bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of the Intrepid Dynamic Exoskeletal Orthosis in the Management of Common Peroneal Nerve Palsy after Knee Dislocation
Authors: Quacinella Michael , Mazzone Brittney , Kuhn Kevin , Wyatt Marilynn 
Published: November 2018

ABSTRACT

Introduction
The intrepid dynamic exoskeletal orthosis (IDEO) is a custom high-level floor reaction ankle-foot orthosis (AFO) designed specifically for the war limb salvage military population. The use of the IDEO has not been described in the management of foot drop after common peroneal nerve (CPN) palsy after knee dislocation. We present two case reports demonstrating the efficacy the IDEO in treating active-duty service members with foot drop after CPN palsy.

Method
Two active-duty male Marines sustained CPN injury and foot drop after knee dislocation as a result of noncontact sports injuries. The IDEO was selected based on both patients' functional limitations despite surgical reconstruction. Both expressed a desire to return to unrestricted active-duty military duty. The IDEO was selected for treatment based on prior successes in limb salvage patients. A three-dimensional gait analysis was performed with the patient ambulating at a self-selected speed under three conditions: 1) barefoot, 2) shod without orthosis, and 3) IDEO with shod. Variables of interest were spatiotemporal and gait kinematics, return to active-duty status, gait symmetry, and Comprehensive High-Level Activity Mobility Predictor (CHAMP) scores.

Results
Sagittal plane kinematics improved while ambulating with the IDEO demonstrating improved steppage gait. Spatiotemporal variables, specifically velocity and cadence, were improved with both the AFO and the IDEO. The most symmetrical gait pattern was observed while using the IDEO. The patients demonstrated their ability to run by completing the CHAMP test with the IDEO. Both patients were cleared for active duty.

Conclusions
The measured improvements in gait kinematics, spatiotemporal variables, gait symmetry, and CHAMP scores as a result of the IDEO show significant functional benefit, making it a useful adjuvant therapy in patients who are motivated to achieve the maximal functional outcome after this devastating injury.
Typical Versus Atypical Antipsychotics for Acute Mania
Authors: Medici Clara Reece , Kai Linda Marie , Kristensen Simon Bang , Kirkedal Christian , Munk-Jørgensen Povl , Straszek Sune 
Published: November 2018

Background:
Mania is challenging to treat. Typical antipsychotics may be more efficient compared with atypical antipsychotics, however, with unfavorable side effects.

Study Question:
To investigate the courses of acute manic episodes and correlations between changes of severity during manic episodes and type of antipsychotic treatment.

Study Design:
This case record study included patients admitted with mania (International Classification of Diseases 10th revision code F30, F31.0, F31.1, F31.2 or F31.6) at the Department of Affective Disorders, Aarhus University Hospital from June 1, 2013 to April 1, 2016.

Measures and Outcomes:
The doses of typical and atypical antipsychotics were standardized as defined daily dose according to the World Health Organization's guidelines. The severity of mania was measured up to 3 times daily with the Modified Bech–Rafaelsen Mania Scale (MAS-M), a nurse administered scale. We applied a linear regression in a mixed model approach to compare MAS-M score over time under the influence of typical plus atypical antipsychotics and atypical antipsychotics only. We further analyzed by mania with and without psychosis and by concomitant use of lithium and/or antiseizure medication.

Results:
We included 56 admissions on 46 patients. The courses of the manic episodes measured by MAS-M varied between patients—both daily variations and changes over time. Patients receiving typical antipsychotics had higher baseline MAS-M, more recent admissions, and were mechanically constrained more often compared with patients receiving atypical antipsychotics only. Adjusted for age, gender, mechanical constraint, and dosage of antipsychotics, the difference in reduction of mania was −0.02 MAS-M points/d (95% confidence interval, −0.05 to 0.01) higher in the group receiving atypical antipsychotics only; however, it is not statistically or clinically significant.

Conclusions:
The rate of improvement of mania was similar in the two groups which supports that atypical antipsychotics can be recommended over typical antipsychotics to reduce risk of severe side effects.
Preventive Effect of l-Carnitine on Scar Formation During Acute Pyelonephritis: A Randomized Placebo-Controlled Trial
Authors: Gheissari Alaleh , Aslani Nahid , Eshraghi Azadeh , Moslehi Masoud , Merikhi Alireza , Keikhah Mojtaba , Haghjoo Javanmard Shaghayegh , Vaseghi Golnaz 
Published: November 2018

Background:
Urinary tract infection and pyelonephritis are clinical problems that frequently occur in children. Several factors are responsible for renal tissue injury, morbidity, and renal scarring after pyelonephritis. The aim of this study was to evaluate the preventive effect of l-carnitine on renal scarring in acute pyelonephritis.

Methods:
A randomized double-blind clinical trial was conducted on 65 children aged 6 months to 10 years. Patients were randomized into 2 groups to receive 7-day treatment with only antibiotics without l-carnitine (control group; n = 32) and 7-day treatment with l-carnitine (case group; n = 33) during the acute phase of infection. Technetium-99m-labeled dimercaptosuccinic acid (DMSA) scintigraphy was performed for all children during the acute phase (in 2–7 days of hospitalization) and late phase. P-value less than 0.05 was statistically significant.

Results:
We recruited 65 participants in the study: 32 children in control group and 33 children in case group. Three children in the control group and 2 children in the case group refused to perform the second DMSA scan. Overall, data analysis at the end of the study was done on 60 patients. Age distribution of girl patients with upper urinary infection was 6.5% in girl children aged between 6 months and 12 months, 41.1% aged between 1 and 5 years, 33.3% aged between 5 and 10 years, respectively. There was no significant difference between 2 groups in age and sex. There was no significant difference between 2 groups in systolic blood pressure, diastolic blood pressure, the lab data including urine white blood cells and serum erythrocyte sedimentation rate, and antibiogram profiles. Voiding dysfunction was detected in 10% of the participants. The baseline DMSA was not significantly difference in 2 groups, but worsening of kidney lesions was significantly higher in control group after 6 months (P = 0.012).

Conclusion:
Our study showed that l-carnitine significantly decreased renal scarring because of acute pyelonephritis.
Outcomes and Patterns of Healthcare Utilization After Hospitalization for Pediatric Critical Illness Due to Respiratory Failure*
Authors: Yagiela Lauren M. , Barbaro Ryan P. , Quasney Michael W. , Pfarr Marie A. , Ursu Dan C. , Prosser Lisa A. , Odetola Fola O. 
Published: November 2018

Objectives:
To quantify home care needs, healthcare utilization, and 2-year mortality after pediatric critical illness due to respiratory failure, and evaluate the impact of new morbidity and abnormal function at hospital discharge on resource use and outcomes.

Design:
Retrospective cohort study.

Setting:
Quaternary care PICU.

Patients:
Patients less than or equal to 18 years with respiratory failure from January 1, 2013, to December 31, 2014.

Measurements and Main Results:
Patient demographics, hospitalization characteristics, and healthcare utilization were quantified and compared according to morbidity development and discharge functional status. Multivariable regression methods evaluated 2-year readmission rates and mortality by morbidity development and discharge functional status. Of 163 patients, the median age was 2.1 years (interquartile range, 0.6–10.9 yr), 61 (37.4%) had a comorbidity, and 73 (44.8%) had abnormal function at admission. Median ventilation duration was 6.0 days (interquartile range, 3.0–11.7 d), and median PICU and hospital length of stay were 8 (interquartile range, 4–15) and 14 days (interquartile range, 8–23 d), respectively. At hospital discharge, eight of 163 (4.9%) had died, and 14 of 163 (8.6%) had a new morbidity. Of the surviving 155 patients at hospital discharge, 87 (56.1%) had abnormal function, 120 (77.4%) had new medications, 24 (15.5%) had new medical devices, and 43 (27.7%) had new home care equipment. Cumulative 2-year mortality was 14 of 163 (8.6%) with six of 163 (3.7%) occurring after discharge. Within 2 years, 81 of 155 of patients (52.2%) were readmitted, often (58/81, 71.6%) to the PICU. Abnormal function at discharge was associated with elevated odds of readmission to the hospital (odds ratio, 1.49; 1.28–1.74; p < 0.0001) and PICU (odds ratio, 1.47; 1.27–1.71; p < 0.0001) within 2 years.

Conclusions:
After critical illness, children have significant new healthcare burdens heretofore unrecognized. Abnormal functional status at hospital discharge was associated with increased healthcare utilization up to 2 years thereafter.
Rethinking the causes of pain in herpes zoster and postherpetic neuralgia: the ectopic pacemaker hypothesis
Authors: Devor Marshall 
Published: November 2018

Abstract

Introduction:
Pain in herpes zoster (HZ) and postherpetic neuralgia (PHN) is traditionally explained in terms of 2 processes: irritable nociceptors in the rash-inflamed skin and, later, deafferentation due to destruction of sensory neurons in one virally infected dorsal root ganglion.

Objectives and methods:
Consideration of the evidence supporting this explanation in light of contemporary understanding of the pain system finds it wanting. An alternative hypothesis is proposed as a replacement.

Results:
This model, the ectopic pacemaker hypothesis of HZ and PHN, proposes that pain in both conditions is driven by hyperexcitable ectopic pacemaker sites at various locations in primary sensory neurons affected by the causative varicella zoster virus infection. This peripheral input is exacerbated by central sensitization induced and maintained by the ectopic activity.

Conclusions:
The shift in perspective regarding the pain mechanism in HZ/PHN has specific implications for clinical management.
Validating a Trigger Tool for Detecting Adverse Drug Events in Elderly Patients With Multimorbidity (TRIGGER-CHRON)
Authors: Toscano Guzmán María Dolores , Banqueri Mercedes Galván , Otero María José , Fidalgo Susana Sánchez , Noguera Isabel Font , Guerrero María Concepción Pérez 
Published: November 2018

Purpose
The aims of the study were to evaluate the performance of an initial list developed to detect adverse drug events (ADEs) in elderly patients with multimorbidity in clinical practice, to explore the possibility of shortening the list, and to use this tool to study the incidence and characteristics of the ADEs among this population.

Methods
This observational study was conducted at 12 Spanish hospitals. A random sample of five charts from each hospital was selected weekly for retrospective review for a 12-week period. We included patients aged 65 years and older with multimorbidity, hospitalized more than 48 hours. Adverse drug events were detected using a list of 51 triggers previously selected by an expert panel by means of a modified Delphi method. The number of triggers identified and ADEs detected were recorded. The severity and preventability of the ADEs were evaluated. The positive predictive value (PPV) of each trigger was calculated and used to select the most efficient triggers.

Results
In 720 charts reviewed, 1430 positive triggers were identified that led to detect 215 ADEs in 178 patients (24.7%), of which 13% were serious. One hundred nineteen ADEs (55.3%) were preventable and mainly related to inadequate treatment monitoring and prescribing errors. Triggers with a PPV of 5% or less were eliminated, resulting in a final list of 32 triggers (TRIGGER-CHRON) with a PPV of 22.1%, which accounted for 98.9% of all ADEs detected and 98.6% of the preventable ADEs.

Conclusions
The shorter final validated TRIGGER-CHRON tool is an efficient list for identifying ADEs in elderly patients with multimorbidity, detecting ADEs in one-fourth of hospitalized patients in internal medicine or geriatric units.
Sentinel Lymph Node Biopsy in Small Papillary Thyroid Cancer
Authors: Garau Ludovico M. , Rubello Domenico , Morganti Riccardo , Boni Giuseppe , Volterrani Duccio , Colletti Patrick M. , Manca Gianpiero 
Published: November 2018

Purpose
The aim of this study was to compare reported results on available techniques for sentinel lymph node detection rate (SDR) in papillary thyroid cancer (PTC).

Methods
The MEDLINE database was searched via a PubMed interface to identify original articles regarding sentinel lymph node biopsy (SNB) in thyroid cancer. Studies were stratified according to the sentinel lymph node (SLN) detection technique: vital-dye (VD), 99mTc-nanocolloid planar lymphoscintigraphy with the use of intraoperative hand-held gamma probes (LS), both 99mTc-nanocolloid planar lymphoscintigraphy with intraoperative use of hand-held gamma probe and VD (LS + VD), 99mTc-nanocolloid planar lymphoscintigraphy with the additional contribution of preoperative SPECT/CT, and intraoperative use of hand-held gamma probe (LS-SPECT/CT). Pooled SDR values were presented with a 95% confidence interval (CI) for each SLN detection techniques. A Z-test was used to compare pooled SDR estimates. False-negative rates were summarized for each method.

Results
Forty-five studies were included. Overall SDRs for the VD, LS, LS + VD, and LS-SPECT/CT techniques were 83% (95% CI, 77%–88%; I
2 = 78%), 96% (95% CI, 90%–98%; I
2 = 68%), 87% (95% CI, 65%–96%; I
2 = 75%), and 93% (95% CI, 86%–97%; I
2 = 0%), respectively. False-negative rates were 0% to 38%, 0% to 40%, 0% to 17%, and 7% to 8%, respectively.

Conclusions
In patients with PTC, 99mTc-nanocolloids offer a higher SDR than that of the VD technique. The addition of SPECT/CT improved identification of metastatic SLNs outside the central neck compartment.
SEAPI Incontinence Classification System: 1-Year Postoperative Results Following Midurethral Sling Placement
Authors: Glass Allison , Durbin-Johnson Blythe , Rothschild Jennifer , Gomelsky Alexander 
Published: November 2018

Objective
There are limited long-term data that has examined postoperative quality-of-life measures following placement of midurethral sling (MUS) for stress urinary incontinence (SUI). The SEAPI incontinence questionnaire includes 5 data points that rate severity of specific urinary symptoms. Our aim was to describe changes in SEAPI questionnaire outcomes 1 year following sling placement.

Methods
We retrospectively reviewed women who underwent MUS for SUI from 2005 to 2012. We included those women who had completed preoperative and postoperative (>12 months) SEAPI scores. Individual S, E, A, P, I score cure was defined as postoperative score of 0 (>0 preoperative). Logistic regression analysis was used to model the effects of patient characteristics on incontinence cure and S, E, A, P, I scores.

Results
A total of 584 women were included. Median follow-up was 25.4 months (12–126.8 months). Follow-up duration and baseline S, P, and I scores were associated with significantly lower odds of overall incontinence cure, whereas rectocele grade has positive association (odds ratio, 1.31; P = 0.040). Type of sling did not impact overall incontinence cure or cure of individual SEAPI scores.

Conclusions
Preoperative S, P, and I scores had negative association with stress incontinence cure. Cure of individual S, E, A, P, I scores was impacted differently by various patient factors. The SEAPI questionnaire provides a unique profile of patient-reported and functional measures in women with SUI and may be helpful in those who undergo MUS.
Activation of dopamine receptor 2 (DRD2) prompts transcriptomic and metabolic plasticity in glioblastoma
Authors: Caragher Seamus P. , Shireman Jack M. , Huang Mei , Miska Jason , Baisiwala Shivani , Park Cheol Hong , Saathoff Miranda R. , Warnke Louisa , Xiao Ting , Lesniak Maciej S. , James C. David , Meltzer Herbert , Tryba Andrew K. , Ahmed Atique U 
Published: November 2018

AbstractGlioblastoma (GBM) is one of the most aggressive and lethal tumor types. Evidence continues to accrue indicating that the complex relationship between GBM and the brain microenvironment contributes to this malignant phenotype. However, the interaction between GBM and neurotransmitters, signaling molecules involved in neuronal communication, remains incompletely understood. Here we examined, in both sexes of humans and mice, how the monoamine dopamine influences GBM cells. We demonstrate that GBM cells express DRD2, with elevated expression in the glioma-initiating cell (GIC) population. Stimulation of DRD2 caused neuron-like depolarization exclusively in GICs. In addition, long-term activation of DRD2 heightened the sphere-forming capacity of GBM cells as well as tumor engraftment efficiency. Mechanistic investigation revealed that DRD2 signaling activates the hypoxia response and functionally alters metabolism. Finally, we found that GBM cells synthesize and secrete dopamine themselves, suggesting a potential autocrine mechanism. These results identify dopamine signaling as a potential therapeutic target in GBM and further highlight neurotransmitters as a key feature of the pro-tumor microenvironment.Significance StatementThis work offers critical insight into the role of the neurotransmitter dopamine in the progression of GBM. We show that dopamine induces specific changes in the state of tumor cells, augmenting their growth and shifting them to a more stem-cell like state. Further, we show that dopamine can alter the metabolic behavior of GBM cells, increasing glycolysis. Finally, we show that GBM cells, including tumor samples from patients, can synthesize and secrete dopamine, suggesting an autocrine signaling process underlying these results. These results describe a novel connection between neurotransmitters and brain cancer, further highlighting the critical influence of the brain milieu on GBM.
Tissue-Specific Enrichment Analysis (TSEA) to decode tissue specificity
Authors: Pei Guangsheng , Dai Yulin , Zhao Zhongming , Jia Peilin 
Published: November 2018

AbstractMotivationDiseases and traits are under dynamic tissue-specific regulation. However, heterogeneous tissues are often collected in biomedical studies, which reduce the power in the identification of disease-associated variants and gene expression profiles.ResultsWe present TSEA, an R package to conduct Tissue-Specific Enrichment Analysis (TSEA) with two built-in reference panels. Statistical methods are developed and implemented for detecting tissue-specific genes and for enrichment test of different forms of query data. Our applications using multi-trait genome-wide association data and cancer expression data showed that TSEA could effectively identify the most relevant tissues for each query trait or sample, providing insights for future studies.Availabilityhttps://github.com/bsml320/TSEAContactpeilin.jia@uth.tmc.edu or zhongming.zhao@uth.tmc.edu
PhenotypeXpression: sub-classification of disease states using public gene expression data and literature
Authors: Wang Lucy Lu , Lin Huaiying , Bao Xiaojun , Sengupta Subhajit , Busby Ben , Butler Robert R 
Published: November 2018

AbstractThe success of personalized medicine relies on proper disease classification and subtyping. Differential gene expression among disease subtypes can have a significant impact on treatment effect. This complicates the role of clinicians seeking more tailored diagnoses in cases where granular disease subtypes are not well defined. PhenotypeXpression (PhenoX) is a tool for rapid disease subtyping using publicly available gene expression data and literature. PhenoX aggregates and clusters gene expression data to determine potential disease subtypes, and develops a phenotypic profile for each subtype using term co-occurrences in published literature. Although the availability of public gene expression data is limited, we are able to observe clearly defined subtypes for several conditions.
Modeling the relative role of human mobility, land-use and climate factors on dengue outbreak emergence in Sri Lanka
Authors: Zhang Ying , Riera Jefferson , Ostrow Kayla , Siddiqui Sauleh , de Silva Harendra , Sarkar Sahotra , Fernando Lakkumar , Gardner Lauren 
Published: November 2018

AbstractBackgroundMore than 80,000 dengue cases including 215 deaths were reported nationally in less than seven months between 2016-2017, a fourfold increase in the number of reported cases compared to the average number over 2010-2016. The region of Negombo, located in the Western province, experienced the greatest number of dengue cases in the country and is the focus area of our study, where we aim to capture the spatial-temporal dynamics of dengue transmission.MethodsWe present a statistical modeling framework to evaluate the spatial-temporal dynamics of the 2016-2017 dengue outbreak in the Negombo region of Sri Lanka as a function of human mobility, land-use, and climate patterns. The analysis was conducted at a 1 km × 1 km spatial resolution and a weekly temporal resolution.ResultsOur results indicate human mobility to be a stronger indicator for local outbreak clusters than land-use or climate variables. The minimum daily temperature was identified as the most influential climate variable on dengue cases in the region; while among the set of land-use patterns considered, urban areas were found to be most prone to dengue outbreak, followed by areas with stagnant water and then coastal areas. The results are shown to be robust across spatial resolutions.ConclusionsOur study highlights the potential value of using travel data to target vector control within a region. In addition to illustrating the relative relationship between various potential risk factors for dengue outbreaks, the results of our study can be used to inform where and when new cases of dengue are likely to occur within a region, and thus help more effectively and innovatively, plan for disease surveillance and vector control.