bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Robotic Gait Training Feasible in Adults With Disorders of Consciousness?
Authors: Williams Kathryn , Christenbury Jennifer , Niemeier Janet P. , Newman Mark , Pinto Shanti 
Published: September 2019

Objective:
To investigate the feasibility and safety of robotic-assisted gait training (RAGT) in adults with disorders of consciousness (DoC).

Setting:
Inpatient rehabilitation hospital.

Participants:
Four adult male patients with traumatic brain injury and DoC.

Design:
Subjects participated in RAGT with body weight support for 5 to 20 minutes, over 1- to 2-week periods.

Main Measures:
Primary measures included vital signs, walking parameters, pain, arousal, and Agitation Behavior Scale scores. Additional data included Modified Ashworth Scale, Coma Recovery Scale-Revised, and Rancho Los Amigos Scale scores.

Results:
All participants safely completed at least one session of RAGT with body weight support with safe vital signs and low agitation levels. Two adverse events occurred (increased somnolence and pain due to harness placement), which were not considered severe. All subjects emerged out of DoC at which point research protocol was stopped.

Conclusions:
Findings suggest inpatient-based RAGT may be safe and feasible to consider when developing a therapy plan of care in adults with DoC.
The Experience of Caregivers Following a Moderate to Severe Traumatic Brain Injury Requiring ICU Admission
Authors: Kreitzer Natalie , Bakas Tamilyn , Kurowski Brad , Lindsell Christopher J. , Ferioli Simona , Foreman Brandon , Ngwenya Laura B. , Thomas Stephanie , Keegan Sara , Adeoye Opeolu 
Published: September 2019

Objectives:
Survivors of moderate and severe traumatic brain injury (TBI) require substantial care, much of which is ultimately provided by friends and family. We sought to describe the unmet needs of informal caregivers.

Design:
Qualitative, semistructured interviews with informal caregivers of moderate and severe TBI survivors were conducted 72 hours, 1 month, 3 months, and 6 months after injury.

Setting:
Intensive care unit of a level 1 trauma center.

Participants:
Informal caregivers were friends or family who planned to provide care for the patient. Patients were 18 years or older with a moderate to severe TBI, and not expected to imminently die of their injuries.

Measurements and Main Results:
Eighteen patient-caregiver dyads were enrolled. Fifty-three interviews with caregivers were completed and analyzed over the course of 6 months. Three themes were identified in the qualitative analysis: caregiver burden, caregiver health-related quality of life, and caregiver needs for information and support.

Conclusions:
This study provides new information about the experience of informal caregivers during the 6 months after their friend or family member survived a moderate to severe TBI. Interventions to promote caregiving may be a substantial opportunity to improve patient-centered outcomes following TBI.
CHARACTERIZATION BY FRACTAL DIMENSION ANALYSIS OF THE RETINAL CAPILLARY NETWORK IN PARKINSON DISEASE
Authors: Shi Ce , Chen Yihong , Kwapong William Robert , Tong Qiaowen , Wu Senxiang , Zhou Yuheng , Miao Hanpei , Shen Meixiao , Ye Hua 
Published: September 2019

Purpose:
To characterize retinal capillary complexity by optical coherence tomography angiography in Parkinson disease.

Method:
Twenty-five Parkinson disease patients and 25 age- and gender-matched healthy controls were recruited. Optical coherence tomography angiography and optical coherence tomography imaged the superficial and deep retinal capillary plexuses and retinal structure. Retinal capillary skeleton density, retinal capillary perfusion density, and fractal dimension analysis of retinal capillary complexity were performed in the total annular zone and quadrant sectors. The thickness of retinal nerve fiber layer, ganglion cell layer and inner plexiform layer, and total retinal thickness were extracted from retinal structural images. Relationships among the retinal capillaries, retinal structure, and clinical parameters were analyzed.

Results:
The superficial retinal capillary plexus in Parkinson disease patients had lower retinal capillary skeleton and perfusion densities and capillary complexity in the total annular zone and all quadrant sectors compared with healthy control subjects. The deep retinal capillary plexus retinal capillary complexity was decreased in the total annular zone and the superior and inferior quadrants. The retinal capillary complexity in the inferior quadrant was negatively correlated with the best-corrected visual acuity and disease duration (r = −0.61, r = −0.43, respectively, both P < 0.05).

Conclusion:
As determined by fractal analysis, retinal capillary complexity can be an objective biomarker in Parkinson disease.
Five-Year Graft Survival and Clinical Outcomes of 500 Consecutive Cases After Descemet Membrane Endothelial Keratoplasty
Authors: Birbal Rénuka S. , Ni Dhubhghaill Sorcha , Bourgonje Vincent J.A. , Hanko Jennifer , Ham Lisanne , Jager Martine J. , Böhringer Stefan , Oellerich Silke , Melles Gerrit R.J. 
Published: September 2019

Purpose:
To report the 5-year graft survival and clinical outcomes after Descemet membrane endothelial keratoplasty (DMEK).

Methods:
A retrospective, interventional case series was performed at a tertiary referral center. Five hundred eyes of 393 patients that underwent DMEK for Fuchs endothelial corneal dystrophy, bullous keratopathy, failed previous corneal transplants other than DMEK, or other indications were evaluated for graft survival, best-corrected visual acuity (BCVA), endothelial cell density, postoperative complications, and retransplantation rate.

Results:
Kaplan–Meier analysis demonstrated an estimated survival probability of 0.90 [95% confidence interval, 0.87–0.94] for the entire cohort at 5 years after DMEK. At this time point, 82% of the eyes achieved a BCVA of ≥20/25 (0.8), 54% achieved ≥20/20 (1.0), and 16% achieved ≥20/17 (1.2). BCVA continued to improve from 6 to 36 months after DMEK surgery (P ≤ 0.005) and then remained stable up to 60 months postoperatively (P > 0.08). Preoperative donor endothelial cell density averaged 2530 (±210) cells/mm2 and decreased by 37% at 6 months, 40% at 1 year, and 55% at 5 years after DMEK surgery (P < 0.001 between all follow-up time points). During the study period, allograft rejection episodes developed in 2.8% of the eyes, primary graft failure occurred in 0.2%, and secondary graft failure in 2.8% of the eyes. Re-keratoplasty was required in 8.8% of the eyes.

Conclusions:
Five-year graft survival after DMEK is high, and visual acuity outcomes remain excellent and are accompanied by a low longer-term complication rate.
Effects of open-label placebo on pain, functional disability, and spine mobility in patients with chronic back pain: a randomized controlled trial
Authors: Kleine-Borgmann Julian , Schmidt Katharina , Hellmann Andreas , Bingel Ulrike 
Published: September 2019

Abstract
Chronic back pain (CBP) is a major global health problem, while its treatment is hampered by a lack of efficacy and restricted safety profile of common frontline therapies. The present trial aims to determine whether a 3-week open-label placebo treatment reduces pain intensity and subjective and objective functional disability in patients with CBP. This randomized controlled trial, following a pretest–posttest design, enrolled 127 patients with CBP (pain duration >12 weeks) from the Back Pain Center, Neurology, University Hospital Essen, Germany. Patients randomized to the open-label placebo group received a 3-week open-label placebo treatment. Patients in the treatment as usual (TAU) group received no intervention. Both groups continued TAU. Primary outcome was the change in pain intensity. Secondary outcomes included patient-reported functional disability and objective measures of spine mobility and depression, anxiety, and stress. One hundred twenty two patients with CBP were randomized to the open-label placebo group (N = 63) or TAU group (N = 59). Open-label placebo application led to a larger reduction of pain intensity (−0.62 ± 0.23 vs 0.11 ± 0.17, all M ± SE, P = 0.001, d = −0.44) as well as patient-reported functional disability (3.21 ± 1.59 vs 0.65 ± 1.15, P = 0.020, d = −0.45) and depression scores (−1.07 ± 0.55 vs 0.37 ± 0.39, P = 0.010, d = −0.50) compared with TAU only. Open-label placebo treatment did not affect objective mobility parameters, anxiety and stress. Our study demonstrates that a 3-week open-label placebo treatment is safe, well tolerated and reduces pain, disability, and depressive symptoms in CBP. Trial registration: German Clinical Trials Register, DRKS00012712.
Spared nerve injury differentially alters parabrachial monosynaptic excitatory inputs to molecularly specific neurons in distinct subregions of the central amygdala
Authors: Li Jun-Nan , Sheets Patrick L. 
Published: September 2019

Abstract
Dissecting the organization of circuit pathways involved in pain affect is pivotal for understanding behavior associated with noxious sensory inputs. The central nucleus of the amygdala (CeA) comprises distinct populations of inhibitory GABAergic neurons expressing a wide range of molecular markers. CeA circuits are associated with aversive learning and nociceptive responses. The CeA receives nociceptive signals directly from the parabrachial nucleus (PBn), contributing to the affective and emotional aspects of pain. Although the CeA has emerged as an important node in pain processing, key questions remain regarding the specific targeting of PBn inputs to different CeA subregions and cell types. We used a multifaceted approach involving transgenic reporter mice, viral vector-mediated optogenetics, and brain slice electrophysiology to delineate cell-type–specific functional organization of the PBn–CeA pathway. Whole-cell patch clamp recordings of molecularly defined CeA neurons while optogenetically driving long-range inputs originating from PBn revealed the direct monosynaptic excitatory inputs from PBn neurons to 3 major subdivisions of the CeA: laterocapsular (CeC), lateral (CeL), and medial (CeM). Direct monosynaptic excitatory inputs from PBn targeted both somatostatin-expressing (SOM+) and corticotropin-releasing hormone expressing (CRH+) neurons in the CeA. We find that monosynaptic PBn input is preferentially organized to molecularly specific neurons in distinct subdivisions of the CeA. The spared nerve injury model of neuropathic pain differentially altered PBn monosynaptic excitatory input to CeA neurons based on molecular identity and topographical location within the CeA. These results provide insight into the functional organization of affective pain pathways and how they are altered by chronic pain.
Peripheral brain-derived neurotrophic factor contributes to chronic osteoarthritis joint pain
Authors: Gowler Peter R.W. , Li Li , Woodhams Stephen G. , Bennett Andrew J. , Suzuki Rie , Walsh David A. , Chapman Victoria 
Published: September 2019

Abstract
Brain-derived neurotrophic factor (BDNF) and the high-affinity receptor tropomyosin receptor kinase B (TrkB) have important roles in neuronal survival and in spinal sensitization mechanisms associated with chronic pain. Recent clinical evidence also supports a peripheral role of BDNF in osteoarthritis (OA), with synovial expression of TrkB associated with higher OA pain. The aim of this study was to use clinical samples and animal models to explore the potential contribution of knee joint BDNF/TrkB signalling to chronic OA pain. Brain-derived neurotrophic factor and TrkB mRNA and protein were present in knee synovia from OA patients (16 women, 14 men, median age 67 years [interquartile range: 61-73]). There was a significant positive correlation between mRNA expression of NTRK2 (TrkB) and the proinflammatory chemokine fractalkine in the OA synovia. Using the surgical medial meniscal transection (MNX) model and the chemical monosodium iodoacetate (MIA) model of OA pain in male rats, the effects of peripheral BDNF injection, vs sequestering endogenous BDNF with TrkB-Fc chimera, on established pain behaviour were determined. Intra-articular injection of BDNF augmented established OA pain behaviour in MIA rats, but had no effect in controls. Intra-articular injection of the TrkB-Fc chimera acutely reversed pain behaviour to a similar extent in both models of OA pain (weight-bearing asymmetry MIA: −11 ± 4%, MNX: −12 ± 4%), compared to vehicle treatment. Our data suggesting a contribution of peripheral knee joint BDNF/TrkB signalling in the maintenance of chronic OA joint pain support further investigation of the therapeutic potential of this target.
Improving Recognition and Reporting of Adverse Drug Reactions in the NICU: A Quality Improvement Project
Authors: Cammack Betsy , Oschman Alexandra , Lewis Tamorah 
Published: September 2019

Introduction:
Adverse drug reactions (ADRs) are under-recognized and under-reported in the Neonatal Intensive Care Unit (NICU) population, with up to 95% of all ADRs not reported. Compared with non-elderly adults, pediatric patients are 3 times more likely to experience an ADR, with varying rates from 0.6% to 16.8%. The Children’s Mercy NICU has an ADR rate of 0.29% (2015). This high rate presents an opportunity to increase recognition and reporting, and improve characterization of ADRs in the NICU.

Methods:
The primary aim of this quality improvement project was for 70% of patients who received specified medications (indomethacin, dexmedetomidine, fentanyl, lorazepam, dexamethasone, or hydrocortisone) in the first 3 months of age to be assessed daily for ADRs. We selected these medications due to the frequency of use and well-understood ADR associations. For each ADR recognized, the Naranjo score, was calculated and compared with the neonatal-specific Du score to assess the effectiveness of ADR characterization.

Results:
Implementation occurred on May 15, 2017. We completed 3 PDSA cycles over 1 year. The bedside monitoring tool was utilized 83% of the time. Twenty-eight potential ADRs were identified, far exceeding the number reported before implementation. The Du score appeared to better characterize ADRs compared with the Naranjo score.

Conclusions:
Use of a bedside monitoring tool improves ADR detection. We experienced challenges with consistently identifying patients on target drugs and getting the tool to the bedside. Application of the Du score for ADR classification in neonates appears to be more appropriate than the use of the Naranjo.
Cranioorbital Morphology Caused by Coronal Ring Suture Synostosis
Authors: Watts Guy D. , Antonarakis Gregory S. , Blaser Susan I. , Phillips John H. , Forrest Christopher R. 
Published: September 2019

Background:
Minor cranial sutural synostosis is currently regarded as a rare diagnosis. As clinical awareness grows, a greater number of cases are being documented. This study aims to describe the variants of unicoronal synostosis with regard to major and minor sutural involvement and secondary effects on cranial and orbital morphology. The information is aimed to improve clinical diagnosis and management.

Methods:
A retrospective study was conducted collecting preoperative computed tomographic scans of patients diagnosed with unicoronal synostosis and listed for surgical interventions, identified from a craniofacial database. Within these patients, different synostotic variants were identified based on which suture was affected. Scans of normal pediatric skulls (trauma) were used for a control group. Computed tomographic scans were analyzed for sutural involvement, cranial base deflection, and ipsilateral and contralateral orbital height and width. One-way analysis of variance was used to detect differences between synostotic variants and controls.

Results:
A total of 57 preoperative computed tomographic scans of patients with unicoronal synostosis were reviewed, in addition to 18 computed tomographic scans of normal skulls (control group). Four variants of unicoronal synostosis were identified: frontoparietal, frontosphenoidal, frontoparietal and frontosphenoidal, and frontosphenoidal and frontoparietal. The last two variants differ in their temporal involvement in the direction of sutural synostosis and ultimately cranial and orbital morphology. Three variants have been previously identified, but the fourth is presented for the first time.

Conclusions:
An understanding of the variants of unicoronal synostosis and their temporal relationships is integral for accurate clinical diagnosis and surgical correction. Recommendations for treatment are based on discrete changes in orbital morphology.
Ultrasonography of Extrathyroidal Diseases Mimicking Intrinsic Thyroid Lesions
Authors: Liu Ruifeng , Chen Cheng , Huang Xuepei , Zhu Qingli , Xia Yu 
Published: September 2019

Abstract
Some localized or multisystem diseases as well as congenital anomalies occasionally involve thyroid and unusual findings will be identified during thyroid ultrasonography. Recognition of these entities will minimize unnecessary complementary examination and lead to appropriate management for patients. Therefore, we aim to review sonographic features of these extrathyroidal diseases that affect thyroid in adults. Our review derives from cases diagnosed in our hospital and published literature, with pictures accessible using as illustration. These disorders included intrathyroidal parathyroid adenoma, intrathyroidal cystic findings of nonthyroid origin, metastases to the thyroid, esophageal diverticulum, paratracheal air cysts, and ossification of anterior longitudinal ligament.
Adult Cranioplasty
Authors: Pasick Christina Marie , Margetis Konstantinos , Santiago Gabriel F. , Gordon Chad , Taub Peter J. 
Published: September 2019

Objectives:
After reading this article, the participant should be able to: Understand the etiology of cranial defects. Understand the anatomy of the cranium. Understand the importance of the preoperative workup in the cranial reconstruction decision-making process. Describe the options available for calvarial reconstruction including autologous and alloplastic materials. Describe the basic differences between available alloplastic materials. Understand the intraoperative and postoperative complications that may arise during cranioplasty.

Summary:
Cranial defects can arise from a variety of causes, yielding a diverse group of patients who require cranioplasty. The goals of calvarial reconstruction are to protect the underlying brain, to restore the aesthetic contour of the calvarium, and/or to treat postcraniectomy cerebrospinal fluid circulation abnormalities that may be symptomatic. Options for calvarial reconstruction include the autogenous bone flap that was removed for access, autologous bone grafting, and a variety of alloplastic materials such as titanium, hydroxyapatite, polymethylmethacrylate, polyether ether ketone, and high-density porous polyethylene. A detailed preoperative workup and discussion with the patient is important to choosing the appropriate reconstructive path.
A Pathway for Developing Postoperative Opioid Prescribing Best Practices
Authors: Howard Ryan , Vu Joceline , Lee Jay , Brummett Chad , Englesbe Michael , Waljee Jennifer 
Published: September 2019

Objective:
Opioid prescriptions after surgery are effective for pain management but have been a significant contributor to the current opioid epidemic. Our objective is to review pragmatic approaches to develop and implement evidence-based guidelines based on a learning health system model.

Summary Background Data:
During the last 2 years there has been a preponderance of data demonstrating that opioids are overprescribed after surgery. This contributes to a number of adverse outcomes, including diversion of leftover pills in the community and rising rates of opioid use disorder.

Methods:
We conducted a MEDLINE/PubMed review of published examples and reviewed our institutional experience in developing and implementing evidence-based postoperative prescribing recommendations.

Results:
Thirty studies have described collecting data regarding opioid prescribing and patient-reported use in a cohort of 13,591 patients. Three studies describe successful implementation of opioid prescribing recommendations based on patient-reported opioid use. These settings utilized learning health system principles to establish a cycle of quality improvement based on data generated from routine practice. Key components of this pathway were collecting patient-reported outcomes, identifying key stakeholders, and continual assessment. These pathways were rapidly adopted and resulted in a 37% to 63% reduction in prescribing without increasing requests for refills or patient-reported pain scores.

Conclusion:
A pathway for creating evidence-based opioid-prescribing recommendations can be utilized in diverse practice environments and can lead to significantly decreased opioid prescribing without adversely affecting patient outcomes.
About some projects with attendant circumstances
Authors: Slepyan Leonid I. 
Published: September 2019

In this brief article (written at the suggestion of Prof. Gennady Mishuris), I discuss some projects, the circumstances under which the associated problems appeared on my desk, the results and what helped me to obtain them.
This article is part of the theme issue ‘Modelling of dynamic phenomena and localization in structured media (part 1)’.
Dynamic fracture of a dissimilar chain
Authors: Gorbushin N. , Mishuris G. 
Published: September 2019

In this paper, we study the dynamic fracture of a dissimilar chain composed of two different mass-spring chains and connected with other springs. The propagation of the fault (crack) is realized under externally applied moving forces. In comparison with a homogeneous double chain, the considered structure displays some new essential features of steady-state crack propagation. Specifically, the externally applied forces are of a different strength, unlike a static case, and should be appropriately chosen to satisfy the equilibrium of the structure. Moreover, there exists a gap in the range of crack speeds where the steady-state fracture cannot occur. We analyse the admissibility of solutions for different model parameters and crack speeds. We complement analytical findings with numerical simulations to validate our results.
This article is part of the theme issue ‘Modelling of dynamic phenomena and localization in structured media (part 1)’.
Low-frequency wave-energy amplification in graded two-dimensional resonator arrays
Authors: Bennetts L. G. , Peter M. A. , Craster R. V. 
Published: September 2019

Energy amplification in square-lattice arrays of C-shaped low-frequency resonators, where the resonator radii are graded with distance, is investigated in the two-dimensional linear acoustics setting for both infinite (in one dimension) and finite arrays. Large amplifications of the incident energy are shown in certain array locations. The phenomenon is analysed using: (i) band diagrams for doubly-periodic arrays; (ii) numerical simulations for infinite and finite arrays; and (iii) eigenvalue analysis of transfer matrices operating over individual columns of the array. It is shown that the locations of the large amplifications are predicted by propagation cut-offs in the modes associated with the transfer-matrix eigenvalues. For the infinite array, the eigenvalues form a countable set, and for the low frequencies considered, only a single propagating mode exists for a given incident wave, which cuts off within the array, leading to predictive capabilities for the amplification location. For the finite array, it is shown that (in addition to a continuous spectrum of modes) multiple discrete propagating modes can be excited, with the grading generating new modes, as well as cutting others off, leading to complicated amplification patterns. The numerical simulations reveal that the largest amplifications are achieved for a single row array, with amplifications an order of magnitude smaller for the corresponding infinite array.
This article is part of the theme issue ‘Modelling of dynamic phenomena and localization in structured media (part 1)’.