bluuebunny/crossref_metadata_2025_split huggingface dataset:
New Evidence Supporting the Role of FBN1 in the Development of Adolescent Idiopathic Scoliosis
Authors: Sheng Fei , Xia Chao , Xu Leilei , Qin Xiaodong , Tang Nelson Leung-Sang , Qiu Yong , Cheng Jack Chun-Yiu , Zhu Zezhang 
Published: July 2018

Study Design.
A genetic association study.

Objective.
To determine whether common variants of fibrillin-1 (FBN1) and fibrillin-2 (FBN2) are associated with adolescent idiopathic scoliosis (AIS), and to further investigate to further investigate the functional role of FBN1 in the onset and progression of AIS.

Summary of Background Data.
Previous studies have identified several rare variants in FBN1 and FBN2 that were associated with AIS. There is, however, a lack of knowledge concerning the association between common variants of FBN1 and FBN2 and AIS.

Methods.
Common variants covering FBN1 and FBN2 were genotyped in 952 patients with AIS and 1499 controls. Paraspinal muscles were collected from 66 patients with AIS and 18 patients with lumbar disc herniation (LDH) during surgical interventions. The differences of genotype and allele distributions between patients and controls were calculated using Chi-square test. The Student t test was used to compare the expression of FBN1 and FBN2 between patients with AIS and LDH. One-way analysis of variance test was used to compare the gene expression among different genotypes of the significantly associated variant. The Pearson correlation analysis was used to determine the relationship between FBN1 expression and the curve severity.

Results.
The common variant rs12916536 of FBN1 was significantly associated with AIS. Patients were found to have significantly lower frequency of allele A than the controls (0.397 vs. 0.450, P = 1.10 × 10−4) with an odds ratio of 0.81. Moreover, patients with AIS were found to have significantly lower FBN1 expression than patients with LDH (0.00033 ± 0.00015 vs. 0.00054 ± 0.00031, P = 1.70 × 10−4). The expression level of FBN1 was remarkably correlated with the curve severity (r = −0.352, P = 0.02). There was no significant difference of FBN1 expression among different genotypes of rs12916536.

Conclusion.
Common variant of FBN1 is significantly associated with the susceptibility of AIS. Moreover, the decreased expression of FBN1 is significantly correlated with the curve severity of AIS. The functional role of FBN in AIS is worthy of further investigation.

Level of Evidence: 3
Survival Outcome and Prognostic Factors After Pulmonary Metastasectomy in Sarcoma Patients
Authors: Cariboni Umberto , De Sanctis Rita , Giaretta Marta , Voulaz Emanuele , Morenghi Emanuela , Colombo Piergiuseppe , Novellis Pierluigi , Bottoni Edoardo , Errico Valentina , Crepaldi Alessandro , Marrari Andrea , Navarria Pierina , Ascolese Anna M. , Testori Alberto , Scorsetti Marta , Quagliuolo Vittorio , Santoro Armando , Alloisio Marco 
Published: July 2018

Background:
Metastatic sarcoma patients have a poor prognosis with 3-year survival rate of 25%. About 30% of them present isolated lung metastases. We aimed to analyze the clinical outcome of sarcoma patients undergoing pulmonary metastasectomy (PM) and prognostic factors associated with local control, disease-free, and overall survival (OS).

Patients and Methods:
All sarcoma patients undergoing PM at Humanitas Cancer Center were retrospectively reviewed. Analyzed variables included clinicopathologic, surgical, and survival data. Exclusion criterion comprised a follow-up period inferior to 1 year. A univariable and multivariable Cox regression analysis was performed (P<0.05).

Results:
In total, 154 patients underwent PM from 1997 to 2015. Total complication rate was 7.1%. The median follow-up was 24 months. The median OS was 35.4 months from initial metastasectomy. In univariable analysis, we identified as significant negative prognostic factors a disease-free interval of <18 months, male sex, grading G3, and bilateral metastases. Three histology risk groups were defined according to OS: high risk (myxofibrosarcoma, malignant peripheral nerve sheath tumor, and Ewing sarcoma), intermediate risk (leiomyosarcoma, liposarcoma, and undifferentiated pleomorphic sarcoma), and low risk (synovial and chondrosarcoma) with a 3-year OS of 21.4%, 45.7%, and 74.1%, respectively. In multivariable analysis, male sex (P=0.042), bilateral metastases (P=0.004), and histology (intermediate vs. low-risk group, P=0.021; high vs. low-risk group, P<0.001) were identified as independent predictors of survival.

Conclusions:
PM for sarcoma is a valid therapeutic option. High-risk histologies and bilaterality of lung metastases are independent negative prognostic factors. A prognostic score to improve patient selection is proposed.
Traumatic Brain Injury Following Military Deployment: Evaluation of Diagnosis and Cause of Injury
Authors: Regasa Lemma Ebssa , Agimi Yll , Stout Katharine C. 
Published: July 2018

Objective:
To evaluate the prevalence of delayed traumatic brain injury (TBI) diagnosis and cause of injury that resulted in a TBI diagnosis after military deployment.

Design:
Medical record notes were reviewed in 2016 from a random sample of 1150 US military service members who had their first-time deployment in 2011 and likely sustained a TBI. Location and cause of the injury were extracted from the progress note for analysis.

Participants and Setting:
Active-duty US military service members who received an International Classification of Diseases, Ninth Revision code for a TBI diagnosis in a military facility.

Main Outcome Measures:
Presence of TBI, location of injury, cause of injury, and time of diagnosis with respect to deployment.

Results:
The odds of being diagnosed with a deployment-related TBI were 8 times higher during the first 4 weeks upon return from deployment than the subsequent 32 weeks. The likelihood of diagnosing a deployment-sustained TBI during weeks 5 to 32 was 2 times higher than during 33 to 76 weeks following return from deployment. The proportion of deployment-related TBI diagnoses decreased with time following return from deployment but remained above 40% during weeks 33 to 76. Service branch, gender, race, occupation, and time between TBI diagnosis and return from deployment were significant predictors of deployment-related TBIs. Moving motor vehicle, sports, parachute, and being struck by objects were the top causes of injury in garrison (nondeployed setting), whereas blast produced the majority (66%) of all causes of injuries that resulted in a TBI in the deployed setting.

Conclusion:
The increased incidence rate of a TBI diagnosis following deployment can be attributed to delayed diagnosis of TBI sustained from injuries during deployment. TBIs sustained during deployment can be diagnosed beyond the initial 4 weeks after return from deployment and may continue up to 76 weeks following return from deployment.
CHALLENGES IN THE MANAGEMENT OF PRESUMED FUNGAL ENDOPHTHALMITIS IN PREGNANCY
Authors: Zhang Alice Y. , Brady Christopher J. , Reddy Ashvini K. 
Published: July 2018

Purpose:
To report a rare case of endogenous endophthalmitis in pregnancy and the challenges of managing culture-negative fungal infection.

Methods:
Retrospective case report. A 30-year-old woman presented with a subfoveal chorioretinal lesion with vitritis and anterior chamber inflammation in the context of intravenous drug use. Spectral domain optical coherence tomography and fluorescein angiography were used for documentation and monitoring.

Results:
After 2 months of systemic and intravitreal injections of amphotericin, the patient had clinical improvement in visual acuity, degree of inflammation, and in the size and activity of the chorioretinal lesion, which was presumed to be fungal in origin.

Conclusion:
Among limited cases of endophthalmitis in pregnancy, we report a challenging case of presumed fungal endogenous endophthalmitis. The patient responded favorably to intravitreal and systemic antifungal medications.
Characterization of Corneal Donor Tissue Lesions by Anterior Segment Optical Coherence Tomography Compared With Eye Bank Technician Slit-Lamp Examination
Authors: Hsu S. Tammy , Perry Isaac , Botsay Sara , Ko Narae , Stinnett Sandra S. , Kuo Anthony N. , Shieh Christine 
Published: July 2018

Purpose:
To compare anterior segment spectral-domain optical coherence tomography (OCT) with eye bank technician slit-lamp examination (SLE) in characterizing lesions in donor corneas.

Methods:
Twenty-nine donor corneas identified by eye bank technicians to have opacities or lesions potentially representing pathologic findings affecting the stroma were evaluated through the use of technician SLE, SLE photography, and OCT. Technicians were tasked with describing the lesion, estimating the lesion depth, and photographing their SLE findings. A masked grader evaluated the OCT images and measured the lesion depth using customized software. The lesions identified on OCT were then compared with those identified on SLE.

Results:
A total of 37 lesions were detected on SLE; 25 of the 37 lesions identified on SLE were matched to a lesion on OCT. SLE and OCT depth measurements were statistically significantly different (P = 0.0042, mean difference 4.8% ± 6.5%), and OCT graded lesions as slightly deeper. Of the 12 out of the 37 lesions that were noted on SLE (but not identified on OCT), these included 2 central and paracentral anterior stromal lesions (OCT showed loose epithelium), 5 peripheral anterior stromal lesions, and 5 corneas with LASIK.

Conclusions:
Our study highlights both advantages and limitations of OCT compared with technician SLE in the evaluation of donor corneal tissue. Although OCT may miss some peripheral lesions and LASIK scars that are identifiable on SLE, OCT's depth resolution is helpful in differentiating whether shallow anterior opacities actually extend deeper into the stroma or are confined superficially to the epithelium.
Comparison of Pharmacy Claims and Electronic Pill Bottles for Measurement of Medication Adherence Among Myocardial Infarction Patients
Authors: Mehta Shivan J. , Asch David A. , Troxel Andrea B. , Lim Raymond , Lewey Jennifer , Wang Wenli , Zhu Jingsan , Norton Laurie , Marcus Noora , Volpp Kevin G. 
Published: July 2018

Background:
Medication adherence after myocardial infarction remains low. Pharmacy claims have typically been used to measure medication adherence, but electronic pill bottles may offer additional information.

Objective:
The main objectives of this study were to compare the association of adherence measured by prescription claims and remote monitoring technologies with cardiovascular events.

Research Design:
This study was a secondary analysis of a remote monitoring intervention to increase medication adherence in myocardial infarction patients.

Subjects:
In total, 682 myocardial infarction patients were randomized to the intervention group with both medical and pharmacy benefits.

Measures:
Pharmacy claims adherence was measured using proportion of days covered (PDC) and GlowCap adherence (GC) was measured as the proportion of days the pill bottle was opened. We compared the association of PDC and GC adherence for statins with time to first vascular readmission or death and assessed model fit using Akaike information criterion and Bayesian information criterion and the likelihood ratio test.

Results:
Higher PDC was significantly associated with a lower hazard rate for vascular readmissions or death (hazard ratio=0.435; P=0.009). There was also an association between GC adherence and vascular readmissions or death (hazard ratio=0.313; P≤0.001). Adding the GC adherence variable to the model using only PDC improved the model fit (likelihood ratio test, P=0.001), as well as vice versa (P=0.050).

Conclusions:
Pharmacy claims data provide useful but not complete data for medication adherence monitoring. New wireless technologies have the potential to provide additional data about clinical outcomes.
Visual Motor Integration in Children With Sickle Cell Disease
Authors: Newby Robert F. , Epping Amanda , Geiger Jennifer A. , Miller Meghan S. , Scott John Paul 
Published: July 2018

Background:Children with sickle cell disease (SCD) demonstrate deficits in cognitive and academic functioning. This study compared the visual motor integration (VMI) skills of children with SCD to non-SCD sibling controls.Procedure:In total, 105 participants (67 patients with SCD, 38 controls) were recruited during a routine clinic visit. Each participant was administered the Grooved Pegboard Test, a test of manual dexterity and the Beery-Buktenica Developmental Test of VMI, a measure of graphomotor skills.Results:Children with SCD demonstrated average (M=89.61, SE=3.08) fine manual dexterity and speed, but more complex fine motor functioning (graphomotor skills) (M=77.61, SE=1.65) was impaired. Relative to healthy siblings, children with SCD were not found to have different fine manual dexterity and speed (P=0.617). Patients with SCD were found to have significantly worse graphomotor skills (P=0.04).Conclusions:Children with SCD were found to have average basic fine motor dexterity and speed, but impaired VMI, a more complex fine motor skill. This finding is significant given the functional importance of complex fine motor skills in early academic activities.
Patient-Centered Care in Primary Care Scale
Authors: Radwin Laurel E. , Cabral Howard J. , Seibert Marjorie Nealon , Stolzmann Kelly , Meterko Mark , Evans Leigh , Barker Anna , Bokhour Barbara 
Published: July 2018

Background:
Nurse contributions to patient-centered care in primary care clinics are all but ignored in standard patient experience surveys.

Purpose:
The purpose was to conduct a pilot study to develop and psychometrically assess a scale measuring nurses' and other providers' patient-centered care in Veteran Affairs primary care clinics.

Method:
We developed a patient experience survey composed of original items and previous studies' items and scales. The survey was field tested online with patients who had a recent clinic appointment. The nonrandom analytic sample comprised 221 patients.

Results:
Exploratory factor analyses yielded a 36-item, 4-factor solution explaining 76% of the variance. The factors were: (1) Provider Knowing the Person/Individualizing Care (18 items; α = 0.98); (2) Nurse Knowing the Person (8; 0.95); (3) Nurse Individualizing Care (7; 0.94); and (4) Continuity of Care (3; not calculated). A short form with 23 items was created using stepwise regression. It had the same 4 factors as the long form with 76% of the variance explained.

Conclusions:
Patients reported distinctive nurse contributions that have not been routinely measured.
The Impact of Budget Cuts on Sexually Transmitted Disease Programmatic Activities in State and Local Health Departments With Staffing Reductions in Fiscal Year 2012
Authors: Gift Thomas L. , Cuffe Kendra M. , Leichliter Jami S. 
Published: July 2018

Abstract
Staffing reductions in state and local health departments in fiscal year 2012 were concentrated in disease investigation specialists and clinicians (local) and disease investigation specialists and administrative staff (state). Local health departments with budget cuts were significantly more likely to report reduced partner services if they had staffing reductions.
Certified Child Life Specialists Lessen Emotional Distress of Children Undergoing Laceration Repair in the Emergency Department
Authors: Hall Johanna E. , Patel Dhruv P. , Thomas John W. , Richards Catherine A. , Rogers Philip E. , Pruitt Christopher M. 
Published: July 2018

Objective
The objective of this study is to evaluate the impact of certified child life specialists (CCLSs) on the emotional responses of children undergoing laceration repair in the emergency department (ED).

Methods
Patients 4 to 12 years of age who required laceration repair by suturing were prospectively enrolled at an urban tertiary pediatric ED. Certified child life specialists are not available at all times in our institution, allowing for a priori categorization of subjects into 2 comparison groups, those with and those without CCLS involvement. Subjects requiring anxiolysis, pharmacologic sedation, narcotics, or physical restraint were excluded. The Children's Emotional Manifestation Scale, a previously validated Likert-like tool, was used to quantify the patients' distress, with a higher score reflecting a more emotional child. Just before placement of the first suture, subjects were scored by trained independent observers. Baseline data included age, sex, race, type of local anesthetic, length and location of laceration, and analgesics administered. The primary endpoint of emotional score was compared with a 2-tailed Mann-Whitney U test, with a P < 0.05 considered statistically significant.

Results
Two hundred one patients constituted the final study cohort, with 103 (51%) having CCLS involvement. Study groups did not differ in regards to any baseline demographic or clinical characteristics. The median emotional score for patients with child life services was 7 (interquartile range, 6–9) versus 9 (interquartile range, 7.5–12) for those without (P < 0.0005).

Conclusions
Certified child life specialist involvement is associated with less emotional distress for children undergoing laceration repair in the ED.
Effect of Racial Inequities in Pre-exposure Prophylaxis Use on Racial Disparities in HIV Incidence Among Men Who Have Sex With Men: A Modeling Study
Authors: Goedel William C. , King Maximilian R. F. , Lurie Mark N. , Nunn Amy S. , Chan Philip A. , Marshall Brandon D. L. 
Published: July 2018

Background:
Pre-exposure prophylaxis (PrEP) uptake has been slow among African American men who have sex with men (AAMSM) in the United States. We used an agent-based model (ABM) to simulate race-specific PrEP coverage to estimate their impact on racial disparities in HIV incidence among MSM in Atlanta, GA.

Methods:
An ABM was constructed to simulate HIV transmission in a dynamic network of 10,000 MSM over 10 years, beginning in 2015. We modeled a base scenario with estimated PrEP coverage of 2.5% among AAMSM and 5.0% among white MSM (WMSM). We then compared HIV incidence over 10 years and calculated a disparity ratio of AAMSM to WMSM incidence rates across varying PrEP scale-up scenarios, with equal and unequal coverage among AAMSM and WMSM.

Results:
Assuming current coverage remains constant, the model predicts HIV incidence rates of 2.95 and 1.76 per 100 person-years among AAMSM and WMSM, respectively, with a disparity ratio of 1.68. If PrEP coverage was to increase 6-fold without addressing inequities in PrEP uptake, the model predicts incidences of 2.65 and 1.34, corresponding to a mean decrease of 10.4% and 24.0% in HIV incidence, respectively. This stronger benefit for WMSM increased the disparity ratio to 1.98. Equal PrEP coverage among AAMSM and WMSM resulted in lower incidence rates overall with lower disparity ratios.

Conclusions:
Lower uptake among AAMSM relative to WMSM may limit the population-level impact of PrEP use among AAMSM, which may ultimately culminate in wider racial disparities in HIV incidence among MSM.
Total Pancreatectomy for Presumed Intraductal Papillary Mucinous Neoplasms
Authors: Poiraud Charles , El Amrani Mehdi , Barbier Louise , Chiche Laurence , Mabrut Jean Yves , Bachellier Philippe , Pruvot François-René , Delpero Jean-Robert , Tuech Jean Jacques , Adham Mustapha , Sauvanet Alain , Turrini Olivier , Truant Stéphanie 
Published: July 2018

Objective:
The aim of the current study was to assess the short and long-term outcome of total pancreatectomy (TP) for IPMN based on the largest series to date.

Background:
Literature data are scarce regarding TP for IPMN, though increasingly performed in this setting.

Methods:
Data of 888 IPMN patients operated between 2004 and 2013 were collected in a multicentric retrospective AFC database. Ninety-three patients (10.5%) who had TP entered this study. Patient demographics, indications, intraoperative data, 3-month morbi-mortality (Clavien), and long-term outcome were analyzed.

Results:
Most patients had mixed type IPMN (59%) and underwent upfront (56%) or intraoperatively-decided (33%) TP. Morbidity and mortality rates were 47.3% and 4.3%, respectively, with no lethal hypoglycemia; morbidity was higher for intraoperatively-decided TP. Misdiagnoses were frequent regarding main pancreatic duct involvement (12%), invasiveness (33%), or mural nodules (50%), resulting in 12 TPs (13%) performed for asymptomatic IPMN showing only low/moderate dysplasia (LMD). On histopathological examination, there were 54 (58%) invasive IPMN (mostly pT3/T4 (76%), N+ (60%), R0 (75%)), with a significantly worse 5-year survival (21.2%) compared to noninvasive group (85.7%; P < 0.0001). In the former, 24 (58.5%) developed recurrence showing mostly distant metastasis, within 2 years in 92%.

Conclusion:
This large series of TP for IPMN reported acceptable morbi-mortality rates with no long-term death from diabetes-related complication. Morphologic assessment was imperfectly reliable with 13% of TP done for LMD only. More than half of patients were operated at an invasive carcinoma stage with poor outcome. Conversely, long-term survival was excellent after TP for noninvasive IPMN.
Declining Resident Experience in Open Vascular Operations Threatens the Status of Vascular Surgery as an Essential Content Area of General Surgery Training
Authors: Potts John R. , Valentine R. James 
Published: July 2018

Objective:
The objective of this study was to document trends in the performance of open arterial vascular surgery procedures (OAVP) by general surgery residents (GSR).

Background:
The ACGME Review Committee for Surgery considers vascular surgery (VS) to be an “essential content area.” However, the operative experience in VS for GSRs is threatened by 1) increasing numbers of GSRs, 2) increasing numbers of VS trainees, and 3) the proliferation of endovascular surgery.

Methods:
The last 16 years of ACGME national reports of case logs for completing GSRs were reviewed. Total vascular operations and OAVPs performed as “surgeon” were recorded and analyzed. The number of individuals completing ACGME programs in general and vascular surgery annually over that period were also recorded and analyzed. To better understand long-term and more recent trends, trends were analyzed for the 15-year period spanned by the 16 years of data as well as the most recent 10- and 5-year periods.

Results:
The number of individuals completing both general and vascular surgery programs increased significantly. Over 15 years, the total vascular operations performed by GSRs significantly declined as did the total OAVPs and the OAVPs in 7 of 9 categories. In just the last 5 years, significant declines occurred in 5 OAVP categories.

Conclusions:
Operative experience in OAVPs for GSRs has significantly declined. Because fundamental VS skills are necessary for operative general surgery, VS should remain an essential content area. However, programs cannot solely depend on operative experience to teach fundamental VS skills.