bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fetal Membrane Inflammation Induces Preterm Birth Via Toll-Like Receptor 2 in Mice With Chronic Gingivitis
Authors: Konishi Haruhisa , Urabe Satoshi , Miyoshi Hiroshi , Teraoka Yuko , Maki Tomoko , Furusho Hisako , Miyauchi Mutsumi , Takata Takashi , Kudo Yoshiki , Kajioka Shunichi 
Published: September 2018

Abstract
Inflammation is associated with preterm birth. We previously described a mouse model of chronic inflammation-induced preterm birth after dental Porphyromonas gingivalis infection. The aim of this study was to employ this model system to investigate the mechanisms through which enhanced uterine contractility induces preterm birth. Messenger RNA (mRNA) encoding contraction-associated proteins, such as oxytocin receptors, was measured at various gestational time points by real-time polymerase chain reaction (PCR). Spontaneous and oxytocin-induced uterine contractile activity at gestational day 18 was assessed using a tissue organ bath. The expression levels of Toll-like receptor 2 (TLR2), TLR4, cyclooxygenase (COX)-2, nuclear factor-kappa B (NF-κB) p65, and p38 mitogen-activated protein kinase (MAPK) on gestational day 18 were also determined by real-time PCR or Western blotting. Messenger RNA encoding contraction-associated proteins was increased at gestational day 18, and the spontaneous contractile activity (1.6-fold greater area under the contraction curve) and sensitivity to oxytocin (EC50: 8.8 nM vs 2.2 nM) were enhanced in the P gingivalis group compared to those in the control group. In the P gingivalis group, COX-2 mRNA expression was not elevated in the placenta or myometrium but was upregulated 2.3-fold in the fetal membrane. The TLR2 mRNA levels in the fetal membrane were 2.7-fold higher in the P gingivalis group, whereas TLR4 levels were not elevated. Activation of the NF-κB p65 and p38 MAPK pathways was enhanced in the fetal membrane of the P gingivalis group. Thus, in mice with chronic dental P gingivalis infection, TLR2-induced inflammation in the fetal membrane leads to upregulation of uterine contractility, leading to preterm birth.
Clinical instructors’ perceptions of virtual reality in health professionals’ cardiopulmonary resuscitation education
Authors: Wong Marie Ann Mae En , Chue Shien , Jong Michelle , Benny Ho Wye Kei , Zary Nabil 
Published: September 2018

Objectives: Cardiopulmonary resuscitation (CPR) is lifesaving. Yet, cardiac arrest survival remains low despite CPR intervention. Education has been highlighted as a strategy to overcome this issue. Virtual Reality technology has been gaining momentum in the field of clinical education. Published studies report benefits of virtual reality for CPR education; yet, perceptions of CPR instructors towards virtual reality remain unexplored. CPR instructors are key stakeholders in CPR education and their perceptions are valuable for the design and adoption of virtual reality-enhanced learning. The purpose of this study is therefore to understand the perceptions of CPR instructors towards using virtual reality for health professionals’ CPR education. The aim was addressed via three research questions: (1) What are the perceptions of CPR instructors towards current health professionals’ CPR education? (2) What are the perceptions of CPR instructors towards features of virtual reality ideal for health professionals’ CPR education? (3) What are the perceptions of CPR instructors towards the potential role of virtual reality in health professionals’ CPR education? Methods: A total of 30 CPR instructors were surveyed on their views towards current health professionals’ CPR education and the use of virtual reality for health professionals’ CPR education, before and after interacting with a CPR virtual reality simulation. Responses were analysed using interpretative thematic analysis. Results: CPR instructors perceived current health professionals’ CPR education as limited due to unideal test preparation (resources, practice, motivation, and frame of mind) and performance. They perceived fidelity, engagement, resource conservation, and memory enhancement as features of virtual reality ideal for health professionals’ CPR education. Virtual reality was viewed by CPR instructors as having potential as a blended learning tool, targeting both ‘novice’ and ‘experienced’ health professionals. Conclusion: The study highlighted the gaps in current health professionals’ CPR education that can be addressed using virtual-reality-enabled learning. Future research could investigate virtual reality simulations with features desirable for CPR education of target populations.
Knowledge mapping of medication literacy study: A visualized analysis using CiteSpace
Authors: Liang Chaocong , Luo Aijing , Zhong Zhuqing 
Published: September 2018

Objective: The objective of this study was to analyze knowledge mapping and demonstrate the status quo, intellectual base, and hotspots in the field of medication literacy. Methods: Using the data from Web of Science Core database, we constructed a knowledge map to visualize medication literacy using CiteSpace, which revealed the power of the studies, core authors and journals, intellectual base, and hotspots in this field. Results: According to an analysis of 2025 literature reports, the stronger studies were mainly conducted at research institutions of higher education in the United States. Core author groups with a higher influence were not identified. The core journals included Patient Educ Couns and Fam Med. The health literacy studies served as the foundation for the medication literacy studies. The keywords formed 13 clusters including 5 major clusters. Conclusion: The topics in medication literacy study focused on instruments assessing medication literacy, measurement and assessment of medication literacy, medication literacy for the prevention of chronic disease and medication treatment adherence, medication literacy education, and family practice. This study provides an insight into medication literacy and valuable information for medication literacy researchers to identify new perspectives on potential collaborators and cooperative institutions and hotspots.
Population health challenges in primary care: What are the unfinished tasks and who should do them?
Authors: North Frederick , Tulledge-Scheitel Sidna M , Matulis John C , Pecina Jennifer L , Franqueira Andrew M , Johnson Sarah S , Chaudhry Rajeev 
Published: September 2018

Background: There are numerous recommendations from expert sources that help guide primary care providers in cancer screening, infectious disease screening, metabolic screening, monitoring of drug levels, and chronic disease management. Little is known about the potential effort needed for a healthcare system to address these recommendations, or the patient effort needed to complete the recommendations. Methods: For 73 recommended population healthcare items, we examined each of 28,742 patients in a primary care internal medicine practice to determine whether they were up-to-date on recommended screening, immunizations, counseling, and chronic disease management goals. We used a rule-based software tool that queries the medical record for diagnoses, dates, laboratory values, pathology reports, and other information used in creating the individualized recommendations. We counted the number of uncompleted recommendations by age groups and examined the healthcare staff needed to address the recommendations and the potential patient effort needed to complete the recommendations. Results: For the 28,742 patients, there were 127,273 uncompleted recommendations identified for population health management (mean recommendations per patient 4.36, standard deviation of 2.65, range of 0–17 recommendations per patient). The age group with the most incomplete recommendations was age of 50–65 years with 5.5 recommendations per patient. The 18–35 years age group had the fewest incomplete recommendations with 2.6 per patient. Across all age groups, initiation of these recommendations required high-level input (physician, nurse practitioner, or physician’s assistant) in 28%. To completely adhere to recommended services, a 1000-patient cross-section cohort would require a total of 464 procedures and 1956 lab tests. Conclusion: Providers and patients face a daunting number of tasks necessary to meet guideline-generated recommendations. We will need new approaches to address the burgeoning numbers of uncompleted recommendations.
Thoracic and paraspinal extramedullary hematopoiesis in a cat with chronic non-regenerative anemia
Authors: Bolfa Pompei , Larson Chris , Peda Andrea , Hilchie David , Christopher Mary M , Thrall Mary Anna 
Published: September 2018

Case summary A 6-year-old neutered male domestic shorthair cat presented with non-regenerative macrocytic anemia of 2 years’ duration and minimally ambulatory paraparesis. Neurologic examination suggested an upper motor neuron paresis or T3–L3 myelopathy. The cat was positive for feline immunodeficiency virus (FIV), neutropenic, had polyclonal gammopathy and was euthanized following a hemolytic crisis. At autopsy, multifocal bilateral dark red masses were observed subpleurally around the costochondral junctions, extradurally and paraspinally in the spinal canal, and paravertebrally, on the lateral and ventral subpleural surfaces of the T4–11 vertebrae. Histologic examination of the masses revealed extramedullary hematopoietic tissue composed primarily of erythroid precursors and megakaryocytes, with occasional myeloid precursors and blood-filled sinuses. Bone marrow findings supported ineffective granulopoiesis, and decreased erythropoiesis and megakaryopoiesis, with probable myelodysplasia as the underlying cause of the hematologic abnormalities. Relevance and novel information Thoracic, paraspinal and paravertebral extramedullary hematopoietis presenting as masses has not been described previously in cats with chronic anemia. This is a unique case of a thoracic–spinal–epidural extramedullary hematopoietic masses resulting in possible spinal cord compression and paraparesis in a cat.
Smallest real differences for robotic measures of upper extremity function after stroke: Implications for tracking recovery
Authors: Zariffa José , Myers Matthew , Coahran Marge , Wang Rosalie H 
Published: September 2018

Introduction Measurements from upper limb rehabilitation robots could guide therapy progression, if a robotic assessment’s measurement error was small enough to detect changes occurring on a time scale of a few days. To guide this determination, this study evaluated the smallest real differences of robotic measures, and of clinical outcome assessments predicted from these measures. Methods A total of nine older chronic stroke survivors took part in 12-week study with an upper-limb end-effector robot. Fourteen robotic measures were extracted, and used to predict Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) scores using multilinear regression. Smallest real differences and intraclass correlation coefficients were computed for the robotic measures and predicted clinical outcomes, using data from seven baseline sessions. Results Smallest real differences of robotic measures ranged from 8.8% to 26.9% of the available range. Smallest real differences of predicted clinical assessments varied widely depending on the regression model (1.3 to 36.2 for FMA-UE, 1.8 to 59.7 for ARAT), and were not strongly related to a model’s predictive performance or to the smallest real differences of the model inputs. Models with acceptable predictive performance as well as low smallest real differences were identified. Conclusions Smallest real difference evaluations suggest that using robotic assessments to guide therapy progression is feasible.
Review of Sickle Cell Disease and Spinal Pathology
Authors: Rudy Hayeem L. , Yang David , Nam Andrew D. , Cho Woojin 
Published: September 2018

Study Design: Sickle cell disease (SCD) is a relatively common blood disorder that has profound implications on the musculoskeletal system and particularly the spine; however, there is a paucity of data in the literature discussing this important topic. Objectives: (1) To elucidate common spinal pathologies affecting patients with SCD, as well as the medical and surgical treatments available for these patients. (2) To discuss indications for surgical management of spinal complications of SCD and important for orthopedic surgeons when taking patients with SCD to the operating room. Methods: A narrative review of the literature was performed. Results: Patients with SCD have a significantly higher risk of developing spinal pathologies including vertebral osteomyelitis, compression fracture, vertebral vaso-occlusive crises, and osteoporosis, among others. In addition, patients with sickle cell disease are particularly susceptible to developing perioperative and post-operative complications including surgical site infection, implant malfunction, and vertebral body compression fracture. Postoperatively patients with SCD are prone to developing complications and adequate hydration is necessary in order to reduce complications of SCD. Conclusions: Several spinal pathologies may arise secondary to SCD and distinguishing these pathologies from one another may be challenging due to similarities in symptoms and inflammatory markers. Although most patients with SCD can benefit from conservative treatment involving rest, symptomatic therapy, antibiotic therapy, and/or orthosis, surgical intervention may be indicated in certain cases. It is preferable to avoid surgery in patients with SCD due to an increased risk of complications such as wound infection and vaso-occlusive crisis.
Everyday executive function and adaptive skills in children and adolescents with autism spectrum disorder: Cross-sectional developmental trajectories
Authors: Kouklari Evangelia-Chrysanthi , Tsermentseli Stella , Monks Claire P 
Published: September 2018

Background and aims The development of Executive Function in Autism Spectrum Disorder has been investigated using mainly performance-based executive function measures. Less is known about the development of everyday executive function skills. The present study aimed to identify the developmental patterns of everyday executive function of children and adolescents with autism spectrum disorder compared to neurotypical controls. The association between executive function and adaptive skills was also investigated. Methods The present study used a cross-sectional developmental trajectory approach and data were collected from 57 children and adolescents with autism spectrum disorder, matched to 63 controls of the same age (7–15 years). Results Results showed age-related performance declines in most everyday executive function domains (e.g. inhibition, working memory, planning) in autism spectrum disorder, whereas for executive function emotional control and shift, non-significant differences emerged across age in autism spectrum disorder. Everyday executive function predicted adaptive skills over and above age and IQ, in participants overall. Conclusions and implications These results suggest that several everyday executive function problems increase in adolescence in autism spectrum disorder and that these everyday executive function developmental patterns deviate to a great extent from those of typical development. Shedding more light on the developmental course of all types of executive function processes as well as their association with crucial social outcomes in autism spectrum disorder could contribute to a better theoretical understanding of the heterogeneity of the neurocognitive development in autism spectrum disorder.
Incidence and Predictive Factors for Prolonged Use of Opioid Medication After Foot and Ankle Surgery
Authors: Ahmad Jamal 
Published: September 2018

Category: Other Introduction/Purpose: The purpose of this study is to evaluate the incidence and factors predictive for patients’ needs for opioid pain medication longer than 2 weeks after orthopaedic foot/ankle surgery in a single surgeon’s practice at a tertiary care center. We hypothesize that the number of patients that require opioids for pain management after 2 weeks post-operatively is low, but certain patient factors may be predictive for those individuals that request these medications at this time period. Methods: This is a prospective study of patients that received orthopaedic foot/ankle surgery between August 2016 and November 2017 by a single surgeon. Inclusion criteria involved surgical patients lacking chronic use of opioids. Patients regularly taking opioids pre-operatively were excluded from this study. Patients’ charts were reviewed for their age, weight, and medical co-morbidities. The diagnosis and procedure(s) that each patient received was recorded. Postoperatively, all patients received 60 tablets of opioids for one to be taken every 6 hours as needed for pain within 2 weeks from surgery. Every patient’s postsurgical course was examined for those that asked for and received opioids after 2 weeks from surgery. This event was defined as prolonged post-operative use of opioids. Results: Of 285 opioid-naïve patients that enrolled in this study and received foot/ankle surgery, 35 (12.3%) asked for and received opioids after 2 weeks from surgery. Three of these 35 patients asked for and received opioids after 4 weeks from surgery. No patients asked for and received opioids after 4 weeks from surgery. Age and anatomical location of surgery were not significantly prognostic for a post-surgical wound complication (P>0.05). Those patients of female gender, morbid obesity, and psychiatric conditions such as anxiety and depression were significantly predictive of requesting opioids after 2 weeks from surgery (P<0.05). Those individuals that received revision foot and/or ankle surgery trended towards a higher likelihood of requesting opioids after 2 weeks from surgery (P<0.15). Conclusion: This study demonstrates that the number of patients that require prolonged post-operative use of opioid medicine after orthopaedic foot and/or ankle surgery is low. However, this research shows that female patients with certain medical conditions such as morbid obesity and psychiatric illness are significantly likely to request opioids after 2 weeks from surgery. This is highly important when providing patients with realistic expectations of pain from foot/ankle surgery and the effectiveness and duration of opioids that help treat such pain.
PROMS and Radiological Outcomes in Mobile Bearing Total Ankle Arthroplasty for Patients with Varus or Valgus Deformity
Authors: Allport Jack , Bennett Adam , Ramaskandhan Jayasree , Siddique Malik 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: There is increasing evidence that outcomes for total ankle arthroplasty (TAA) are not adversely affected by pre-operative varus deformity. There is a sparsity of evidence relating to outcomes in valgus ankle arthritis. We present our outcomes using a mobile bearing prosthesis (Mobility TAA system, DePuy, Raynham, Massachusetts, USA) with a comparison of neutral, varus and valgus ankles. Methods: This is a single surgeon, retrospective cohort study of consecutive cases. Cases were identified from a locally held joint registry which routinely records PROMS data pre-operatively and at annual intervals. Patients undergoing primary TAA between March 2006 and June 2014 were included. Rrevision procedures along with those with inadequate radiographic images for deformity analysis were excluded. Patients with inadequate PROMS data were included in the radiological analysis but not the PROMS analysis. Data collected included FAOS (Womac Pain, Function and Stiffness), SF-36 scores and patient satisfaction. Radiological data was gathered from routinely taken AP weight bearing radiographs pre-operatively, immediately post-operatively and at final follow up. Pre-operative deformity was measured between the tibial anatomical axis and a line perpendicular to the talus. Patients were classified as neutral, varus (≥10 degrees varus) or valgus (≥10 degrees valgus). Results: 230 cases (see image) underwent radiological classification (152 neutral, 60 varus, 18 valgus) and were included in the radiological analysis (mean follow-up 55.9 months). 164 cases were included in the PROMS analysis (mean follow-up 61.6 months). The groups were similar with regards to BMI and length of follow-up but neutral ankles were younger (P<0.001). Baseline scores were equal except physical health with valgus ankles scoring lowest (P=0.045). Valgus ankles had statistically better post-operative pain (P=0.0247) and function (P=0.012) than neutral ankles. Pre to post-operative change did not reach statistical significance except physical health where valgus outperformed neutral and varus (p=0.039). Mean post-operative angle was 3.1 and final angle 3.7 with no significant differences. There was no significant differences in revision rates. Conclusion: Our study confirms previous evidence that varus deformity does not affect outcome in TAA. Contrary to this, valgus ankles in our cohort performed better post-operatively than neutral ankles. Post-operative coronal radiological alignment was not affected by pre-operative deformity and was maintained over a number of years. Coronal plane deformity does not negatively impact either radiological or clinical outcomes in TAA should not be considered an absolute contra-indication.
Intraoperative Radiographic Assessment of Ankle Prosthesis Alignment
Authors: Barg Alexej , Weinberg Maxwell , Saltzman Charles 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: In the last 2 decades, total ankle replacement (TAR) has gained greater acceptance as a treatment option for patients with end-stage ankle osteoarthritis. However, TAR still has a higher failure rate than either hip or knee replacements. One of the most common reasons for TAR failure is malalignment of the prosthesis component which accounts for 15% of all failures. The purpose of this study was to assess ankle prosthesis alignment using intraoperative fluoroscopy images and to compare the results with postoperative weightbearing radiographs. Methods: Sixty-eight primary TARs were performed using the Zimmer trabecular metal implant (37 men and 31 women, mean age of 67.7±8.2 years) from October 2012 to August 2017. Alpha and beta angles were used to assess the alignment of the tibial component in the coronal and sagittal plane, respectively. Gamma angle was used to assess the alignment of the talar component in the sagittal plane. All measurements were performed by two observers (ICC 0.787-0.984). One observer evaluated all images twice at a 6-week interval to determine the intraobserver reliability (ICC 0.858-0.986). Results: There were significant differences between intraoperative and postoperative assessment for all three angles. For the alpha angle, the mean absolute difference was 1.8º±1.5º with a range between 0º and 6º (p = 0.001). For the beta angle, the mean absolute difference was 2.1º±1.5º with a range between 0º and 7º (p = 0.034). For gamma angle, the mean absolute difference was 2.0º±1.5º with a range between 0º and 6º (p = 0.002). The Pearson coefficient for the alpha, beta, and gamma angle was 0.664 (p < 0.001), 0.852 (p < 0.001), and 0.928 (p < 0.001), respectively. Conclusion: In the present study, radiographic assessment of the prosthesis’ component alignment demonstrated significant differences up to 7 degrees. This can be partially explained by the lack of a standardized radiographic technique to obtain fluoroscopic images, difficult identification of anatomic landmarks for intraoperative measurements, and distortion of x-rays using fluoroscopy.