bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mood disorders do not predict a more difficult course after primary anatomic total shoulder arthroplasty
Authors: Lonergan Timothy M. , Villarreal Arturo D. , Smith Richard A. , Brolin Tyler J. , Azar Frederick M. , Throckmorton Thomas W. 
Published: March 2019

Background:
Mood disorders are present in up to 30% of patients with arthroplasty procedures, but information is lacking about their impact on shoulder arthroplasty. As risk stratification models for bundled payment programs develop, this information becomes increasingly relevant because these plans typically are tied to 90-day episode of care. We studied the effect of mood disorders on pain, narcotic use, length of hospital stay, and complications following primary anatomic total shoulder arthroplasty (TSA) in this period.

Methods:
Patients with mood disorders were identified by notation of depression and/or anxiety on intake forms or use of prescription mood stabilizers. Visual analog pain scores (VAS) were recorded at the preoperative visit and at 2-, 6-, and 12-weeks after surgery. Oral morphine equivalents (OME) were recorded for in-hospital use, discharge medications, and prescriptions given at 2-, 6-, and 12-weeks. Length-of-stay and complication data also were recorded.

Results:
Of 133 primary anatomic TSAs, 29 patients (32 shoulders) had mood disorders, 101 did not. There were no significant differences between groups regarding age, operative indication, body mass index (BMI), or comorbidities; no significant differences in VAS scores or OME narcotic use at any of the recorded time points and no statistically significant differences in length of hospital stay or postoperative complications.

Conclusions:
Patients with a mood disorder can expect a postoperative course similar to patients without depression or anxiety. A mood disorder does not appear to be a significant risk factor for bundled payment plans to consider when developing predictive modeling for primary anatomic TSA.

Level of Evidence:
Level III, retrospective case-control prognostic study
Sternoclavicular Joint Dislocation: A Systematic Review and Meta-analysis
Authors: Sernandez Haley , Riehl John 
Published: March 2019

Objectives:
This meta-analysis was performed to answer the following questions: (1) What is the expected outcome of sternoclavicular (SC) dislocations left untreated? (2) What are the indications for closed reduction of SC dislocations? (3) What are the indications for open reduction of SC dislocations? and (4) Does the evidence support the need for a cardiothoracic surgeon to be available for the open reduction of a SC dislocation?

Data Sources:
Articles were obtained from the database EBSCOhost and supplemented by hand searching of bibliographies of included references. A search using the following terms: SC joint AND (dislocation OR injuries OR vascular injury OR cardiovascular surgeon) of the English-language literature from 1970 to 2018 on the topic of SC joint dislocations was performed.

Study Selection:
Studies were included if they contained clinical data on one or more of our study objectives. Articles were included if they contained participants presenting with an acute (<3 week old) SC joint dislocation who were 16 years of age or above. A total of 92 cases fit this participant criteria.

Data Extraction:
Studies chosen based on the inclusion and exclusion criteria were assessed for level of evidence and were then carefully reviewed for data pertaining to the current study questions. Data from individual articles were recorded in a spreadsheet program and grouped appropriately.

Data Synthesis:
Individual cases of acute SC joint dislocations reported in the literature were noted by the authors. The cases were organized into a spreadsheet, which allowed for the calculation of total patients treated and with what treatment option. Complications that followed treatment were also noted, allowing for a quantitative analysis of patient outcome.

Conclusions:
Based on the current body of literature, closed reduction should be attempted in the acute setting and open treatment performed in cases of failed closed reduction in posterior SC dislocations.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
New approaches in salivary gland carcinoma
Authors: Even Caroline , Baste Neus , Classe Marion 
Published: March 2019

Purpose of review
Salivary gland carcinomas (SGCs) are rare tumors of the head and neck with a wide diversity of histologic subtypes characterized by specific morphological, immunohistochemical, and genetic features as well as particular clinical behavior. Chemotherapy is employed almost exclusively with a palliative aim in patients with metastatic and/or recurrent disease and has demonstrated poor activity.

Recent findings
Important advances have been made in the understanding of the molecular pathogenesis of SGCs. Recent studies using next-generation sequencing and genomic and expression profiling methods have identified several genomic alterations of potential clinical significance. We discuss here the recent and most important advances in SGCs biomarkers and their clinical implication. Last years, immune checkpoint inhibitors (ICIs) have changed the landscape of oncology. We report here the few available data in SGCs.

Summary
A strategy based on molecular screening and targeted therapy seems to be the best approach for treating patients with SGCs, in the future. More data on ICI's efficacy and biomarkers of response are required to define the place of immunotherapy in the management of SGCs.
Targeting advanced urothelial carcinoma-developing strategies
Authors: Alhalabi Omar , Rafei Hind , Shah Amishi , Siefker-Radtke Arlene , Campbell Matthew , Gao Jianjun 
Published: March 2019

Purpose of review
Advanced urothelial carcinoma is a heterogeneous disease with high burden of morbidity, mortality, and cost. Significant progress has been made in understanding the biology of the disease and the development of immunotherapies and targeted therapies. In this review, we summarize the current and future therapeutic approaches in the management of urothelial carcinoma.

Recent findings
Advances in immune checkpoint inhibitors resulted in the Food and Drug Administration (FDA) approvals of atezolizumab in 2016, and pembrolizumab, avelumab, durvalumab, and nivolumab in 2017 for the treatment of advanced urothelial carcinoma. More recently, development of inhibitors targeting the fibroblast growth factor receptor genetic alterations and antibody–drug conjugates targeting specific cell surface antigens (trop2, nectin4, and SLITRK6) resulted in several FDA breakthrough designations for urothelial carcinoma.

Conclusion
The development of novel therapies targeting the immune and molecular pathways of advanced urothelial carcinoma is promising for the improvement of outcomes in this lethal disease. Ongoing efforts are poised to optimize therapeutic options in the post-chemotherapy arena. In the era of precision medicine, the future of urothelial carcinoma lies in using less cytotoxic chemotherapy, more targeted therapy and immunotherapy, and possibly a combination of these therapeutic approaches.
Six Principles for Remaining Positive in a Negative Work Environment
Authors: Johanson Linda S. 
Published: March 2019

ABSTRACT:
Nurses employed in a caustic work environment can find their ability to give quality patient care impeded. Situations in which there is incivility, high stress, jealousy, or harassment, exemplify work environments that can be discouraging, especially for Christian nurses who may have pursued the profession in response to a spiritual calling. There are biblical passages that nurses may use to help them cope, including six focus points to guide and encourage nurses in caustic work situations.
No Additional Benefit of Combining Fractional Carbon Dioxide Laser With Narrow-Band Ultraviolet B Phototherapy for Vitiligo: A Randomized Prospective Study With Half-Body Side Comparison
Authors: Eşme Pelin , Gür Aksoy Güneş , Elçin Gonca 
Published: March 2019

BACKGROUND
Narrow-band ultraviolet B (nb-UVB) phototherapy constitutes the gold standard treatment for vitiligo. Whether carbon dioxide (CO2) laser might increase the efficacy of nb-UVB is still a topic of debate.

OBJECTIVE
To test the hypothesis that the addition of fractional CO2 laser to nb-UVB may enhance repigmentation.

PATIENTS AND METHODS
Fractional CO2 laser was applied with an interval of 2 weeks for 7 sessions, only to 1 of the 2 symmetrical vitiligo patches located on 2 different half-body sides. Patients received whole-body nb-UVB phototherapy 3 times a week, for at least 4 months. Repigmentation was scored with a quartile grading scale, with the help of a computer program using the photographs taken by the digital dermatoscope.

RESULTS
Fifty-one symmetrical vitiligo patches of 30 patients were included. No statistically significant difference was found between the mean repigmentation scores for the laser and nonlaser sides (p = .11).

CONCLUSION
Results of this study suggest that combining fractional CO2 laser with nb-UVB phototherapy with the regimen used in this study does not increase the repigmentation scores for vitiligo.
Efficacy and Safety of Botulinum Toxin A in Axillary Bromhidrosis and Associated Histological Changes in Sweat Glands: A Prospective Randomized Double-Blind Side-by-Side Comparison Clinical Study
Authors: Wu Chien-Ju , Chang Chun-Kai , Wang Chi-Yu , Liao Yi-Shu , Chen Shyi-Gen 
Published: March 2019

BACKGROUND
The efficacy of botulinum toxin A (BTX-A) therapy in axillary hyperhidrosis has been documented; however, there are a few studies reporting the efficacy of BTX-A in treating axillary bromhidrosis. The histological changes occurring in sweat glands after BTX-A treatment are also unknown.

OBJECTIVE
The authors report on the efficacy and safety of BTX-A in the treatment of axillary bromhidrosis and on the histological changes in sweat glands after BTX-A treatment.

MATERIALS AND METHODS
Nineteen patients were included in this study. The patients were administered BTX-A injection in one axilla and sterile normal saline as placebo in the other axilla. The degree of malodor was evaluated subjectively by the patients before and 3 months after treatment. Sweat secretion was quantified by the gravimetric method. All patients underwent standard apocrinectomy in both axillary regions.

RESULTS
The mean degree of malodor and mean sweat production in the BTX-A–treated axilla were significantly lower than those in the control axilla (2.42 vs 8.00; p < .0001 and 13.33 vs 33.75 mg/min; p = .0028, respectively) at 3 months after therapy. The histological studies showed apocrine sweat glands with atrophic changes and hypoplasia in treated axilla.

CONCLUSION
BTX-A injection is an easy, fast, noninvasive method of treating axillary bromhidrosis.
A Simple Method to Screen for Radiostrontium in Water by Ion Exchange Chromatography
Authors: Nguyen Dao M. , Moody W. Allen , Williamson John A. 
Published: March 2019

Abstract
Radiostrontium isotopes (85Sr, 89Sr, and 90Sr) are major fission by-products in nuclear reactors, in radiological events, and in environmental radioactive contamination. A method to analyze 89Sr and 90Sr in water has been developed using gradient elution with dilute hydrochloric acid and cation exchange resin, followed by carbonate precipitation. Counting was done on a gas proportional counter. The sample was recounted a second time after 2 to 3 wk to permit 90Y, a progeny of 90Sr, to achieve secular equilibrium and to allow 89Sr and 90Sr to be determined. This method was found to be simple, exhibiting high recovery, reduced use of hazardous chemicals, and lower cost compared to other current methods. An extensive comparison of the performance of the cation exchange method vs. a method using strong nitric acid (US Environmental Protection Agency Method 905.0) and a method using a specific strontium resin was conducted on performance test samples containing 90Sr (in a number of matrices) from the US Department of Energy’s Mixed Analyte Performance Evaluation Program and mixed 89Sr- and 90Sr-containing water samples from the Environmental Resource Associates quality assurance program. The method described here is shown to yield comparable results to others.
Risk Communication Strategies for Possible Health Risks From Radio-Frequency Electromagnetic Fields (RF-EMF) Emission by Telecommunication Structures
Authors: Fernandez Prasana Rosaline , Ng Kwan-Hoong , Kaur Surinderpal 
Published: March 2019

AbstractThere is widespread anxiety and speculation about RF-EMF emissions by telecommunication base stations and structures, as it is perceived by some to be unsafe and a threat to public health. Scientists, medical experts, politicians, journalists, and mobile telecommunication company specialists are involved in an active debate on whether people are immune to RF or if we are gambling with our future. Interviews with 31 individuals from 7 stakeholder groups in Malaysia reveal that the residents’ main concerns are that the telecommunication companies do not follow guidelines and as a result the telecommunication structures are constructed close to their homes, which they perceive as a threat to public health. Some residents also do not want these structures because of cultural reasons, while some are jealous over rental income received by the landlords. Meanwhile, the authorities entrusted with safe-guarding public health are involved in a blame game as there is no agency that is clearly in charge. The interviews also highlight that the current risk communication initiatives are more reactive rather than proactive, and that the authorities do not speak in one voice. Based on the outcome of the interviews, eleven recommendations are formulated to improve risk communication initiatives in Malaysia. The recommendations stress on repairing, building, and strengthening trust, because trust in agencies, along with credibility, determines risk communication initiatives’ effectiveness. These strategies can also be effectively replicated across regions to deal with contestations over RF-EMF emissions and the impact on health.
Dimensions and Morphologic Variability of the Retro-Orbicularis Oculi and Frontalis Muscle Fat Pad
Authors: Blandford Alexander D. , Bachour Salam P. , Chen Rachel , Xu Lucy T. , Hwang Catherine J. , Perry Julian D. 
Published: March 2019

Purpose:
To quantify the complete dimensions of the retro-orbicularis oculi fat (ROOF) pad and to determine its relationship to other fat compartments of the forehead.

Methods:
The entire forehead of 14 hemifaces of seven fresh frozen human cadavers (four female, three male) was dissected in the subcutaneous and submuscular planes. For each plane, a ruler was placed at the facial midline, and images of the dissection plane were taken at 90° and 45°. Images were analyzed for vertical height, horizontal length, the distance to midline from the point of maximal height, and area for each hemiface of the ROOF and for the entire fat compartment contiguous with the ROOF. A two-tailed t test was conducted between ROOF and ROOF plus the extended fat plane across all measurements. A Wilcoxon nonparametric signed rank test was performed to determine equivalent fat distribution of the extended fat plane over each cadaver’s respective eye.

Results:
The deep fat originating from the ROOF consistently extended laterally and superiorly in each specimen, distinctly separated via septae from the deep central, deep lateral, and the deep temporal fat compartments. The color, composition, and distribution of this contiguous deep fat did not differ phenotypically from the traditional ROOF. The extended deep fat plane possessed an average vertical height of 3.09 ± 0.68 cm, average distance to midline from point of maximal height of 3.56 ± 0.53 cm, an average horizontal length of 5.37 ± 0.82 cm, and an average area of 13.40 ± 2.69 cm2. The extended deep fat demonstrated a statistically significant increase in maximal height, length, and total area compared with the ROOF. A Wilcoxon nonparametric signed rank test was nonsignificant (α = 0.01) across all measurements, demonstrating that the extended fat plane was similarly distributed over each eye.

Conclusions:
A layer of deep fat originating from the traditionally defined ROOF extends superiorly and laterally beneath the frontalis muscle, separate from the deep lateral, deep central, and deep temporal fat pads. This is the first study to clearly demonstrate a contiguous superficial musculoaponeurotic system layer of fat extending under both the orbicularis oculi and frontalis muscles. This plane of fat is more appropriately described as the retro-orbicularis oculi and frontalis fat.
Orbital Septum Fibrosis in Congenital Ptosis Correlates With Eyelid Function: A Clinicopathologic Study
Authors: Heisel Curtis J. , Heider Amer , Stewart Krista J. , Andrews Christopher A. , Kahana Alon 
Published: March 2019

Purpose:
Congenital ptosis can threaten visual function and is usually treated with surgical correction. This study tests the hypothesis that congenital ptosis involves not only the levator muscle but also the orbital septum, which may tether the eyelid in the primary position.

Methods:
A retrospective chart review was performed on 30 patients (41 eyelids) with congenital ptosis who underwent surgical correction that included partial septum excision. Histologic analysis was performed by a masked pediatric pathologist, with grading of septal tissue disorganization and fibrosis based on standard histologic criteria. An independent comparison of histologic grading with clinical ptosis measures was then performed.

Results:
Fifteen eyelids demonstrated significant septal fibrosis, 19 were mild, and 7 were not fibrotic. Thirty-six eyelids demonstrated histologic disorganization. Mildly fibrotic eyelids were found to have reduced preoperative levator function than those that were not fibrotic (2.84 ± 1.92 vs. 9.57 ± 4.76 mm; p < 0.0001). Samples that demonstrated significant fibrosis were also found to have reduced preoperative levator function (4.67 ± 2.12 vs. 9.57 ± 4.76 mm; p = 0.0007). Histologically disorganized samples were also found to have a lower preoperative levator function (9.50 ± 6.04 vs. 3.99 ± 2.49; p = 0.0052).

Conclusions:
Orbital septae in patients with congenital ptosis demonstrate histologic disorganization and fibrosis. When decreased levator function is observed clinically, septal fibrosis and/or disorganization is likely present. These observations suggest that debulking the fibrotic septum during congenital ptosis surgery may improve outcomes by releasing the eyelid from its congenitally tethered position, improving eyelid elasticity.
Clinical and Ultrasonographic Evaluation of Infantile Periocular Hemangioma Treated With Oral Propranolol
Authors: Jamshidian-Tehrani Mansooreh , Nabavi Amin , Taghavi Mostafa , Sharif-Kashani Shervin , Kasaee Abolfazl , Sadeghi-Tari Ali , Mirhosseini Mohammad , Nowroozzadeh M. Hossein 
Published: March 2019

Purpose:
To evaluate the clinical and ultrasonographic response of periocular infantile capillary hemangioma during treatment with oral propranolol.

Methods:
Patients with infantile periocular hemangioma and visual or cosmetic concerns were enrolled in this prospective interventional case series. Propranolol was given at a dose of 2 mg/kg per day for at least 6 months. Evaluation of treatment response was performed at month 3 (time point 1) and month 6 (time point 2). Gray scale ultrasonography and color Doppler imaging were performed at baseline and month 3.

Results:
Thirty-one patients with mean age of 4.1 ± 2.3 months were eligible for analysis. Complete or near complete clinical resolution was observed in 4 patients (12.9%) at time point 1 and 21 patients (67.7%) at time point 2. Longitudinal diameter, transverse diameter, thickness, arterial peak systolic velocity, and end diastolic velocity reduced significantly from baseline to 3-month follow up. Complete clinical response at time point 2 was significantly higher in patients with peak systolic velocity reduction >50% from baseline to month 3 than patients with peak systolic velocity reduction of 10% to 50% and <10%.

Conclusions:
Propranolol is safe and effective for infantile periocular hemangioma. Ultrasonography and color Doppler imaging are useful modalities to monitor and predict the treatment response.
Demographics, Psychological Distress, and Pain From Pressure Injury
Authors: Kim Junglyun , Lyon Debra , Weaver Michael T. , Keenan Gail , Stechmiller Joyce 
Published: March 2019

Background
There is a knowledge gap regarding factors that influence the intensity of pain associated with pressure injuries.

Objectives
We examined the influence of age, gender, race, and comorbidity on the relationships between pressure injuries, psychological distress, and pain intensity in hospitalized adults.

Methods
This study was a cross-sectional, retrospective secondary analysis using data from a regional acute hospital’s electronic health records from 2013 to 2016. A sample of 454 cases met the inclusion criteria and were analyzed using path analysis.

Results
The hypothesized model (Model A) and two alternative models (Models B and C) were tested and demonstrated adequate model fit. All tested models demonstrated statistically significant independent direct effects of age on the severity of pressure injury (p < .001) and pain intensity (p = .001), as well as independent direct effects of gender (p ≤ .005), race (p < .001), and comorbidity (p = .001) on psychological distress.

Discussion
Pain management for individuals with pressure injuries should include not only the treatment of wounds but also the individual characteristics of the patient such as demographics, comorbidity, and psychological status that may affect pain. Given the limitations of secondary analyses, further studies are suggested to validate these findings.
Impact of Adoption of Smart Pump System With Continuous Capnography Monitoring on Opioid-Related Adverse Event Rates: Experience From a Tertiary Care Hospital
Authors: Steele Terry , Eidem Leslie , Bond Jack 
Published: March 2019

Objectives
The use of opioid analgesics for pain management in hospitalized patients is associated with a high risk of adverse events, including respiratory depression which may lead to respiratory arrest and death. Patients who experience opioid-related adverse drug reactions (ADRs) have been shown to experience longer and more costly hospital stays and have a higher risk of requiring a readmission after discharge. In this study, we report on the impact of the introduction of Wesley Medical Center's Safe Medication Practice Protocol on opioid-related ADRs.

Methods
A retrospective, pre-post cohort study using electronic health records combined with manual chart review was undertaken at the Wesley Medical Center, a 760-bed tertiary care facility. The Safe Medication Practice Protocol incorporating a smart infusion pump system with capnography monitoring was implemented in May 2010 hospital-wide. The number and severity of ADRs and the duration of opioid treatment were compared between the pre (2007-April 2010) and post (May 2010–2014) periods.

Results
A total of 139,734 (pre-period) versus 267,573 (post-period) patients received opioid treatment during the hospital stay. Compared with the pre-period, the post-period resulted in a 79.2% reduction in the number of severe adverse reactions (3.08 vs 0.64 per 10,000 patients treated with opioid, P < 0.0001) as well as a shorter duration of opioid treatment (average 2.05 vs 1.37 days, P < 0.0001).

Conclusions
Implementing education, revisions to patient-controlled analgesia policies and procedures, and capnography monitoring with patient-controlled analgesia pause is associated with significantly lower rates of severe ADRs and shorter opioid treatment duration.