bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proximal both-bone forearm fractures in children: factors predicting outcome
Authors: Littleton Travis W. , Pharr Zachary K. , Kelly Derek M. , Moisan Alice 
Published: April 2018

Background:
The literature is replete with outcomes studies on pediatric forearm fractures; however, information concerning the outcomes of both-bone fractures of the proximal radius and ulna is limited. The purpose of our study was to evaluate the prognosis and outcomes in children with combined fractures of the proximal radius and ulna, with special attention to complications.

Methods:
A single-center, retrospective study identified patients ages 3 to 15 yr old with proximal forearm fractures treated between January of 1994 and February of 2014. Patients were excluded if they did not have both-bone fractures of the proximal forearm. Records were reviewed with a focus on outcomes and their association with age at the time of injury, severity of injury, type of treatment, and complications.

Results:
Thirty-one patients met the inclusion criteria. Significant differences were seen between patients younger than 10 yr of age and patients older than 10 yr of age in rates of requiring operative treatment (P=0.048) and returning to the operating room (P=0.037). There was no significant difference in nerve injury (P=0.519) or range-of-motion deficits (P=0.872) based on age. In addition, no difference was seen in range-of-motion deficits based on severity of injury as determined by displacement (complete or none) (P=0.139).

Conclusions:
Most proximal both-bone forearm fractures in children, including olecranon and radial neck fractures, Monteggia type IV fractures, and nonspecific proximal both-bone forearm fractures, have good-to-excellent results. In our study, older age, defined as 10 yr of age or older at the time of injury, resulted in more frequent need for operative intervention, a higher rate of return to the operating room, and greater risk of nerve injury. The older children were not more likely to have range of motion deficits despite a more involved course, which contradicts previous reports, and older age at the time of injury did not necessarily predict poorer outcomes.

Level of Evidence:
Level IV, case series.
A Comparison of Isolated Lumbar Extension Strength Between Healthy Asymptomatic Participants and Chronic Low Back Pain Participants Without Previous Lumbar Spine Surgery
Authors: Conway Rebecca , Behennah Jessica , Fisher James , Osborne Neil , Steele James 
Published: April 2018

Study Design.
Cross-sectional case-control study.

Objective.
To compare isolated lumbar extension strength between healthy asymptomatic participants and participants with chronic low back pain (CLBP), while controlling for previous lumbar spine surgery.

Summary of Background Data.
Deconditioning of the lumbar musculature is common in those with previous lumbar surgery, resulting in decreased strength and endurance. Evidence is required to support whether this is the case for participants with CLBP yet no previous surgery compared with asymptomatic participants.

Methods.
Forty-two healthy (25 males and 17 females) asymptomatic participants, and 53 participants with non-specific CLBP (30 males and 23 females) aged between 19 and 76 years were recruited. Maximal isometric isolated lumbar extension (ILEX) strength was examined.

Results.
A Mann–Whitney U test indicated that ILEX strength was significantly greater in the asymptomatic group compared with the CLBP group (Z = 1441.00, P = 0.014). Post-hoc effect size was calculated to be d = 0.56, showing a moderate effect.

Conclusion.
These results indicate that ILEX weakness and lumbar extensor deconditioning is present independent of surgery and may be a factor involved in CLBP. As such, lumbar extensor deconditioning would appear to be a reasonable target for interventions in CLBP.

Level of Evidence: 3
Performance Testing of Criticality Accident Detectors with the Godiva Burst Reactor
Authors: Vickers Linda 
Published: April 2018

Abstract
Criticality accident detectors are required for all operations involving fissile materials in which a criticality accident can occur and cause personnel to receive unacceptable exposure to radiation (ANSI/ANS 8.3‐R2012). Recently, the U.S. Department of Energy Y‐12 National Security Complex tested six criticality accident detectors and eight Portable Radiation Detection Instruments (PRDIs) to verify their performance under actual criticality conditions. The tests were performed by Los Alamos National Laboratory using the Godiva critical assembly located at the National Criticality Experiments Research Center at the U.S. Department of Energy Nevada National Security Site. All six criticality accident detectors and eight Portable Radiation Detection Instruments passed the performance tests. The test results provide reasonable assurance that the Y-12 criticality accident detectors and PRDIs will detect a criticality accident and warn workers to evacuate the area to minimize their exposure to this life-threatening hazard.
Development of pain in older adults: a latent class analysis of biopsychosocial risk factors
Authors: O'Neill Aoife , O'Sullivan Kieran , O'Keeffe Mary , Hannigan Ailish , Walsh Cathal , Purtill Helen 
Published: April 2018

Abstract
Pain significantly restricts the quality of life and well-being of older adults. With our increasingly ageing population, it is important to examine whether differing classes of biopsychosocial risk factors can predict the development of pain in older adults. Latent class analysis provides a model-based approach to identifying underlying subgroups in a population, based on some measured characteristics. In this study, latent class analysis was used to identify biopsychosocial risk classes in people aged 50 years and older, from The Irish Longitudinal Study on Ageing, who reported not often being troubled by pain at wave 1 and completed the 2-year follow-up at wave 2 (n = 4458). Four classes were identified based on 11 potential risk factors at wave 1. These classes were characterised as “Low Risk,” “Physical Health Risk,” “Mental Health Risk,” and “High Risk.” The Low-Risk class accounted for over half the sample (51.2%), whereas the High-Risk class represented 7.8% of the sample. At follow-up (wave 2), 797 (17.9%) participants reported being troubled by pain. Associations between the biopsychosocial risk classes and developing pain were examined using logistic regression, adjusting for sociodemographic variables. The High-Risk class was more likely to develop pain compared with the Low-Risk class (adjusted OR = 3.16, 95% CI = 2.40-4.16). These results add to existing data in other populations supporting the role of a range of biopsychosocial risk factors that increase the risk of developing pain. These findings have important implications for the identification, and potential moderation, of these risk factors.
Benefits of Bimodal Hearing With Cochlear and Middle Ear Implants: Preliminary Results in Four Patients
Authors: Lee Hyun Jin , Kim Sung Huhn , Moon In Seok , Jung Jinsei , Lee Jeon Mi , Choi Jae Young 
Published: April 2018

Objective:
Conventional hearing aids have some limitations in overcoming a large air-bone gap or in cases of severe high-frequency hearing loss. The authors aimed to evaluate the benefit of a new bimodal hearing configuration combining cochlear implantation (CI) and middle ear implant (MEI) in patients with severe mixed conductive and ski-slope hearing loss.

Study Design:
Retrospective case review.

Setting:
Tertiary referral center.

Patients:
Four patients with severe to profound hearing loss, who underwent CI in one ear and MEI in the other, were enrolled.

Intervention:
Audiological outcomes were assessed at least 6 months after the MEI/CI operation. Pure-tone audiometry (PTA) in unaided, CI-aided, and MEI-aided conditions were measured.

Main Outcome Measures:
Average threshold changes in bands of frequencies (<1 kHz, ≥1 kHz) were compared between MEI-aided and HA-aided conditions. The Korean version of the Hearing-in-Noise Test (K-HINT), and speech perception score in noisy and quiet conditions were evaluated in the bimodal configuration (i.e., MEI with CI).

Results:
MEI-aided PTA was especially increased in high-frequency areas (≥1 kHz). Speech perception in noisy and quiet conditions demonstrated better scores in the bimodal configuration. K-HINT also demonstrated better scores in the bimodal configuration.

Conclusions:
There is an increasing number of patients with unilateral CI and residual hearing in the contralateral ear. The benefits of a new bimodal hearing configuration with CI and MEI were demonstrated in patients with severe high-frequency hearing loss or mixed conductive hearing loss in the contralateral ear.
Short article: Crohn’s disease and pemphigus: is there an association?: a population-based study
Authors: Kridin Khalaf , Comaneshter Doron , Cohen Arnon D. 
Published: April 2018

Background
Although the coexistence of Crohn’s disease (CD) and pemphigus has been reported in several individuals, the association between the two conditions was not investigated systematically in the past. A recent association between pemphigus and ulcerative colitis has been reported. The study aims to estimate the association between pemphigus and CD using a large-scale real-life computerized database.

Patients and methods
A cross-sectional study was carried out comparing pemphigus patients with age-matched, sex-matched, and ethnicity-matched control participants in terms of the prevalence of CD. χ
2-Test and t-test were used for univariate analysis and a logistic regression model was used for multivariate analysis. The study was carried out utilizing the computerized database of Clalit Health Services ensuring 4.5 million patients.

Results
A total of 1985 pemphigus patients and 9874 controls were included in the study. The prevalence of CD was comparable in patients with pemphigus and controls [0.4 vs. 0.3%, respectively; odds ratio (OR): 1.2; 95% confidence interval (CI): 0.5–2.5; P=0.688]. In an age-stratified analysis, a significant association was observed between pemphigus and CD in patients younger than 40 years (2.1 vs. 0.4%, respectively; OR: 5.1; 95% CI: 1.0–25.7; P=0.027). In a multivariate analysis adjusting for potential confounding factors, no independent association between the two conditions was found (OR: 0.9; 95% CI: 0.4–2.0; P=0.828). Study findings were robust to sensitivity analysis that included patients under pemphigus-specific treatments.

Conclusion
Unlike ulcerative colitis, CD was not associated with pemphigus. Further research is warranted to understand the pathophysiology of these observations better.
ETS transcription factor ETV2/ER71/Etsrp in haematopoietic regeneration
Authors: Choi Kyunghee 
Published: April 2018

Purpose of review
Recent studies have established that haematopoietic stem cells (HSCs) remain quiescent in homeostatic conditions, and minimally contribute to haematopoietic homeostasis. However, they undergo extensive cell cycle and expansion upon bone marrow transplantation or haematopoietic injury to reestablish the haematopoietic system. Molecular basis for the HSC activation and expansion is not completely understood. Here, we review the recent study elucidating the role of the developmentally critical Ets transcription factor Etv2 in reestablishing haematopoietic system upon injury through promoting HSC regeneration.

Recent findings
We recently demonstrated that the ETS transcription factor Etv2, a critical factor for haematopoietic and vascular development, is also required for haematopoietic regeneration. Etv2, which is silent in homeostatic HSCs, was transiently activated in regenerating HSPCs and was required for the HSC expansion and regeneration following bone marrow transplantation or haematopoietic injury. As such, while Etv2 is dispensable for maintaining HSCs in steady states, it is required for emergency haematopoiesis.

Summary

Etv2 has been identified as a novel regulator of haematopoietic regeneration. Comprehensive understanding of the upstream regulators and downstream effectors of Etv2 in haematopoietic regeneration would be critical for fundamental understanding of haematopoietic stem cell biology, and the findings will be broadly applicable to clinical practice involving haematopoietic regenerative medicine; bone marrow transplantation, gene therapy and in-vitro HSC expansion.
A Mixed Presentation of Serotonin Syndrome vs Neuroleptic Malignant Syndrome in a 12-Year-Old Boy
Authors: Sun Christie , Sweet Hannah , Minns Alicia B. , Shapiro Desiree , Jenkins Willough 
Published: April 2018

Background
Neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) are serious medical conditions associated with commonly prescribed psychiatric medications. Although the mechanisms differ, they can be clinically difficult to distinguish. We report a case of a pediatric patient with complicated psychiatric history that developed features of both syndromes in the setting of polypharmacy.

Case
A 12-year-old boy with a history of developmental delay, attention-deficit hyperactivity disorder, and posttraumatic stress disorder presented to the emergency department with behavior changes consisting of delayed reactions, gait instability, drooling, and slowed movements. Ten days before presentation, his outpatient psychiatrist had made multiple medication changes including discontinuation of cyproheptadine (an appetite stimulant) and initiation of aripiprazole. On arrival, the patient was noted to be tachycardia and hypertensive for age. He was disoriented, intermittently agitated, and tremulous with increased tonicity, clonus in the lower extremities, and mydriasis. He was supportively treated with lorazepam and intravenous fluids while discontinuing potential offending agents. His course was complicated by hypertension and agitation managed with dexmedetomidine infusion and benzodiazepines. His mental status, tremors, and laboratory values began to improve over the next 2 days, and eventually transitioned to the inpatient psychiatric unit on hospital day 7.

Discussion
Diagnosis of NMS or SS can be difficult when there is overlap between syndromes, particularly in the setting of multiple potential offending agents or underlying developmental delay. In addition, pediatric patients may present atypically as compared with adult patients with the same condition.

Conclusion
The use of antipsychotic medications for young children with behavioral problems has risen dramatically in the last decade, increasing their risk for developing SS or NMS.
Unintentional Exposure of an Infant to Synthetic Cannabinoid (Bonzai) Related to the Parent's Use
Authors: Dinleyici Meltem , Kiral Eylem , Sahin Sabiha , Carman Kursat Bora 
Published: April 2018

Abstract
The increase of available synthetic cannabinoids poses an emerging public health threat worldwide. Synthetic cannabinoid use has been mainly reported in adolescent cases in pediatric practices; there are few reported cases involving infants affected by unintentional use. In this case report, we present the youngest age of synthetic cannabinoid bonzai exposure in the literature, discussing a 3-month-old child affected by exposure to the parents' use of bonzai in the home environment. Because unintentional exposure to synthetic cannabinoids like bonzai might be encountered, pediatric emergency teams should be aware of this condition and child protection teams should be informed of suspicions of child negligence and abuse as a part of the medical approach.
Lung Metastases of Intracranial Atypical Meningioma Diagnosed on Posttherapeutic Imaging After 177Lu-DOTATATE Therapy
Authors: Backhaus Philipp , Huss Sebastian , Kösek Volkan , Weckesser Matthias , Rahbar Kambiz 
Published: April 2018

Abstract
Meningiomas are typically benign solitary intracranial tumors. Atypical (World Health Organization [WHO] grade II) or malignant/anaplastic (WHO grade III) meningiomas are seldom, and distant metastases occur only in rare exceptions. We present a case of a 54-year-old male patient with atypical (WHO grade II) meningioma who underwent 1 cycle of peptide receptor radionuclide therapy. Previous imaging studies were confined to the head, but posttherapeutic whole-body 177Lu-DOTATATE scintigraphy revealed thoracic uptake arising from previously undetected pulmonic meningioma metastases. The case highlights the importance of consideration of rare/untypical metastatic sides and the value of radiotracer whole-body imaging in identifying these.
Prediction of Normal Organ Absorbed Doses for [177Lu]Lu-PSMA-617 Using [44Sc]Sc-PSMA-617 Pharmacokinetics in Patients With Metastatic Castration Resistant Prostate Carcinoma
Authors: Khawar Ambreen , Eppard Elisabeth , Sinnes Jean Phlippe , Roesch Frank , Ahmadzadehfar Hojjat , Kürpig Stefan , Meisenheimer Michael , Gaertner Florian C. , Essler Markus , Bundschuh Ralph A. 
Published: April 2018

Aim
In vivo pharmacokinetic analysis of [44Sc]Sc-PSMA-617 was used to determine the normal organ-absorbed doses that may result from therapeutic activity of [177Lu]Lu-PSMA-617 and to predict the maximum permissible activity of [177Lu]Lu-PSMA-617 for patients with metastatic castration-resistant prostate carcinoma.

Methods
Pharmacokinetics of [44Sc]Sc-PSMA-617 was evaluated in 5 patients with metastatic castration-resistant prostate carcinoma using dynamic PET/CT, followed by 3 static PET/CT acquisitions and blood sample collection over 19.5 hours, as well as urine sample collection at 2 time points. Total activity measured in source organs by PET imaging, as well as counts per milliliter measured in blood and urine samples, was decay corrected back to the time of injection using the half-life of 44Sc. Afterward, forward decay correction using the half-life of 177Lu was performed, extrapolating the pharmacokinetics of [44Sc]Sc-PSMA-617 to that of [177Lu]Lu-PSMA-617. Source organs residence times and organ-absorbed doses for [177Lu]Lu-PSMA-617 were calculated using OLINDA/EXM software. Bone marrow self-dose was determined with indirect blood-based method, and urinary bladder contents residence time was estimated by trapezoidal approximation. The maximum permissible activity of [177Lu]Lu-PSMA-617 was calculated for each patient considering external beam radiotherapy toxicity limits for radiation absorbed doses to kidneys, bone marrow, salivary glands, and whole body.

Results
The predicted mean organ-absorbed doses were highest in the kidneys (0.44 mSv/MBq), followed by the salivary glands (0.23 mSv/MBq). The maximum permissible activity was highly variable among patients; limited by whole body–absorbed dose (1 patient), marrow-absorbed dose (1 patient), and kidney-absorbed dose (3 patients).

Conclusions
[44Sc]Sc-PSMA-617 PET/CT imaging is feasible and allows theoretical extrapolation of the pharmacokinetics of [44Sc]Sc-PSMA-617 to that of [177Lu]Lu-PSMA-617, with the intent of predicting normal organ-absorbed doses and maximum permissible activity in patients scheduled for therapy with [177Lu]Lu-PSMA-617.
The Challenge of Measuring Surgeon Spending for Payment Policies
Authors: VonAchen Paige , Hayward Rodney A. , Norton Edward C. , Denton Brian , Ellimoottil Chad 
Published: April 2018

Objective:
Our objective was to understand the reliability of profiling surgeons on average health care spending.

Summary of Background Data:
Under its Merit-based Incentive Payment System (MIPS), Medicare will measure surgeon spending and tie performance to payments. Although the intent of this cost-profiling is to reward low-cost surgeons, it is unknown whether surgeons can be accurately distinguished from their peers.

Methods:
We used Michigan Medicare and commercial payer claims data to construct episodes of surgical care and to calculate average annual spending for individual surgeons. We then estimated the “reliability” (ie, the ability to distinguish surgeons from their peers) of these cost-profiles and the case-volume that surgeons would need in order to achieve high reliability [intraclass correlation coefficient (ICC) >0.8]. Finally, we calculated the reliability of 2 alternative methods of profiling surgeons (ie, using multiple years of data and grouping surgeons by hospitals).

Results:
We found that annual cost-profiles of individual surgeons had poor reliability; the ICC ranged from <0.001 for CABG to 0.061 for cholecystectomy. We found that few surgeons in the state of Michigan have sufficient case-volume to be reliably compared; 1% had the minimum yearly case. Finally, we found that the reliability of the cost-profiles can be improved by measuring spending at the hospital-level and/or by incorporating additional years of data.

Conclusion:
These findings suggest that the Medicare program should measure surgeon spending at a group level or incorporate multiple years of data to reduce misclassification of surgeon performance in the MIPS program.
Potential Impact of “Take the Volume Pledge” on Access and Outcomes for Gastrointestinal Cancer Surgery
Authors: Jacobs Ryan C. , Groth Shawn , Farjah Farhood , Wilson Mark A. , Petersen Laura A. , Massarweh Nader N. 
Published: April 2018

Objective:
To quantify the number of US hospitals that would meet “Take the Volume Pledge” (TVP) volume thresholds and compare outcomes at hospitals meeting and not meeting TVP thresholds.

Summary Background Data:
TVP aims to regionalize complex cancer resections to hospitals meeting established annual average volume thresholds. There is little data describing the potential impact on patient access if this initiative were broadly implemented or the relationship between these volume thresholds and quality of oncologic care.

Methods:
Hospitals in the National Cancer Database (2006–2012) performing esophagectomy (n = 968), proctectomy (n = 1250), or pancreatectomy (n = 1068) were categorized based on frequency meeting TVP thresholds: always low volume (LV); low annual average and intermittently low volume (ILV); high annual average and intermittently high volume (IHV); always high volume (HV). Multivariable generalized estimating equations were used to evaluate the association between hospital TVP category, oncologic care processes, and perioperative outcomes.

Results:
Few hospitals met annual TVP thresholds (HV or IHV)—esophagectomy 1.6%; proctectomy 19.7%; pancreatectomy 6.6%. The majority of esophagectomy (77.8%) and pancreatectomy (53.4%) and 48.1% of proctectomy patients received care at hospitals not meeting annual TVP thresholds (LV or ILV). While performance for all three procedures was generally better at ILV, IHV, and HV hospitals relative to LV hospitals, there were few differences (none of which were consistent) when comparing ILV, IHV, and HV hospitals to each other.

Conclusions and Relevance:
Few hospitals would meet TVP volume thresholds for complex cancer resections with little difference in outcomes between ILV, IHV, and HV hospitals. While a policy to regionalize complex surgical care may have merit, it could also compromise patient autonomy and limit access to care if patients are unable or unwilling to travel.