bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rib Hyperostosis as a Risk Factor for Poor Prognosis in Cervical Spine Injury Patients With Diffuse Idiopathic Skeletal Hyperostosis
Authors: Sawakami Kimihiko , Watanabe Kei , Sato Tsuyoshi , Miura Kazuto , Katsumi Keiichi , Hosaka Noboru , Nomura Shinsen , Fujikawa Ryuta , Kikuchi Ren , Tashi Hideki , Minato Keitaro , Segawa Hiroyuki , Ito Takui , Ishikawa Seiichi , Hirano Toru , Endo Naoto 
Published: September 2019

Study Design.
Retrospective multi-center study.

Objective.
To identify the morphological features of costovertebral joints and ribs in surgically managed cervical injury patients with diffuse idiopathic skeletal hyperostosis (DISH) and to examine its impact on their vital prognosis.

Summary of Background Data.
Several reports have indicated that DISH is an independent risk factor for mortality after spinal fracture. The reason for the high mortality in cervical injury patients with DISH is unclear, although some reports have suggested a possible association between pulmonary complications and mortality.

Methods.
From 1999 to 2017, a total of 50 DISH patients (44 males) with cervical spine injuries who underwent spinal surgery were enrolled (average age 74 yrs). Prognosis and clinical risk factor data were collected; the morphological features of the patients’ costovertebral joints and ribs were evaluated with computed tomography. The influence of each proposed risk factor and thoracic morphological feature on mortality was tested with univariate and multivariate analyses.

Results.
The survival rate at 5 years after surgery was 52.3%. Nineteen (38%) patients died, and the most common cause of death was pneumonia (68%). Costovertebral bone excrescences and rib hyperostosis were found to be thoracic pathognomonic signs; their frequencies were 94% and 82%, respectively, and these conditions occurred in an average of 7.0 joints and 4.7 bones, respectively. The results of the log-rank test showed a significant difference in age, injury severity score (ISS), costovertebral bone excrescences, and rib hyperostosis. The results of age-adjusted multivariate analysis indicated that age (hazard ratio [HR] = 8.65, 95% confidence interval [CI] = 1.10–68.28, P = 0.041) and rib hyperostosis (HR = 3.82, 95% CI = 1.38–10.57, P = 0.010) were associated with mortality.

Conclusion.
Reduced chest wall mobility associated with rib hyperostosis in cervical spine injury patients with DISH leads to a poor prognosis.

Level of Evidence: 3
The Nursing Activities Score Per Nurse Ratio Is Associated With In-Hospital Mortality, Whereas the Patients Per Nurse Ratio Is Not*
Authors: Margadant Charlotte , Wortel Safira , Hoogendoorn Marga , Bosman Rob , Spijkstra Jan Jaap , Brinkman Sylvia , de Keizer Nicolette 
Published: September 2019

Objectives:
Studies have shown contradicting results on the association of nursing workload and mortality. Most of these studies expressed workload as patients per nurse ratios; however, this does not take into account that some patients require more nursing time than others. Nursing time can be quantified by tools like the Nursing Activities Score. We investigated the association of the Nursing Activities Score per nurse ratio, respectively, the patients per nurse ratio with in-hospital mortality in ICUs.

Design:
Retrospective analysis of the National Intensive Care Evaluation database.

Setting:
Fifteen Dutch ICUs.

Patients:
All ICU patients admitted to and registered ICU nurses working at 15 Dutch ICUs between January 1, 2016, and January 1, 2018, were included. The association of mean or day 1 patients per nurse ratio and Nursing Activities Score per nurse ratio with in-hospital mortality was analyzed using logistic regression models.

Interventions:
None.

Measurements and Main Results:
Nursing Activities Score per nurse ratio greater than 41 for both mean Nursing Activities Score per nurse ratio as well as Nursing Activities Score per nurse ratio on day 1 were associated with a higher in-hospital mortality (odds ratios, 1.19 and 1.17, respectively). After case-mix adjustment the association between a Nursing Activities Score per nurse ratio greater than 61 for both mean Nursing Activities Score per nurse ratio as well as Nursing Activities Score per nurse ratio on day 1 and in-hospital mortality remained significant (odds ratios, 1.29 and 1.26, respectively). Patients per nurse ratio was not associated with in-hospital mortality.

Conclusions:
A higher Nursing Activities Score per nurse ratio was associated with higher in-hospital mortality. In contrast, no association was found between patients per nurse ratios and in-hospital mortality in The Netherlands. Therefore, we conclude that it is more important to focus on the nursing workload that the patients generate rather than on the number of patients the nurse has to take care of in the ICU.
Role of Sleep Duration in the Association Between Socioecological Protective Factors and Health Risk Behaviors in Adolescents
Authors: Ordway Monica Roosa , Wang Guanghai , Jeon Sangchoon , Owens Judith 
Published: September 2019

Abstract:

Objective:
The purpose of this study was to examine the associations of sleep duration and socioecological protective factors with patterns of adolescent risk behaviors in Fairfax County, VA—one of the largest public school districts in the United States.

Methods:
A total of 21,360 and 20,330 students in 10th and 12th grades who completed the Youth Risk Behavior Survey were included in this cross-sectional analysis. Sleep duration was measured by self-report of the average number of hours of sleep on a school night. Ten socioecological protective factors included peer-individual, family, school, and community domains. Latent class analysis was used to classify 7 risk behaviors (alcohol use, cigarette use, illicit drug use, inappropriate prescription drug use, risky sexual behavior, deviant behavior, and academic failure) into 4 class memberships (low, some, moderate, and high). Multinomial regression models were adjusted for age, sex, and race.

Results:
Adolescents who reported sleeping the recommended 8 to 9 hours were significantly less likely to belong to the class memberships of greater risk behaviors compared with those who reported short and long sleep duration after controlling for age, sex, race, and survey year. There was a significant inverse relationship between the number of socioecological protective factors and risk behaviors for both 10th and 12th graders. Potential risks of age, sex, and race on risk behaviors were observed. No significant interaction between sleep duration and protective factors was found in either grade.

Conclusion:
This study highlights the significant associations between sleep duration and risk behaviors in adolescents with diverse socioecological protective factors. Prioritization of prevention-focused resources should consider sleep duration in addition to the socioecological protective factors commonly cited in the literature when addressing adolescent risk behaviors.
Should we adjust for delivery hospital in studies of air pollution and pregnancy outcomes?
Authors: Savitz David A. , Eliot Melissa N. , Ito Kazuhiko , Johnson Sarah , Manjourides Justin , Danilack Valery A. , Wellenius Gregory A. 
Published: September 2019

Background:
In conducting a study of ambient air pollution and pregnancy outcome in New York City, we identified delivery hospital as a potential confounder, given its association with both maternal residence and therefore air pollution exposure, and with clinical practices and as a potential marker of outcome misclassification in the coding of pregnancy complications. Motivated by evidence that adjustment for delivery hospital affected associations between air pollution and pregnancy outcome, we undertook a detailed empirical examination of the role of delivery hospital that warrants consideration by others addressing this topic.

Methods:
In a study of air pollution and pregnancy outcome, we identified births from 2008 to 2010 to residents of New York City and, after restrictions, included 238,960 in the analysis. Air pollution exposure estimates for ambient fine particles (PM2.5) and nitrogen dioxide (NO2) were derived from a community-wide exposure study and assigned based on geocoded maternal residence. We examined the impact of adjusting for delivery hospital and explored the relationship between delivery hospital and both exposure and pregnancy outcomes.

Results:
Statistical adjustment for delivery hospital markedly attenuated the relationship of air pollution with birth weight and gestational hypertension, with smaller effects on preterm birth and preeclampsia. Delivery hospital was associated with estimated maternal air pollution levels after adjusting for individual-level patient characteristics, more strongly for PM2.5 than for NO2. Delivery hospital predicted pregnancy outcome after adjustment for individual attributes, with larger hospitals and those that managed a greater volume of complicated cases having lower birth weight, more medically indicated preterm births, and more diagnosed gestational hypertension. Evaluation through the use of directed acyclic graphs illustrates the potential for adjustment for hospital to reduce residual spatial confounding, but also indicates the possibility of introducing bias through adjustment of a mediator.

Conclusions:
Based on these results, delivery hospital warrants closer consideration in studies of air pollution and other spatial factors in relation to pregnancy outcomes. The possibility of confounding by delivery hospital needs to be balanced with the risk of adjusting for a mediator of the air pollution—pregnancy outcome association in studies of this type.
Prenatal exposure to metal mixture and sex-specific birth outcomes in the New Hampshire Birth Cohort Study
Authors: Signes-Pastor Antonio J. , Doherty Brett T. , Romano Megan E. , Gleason Kelsey M. , Gui Jiang , Baker Emily , Karagas Margaret R. 
Published: September 2019

Background:
In utero exposure to individual metals may impact fetal growth, though little is known about the effects of exposure to metal mixtures. Therefore, we investigated joint effects of in utero exposure to a mixture of As (arsenic), Mn (manganese), and Pb (lead) on newborn outcomes in a United States population.

Methods:
Concentrations of As, Mn, and Pb were determined in maternal postpartum toenail samples, a biomarker of in utero exposure, from 989 maternal-infant pairs (492 females and 497 males). Newborns’ anthropometric characteristics, including head circumference, length, and weight, were obtained from medical records. The joint effects of the three metals were modeled using Bayesian kernel machine regression and linear regression. Both sex-combined and sex-stratified statistical analyses were performed.

Results:
We observed an inverted-U-shape association between maternal toenail Mn concentrations and newborn head circumference, particularly among female infants. Concentrations of Pb were related to reduced head circumference, weight, and length, especially among females at lower concentrations of the other metals. Overall, toenail As concentrations were related to reduced head circumference, especially among males, and an increase in birth length and weight among females. We found little evidence of As interactions with other metals within the mixture.

Conclusions:
Our findings suggest that in utero metal mixture exposures may influence birth outcomes, and that such relations may differ by infant sex.
Characterization of Metabolic Syndrome Risk Factors and Health-Related Behaviors in Korean Patients With Breast Cancer by Abdominal Obesity Status
Authors: KIM Hye-Jin , KIM Hee-Seung , KIM Hye-Ryoung , YOO Yang-Sook , SONG Byung Joo 
Published: September 2019

ABSTRACT

Background
Breast cancer is the second most prevalent malignancy among Korean women. Changes in lifestyle during and after remission of breast cancer tend to increase abdominal visceral fat, leading to increased risks of metabolic syndrome and chronic diseases.

Purpose
This cross-sectional study examined the differences in metabolic syndrome risk factors and health-related behaviors between abdominally obese and nonabdominally obese groups of Korean patients with breast cancer.

Methods
The participants were assigned to nonabdominal obesity (waist circumference < 85 cm, n = 77) and abdominal obesity (waist circumference ≥ 85 cm, n = 59) groups, and a questionnaire was used to assess the prevalence of risk factors of metabolic syndrome and health-related behaviors in each. The chi-square test and t test were used to analyze the data.

Results
The average age was 54.2 years in the abdominal obesity group and 51.3 years in the nonabdominal obesity group. The average blood pressure and fasting blood glucose levels were higher in the abdominal obesity than the nonabdominal obesity group (117.3/76.3 vs. 108.9/70.4 mmHg, respectively [p = .001]; 96.9 and 90.1 mg/dl, respectively [p = .007]). High-density lipoprotein cholesterol was lower in the abdominal obesity than the nonabdominal obesity group (55.4 and 62.5 mg/dl, respectively [p = .005]), whereas triglycerides were higher in the abdominal obesity than the nonabdominal obesity group (151.6 and 111.3 mg/dl, respectively [p = .006]). The prevalence of metabolic syndrome in the abdominal obesity and nonabdominal obesity groups were 42.4% and 9.1%, respectively (p = .001). Moreover, eating habits differed between the two groups, with the frequency of vegetable consumption lower in the abdominal obesity than the nonabdominal obesity group (p = .040) and the frequencies of salty and sweet food consumption and of overeating higher in the abdominal obesity than the nonabdominal obesity group. The percentage of participants who exercised for 30 minutes three times per week was 52.5% in the abdominal obesity group and 71.4% in the nonabdominal obesity group (p = .024).

Conclusions/Implications for Practice
This observational study found more metabolic syndrome risk factors in the abdominal obesity group than the nonabdominal obesity group. Consumption of sweet foods and overeating were higher and the frequencies of vegetable intake and exercise were lower in the abdominal obesity group. These findings suggest that female abdominally obese patients with breast cancer exhibit health-related behaviors that require improvement and better management. Interventional programs should be developed based on the findings of this study to reduce cancer recurrence and mortality in patients with breast cancer.
Assessment of a Novel 3T MRI Compatible Cochlear Implant Magnet: Torque, Forces, Demagnetization, and Imaging
Authors: Tysome James Russell , Tam Yu Chuen , Patterson Ilse , Graves Martin John , Gazibegovic Dzemal 
Published: September 2019

Hypothesis:
A novel cochlea implant (CI) device magnet providing alignment to the static field of a magnetic resonance imaging (MRI) will lead to reduced torque, longitudinal forces, and demagnetization effects. The image void and distortion will be comparable to those obtained with standard CI magnets.

Background:
MRI investigations of CI users pose several challenges such as magnet dislocation, demagnetization, and may cause pain. The presence of a CI magnet within MRI field causes image distortions and may diminish the diagnostic value of an MRI procedure. Objective of this work is to evaluate magnetic forces and imaging properties of the novel CI magnet within 1.5 and 3T MRI.

Methods:
Forces and torque of the novel CI magnet were measured in both 1.5 and 3T MRI and compared with the standard magnet in 1.5T. One cadaver head was implanted with the CI devices containing the novel and standard magnets in different configurations reflecting clinical scenarios and imaging properties were assessed and compared.

Results:
In particular the torque has been reduced with the novel CI magnet in comparison to the standard one. Both CI magnets have not shown any signs of demagnetization. The image void and distortion was comparable between the two magnets for the main MRI clinical scanning protocols in 1.5T MRI.

Conclusions:
The novel CI magnet is safe to use for MRI investigations of CI users in 3T MRI without a need for bandaging and has acceptable level of image artefacts.
Incidence, characteristics and outcomes in very young patients with ST segment elevation myocardial infarction
Authors: Khoury Shafik , Soleman Moaad , Margolis Gilad , Barashi Rami , Rozenbaum Zach , Keren Gad , Shacham Yacov 
Published: September 2019

Objective
ST-segment elevation acute myocardial infarction (STEMI) in very young adults is uncommon. Many studies have focused on the cutoff of 45–50 years old to define young patients with STEMI leaving limited data on the group of very young patients aged less than 35 years old. We investigated the incidence of STEMI in different subgroups of young patients and focused on the characteristics, possible pathogenesis and outcomes in very young patients aged less than 35 years old.

Methods
We retrospectively studied 792 STEMI patients aged less than 55 years who underwent successful primary PCI. We categorized patients as very young if they were or less 35 years old and as young if they were between 36 and 55 years old. Baseline characteristics, angiographic findings, as well as short- and long-term outcomes were compared between the two groups.

Results
There were 46 (6%) very young patients (age ≤ 35 years) and 748 (94%) young patients (36 < age ≤ 55 years). Very young patients had fewer atherosclerotic risk factors than young patients, but there was no difference in short- or long-term outcomes. Overt hypercoagulable state was evident serologically (antiphospholipid antibodies) in 2/7 (29%) of screened patients and clinically (left ventricular thrombus or acute coronary thrombosis without an atherosclerotic plaque) in 6/46 patients (13%).

Conclusion
Very young patients with STEMI constitute a distinct subset of young patients with fewer atherosclerotic risk factors yet comparable outcomes. More efforts should be made screening for serologic and clinical evidence of hypercoagulability in this group of patients.
Acute kidney injury in pregnancy
Authors: Vijayan Madhusudan , Avendano Maria , Chinchilla Kana A. , Jim Belinda 
Published: September 2019

Purpose of review
Pregnancy-related acute kidney injury (Pr-AKI) is associated with increased maternal and fetal morbidity and mortality and remains a large public health problem.

Recent findings
Pr-AKI incidence has globally decreased over time for the most part. However, the cause presents a disparity between developing and developed countries, reflecting differences in socioeconomic factors and healthcare infrastructure – with the noteworthy outlier of increased incidence in the United States and Canada. Although Pr-AKI can be secondary to conditions affecting the general population, in most cases it is pregnancy specific. Septic abortion, hyperemesis gravidarum, and hemorrhage have become less prevalent with access to healthcare but are being displaced by thrombotic microangiopathies, such as preeclampsia, hemolysis, elevated liver enzymes, low platelets syndrome, thrombotic thrombocytopenic purpura, and pregnancy-associated hemolytic-uremic syndromes, as well as acute fatty liver of pregnancy. Understanding these conditions plays a pivotal role in the timely diagnosis and enhancement of therapeutic approaches.

Summary
In this review, we focus on the renal physiology of the pregnancy, epidemiology, and specific conditions known to cause Pr-AKI, summarizing diagnostic definition, insights in pathophysiology, clinical considerations, and novel treatment approaches, thus providing the reader a framework of clinically relevant information for interdisciplinary management.
Acute kidney injury in hematopoietic stem cell transplantation
Authors: Wanchoo Rimda , Stotter Brian R. , Bayer Ruthee L. , Jhaveri Kenar D. 
Published: September 2019

Purpose of review
Acute kidney injury (AKI) in the setting of hematopoietic stem cell transplantation (HSCT) is common in pediatric and adult patients. The incidence ranges from 12 to 66%, and development of AKI in the posttransplant course is independently associated with higher mortality.

Recent findings
Patients who undergo HSCT have many risk factors for developing AKI, including sepsis, use of nephrotoxic medications, graft versus host disease (GVHD), and veno-occlusive disease (VOD). In addition, engraftment syndrome/cytokine storm, transplant-associated thrombotic microangiopathy (TA-TMA), and less common infections with specific renal manifestations, such as BK and adenovirus nephritis, may lead to kidney injury. There has been significant advancement in the understanding of TA-TMA in particular, especially the role of the complement system in its pathophysiology. The role of early dialysis has been explored in the pediatric population, but not well studied in adult HSCT recipients

Summary
This review provides an update on the risk factors, causes, and treatment approaches to HSCT-associated AKI.

Video abstract
http://links.lww.com/COCC/A29
Persistent pollutants: focus on perfluorinated compounds and kidney
Authors: Ferrari Fiorenza , Orlando Anita , Ricci Zaccaria , Ronco Claudio 
Published: September 2019

Purpose of review
There is increasing interest in the environmental and human damage caused by pollutants. Big efforts are continuously made to monitor their levels and identify safe thresholds. For this purpose, an essential step is to prioritize harmful substances and understand their effect on human body. Perfluorinated compounds (PFCs) deserve particular attention because of their wide diffusion and potential correlation with different diseases including glucose intolerance, hyperlipidaemia, thyroid diseases, gestational diabetes mellitus and hypertension, testicular and genitourinary cancer as well as impaired kidney function. This review focuses on the renal effects of PFCs, with the attempt to clarify their occurrence and pathogenetic mechanisms.

Recent findings
We reviewed MEDLINE and EMBASE citations between 31 October 2017 and 31 May 2019 and selected human studies measuring PFCs exposure, kidney function markers and the ability of haemodialysis to remove PFCs from the circulating blood. It has been currently clarified that exposure to PFCs is linked with an impaired kidney function and that they can be removed by blood purification.

Summary
Further studies are required on the potential synergic negative effect of PFCs co-exposure with other pollutants as well as animal studies about the removal capacity of different haemodialysis membranes.
Abdominal compartment syndrome and intra-abdominal hypertension
Authors: Pereira Bruno M. 
Published: September 2019

Purpose of review
Abdominal compartment syndrome (ACS) is a severe complication resulting from an acute and sustained increase in intra-abdominal pressure (IAP), causing significant morbidity and mortality. Although prospective double-blinded, randomized trials, and evidence-based analysis are lacking there is new evidence that still demonstrates high morbidity and mortality in critically ill populations because of intra-abdominal hypertension (IAH) in the 21st century. The objective of this review is to alert the health professional about this important diagnosis and to highlight the latest updates proposed by the World Abdominal Compartment Society.

Recent findings
The present article reviews the clinical conditions of ACS and IAH and the latest updates from pathophysiology to the new management flowchart resulting from the implantation of point-of-care ultrasound in the monitoring and assistance of medical treatment of IAH/ACS.

Summary
The present review emphasizes the importance of IAH in daily clinical practice and brings new WSACS updates on monitoring and treatment.