bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Chronic Opioid Therapy
Authors: Jain Nikhil , Phillips Frank M. , Weaver Tristan , Khan Safdar N. 
Published: March 2018

Study Design.
Retrospective, economic analysis.

Objective.
To study patient profile associated with preoperative chronic opioid therapy (COT), and study COT as a risk factor for 90-day complications, emergency department (ED) visits, and readmission after primary one- to two-level posterior lumbar fusion (PLF) for degenerative spine disease. We also evaluated associated costs, risk factors, and adverse events related to long-term postoperative opioid use.

Summary of Background Data.
Chronic opioid use is associated with poor outcomes and dependence after spine surgery. Risk factors, complications, readmissions, adverse events, and costs associated with COT in patients undergoing lumbar fusion are not entirely known. As providers look to reduce healthcare costs and improve outcomes, identification of modifiable risk factors is important.

Methods.
Commercial insurance data from 2007 to Q3–2015 was used to study preoperative opioid use in patients undergoing primary one- to two-level PLF. Ninety-day complications, ED visits, readmissions, 1-year adverse events, and associated costs have been described. Multiple-variable regression analyses were done to study preoperative COT patient profile and opioid use as a risk factor for complications and adverse events.

Results.
A total of 24,610 patients with a mean age of 65.6 ± 11.5 years were included. Five thousand five hundred (22.3%) patients had documented opioid use for more than 6 months before surgery, and 87.4% of these had continued long-term use postoperatively. On adjusted analysis, preoperative COT was found to be a risk factor for 90-day wound complications, pain diagnoses, ED visits, readmission, and continued use postoperatively. Postspinal fusion long-term opioid users had an increased utilization of epidural/facet joint injections, risk for revision fusion, and increased incidence of new onset constipation within 1 year postsurgery. The cost associated with increase resource use in these patients has been reported.

Conclusion.
Preoperative COT is a modifiable risk factor for complications, readmission, adverse events, and increased costs after one- or two-level PLF.

Level of Evidence: 3
Negative correlation of high-density lipoprotein-cholesterol and bone mineral density in postmenopausal Iranian women with vitamin D deficiency
Authors: Maghbooli Zhila , Khorrami-nezhad Leila , Adabi Elham , Ramezani Majid , Asadollahpour Effat , Razi Farideh , Rezanejad Mohamadtaher 
Published: March 2018

Abstract

Objective:
The aim of the study was to investigate the association between high-density lipoprotein (HDL) and bone status taking into account serum vitamin D levels in postmenopausal Iranian women.

Methods:
During January 2015 and February 2016, a total of 488 postmenopausal Iranian women participated in this cross-sectional study, all of whom were not taking osteoporosis medication and were not suffering from any chronic disorder. Dual X-ray absorptiometry was used to assess bone mineral density (BMD) of the total hip, femoral neck, and lumbar vertebrae (L2-L4). Each person was categorized based on the World Health Organization osteoporosis criteria in at least one skeletal region. At the end of the data collection, lipid profiles and vitamin D levels were measured for all participants. Vitamin D serum levels less than 30 ng/mL were defined as vitamin D deficiency or insufficiency.

Results:
27.9% of all participants displayed osteoporosis. Osteoporotic participants tended to be older with higher HDL serum levels (P < 0.001). No significant difference was seen in low-density of lipoprotein, total triglyceride, and total cholesterol levels among participants (P > 0.05). In a univariate model, after adjusting for age, menopausal age, obesity, physical activity, and use of antihyperlipidemic drugs (statins), there were significant negative associations among HDL levels and BMD values and T-score in the three regions (P < 0.004). Interestingly, after classification of participants based on vitamin D levels and adjustment for confounding factors, these significant negative associations between HDL levels and BMD values as well as T-score were observed only in participants with vitamin D deficiency or insufficiency, in the three regions (P < 0.008).

Conclusions:
Our data show that in postmenopausal women with vitamin D deficiency, serum levels of HDL have negative correlation with bone status.
The Influence of Corneal Biomechanical Properties on Intraocular Pressure Measurements Using a Rebound Self-tonometer
Authors: Brown Lyndsay , Foulsham William , Pronin Savva , Tatham Andrew J. 
Published: March 2018

Purpose:
The purpose of this study was to examine the effect of corneal biomechanical properties on intraocular pressure (IOP) measurements obtained using a rebound self-tonometer (Icare HOME) compared with Goldmann applanation tonometry (GAT).

Methods:
An observational study of 100 patients with glaucoma or ocular hypertension. All had a comprehensive ophthalmic examination and standard automated perimetry. IOP was assessed by GAT, Icare HOME and Ocular Response Analyzer, which was also used to assess corneal hysteresis (CH) and corneal resistance factor (CRF). Central corneal thickness (CCT) was recorded.

Results:
Mean (±SD) IOP measurements were 14.3±3.9 and 11.7±4.7 mm Hg using GAT and Icare HOME, respectively. Average CCT, CRF, and CH were 534.5±37.3 μm, 9.0±1.7 mm Hg, and 9.4±1.5 mm Hg, respectively. The mean difference between Icare HOME and GAT was −2.66±3.13 mm Hg, with 95% limits of agreement of −8.80 to 3.48 mm Hg, however, there was evidence of proportional bias. There was negative correlation between IOP and CH [5.17 mm Hg higher Icare HOME IOP (P=0.041, R
2=0.029) and 7.23 mm Hg higher GAT IOP (P=0.008, R
2=0.080) for each 10 mm Hg lower CH], whereas thinner CCT was significantly associated with lower IOP (P<0.001, R
2=0.14 for Icare HOME and P<0.001, R
2=0.08 for GAT). In multivariable analysis, although CRF and CH remained associated with IOP measured using either GAT or Icare HOME, CCT was no longer significant.

Conclusion:
IOP measurements obtained using a self-tonometer, similar to GAT, were more influenced by overall corneal biomechanics than CCT.
Factors Associated With Early Virological Response in HIV-Infected Individuals Starting Antiretroviral Therapy in Brazil (2014–2015): Results From a Large HIV Surveillance Cohort
Authors: Meireles Mariana V. , Pascom Ana Roberta P. , Duarte Elisabeth C. 
Published: March 2018

Objective:
To identify clinical, sociodemographic, and treatment-related factors associated with early virological response in HIV-infected adults starting antiretroviral treatment (ART) in Brazil in 2014–2015.

Methods:
Data from 4 information systems from the Brazilian AIDS Program were combined to create a historical cohort. Unconditional logistic regression models were used to assess the likelihood of not achieving viral load suppression (VLS), defined as having either a viral load (VL) count >200 copies per milliliter or an aids-related death recorded within 180 ± 90 days after treatment initiation.

Results:
Among 76,950 individuals, 64.8% were men; median age, CD4+, and VL counts were 34 years, 378 cells per micro liter, and 38,131 copies per milliliter, respectively, and 85.2% achieved VLS. In the multivariate analysis, some factors which increased the odds of non-VLS were as follows: lower CD4+ and higher VL counts, younger age, heterosexual or injection drug use groups (relative to men who have sex with men), lower educational level, black/brown race, higher pill burden, and higher dosing frequency. Regimens containing boosted protease inhibitors were similar to those containing nonnucleoside reverse transcriptase inhibitors and superior to those containing unboosted protease inhibitors (all P values <0.001). No difference was observed between patients with CD4+ counts 350–499 and 500+ cells per micro liter.

Conclusions:
Our findings support the decision made in Brazil in 2013 to recommend immediate initiation of ART regardless of clinical stage or CD4+. Several factors were found to be associated with poorer virologic outcomes and should be addressed to maximize ART adherence and success rates.
Four-Minute Bone SPECT Using Large-Field Cadmium-Zinc-Telluride Camera
Authors: Gregoire Bastien , Pina-Jomir Géraldine , Bani-Sadr Alexandre , Moreau-Triby Caroline , Janier Marc , Scheiber Christian 
Published: March 2018

Purpose
The aim of this study was to determine the minimum acquisition time without decreasing lesion detectability of bone SPECT using a whole-body cadmium-zinc-telluride camera.

Methods
Patients referred for bone SPECT were retrospectively included. SPECT of 30 patients were reframed from native data (16 s/projection) to produce 10-, 5-, and 3-s/projection data sets. A “critical” acquisition time/projection was defined as that below which the SPECT quality becomes insufficient for interpretation, as determined by 3 reviewers using a 4-point scale (0 = quality insufficient for interpretation, 1 = average, 2 = good, 3 = excellent). Three reviewers (blinded to the acquisition time) evaluated SPECT data sets (n = 79), native and reframed with “critical” acquisition times, in a randomized order. A lesion was defined as any uptake considered pathological by a reviewer. Lesion detectability equivalence between native SPECT and reframed SPECT was assessed by calculating a coefficient (κ) for each reviewer.

Results
Image quality of the first sample (n = 30) was significantly and progressively less well graded for the reframed data sets by all reviewers. Only 1 patient was graded 0 by each reviewer for the 5-s/projection data set. For the 3-s/projection data set, 3 patients were graded 0. No patients were graded 0 for 10-s/projection data set. The minimal acquisition time, for each projection, was defined as 5 s/projection. The coefficient κ, between native and reframed, with critical acquisition time/projection SPECT was greater than 0.9 for each reviewer.

Conclusions
The more contrasted images of the cadmium-zinc-telluride camera allow performance of 5-s/projection SPECT without loss of lesion detectability. This suggests the possibility of performing whole-body SPECT in a reasonable time or reducing injected doses, especially in pediatric patients.
Patient-Selected Strategies for Post Cardiac Rehabilitation Exercise Adherence in Heart Failure
Authors: Nielsen Jessica , Duncan Kathleen , Pozehl Bunny 
Published: March 2018

Abstract

Purpose
The aim of this study was to evaluate the use of patient-selected exercise adherence strategies following cardiac rehabilitation (CR).

Design
Twenty patients with heart failure (HF) were recruited and randomly assigned to the intervention or control group at completion of CR.

Methods
The intervention included the use of six adherence strategies (logs, graphs, pedometers, phone follow-up, education, and a letter from CR staff), which were provided for 6 weeks post CR and during home-based exercise. After 6 weeks, the intervention group selected strategies to continue, and only those were provided for the last 6 weeks. At 12 weeks, patients were retested.

Findings
Patients with HF demonstrated improvement in distance walked and less HF symptoms and adhered to exercise at levels recommended during CR.

Conclusion
Inclusion of patient-selected adherence strategies supports continued exercise and helps to sustain physiological improvements.

Clinical Relevance
Results from this study have implications for CR programs serving HF patients and provide insight into adherence strategies.
The S100A10 Pathway Mediates an Occult Hyperfibrinolytic Subtype in Trauma Patients
Authors: Gall Lewis S. , Vulliamy Paul , Gillespie Scarlett , Jones Timothy F. , Pierre Rochelle S. J. , Breukers Sabine E. , Gaarder Christine , Juffermans Nicole P. , Maegele Marc , Stensballe Jakob , Johansson Pär I. , Davenport Ross A. , Brohi Karim 
Published: March 2018

Objective:
To determine the characteristics of trauma patients with low levels of fibrinolysis as detected by viscoelastic hemostatic assay (VHA) and explore the underlying mechanisms of this subtype.

Background:
Hyperfibrinolysis is a central component of acute traumatic coagulopathy but a group of patients present with low levels of VHA-detected fibrinolysis. There is concern that these patients may be at risk of thrombosis if empirically administered an antifibrinolytic agent.

Methods:
A prospective multicenter observational cohort study was conducted at 5 European major trauma centers. Blood was drawn on arrival, within 2 hours of injury, for VHA (rotation thromboelastometry [ROTEM]) and fibrinolysis plasma protein analysis including the fibrinolytic mediator S100A10. An outcomes-based threshold for ROTEM hypofibrinolysis was determined and patients grouped by this and by D-dimer (DD) levels.

Results:
Nine hundred fourteen patients were included in the study. The VHA maximum lysis (ML) lower threshold was determined to be <5%. Heterogeneity existed among patients with low ML, with survivors sharing similar clinical and injury characteristics to patients with normal ML values (5–15%). Those who died were critically injured with a preponderance of traumatic brain injury and had a 7-fold higher DD level (died vs. survived: 103,170 vs. 13,672 ng/mL, P < 0.001). Patients with low ML and high DD demonstrated a hyperfibrinolytic biomarker profile, low tissue plasminogen activator levels but high plasma levels of S100A10. S100A10 was negatively correlated with %ML (r = −0.26, P < 0.001) and caused a significant reduction in %ML when added to whole blood ex-vivo.

Conclusions:
Patients presenting with low ML and low DD levels have low injury severity and normal outcomes. Conversely, patients with low ML but high DD levels are severely injured, functionally coagulopathic and have poor clinical outcomes. These patients have low tissue plasminogen activator levels and are not detectable by ROTEM. S100A10 is a cell surface plasminogen receptor which may drive the hyperfibrinolysis in these patients and which when shed artificially lowers %ML ex-vivo.
Association Between Hospital Participation in Medicare Shared Savings Program Accountable Care Organizations and Readmission Following Major Surgery
Authors: Borza Tudor , Oerline Mary K. , Skolarus Ted A. , Norton Edward C. , Dimick Justin B. , Jacobs Bruce L. , Herrel Lindsey A. , Ellimoottil Chad , Hollingsworth John M. , Ryan Andrew M. , Miller David C. , Shahinian Vahakn B. , Hollenbeck Brent K. 
Published: March 2018

Objective:
To evaluate the effect of Medicare Shared Savings Program accountable care organizations (ACOs) on hospital readmission after common surgical procedures.

Summary Background Data:
Hospital readmissions following surgery lead to worse patient outcomes and wasteful spending. ACOs, and their associated hospitals, have strong incentives to reduce readmissions from 2 distinct Centers for Medicare and Medicaid Services policies.

Methods:
We performed a retrospective cohort study using a 20% national Medicare sample to identify beneficiaries undergoing 1 of 7 common surgical procedures—abdominal aortic aneurysm repair, colectomy, cystectomy, prostatectomy, lung resection, total knee arthroplasty, and total hip arthroplasty—between 2010 and 2014. The primary outcome was 30-day risk-adjusted readmission rate. We performed difference-in-differences analyses using multilevel logistic regression models to quantify the effect of hospital ACO affiliation on readmissions following these procedures.

Results:
Patients underwent a procedure at one of 2974 hospitals, of which 389 were ACO affiliated. The 30-day risk-adjusted readmission rate decreased from 8.4% (95% CI, 8.1–8.7%) to 7.0% (95% CI, 6.7–7.3%) for ACO affiliated hospitals (P < 0.001) and from 7.9% (95% CI, 7.8–8.0%) to 7.1% (95% CI, 6.9–7.2%) for non-ACO hospitals (P < 0.001). The difference-in-differences of the 2 trends demonstrated an additional 0.52% (95% CI, 0.97–0.078%) absolute reduction in readmissions at ACO hospitals (P = 0.021), which would translate to 4410 hospitalizations avoided.

Conclusion:
Readmissions following common procedures decreased significantly from 2010 to 2014. Hospital affiliation with Shared Savings ACOs was associated with significant additional reductions in readmissions. This emphasis on readmission reduction is 1 mechanism through which ACOs improve value in a surgical population.
Viruses have multiple paths to central nervous system pathology
Authors: Agner Shannon C. , Klein Robyn S. 
Published: March 2018

Purpose of review
Although viral infections of the central nervous system (CNS) are known to acutely cause pathology in the form of cytokine-mediated neural tissue damage and inflammation, the pathophysiology of neurologic sequelae after viral clearance is incompletely understood.

Recent findings
Alterations in microglial and glial biology in response to initial infiltration of immune cells that persist within the CNS have recently been shown to promote neuronal dysfunction and cognitive deficits in animal models of viral encephalitis.

Summary
The current review summarizes the current knowledge on the possible role of innate immune signaling during acute infections as triggers of neurologic sequelae that persist, and may even worsen, after clearance of viral infections within the CNS.
Altered Bile Acid Profile Associates with Cognitive Impairment in Alzheimer’s Disease – An Emerging Role for Gut Microbiome
Authors: MahmoudianDehkordi Siamak , Arnold Matthias , Nho Kwangsik , Ahmad Shahzad , Jia Wei , Xie Guoxiang , Louie Gregory , Kueider-Paisley Alexandra , Moseley M. Arthur , Thompson J. Will , John Williams Lisa St , Tenenbaum Jessica D. , Blach Colette , Baillie Rebecca , Han Xianlin , Bhattacharyya Sudeepa , Toledo Jon B. , Schafferer Simon , Klein Sebastian , Koal Therese , Risacher Shannon L. , Kling Mitchel Allan , Motsinger-Reif Alison , Rotroff Daniel M. , Jack John , Hankemeier Thomas , Bennett David A. , De Jager Philip L. , Trojanowski John Q. , Shaw Leslie M. , Weiner Michael W. , Doraiswamy P. Murali , van Duijn Cornelia M. , Saykin Andrew J. , Kastenmüller Gabi , Kaddurah-Daouk Rima ,   for the Alzheimer’s Disease Neuroimaging Initiative and the Alzheimer Disease Metabolomics Consortium
Published: March 2018

AbstractIntroductionIncreasing evidence suggests a role for the gut microbiome in central nervous system disorders and specific role for the gut-brain axis in neurodegeneration. Bile acids (BA), products of cholesterol metabolism and clearance, are produced in the liver and are further metabolized by gut bacteria. They have major regulatory and signaling functions and seem dysregulated in Alzheimer disease (AD).MethodsSerum levels of 15 primary and secondary BAs and their conjugated forms were measured in 1,464 subjects including 370 cognitively normal older adults (CN), 284 with early mild cognitive impairment (MCI), 505 with late MCI, and 305 AD cases enrolled in the AD Neuroimaging Initiative. We assessed associations of BA profiles including selected ratios with diagnosis, cognition, and AD-related genetic variants, adjusting for cofounders and multiple testing.ResultsIn AD compared to CN, we observed significantly lower serum concentrations of a primary BA (cholic acid CA) and increased levels of the bacterially produced, secondary BA, deoxycholic acid (DCA), and its glycine and taurine conjugated forms. An increased ratio of DCA:CA, which reflects 7α-dehydroxylation of CA by gut bacteria, strongly associated with cognitive decline, a finding replicated in serum and brain samples in the Rush Religious Orders and Memory and Aging Project. Several genetic variants in immune response related genes implicated in AD showed associations with BA profiles.ConclusionWe report for the first time an association between altered BA profile, genetic variants implicated in AD and cognitive changes in disease using a large multicenter study. These findings warrant further investigation of gut dysbiosis and possible role of gut liver brain axis in the pathogenesis of AD.
Motor Responses Influence Perceptual Awareness Judgements
Authors: Siedlecka Marta , Hobot Justyna , Skóra Zuzanna , Paulewicz Borysław , Timmermans Bert , Wierzchoń Michał 
Published: March 2018

AbstractPerception and action are tightly related, but what is the relation between perceptual awareness and action? In this study we tested the hypothesis that motor response influences perceptual awareness judgements. We design a procedure in which participants were asked to decide whether Gabor grating was oriented towards the left or the right. Presentation of the stimuli was immediately followed by a cue requiring motor response that was irrelevant to the task but could be the same, opposite or neutral to the correct response to the Gabor patch. After responding to the cue participants were asked to rate their stimulus awareness using Perceptual Awareness Scale and then to report their discrimination decision.The results showed that participants reported a higher level of stimulus awareness after carrying out responses that were either congruent or incongruent with a response required by a stimulus, compared to the neutral condition. The results suggest that directional motor response (congruent or incongruent with correct response to the stimulus) provides information about the decision process and its outcome increasing reported awareness of a stimulus.