bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spinal Protein Kinase Mζ Regulates α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid Receptor Trafficking and Dendritic Spine Plasticity via Kalirin-7 in the Pathogenesis of Remifentanil-induced Postincisional Hyperalgesia in Rats
Authors: Zhang Linlin , Guo Suqian , Zhao Qi , Li Yize , Song Chengcheng , Wang Chunyan , Yu Yonghao , Wang Guolin 
Published: March 2018

Abstract

Background
Intraoperative remifentanil anesthesia exaggerates postoperative pain sensitivity. Recent studies recapitulate the significance of protein kinase Mζ in α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor–mediated pathologic pain. Kalirin-7, a Rho guanine nucleotide exchange factor, coordinates AMPA receptor trafficking and dendritic spine plasticity. This study examines whether protein kinase Mζ and Kalirin-7 contribute to remifentanil-induced postincisional hyperalgesia via AMPA receptor.

Methods
Plantar incision was performed 10 min after the start of remifentanil infusion (1 µg · kg−1 · min−1 for 60 min). Paw withdrawal threshold (primary outcome), spinal protein kinase Mζ activity, Kalirin-7 expression, AMPA receptor trafficking, and spine morphology were assessed. Protein kinase Mζ inhibitor and Kalirin-7 knockdown by short hairpin RNA elucidated the mechanism and prevention of hyperalgesia. Whole-cell patch-clamp recording analyzed the role of protein kinase Mζ in spinal AMPA receptor–induced current.

Results
Remifentanil reduced postincisional paw withdrawal threshold (mean ± SD, control vs. hyperalgesia, 18.9 ± 1.6 vs. 5.3 ± 1.2 g, n = 7) at postoperative 48 h, which was accompanied by an increase in spinal protein kinase Mζ phosphorylation (97.8 ± 25.1 vs. 181.5 ± 18.3%, n = 4), Kalirin-7 production (101.9 ± 29.1 vs. 371.2 ± 59.1%, n = 4), and number of spines/10 µm (2.0 ± 0.3 vs. 13.0 ± 1.6, n = 4). Protein kinase Mζ inhibitor reduced remifentanil-induced hyperalgesia, Kalirin-7 expression, and GluA1 trafficking. Incubation with protein kinase Mζ inhibitor reversed remifentanil-enhanced AMPA receptor-induced current in dorsal horn neurons. Kalirin-7 deficiency impaired remifentanil-caused hyperalgesia, postsynaptic GluA1 insertion, and spine plasticity. Selective GluA2-lacking AMPA receptor antagonist prevented hyperalgesia in a dose-dependent manner.

Conclusions
Spinal protein kinase Mζ regulation of GluA1-containing AMPA receptor trafficking and spine morphology via Kalirin-7 overexpression is a fundamental pathogenesis of remifentanil-induced hyperalgesia in rats.
Comparison of Placental and Neonatal Admission Complete Blood Cell Count and Blood Cultures
Authors: Newberry Desi M. 
Published: March 2018

Background:
The utilization of placental blood for neonatal admission laboratory tests, specifically the complete blood cell (CBC) count and blood culture, has the potential to delay the onset of anemia of prematurity and intraventricular hemorrhage, frequency of blood transfusions and associated complications, and painful procedures related to laboratory sampling.

Purpose:
To determine the feasibility of drawing neonatal admission laboratory tests from the placenta rather than the neonate and to compare CBC count and blood culture results.

Methods:
All infants less than 35 weeks' gestational age and all term infants with a maternal history of chorioamnionitis or untreated, positive group B Streptococcus status were eligible to participate. Participating infants had paired CBC count and blood cultures obtained from the placenta and the infant.

Results:
All CBC count outcomes were significantly, positively correlated between placental and infant blood (all Ps < .05). The paired white blood cells, neutrophils, and lymphocytes were strongly correlated (r = 0.761, r = 0.797, and r = 0.815, respectively), whereas the hemoglobin, hematocrit, platelet, and eosinophils were moderately correlated (r = 0.554, r = 0.545, r = 0.563, and r = 0.478, respectively). Monocytes and basophils were only weakly correlated (r = 0.373 and r = 0.217, respectively). There were 13 (93%) pairs where placental blood culture was positive but the direct infant draw blood culture was negative, and 1 (7%) pair where the placental culture was negative but the direct infant draw blood culture was positive.

Implications for Practice:
The results of this and other studies suggest that placental blood can be reliably used to obtain neonatal admission CBC count and blood cultures.

Implications for Research:
Further research is needed regarding the prevention of blood culture contamination, especially in vaginally delivered placentas. Institutions that adopt this procedure should perform quality improvement initiatives to monitor outcomes and add to the growing body of literature on the utilization of placental blood for neonatal admission laboratory tests.
The Impact of Comorbid Mental Health Disorders on Complications Following Cervical Spine Surgery With Minimum 2-Year Surveillance
Authors: Diebo Bassel G. , Lavian Joshua D. , Liu Shian , Shah Neil V. , Murray Daniel P. , Beyer George A. , Segreto Frank A. , Maffucci Fenizia , Poorman Gregory W. , Cherkalin Denis , Torre Barrett , Vasquez-Montes Dennis , Yoshihara Hiroyuki , Cukor Daniel , Naziri Qais , Passias Peter G. , Paulino Carl B. 
Published: March 2018

Study Design.
Retrospective analysis.

Objective.
To improve understanding of the impact of comorbid mental health disorders (MHDs) on long-term outcomes following cervical spinal fusion in cervical radiculopathy (CR) or cervical myelopathy (CM) patients.

Summary of Background Data.
Subsets of patients with CR and CM have MHDs, and their impact on surgical complications is poorly understood.

Methods.
Patients admitted from 2009 to 2013 with CR or CM diagnoses who underwent cervical surgery with minimum 2-year surveillance were retrospectively reviewed using New York State's Statewide Planning and Research Cooperative System. Patients with a comorbid MHD were compared against those without (no-MHD). Univariate analysis compared demographics, complications, readmissions, and revisions between MHD and no-MHD cohorts. Multivariate binary logistic regression models identified independent predictors of outcomes (covariates: age, sex, Charlson/Deyo score, and surgical approach).

Results.
A total of 20,342 patients (MHD: n = 4819; no-MHD: n = 15,523) were included. MHDs identified: depressive (57.8%), anxiety (28.1%), sleep (25.2%), and stress (2.9%). CR patients had greater prevalence of comorbid MHD than CM patients (P = 0.015). Two years postoperatively, all patients with MHD had significantly higher rates of complications (specifically: device-related, infection), readmission for any indication, and revision surgery (all P < 0.05); regression modeling corroborated these findings and revealed combined surgical approach as the strongest predictor for any complication (CR, odds ratio [OR]: 3.945, P < 0.001; CM, OR: 2.828, P < 0.001) and MHD as the strongest predictor for future revision (CR, OR: 1.269, P = 0.001; CM, OR: 1.248, P = 0.008) in both CR and CM cohorts.

Conclusion.
Nearly 25% of patients admitted for CR and CM carried comorbid MHD and experienced greater rates of any complication, readmission, or revision, at minimum, 2 years after cervical spine surgery. Results must be confirmed with retrospective studies utilizing larger national databases and with prospective cohort studies. Patient counseling and psychological screening/support are recommended to complement surgical treatment.

Level of Evidence: 3
What Faces Reveal: A Novel Method to Identify Patients at Risk of Deterioration Using Facial Expressions*
Authors: Madrigal-Garcia Maria Isabel , Rodrigues Marcos , Shenfield Alex , Singer Mervyn , Moreno-Cuesta Jeronimo 
Published: March 2018

Objectives:
To identify facial expressions occurring in patients at risk of deterioration in hospital wards.

Design:
Prospective observational feasibility study.

Setting:
General ward patients in a London Community Hospital, United Kingdom.

Patients:
Thirty-four patients at risk of clinical deterioration.

Interventions:
A 5-minute video (25 frames/s; 7,500 images) was recorded, encrypted, and subsequently analyzed for action units by a trained facial action coding system psychologist blinded to outcome.

Measurements and Main Results:
Action units of the upper face, head position, eyes position, lips and jaw position, and lower face were analyzed in conjunction with clinical measures collected within the National Early Warning Score. The most frequently detected action units were action unit 43 (73%) for upper face, action unit 51 (11.7%) for head position, action unit 62 (5.8%) for eyes position, action unit 25 (44.1%) for lips and jaw, and action unit 15 (67.6%) for lower face. The presence of certain combined face displays was increased in patients requiring admission to intensive care, namely, action units 43 + 15 + 25 (face display 1, p < 0.013), action units 43 + 15 + 51/52 (face display 2, p < 0.003), and action units 43 + 15 + 51 + 25 (face display 3, p < 0.002). Having face display 1, face display 2, and face display 3 increased the risk of being admitted to intensive care eight-fold, 18-fold, and as a sure event, respectively. A logistic regression model with face display 1, face display 2, face display 3, and National Early Warning Score as independent covariates described admission to intensive care with an average concordance statistic (C-index) of 0.71 (p = 0.009).

Conclusions:
Patterned facial expressions can be identified in deteriorating general ward patients. This tool may potentially augment risk prediction of current scoring systems.
Understanding and Treating Supralevator Fistula-in-Ano: MRI Analysis of 51 Cases and a Review of Literature
Authors: Garg Pankaj 
Published: March 2018

BACKGROUND:
Supralevator fistulas are highly complex. The delineation of the supralevator fistula has become accurate because of MRI.

OBJECTIVE:
The aim of the study was to analyze the pathophysiology and treatment of different types of supralevator fistulas.

DESIGN:
This was a prospective study.

SETTINGS:
The study was conducted at a specialized fistula treatment center in North India.

PATIENTS:
All of the patients with fistula-in-ano who presented in the outpatient department were assessed with a physical examination and MRI scan. The patients in whom the supralevator extension was confirmed on MRI were included in the study.

MAIN OUTCOME MEASURES:
The MRI scans of patients included in the study were analyzed in detail to assess the types of supralevator fistulas and other characteristics of these fistulas. The patients who were operated on were followed for cure rate and deterioration in incontinence.

RESULTS:
Of 702 patients with fistula-in-ano who were analyzed by MRI over a period of 3 years, 51 patients with supralevator fistula-in-ano were identified. The mean age was 44.3 ± 12.1 years and the male:female ratio was 16:1. The incidence of supralevator fistulas was 7.26% (51 of 702). In supralevator fistulas, the supralevator extension (upper part) was found to be in the intersphincteric plane in all of the patients. This upper part could be successfully managed by laying it open through the transanal route. The infralevator (lower) part could be of 3 types: intersphincteric (n = 13), low transsphincteric (n = 3), or high transsphincteric (n = 35). The lower part could be managed conventionally. There were no extrasphincteric fistulas. An extensive review of the literature revealed only 2 studies (total fistulas = 16) in which supralevator fistula was studied.

LIMITATIONS:
This was a retrospective study.

CONCLUSIONS:
The upper supralevator extension in all of the supralevator fistulas is almost always in the intersphincteric plane. This upper part could be laid open through the transanal route. The lower infralevator part could be of 3 types, intersphincteric, low transsphincteric, or high transsphincteric, which could be managed conventionally. Thus, supralevator fistulas could be managed successfully and easily. See Video Abstract at http://links.lww.com/DCR/A630.
Mucinous Histology Signifies Poor Oncologic Outcome in Young Patients With Colorectal Cancer
Authors: Soliman Basem G. , Karagkounis Georgios , Church James M. , Plesec Thomas , Kalady Matthew F. 
Published: March 2018

BACKGROUND:
The incidence of colorectal cancer in the young (under age 40) is increasing, and this population has worse oncologic outcomes. Mucinous histology is a potential prognostic factor in colorectal cancer, but has not been evaluated specifically in young patients.

OBJECTIVE:
The objective of the study was to determine factors associated with poor outcome in young patients with colorectal cancer (≤40 years) and to determine relationships between mucinous histology and oncologic outcomes in this population.

DESIGN:
This is a retrospective study.

SETTING:
Patients from a single-institution tertiary care center were studied.

PATIENTS:
A total of 224 patients with colorectal cancer under 40 years of age diagnosed between 1990 and 2010 were included (mean age, 34.7 years; 51.3% female). 34 patients (15.2%) had mucinous histology.

INTERVENTIONS(S):
There were no interventions.

MAIN OUTCOME MEASURES:
Oncologic outcomes were analyzed according to the presence of mucinous histology.

RESULTS:
The mucinous and nonmucin colorectal cancer study populations were statistically similar in age, sex, tumor location, pathological stage, differentiation, and adjuvant chemotherapy use. Five-year disease-free survival was 29.1% versus 71.3% (p < 0.0001) and 5-year overall survival was 54.7% versus 80.3% (p < 0.0001) for mucinous and nonmucinous patients, respectively. Mucinous colorectal cancers recurred earlier at a median time of 36.4 months versus 94.2 months for nonmucin colorectal cancers (p < 0.001). On multivariate analysis, pathological stage (stage II HR, 3.61; 95% CI, 1.37–9.50; stage III HR, 5.27; 95% CI, 2.12–12.33), positive margins (HR, 1.95; 95% CI, 1.12–3.23), angiolymphatic invasion (HR, 2.15; 95% CI, 1.26–3.97), and mucinous histology (HR, 2.36; 95% CI, 1.44–3.96) were independently associated with worse disease-free and overall survival.

LIMITATIONS:
This is a retrospective study without genetic information.

CONCLUSIONS:
Mucinous histology is a negative prognostic factor in young patients with colorectal cancer. This is associated with early and high recurrence rates, despite use of standard neoadjuvant and adjuvant regimens. Physicians need to be aware of this association and potentially explore novel treatment options. See Video Abstract at http://links.lww.com/DCR/A575.
A Systematic Review and Meta-analysis of Mesenchymal Stem Cell Injections for the Treatment of Perianal Crohn’s Disease: Progress Made and Future Directions
Authors: Lightner Amy L. , Wang Zhen , Zubair Abba C. , Dozois Eric J. 
Published: March 2018

BACKGROUND:
There has been a surge in clinical trials studying the safety and efficacy of mesenchymal stem cells for the treatment of perianal Crohn’s disease.

OBJECTIVE:
The purpose of this work was to systematically review the literature to determine safety and efficacy of mesenchymal stem cells for the treatment of refractory perianal Crohn’s disease.

DATA SOURCES:
Sources included PubMed, Cochrane Library Central Register of Controlled Trials, and Embase.

STUDY SELECTION:
Studies that reported safety and/or efficacy of mesenchymal stem cells for the treatment of perianal Crohn’s disease were included. Two independent assessors reviewed eligible articles.

INTERVENTION:
The study intervention was delivery of mesenchymal stem cells to treat perianal Crohn’s disease.

MAIN OUTCOMES MEASURES:
Safety and efficacy of mesenchymal stem cells used to treat perianal Crohn’s disease were measured.

RESULTS:
Eleven studies met the inclusion criteria and were included in the systematic review. Three trials with a comparison arm were included in the meta-analysis. There were no significant increases in adverse events (OR = 1.07 (95% CI, 0.61–1.89); p = 0.81) or serious adverse events (OR = 0.53 (95% CI, 0.28–0.98); p = 0.04) in patients treated with mesenchymal stem cells. Mesenchymal stem cells were associated with improved healing as compared with control subjects at primary end points of 6 to 24 weeks (OR = 3.06 (95% CI, 1.05–8.90); p = 0.04) and 24 to 52 weeks (OR = 2.37 (95% CI, 0.90–6.25); p = 0.08).

LIMITATIONS:
The study was limited by its multiple centers and heterogeneity in the study inclusion criteria, mesenchymal stem cell origin, dose and frequency of delivery, use of scaffolding, and definition and time point of fistula healing.

CONCLUSIONS:
Although there have been only 3 trials conducted with control arms, existing data demonstrate improved efficacy and no increase in adverse or serious adverse events with mesenchymal stem cells as compared with control subjects for the treatment of perianal Crohn’s disease.
Aggressive Digital Papillary Adenocarcinoma: Population-Based Analysis of Incidence, Demographics, Treatment, and Outcomes
Authors: Rismiller Kyle , Knackstedt Thomas J. 
Published: March 2018

BACKGROUND
As a rare cutaneous malignancy, epidemiologic and outcomes data for aggressive digital papillary adenocarcinoma (ADPA) are limited and no treatment guidelines exist.

OBJECTIVE
To provide a population-based study of ADPA incidence and outcomes with a subgroup comparison of patients with localized versus regional disease.

METHODS
Data from 18 registries within the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program were examined for patients with ADPA (1995–2013) to provide demographic- and cancer-related information, and to calculate race- and age-specific rate ratios, incidence, and mortality. Patients were stratified by the stage for further comparison.

RESULTS
Ninety-four cases of ADPA were identified. Overall, ADPA incidence was 0.08 per 1,000,000 person-years, 4 times higher in males than in females (0.13 vs 0.03, p < .001), and most common in Caucasians. Regional disease spread occurred in 22.3% of patients and disease-specific mortality in 2.1% of patients. Patients with regional versus localized disease at diagnosis did not differ significantly in sex, age, race, primary site, tumor size, or mortality.

CONCLUSION
Aggressive digital papillary adenocarcinoma is a rare malignancy with increasing incidence. Regional disease spread is not infrequent, but mortality is rare. Identification of patients best suited for additional diagnostic procedures or more extensive surgical resection remains challenging.
Skin and Soft Tissue Surgery in the Office Versus Operating Room Setting: An Analysis Based on Individual-Level Medicare Data
Authors: Kantor Jonathan 
Published: March 2018

BACKGROUND
The relative volume of skin and soft tissue excision and reconstructive procedures performed in the outpatient office versus facility (ambulatory surgical center or hospital) differs by specialty, and has major implications for quality of care, outcomes, development of guidelines, resident education, health care economics, and patient perception.

OBJECTIVE
To assess the relative volume of surgical procedures performed in each setting (office vs ambulatory surgery center [ASC]/hospital) by dermatologists and nondermatologists.

METHODS
A cross-sectional analytical study was performed using the Medicare public use file (PUF) for 2014, which includes every patient seen in an office, ASC, or hospital in the United States billed to Medicare part B. Data were divided by physician specialty and setting.

RESULT
A total of 9,316,307 individual encounters were included in the Medicare PUF. Dermatologists account for 195,001 (2.1%) of the total. Dermatologists were more likely to perform surgical procedures in an office setting only (odds ratio 5.48 [95% confidence interval 5.05–5.95], p < .0001) than other specialists in aggregate.

CONCLUSION
More than 90% of surgical procedures are performed in an office setting, and dermatologists are more than 5 times as likely as other specialists to operate in an office setting.
Quantification of Apixaban, Dabigatran, Edoxaban, and Rivaroxaban in Human Serum by UHPLC-MS/MS—Method Development, Validation, and Application
Authors: Lindahl Sofia , Dyrkorn Roar , Spigset Olav , Hegstad Solfrid 
Published: March 2018

Background:
Direct oral anticoagulants (DOACs) are prescribed for anticoagulation in patients with atrial fibrillation and venous thromboembolic disease. Fixed doses are recommended, but measuring their serum drug concentrations as a basis for dose adjustments may be useful in some clinical settings.

Methods:
An ultra–high-performance liquid chromatography-tandem mass spectrometry method for the analysis of the DOACs apixaban, dabigatran, edoxaban, and rivaroxaban in human serum was developed and validated. A 100-µL serum sample was handled using a pipetting robot. Protein precipitation was performed with 375 µL of 1% formic acid in acetonitrile (vol/vol), and phospholipid removal was performed using a Waters Ostro 96-well plate. The injection volume was 1 µL, and run time was 3.0 minutes.

Results:
The calibration range was 5–800 nmol/L. The between-day precision relative SDs were in the range of 3.3%–10%. Recoveries ranged from 85% to 105%, and matrix effects from 88% to 102%, when corrected with internal standard. Edoxaban was, in contrast to the other DOACs, unstable when stored for more than 6 hours at 30°C. The suitability of the method was demonstrated by analyzing routine samples from 345 patients undergoing anticoagulation treatment.

Conclusions:
The developed method fulfilled the set validation criteria, and its suitability was demonstrated in a routine setting. The instability of edoxaban may complicate the transport of routine samples to the laboratory.
Accurate Prediction of Submental Lymph Nodes Using Magnetic Resonance Imaging for Lymphedema Surgery
Authors: Asuncion Mora-Ortiz , Chu Sung-Yu , Huang Yen-Ling , Lin Chia-Yu , Cheng Ming-Huei 
Published: March 2018

Background:
Submental lymph node transfer has proved to be an effective approach for the treatment of lymphedema. This study was to investigate the anatomy and distribution of vascularized submental lymph node (VSLN) flap using magnetic resonance imaging (MRI) and their clinical outcome.

Methods:
Fifteen patients who underwent 19 VSLN flap transfers for upper or lower limb lymphedema were retrospectively analyzed. The number of submental lymph nodes was compared among preoperative MRI, preoperative sonography, intraoperative finding, postoperative sonography, and postoperative computed tomography angiography. The outcome was compared between preoperatively and postoperatively.

Results:
All 19 VSLN flaps survived. Two hundred fifteen lymph nodes were identified in 30 submandibular regions by MRI. The mean number of submental lymph nodes on preoperative MRI was 7.2 ± 2.4, on preoperative sonography was 3.2 ± 1.1, on intraoperative finding was 3.1 ± 0.6, postoperative sonography was 4.6 ± 1.8, and postoperative CTA was 5.2 ± 1.9. Sixty-one percent of the lymph nodes were located in the central two-quarters of the line drawn from the mental protuberance to the mandibular angle. The actual harvest rate of submental lymph nodes was 72.2%. At a 12-month follow-up, mean episodes of cellulitis were improved from 2.7 ± 0.6 to 0.8 ± 0.2 (P < 0.01); mean of circumferential difference was improved 3.2 ± 0.4 cm (P < 0.03). The overall lymphedema quality-of-life was improved 4.9 ± 0.3 (P < 0.04).

Conclusions:
The preoperative MRI is a useful tool for the detection of mean 7.2 submental lymph nodes. Mean 72.2% of submental lymph nodes can be successfully transferred for extremity lymphedema with optimal functional recovery.