bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiation Exposure to the Surgeons and Patients in Fluoroscopic-Guided Segmental Pedicle Screw Placement for Pediatric Scoliosis
Authors: Yoshihara Hiroyuki , Paulino Carl B. 
Published: May 2018

Study Design.
Prospective case series.

Objective.
To analyze the radiation exposure to the surgeons and patients in fluoroscopic-guided segmental pedicle screw placement for pediatric scoliosis.

Summary of Background Data.
Fluoroscopic-guided pedicle screw placement is a safer technique for pedicle screw placement in spinal deformity. However, radiation exposure is a concern, particularly for spine surgeons due to the requirement of multiple pedicle screws in spinal deformity surgery.

Methods.
We measured radiation dose to the surgeons and pediatric patients undergoing scoliosis surgery by a team of two surgeons (S1 and S2) from March 2016 to December 2017. Surgery was performed using fluoroscopic-guided segmental pedicle screw placement. The dosimeters were placed at the forehead, inside and outside thyroid shield, both hands, back, and suprapubic under lead apron for each surgeon; and at the thyroid and gonads for patients.

Results.
Thirty patients were included in the study. The mean numbers of pedicle screws per case were 23.2 ± 3.4. The mean dose (mrem) per case for the two surgeons S1 and S2 was 0.07 and 0.47 at forehead, 0.07 and 0.37 at outside thyroid shield, 0.00 and 0.30 at inside thyroid shield, 16.87 and 13.73 at right hand, 6.07 and 11.37 at left hand, 0.50 and 0.00 at back, and 0.00 and 0.00 at suprapubic under lead apron, respectively. The mean dose (mrem) per case for the male and female patient was 3.67 and 14.71 for thyroid and 3.83 and 3.17 for gonads, respectively.

Conclusion.
The results of this study demonstrated that radiation exposure to the spine surgeons and patients is low using fluoroscopic-guided segmental pedicle screw technique for pediatric scoliosis surgery. Both hands of the surgeons received much higher doses compared to other body areas and, and thus radiation-reducing gloves and careful attention to surgeon's hands need to be considered for this procedure.

Level of Evidence: 2
The Relationship Between Fear-Avoidance and Neuromuscular Measures of Function in Patients With Adult Degenerative Scoliosis
Authors: Haddas Ram , Lieberman Isador H. , Block Andrew 
Published: May 2018

Study Design.
A prospective cohort study.

Objective.
To examine the relationship of fear-avoidance beliefs and neuromuscular activity during gait in adult degenerative scoliosis (ADS) patients.

Summary of Background Data.
Among patients with chronic spine pain, fear-avoidance beliefs are predictive of poor surgical outcomes. Fear-avoi occurs when patients perceive that movement will worsen underlying physical problems. This process leads them to restrict activity, which further heightens emotional distress. Patients with ADS have previously been shown to have an altered gait pattern. Electromyography is evolving into a useful tool to further our understanding of the pathologic manifestations of ADS during gait.

Methods.
Fifty ADS patients completed the Tampa Scale for Kinesiophobia (TSK) questionnaire and the Fear Avoidance Beliefs Questionnaire (FABQ). Surface electromyography electrodes were bilaterally placed on trunk and lower extremity muscles. Each patient performed a series of over-ground gait trials at a self-selected comfortable speed. Pearson Product Correlation analysis was used to determine the relationship between the self-reported fear of movement measures and the neuromuscular gait analysis biomechanical data.

Results.
The TSK total score and the FABQ physical were correlated with muscle onset of the External Oblique (P = 0.005), Gluteus Maximus (P = 0.018), Multifidi (P = 0.017), Erector Spinae (P = 0.014), Rectus Femoris (i = 0.008), Semitendinosus (P = 0.012), Tibilais Anterior (P = 0.012), and Medial Gastrocnemius (P = 0.010). Furthermore, the TSK total score, FABQ physical portion were correlated with muscle peak activity of Medial Gastrocnemius (P = 0.007), Multifidi (P = 0.014), and Tibilais Anterior (i = 0.050) and time to peak muscle activity of the Medial Gastrocnemius (P = 0.006) and Semitendinosus P = 0.038.

Conclusion.
This study demonstrates a strong correlation between neuromuscular gait parameters and fear-avoidance of movement which may reflect ADS patient experiences during ambulation. Further, it demonstrates that there are different aspects of fear-avoidance that may influence gait parameters. This study extends previous research on the role of fear-avoidance to include patients with spinal deformity.

Level of Evidence: 3
Free Functional Muscle Transfer for Thumb Opposition
Authors: Seal Alexander , Stevanovic Milan 
Published: May 2018

Summary:
Traumatic injuries and other conditions resulting in thenar loss and loss of opposition function can cause significant functional limitations. There are limited options available to restore function and bulk to the thenar musculature. A 26-year-old man had an unfortunate accident at work with a machine mixer creating a crush injury to his left hand. This required several debridements due to the tissue injury and resulted in loss of the thenar muscles and ability to oppose the thumb. He recovered well from the initial injury, however, was left with difficulty with grasp and holding objects due to the loss of thenar motion and strength. His function was also affected by the loss of bulk. He successfully underwent a free functional muscle reconstruction with his serratus anterior. This case report is a description of his reconstruction and a review of the literature. The patient had an excellent outcome. He obtained active opposition and improved grip strength, improving his activities of daily living and vocational life. The serratus anterior muscle can successfully be used for thumb opposition reconstruction. This case report demonstrates good outcomes for both motion and bulk restoration.
The Role of Stem Cells in Dupuytren’s Disease: A Review
Authors: Tan Kirin , Withers Aaron H. J. , Tan Swee T. , Itinteang Tinte 
Published: May 2018

Summary:
The pathogenesis of Dupuytren’s disease (DD) remains unclear although there is increasing evidence supporting the role of stem cells in this and other fibrotic conditions. This review examines the role of DD tissue-associated embryonic stem cells (ESCs) and mesenchymal stem cells (MSCs), and circulating fibrocytes and circulating MSCs, in the biology of DD. It is exciting to infer that dysfunction of an upstream ESC-like population within the affected tissue leads to the downstream development and proliferation of aberrant myofibroblasts through a putative MSC intermediate. This ESC-like population may be a potential novel therapeutic target through modulation of the renin-angiotensin system. Furthermore, circulating CD34+ fibrocytes and MSCs either derived from the bone marrow, peripheral blood cells, or DD-associated ESC-like population, may serve as potential additional extra-palmar reservoirs that undergo endothelial-to-mesenchymal transition, eventually giving rise to the aberrant myofibroblasts. Further studies examining the relative roles of these stem cells and the precise regulatory pathways that govern them may lead to novel therapy that targets these populations.
Preference-based Glaucoma-specific Health-related Quality of Life Instrument: Development of the Health Utility for Glaucoma
Authors: Muratov Sergei , Podbielski Dominik W. , Kennedy Kevin , Jack Susan M. , Pemberton Julia , Ahmed Iqbal I.K. , Baltaziak Monika , Xie Feng 
Published: May 2018

Purpose:
To develop a descriptive system for a glaucoma-specific preference-based health-related quality of life (HRQoL) instrument: the Health Utility for Glaucoma (HUG-5).

Methods:
The descriptive system was developed in 2 stages: item identification and item selection. A systematic literature review of HRQoL assessment of glaucoma was conducted using a comprehensive search strategy. Purposeful sampling was used to recruit patients with different clinical characteristics. Relevant items were presented to glaucoma patients through face-to-face, semistructured interviews. Framework methodology was applied to analyze interview content. The recurring themes identified through an iterative content analysis represented topics of most importance and relevance to patients. These themes formed the domains of the HUG-5 descriptive system. Three versions of the descriptive system, differing in explanatory detail, were pilot tested using a focus group.

Results:
The literature review identified 19 articles which contained 266 items. These items were included for the full-text review and were used to develop an interview guide. From 12 patient interviews, 22 themes were identified and grouped into 5 domains that informed the 5 questions of the descriptive system. The HUG-5 measures visual discomfort, mobility, daily life activities, emotional well-being, and social activities. Each question has 5 response levels that range from “no problem” to “severe problem.” The focus group comprised 7 additional patients unanimously preferred the version that contained detailed, specific examples to support each question.

Conclusions:
A 5-domain descriptive system of a glaucoma-specific preference-based instrument, the HUG-5, was developed and remains to be evaluated for validity and reliability in the glaucoma patient population.
Influence of Removing the Large Retinal Vessels–related Effect on Peripapillary Vessel Density Progression Analysis in Glaucoma
Authors: Holló Gábor 
Published: May 2018

Purpose:
To investigate the usefulness of removing the large vessel–related information from peripapillary optical coherence tomography angiography progression analysis. Peripapillary vessel density (VD) image series which had shown no progression with an earlier software version that did not separate capillary and large vessel–related effects were reevaluated for selective peripapillary capillary VD progression.

Materials and Methods:
Prospective retinal nerve fiber layer thickness and peripapillary VD measurements were made using the Angiovue/RTvue-XR OCT on 1 eye of 9 normal, 20 under treatment ocular hypertensive, and 24 under treatment open-angle glaucoma patients at 6-month intervals for 2 years (5 visits). In the current investigation the previously analyzed images were reanalyzed. Linear regression analysis for capillary VD progression in the radial peripapillary capillaries layer of the superior and inferior peripapillary hemifields, respectively, was made using the instrument’s new software (version 2017.1, Phase 7 update).

Results:
A statistically significant negative capillary VD slope was found in 4 glaucoma eyes. Two eyes progressed in both hemifields, and 2 eyes in 1 hemifield. The rate of statistically significant progression ranged between −1.3% and−3.2% per year. In 2 eyes the spatially corresponding hemifield retinal nerve fiber layer thickness progression was also significant (−1.4 μm/y and −1.8 μm/y). No normal and ocular hypertensive eyes showed significant capillary VD progression.

Conclusions:
In this 2-year prospective study no eye showed progression for peripapillary VD when all vessel-related information was used. In contrast, software-provided removal of the large retinal vessels–related information resulted in detection of significant capillary VD progression in 17% of the glaucoma eyes.
Exposure–Response Analysis of Micafungin in Neonatal Candidiasis
Authors: Kovanda Laura L. , Walsh Thomas J. , Benjamin Daniel K. , Arrieta Antonio , Kaufman David A. , Smith P. Brian , Manzoni Paolo , Desai Amit V. , Kaibara Atsunori , Bonate Peter L. , Hope William W. 
Published: May 2018

Background:
Neonatal candidiasis causes significant morbidity and mortality in high risk infants. The micafungin dosage regimen of 10 mg/kg established for the treatment of neonatal candidiasis is based on a laboratory animal model of neonatal hematogenous Candida meningoencephalitis and pharmacokinetic (PK)–pharmacodynamic (PD) bridging studies. However, little is known about the how these PK–PD data translate clinically.

Methods:
Micafungin plasma concentrations from infants were used to construct a population PK model using Pmetrics software. Bayesian posterior estimates for infants with invasive candidiasis were used to evaluate the relationship between drug exposure and mycologic response using logistic regression.

Results:
Sixty-four infants 3–119 days of age were included, of which 29 (45%) infants had invasive candidiasis. A 2-compartment PK model fits the data well. Allometric scaling was applied to clearance and volume normalized to the mean population weight (kg). The mean (standard deviation) estimates for clearance and volume in the central compartment were 0.07 (0.05) L/h/1.8 kg and 0.61 (0.53) L/1.8 kg, respectively. No relationship between average daily area under concentration–time curve or average daily area under concentration–time curve:minimum inhibitory concentration ratio and mycologic response was demonstrated (P > 0.05). Although not statistically significant, mycologic response was numerically higher when area under concentration–time curves were at or above the PD target.

Conclusions:
While a significant exposure–response relationship was not found, PK–PD experiments support higher exposures of micafungin in infants with invasive candidiasis. More patients would clarify this relationship; however, low incidence deters the feasibility of these studies.
Robotic Bronchoscopy for Diagnosis of Suspected Lung Cancer
Authors: Rojas-Solano José R. , Ugalde-Gamboa Luis , Machuzak Michael 
Published: May 2018

Background:
Robotic bronchoscopy may offer alternative approaches to address limitations of current bronchoscopic techniques for biopsy of suspected peripheral lung lesions. This study sought to evaluate complications and feasibility of robotic bronchoscopy performed with the Robotic Endoscopy System (RES).

Methods:
Adult patients from a single institution underwent bronchoscopy of suspected lesions with a bronchus sign with the RES. The primary outcome was complication rate, as assessed by the incidence of related serious adverse events (SAE). The secondary outcome was technical feasibility. Data are presented as median (range), counts, and percentage. P-value was calculated using the Mann-Whitney U test.

Results:
Of 17 screened patients, 15 were eligible. The median age was 67 (38 to 79) years. The lesions (12 peripheral and 3 central) were located in the right lower lobe (33%), right upper lobe (27%), left upper lobe (27%), and left lower lobe (13%). No SAE, including pneumothorax and significant bleeding, occurred. Biopsy samples were obtained from 93% of patients. One sampling (right upper lobe) required conventional bronchoscopy and another required surgery to confirm malignancy. Cancer was confirmed in 60% (9/15) of patients. Benign features were found in 5 of 6 patients. Time to biopsy location reduced from 45 (21 to 84) minutes (first 5 cases) to 20 (7 to 47) minutes (last 9 cases), P=0.039.

Conclusions:
The study results and absence of SAE support feasibility of the RES in accessing the periphery of the lung. The RES has potential to address challenges associated with biopsy of peripheral lung lesions.
The Impact of Varying Numbers of Quadrivalent Human Papillomavirus Vaccine Doses on Anogenital Warts in the United States: A Database Study
Authors: Zeybek Burak , Lin Yu-Li , Kuo Yong-Fang , Rodriguez Ana M. 
Published: May 2018

Objective
The aim of the study was to investigate the effects of 3 or less quadrivalent human papillomavirus (HPV) vaccine doses on anogenital warts in both males and females in the United States.

Materials and Methods
We conducted a retrospective database study that included males and females aged 9 to 26 years who received varying numbers of vaccine doses between 2006 and 2015. The primary outcome was the incidence of anogenital warts starting 3 months after the last dose of the HPV vaccine. Proportional hazard regression models were used to examine the association between the number of HPV vaccine doses and the incidence of anogenital warts. The Kaplan-Meier method was used to estimate the proportion of subjects.

Results
A total of 440,532 females and 133,394 males were included in the study. We found a significant 2-way interaction (p < .0001) between the number of doses and age. For the group between 15 and 19 years of age, the hazard ratio of anogenital warts for the 3-dose vaccine was 0.58 (95% CI = 0.49–0.70), whereas it was 0.65 (95% CI = 0.49–0.85) and 0.67 (95% CI = 0.51–0.89) for the 1- and 2-dose groups, respectively.

Conclusions
Our findings showed that 1, 2, and 3 doses of the quadrivalent HPV vaccine were similarly effective against anogenital warts in 15- to 19-year-old adolescents, irrespective of sex.
Flow Cytometry
Authors: Pane Marco , Allesina Serena , Amoruso Angela , Nicola Stefania , Deidda Francesca , Mogna Luca 
Published: May 2018

Goals:
The purpose of this trial was to verify that the analytical method ISO 19344:2015 (E)-IDF 232:2015 (E) is valid and reliable for quantifying the concentration of the probiotic Lactobacillus rhamnosus GG (ATCC 53103) in a finished product formulation.

Background:
Flow cytometry assay is emerging as an alternative rapid method for microbial detection, enumeration, and population profiling. The use of flow cytometry not only permits the determination of viable cell counts but also allows for enumeration of damaged and dead cell subpopulations. Results are expressed as TFU (Total Fluorescent Units) and AFU (Active Fluorescent Units). In December 2015, the International Standard ISO 19344-IDF 232 “Milk and milk products—Starter cultures, probiotics and fermented products—Quantification of lactic acid bacteria by flow cytometry” was published. This particular ISO can be applied universally and regardless of the species of interest.

Study:
Analytical method validation was conducted on 3 different industrial batches of L. rhamnosus GG according to USP39<1225>/ICH Q2R1 in term of: accuracy, precision (repeatability), intermediate precision (ruggedness), specificity, limit of quantification, linearity, range, robustness.

Results:
The data obtained on the 3 batches of finished product have significantly demonstrated the validity and robustness of the cytofluorimetric analysis.

Conclusions:
On the basis of the results obtained, the ISO 19344:2015 (E)-IDF 232:2015 (E) “Quantification of lactic acid bacteria by flow cytometry” can be used for the enumeration of L. rhamnosus GG in a finished product formulation.
Ombitasvir/paritaprevir/ritonavir+dasabuvir+ribavirin for chronic hepatitis C virus genotype 1b-infected cirrhotics (TURQUOISE-IV)
Authors: Isakov Vasily , Paduta Dzmitry , Viani Rolando M. , Enejosa Jeffrey V. , Pasechnikov Viktor , Znoyko Olga , Ogurtsov Pavel , Bogomolov Pavel O. , Maevskaya Marina V. , Chen Xiaotian , Shulman Nancy S. 
Published: May 2018

Objective
An estimated 336 per 100 000 people in Russia are infected with hepatitis C virus, including up to 75% with genotype (GT) 1b. In the TURQUOISE-II/-III trials, a 12-week regimen of the direct-acting antiviral agents ombitasvir (OBV), paritaprevir (PTV), ritonavir, and dasabuvir (DSV) in GT1b-infected patients with compensated cirrhosis resulted in 12-week sustained virologic response (SVR) rates of 100%.

Patients and methods
In TURQUOISE-IV, GT1b-infected patients (n=36) from Russia and Belarus with compensated cirrhosis, who were treatment naive or previously treated with pegylated interferon/ribavirin (RBV), received OBV/PTV/ritonavir+DSV+RBV for 12 weeks. The primary efficacy end point was SVR at 12 weeks. Safety assessments included adverse event (AE) monitoring and laboratory testing.

Results
At baseline, patients had Child–Pugh scores of 5 (92%) or 6 (8%). Overall, 69% were treatment experienced (44% prior null responders, 32% relapsers, and 16% partial responders). All patients achieved SVR at 12 weeks (36/36; 100%). No patient experienced a serious AE or discontinued treatment prematurely. Treatment-emergent AEs possibly related to study drugs occurring in greater than or equal to 10% of patients were asthenia (19%), anemia (14%), cough (14%), and headache (11%); most events were mild in severity. Clinically significant laboratory abnormalities were infrequent.

Conclusion
In Russian and Belarusian patients with hepatitis C GT1b infection and compensated cirrhosis, 100% achieved SVR at 12 weeks after 12 weeks’ treatment with OBV/PTV/ritonavir+DSV+RBV. The treatment was well tolerated.
Microbial Fermentation of Starch
Authors: Kalhan Satish C. 
Published: May 2018

ABSTRACTStarch, a major source of carbohydrates in human nutrition, is extensively hydrolyzed in the gastrointestinal tract of children and adults. A small fraction of the ingested starch reaches the cecum and colon where it is fermented by the gut microbiome into short‐chain fatty acids (SCFA) and other products. Recent data in humans and in animal models have demonstrated the extensive effects of short‐chain fatty acids on whole body energy metabolism, appetite, insulin resistance, fatty acid oxidation, fat accretion, obesity, and diabetes. Clear discernible effects of SCFA on the rates of production of glucose, its oxidation and uptake in the fasting state were, however, not observed. In the fed state, the effects on glucose metabolism are related to the effects of SCFA on insulin sensitivity, possibly the consequence of their influence on lipid metabolism. The suggested limits of carbohydrate intake were based upon the kinetics and metabolism of glucose in the basal state and on the responses to glucose administration. It is postulated that in healthy subjects, the present data do not suggest any significant impact of microbial fermentation of starch on the range of acceptable intake of carbohydrates.
Use of Starch and Modified Starches in Infant Feeding
Authors: Greer Frank R. 
Published: May 2018

ABSTRACTThere is a long history of the use of starch in infant feeding. Proprietary infant foods (1867–1920) contained added starch from either cereal grains or malted carbohydrates. When evaporated milk became available in the 1920s, the use of proprietary foods fell out of favor. Evaporated milk formulas were a mixture of milk, water, and modified starch or milk sugar (lactose). By the late 1920s, however, corn syrup became the most common modified starch added to evaporated milk formulas as it was widely available, inexpensive, and readily accepted. The ongoing development of the modern calorie‐based infant formula, made from non‐fat cow's milk, lactose, oleo and vegetable oils, largely replaced the evaporated milk formulas in the 1960s. On the other hand, after 1940, added starch and modified starch became increasingly important in the production of pureed fruits and vegetables. Not surprisingly, this included their use in the modern “industrialized” food for use in infants, including their use in a proliferation of grain based fortified infant cereals. This coincided with the increasing production largely due to the earlier introduction of complementary foods, commonly before 3 months of age by 1958. After 1969, the increasing public awareness and media scrutiny of infant foods lead to a growing criticism of the use of modified starches. Even though the National Research Council and the American Academy of Pediatrics concluded that modified starches were safe for use, continued public pressure led to their removal from most infant foods in the 1990s. This paralleled the natural food and organic food movements in the United States. Though modified starches are still used in infant dinners of mixed foods today, their use has been minimized and this issue is not currently of significant concern to the public.