bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bile Duct Injury in Children: Is There a Role for Early Endoscopic Retrograde Cholangiopancreatography?
Authors: Aljahdali Akram , Murphy James 
Published: July 2018

Introduction Liver injury is common among pediatric abdominal trauma. Nonoperative management is the standard of care in isolated stable liver injuries. Bile leak is not an uncommon complication in moderate- and high-grade injuries.
Case series Three pediatric patients (age: 10–15 years) suffered grade IV liver injuries secondary to blunt abdominal trauma. All developed significant bile leak treated nonoperatively with endoscopic retrograde cholangiopancreatography (ERCP), and patients 1 and 2 were treated with bile duct stent alone. Patient 3 required laparotomy for bile peritonitis and abdominal compartment syndrome followed by interval ERCP and bile duct stent.
Conclusion Traumatic bile leaks if not recognized and managed early can result in significant morbidity. This paper describes the presentation and treatment of three pediatric patients with blunt liver trauma complicated by significant bile leaks that were managed successfully with ERCP and bile duct stent. This paper demonstrates the importance of early detection of bile leak to prevent bile peritonitis. Abdominal imaging 4 to 5 days postinjury can help in detecting bile accumulation. We believe that ERCP and bile duct stent are becoming the standard of care in diagnosing and treating traumatic bile leak. This paper confirms the safety and feasibility of this technique in the pediatric population.
Evaluation of the Painful Total Hip Arthroplasty
Authors: Eyberg Blake , Jacofsky David , Hess Shane 
Published: July 2018

AbstractThe total hip arthroplasty (THA) remains as one of the most successful procedures improving function and quality of life. However, despite its success, failures do occur. The workup of a painful THA should be methodical, prioritizing the most likely to least likely etiologies. Intrinsic and extrinsic sources of pain must be evaluated from data collected through an accurate history, detailed physical examination, laboratory analysis, and imaging interpretation.
Long-term ecology of investors in a financial market
Authors: Musciotto Federico , Marotta Luca , Piilo Jyrki , Mantegna Rosario N. 
Published: July 2018

AbstractThe cornerstone of modern finance is the efficient market hypothesis. Under this hypothesis all information available about a financial asset is immediately incorporated into its price dynamics by fully rational investors. In contrast to this hypothesis many studies have pointed out behavioral biases in investors. Recently it has become possible to access databases that track the trading decisions of investors. Studies of such databases have shown that investors acting in a financial market are highly heterogeneous among them, and that heterogeneity is a common characteristic of many financial markets. The article describes an empirical study of the daily trading decisions of all Finnish investors investing Nokia stock over a time period of 15 years. The investigation is performed by adapting and using methods and tools in network science. By investigating daily trading decisions, and by constructing the time-evolution of statistically validated networks of investors, clusters of investors—and their time evolution— which are characterized by similar trading profiles are detected. These clusters are performing distinct trading decisions on time scales ranging from several months to twelve years. These empirical observations show the presence of an ecology of groups of investors characterized by different attributes and by various investment styles over many years. Some of the detected clusters present a persistent over-expression of specific investor categories. The study shows that the logarithm of the ratio of pairs of statistically validated trading decisions is different for different values of the market volatility. These findings suggest that an ecology of investors is present in financial markets and that groups of traders are always competing, adopting, using and eventually discarding new investment strategies. This adaptation process is observed over a multiplicity of time scales, and is compatible with several conclusions of behavioral finance and with the assumptions of the so-called adaptive market hypothesis.
Supplier Relationship Management towards Quality Management System of Indian automotive manufacturing industry - A Total Interpretive Structural Modeling approach
Authors: Pothal L K , Tripathy S , Satapathy S 
Published: July 2018

Abstract
This research paper identifies Supplier Relationship Management (SRM) as a significant factor influencing quality development of products in automobile sector. SRM is a crucial methodology to achieve mutual gains by companies and their suppliers. The supplier may be having different business culture than the company. The business culture and environment differs from organization to organization. SRM provides a common platform for exchange of knowledge, ideas, goals, etc. for the company and its suppliers which enhance processes like material handling, procurement and goods management. SRM impacts product quality directly and in a positive way. Finally, through Interpretive Structural Modeling (ISM), different manufacturing and quality issues are identified at different levels & their contributions, which ultimately construct the direction towards Quality Management System (QMS) and then through Total Interpretive Structural Modeling(TISM) the developed model is logically modified.
Research on Multi-source Energy Consumption Characteristics of CNC Machine Tool Processing System
Authors: Zhou Yan , Tan Chong 
Published: July 2018

Abstract
CNC machine tools are a complex and variable system with a large number of energy-consuming components and the energy consumption type covers the field of electromechanical liquid. Therefore, it is of great significance to study the energy consumption of CNC machine tools in order to find energy conservation and emission reduction, improve resource utilization, reduce environmental pollution, and promote green manufacturing. This paper analyzes the energy consumption form and characteristics of a typical machine tool, combines the machining status of the machine tool, and studies the various energy-consuming components of the machine tool, establishes the power balance equations of each state, and the specific energy consumption and energy efficiency model of the machine tool. The model combines the energy consumption characteristics and machining status of the machine tool, and lays a theoretical foundation for the research of the energy of the CNC machine tool.
Exercise Reverses Nociceptive Sensitization, Upregulated Neuropeptide Signaling, Inflammatory Changes, Anxiety, and Memory Impairment in a Mouse Tibia Fracture Model
Authors: Shi Xiaoyou , Guo Tian-zhi , Li Wenwu , Sahbaie Peyman , Rice Kenner C. , Sulima Agnieszka , Clark J. David , Kingery Wade S. 
Published: July 2018

Abstract

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
This study tested the hypothesis that ad lib running wheel exercise in a tibia fracture model of complex regional pain syndrome can reverse hindlimb nociceptive sensitization and inflammation in mice.

Methods
Three weeks after tibia fracture, the cast was removed and hindlimb von Frey thresholds and unweighting were tested; the mice were then randomized to either ad lib access to a running wheel for 4 weeks or no wheel access. After 4 weeks the behavioral testing was repeated and then skin, sciatic nerve, and spinal cord tissues collected for polymerase chain reaction and enzyme immunoassay measurements of neuropeptide and inflammatory mediator levels. A similar protocol was used in fracture mice treated with exercise for 4 weeks, and then the running wheel was removed for 2 weeks. Memory and anxiety were measured in both groups with use of open-field, zero-maze, and novel-objects recognition assays.

Results
At 7 weeks postfracture the mice with no wheel access exhibited hindlimb allodynia and unweighting, anxiety, memory loss, upregulated spinal neuropeptide signaling, and increased hind paw and spinal inflammatory mediator expression, but the postfracture mice allowed to exercise for 4 weeks exhibited none of these changes (n = 12/cohort). When exercise was stopped for 2 weeks after 4 weeks of running, hindlimb allodynia and unweighting were rekindled, and this nociceptive sensitization was associated with increased sciatic nerve neuropeptide levels and hind paw skin interleukin 6 and nerve growth factor expression (n = 12/cohort).

Conclusions
Daily exercise reversed nociceptive sensitization, inflammation, anxiety, and memory loss after tibia fracture.
Impact of the Choice of Risk Model for Identifying Low-risk Patients Using the 2014 American College of Cardiology/American Heart Association Perioperative Guidelines
Authors: Glance Laurent G. , Faden Eric , Dutton Richard P. , Lustik Stewart J. , Li Yue , Eaton Michael P. , Dick Andrew W. 
Published: July 2018

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
The 2014 American College of Cardiology Perioperative Guideline recommends risk stratifying patients scheduled to undergo noncardiac surgery using either: (1) the Revised Cardiac Index; (2) the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator; or (3) the Myocardial Infarction or Cardiac Arrest calculator. The aim of this study is to determine how often these three risk-prediction tools agree on the classification of patients as low risk (less than 1%) of major adverse cardiac event.

Methods
This is a retrospective observational study using a sample of 10,000 patient records. The risk of cardiac complications was calculated for the Revised Cardiac Index and the Myocardial Infarction or Cardiac Arrest models using published coefficients, and for the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator using the publicly available website. The authors used the intraclass correlation coefficient and kappa analysis to quantify the degree of agreement between these three risk-prediction tools.

Results
There is good agreement between the American College of Surgeons National Surgical Quality Improvement Program and Myocardial Infarction or Cardiac Arrest estimates of major adverse cardiac events (intraclass correlation coefficient = 0.68, 95% CI: 0.66 to 0.70), while only poor agreement between (1) American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator and the Revised Cardiac Index (intraclass correlation coefficient = 0.37; 95% CI: 0.34 to 0.40), and (2) Myocardial Infarction or Cardiac Arrest and Revised Cardiac Index (intraclass correlation coefficient = 0.26; 95% CI: 0.23 to 0.30). The three prediction models disagreed 29% of the time on which patients were low risk.

Conclusions
There is wide variability in the predicted risk of cardiac complications using different risk-prediction tools. Including more than one prediction tool in clinical guidelines could lead to differences in decision-making for some patients depending on which risk calculator is used.
Cosmetic and Functional Outcomes of Second Intention Healing for Mohs Defects of the Lips
Authors: Donigan Jessica M. , Millican Eric A. 
Published: July 2018

BACKGROUND
The lips are a common location for skin cancer and thus for Mohs micrographic surgery (MMS). There are few studies looking at second intention healing of Mohs defects of the lips, and none have used a scar assessment scale.

OBJECTIVE
To evaluate the acceptability of second intention healing of the vermilion lips following MMS using a patient questionnaire and the Patient and Observer Assessment Scale (POSAS).

METHODS
Eligible patients were found through chart review. A patient questionnaire and the patient scale of the POSAS were performed over the phone. For patients who were able to come to clinic, the observer scale of the POSAS was performed.

RESULTS
Forty-seven phone interviews and 21 clinic assessments were performed. Overall, patients noted excellent functional outcomes, and good to excellent cosmetic outcomes, and were satisfied with healing time. There was not a significant difference between the patient and observer total scores (p = .63) or overall scores (p = .59).

CONCLUSION
Second intention healing can have satisfactory functional and cosmetic outcomes and healing times with few complications and should be considered for surgical defects on the vermilion lips as large as 2.8 cm2 even when there is involvement of the cutaneous lip and muscular layer.
Fluorescent Detection of Merlin-deficient Schwann Cells and Primary Human Vestibular Schwannoma Cells Using Sodium Fluorescein
Authors: Perez Enrique R. , Bracho Olena , Ein Liliana , Szczupak Mikhaylo , Monje Paula V. , Fernandez-Valle Cristina , Alshaiji Abdulaziz , Ivan Michael , Morcos Jacques , Liu Xue-Zhong , Hoffer Michael , Eshraghi Adrien , Angeli Simon , Telischi Fred , Dinh Christine T. 
Published: July 2018

Hypothesis:
Merlin-deficient Schwann cells (MD-SC) and primary human vestibular schwannoma (VS) cells exhibit selective uptake of sodium-fluorescein (SF), allowing for fluorescent detection and improved visualization of tumor cells, when compared with Schwann cells (SC).

Background:
SF is a fluorescent compound used for fluorescence-guided resection of gliomas. The utility of SF for VS surgery has not been assessed.

Methods:
Mouse MD-SCs and rat SCs were cultured on 96-well plates at different cell densities and treated with SF at several drug concentrations and durations. Relative fluorescence units (RFU) were measured using a fluorometer to determine optimal treatment parameters in vitro. Subsequently, a four-point Likert scale for fluorescence visualization of pelleted cells was created and validated. Blinded observers rated SF-treated primary human VS and SC cultures, which were developed from deidentified specimens obtained from live and cadaveric donors, respectively.

Results:
In contrast to SCs that showed low levels of fluorescence, MD-SCs demonstrated dose-dependent increases in RFUs when treated with incremental dosages of SF as well as longer treatment and fluorescent excitation times. In addition, RFUs were higher at greater MD-SC densities. The Likert scale for fluorescence visualization was validated using nine blinded observers and there were excellent inter- and intrarater reliabilities (intraclass coefficients of 0.989 and >0.858, respectively). Using the Likert scale, human VS treated with SF received higher scores than human SCs (p < 0.001).

Conclusion:
Mouse MD-SC and human VS cells demonstrate preferential uptake of SF when compared with normal primary SCs. Observers detected differences in fluorescence using the validated Likert scale. Further investigations into the utility of SF-guidance in VS surgery are warranted.
Sudden Sensorineural Hearing Loss Predicts Ischemic Stroke: a Longitudinal Follow-Up Study
Authors: Kim So Young , Lim Jae-Sung , Sim Songyong , Choi Hyo Geun 
Published: July 2018

Objectives:
To investigate the risk of stroke in SSNHL patients.

Study Design:
A longitudinal follow-up cohort study.

Setting:
The Korean National Health Insurance Service-National Sample Cohort from 2002 to 2013.

Patients:
The 4,944 SSNHL participants were matched with 19,776 controls for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia. The SSNHL subjects were diagnosed (International Classification of Disease [ICD]-10: H91.2), underwent an audiometry examination, and were treated with steroids. The history of hemorrhagic stroke, ischemic stroke, hypertension, diabetes, dyslipidemia, ischemic heart disease, and depression was investigated based on the ICD-10.

Main Outcome Measures:
The hazard ratios (HRs) for hemorrhagic and ischemic stroke were analyzed using a Cox proportional hazard model. Subgroup analyses were conducted according to age (< 50 vs. ≥ 50 yr old) and sex.

Results:
Participants diagnosed with ischemic stroke included 4.2% of SSNHL subjects and 3.5% of control subjects (p = 0.013). The adjusted HR of SSNHL for ischemic stroke was 1.22 (95% confidence interval [95% CI] = 1.05 – 1.43, p = 0.012). The ≥ 50-year-old male SSNHL subgroup showed 1.40 adjusted HRs for ischemic stroke (95% CI = 1.10 – 1.78, p = 0.006). The rate of hemorrhagic stroke was 0.7% for SSNHL and 0.6% for control subjects. SSNHL did not elevate the risk of hemorrhagic stroke (p = 0.310).

Conclusion:
SSNHL elevated the risk of ischemic stroke in the general population. Older males with SSNHL demonstrated a high risk for ischemic stroke; however, SSNHL did not increase the risk of hemorrhagic stroke.
Clinical and Health System Determinants of Venous Thromboembolism Event Rates After Hip Arthroplasty
Authors: Januel Jean-Marie , Romano Patrick S. , Couris Chantal M. , Hider Phil , Quan Hude , Colin Cyrille , Burnand Bernard , Ghali William A. 
Published: July 2018

Background:Routinely collected hospital data provide increasing opportunities to assess the performance of health care systems. Several factors may, however, influence performance measures and their interpretation between countries.Objective:We compared the occurrence of in-hospital venous thromboembolism (VTE) in patients undergoing hip replacement across 5 countries and explored factors that could explain differences across these countries.Methods:We performed cross-sectional studies independently in 5 countries: Canada; France; New Zealand; the state of California; and Switzerland. We first calculated the proportion of hospital inpatients with at least one deep vein thrombosis (DVT) or pulmonary embolism by using numerator codes from the corresponding Patient Safety Indicator. We then compared estimates from each country against a reference value (benchmark) that displayed the baseline risk of VTE in such patients. Finally, we explored length of stay, number of secondary diagnoses coded, and systematic use of ultrasound to detect DVT as potential factors that could explain between-country differences.Results:The rates of VTE were 0.16% in Canada, 1.41% in France, 0.84% in New Zealand, 0.66% in California, and 0.37% in Switzerland, while the benchmark was 0.58% (95% confidence interval, 0.35–0.81). Factors that could partially explain differences in VTE rates between countries were hospital length of stay, number of secondary diagnoses coded, and proportion of patients who received lower limb ultrasound to screen for DVT systematically before hospital discharge. An exploration of the French data showed that the systematic use of ultrasound may be associated with over detection of DVT but not pulmonary embolism.Conclusions:In-hospital VTE rates after arthroplasty vary widely across countries, and a combination of clinical, data-related, and health system factors explain some of the variations in VTE rates across countries.
Gaze Performance Adjustment During Needlestick Application
Authors: Sanchez Yerly Paola , Wilson-Keates Barbara , Conway Adam , Zheng Bin 
Published: July 2018

Background
Novice health care students suffer more needlestick injuries (NSIs) than experts. NSIs may be prevented by learning experts' behavior during this procedure. Eye tracking offers the possibility to study both experts' and novices' eye behavior during this task.

Purpose
The aim of this study was to offer novel information about the understanding of eye behavior in human errors during handling needles.

Methods
A group of third-year nursing students performed 3 subcutaneous injections in a simulated abdominal pad while their eye behavior was recorded. Similarly, the gaze patterns of experts were recorded and then compared with the novices.

Results
Total task time for experts was faster than that for novices (P < .001), but both groups showed similar accuracy (P = .959). However, novices demonstrated gazing longer at the syringe rather than the abdominal pad compared with experts (P = .009). Finally, experts demonstrated fewer attention switches than novices (P = .002).

Conclusion
Novices demonstrated more tool-tracking eye behaviors with longer dwelling time and attentional switches than did experts, which may translate into errors in clinical performance with needles.
Outcomes of Corticosteroid Treatment for Trigger Finger by Stage
Authors: Shultz Kevin J. , Kittinger Janae L. , Czerwinski Wendy L. , Weber Robert A. 
Published: July 2018

Background:
Although steroid injection remains a common first-line treatment of trigger finger, clinical experience suggests that not all cases of trigger finger respond the same. The purpose of this study was to use a classification system for trigger finger that is simple and reproducible, and produces clearly definable, clinically relevant cutoff points to determine whether responsiveness to steroid injection correlates to clinical staging.

Methods:
The authors conducted a prospectively collected longitudinal study of trigger finger patients separated into four stages of severity. Each subject received a single injection of 6 mg of dexamethasone acetate. One-month outcomes were analyzed to evaluate the efficacy of steroid injection. These outcomes were further stratified based on baseline characteristics and stage of triggering.

Results:
A total of 99 digits and 69 subjects were included. Two variables were found to be significant in predicting response to initial injection: (1) multiple affected digits and (2) stage severity. Patients with multiple involved fingers were 5.8 times more likely to have no resolution of symptoms compared with those with a single affected finger. For every level of stage increase, the odds doubled for having no resolution of symptoms.

Conclusions:
Steroid injection remains a viable first-line option for patients presenting with mild triggering (stage 1 and 2). For more severe triggering (stage 3 and 4) or multiple affected digits, the success of steroid injection is significantly lower at 1 month. For the latter patients, surgery may be a more reasonable initial treatment.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Aesthetic Comparison of Two Different Types of Web-Space Reconstruction for Finger Syndactyly
Authors: Yuan Frank , Zhong Lin , Chung Kevin C. 
Published: July 2018

Background:
Syndactyly reconstruction incorporates techniques of applying skin grafts or dorsal advancement flaps without the use of skin grafts. Comparative outcome studies of these two approaches are lacking. The authors’ study compares the long-term aesthetic outcomes of these two flap techniques.

Methods:
Forty-five patients were included in the authors’ study. The methods of reconstruction used were a dorsally based rectangular flap with skin graft from the groin and a dorsal pentagonal advancement flap without skin grafting. Eighteen independent raters completed a visual analogue scale and a unique classification scale to subjectively assess aesthetic outcomes. The authors used univariate analyses to determine which variables significantly influenced the outcome score. The authors then used multivariable regression models to compare the two flap types.

Results:
Dorsally based rectangular flaps with skin graft had statistically significantly better visual analogue scale scores and greater odds of receiving an “excellent” rating compared with dorsal pentagonal advancement flaps.

Conclusions:
Despite the use of skin grafting, with its associated donor-site morbidity, dorsal rectangular flaps may offer better overall aesthetic outcomes for patients. Future comparative studies should incorporate functional and patient-reported outcomes to better assess the optimal reconstruction type.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.