bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical Marijuana Users are More Likely to Use Prescription Drugs Medically and Nonmedically
Authors: Caputi Theodore L. , Humphreys Keith 
Published: April 2018

Objectives:
Previous studies have found a negative population-level correlation between medical marijuana availability in US states, and trends in medical and nonmedical prescription drug use. These studies have been interpreted as evidence that use of medical marijuana reduces medical and nonmedical prescription drug use. This study evaluates whether medical marijuana use is a risk or protective factor for medical and nonmedical prescription drug use.

Methods:
Simulations based upon logistic regression analyses of data from the 2015 National Survey on Drug Use and Health were used to compute associations between medical marijuana use, and medical and nonmedical prescription drug use. Adjusted risk ratios (RRs) were computed with controls added for age, sex, race, health status, family income, and living in a state with legalized medical marijuana.

Results:
Medical marijuana users were significantly more likely (RR 1.62, 95% confidence interval [CI] 1.50–1.74) to report medical use of prescription drugs in the past 12 months. Individuals who used medical marijuana were also significantly more likely to report nonmedical use in the past 12 months of any prescription drug (RR 2.12, 95% CI 1.67–2.62), with elevated risks for pain relievers (RR 1.95, 95% CI 1.41–2.62), stimulants (RR 1.86, 95% CI 1.09–3.02), and tranquilizers (RR 2.18, 95% CI 1.45–3.16).

Conclusions:
Our findings disconfirm the hypothesis that a population-level negative correlation between medical marijuana use and prescription drug harms occurs because medical marijuana users are less likely to use prescription drugs, either medically or nonmedically. Medical marijuana users should be a target population in efforts to combat nonmedical prescription drug use.
A Randomized, Placebo-controlled, Clinical Trial of Prazosin for the Treatment of Alcohol Use Disorder
Authors: Wilcox Claire E. , Tonigan J. Scott , Bogenschutz Michael P. , Clifford Joshua , Bigelow Rose , Simpson Tracy 
Published: April 2018

Objectives:
The noradrenergic system plays an important role in the pathophysiology of alcohol use disorder (AUD). Medications in this class may reduce drinking. Our aims were to investigate this in a unique sample of individuals with AUD.

Methods:
Thirty-six individuals with AUD were randomized to treatment with prazosin, an alpha-1 noradrenergic antagonist, or placebo, for 6 weeks (target daily dose 16 mg). Hierarchical linear modeling was used to examine the effect of treatment group on rate of change in primary (drinks per week [DPW]) and several secondary outcome measures.

Results:
Prazosin did not significantly affect rate of reduction in alcohol use in the intent to treat sample (n = 36) compared with placebo, but did significantly increase the rate of reduction in DPW in an optimal treatment exposure subgroup (beta = −0.3; P = 0.01; event rate ratio 0.74; confidence interval 0.59, 0.93; n = 27). Poor adherence and tolerability may have contributed to null effects. Diastolic blood pressure (DBP) moderated the effects of treatment group on rate of reduction in drinks per drinking day, supporting previous work in doxazosin, another alpha-1 antagonist. Specifically, prazosin was associated with greater rates of reduction in drinking compared with placebo in individuals with high but not low DBP.

Conclusions:
Our findings do not support the clinical utility of prazosin for all treatment-seeking AUD, but post hoc analyses indicate that it might have some efficacy in individuals who can tolerate it. Further work exploring the clinical utility of DBP as a treatment matching variable, and defining optimal values using sensitivity and specificity analyses, is warranted.
Development and Validation of a Deep Neural Network Model for Prediction of Postoperative In-hospital Mortality
Authors: Lee Christine K. , Hofer Ira , Gabel Eilon , Baldi Pierre , Cannesson Maxime 
Published: April 2018

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
The authors tested the hypothesis that deep neural networks trained on intraoperative features can predict postoperative in-hospital mortality.

Methods
The data used to train and validate the algorithm consists of 59,985 patients with 87 features extracted at the end of surgery. Feed-forward networks with a logistic output were trained using stochastic gradient descent with momentum. The deep neural networks were trained on 80% of the data, with 20% reserved for testing. The authors assessed improvement of the deep neural network by adding American Society of Anesthesiologists (ASA) Physical Status Classification and robustness of the deep neural network to a reduced feature set. The networks were then compared to ASA Physical Status, logistic regression, and other published clinical scores including the Surgical Apgar, Preoperative Score to Predict Postoperative Mortality, Risk Quantification Index, and the Risk Stratification Index.

Results
In-hospital mortality in the training and test sets were 0.81% and 0.73%. The deep neural network with a reduced feature set and ASA Physical Status classification had the highest area under the receiver operating characteristics curve, 0.91 (95% CI, 0.88 to 0.93). The highest logistic regression area under the curve was found with a reduced feature set and ASA Physical Status (0.90, 95% CI, 0.87 to 0.93). The Risk Stratification Index had the highest area under the receiver operating characteristics curve, at 0.97 (95% CI, 0.94 to 0.99).

Conclusions
Deep neural networks can predict in-hospital mortality based on automatically extractable intraoperative data, but are not (yet) superior to existing methods.
γ-Aminobutyric Acid Type A Receptor Potentiation Inhibits Learning in a Computational Network Model
Authors: Storer Kingsley P. , Reeke George N. 
Published: April 2018

Abstract

Background
Propofol produces memory impairment at concentrations well below those abolishing consciousness. Episodic memory, mediated by the hippocampus, is most sensitive. Two potentially overlapping scenarios may explain how γ-aminobutyric acid receptor type A (GABAA) potentiation by propofol disrupts episodic memory—the first mediated by shifting the balance from excitation to inhibition while the second involves disruption of rhythmic oscillations. We use a hippocampal network model to explore these scenarios. The basis for these experiments is the proposal that the brain represents memories as groups of anatomically dispersed strongly connected neurons.

Methods
A neuronal network with connections modified by synaptic plasticity was exposed to patterned stimuli, after which spiking output demonstrated evidence of stimulus-related neuronal group development analogous to memory formation. The effect of GABAA potentiation on this memory model was studied in 100 unique networks.

Results
GABAA potentiation consistent with moderate propofol effects reduced neuronal group size formed in response to a patterned stimulus by around 70%. Concurrently, accuracy of a Bayesian classifier in identifying learned patterns in the network output was reduced. Greater potentiation led to near total failure of group formation. Theta rhythm variations had no effect on group size or classifier accuracy.

Conclusions
Memory formation is widely thought to depend on changes in neuronal connection strengths during learning that enable neuronal groups to respond with greater facility to familiar stimuli. This experiment suggests the ability to form such groups is sensitive to alteration in the balance between excitation and inhibition such as that resulting from administration of a γ-aminobutyric acid–mediated anesthetic agent.
Tibial Fracture Nonunion and Time to Healing After Reamed Intramedullary Nailing: Risk Factors Based on a Single-Center Review of 1003 Patients
Authors: Dailey Hannah L. , Wu Katherine A. , Wu Ping-Shi , McQueen Margaret M. , Court-Brown Charles M. 
Published: April 2018

Objective:
To determine factors associated with nonunion of adult tibial fractures.

Design:
Retrospective review with data collection for logistic regression and survival analysis.

Setting:
Scottish Level I trauma center, 1985–2007.

Patients:
During this period, 1590 adult tibial fractures were treated by reamed nailing and 1003 fractures met all inclusion criteria for the chosen analysis.

Intervention:
Reamed intramedullary nailing.

Main Outcome Measures:
Record of nonunion diagnosis and final union time with characteristics, including age, gender, closed or open injury, OTA/AO classification, Gustilo classification, fasciotomy, infection, polytrauma, smoking, and injury severity score.

Results:
The overall nonunion rate was 12%, and median time to healing was 18 weeks. Age significantly influenced nonunion, with middle-aged patients at highest risk. Both fracture type (closed/open) and morphology (OTA/AO classification) significantly influenced nonunion risk and time to union. Among closed injuries, the highest nonunion rate was for OTA/AO type B fractures (15%). Among open injuries, the highest nonunion rate was for OTA/AO type C (61%). Both compartment syndrome and smoking did not significantly influence nonunion risk but did significantly extend time to union.

Conclusions:
Injury characteristics including fracture morphology and severity of soft tissue injury were strong predictors of compromised fracture healing. Age also influenced nonunion risk in an unexpected way, with highest rates in the middle decades of adulthood. Future studies should consider the possibility of similar age-related effects and clinical studies should seek to identify explanations for why this may arise, including both physiological and socio-behavioral factors.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Should All Orthopaedists Perform Hemiarthroplasty for Femoral Neck Fractures? A Volume–Outcome Analysis
Authors: Clement R. Carter , Strassle Paula D. , Ostrum Robert F. 
Published: April 2018

Objectives:
To determine whether very low surgeon and hospital hip arthroplasty volumes are associated with unfavorable outcomes after hemiarthroplasty for femoral neck fractures.

Methods:
Patients ≥60 years of age and who underwent hemiarthroplasty for femoral neck fracture were identified in the New York Statewide Planning and Research Cooperative System data from 2001 to 2015. Incidence of inpatient mortality and postoperative complications were compared across both surgeon and hospital volume using multivariable Cox proportional hazards regression, adjusting for clinical and demographic factors.

Results:
Fifty eight thousand eight hundred fourteen patients were included. Low surgeon volume (1 case/year) was associated with increased complications [hazard ratio (HR) 1.35, 95% CI, 1.26–1.44, P < 0.0001), including dislocations (HR 1.31 95% CI, 1.04–1.65, P = 0.02) and several medical complications (P = 0.003) compared with surgeons performing at least 2 hip arthroplasties/year. Low hospital volume (<20 cases/year) was associated with increased complications (HR 1.11, 95% CI, 1.02–1.20, P = 0.02), including deep infections (HR 1.39, 95% CI, 1.02–1.89, P = 0.04) and certain medical complications (P = 0.02) compared with centers performing at least 50 hip arthroplasties/year. Hospital and surgeon volume were not associated with inpatient mortality (P = 0.98) or reoperations (P = 0.40).

Conclusions:
Providers who rarely perform hemiarthroplasty for femoral neck fractures should defer these cases to surgeons and hospitals who regularly perform hip arthroplasty. Additional research is needed to further characterize the thresholds for “low volume” and to determine whether there is additional benefit afforded by high-volume surgeons and hospitals (or if it is adequate that providers performing hemiarthroplasty maintain volumes above relatively low thresholds as identified here).

Level of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Biomechanical Testing of a 3-Hole Versus a 4-Hole Sliding Hip Screw in the Presence of a Retrograde Intramedullary Nail for Ipsilateral Intertrochanteric and Femur Shaft Fractures
Authors: Olsen Michael , Goshulak Peter , Crookshank Meghan C. , Moktar Joel , Brazda Ignace J. , Schemitsch Emil H. , Zdero Radovan 
Published: April 2018

Objective:
The goal of this study was to compare a 3-hole versus a 4-hole sliding hip screw (SHS) in the presence of a retrograde intramedullary (RIM) nail for fixing intertrochanteric and comminuted midshaft femur fractures.

Methods:
Mechanical tests were performed on 10 matched pairs of human cadaveric femurs that were osteotomized and then fixed using a 3-hole SHS versus the traditional “gold standard” 4-hole SHS in the presence of an RIM nail.

Results:
Data showed no differences between the 3-hole SHS with RIM nail versus 4-hole SHS with RIM nail for stiffness (281 ± 127 vs. 260 ± 118 N/mm, P = 0.76), clinical failure at 10 mm of hip displacement (2014 ± 363 vs. 2134 ± 614 N, P = 0.52), or ultimate mechanical failure (3476 ± 776 vs. 3669 ± 755 N, P = 0.12).

Conclusions:
For this fracture pattern, a 3-hole SHS with RIM nail may be a suitable surgical alternative to the traditional “gold standard” method because it provides the same biomechanical properties while potentially reducing surgical time, blood loss, and hardware used.
Evaluating the Accuracy and Quality of the Information in Kyphosis Videos Shared on YouTube
Authors: Erdem Mehmet Nuri , Karaca Sinan 
Published: April 2018

Study Design.A quality-control YouTube-based study using the recognized quality scoring systems.Objective.In this study, our aim was to confirm the accuracy and quality of the information in kyphosis videos shared on YouTube.Summary of Background Data.The Internet is a widely and increasingly used source for obtaining medical information both by patients and clinicians. YouTube, in particular, manifests itself as a leading source with its ease of access to information and visual advantage for Internet users.Methods.The first 50 videos returned by the YouTube search engine in response to “kyphosis” keyword query were included in the study and categorized under seven and six groups, based on their source and content. The popularity of the videos was evaluated with a new index called the video power index (VPI). The quality, educational quality, and accuracy of the source of information were measured using theJournal of American Medical Association(JAMA) score, Global Quality Score (GQS), and Kyphosis-Specific Score (KSS).Results.Videos had a mean duration of 397 seconds and a mean number of 131,644 views, with a total viewing number of 6,582,221. The source (uploader) in 36% of the videos was a trainer and the content in 46% of the videos was exercise training. Seventy-two percent of the videos were about postural kyphosis. Videos had a mean JAMA score of 1.36 (range: 1–4), GQS of 1.68 (range: 1–5), and KSS of 3.02 (range: 0–32). The academic group had the highest scores and the lowest VPIs.Conclusion.Online information on kyphosis is low quality and its contents are of unknown source and accuracy. In order to keep the balance in sharing the right information with the patient, clinicians should possess knowledge about the online information related to their field and should contribute to the development of optimal medical videos.Level of Evidence:3
Postoperative Status of Global Sagittal Alignment With Compensation in Adult Spinal Deformity
Authors: Inami Satoshi , Moridaira Hiroshi , Takeuchi Daisaku , Ueda Haruki , Shiba Yo , Asano Futoshi , Aoki Hiromichi , Taneichi Hiroshi 
Published: April 2018

Study Design.
A retrospective study of consecutive patients undergoing surgery for adult spinal deformity (ASD).

Objective.
The aim of this study was to classify postoperative ASD patients by sagittal compensation and characterize the features of each group.

Summary of Background Data.
Sagittal compensatory mechanisms to keep the erect position would function in not only nonoperative ASD patients but also in postoperative patients. However, details of sagittal compensatory mechanisms after surgery have been unclear, because the majority of previous studies examined the compensatory mechanisms in nonoperative patients.

Methods.
A total of 73 postoperative ASD patients were recruited. Spinopelvic parameters and Oswestry Disability Index (ODI) were measured before surgery, at 1-month and 2-year follow-up. The changes in parameters (Δ) between postoperative 1-month and 2-year were also evaluated. Cluster analysis based on pelvic tilt (PT) and sagittal vertical axis (SVA) at 2-year follow-up was performed, and then the parameters were compared among clusters.

Results.
Cluster analysis identified three clusters: the physiological group (n = 38, PT = 19.6°, SVA = 17.2 mm), the compensated group (n = 23, PT = 34.3°, SVA = 45.6 mm), and the decompensated group (n = 12, PT = 36.6°, SVA = 118.8 mm). Comparisons of the parameters among the groups showed that the physiological group had smaller pelvic incidence minus lumbar lordosis (PI-LL) and better ODI. The compensated group had significantly larger Δ thoracic kyphosis (TK), Δ proximal junctional angle (PJA), and ΔPT than the physiological group. The decompensated group had significantly higher PI and higher age.

Conclusion.
Three groups were defined in terms of postoperative compensatory mechanisms. Patients in the physiological group had little postoperative alignment change and good ODI value. The compensated group had pelvic retroversion to keep SVA in the physiological range, but the compensation in the thoracic spine was unlikely to work. High PI and advanced age were characteristics of the decompensated group.

Level of Evidence: 4
Positive Surgical Margins in Favorable-Stage Differentiated Thyroid Cancer
Authors: Mercado Catherine E. , Drew Peter A. , Morris Christopher G. , Dziegielewski Peter T. , Mendenhall William M. , Amdur Robert J. 
Published: April 2018

Objective:
The significance of positive margin in favorable-stage well-differentiated thyroid cancer is controversial. We report outcomes of positive-margin patients with a matched-pair comparison to a negative-margin group.

Materials and Methods:
A total of 25 patients with classic-histology papillary or follicular carcinoma, total thyroidectomy +/− node dissection, stage T1-3N0-1bM0, positive surgical margin at primary site, adjuvant radioactive iodine (I-131), and age older than 18 years were treated between 2003 and 2013. Endpoints were clinical and biochemical (thyroglobulin-only) recurrence-free survival. Matched-pair analysis involved a 1:1 match with negative-margin cases matched for overall stage and I-131 dose.

Results:
Recurrence-free survival in positive-margin patients was 71% at 10 years. No patient was successfully salvaged with additional treatment. Only 1 patient died of thyroid cancer. Recurrence-free survival at 10 years was worse with a positive (71%) versus negative (90%) margin (P=0.140).

Conclusions:
Cure with a microscopically positive margin was suboptimal (71%) despite patients having classic-histology papillary and follicular carcinoma, favorable stage, and moderate-dose I-131 therapy.
Correlation Between Extended Leukocyte Differential Count and Coronary Artery Disease
Authors: Chen Si , Zhang Shulan , Luan Haixia , Zeng Xiaoli , Li Yongzhe , Yuan Hui 
Published: April 2018

Background:
Leukocyte count is closely associated with the risk of coronary artery disease (CAD). Levels of leukocyte subpopulations in patients with CAD, however, remain largely unknown.

Methods:
In this study, we compared the distributions and counts of 16 leukocyte subpopulations between 40 patients with CAD and 40 healthy controls using the CytoDiff flow cytometric system.

Results:
Our results demonstrated significant increases in the frequencies and counts of all monocytes, immature granulocytes, and B-lymphocytes in patients with CAD, suggesting that the levels of these leukocyte subpopulations may serve as potential biomarkers for diagnosis of CAD. By contrast, the levels of cytotoxic T/natural killer lymphocytes were markedly decreased in patients with CAD. In addition, the levels of T/natural killer lymphocytes, noncytotoxic T-lymphocytes, mature neutrophils, total neutrophils, eosinophils, basophils, and T-cell blasts in CAD patients with elevated levels of cardiac troponin I (cTnI), an independent indicator for poor prognosis in CAD, were significantly different from those in CAD patients with normal levels of cTnI. These data may help in the screening for biomarkers to discriminate between stable and unstable patients with CAD.

Conclusions:
Collectively, our results provide a detailed distribution profile of leukocyte subpopulations in patients with CAD and suggest their possible clinical application in predicting the risk and severity of CAD.
Embryo morphokinetic characteristics and euploidy
Authors: Pennetta Francesca , Lagalla Cristina , Borini Andrea 
Published: April 2018

Purpose of review
The purpose of the current review is to provide an update on time-lapse morphokinetic assessment related to embryo ploidy status.

Recent findings
The main limitation of the available studies regarding correlation between morphokinetic variables and ploidy is that each embryo is considered as an independent unit whereas recent findings show that embryo kinetics may be affected by patient and ovarian stimulation-related factors, so that clustered data analysis is more appropriate. Moreover, some experimental evidences show how embryos with irregular developmental patterns, often used as deselection criteria, can evolve into usable embryos and give pregnancy.

Summary
Time lapse technology has allowed us to obtain a lot of information about human embryo development through the characterization of events that are otherwise not visible using static morphological observations. Many morphokinetic parameters have been tested in relation to a variety of outcomes including implantation potential, blastocyst development and ploidy status. Regarding to this last point, most efforts aim to unravel this relationship with conflicting results in their predictive ability. Furthermore, embryos originating from anomalous behaviour, although with a reduced developmental potential, may result in euploid and transferrable blastocysts.