bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants of Patient Satisfaction 2 Years After Spinal Deformity Surgery
Authors: Yang Jingyan , Lafage Virginie , Lafage Renaud , Smith Justin , Klineberg Eric O. , Shaffrey Christopher I. , Mundis Gregory , Hostin Richard , Burton Douglas , Ames Christopher P. , Bess Shay , Kim Han Jo , Schwab Frank 
Published: June 2018

Study Design.
Retrospective review of prospective multicenter database.

Objective.
To investigate the determinants of patient satisfaction with respect to changes in functional limitations 2 years after spinal deformity surgery.

Summary of Background Data.
For operatively treated adult spine deformity (ASD), patient satisfaction has become an important component of evaluating quality of care.

Methods.
A total of 430 operative patients with ASD with 2-year follow-up were analyzed. Patient satisfaction was assessed using the Scoliosis Research Society 22-item. Latent class analysis was performed to assign individuals to classes based on the changes in pre- and 2-year postoperative functions, assessed using the Oswestry Disability Index (ODI). An ordered logistic regression was conducted to assess the association of class membership and satisfaction.

Results.
Latent class analysis identified four classes. The worsened-condition class (WC: 1.4%) consisted of patients who were likely to experience worsened function, particularly in lifting and pain intensity. The remained-same class (RS: 13.0%) included patients who remained the same, because the majority reported approximately no change in walking, standing, and sitting. The mild-improved class (mild-I: 40.2%) included patients with mildly enhanced conditions, specifically, in standing, social life, and employment. The most-improved class (most-I: 45.3%) included patients with great improvement after surgery mainly in standing, followed by social life and employment. The odds of being satisfied were significantly increased by 3.91- (P < 0.001) and 16.99-fold (P < 0.001), comparing patients in mild-I and most-I to the RS/WC class, respectively, after controlling for confounders.

Conclusion.
Improvement in standing, social life, and employment are the most important determinants of patient satisfaction postsurgery. Reduced pain intensity and enhanced walking ability also help to elevate patient satisfaction. However, lifting, personal care, sitting, sleeping, and travelling may be of less importance. Examining the heterogeneity of patient-reported outcome in patients with ASD allows the identification of classes with different patient characteristics and satisfaction, and thus, help to guide tailored provision of care.

Level of Evidence: 4
“As Black as Ink”
Authors: Donaldson Callum J. , Mitchell Stuart L. , Riley Lee H. , Kebaish Khaled M. 
Published: June 2018

Study Design.
Case report and literature review.

Objective.
To characterize the rare presentation of myelopathy occurring secondary to alkaptonuria and to evaluate the available evidence regarding its treatment.

Summary of Background Data.
Alkaptonuria is an autosomal recessive genetic condition with an estimated incidence of 1 in 250,000 to 1 in 1,000,000 people. Mutation of the enzyme homogentisate 1,2-dioxygenase leads to the production of high levels of homogentisic acid, with subsequent deposition in ligaments, cartilage, and menisci. Involvement of the spine is termed “ochronotic spondyloarthropathy,” of which myelopathy is an uncommon presentation.

Methods.
We present the case of a 57-year-old man with alkaptonuria-associated myelopathy, who underwent surgical decompression. Ten additional cases were identified in the literature by a systematic search of PubMed and Google Scholar.

Results.
In a patient presenting with myelopathy, alkaptonuria may be suspected because of medical history, family history, symptoms (including darkened urine, pigmented ear cartilage, and sclera), or radiographic changes, such as multilevel disc collapse, progressive wafer-like disc calcification, extensive osteophyte formation, and spinal deformity. The diagnosis can be confirmed by urine homogentisic acid testing. Of the 11 patients presented here or identified in the literature, 2 were treated nonoperatively, 8 were treated with decompressive spinal surgery, and treatment of the myelopathy was not discussed for 1 patient. In all cases in which outcomes were reported, substantial improvement in the patient's condition was seen.

Conclusion.
Alkaptonuria is a rare cause of myelopathy, but one that clinicians should understand. Although no disease-modifying treatment currently exists for alkaptonuria, the use of symptomatic treatments and, particularly, surgical decompression is recommended to address myelopathy if it develops.

Level of Evidence: 4
Human Myocardium Has a Robust α1A-Subtype Adrenergic Receptor Inotropic Response
Authors: Janssen Paul M. L. , Canan Benjamin D. , Kilic Ahmet , Whitson Bryan A. , Baker Anthony J. 
Published: June 2018

Abstract:
Recent studies report that a single subtype of α1-adrenergic receptor (α1-AR), the α1A-subtype, mediates robust cardioprotective effects in multiple experimental models of heart failure, suggesting that the α1A-subtype is a potential therapeutic target for an agonist to treat heart failure. Moreover, we recently found that the α1A-subtype is present in human heart. The goal of this study was to assess the inotropic response mediated by the α1A-subtype in human myocardium, and to determine whether the response is downregulated in myocardium from failing human heart. We measured in vitro contractile responses of cardiac muscle preparations (trabeculae) isolated from the right ventricle from nonfailing and failing human hearts. Addition of the α1A-subtype agonist A61603 (100 nM) resulted in a large positive inotropic response (force increased ≈ 2-fold). This response represented ≈70% of the response mediated by the β-adrenergic receptor agonist isoproterenol (1 μM). Moreover, in myocardium from failing hearts, α1A-subtype responses remained robust, and only slightly reduced relative to nonfailing hearts. We conclude that α1A-subtype–mediated inotropy could represent a significant source of inotropic support in the human heart. Furthermore, the α1A-subtype remains functional in myocardium from failing human hearts and thus, might be a therapeutic target to support cardioprotective effects in patients with heart failure.
Size-Dependent Ability of Liposomes to Accumulate in the Ischemic Myocardium and Protect the Heart
Authors: Mukhamadiyarov Rinat A. , Senokosova Evgeniya A. , Krutitsky Sergey S. , Voevoda Darya V. , Pyshnaya Inna A. , Ivanov Vladimir V. , Lewis Martin J. , Khaliulin Igor 
Published: June 2018

Abstract:
Liposomes have the potential to be used for drug delivery. Meanwhile, liposome size may affect their accumulation in the target tissue. We investigated the myocardial accumulation of 2 populations of liposomes (∼70 and 110 nm diameter) during ischemia and their effect on ischemia/reperfusion injury. Isolated rat hearts were subjected to 30 minutes of low-flow ischemia with the liposomes, followed by 30 minutes of liposome-free reperfusion. The liposomes were loaded with the fluorescent dye Nile Red to assess their accumulation in the myocardium. The cardiac functional recovery during reperfusion was evaluated using force–velocity characteristics and coronary flow (CF). Reperfusion injury was evaluated by lactate dehydrogenase release. In addition, CF and contractility were assessed in hearts perfused normally with 70 nm liposomes. There was a 6- and 4-fold greater accumulation of the small liposomes in the myocardium and mitochondria, respectively, compared with the large liposomes. Importantly, even without any incorporated drugs, both populations of liposomes improved functional recovery and reduced lactate dehydrogenase release. However, the smaller liposomes showed significantly higher protective and vasodilatory effects during reperfusion than the larger particles. These liposomes also increased CF and contractility during normal perfusion. We suggest that the protective properties of the liposomes could be related to their membrane-stabilizing effect.
Triamcinolone for the Treatment of Graves Ophthalmopathy Tested With Short Tau Inversion Recovery Magnetic Resonance
Authors: Ortiz-Basso Tomás , Vigo Rodolfo L. , Sidelnik Mariano , Vazquez-Durand Mariana S. , Shokida María F. , Prémoli Eduardo J. , García-Mónaco Ricardo 
Published: June 2018

Purpose:
To evaluate if parabulbar triamcinolone reduces orbital swelling in patients with Graves ophthalmopathy.

Methods:
This is a prospective study of a series of patients with active and moderate Graves ophthalmopathy. Short tau inversion recovery magnetic resonance was used to evaluate the intensity of the extraocular rectus muscles and orbital fat, before and after the treatment with parabulbar triamcinolone.

Results:
The signal intensity ratio of the sum of the OD rectus muscles was 3.67 before treatment (95% CI, 3.26–4.09) and 2.83 after treatment (95% CI, 2.63–3.03) (p < 0.001), and of the muscles of the left orbit, 3.94 before treatment (95% CI, 3.50–4.38) and 2.85 after treatment (95% CI, 2.56–3.14) (p < 0.001). The signal intensity ratio of the fat decreased from 2.95 (95% CI, 2.69–3.21) to 2.33 (95% CI, 2.07–2.58) (p < 0.001). After treatment, there were no local or systemic complications.

Conclusion:
The use of parabulbar triamcinolone reduces orbital inflammation of patients with active and moderate Graves ophthalmopathy.
Expression of Surfactant Proteins in the Human Canaliculus: Evidence and Potential Insights Into the Tear Flow Dynamics
Authors: Ali Mohammad Javed , Kumar Nadimpalli Siva , Bräuer Lars , Paulsen Friedrich , Schicht Martin 
Published: June 2018

Purpose:
To investigate the presence and distribution patterns of 6 surfactant proteins (SPs) in the human lacrimal canaliculus.

Methods:
The study was performed on fresh frozen cadaveric samples of canaliculi. Immunohistochemical labeling was performed for assessing the presence and distribution of SP: SP-A, SP-B, SP-C, SP-D, SP-G/SFTA2, and SP-H/SFTA3. Immunofluorescence double staining was performed using the respective fluorescein-conjugated antibodies and the results were scored as positive or negative and the distribution pattern within the canalicular system was assessed. Western blot analysis was performed on the protein content which was resolved by reducing 15% sodium dodecyl sulfate-polyacrylamide electrophoresis and bands were studied following staining with primary and secondary antibodies. Human lung tissues were used as controls.

Results:
Fluorescence double staining with 4,6-diamidino 2-pheynlindole and SPs showed strong immunostaining for SP-A, SP-B, SP-C, SP-D, and SP-H/SFTA3. The positive immunofluorescence was noticed across all the layers of the epithelium but not the subepithelial structures. The expression was noted on the surfaces and superficial cytoplasm of the superficial and deep epithelial cells. There was no expression of SP-G/SFTA2 across the canalicular system. Western blot analysis of the proteins confirmed and concurred with the immunofluorescence findings.

Conclusions:
This study provides a proof of principle for the presence of SPs known from lungs in the canalicular system and hypothesizes their possible functions and also their potential role in the tear flow dynamics between the ocular surface and the lacrimal drainage system.
No Requirement for Targeted Theophylline Levels for Diuretic Effect of Aminophylline in Critically Ill Children
Authors: Park Katie , Trout Lindsay C. , Xu Cong , Wang Ming , Tamburro Robert F. , Halstead E. Scott 
Published: June 2018

Objectives:
To determine the relationship between theophylline trough levels and urine output in critically ill children administered aminophylline as adjunctive diuretic therapy.

Design:
Retrospective cohort study.

Setting:
The PICU of a tertiary care children’s hospital.

Patients:
A mixed population of medical/surgical including postoperative cardiothoracic surgery patients less than 18 years old.

Interventions:
Electronic medical records of all PICU patients admitted from July 2010 to June 2015 were reviewed, and patients who received aminophylline as diuretic therapy were identified.

Measurements and Main Results:
Patient cohort data including demographics, daily aminophylline, furosemide and chlorothiazide dosing, theophylline trough levels, fluid intake, urine output and total fluid balance, blood urea nitrogen, and creatinine levels were abstracted. Multivariate analysis based on a generalized estimating equations approach demonstrated that aminophylline administration, when analyzed as a categorical variable, was associated with an increase in urine output and decreased fluid balance. However, aminophylline dosing, when analyzed as a continuous variable, was associated with neither an increase in urine output nor decreased fluid balance. Theophylline trough levels were not correlated with urine output at 24 hours (p = 0.78) and were negatively correlated with urine output at 48 hours (r
2 = 0.078; p < 0.005).

Conclusions:
Aminophylline administration provided a measure of increased diuresis, regardless of dosage, and theophylline trough levels. Therefore, achieving a prescribed therapeutic trough level may not be necessary for full diuretic effect. Because, as opposed to the diuretic effect, the side effect profile of aminophylline is dose-dependent, low maintenance dosing may optimize the balance between providing adjunctive diuretic effect while minimizing the risk of toxicity.
Logistics in Coordinating the First Adult Transatlantic Bilateral Hand Transplant: Lessons Learned
Authors: Ben-Amotz Oded , Kruger Erwin A. , McAndrew Christine , Lantieri Laurent , Bozentka David , Steinberg David , Chang Benjamin , Levin L. Scott 
Published: June 2018

Summary:
Hand transplantation requires precise preoperative planning and surgical execution. Coordinating a transplant team—including surgeons, anesthesiologists, nurses, and supporting staff—is a time-sensitive challenge when a donor-recipient match is confirmed. International human limb transplantation occurs when the recipient and donor are in separate countries. The authors describe the logistics behind the first transatlantic adult bilateral hand transplantation, which, to date, required the highest level of coordination and timing. The authors’ experience serves as a proof of concept that international limb transplantation or salvage is possible when the complex logistics of such an endeavor are carefully anticipated.
Comparison of Immediate versus Delayed DIEP Flap Reconstruction in Women Who Require Postmastectomy Radiotherapy
Authors: O’Connell Rachel L. , Di Micco Rosa , Khabra Komel , Kirby Anna M. , Harris Paul A. , James Stuart E. , Power Kieran , Ramsey Kelvin W. D. , Rusby Jennifer E. 
Published: June 2018

Background:
The authors investigated aesthetic outcome and patient satisfaction in women who have undergone deep inferior epigastric artery perforator (DIEP) flap reconstruction in the setting of postmastectomy radiotherapy. Patients who underwent DIEP flap reconstruction without postmastectomy radiotherapy were the control group.

Methods:
Participants who had undergone DIEP flap reconstruction between September 1, 2009, and September 1, 2014, were recruited, answered the BREAST-Q, and underwent three-dimensional surface-imaging. A panel assessed the aesthetic outcome by reviewing these images.

Results:
One hundred sixty-seven women participated. Eighty women (48 percent) underwent immediate DIEP flap reconstruction and no postmastectomy radiotherapy; 28 (17 percent) underwent immediate DIEP flap reconstruction with postmastectomy radiotherapy; 38 (23 percent) underwent simple mastectomy, postmastectomy radiotherapy, and DIEP flap reconstruction; and 21 (13 percent) underwent mastectomy with temporizing implant, postmastectomy radiotherapy, and DIEP flap reconstruction. Median satisfaction scores were significantly different among the groups (p < 0.05). Post hoc comparison demonstrated that women who had an immediate DIEP flap reconstruction were significantly less satisfied if they had postmastectomy radiotherapy. In women requiring radiotherapy, those undergoing delayed reconstruction after a simple mastectomy were most satisfied, but there was no significant difference between the immediate DIEP flap and temporizing implant groups. Median panel scores differed among groups, being significantly higher if the immediate reconstruction was not subjected to radiotherapy. There was no significant difference in panel assessment among the three groups of women who had received radiotherapy.

Conclusions:
Patients who avoid having their immediate DIEP flap reconstruction irradiated are more satisfied and have better aesthetic outcome than those who undergo postmastectomy radiotherapy. In women requiring radiotherapy and who wish to have an immediate or “delayed-immediate” reconstruction, there were no significant differences in panel or patient satisfaction. Therefore, immediate DIEP flap reconstruction or mastectomy with temporizing implant then DIEP flap surgery are acceptable treatment pathways in the context of post-mastectomy radiotherapy.
Postural Disorders and Antiparkinsonian Treatments in Parkinson Disease: An Exploratory Case-Control Study
Authors: Ameghino Lucía , Bruno Verónica , Merello Marcelo 
Published: June 2018

Objective
The aim of this study was to evaluate the relationship between antiparkinsonian treatments, especially dopamine agonist (DAs) and the development of postural disorders in patients with Parkinson's disease (PD).

Methods
We performed an exploratory case-control study. Cases were PD patients with camptocormia, Pisa syndrome, or anterocollis. Control subjects were PD patients without postural disorders matched by sex and age. Demographic and clinical data including pharmacologic treatments history were collected retrospectively. Characteristics of cases and control subjects were compared using parametric and nonparametric tests accordingly, and logistic regression models were used to analyze correlations.

Results
We included 63 patients with PD and postural disorders and 63 control subjects. Cases were more exposed to DAs (74.60% vs 58.73%, P = 0.05) and amantadine (30.16% vs 7.94%, P < 0.05) than control subjects. Cases showed longer disease duration (7.63 ± 7.83 vs 4.27 ± 3.87 years, P < 0.05), higher Hoehn and Yahr stage (2.83 ± 0.80 vs 2.15 ± 0.73, P < 0.05), higher Movement Disorder Society Unified Parkinson's Disease Rating Scale part III score (29.61 ± 1.39 vs 20.76 ± 10.94, P = 0.05), and more dyslipidemia (28.57% vs 12.70%, P < 0.05) than control subjects, as well as lower prevalence of depression (46.03% vs 28.57%, P < 0.05). We found no clinical predictors for the development of postural disorders after multivariable adjusted regression.

Conclusions
Our results suggest a possible association between the use of DAs and amantadine and the development of postural disorders in PD and suggest potential risk factors including advanced disease and more severe motor symptoms. These results support the need of a cautious use of these medications in patients with advanced disease due to the possibility of increasing the risk-benefit ratio.
Genomic variants among threatenedAcroporacorals
Authors: Kitchen S. A. , Ratan A. , Bedoya-Reina O. C. , Burhans R. , Fogarty N. D. , Miller W. , Baums I. B. 
Published: June 2018

ABSTRACTGenomic sequence data for non-model organisms are increasingly available requiring the development of efficient and reproducible workflows. Here, we develop the first genomic resources and reproducible workflows for two threatened members of the reef-building coral genusAcropora. We generated genomic sequence data from multiple samples of the CaribbeanA. cervicornis(staghorn coral) andA. palmata(elkhorn coral), and predicted millions of nucleotide variants among these two species and the PacificA. digitifera. A subset of predicted nucleotide variants were verified using restriction length polymorphism assays and proved useful in distinguishing the two Caribbean Acroporids and the hybrid they form (“A. prolifera”). Nucleotide variants are freely available from the Galaxy server (usegalaxy.org), and can be analyzed there with computational tools and stored workflows that require only an internet browser. We describe these data and some of the analysis tools, concentrating on fixed differences betweenA. cervicornisandA. palmata. In particular, we found that fixed amino acid differences between these two species were enriched in proteins associated with development, cellular stress response and the host’s interactions with associated microbes, for instance in the Wnt pathway, ABC transporters and superoxide dismutase. Identified candidate genes may underlie functional differences in the way these threatened species respond to changing environments. Users can expand the presented analyses easily by adding genomic data from additional species as they become available.Article SummaryWe provide the first comprehensive genomic resources for two threatened Caribbean reef-building corals in the genusAcropora. We identified genetic differences in key pathways and genes known to be important in the animals’ response to the environmental disturbances and larval development. We further provide a list of candidate loci for large scale genotyping of these species to gather intra- and interspecies differences betweenA. cervicornisandA. palmataacross their geographic range. All analyses and workflows are made available and can be used as a resource to not only analyze these corals but other non-model organisms.
Using vocational education to provide development solutions in the Pacific: An emphasis on climate change and health
Authors: Havea Peni Hausia , Siga Amelia , Rabuatoka Titilia , Tamani Apenisa Tagivetaua , Devi Priya , Senikula Ruci , Hemstock Sarah L , Combes Helene Jacot Des 
Published: June 2018

AbstractThis article reports on the results of the EU PacTVET project, which explored the use of Technical Vocational Education and Training (TVET) to provide a better understanding on the development solution for the impact of climate change on human health in the region. It describes the findings of a 2014-2018 project on the use of vocational education to provide development solutions in the Pacific with an emphasis on climate change and health. An exploratory design was used to investigate how vocational education developed solutions for climate change and health in the 15 Pacific – African Caribbean and Pacific (P-ACP) countries: Cook Islands, Federated States of Micronesia (FSM), Fiji, Kiribati, Nauru, Niue, Palau, Papua New Guinea (PNG), Republic of Marshall Islands (RMI), Samoa, Solomon Islands, Timor-Leste, Tonga, Tuvalu and Vanuatu. Information collected via personal communication with relevant stakeholders, qualitative interviews, documents review, and survey (n=48) of youths and young women in Fiji. Data analysis was performed using thematic analytical strategy and frequency analysis. The study found that vocational education plays a significant role in building the capacity of people to become more sustainable and resilient in their life now and in the future. Also, getting an accredited qualification on health resilience and/or job in the health sector may help them to respond effectively and efficiently in the event of climate change and/or disasters caused by natural hazards. The same factors were explored quantitatively using descriptive analytical strategy, and concluded TVET education, to have a positive influence on climate change and health. As a result, vocational education could provide development solutions for health adaptation in the Pacific. These results indicate global actions for vocational education, that would perfect the course of resilience for these 15 P-ACP in the Pacific and alike in the U.S.