Background Data.
MetS is defined as the presence of a combination of hypertension, diabetes mellitus, and obesity. Past literature has reported MetS to complicate postoperative care in patients undergoing various surgical procedures, including lumbar fusions.

Methods.
The 2015 to 2016 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried using current procedural terminology (CPT) codes 22,551 (single-level) and 22,552 (additional level). Patients undergoing disc arthroplasty, multi-level (>3) fusion, posterior cervical spine surgery, and patients with fracture, tumor, infection were excluded. MetS was defined using a pre-set criteria used by other NSQIP studies as the presence of—(1) diabetes mellitus, (2) hypertension requiring medication, and (3) body mass index (BMI) more than or equal to 30 kg/m2.

Results.
A total of 1384 (8.8%) patients with MetS underwent a cervical fusion. Following adjusted analysis, results showed that presence of MetS was associated with higher odds of a prolonged length of stay more than or equal to 3 days (odds ratios [OR] 1.32 [95% confidence interval [CI] 1.12–1.56]; P = 0.001). No significant association was found between MetS and 30-day complications, 30-day reoperations, 30-day re-admissions, a non-home discharge, and death.

Conclusion.
While MetS was associated with a prolonged length of stay, its presence does not have a large impact on 30-day outcomes following elective ACDF.

Level of Evidence: 3
Drowning in fresh or salt water: respective influence on respiratory function in a matched cohort study
Authors: Michelet Pierre , Dusart Marion , Boiron Laurence , Marmin Julien , Mokni Tarak , Loundou Anderson , Coulange Mathieu , Markarian Thibaut 
Published: August 2018

Introduction
For the most severe drowned patients, hypoxemia represents one of the major symptoms. As the influence of the type of water (fresh or salt water) on respiratory function is still unclear, the primary endpoint of this multicenter study was to compare hypoxemia according to the type of water.

Methods
Medical records of adult patients who experienced a drowning event and were consequently admitted to 10 ICU for acute respiratory failure were analyzed retrospectively using data collected over three consecutive summer periods. From an initial cohort of acute respiratory failure drowned patients, patients were matched by age, sex, Glasgow Coma Scale, and occurrence of cardiac arrest (yes or no).

Results
Among an initial cohort of 242 patients, 38 pairs were matched correctly. At the initial assessment, carried out upon ICU admission, hypoxemia was found to be deeper in the fresh water group (PaO2/FiO2: 141 ± 76 vs. 220 ± 122, P < 0.05). However, there was no significant difference in tissue oxygenation (assessed by blood lactate level) between groups. In terms of biology results, sodium levels were higher in the salt water group in the initial assessment (144 ± 6.8 vs. 140 ±5.2 mmol/l, P = 0.004), but no difference was observed later. No difference was recorded in the outcome or length of stay in ICU between groups.

Conclusion
Drowning in fresh water was associated with deeper hypoxemia in the initial assessment. Despite this initial difference, latter respiratory and biological parameters or outcome were similar in both groups.
Exocrine Pancreatic Insufficiency and Malnutrition in Chronic Pancreatitis
Authors: Min May , Patel Boskey , Han Samuel , Bocelli Lisa , Kheder Joan , Vaze Aditya , Wassef Wahid 
Published: August 2018

Objectives
The purpose of this study was to examine the impact of exocrine pancreatic insufficiency (EPI) on chronic pancreatitis (CP) patients and to identify challenges with its diagnosis and treatment.

Methods
Ninety-one patients with CP diagnosed with endoscopic ultrasound were identified and assessed for symptoms of EPI, fat-soluble vitamin levels, dual-energy x-ray absorptiometry scan T-scores, and treatment with pancreatic enzyme replacement therapy. All patients were also screened with the Malnutrition Universal Screening Test.

Results
Exocrine pancreatic insufficiency was diagnosed in 84.6% (77/91) of patients based on symptoms of bloating, steatorrhea, or weight loss. Of these patients, 35.2% (19/54) had vitamin A deficiency, 62.5% (55/88) had vitamin D deficiency, and 17.7% (9/51) had vitamin E deficiency. Either osteopenia or osteoporosis was found in 68.9% (31/45). A medium or higher risk for malnutrition based on Malnutrition Universal Screening Test score of 1 or higher was found in 31.5% (28/89). Malnutrition Universal Screening Test score of 1 or higher was associated with an increased risk for osteopenia and osteoporosis on Fisher’s exact test (P = 0.0037).

Conclusions
There is a high prevalence of fat-soluble vitamin deficiencies, osteopathy, and malnutrition in CP patients, which is underestimated due to a lack of effective diagnosis and suboptimal therapies for EPI.
The Impact of Behavioral Health Patients on a Pediatric Emergency Department's Length of Stay and Left Without Being Seen
Authors: Conrad Heather B. , Hollenbach Kathryn A. , Gehlbach Daniel L. , Ferran Karen L. , Barham Tiffani A. , Carstairs Keri L. 
Published: August 2018

Objective
Emergency department (ED) boarding of admitted patients negatively impacts ED length of stay (LOS). Behavioral health (BH) patients are often challenging to safely discharge. We examined the association between daily BH census and non-BH LOS and left without being seen (LWBS) rates.

Methods
Retrospective analysis of BH and non-BH patients at a high-volume tertiary care pediatric ED from December 2014 to June 2016 examined the association between BH patients and non-BH LOS and LWBS rates. Behavioral health patients were identified by presence of social work assessment and BH chief complaint and/or final diagnosis. Data were analyzed using 1-sample test of proportions, Student t test, Spearman and Pearson correlations, logistic regression, and odds ratios with 95% confidence intervals.

Results
A total of 143,141 patients were seen, 3% (n = 4351) for BH presentations. Median LOS for discharged non-BH patients was 128 minutes compared with 446 minutes for BH patients. Daily LOS and bed hold hours were significantly longer for BH than for non-BH patients (P < 0.0001 for each analysis). After adjusting for ED census, daily BH census was significantly associated with increasing LWBS rates and non-BH LOS.

Conclusions
Behavioral health census and bed hold hours were significantly associated with increased LOS and LWBS rates and with our inability to meet desired LOS and LWBS rates. These associations support the existence of a threshold where the ED has reached capacity and is no longer able to absorb BH patients. Improving BH facility access may help improve overall pediatric ED patient care.
Impact of Temporomandibular Disorders and Sleep Bruxism on Oral Health-Related Quality of Life of Individuals With Complete Cleft Lip and Palate
Authors: Silva Fernanda Coelho da , Oliveira Thais Marchini de , Almeida Ana Lúcia Pompéia Fraga de , Bastos Roosevelt da Silva , Neppelenbroek Karin Hermana , Soares Simone 
Published: August 2018

Abstract
The temporomandibular disorders (TMDs) and sleep bruxism (SB) affect the quality of life (QoL) of the individuals in general. However, the literature lacks studies on individuals with cleft lip and palate (CLP). Thus, this study aimed to evaluate the impact of TMD and SB on the oral health-related quality of life (OHRQoL) of individuals with CLP. Thirty-six individuals, both genders, aged between 30 and 50 years, at routine treatment in the Dental Prosthesis Sector of Hospital for Rehabilitation of Craniofacial Anomalies—University of São Paulo were selected and divided into the following groups: G1—unilateral complete CLP (n = 22) and G2—bilateral complete CLP (n = 14). Three questionnaires were applied: Oral Health Impact Profile (OHIP-14), SB self-report and Research Diagnosis Criteria for TMD. Fisher test, Mann–Whitney test, and t test were applied to verify values between TMD, SB, gender, and OHIP-14 (P < 0.05). The mean OHIP-14 score was of 5.80, and females had higher (8.58) OHRQoL than males (3.31). There was association with gender and OHRQoL (t test, P = 0.006), TMD with OHRQoL (Mann–Whitney test, P = 0.036), and TMD and SB (Fisher test, P = 0.006). Temporomandibular disorder was diagnosed in 30% of the individuals. Of these, 16.66% did not present SB, while 13.88% presented it. The association TMD versus SB showed statistically significant differences and 83.33% of the individuals reporting SB also had TMD. Based on this study, the authors can conclude that: TMD impacts OHRQoL in CLP patients, females are more affected in their OHRQoL than males, SB was strongly associated with TMD.
Liver Transplantation and Hepatic Resection can Achieve Cure for Hepatocellular Carcinoma
Authors: Pinna Antonio Daniele , Yang Tian , Mazzaferro Vincenzo , De Carlis Luciano , Zhou Jian , Roayaie Sasan , Shen Feng , Sposito Carlo , Cescon Matteo , Di Sandro Stefano , Yi-feng He , Johnson Philip , Cucchetti Alessandro 
Published: August 2018

Objective:
The aim of this study was to estimate probabilities of achieving the statistical cure from hepatocellular carcinoma (HCC) with hepatic resection (HR) and liver transplantation (LT).

Background:

Statistical cure occurs when the mortality of a specific population returns to values of that of general population. Resection and transplantation are considered potentially curative therapies for HCC, but their effect on the residual entire life-expectancy has never been investigated.

Methods:
Data from 3286 HCC patients treated with LT (n = 1218) or HR (n = 2068) were used to estimate statistical cure. Disease-free survival (DFS) was the primary survival measure to estimate cure fractions through a nonmixture model. Overall survival (OS) was a secondary measure. In both, patients were matched with general population by age, sex, year, and race/ethnicity. Cure variations after LT were also adjusted for different waiting-list drop-outs.

Results:
Considering DFS, the cure fraction after LT was 74.1% and after HR was 24.1% (effect size >0.8). LT outperformed HR within all transplant criteria considered (effect size >0.8), especially for multiple tumors (>0.9) and even in presence of a drop-out up to 20% (>0.5). Considering OS, the cure fraction after LT marginally increased to 75.8%, and after that HR increased to 40.5%. The effect size of LT over HR in terms of cure decreased for oligonodular tumors (<0.5), became small for drop-out up to ∼20% (<0.2), and negligible for single tumors <5 cm (∼0.1).

Conclusion:
As other malignancies, statistical cure can occur for HCC, primarily with LT and secondarily with HR, depending on waiting-list capabilities and efficacy of tumor recurrence therapies after resection.
Effectiveness of Fibrin Sealant Application on the Development of Staple Line Complications After Sleeve Gastrectomy
Authors: Rebibo Lionel , Dhahri Abdennaceur , Chati Rachid , Cosse Cyril , Huet Emmanuel , Regimbeau Jean-Marc 
Published: August 2018

Objectives:
Evaluate the effectiveness of the use of fibrin sealant (FS) for preventing the development of staple line complications (SLCs) after sleeve gastrectomy (SG).

Background:
There is no consensus on the best means of preventing SLCs after SG.

Methods:
This was a prospective, intention-to-treat, randomized, 2 center study of a group of 586 patients undergoing primary SG (ClinicalTrials.gov identifier: NCT01613664) between March 2014 and June 2017. The 1:1 randomization was stratified by center, age, sex, gender, and body mass index, giving 293 patients in the FS group and 293 in the control group (without FS). The primary endpoint (composite criteria) was the incidence of SLCs in each of the 2 groups. The secondary criteria were the mortality rate, morbidity rate, reoperation rate, length of hospital stay, readmission rate, and risk factors for SLC.

Results:
There were no intergroup differences in demographic variables. In an intention-to-treat analysis, the incidence of SLCs was similar in the FS and control groups (1.3% vs 2%, respectively; P = 0.52). All secondary endpoints were similar: complication rate (5.4% vs 5.1%, respectively; P = 0.85), mortality rate (0.3% vs 0%, respectively; P = 0.99), GL rate (0.3% vs 1.3%, respectively; P = 0.18), postoperative hemorrhage/hematoma rate (1% vs 0.7%, respectively; P = 0.68), reoperation rate (1% vs 0.3%, respectively; P = 0.32). Length of stay was 1 day in both groups (P = 0.89), and the readmission rate was similar (5.1% vs 3.4%, respectively; P = 0.32). No risk factors for SLCs were found.

Conclusion:
The incidence of postoperative SLCs did not appear to depend on the presence or absence of FS.
A Randomized Controlled Trial Comparing Epidural Analgesia Versus Continuous Local Anesthetic Infiltration Via Abdominal Wound Catheter in Open Liver Resection
Authors: Bell Richard , Ward Deesa , Jeffery Julie , Toogood Giles J. , Lodge JPeter A. , Rao Krishna , Lotia Sharmeen , Hidalgo Ernest 
Published: August 2018

Aim:
To compare outcomes following open liver resection (OLR) between patients receiving thoracic epidural (EP) versus abdominal wound catheters plus patient-controlled analgesia (AWC-PCA).

Method:
Patients were randomized 1:1 to either EP or AWC-PCA within an enhanced recovery protocol. Primary outcome was length of stay (LOS), other variables included functional recovery, pain scores, peak flow, vasopressor and fluid requirements, and postoperative complications.

Results:
Between April 2015 and November 2017, 83 patients were randomized to EP (n = 41) or AWC-PCA (n = 42). Baseline demographics were comparable. No difference was noted in LOS (EP 6 d (3–27) vs AWC-PCA 6 d (3–66), P = 0.886). Treatment failure was 20% in the EP group versus 7% in the AWC-PCA (P = 0.09). Preoperative anesthetic time was shorter in the AWC-PCA group, 49 minutes versus 62 minutes (P = 0.003). EP patients required more vasopressor support immediately postoperatively on day 0 (14% vs 54%, P = <0.001) and day 1 (5% vs 23%, P = 0.021). Pain scores were greater on day 0, afternoon of day 1 and morning of day 2 in the AWC-PCA group however were regarded as low at all time points. No other significant differences were noted in IV fluid requirements, nausea/sedation scores, days to open bowels, length of HDU, and postoperative complications.

Conclusion:
AWC-PCA was associated with reduced treatment failure and a reduced vasopressor requirement than EP up to 2 days postoperatively. While the use of AWC-PCA did not translate into a shorter LOS in this study, it simplified patient management after OLR. EP cannot be routinely recommended following open liver resections.
Complex dynamics in simplified neuronal models: reproducing Golgi cell electroresponsiveness
Authors: Geminiani Alice , Casellato Claudia , Locatelli Francesca , Prestori Francesca , Pedrocchi Alessandra , D’Angelo Egidio 
Published: August 2018

AbstractBrain neurons exhibit complex electroresponsive properties - including intrinsic subthreshold oscillations and pacemaking, resonance and phase-reset - which are thought to play a critical role in controlling neural network dynamics. Although these properties emerge from detailed representations of molecular-level mechanisms in “realistic” models, they cannot usually be generated by simplified neuronal models (although these may show spike-frequency adaptation and bursting). We report here that this whole set of properties can be generated by theextended generalized leaky integrate-and-fire(E-GLIF) neuron model. E-GLIF derives from the GLIF model family and is therefore mono-compartmental, keeps the limited computational load typical of a linear low-dimensional system, admits analytical solutions and can be tuned through gradient-descent algorithms. Importantly, E-GLIF is designed to maintain a correspondence between model parameters and neuronal membrane mechanisms through a minimum set of equations. In order to test its potential, E-GLIF was used to model a specific neuron showing rich and complex electroresponsiveness, the cerebellar Golgi cell, and was validated against experimental electrophysiological data recorded from Golgi cells in acute cerebellar slices. During simulations, E-GLIF was activated by stimulus patterns, including current steps and synaptic inputs, identical to those used for the experiments. The results demonstrate that E-GLIF can reproduce the whole set of complex neuronal dynamics typical of these neurons - including intensity-frequency curves, spike-frequency adaptation, depolarization-induced and post-inhibitory rebound bursting, spontaneous subthreshold oscillations, resonance and phase-reset, - providing a new effective tool to investigate brain dynamics in large-scale simulations.
Variability of collective dynamics in random tree networks of strongly-coupled stochastic excitable elements
Authors: Khaledi-Nasab Ali , Kromer Justus A. , Schimansky-Geier Lutz , Neiman Alexander B. 
Published: August 2018

We study the collective dynamics of strongly diffusively coupled excitable elements on small random tree networks. Stochastic external inputs are applied to the leaves causing large spiking events. Those events propagate along the tree branches and, eventually, exciting the root node. Using Hodgkin-Huxley type nodal elements, such a setup serves as a model for sensory neurons with branched myelinated distal terminals. We focus on the influence of the variability of tree structures on the spike train statistics of the root node. We present a statistical description of random tree network and show how the structural variability translates into the collective network dynamics. In particular, we show that in the physiologically relevant case of strong coupling the variability of collective response is determined by the joint probability distribution of the total number of leaves and nodes. We further present analytical results for the strong coupling limit in which the entire tree network can be represented by an effective single element.PACS numbers: 87.19.ll, 87.19.lb, 87.19.lc, 05.45.Xt, 05.10.Gg
Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men: a secondary analysis of energy expenditure and physical activity
Authors: Friedman Mark I. , Appel Scott 
Published: August 2018

ABSTRACTBackgroundA previously published pilot study assessed energy expenditure (EE) of participants with overweight and obesity after they were switched from a baseline high-carbohydrate diet (BD) to an isocaloric low-carbohydrate ketogenic diet (KD). EE measured using metabolic chambers increased transiently by what was considered a relatively small extent after the switch to the KD, whereas EE measured using doubly labeled water (EEDLW) increased to a greater degree after the response in the chambers had waned. Using a publicly available dataset, we examined the effect of housing conditions on the magnitude of the increase in EEDLW after the switch to the KD and the role of physical activity in that response.MethodsThe 14-day EEDLW measurement period included 4 days when subjects were confined to chambers instead of living in wards. To determine the effect on EEDLW only for the days subjects were living in the wards, we calculated non-chamber EE (EEnonchamber). To assess the role of physical activity in the response to the KD, we analyzed chamber and non-chamber accelerometer data for the BD and KD EEDLW measurement periods.ResultsIn comparison with the increase in average 14-day EEDLW of 151 kcal/d ± 63 (P = 0.03) after the switch to the KD, EEnonchamber increased by 203 ± 89 kcal/d (P = 0.04) or 283 ± 116 kcal/d(P = 0.03) depending on the analytical approach. Hip accelerometer counts decreased significantly (P = 0.01) after the switch to the KD, whereas wrist and ankle accelerometer counts did not change.ConclusionsSwitching from the BD to the KD substantially increased EEDLW, but apparently only on days subjects were living in the ward outside the metabolic chamber. Increased physical activity as measured by accelerometry did not appear to account for this effect.