bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frailty Phenotypes and Relations With Surgical Outcomes: A Latent Class Analysis
Authors: Sadiq Furqaan , Kronzer Vanessa L. , Wildes Troy S. , McKinnon Sherry L. , Sharma Anshuman , Helsten Daniel L. , Scheier Lawrence M. , Avidan Michael S. , Ben Abdallah Arbi 
Published: August 2018

BACKGROUND:Frailty is an important concept in the care of older adults although controversy remains regarding its defining features and clinical utility. Both the Fried phenotype and the Rockwood deficit accumulation approaches cast frailty as a “burden” without exploring the relative salience of its cardinal markers and their relevance to the patient. New multifactorial perspectives require a reliable assessment of frailty that can validly predict postoperative health outcomes.METHODS:In a retrospective study of 2828 unselected surgical patients, we used item response theory to examine the ability of 32 heterogeneous markers capturing limitations in physical, functional, emotional, and social activity domains to indicate severity of frailty as a latent continuum. Eighteen markers efficiently indicated frailty severity and were then subject to latent class analysis to derive discrete phenotypes. Next, we validated the obtained frailty phenotypes against patient-reported 30-day postoperative outcomes using multivariable logistic regression. Models were adjusted for demographics, comorbidity, type and duration of surgery, and cigarette and alcohol consumption.RESULTS:The 18 markers provided psychometric evidence of a single reliable continuum of frailty severity. Latent class analyses produced 3 distinct subtypes, based on patients’ endorsement probabilities of the frailty indicators: not frail (49.7%), moderately frail (33.5%), and severely frail (16.7%). Unlike the moderate class, severely frail endorsed emotional health problems in addition to physical burdens and functional limitations. Models adjusting for age, sex, type of anesthesia, and intraoperative factors indicated that severely frail (odds ratio, 1.89; 95% confidence interval, 1.42–2.50) and moderately frail patients (odds ratio, 1.31; 95% confidence interval, 1.03–1.67) both had higher odds of experiencing postoperative complications compared to not frail patients. In a 3-way comparison, a higher proportion of severely frail patients (10.7%) reported poorer quality of life after surgery compared to moderately frail (9.2%) and not frail (8.3%) patients (P< .001). There was no significant difference among these groups in proportions reporting hospital readmission (5.6%, 5.1%, and 3.8%, respectively;P= .067).CONCLUSIONS:Self-report frailty items can accurately discern 3 distinct phenotypes differing in composition and their relations with surgical outcomes. Systematically assessing a wider set of domains including limitations in functional, emotional, and social activities can inform clinicians on what precipitates loss of physiological reserve and profoundly influences patients’ lives. This information can help guide the current discussion on frailty and add meaningful clinical tools to the surgical practice.
Midazolam Premedication Facilitates Mask Ventilation During Induction of General Anesthesia: A Randomized Clinical Trial
Authors: Park Jin-Woo , Min Byung Hun , Park Seong-Joo , Kim Bo Young , Bae Sung Il , Han Sung-Hee , Hwang Jung-Won , Kim Jin-Hee 
Published: August 2018

BACKGROUND:
During induction of general anesthesia, proper mask ventilation is crucial for supplying sufficient oxygen to unconscious patients. Midazolam has a relaxing effect on airway muscles. We hypothesized that sedative premedication with midazolam would facilitate mask ventilation during anesthetic induction.

METHODS:
Patients undergoing elective surgery under general anesthesia were randomized into 2 groups. The midazolam group received midazolam premedication at the reception area, 3 minutes before transfer to the operating room. Patients in the control group were treated with normal saline as a placebo. The primary outcome was difficulty of mask ventilation during induction, as evaluated using the Warters scales.

RESULTS:
A total of 97 patients completed the analysis: 49 in the control group and 48 in the midazolam group. The patients in the midazolam group showed a significantly lower mask ventilation difficulty score on the Warters scale than that of the control group (mean [standard deviation], 0.92 [1.13] vs 0.19 [0.57]; estimated difference [95% confidence interval], 0.73 [0.37−1.09]; P < .001). The incidence of difficult mask ventilation (≥2 Warters scale) was significantly lower in the midazolam group than in the control group (risk ratio [95% confidence interval], 0.15 [0.03−0.72]; P = .015).

CONCLUSIONS:
This randomized clinical trial demonstrated that midazolam premedication enhanced mask ventilation during induction of general anesthesia.
Postoperative Corneal Injuries: Incidence and Risk Factors
Authors: Deljou Atousa , Weingarten Toby N. , Mahr Michael A. , Sprung Juraj , Martin David P. 
Published: August 2018

BACKGROUND:
Previous studies of postoperative corneal injury rates relied on provider-initiated incident reports, which may underestimate the true incidence. Postoperative administration of proparacaine eye drops is used almost exclusively to diagnose corneal injury; therefore, identifying instances of administration may provide a better estimate of corneal injuries. We compared proparacaine administration versus provider-initiated reports to determine rates of corneal injury. In addition, potential associations between clinical variables and injury were assessed with a matched case–control study.

METHODS:
The health records of 132,511 sequential adult postanesthesia recovery room admissions (January 1, 2011 to June 30, 2017) were reviewed to identify postoperative proparacaine administration and incident reports of corneal injury. Patients with corneal injury were matched with control patients at a 1:2 ratio to assess factors associated with injury.

RESULTS:
Proparacaine drops were administered to 442 patients (425 patients received proparacaine for diagnosis and 17 patients received proparacaine for unrelated reasons). Incident reports identified 320 injuries, and the aggregate corneal injury count was 436 (incidence, 3.3 injuries [95% confidence interval {CI}, 3.0–3.6] per 1000 cases of general anesthesia). Proparacaine administration had a greater case ascertainment percentage than incident reporting (97.5% vs 73.4%; P < .001). The matched case–control analysis found greater risks associated with longer duration of anesthesia (odds ratio, 1.05 [95% CI, 1.03–1.07] per 10 minutes of anesthesia; P < .001) and nonsupine surgical position (odds ratio, 3.89 [95% CI, 2.17–6.98]; P < .001). Patients with injuries also had more evidence of sedation and agitation during anesthesia recovery.

CONCLUSIONS:
Calculation of incidence by using the administration of a medication (proparacaine eye drops) that is almost exclusively used to diagnose a specific injury (corneal injury) showed higher case ascertainment percentage than incident-reporting methods. Similar strategies could be used to monitor the rates of other adverse events.
The endoderm from a diverse perspective
Authors: Dunn N. Ray , Hogan Brigid L. M. 
Published: August 2018

ABSTRACT
The historic town of Taos, New Mexico, with its rich multicultural history of art and craft, was the site of the second Keystone Symposium on ‘Endoderm Development and Disease’, which was held in February 2018. The theme of the meeting was ‘Cross-Organ Comparison and Interplay’, emphasizing an integrative and multisystem approach to the broad topics of organ physiology, homeostasis, repair, regeneration and disease. As we review here, participants shared their recent discoveries and discussed how new technologies developed in one organ system might be applied to answer crucial questions in another. Other integrative themes were how agents such as parasites, microbes, immune cells, physical forces and innervation can affect tissue organization and progenitor cell dynamics, and how defects in the development of an organ can impact its adult function. Participants came away with a broader vision of their field and a renewed sense of collective energy empowered by novel tools and fresh ideas.
ESR1 rs2234693 Polymorphism Is Associated with Muscle Injury and Muscle Stiffness
Authors: KUMAGAI HIROSHI , MIYAMOTO-MIKAMI ERI , HIRATA KOSUKE , KIKUCHI NAOKI , KAMIYA NOBUHIRO , HOSHIKAWA SEIGO , ZEMPO HIROFUMI , NAITO HISASHI , MIYAMOTO NAOKAZU , FUKU NORIYUKI 
Published: August 2018

ABSTRACTPurposeMuscle injury is the most common sports injury. Muscle stiffness, a risk factor for muscle injury, is lower in females than in males, implying that sex-related genetic polymorphisms influence muscle injury associated with muscle stiffness. The present study aimed to clarify the associations between two genetic polymorphisms (rs2234693 and rs9340799) in the estrogen receptor 1 gene (ESR1) and muscle injury or muscle stiffness.MethodsIn study 1, a questionnaire was used to assess the muscle injury history of 1311 Japanese top-level athletes. In study 2, stiffness of the hamstring muscles was assessed using ultrasound shear wave elastography in 261 physically active young adults. In both studies, rs2234693 C/T and rs9340799 G/A polymorphisms in theESR1were analyzed using the TaqMan SNP Genotyping Assay.ResultsIn study 1, genotype frequencies forESR1rs2234693 C/T were significantly different between the injured and noninjured groups in a C-allele dominant (CC + CT vs TT: odds ratio, 0.62; 95% confidence interval, 0.43–0.91) and additive (CC vs CT vs TT: odds ratio, 0.70; 95% confidence interval, 0.53–0.91) model in all athletes. In study 2, hamstring muscle stiffness was lower in subjects with the CC + CT genotype than in those with the TT genotype; a significant linear trend (CC < CT < TT) was found (r= 0.135,P= 0.029). In contrast, no associations were observed betweenESR1rs9340799 G/A and muscle injury or stiffness.ConclusionsOur results suggest that theESR1rs2234693 C allele, in contrast to the T allele, provides protection against muscle injury by lowering muscle stiffness.
Equivalent Hypertrophy and Strength Gains in β-Hydroxy-β-Methylbutyrate- or Leucine-supplemented Men
Authors: JAKUBOWSKI JOSEPHINE S. , WONG EDWIN P. T. , NUNES EVERSON A. , NOGUCHI KENNETH S. , VANDEWEERD JOSHUA K. , MURPHY KEVIN T. , MORTON ROBERT W. , MCGLORY CHRIS , PHILLIPS STUART M. 
Published: August 2018

ABSTRACT
Ingestion of proteins with high leucine content during resistance training (RT) can augment hypertrophy. Some data suggest that a leucine metabolite, β-hydroxy, β-methylbutyrate (HMB), is substantially more anabolically efficacious than leucine.

Purpose
We aimed to test whether supplementation with HMB versus leucine, added to whey protein, would result in differential muscle hypertrophy and strength gains in young men performing RT.

Methods
Twenty-six resistance-trained men (23 ± 2 yr) performed 12 wk of RT with three phases. Phase 1: 8 wk of periodized RT (three training sessions per week). Phase 2: 2 wk overreaching period (five sessions per week). Phase 3: 2 wk taper (three sessions per week). Participants were randomly assigned to twice daily ingestion of: whey protein (25 g) plus HMB (1.5 g) (whey+HMB; n = 13) or whey protein (25 g) plus leucine (1.5 g) (whey+leu; n = 13). Skeletal muscle biopsies were performed before and after RT. Measures of fat- and bone-free mass, vastus lateralis (VL) muscle thickness and muscle cross-sectional area (CSA) (both by ultrasound), muscle fiber CSA, and 1-repetition maximum (1-RM) strength tests were determined.

Results
We observed increases in fat- and bone-free mass, VL muscle thickness, muscle CSA and fiber type CSA and 1-RM strength with no differences between groups at any phase. We observed no differences between groups or time–group interactions in hormone concentrations at any phase of the RT program.

Conclusions
β-Hydroxy-β-methylbutyrate added to whey did not result in greater increases in any measure of muscle mass, strength, or hormonal concentration compared to leucine added to whey. Our results show that HMB is no more effective in stimulating RT-induced hypertrophy and strength gains than leucine.
Το ζήτημα της εκπαίδευσης των μαθητών με αυτισμό στην Ελλάδα υπό το πρίσμα των γνώσεων/αντιλήψεων και στάσεων των εκπαιδευτικών: μια ανασκόπηση της βιβλιογραφίας
Authors: Λάππα (Lappa) Χριστίνα (Christina) Σ. , Μαντζίκος (Mantzikos) Κωνσταντίνος (Constantinos) Ν. 
Published: August 2018

Οι ερευνητές πραγματοποίησαν μια ανασκόπηση της βιβλιογραφίας για τις γνώσεις/αντιλήψεις των εκπαιδευτικών για τον αυτισμό και τις στάσεις τους για τη συμπερίληψη των μαθητών/ριών με αυτισμό στην Ελλάδα. Για να βρουν τις σχετικές με το θέμα έρευνες διεξήγαγαν αναζήτηση στο Google Scholar και στις βάσεις δεδομένων ERIC και PubMed με τις λέξεις-κλειδιά «Εκπαιδευτικοί», «μαθητές με Αυτισμό», «Αυτισμός», «Αντιλήψεις», «Γνώσεις», «Απόψεις», «Στάσεις», «Γενικοί παιδαγωγοί», «Ειδικοί παιδαγωγοί», «Δάσκαλοι», και «Νηπιαγωγοί». Από την αναζήτηση βρέθηκαν 9 άρθρα σχετικά με το θέμα τους. Τα αποτελέσματα έδειξαν ότι οι εκπαιδευτικοί γνωρίζουν σε ένα καλό επίπεδο τον αυτισμό και έχουν θετικές στάσεις στη συμπερίληψη αυτών των μαθητών. Επίσης, η ανασκόπηση έδειξε ότι η διδακτική εμπειρία παίζει σημαντικό ρόλο στις γνώσεις και στάσεις των εκπαιδευτικών. Τέλος, οι εκπαιδευτικοί ειδικής αγωγής και αυτοί που έχουν κάποια εξειδίκευση και εμπειρία στον αυτισμό γνωρίζουν καλύτερα τον αυτισμό σε σχέση με τους εκπαιδευτικούς γενικής αγωγής και εκείνους που δεν έχουν κάποια εξειδίκευση και εμπειρία στον αυτισμό. Συμπερασματικά, η ύπαρξη περισσότερων επιμορφωτικών προγραμμάτων πάνω στον αυτισμό θα βοηθήσει τους εκπαιδευτικούς να εκπαιδεύσουν αποτελεσματικά τους μαθητές με αυτισμό και να αναπτύξουν θετικές στάσεις για τη συμπερίληψή τους.
Solving the Whistler-Blackcomb Mega Day Challenge
Authors: Lyons John S. F. , Bell Peter C. , Begen Mehmet A. 
Published: August 2018

The Whistler-Blackcomb (WB) Mega Day challenge requires a skier to ride all 24 lifts at the resort in a single day. Among over two million people who ski annually at WB, only 313 completed the challenge in the 14 months following the introduction of a system that tracks lift use by skier. Apart from the physical challenge of skiing, a key difficulty is finding a route that matches one’s skill level while accounting for variable lift opening and closing times. We use data from WB’s radio-frequency identification (RFID) ticketing system to estimate ski times between lifts for skiers of various skill levels. We then formulate and solve the problem by a combined, iterative integer programming and heuristic approach, up to the highest feasible skier skill level. The problem’s distinctive features preclude the use of known solution methods for similar problems; therefore, we use a practical, staged-solution approach. Our results include a recommended route that enables the greatest number of skiers, roughly the fastest quartile, to achieve the challenge. We also provide a benchmark that skiers who can ski a particular common run in 12 minutes or less should be able to complete the challenge. In the three months following communication of our recommended solution, the rate at which skiers completed the Mega Day challenge increased by two-thirds over the previous seven skiing months.
Introduzione al Active Case Management nella procedura civile: premesse e sfide
Authors: Caureo Elisângela Simon 
Published: August 2018

Sommario: 1. Introduzione. -2. Case management: il concetto. - 3. Pre-trial e discovery. – 4. Caratteristiche del Case management. 5.- L’importanza della fase preparatoria. – 6. La sommarizzazione e la cognizione piena. – 7. Active case management nel diritto italiano. 8. La questione dei costi del processo. – 9. Conclusioni.Parole-chiave: Case management. Sommarizzazione. Costi del processo. Procedura Civile. Discovery. Tendenze della procedura civile. Abstract: This paper commence by reflecting upon some introductory notions of case management, disclosure, discovery and the most actual tendencies in Procedural law, next it will reflect upon the effects of Lord Wolf Reform to the civil procedure worldwide. It will also analise the role of the preparatory fase in the civil procedure and the possible role of case management in Italy. Keywords: Case management. Litigation costs. Procedural law. Discovery. Disclosure. Procedural Law tendencies.
What influences contracture formation in lower motor neuron disorders, severity of denervation or residual muscle function? An analysis of the elbow contracture in 100 children with unilateral Brachial Plexus Birth Injury
Authors: van der Sluijs J. A. , van der Sluijs M. J. , van de Bunt F. , van Ouwerkerk W. J. R. 
Published: August 2018

Purpose As in other neuromuscular disorders, both denervation and muscle paresis/imbalance are implicated as aetiological factors for contractures in children with a Brachial Plexus Birth Injury (BPBI). Although both factors are related, it is unclear which factor is dominant. The aim of this study is to assess whether contracture formation in children is predominantly related to denervation or to residual muscle function/imbalance. This might be relevant for understanding contracture formation in other neuromuscular disorders. Methods A total of 100 children (61 boys; mean age 10.4 years, 4 to 18) with unilateral BPBI were included in this cross-sectional study. Severity of the denervation was classified according to Narakas. Muscle function of flexors and extensors of both elbows was measured (in Newtons) using a hand-held dynamometer and flexion contractures were measured with a goniometer. The relation between denervation, muscle function/muscle balance and flexion contracture was assessed using univariate and multivariate analysis. Results Of the children, 57 were Narakas class I, 13 class II and 30 class III. Mean flexion contracture was 25° (90° to −5°). At the affected side the forearm flexion force was 47% and extension force was 67% of the force of the unaffected side. Contractures were more severe in children with higher Narakas classifications (p = 0.001), after neurosurgery (Mann-Whitney U test, p = 0.009) and were related to age (Spearman's Rho = −0.3, p = 0.008) and to paresis of the extensors (Rho = 0.4, p = 0.000). Flexor paresis as a percentage of unaffected side (Rho = 0.06, p = 0.6) and muscle balance had no influence. Conclusion In BPBI, elbow contractures are related to the severity of the neurological lesion, not to residual muscle function. Level of evidence Level II – prognostic study
Triceps on, alignment off? A comparison of total elbow arthroplasty component positioning with a triceps-on and a triceps-off approach
Authors: King A , Booker SJ , Thomas WJ , Smith CD 
Published: August 2018

Introduction This retrospective review investigates whether the triceps-on approach obtains alignment of total elbow arthroplasty implants equivalent to a triceps-off approach. Methods The last 30 consecutive total elbow arthroplasties performed by the senior author were reviewed to identify the approach used and pathology treated. Initially, a triceps split and reflection approach was used, then a triceps-preserving approach. Two blinded reviewers measured the component alignment in standardised radiographs. Pearson’s correlation coefficient was calculated to investigate inter/intra-observer and error. The two groups were compared using an unpaired Student t-test. Results There were 13 elbows in the triceps-off group and 17 in the triceps-on group. Pearson’s coefficient was 0.75 for interobserver error, 0.89 for intra-observer error. There was no statistical difference between the achieved alignment. All ulna components were flexed with a mean angle deviation of 4.5 degrees in the triceps-off group and 5.7 degrees in the triceps on. Two (15%) ulna components in the triceps-off group were placed in over 5 degrees of flexion, compared with seven (44%) in the triceps-on group. Conclusion These results demonstrate no statistical difference in the achieved alignment between the two groups. Surgeons should beware of the tendency to place the ulna component in a flexed position, especially in the triceps-on approach.
The incidence of stoma related morbidity – a systematic review of randomised controlled trials
Authors: Malik TAM , Lee MJ , Harikrishnan AB 
Published: August 2018

Introduction Several stoma related complications can occur following ileostomy or colostomy formation. The reported incidence of these conditions varies widely in the literature. A systematic review of randomised controlled trials reporting the incidence of stoma related complications in adults was performed to provide the most comprehensive summary of existing data. Methods PubMed, CINAHL® (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library were searched for trials assessing the incidence of complications in adults undergoing conventional stoma formation. Data were extracted by two independent reviewers and entered into SPSS® for statistical analysis. The Cochrane Collaboration tool for assessing risk of bias was used to critically appraise each study. Cochran’s Q statistic and the I2 statistic were used to measure the level of heterogeneity between studies. Results Overall, 18 trials were included, involving 1,009 patients. The incidence of stoma related complications ranged from 2.9% to 81.1%. Peristomal skin complications and parastomal hernia were the most common complications. End colostomy had the highest incidence of morbidity, followed by loop colostomy and loop ileostomy. There were no trials involving patients with end ileostomy. There was a high level of detection bias and heterogeneity between studies. Conclusions This systematic review has summarised the best available evidence concerning the incidence of stoma related morbidity. The high level of heterogeneity between studies has limited the accuracy with which the true incidence of each stoma related complication can be reported. Large, multicentre trials investigating homogenous participant populations are therefore required.
Bariatric fellowship positively influences early outcomes for laparoscopic Roux-en-Y gastric bypass surgery over seven years of independent practice
Authors: Ilczyszyn A , Lynn W , Rasheed S , Davids J , Aguilo R , Agrawal S 
Published: August 2018

Introduction Laparoscopic Roux-en-Y gastric bypass (LRYGB) is technically demanding and has an associated learning curve. We published previously that bariatric fellowship reduces the learning curve of primary LRYGB and improves patient outcomes after one year of independent practice. However, the long-term effect of fellowship is unknown. We therefore aimed to compare the 30-day outcomes of LRYGB between the first year of a surgeon’s independent practice with the subsequent six years. Materials and methods A prospective database of patients undergoing primary LRYGB under a single surgeon from March 2010 until February 2017 was analysed. Two groups were studied: first year (< 1 year) and the subsequent six years (≥ 1 year) of independent practice. Patient demographics, length of hospital stay, conversion to open surgery, perioperative complications and mortality were compared. Results Among 279 eligible patients, 74 (26.5%) were in the < 1 year group and 205 (73.5%) in ≥ 1 year group. The preoperative risk scores, American Society of Anesthesiologists (ASA) grade, P = 0.00; obesity surgery mortality risk score (OS-MRS), P = 0.04) were significantly higher in ≥ 1 year group. There was no significant difference in perioperative outcomes (length of stay, P = 0.38; total complications, P = 0.20; readmissions, P = 1.00; reoperations, P = 0.60) between the two groups. Conclusions Bariatric fellowship reduces the learning curve for LRYGB and helps to achieve excellent outcomes in the first and subsequent years of independent practice. The higher risk profile of ≥ 1 year group did not equate to an increase in complications, suggesting that experience and standardisation may help in handling complex cases. To our knowledge, this represents the only such study in the literature.