bluuebunny/crossref_metadata_2025_split huggingface dataset:
Negative Affect–Related Factors Have the Strongest Association with Prescription Opioid Misuse in a Cross-Sectional Cohort of Patients with Chronic Pain
Authors: Gilam Gadi , Sturgeon John A , You Dokyoung S , Wasan Ajay D , Darnall Beth D , Mackey Sean C 
Published: September 2019

AbstractObjectiveIncreased opioid prescription to relieve pain among patients with chronic pain is associated with increased risk for misuse, potentially leading to substance use disorders and overdose death. We aimed to characterize the relative importance and identify the most significant of several potential risk factors for the severity of self-reported prescribed opioid misuse behaviors.MethodsA sample of 1,193 patients (mean age ± SD = 50.72 ± 14.97 years, 64.04% female) with various chronic pain conditions completed a multidimensional registry assessing four pain severity measures and 14 physical, mental, and social health status factors using the National Institutes of Health’s Patient-Reported Outcomes Measurement Information System (PROMIS). A validated PROMIS measure of medication misuse was completed by 692 patients who endorsed currently taking opioid medication. Patients taking opioid medications were compared across all measures with those who do not take opioid medications. Subsequently, a data-driven regression analysis was used to determine which measures best explained variability in severity of misuse. We hypothesized that negative affect–related factors, namely anxiety, anger, and/or depression, would be key predictors of misuse severity due to their crucial role in chronic pain and substance use disorders.ResultsPatients taking opioid medications had significantly greater impairment across most measures. Above and beyond demographic variables, the only and most significant predictors of prescribed opioid misuse severity were as follows: anxiety (β = 0.15, P = 0.01), anger (β = 0.13, P = 0.02), Pain Intensity–worst (β = 0.09, P = 0.02), and depression (β = 0.13, P = 0.04).ConclusionsFindings suggest that anxiety, anger, and depression are key factors associated with prescribed opioid misuse tendencies in patients with chronic pain and that they are potential targets for therapeutic intervention.
Rare Presentation of Postsurgical Pyoderma Gangrenosum Presenting as Necrotizing Soft Tissue Infection
Authors: Flynn Rod L. , Chowdhury Mashiul H. , Rudolph Joseph , Einstein Stephanie 
Published: September 2019

ABSTRACTPyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis believed to be mediated by an autoimmune reaction. Typical treatment includes autolytic debridement, management of exudate, protection from trauma, and steroid therapy. A diagnosis of exclusion, PG is frequently mistaken for a wound infection, but antibiotics do not alleviate the condition. Incision and debridement has been observed to cause further spread of the lesions because of pathergy resulting from the additional trauma. This case report describes a patient who was misdiagnosed with necrotic soft tissue infection that was actually postsurgical PG.
Refining Heel Pressure Injury Risk Factors in the Hospitalized Patient
Authors: Delmore Barbara , Ayello Elizabeth A. , Smith Daniel , Rolnitzky Linda , Chu Andy S. 
Published: September 2019

ABSTRACT

OBJECTIVE
To replicate previous research that found four independent and significant predictors of heel pressure injuries (HPIs) in hospitalized patients using a larger and more diverse patient population.

METHODS
Researchers conducted a retrospective, case-control study with a main and a validation analysis (N = 1,937). The main analysis had 1,697 patients: 323 patients who had HPIs and 1,374 who did not. The validation analysis had 240 patients: 80 patients who developed HPIs and 160 who did not. Researchers used a series of diagnosis codes to define variables associated with an HPI. Data were extracted from the New York Statewide Planning and Research Cooperative System for January 2014 to June 2015. Study authors conducted a series of forward stepwise logistic regression analyses for both samples to select the variables that were significantly and independently associated with the development of an HPI in a multivariable setting. Researchers generated a receiver operating characteristic curve using the final model to assess the regression model's ability to predict HPI development.

RESULTS
Seven variables were significant and independent predictors associated with HPIs: diabetes mellitus, vascular disease, perfusion issues, impaired nutrition, age, mechanical ventilation, and surgery. The receiver operating characteristic curve demonstrated predictive accuracy of the model.

CONCLUSIONS
Beyond a risk assessment scale, providers should consider other factors, such as comorbidities, which can predispose patients to HPI development.
Cervical Spine Computed Tomography Hounsfield Units Accurately Predict Low Bone Mineral Density of the Femoral Neck
Authors: Colantonio Donald F. , Saxena Sameer K. , Vanier Alan , Rodkey Daniel , Tintle Scott , Wagner Scott C. 
Published: September 2019

Study Design:
A retrospective cohort.

Objective:
The objective of this study to determine the correlation between Hounsfield unit (HU) measurements from the C4 vertebral body and dual-energy x-ray absorptiometry (DXA) T-score.

Summary of Background Data:
Recent attention has turned to the utilization of HU measurements from computed tomography (CT) as a potential screening method for low bone mineral density (BMD). We hypothesized that cervical spine CT HU measurements will correlate with BMD measurements conducted with DXA scans of the femoral neck.

Material and Methods:
Patients with cervical CT and femoral neck DXA scans at 1 institution were included in the study. HUs were manually measured from the cancellous bone in the C4 vertebrae by 1 author blinded to DXA scans. HU measurements were compared with femoral neck DXA T-scores for the entire population.

Results:
A total of 149 patients with 149 cervical CT and femoral neck DXA scans were included in the study. The low BMD group (osteoporotic and osteopenic combined) showed a significant difference in HU compared with the normal groups within the study (P<0.0001). A low BMD screening value of 447 HU captured over 95% of patients with low BMD within our study and provided a sensitivity of 92% and negative predictive value of 82.1%. The male and female intrasex analysis demonstrated a significant difference between the low BMD and normal BMD groups with P=0.001 and P=0.0001, respectively.

Conclusions:
HU measurements taken from the C4 vertebral body on CT scan correlate with low BMD of the femoral neck as determined by DXA scan T-scores. Screening values of 447 HU captured 95% of patients with low BMD, with a high degree of sensitivity, and negative predictive value of 80%. Utilization of cervical spine HU as a screening method provides a simple, quick, and easily assessable screening tool for assessing low BMD.

Level of Evidence:
Level III—diagnostic.
Comparison of Posterior Lumbar Interbody Fusion and Microendoscopic Muscle-preserving Interlaminar Decompression for Degenerative Lumbar Spondylolisthesis With >5-Year Follow-up
Authors: Kimura Ryota , Yoshimoto Mitsunori , Miyakoshi Naohisa , Hongo Michio , Kasukawa Yuji , Kobayashi Takashi , Kikuchi Kazuma , Okuyama Koichiro , Kido Tadato , Hirota Ryosuke , Hamada Shuto , Chiba Mitsuho , Abe Eiji , Yamashita Toshihiko , Shimada Yoichi 
Published: September 2019

Study Design:
Retrospective analysis of prospectively collected observational multicenter data.

Objective:
To compare the clinical results and rates of revision surgery after posterior lumbar interbody fusion (PLIF) and microendoscopic muscle-preserving interlaminar decompression (ME-MILD) in patients with single-level, mild degenerative lumbar spondylolisthesis (DLS) and follow-up of at least 5 years.

Summary of Background Data:
Surgery for symptomatic DLS remains controversial. Evaluating long-term results may reveal problems such as adjacent segmental diseases of the PLIF and decreased quality of life because of slippage and restenosis of the ME-MILD.

Methods:
We enrolled 116 patients who underwent PLIF (79 patients) or ME-MILD (37 patients). Operative times, blood losses, surgical complications, Short-Form 36 (SF-36), Japanese Orthopedic Association (JOA) score, the JOA Back Pain Questionnaire (JOABPEQ), visual analog scales (VAS), and Zurich Claudication Questionnaire (ZCQ) were evaluated.

Results:
PLIF was observed to require significantly longer operative times and entailed greater operative blood losses than did ME-MILD (151.1 vs. 119.9 min; 202.2 vs. 6.4 mL, respectively). Surgery-related complications were identified in 3 cases in the PLIF group and 2 cases in the ME-MILD group. Seventy-eight patients (50 and 28 patients in the PLIF and ME-MILD groups, respectively) were successfully followed-up for >5 years. The follow-up rate was 67.2%. No significant differences between the groups were found in terms of preoperative and postoperative JOA scores, postoperative JOABPEQ, VAS, or ZCQ. Significant improvements in JOA scores were observed in both groups. Significant improvements in the SF-36 were observed in all subscales except in role physical, general health, vitality, and mental health in the ME-MILD group. Revision surgical procedures were performed in 2 patients in the ME-MILD group and 4 patients in the PLIF group.

Conclusions:
PLIF and ME-MILD resulted in equivalent improvements in SF-36 and JOA scores. There were no differences in revision surgery rates among patients with single-level, mild DLS.

Level of Evidence:
Level III—a retrospective analysis.
Measuring Self-Reported Cognitive Function Following TBI: Development of the TBI-QOL Executive Function and Cognition-General Concerns Item Banks
Authors: Carlozzi Noelle E. , Tyner Callie E. , Kisala Pamela A. , Boulton Aaron J. , Sherer Mark , Chiaravalloti Nancy , Tulsky David S. 
Published: September 2019

Objective:
To develop and calibrate new patient-reported outcome measures of cognitive concerns for individuals with traumatic brain injury (TBI).

Setting:
Five TBI model systems rehabilitation centers in the United States.

Participants:
Adults with medically confirmed history of TBI.

Design:
Cross-sectional survey in interview format.

Main Measures:
Traumatic Brain Injury-Quality of Life (TBI-QOL) Executive Function and TBI-QOL Cognition-General Concerns item banks.

Results:
A total of 569 adults with complicated-mild, moderate, or severe TBI completed preliminary item pools, which included 65 Executive Function items and 56 Cognition-General Concerns items. Confirmatory factor analysis supported the retention of 37 Executive Function and 39 Cognition-General Concerns items. Samejima's graded response model was used to estimate item parameters for associated computer adaptive test administrations, and informed the selection of corresponding static short forms. Data from an independent sample of 77 adults with complicated-mild, moderate, or severe TBI supported the test-retest reliability of these newly developed measures.

Conclusion:
The TBI-QOL Executive Function and Cognition-General Concerns item banks provide researchers and clinicians with reliable tools for assessing patient-reported post-TBI cognitive difficulties as part of the comprehensive TBI-QOL measurement system.
Daily Enemas for Pediatric Bowel Management
Authors: Mantel Connie , Carlin Kristen , Thomas Karen 
Published: September 2019

Introduction
Children born with anorectal malformations, Hirschsprung disease, spinal cord defects, and related conditions have problems with constipation and fecal incontinence. In a large pediatric healthcare center, a weeklong outpatient program is offered to families, teaching daily high-volume enema administration. The purpose of this study is to assess the rate of adherence with daily enemas for bowel management and assess problems among children with elimination abnormalities.

Methods
A single-cohort observational study was conducted. Subjects included children ages 3–18 years and their parents who had attended a bowel management training program from April 2012 to December 2017. Data were collected utilizing an anonymous REDCap survey. Survey questions addressed adherence with daily enemas, supports and challenges, and parent-reported satisfaction and child acceptance.

Results
Surveys were sent to 112 parents, and 32 parents had completed the surveys. Approximately half of the sample, with a mean age of 9.9 years (SD = 3.7), adhered to daily enemas for bowel management. Parents reported a variety of problems and barriers to adherence with daily enemas, including child resistance (31.3%), difficulty retaining enema fluid (37.5%), cramping during enema (62.5%), time constraints (40.6%), getting or replacing equipment (28.1%), and bathroom space issues (25.0%). Sixty percent of the sample reported that enema administration requires more than 1 hour.

Discussion
In general, parents reported child acceptance, satisfaction, and limited difficulty with enema management; however, adherence was not as desired, and the rate of reported problems was high. Insight into problems experienced by parents provides nursing opportunity for educational programs that may improve adherence.
Assessment of Health Care Utilization for Dizziness in Ambulatory Care Settings in the United States
Authors: Dunlap Pamela M. , Khoja Samannaaz S. , Whitney Susan L. , Freburger Janet K. 
Published: September 2019

Objective:
Describe patient and physician characteristics, and physician recommendations for ambulatory care visits for dizziness in the US.

Study Design:
Cross-sectional analysis of visits for dizziness from the National Ambulatory Medical Care Survey (2013–2015).

Setting:
Ambulatory care clinics in the US.

Patients:
20.6 million weighted adult visits [mean age 58.7 (1.0)] for dizziness, identified using ICD-9-CM codes (386.00–386.90, 780.40).

Main Outcome Measures:
Patient, clinical, and physician characteristics and physician diagnostic and treatment recommendations. Prevalence rates for benign paroxysmal positional vertigo (BPPV), unspecified dizziness, and other vestibular disorders were estimated, and descriptive statistics were used to characterize patients, physicians, and physicians’ recommendations.

Results:
The prevalence rate for dizziness visits was 8.8 per 1,000 (95% confidence interval [CI]: 7.5, 10.3). Most visits were for unspecified dizziness (75%), made by women (65%), whites (79%), and were insured by private insurance (50%). Visits for dizziness were to primary care physicians (51.9%), otolaryngologists (13.3%), and neurologists (9.6%). Imaging was ordered and medication prescription was provided in 5.5% and 20.1% of visits. Physical therapy (PT) was used for a higher percentage of BPPV visits (12.9%), than for other diagnoses (<1.0%). Physician treatment recommendations for vestibular diagnoses varied by physician specialty.

Conclusions:
A large percentage of visits had an unspecified diagnosis. A low number of visits for vestibular disorders were referred to PT. There are opportunities to improve care by using specific diagnoses and increasing the utilization of effective interventions for vestibular disorders.
Specificity of Procedure volume and its Association With Postoperative Mortality in Digestive Cancer Surgery
Authors: El Amrani Mehdi , Lenne Xavier , Clement Guillaume , Delpero Jean-Robert , Theis Didier , Pruvot François-René , Bruandet Amelie , Truant Stephanie 
Published: September 2019

Objectives:
We aimed to examine whether the improved outcome of a digestive cancer procedure in high-volume hospitals is specific or correlates with that of other digestive cancer procedures, and determine if the discriminant cut-off of hospital volume may influence postoperative mortality (POM) regardless of the procedure.

Background:
Performing complex surgeries in tertiary centers is associated with improved outcome. However, the association between POM and hospital volume of nonspecific procedures is unknown.

Methods:
Patients who underwent colectomy, proctectomy, esophagectomy, gastrectomy, pancreatectomy, and hepatectomy for cancer between 2012 and 2017 were identified in the French nationwide database. Chi-square automatic interaction detector was used to identify the cut-off values of the annual caseload affecting the 90-day POM. A common threshold was estimated by minimization of chi-square distance taking into account the specific mortality of each procedure.

Results:
Overall, 225,752 patients were identified. Hospitals were categorized according to the procedure volume (colectomy: ≥80 cases/yr, proctectomy: ≥35/yr, esophagectomy: ≥41/yr, gastrectomy: ≥16/yr, pancreatectomy: ≥26/yr, and hepatectomy: ≥76/yr). The overall 90-day POM was 5.1% and varied significantly with volume. The benefits of high volume were transferable across procedures. High-volume hospitals for colorectal cancer surgery significantly influenced the risk of death after hepatectomy (P < 0.001) and pancreatectomy (P < 0.001). The common threshold for all procedures that influenced POM was 199 cases/yr (odds ratio 1.29, P < 0.001).

Conclusion:
In digestive cancer surgery, the volume–POM relationship of one procedure was associated with the volume of other procedures. Thus, tertiary hospitals should be defined according to the common threshold of different procedures.
Dynamic biological adhesion: mechanisms for controlling attachment during locomotion
Authors: Federle Walter , Labonte David 
Published: September 2019

The rapid control of surface attachment is a key feature of natural adhesive systems used for locomotion, and a property highly desirable for man-made adhesives. Here, we describe the challenges of adhesion control and the timescales involved across diverse biological attachment systems and different adhesive mechanisms. The most widespread control principle for dynamic surface attachment in climbing animals is that adhesion is ‘shear-sensitive’ (directional): pulling adhesive pads towards the body results in strong attachment, whereas pushing them away from it leads to easy detachment, providing a rapid mechanical ‘switch’. Shear-sensitivity is based on changes of contact area and adhesive strength, which in turn arise from non-adhesive default positions, the mechanics of peeling, pad sliding, and the targeted storage and controlled release of elastic strain energy. The control of adhesion via shear forces is deeply integrated with the climbing animals’ anatomy and locomotion, and involves both active neuromuscular control, and rapid passive responses of sophisticated mechanical systems. The resulting dynamic adhesive systems are robust, reliable, versatile and nevertheless remarkably simple.This article is part of the theme issue ‘Transdisciplinary approaches to the study of adhesion and adhesives in biological systems’.
Bidirectional crosstalk between Hypoxia-Inducible Factor and glucocorticoid signalling in zebrafish larvae
Authors: Marchi Davide , Santhakumar Kirankumar , Markham Eleanor , Li Nan , Storbeck Karl-Heinz , Krone Nils , Cunliffe Vincent T. , van Eeden Fredericus J.M. 
Published: September 2019

AbstractIn the last decades in vitro studies highlighted the potential for crosstalk between Hypoxia-Inducible Factor-(HIF) and glucocorticoid-(GC) signalling pathways. However, how this interplay precisely occurs in vivo is still debated. Here, we use zebrafish larvae (Danio rerio) to elucidate how and to what degree hypoxic signalling affects the endogenous glucocorticoid pathway and vice versa, in vivo. Firstly, our results demonstrate that in the presence of upregulated HIF signalling, both glucocorticoid receptor (Gr) responsiveness and endogenous cortisol levels are repressed in 5 days post fertilisation larvae. In addition, despite HIF activity being low at normoxia, our data show that it already impedes both glucocorticoid activity and levels. Secondly, we further analysed the in vivo contribution of glucocorticoids to HIF activity. Interestingly, our results show that both glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) play a key role in enhancing it. Finally, we found indications that glucocorticoids promote HIF signalling via multiple routes. Cumulatively, our findings allowed us to suggest a model for how this crosstalk occurs in vivo.Author summaryHypoxia is a common pathophysiological condition to which cells must rapidly respond in order to prevent metabolic shutdown and subsequent death. This is achieved via the activity of Hypoxia-Inducible Factors (HIFs), which are key oxygen sensors that mediate the ability of the cell to cope with decreased oxygen levels.Although it aims to restore tissue oxygenation and perfusion, it can sometimes be maladaptive and contributes to a variety of pathological conditions including inflammation, tissue ischemia, stroke and growth of solid tumours. In this regard, synthetic glucocorticoids which are analogous to naturally occurring steroid hormones, have been used for decades as anti-inflammatory drugs for treating pathological conditions which are linked to hypoxia (i.e. asthma, rheumatoid arthritis, ischemic injury). Indeed, previous in vitro studies highlighted the presence of a crosstalk between HIF and glucocorticoids. However, how this interplay precisely occurs in an organism and what the molecular mechanism is behind it are questions that still remain unanswered. Here, we provide a thorough in vivo genetic analysis, which allowed us to propose a logical model of interaction between glucocorticoid and HIF signalling. In addition, our results are important because they suggest a new route to downregulate HIF for clinical purposes.
Sex differences in cortisol and memory following acute social stress in amnestic mild cognitive impairment
Authors: Murphy Kelly J. , Hodges Travis E. , Sheppard Paul A.S. , Troyer Angela K. , Hampson Elizabeth , Galea Liisa A.M. 
Published: September 2019

AbstractObjectiveOlder adults with amnestic mild cognitive impairment (aMCI) develop Alzheimer’s type dementia approximately ten times faster annually than the normal population. Adrenal hormones are associated with aging and cognition. We investigated the relationship between acute stress, cortisol, and memory function in aMCI with an exploratory analysis of sex.MethodSalivary cortisol was sampled diurnally and during two test sessions, one session with the Trier Social Stress Test (TSST), to explore differences in the relationship between cortisol and memory function in age-normal cognition (NA) and aMCI. Participants with aMCI (n=6 women, 9 men; mean age=75) or similarly aged NA (n=9 women, 7 men, mean age=75) were given tests of episodic, associative, and spatial working memory with a psychosocial stressor (TSST) in the second session.ResultsThe aMCI group performed worse on the memory tests than NA as expected, and males with aMCI had elevated cortisol levels on test days. Immediate episodic memory was enhanced by social stress in NA but not in the aMCI group, indicating that stress-induced alterations in memory are different in individuals with aMCI. High cortisol was associated with impaired performance on episodic memory in aMCI males only. Cortisol in Session 1 moderated the relationship with spatial working memory, whereby higher cortisol was associated with worse performance in NA, but better spatial working memory in aMCI. In addition, effects of aMCI on perceived anxiety in response to stress exposure were moderated by stress-induced cortisol in a sex-specific manner.ConclusionsWe show effects of aMCI on Test Session cortisol levels and effects on perceived anxiety, and stress-induced impairments in memory in males with aMCI in our exploratory sample. Future studies should explore sex as a biological variable as our findings suggests that effects at the confluence of aMCI and stress can be obfuscated without sex as a consideration.