bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidermal Fluence Threshold Determination by Real-Time Melanin Measurements
Authors: Lloyd Amanda Abramson , Graves Michael S. , Ross Edward V. 
Published: July 2018

BACKGROUND AND OBJECTIVE
Epidermal preservation is essential during laser treatment for vascular, hair, and benign pigment dyschromias. Epidermal tolerance is determined by epidermal melanin content, fluence, pulse width, wavelength, skin cooling, and spot size. The authors' objective was to determine the maximum epidermal tolerance for the long-pulse alexandrite 755 nm and the long-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG) 1064-nm lasers for varying epidermal melanin content.

MATERIALS AND METHODS
Skin melanin measurements were performed at the test sites with a melanin reader, and 0.5 to 1 second of refrigerated air precooled the skin. Then, alexandrite and Nd:YAG laser test spots of 5 to 18 mm were delivered in a series of ascending fluences using 5-, 20-, and 50-ms pulse widths. Skin response at 24 to 48 and 96 hours was scored from 0 to 15 varying from “no reaction” to “severe scabbing.”

RESULTS
Alexandrite laser, mean threshold fluences increased by a factor of 1.2 increasing from 5 to 20 ms, and by a factor of 1.4 increasing from 5 to 50 ms, among subjects with a melanin index (MI) from 9 to 25 (Fitzpatrick skin phototype I-III). The Nd:YAG fluence to reach epidermal tolerance was 6X the fluence with the alexandrite laser for the same MI in subjects with MI 26 to 35.

CONCLUSION
Epidermal melanin measurements are quantitative and objective, therefore, improving treatment setting determination by decreasing the risk of overtreatment or undertreatment.
AMPLITUDE LOSS OF THE HIGH-FREQUENCY FLICKER ELECTRORETINOGRAM IN EARLY DIABETIC RETINOPATHY
Authors: McAnany J. Jason , Park Jason C. , Chau Felix Y. , Leiderman Yannek I. , Lim Jennifer I. , Blair Norman P. 
Published: July 2018

Purpose:
To evaluate retinal dysfunction in diabetic patients who have mild or no nonproliferative diabetic retinopathy (DR) using the high-frequency flicker electroretinogram.

Methods:
Light-adapted flicker electroretinograms were recorded from 15 diabetic patients who have no clinically apparent retinopathy, 15 diabetic patients who have mild nonproliferative DR, and 15 nondiabetic, age-equivalent controls. Electroretinograms were elicited by full-field flicker at 2 temporal frequencies, 31.25 and 62.5 Hz, and were recorded using conventional techniques. Amplitude and timing of the flicker responses were compared among the groups and correlated with clinical characteristics including age, acuity, disease duration, and HbA1c.

Results:
The 31.25-Hz flicker amplitude was slightly, but nonsignificantly, smaller for subjects with no DR and mild nonproliferative DR , compared with the control group (both t < 1.38, P > 0.31); small, nonsignificant response delays for both patient groups were also observed (both t < 1.57, P > 0.12). By contrast, there were significant amplitude reductions for the 62.5-Hz flicker stimulus: mean amplitude was reduced by 32% for subjects with no DR and by 41% for subjects with mild nonproliferative DR (both t > 2.92 and P < 0.01). Response timing at 62.5 Hz did not differ significantly from control for either group (both t < 1.2 and P > 0.39). Electroretinogram amplitude and timing were not correlated significantly with clinical characteristics.

Conclusion:
The 62.5-Hz flicker electroretinogram is useful for evaluating retinal dysfunction in diabetic patients who have mild or no DR because this response can be significantly reduced. Attenuation of the high-frequency flicker electroretinogram, which is primarily generated by bipolar cells, suggests a relatively early retinal site of neural dysfunction.
Nonpharmacological Management of Persistent Pain in Elite Athletes: Rationale and Recommendations
Authors: Moseley G. Lorimer , Baranoff John , Rio Ebonie , Stewart Mike , Derman Wayne , Hainline Brian 
Published: July 2018

Abstract:
Persistent pain is common in elite athletes. The current review arose from a consensus initiative by the International Olympic Committee to advance the development of a standardized, scientific, and evidence-informed approach to management. We suggest that optimal management of persistent pain in elite athletes requires an understanding of contemporary pain science, including the rationale behind and implementation of a biopsychosocial approach to care. We argue that athletes and clinicians need to understand the biopsychosocial model because it applies to both pain and the impact of pain with special reference to the sport setting. Management relies on thorough and precise assessment that considers contributing factors across nociceptive, inflammatory, neuropathic, and centrally acting domains; these can include contextual and psychosocial factors. Pain management seeks to remove contributing factors wherever possible through targeted education; adjustment of mechanical loading, training, and performance schedules; psychological therapies; and management of inflammation.
Audiologic Manifestations of Marshall Syndrome
Authors: Bacciu Andrea , Di Lella Filippo , Iaccarino Ilaria , Pasanisi Enrico , Fava Giovanni , Vincenti Vincenzo , Falcioni Maurizio 
Published: July 2018

Objective:
Marshall syndrome is a genetic disorder caused by mutations in the COL11A1 gene. This syndrome is characterized by skeletal, ophthalmologic, craniofacial, and auditory abnormalities. Hearing loss is among the main manifestations reported in this disorder being observed in approximately 80% of affected individuals.
The present study aims to describe the audiologic characteristics of three members of a family with Marshall syndrome and also serves as a review of the literature.

Study Design:
Family study.

Setting:
Tertiary care otology and skull base center.

Patients:
We report the audiologic findings in a family with Marshall syndrome consisting of a mother and her son and daughter.

Intervention(s): :
The audiologic evaluation included tympanometry, acoustic reflexes testing, auditory brainstem response, transient otoacoustic emissions, pure-tone audiometry, speech audiometry in quiet, and conditioned play audiometry. These methods were applied according to the age of the patients. In addition, we provide a review of the English-language literature in an attempt to clarify the auditory phenotype of this syndrome.

Results:
All 3 affected individuals had heterozygous c.3816+1G>A mutation in the splicing donor site of intron 50 of the COL11A1 gene. All three patients in our study had bilateral sensorineural hearing loss. Hearing impairment ranged from mild to moderate in the daughter, moderate in the son, and from mild to moderate in their mother.

Conclusion:
The majority of individuals with Marshall syndrome present early-onset bilateral sensorineural hearing loss. Hearing impairment is usually detected in early childhood, progresses gradually, and becomes stable in late adulthood, with a severity ranging from mild to severe.
The Epidemiology of Vestibular Migraine: A Population-based Survey Study
Authors: Formeister Eric J. , Rizk Habib G. , Kohn Michael A. , Sharon Jeffrey D. 
Published: July 2018

Objectives:
1. Describe the epidemiology of vestibular migraine (VM) in the United States, using data from the 2008 National Health Interview Survey (NHIS). 2. Characterize the sociodemographic and clinical attributes of people with VM.

Study Design:
Population-based nationwide survey study of US adults.

Patients:
Adult respondents to the 2008 NHIS.

Main Outcome Measures:
The responses of participants in the 2008 NHIS balance and dizziness supplement (n = 21,781) were analyzed using statistical software. A case definition for VM was generated based on consensus criteria for diagnosis, and this was applied to the dataset to ascertain the prevalence, demographic, and clinical characteristics of VM.

Results:
The 1-year prevalence of a dizziness or balance problem in the United States was 11.9% (2,490 respondents). Of respondents with dizziness, 584 (23.4%) met our case definition of VM, which represents a prevalence of VM in 2.7% of adults. There was a female preponderance (64.1%) and a slightly younger mean age (40.9 yr) for those with VM as compared with all respondents (51.7% females and 46.0 yr, respectively). Multivariate analysis showed that age less than 40, female sex, anxiety, depression, and prior head trauma were all associated with significantly increased odds of experiencing VM. Only 10% of subjects meeting criteria for VM were told that migraine was the cause of their dizziness.

Conclusion:
Using a representative database, we found a much higher prevalence of VM in the United States than previously reported. Results from this study indicate likely under-diagnosis of VM.
Lipid-driven immunometabolic responses in atherosclerosis
Authors: Gisterå Anton , Ketelhuth Daniel F.J. 
Published: July 2018

Purpose of review
Atherosclerosis is a chronic inflammatory disease in which subendothelial infiltration of lipoproteins leads to inflamed lesions in arteries. Despite improvements in secondary prevention, most cardiovascular events cannot be avoided with current therapies. This review focuses on novel mechanistic insights on lipid-driven immune activation, which could pave the way for new anti-inflammatory treatments for atherosclerosis.

Recent findings
Immunometabolic interactions can shape the immune response. Within atherosclerotic plaques, macrophages and T cells are the dominant immune cell populations. Using multiple mechanisms, lipoprotein-derived components activate both the innate and adaptive immune systems. Cholesterol crystals and apolipoprotein B-peptides have been shown to activate macrophages and T cells, respectively. Lipoproteins are also important modulators of regulatory T cells that can hamper vascular inflammation. In the liver, T cells can influence hepatic inflammation and lipoprotein metabolism. Hence, there is an intricate crosstalk between the immune system and lipoprotein metabolism.

Summary
Novel treatments are needed to prevent clinical manifestations of atherosclerosis. Improved understanding of lipid-driven immunometabolic responses is likely to reveal new therapeutic targets.
Cardiovascular disease in Noonan syndrome
Authors: Pierpont Mary Ella , Digilio Maria Cristina 
Published: July 2018

Purpose of reviewTo provide information on the scope of cardiac disease in Noonan syndrome.Recent findingsNoonan syndrome is a common autosomal dominant RASopathy disorder characterized by clinical findings of facial dysmorphism, congenital heart disease, and short stature. The degree of genetic heterogeneity has recently become evident in that Noonan syndrome is now known to be caused by mutations in a large variety of genes which produce dysregulation of the RAS–MAPK (mitogen-activated protein kinase) signaling pathway. The scope of cardiac disease in Noonan syndrome is quite variable depending on the gene mutation, with some mutations usually associated with a high incidence of congenital heart defects (PTPN11,KRAS, and others) while those with predominantly hypertrophic cardiomyopathy (HCM) have higher risk and morbidity profiles (RAF1,RIT1, and those associated with multiple lentigines).SummaryCardiac disease in Noonan syndrome varies according to the type of gene mutation. The most common forms of cardiac disease include pulmonary stenosis, HCM, and atrial septal defect. HCM in general is associated with increased risk, mortality, and morbidity. New concepts for potential treatments are discussed.
Major Adverse Events Following Over-Shunting Are Associated With Worse Outcomes Than Major Adverse Events After a Blocked Systemic-to-Pulmonary Artery Shunt Procedure
Authors: Soo Kok Wai , Brink Johann , d’Udekem Yves , Butt Warwick , Namachivayam Siva P. 
Published: July 2018

Objectives:
Causes of major adverse event after systemic-to-pulmonary shunt procedure are usually shunt occlusion or over-shunting. Outcomes categorized on the basis of these causes will be helpful both for quality improvement and prognostication.

Design:
Retrospective cohort analysis of children who underwent a systemic-to-pulmonary shunt after excluding those who had it for Norwood or Damus-Kaye-Stansel procedure.

Setting:
The Royal Children’s Hospital, Melbourne, VIC, Australia.

Patients:
From 2008 to 2015, 201 children who had a systemic-to-pulmonary shunt were included.

Interventions:
Major adverse event is defined as one or more of cardiac arrest, chest reopening, or requirement for extracorporeal membrane oxygenation. Study outcome is a “composite poor outcome,” defined as one or more of acute kidney injury, necrotizing enterocolitis, brain injury, or in-hospital mortality.

Measurements and Main Results:
Median (interquartile range) age was 12 days (6–38 d) and median (interquartile range) time to major adverse event was 5.5 hours (2–17 hr) after admission. Overall, 36 (18%) experienced a major adverse event, and reasons were over-shunting (n = 17), blocked shunt (n = 13), or other (n = 6). Fifteen (88%) in over-shunting group suffered a cardiac arrest compared with two (15%) in the blocked shunt group (p < 0.001). The composite poor outcome was seen in 15 (88%) in over-shunting group, four (31%) in the blocked shunt group, and 56 (34%) in those who did not experience a major adverse event (p < 0.001). By multivariable analysis, predictors for composite poor outcome were major adverse event due to over-shunting (no major adverse event—reference; over-shunting odds ratio, 18.60; 95% CI, 3.87–89.4 and shunt-block odds ratio, 1.57; 95% CI, 0.46–5.35), single ventricle physiology (odds ratio, 4.70; 95% CI, 2.34–9.45), and gestation (odds ratio, 0.84/wk increase; 95% CI, 0.74–0.96).

Conclusions:
Infants who suffer major adverse event due to over-shunting experience considerably poorer outcomes than those who experience events due to shunt block. A mainly hypoxic event with maintenance of systemic perfusion (as often seen in a blocked shunt) is less likely to result in poorer outcomes than those after a hypoxic-ischemic event (commonly seen in over-shunting).
Chronic Family Stress and Adolescent Health: The Moderating Role of Emotion Regulation
Authors: Jones Emily J. , Lam Phoebe H. , Hoffer Lauren C. , Chen Edith , Schreier Hannah M.C. 
Published: July 2018

ABSTRACT

Objective
The aim of the study was to assess whether the association between chronic family stress and physiological measures is moderated by emotion regulation strategies in an adolescent sample.

Methods
Chronic family stress was assessed via a semistructured interview and emotion regulation strategies (cognitive reappraisal and suppression) via questionnaire among 261 adolescents (14.57 (1.07) years). Several metabolic (waist-hip ratio, systolic and diastolic blood pressure) and inflammatory markers (basal and stimulated proinflammatory cytokine production in response to bacterial challenge) as well as glucocorticoid sensitivity were assessed.

Results
There were no main effects of chronic family stress, cognitive reappraisal, or suppression on physiological measures (all p's > .10). Emotion regulation moderated the association between chronic family stress and physiological measures. As chronic family stress increased, adolescents higher in cognitive reappraisal had smaller waist-hip ratios (B = −.003, SE = .001, p = .015) and lower systolic blood pressure (B = −.303, SE = .143, p = .035), although no moderation was found with respect to inflammatory markers and glucocorticoid sensitivity (all p's > .30). In addition, as chronic family stress increased, adolescents higher in suppression showed evidence of higher stimulated proinflammatory cytokine production (B = .046, SE = .020, p = .021) and lower glucocorticoid sensitivity (B = .051, SE = .021, p = .015), although basal inflammation and metabolic measures were not moderated by suppression (all p's > .50).

Conclusions
This study suggests that the types of emotion regulation strategies used by adolescents may affect the extent to which chronic family stress affects important metabolic and immune processes.
What Can Apologies in the Electronic Health Record Tell Us About Health Care Quality, Processes, and Safety?
Authors: Matulis John C. , North Frederick 
Published: July 2018

Introduction
Apologizing to patients is an encouraged practice, yet little is known about how and why providers apologize and what insights apologies could provide in improving quality and safety.

Objective
The aim of the study was to determine whether provider apologies in the electronic health record could identify patient safety concerns and opportunities for improvement.

Methods
After performing a free-text search, we randomly selected 100 clinical notes from 1685 available containing terminology related to apology. We categorized the reason for apology, presence and classification of medical error, level of patient harm, and practice improvement opportunities. We compared patient events discovered from apologies in the medical record to standard patient incident report logs.

Results
Of 100 randomly selected apologies, 37 were related to a delay in care, 14 to misunderstanding, 11 to access to care, and 8 to information technology. For apologies related to delay, the median delay was 6 days (mean = 8.9, range = 0–41). Twenty-four (65%) of the 37 delays were related to diagnostic testing.
Medical errors were associated with 46 (46%) of the 100 apologies. Sixty-four (64%) of the 100 apologies were associated with actionable opportunities for improvement. These opportunities were classified into 37 discrete issues across 8 broad categories. When apology review was compared with standard incident report logs, 27 (73%) of the 37 discrete issues identified by patient apology review were not found in incident reporting; both methods identified similar rates of patient harm.

Conclusions
Review of apologies in the electronic health record can identify patient safety concerns and improvement opportunities not apparent through standard incident reporting.
Reconstruction of Contracted Eye Socket With Autogenic Dermal Sphere Connected to Epidermis
Authors: Tian Rui , Xu Haitao , Huang Xinyu , Wang Xingxing , Zhang Jialu , Du Yuanyuan 
Published: July 2018

Background:
Because of the deficiency of blood circulation and soft tissue, reconstruction of the eye socket for severe conjunctival sac stenosis in anophthalmic patients is very difficult. In this article, the authors report an innovative technique for conducting a 1-stage operation to reconstruct the contracted eye socket with an autogenic dermal sphere connected to the epidermis (ADSE).

Methods:
Five patients, each having a single severely contracted eye socket and conjunctival sac, were included in this study. An ADSE was transplanted into the contracted eye socket and conjunctival sac. After the operation, several observation indexes were evaluated, such as the survival and stability of implanted autologous tissue, the improvement of the contracted eye socket, and the degree of patients’ satisfaction with their appearance.

Results:
All of the implanted epidermal and dermal tissues survived well after 6 months’ observation. Although somewhat absorbed, the transplanted dermal ball was plump in the eye socket, and the epithelial tissues merged well with the residual conjunctival epithelium. Moreover, the transplanted epidermis assumed a mucosal appearance in 4 of 5 patients. After reconstruction of the eye socket, the size of the conjunctival sac and depth of the eye socket were corrected sufficiently for patients to wear an ocular prosthesis.

Conclusions:
The implantation of an ADSE can reconstruct a severely contracted eye socket in anophthalmic patients. Because of the high survival rate and limited absorption ratio, this 1-stage operation satisfied both patients and their ophthalmologists.
Sinusitis Due to the Presence of a Dental Implant Inside the Maxillary Sinus
Authors: Conforte Jadison Junio , Ponzoni Daniela 
Published: July 2018

Abstract
The migration of a dental implant into the maxillary sinus is an uncommon event of occurrence. Disrespect for concepts of implantology, low alveolar bone density at the site, high incidence of masticatory force in posterior region, and clinical intercurrences predispose to failure in rehabilitation.
Emergency general surgery in the United Kingdom: A lot of general, not many emergencies, and not much surgery
Authors: Ramsay George , Wohlgemut Jared M. , Jansen Jan O. 
Published: July 2018

BACKGROUND
The provision of emergency general surgery services is a global issue, with important implications for patients and workforce. The aim of this study was to analyze the characteristics of emergency general surgical patients in the United Kingdom, with reference to diagnostic case mix, operative workload, comorbidity, discharge destination, and outcomes, to facilitate comparisons and future service development.

METHODS
This is a cross-sectional population-based study based in the National Health Service in Scotland, one of the home nations of the United Kingdom. All patients aged 16 or older admitted under the care of a general surgeon, as an emergency, to a National Health Service hospital in Scotland, in 2016, were included.

RESULTS
There were 81,446 emergency general surgery admissions by 66,498 patients. Median episode age was 53 years. There were more female patients than male (55% vs 45%, p < 0.0001). The most common diagnoses were nonspecific abdominal pain (20.2%), cholecystitis (7.2%), constipation (3.4%), pancreatitis (3.1%), diverticular disease (3.1%), and appendicitis (3.1%). Only 25% of patients had operations (n = 20,292). The most frequent procedures were appendicectomy (13.1%), endoscopy (11.3%), and drainage of skin lesions (9.7%). Diagnoses and operations differed with age. Overall median length of stay was 1 day. With a 6-month follow-up, patients older than 75 years had a 19.8% mortality rate.

CONCLUSIONS
Emergency general surgery in the United Kingdom is a high-volume, diagnostically diverse, and low–operative volume specialty with high short-term mortality rate in elderly patients. Consideration should be given to alternative service delivery models, which make better use of surgeons’ skills while also ensuring optimal care for patients who are increasingly elderly and have complex chronic health problems.

LEVEL OF EVIDENCE
Epidemiologic study, level III.
A Review of the Effects of Transcranial Direct Current Stimulation for the Treatment of Hallucinations in Patients With Schizophrenia
Authors: Mondino Marine , Sauvanaud Florence , Brunelin Jérôme 
Published: July 2018

Abstract
Some 25% to 30% of patients with schizophrenia report auditory verbal hallucinations (AVHs) that fail to respond adequately to antipsychotic treatments. In such cases, transcranial direct current stimulation (tDCS) has been proposed as a therapeutic option. Here, we aim to provide an exhaustive review of the literature examining the clinical effects of tDCS on AVH in patients with schizophrenia. A systematic search in the PubMed and Web of Science databases yielded 14 results, 7 randomized controlled trials (RCTs) and 7 open-label studies. Among them, 4 RCTs and 7 open-label studies reported a significant reduction of AVH after repeated sessions of tDCS, whereas 3 RCTs did not show any advantage of active tDCS over sham tDCS. Altogether, current studies showed an overall decrease of approximately 26% of AVH after active tDCS and 11% after sham tDCS. One suitable approach to decreasing AVH was to deliver twice-daily sessions of tDCS over 5 consecutive days (10 sessions at 20 minutes each, 2 mA) with the anode over the left dorsolateral prefrontal cortex and the cathode over the left temporoparietal junction. Demographic and clinical parameters such as young age, nonsmoking status, and higher frequencies of AVH occurrence seemed to be predictors of clinical improvement. Further RCTs, with larger sample sizes, are needed to confirm the usefulness of tDCS for AVH.