bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age-Related Alterations in Gait Function in Freely Moving Male C57BL/6 Mice: Translational Relevance of Decreased Cadence and Increased Gait Variability
Authors: Tarantini Stefano , Yabluchanskiy Andriy , Fülöp Gábor A , Kiss Tamas , Perz Aleksandra , O’Connor Daniel , Johnson Emily , Sorond Farzaneh , Ungvari Zoltan I , Csiszar Anna 
Published: November 2018

Abstract
Age-related gait dysfunction and balance disorders are a major cause of falls and injury in the elderly population. Epidemiological studies have shown that disturbances in gait coordination which manifest with age are associated with increased morbidity and mortality, impaired cognitive capacity, as well as reduced level of function and loss of independence. In geroscience, mice are the most frequently used model system to test efficiency of antiaging interventions. Despite the clinical importance of age-related gait abnormalities in older adults, the impact of aging on mouse gait coordination is not well documented in the literature. To characterize the effect of aging on mouse gait, we assessed gait function in young (3-month-old) and aged (24-month-old) freely moving C57BL/6 mice using the semiautomated, highly sensitive CatWalk XT system for quantitative assessment of footfall and motor performance. We found that aged mice exhibited significantly decreased cadence and increased stride time variability. Aging also tended to alter footfall patterns. In aged mice, speed, swing speed, stride length, duty cycle, base of support, terminal dual stance, the regularity index, and the gait symmetry index were unaltered. Thus, aging is associated with characteristic alterations in gait function in C57BL/6 mice, which could potentially be assessed as clinically relevant endpoints in geroscience studies testing the effects of antiaging interventions.
Mean and variance of greenness and pregnancy outcomes in Tel Aviv during 2000–14: longitudinal and cross-sectional approaches
Authors: Agay-Shay Keren , Michael Yaron , Basagaña Xavier , Martínez-Solanas Èrica , Broday David , Lensky Itamar M , Rudolf Mary , Rubin Lisa , Kent Rafi , Levy Nadav , Haklai Ziona , Grotto Itamar 
Published: November 2018

Abstract

Background
Natural environments may have beneficial impacts on pregnancy outcomes. However, longitudinal evidence is limited and the associations with variance in surrounding greenness is unknown. Our objective was to evaluate these associations among 73 221 live births in Tel Aviv, Israel.

Methods
Longitudinal exposure to mean of greenness during pregnancy and trimesters were calculated using satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS) Normalised Difference Vegetation Index (NDVI) data. In addition, exposure to mean and variation of NDVI from high-resolution satellite and percentage of tree cover [Vegetation Continuous Fields (VCF)] at 300-m buffer were evaluated in a cross-sectional approach. Generalized linear models were used to estimate the crude and adjusted associations. We explore the possible mediating role of ambient exposures and distance to ‘outdoor gyms’ located in parks.

Results
Crude beneficial associations between exposure to higher mean NDVI during pregnancy and pregnancy outcomes were observed [for birthweight, 3rd/1st tertile exposure increased the mean by 25.5 g, 95% confidence intervals (CIs): 15.4, 35.5] and decreased the odds of low birthweight, small for gestational age, preterm deliveries (PTD) and very PTD. Adjustment for individual and neighbourhood-level markers of socio-economic status (SES) attenuated all the associations. Strongest associations were observed during the first and second trimesters. Cross-sectional associations for mean greenness were similar with narrower CIs, and associations with NDVI were stronger than with tree cover and stronger for mean compared with variance of greenness. Associations were consistent for term births, different buffer sizes and for further adjustment to maternal education. Stronger associations were observed for lowest SES. Distance to ‘outdoor gyms’ and variance of greenness had the largest estimates of mediation.

Conclusion
This study adds to the limited information on when exposure to greenness is most beneficial, on the association with variance of greenness and the possible pathways. These observations require confirmation in other populations.
Comparative Efficacy of Artemether-Lumefantrine and Dihydroartemisinin-Piperaquine for the Treatment of Uncomplicated Malaria in Ugandan Children
Authors: Yeka Adoke , Wallender Erika , Mulebeke Ronald , Kibuuka Afizi , Kigozi Ruth , Bosco Agaba , Kyambadde Paul , Opigo Jimmy , Kalyesubula Simeon , Senzoga Joseph , Vinden Joanna , Conrad Melissa , Rosenthal Philip J 
Published: November 2018

Abstract

Background
In Uganda, artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DHA-PQ) showed excellent treatment efficacy for uncomplicated malaria in prior trials. Because the frequency of resistance to artemisinins and piperaquine is increasing in Southeast Asia and the prevalence of Plasmodium falciparum polymorphisms associated with resistance has changed, we reassessed treatment efficacies at 3 sites in Uganda.

Methods
For this randomized, single-blinded clinical trial, children aged 6–59 months with uncomplicated falciparum malaria were assigned treatment with AL or DHA-PQ and followed for 42 days. Primary end points were risks of recurrent parasitemia, either unadjusted or adjusted to distinguish recrudescence from new infection. We assessed selection by study regimens of relevant P. falciparum genetic polymorphisms associated with drug resistance.

Results
Of 599 patients enrolled, 578 completed follow-up. There were no early treatment failures. The risk of recurrent parasitemia was lower with DHA-PQ as compared to AL at all 3 sites at 42 days (26.0% vs 47.0%; P &lt; .001). Recrudescent infections were uncommon in both the DHA-PQ and AL arms (1.1% and 2.2%, respectively; P = .25). Neither regimen selected for pfcrt or pfmdr1 polymorphisms associated with drug resistance.

Conclusions
AL and DHA-PQ remain effective for the treatment of malaria in Uganda. Neither regimen selected for genetic polymorphisms associated with drug resistance.

Clinical Trials Registration
ISRCTN15793046.
Modeling Zika Virus-Associated Birth Defects in Nonhuman Primates
Authors: Mohr Emma L 
Published: November 2018

AbstractIn utero infection with Zika virus (ZIKV) during pregnancy can lead to the development of birth defects and postnatal deficits. A nonhuman primate (NHP) model of congenital ZIKV infection can help fill the gaps in knowledge where tissue studies are required to define viral pathogenesis and identify targets for therapeutic intervention. This model system has already identified critical features of ZIKV pathogenesis in congenital infection. Before translating these NHP studies to human clinical trials, we must understand the similarities and differences between human and NHP fetal immune system development, neural development, and infant assessment tools. Because of the overall similarity between fetal and infant development in humans and NHPs, this NHP model can complement human clinical trials by defining immune correlates of protection and evaluating therapeutic interventions.
What is the Responsibility of Australian Medical Professionals Whose Patients Travel Abroad for Assisted Reproduction?
Authors: Millbank Jenni 
Published: November 2018

Abstract
Australian medical professionals whose patients undertake assisted reproductive treatment abroad face a conflict: to try to provide optimal and on-going care for their patient at the same time as ensuring compliance with Australian legal, ethical, and professional rules which proscribe as unsafe or unethical key aspects of such treatment.
A major suggestion from literature on medical travel is that risks to the patient can be mitigated through the involvement of the local professional. However, the force of legal regulation and ethical guidance in Australia strenuously directs clinicians away from involvement in overseas reproductive treatment.
This article reports on 37 interviews with Australians travelling abroad for surrogacy, egg donation, and embryo donation, reflecting on patients’ experiences with Australian medical professionals both before and after they travelled. Patient reports demonstrate a fragmented and bewildering medical landscape in Australia, in which the ability to access domestic care and expertise varied markedly depending upon the kind of treatment patients were seeking abroad, and the mode of practice of the Australian doctor. Doctors practicing within licensed IVF clinics were notably more constrained than those outside such a setting. Patients seeking egg donation were offered information and received a wide range of diagnostic and preparatory treatments, while those seeking surrogacy were shunned, chided and offered limited (and sometimes covert) assistance.
While recent changes to national ethical guidance improve clarity on information giving, the ethical and legal propriety of Australian medical professionals providing diagnostic or preparatory treatment for cross border reproduction remains uncertain.
Adjustment of the multi-biomarker disease activity score to account for age, sex and adiposity in patients with rheumatoid arthritis
Authors: Curtis Jeffrey R , Flake Darl D , Weinblatt Michael E , Shadick Nancy A , Østergaard Mikkel , Hetland Merete Lund , Brahe Cecilie Heegaard , Hwang Yong Gil , Furst Daniel E , Strand Vibeke , Etzel Carol J , Pappas Dimitrios A , Wang Xingbin , Hwang Ching Chang , Sasso Eric H , Gutin Alexander , Hitraya Elena , Lanchbury Jerry S 
Published: November 2018

Abstract

Objective
To develop and evaluate an adjusted score for the multi-biomarker disease activity (MBDA) test to account for the effects of age, sex and adiposity in patients with RA.

Methods
Two models were developed to adjust MBDA score for age, sex and adiposity, using either serum leptin concentration or BMI as proxies for adiposity. Two cohorts were studied. A cohort of 325 781 RA patients who had undergone commercial MBDA testing and had data for age, sex and serum leptin concentration was used for both models. A cohort of 1411 patients from five studies/registries with BMI data was used only for the BMI-adjusted MBDA score. Univariate and multivariate linear regression analyses evaluated the adjusted MBDA scores and conventional clinical measures as predictors of radiographic progression, assessed in terms of modified total Sharp score (ΔmTSS).

Results
Two models were developed, based on findings that MBDA score was higher in females than males and increased with age, leptin concentration and BMI. In pairwise regression analyses, the leptin-adjusted (P = 0.00066) and BMI-adjusted (P = 0.0027) MBDA scores were significant independent predictors of ΔmTSS after adjusting for DAS28-CRP, whereas DAS28-CRP was not, after adjusting for leptin-adjusted (P = 0.74) or BMI-adjusted (P = 0.87) MBDA score. Moreover, the leptin-adjusted MBDA score was a significant predictor of ΔmTSS after adjusting for the BMI-adjusted MBDA score (P = 0.025) or the original MBDA score (0.027), whereas the opposite was not true.

Conclusion
Leptin-adjusted MBDA score significantly adds information to DAS28-CRP and the original MBDA score in predicting radiographic progression. It may offer improved clinical utility for personalized management of RA.
Implementation of a Central Line Maintenance Bundle for Dislodgement and Infection Prevention in the NICU
Authors: Short Kira L. 
Published: November 2018

Background:
Infants in the newborn intensive care unit (NICU) often receive medications or nutritional support for extended periods. Due to the fragility of veins, central lines are often used. Adverse outcomes from central lines such as infections and line dislodgements, where the line terminates in a peripheral vessel rather than centrally, can drastically increase infant morbidity and mortality. Although evidence exists addressing the specialized needs of premature or smaller infants, there is far less evidence regarding infants that are larger, more physiologically complex, and have longer stays.

Purpose:
Using evidence-based practice strategies, we examined the literature for central line maintenance practices specific to the NICU population and created a care maintenance bundle to reduce infection and line dislodgement rates. Furthermore, we examined implementation of this bundle.

Methods/Search Strategy:
A systematic search of PubMed, Cochrane Library, and CINAHL provided evidence for a practice change for central line maintenance for our nontunneled central lines. During project implementation, infection and dislodgement rates for both tunneled and nontunneled lines were examined in order have a control and intervention group.

Findings/Results:
Prior to central line maintenance bundle implementation, there were 19 total incidences of central line dislodgements and 5 central line infections (14 dislodgements and 4 infections were from nontunneled lines, 5 dislodgements and 1 infection from a tunneled line). Postintervention there were 1 total dislodgement and 4 central line infections (the dislodgement was from a nontunneled line and all infections were from tunneled lines).

Implications for Practice:
Although research has shown frequent, scheduled dressing changes using the chlorhexidine patch decreases infection rates, the risk of dislodgement and skin breakdown for NICU infants outweighs the potential benefit of decreased infection.

Implications for Research:
Further research is needed to determine whether this central line maintenance bundle would be beneficial for tunneled central lines.
Optimization of Casting in Early-onset Scoliosis
Authors: Fedorak Graham T. , Stasikelis Peter J. , Carpenter Ashley M. , Nielson Alexandra N. , D’Astous Jacques L. 
Published: November 2018

Background:
Early-onset scoliosis is a spine deformity that presents before the age of 3 years. When compared with age-matched controls, children with the condition are known to be at risk for significant morbidity and mortality. Although many works support the use of casting for this condition, the key technical factors to optimize the outcomes of casting are not clear. This work was designed to evaluate the role of frequency of radiographic imaging and over the shoulder straps in the outcomes of casting.

Methods:
Two surgeons at 2 centers followed nearly identical protocols for applying casts for early-onset scoliosis. At center A, the surgeon hoped to improve outcomes by obtaining radiographs after each cast and by reinforcing the cast with shoulder straps. At center B, the surgeon did not use shoulder straps and limited radiographs to once every 6 months. Children were included if they were 3 years or below of age and had a curve of ≥50 degrees at the time of the first cast and had a minimum of 3 years of follow-up. Center was used as a variable in a multivariable regression that also included: age at first cast, initial curve magnitude, and presence of a syrinx or genetic syndrome with the outcome of curve resolution.

Results:
There were 40 children at center A, 9 of whom experienced resolution of their scoliosis. There were 36 children at center B, and 11 demonstrated scoliosis resolution. At center A, 2 of 10 children with a syrinx or genetic syndrome demonstrated curve resolution while 7 of 30 without these comorbidities did. At center B 3 of 10 children with a syrinx or genetic syndrome had curve resolution while 8 of 26 children without these comorbidities did.

Conclusions:
The children in group A demonstrated results very similar to the children of group B. Thus, the extra burden of shoulder straps and frequent radiographs are unnecessary.

Level of Evidence:
Level III.
Effect of Prosthesis Width and Depth on Heterotopic Ossification After Cervical Disc Arthroplasty
Authors: Zeng Junfeng , Liu Hao , Chen Hua , Rong Xin , Meng Yang , Yang Yi , Deng Yuxiao , Ding Chen 
Published: November 2018

Study Design.
Retrospective analysis.

Objective.
To investigate the effect of width and depth of the inserted cervical disc prosthesis on heterotopic ossification (HO) after cervical disc arthroplasty, and to explore the relationship between clinical outcome and HO.

Summary of Background Data.
The mechanism of HO formation still remains unknown. Footprint mismatch of cervical disc prosthesis was common in cervical arthroplasty. Compared with endplate, some inserted prostheses were smaller in width and length.

Methods.
Retrospectively analyze the patients who underwent cervical disc arthroplasty with Prestige-LP Disc in our institute. Patients were divided into HO group or non-HO group according to the McAfee classification. The ratios of the width (Rw) and depth (Rd) of prosthesis to endplate were calculated. Radiographic and clinical assessments included: C2–7 angle, segmental angle, range of motion (ROM) of the index level, visual analogue scale, neck disability index, and Japanese orthopaedic association scores.

Results.
The mean follow-up time was 47.7 months. At the last follow-up, the overall incidence of HO was 34.3% (35/102). There were 35 patients in the HO-group, and 67 patients in the non-HO group. The overall Rw and Rd were 0.887 ± 0.057 and 0.927 ± 0.048, respectively. Both the Rw and Rd of HO-group were smaller than those of non-HO group (0.869 vs. 0.897, P = 0.033; 0.888 vs. 0.948, P < 0.001). There were no significant differences in visual analogue scale, neck disability index, or Japanese orthopaedic association scores, C2-7 angle, or segmental angle between the two groups. But the HO group had less ROM of the index level than the non-HO group (5.3° vs. 9.0°).

Conclusion.
Some of prosthesis had insufficient coverage to the endplate in width and depth. Insufficient coverage of endplate in width and depth may induce the formation of HO. HO could reduce the ROM of the index level, but did not influence the clinical outcome.

Level of Evidence: 3
Longer Preoperative Duration of Symptoms Negatively Affects Health-related Quality of Life After Surgery for Cervical Radiculopathy
Authors: Tarazona Daniel , Boody Barrett , Hilibrand Alan S. , Stull Justin , Bell Kerri , Fang Taolin , Goyal Dhruv , Galetta Matthew , Kaye David , Kepler Christopher K. , Kurd Mark F. , Woods Barrett I. , Radcliff Kris E. , Rihn Jeffery A. , Anderson David Greg , Vaccaro Alexander R. , Schroeder Gregory D. 
Published: November 2018

Study Design.
Retrospective cohort.

Objective.
Determine the effect of duration of symptoms (DOS) on health-related quality of life (HRQOL) outcomes for patients with cervical radiculopathy.

Summary of Background Data.
The effect of DOS has not been extensively evaluated for cervical radiculopathy.

Methods.
A retrospective analysis of patients who underwent an anterior cervical decompression and fusion for radiculopathy was performed. Patients were grouped based on DOS of less than 6 months, 6 months to 2 years, and more than 2 years and HRQOL outcomes were evaluated.

Results.
A total of 216 patients were included with a mean follow-up of 16.0 months. There were 86, 61, and 69 patients with symptoms for less than 6 months, 6 months to 2 years, and more than 2 years, respectively. No difference in the absolute postoperative score of the patient reported outcomes was identified between the cohorts. However, in the multivariate analysis, radiculopathy for more than 2 years predicted lower postoperative Short Form-12 Physical Component Score (P = 0.037) and Short Form-12 Mental Component Score (P = 0.029), and higher postoperative Neck Disability Index (P = 0.003), neck pain (P = 0.001), and arm pain (P = 0.004) than radiculopathy for less than 6 months. Furthermore, the recovery ratios for patients with symptoms for less than 6 months demonstrated a greater improvement in NDI, neck pain, and arm pain than for 6 months to 2 years (P = 0.041; 0.005; 0.044) and more than 2 years (P = 0.016; 0.014; 0.002), respectively.

Conclusion.
Patients benefit from spine surgery for cervical radiculopathy at all time points, and the absolute postoperative score for the patient reported outcomes did not vary based on the duration of symptoms; however, the regression analysis clearly identified symptoms for more than 2 years as a predictor of worse outcomes, and the recovery ratio was statistically significantly improved in patients who underwent surgery within 6 months of the onset of symptoms.

Level of Evidence: 3
Treatment for Frailty Does Not Improve Complication Rates in Corrective Surgery for Adult Spinal Deformity
Authors: Yagi Mitsuru , Michikawa Takehiro , Hosogane Naobumi , Fujita Nobuyuki , Okada Eijiro , Suzuki Satoshi , Tsuji Osahiko , Nagoshi Narihito , Asazuma Takashi , Tsuji Takashi , Nakamura Masaya , Matsumoto Morio , Watanabe Kota 
Published: November 2018

Study Design.
A retrospective multicenter database review of 240 consecutive patients at least 21 years of age (mean 58 ± 17, range 22–79) who underwent surgery for adult spinal deformity (ASD) and were followed at least 2 years.

Objective.
To investigate how treatment for frailty affects complications in surgery for ASD.

Summary of Background Data.
Several recent studies have focused on associations between frailty and surgical complications. However, it is not clear whether treating frailty affects complication rates in surgery for ASD.

Methods.
Patients were categorized as robust (R group), prefrail, or frail based on the modified frailty index (mFI); prefrail and frail patients were divided by good control of frailty (G group), defined as treatment following the appropriate guidelines for each mFI factor, or poorly controlled frailty (PC group). We compared clinical outcomes and perioperative and 2-year complications between the three groups.

Results.
Of the 240 patients, 142 (59%) were robust, 81 (34%) were prefrail, and 17 (7%) were frail. Among the frail and prefrail patients, 71 (72%) were classified as G and 27 (28%) as PC. The perioperative complication rate was similar in the G and PC groups (32% vs. 37%) but was significantly lower in the R group (15%, P < 0.01). The age- and sex-adjusted odds ratio for 2-year complications was not different in the P group when the G group was referenced (odds ratio 1.3 [0.5–3.2], P = 0.63). In the G and PC groups, which had similar 2-year outcomes, the Scoliosis Research Society-22 function and total scores were significantly lower than in the R group (function: R 3.9 ± 0.7, G 3.5 ± 0.7, P 3.3 ± 0.6; total: R 3.9 ± 0.6, 3.7 ± 0.7, 3.4 ± 0.6; P < 0.01).

Conclusion.
Regardless of its treatment status, frailty increases the risk of complications and inferior clinical outcomes in ASD surgery. Surgeons should routinely evaluate frailty and inform patients of frailty-related risks when considering surgery for ASD.

Level of Evidence: 4