bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Associated with Insulin Resistance in Women with Migraine: A Cross-Sectional Study
Authors: Gur-Ozmen Selen , Karahan-Ozcan Ruhan 
Published: February 2019

AbstractObjectiveStudies have shown a relationship between insulin resistance (IR) and migraine that is more evident in some migraineurs. Long-term use of various drugs and increased risk of diverse side effects is an unavoidable reality in this population of patients. Thus, in this study, we aimed to investigate factors associated with IR in migraine and the impact of chronic usage of various drugs, which might play a part in development of IR.DesignCross-sectional study.SettingGebze Fatih General Hospital, Kocaeli, Turkey.SubjectsMigraine patients (N = 150) were investigated.MethodsWeight, height, waist circumference, and blood pressure were measured. Fasting glucose, fasting insulin, glycated hemoglobin, and lipid profile were also measured. IR was selected as a dependent variable. The independent variables included age, cigarette smoking, alcohol consumption, family history of migraine, diabetes mellitus and hypertension, characteristics of pain, migraine triggers and subgroups, medication used during attack treatment, medication used as prophylactic treatment, and oral contraceptive treatment. Descriptive analysis and multivariate logistic regression were performed.ResultsCentral obesity (odds ratio [OR] = 7.131, 95% confidence interval [CI] = 2.451–20.741, P < 0.0001), metoclopramide treatment during an attack (OR = 3.645, 95% CI = 0.996–13.346, P = 0.041), family history of DM (OR = 3.109, 95% CI = 1.189–8.132, P = 0.035), nonsteroidal anti-inflammatory drug (NSAID) usage during an attack (OR = 2.578, 95% CI = 1.053–6.311, P = 0.043), and negative family history of hypertension (OR = 0.226, 95% CI = 0.085–0.602, P = 0.002) were significant factors for exhibiting IR in migraine.ConclusionsOur study demonstrates an association between metoclopramide and NSAID treatments and IR in migraine.
Incorporating the latest pediatric nutrition support guidelines into clinical practice
Authors: Irving Sharon Y. , Guenter Peggi , Mehta Nilesh M. 
Published: February 2019

Abstract:
Optimal nutrition support in critically ill children is associated with improved outcomes and decreased mortality. Nutrition provision often competes with other care priorities in critically ill patients. The 2017 Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient supplement clinician knowledge and inform best practices for nutrition therapy in this vulnerable patient population.
Glucose and Lactate Concentrations in Cerebrospinal Fluid After Traumatic Brain Injury
Authors: Lozano Angels , Franchi Federico , Seastres Ramon J. , Oddo Mauro , Lheureux Olivier , Badenes Rafael , Scolletta Sabino , Vincent Jean-Louis , Creteur Jacques , Taccone Fabio S. 
Published: February 2019

Background:
Studies in which brain metabolism has been monitored using microdialysis have indicated decreases in cerebral glucose concentration and increases in lactate concentration in patients with traumatic brain injury (TBI). However, few data are available on glucose and lactate concentrations in the cerebrospinal fluid (CSF) of TBI patients. This study investigates the relationship between CSF glucose and lactate concentrations and outcomes after TBI.

Methods:
Consecutive adult (>18 y) TBI patients were admitted to our 35-bed medicosurgical between 2011 and 2014 and were included in the study if they met the following inclusion criteria: presence of an external ventricular drain (EVD) for intracranial pressure monitoring, daily analysis of CSF glucose and lactate concentrations for 4 consecutive days, and concomitant measurements of blood glucose/lactate concentrations. Neurological outcome was assessed at 3 months using the extended Glasgow Outcome Scale (GOS), and unfavorable outcome defined as a GOS 1 to 4.

Results:
Of 151 TBI patients who had an EVD, 56 met the inclusion criteria. Most EVDs were placed on the day of intensive care unit admission, and maintained for 10 (interquartile range: 6 to 14) days. On day 1, there was a weak but significant correlation between blood and CSF glucose concentrations (R
2=0.07, P=0.04), and a greater correlation between blood and CSF lactate (R
2=0.32, P<0.001). In multivariable analysis, day 1 CSF glucose/lactate ratio was independently associated with mortality (odds ratio: 0.22, 95% confidence interval: 0.08-0.61; P=0.003), and day 1 CSF lactate concentration with unfavorable outcome (odds ratio: 4.86; 95% confidence interval: 1.86-12.67; P=0.001).

Conclusions:
Low CSF glucose/lactate ratio is observed in nonsurvivors after severe TBI and may have prognostic value.
The Impact of Cervical Spinal Muscle Degeneration on Cervical Sagittal Balance and Spinal Degenerative Disorders
Authors: Tamai Koji , Grisdela Phillip , Romanu Joshua , Paholpak Permsak , Nakamura Hiroaki , Wang Jeffrey C. , Buser Zorica 
Published: February 2019

Study Design:
This is a retrospective analysis of kinematic magnetic resonance images (kMRI).

Objective:
To assess the association of cervical paraspinal muscle with cervical sagittal balance and degenerative spinal disorders.

Summary of Background Data:
Although the effects of spinal disorders and cervical imbalance on patient’s symptoms have been well described, the relationship of the cervical muscle quality and volume to cervical imbalance or spinal disorders is not well established.

Materials and Methods:
In total, 100 kMRI taken in a neutral weight-bearing position were analyzed. The adjusted cross-sectional area ratio (aCSA ratio: the value of muscle CSA divided by the vertebral CSA) and fat infiltration ratio of the transversospinalis muscles at C4 and C7 vertebral levels were measured using axial slice of kMRI. The correlation with cervical balance parameters [Oc–C2 angle, C2–C7 angle, C7–T1 angle, C7 slope, T1 slope, cranial tilt, cervical tilt, thoracic inlet angle (TIA), and neck tilt] and cervical degenerative disorders (disk degeneration, Modic change, and spondylolisthesis) were evaluated.

Results:
The aCSA ratio at C4 correlated with C2–C7 angle (r=0.267), C7 slope (r=0.207), T1 slope (r=0.221), disk degeneration at C3–4, C4–5, C5–6 (r=−0.234, −0.313, −0.262) and spondylolisthesis at C3 (anterior: r=−0.206, posterior: r=−0.249). The aCSA ratio at C7 correlated with disk degeneration at C3–4, C4–5, C5–6, C6–7 (r=−0.209, −0.294, −0.239, −0.209). The fat infiltration ratio at C4 correlated with TIA (r=0.306) and neck tilt (r=0.353), likewise the ratio at C7 correlated with TIA (r=0.270) and neck tilt (r=0.405). All correlations above were statistically significant with P<0.05.

Conclusions:
The paraspinal muscle volume showed significant relationship with the cervical balance parameters and disk degeneration. While, paraspinal muscle quality related to the thoracic inlet parameters. Our findings can be an important step to develop the knowledge of the association between cervical muscle and cervical degenerative disorders, as well as the sagittal balance of the cervical spine.

Level of Evidence:
Level III.
Comparison Between Stable Sagittal Vertebra and First Lordotic Vertebra Instrumentation for Prevention of Distal Junctional Kyphosis in Scheuermann Disease
Authors: Gong Yining , Yuan Lei , He Miao , Yu Miao , Zeng Yan , Liu Xiaoguang , Chen Zhongqiang 
Published: February 2019

Study Design:
This study was a systematic review and meta-analysis.

Objectives:
To compare stable sagittal vertebra (SSV) and first lordotic vertebra (FLV) instrumentation for prevention of distal junctional kyphosis (DJK) in Scheuermann disease.

Summary of Background Data:
The SSV has been increasingly chosen as the lowest instrumented vertebra to prevent DJK, and some studies have provided supportive results. However, other studies demonstrate that lowest instrumented vertebra located in the FLV has similar DJK incidence with the benefit of saving levels.

Materials and Methods:
Electronic searches of PubMed, Embase, the Cochrane Database, and Web of Science were performed. Radiographic parameters, incidence of DJK, and revision surgery rates were compared between SSV and FLV groups. The odds ratio (OR) was used to identify differences between the groups and P<0.05 was considered statistically significant.

Results:
Four studies with a total of 173 patients were included. There were no differences between the SSV and FLV groups in most radiographic parameters. The incidence of DJK among 173 patients was 20.8% (36/173). The SSV group demonstrated a significantly lower DJK rate than the FLV group (OR, 0.11; 95% confidence interval, 0.04–0.30; P<0.0001; I
2=39%). In this study, 5.9% (5/85) of the SSV group and 43.6% (24/55) of the FLV group developed DJK; 27.8% (10/36) who developed DJK underwent revision surgery, including 25.0% (6/24) in the FLV group and 40.0% (2/5) in the SSV group. The revision surgery rate was lower in the FLV group than in the SSV group, with no statistical difference (OR, 3.27; 95% confidence interval, 0.26–41.73; P=0.36; I
2=0%).

Conclusions:
The overall DJK rate in Scheuermann disease was 20.8%, and 27.8% of DJK patients needed revision surgery. A distal fusion level including the SSV demonstrated a significantly lower DJK rate.
Closing the Gap: Experienced Simulation Educators' Role and Impact on Everyday Health care
Authors: Tamás Éva , Södersved Källestedt Marie-Louise , Hult Håkan , Karlgren Klas , Allvin Renée 
Published: February 2019

Introduction:
Trained simulation educators (SEs) usually work both at simulation centers and in everyday health care, and thus, they possess dual expertise. Experienced SEs are known to grow confident with their expanding experience, but evidence is scarce about how this affects their development as clinical professionals. The aim of this study was to explore how experienced SEs describe their role within the context of everyday health care.

Methods:
An explorative descriptive study including 14 semistructured interviews and 27 questionnaires was conducted with 41 experienced SEs. An inductive thematic analysis was used to identify and analyze patterns describing SEs' perceptions of the influence of their educational work on everyday health care.

Results:
The SEs' descriptions of their encounters during everyday clinical work, which were affected by the fact that they had experience of facilitating simulation training, were gathered into three main themes with three of their own subthemes: education (educational needs, routines/guidelines, and being a resource), nontechnical skills (communication, feedback, and leadership/coworkership), and clinical proficiency (situational insight, role model, and confidence in clinical practice). The insights gained and actions taken as clinical professionals are all intended to be implemented with the ultimate aim of safe patient care.

Discussion:
All the aspects of the SEs' work are perceived to be successfully translated into clinical practice and can be summarized by the main themes of education, nontechnical skills, and clinical proficiency as delineated by this study. These themes are demonstrated at the individual, team, and organizational levels through increased competence and confidence.
Phase IB Study of Induction Chemotherapy With XELOX, Followed by Radiation Therapy, Carboplatin, and Everolimus in Patients With Locally Advanced Esophageal Cancer
Authors: Saba Nabil F. , Force Seth , Staley Charley , Fernandez Felix , Willingham Field , Pickens Allan , Cardona Kenneth , Chen Zhengjia , Goff Laura , Cardin Dana , Lambright Eric , Nesbitt Jon , Krasinskas Alyssa , Higgins Kristin , Harvey R. Donald , Owonikoko Taofeek , Ramalingam Suresh S. , Shin Dong M. , Beitler Jonathan J. , El-Rayes Bassel F. , Salaria Safia , El-Rifai Wael , Landry Jerome , Chakravarthy A.B. 
Published: February 2019

Purpose:
Preclinical studies have shown synergy between everolimus, an mTOR inhibitor, radiation, and platinum agents. We conducted a phase IB trial to determine the recommended phase II dose of everolimus with carboplatin and radiation.

Materials and Methods:
Patients with stage II/III esophageal cancer were enrolled. Following 2 cycles of Capecitabine/Oxaliplatin (XELOX), patients with no disease progression, received 50.4 Gy in 28 fractions and concurrent weekly carboplatin (area under the curve=2), with escalating doses of everolimus. A standard 3+3 dose escalation design was used.

Results:
Nineteen patients were enrolled. Two patients were screen failures and 4 were removed due to poor tolerance to XELOX (n=2) or disease progression (n=2). All treated patients had adenocarcinoma. Median age was 58 (44 to 71 y) and 85% were male patients. One patient at dose level 1 was replaced due to ongoing anxiety. One of 6 patients had a dose-limiting toxicity of bowel ischemia that was fatal. At dose level 2, two of 6 patients had a dose-limiting toxicity (fever with neutropenia and nausea). The recommended phase II dose of everolimus was 2.5 mg QOD. Grade ≥3 toxicities included lymphopenia (11%), nausea (10%), low white blood cell (8.0%) vomiting (5.5%), decreased neutrophils (4.0%). All patients achieved an R0 resection with a pathologic response rate of 40% and a pathologic complete response (ypCR) rate of 23%. The 2-year progression-free survival and overall survival were 50% and 49.6%, respectively.

Conclusions:
The recommended phase II dose of everolimus with concurrent weekly carboplatin and radiation is 2.5 mg QOD.
Effects of Social and Contextual Factors Including Marital Status and Children on the Use of Palliative Chemotherapy in Metastatic Colorectal Cancer
Authors: Ahmed Shahid , Baig Tayyba , Iqbal Nayyer , Le Duc , Chalchal Haji , Zaidi Adnan , Pahwa Punam 
Published: February 2019

Background:
There is evidence that social and contextual factors such as living alone are associated with outcomes in cancer patients. However, little is known about their influence on the use of palliative chemotherapy in metastatic colorectal cancer (mCRC). In this study, we examined social and contextual factors, including marital status, having children, and distance to a cancer center, for their association with the use of chemotherapy in patients with mCRC.

Methods:
A cohort of patients with mCRC diagnosed from 2006 to 2010 in Saskatchewan was evaluated. Logistic regression analyses were performed to assess the relationship between the variables and use of chemotherapy.

Results:
Of 569 patients, 326 (57%) received chemotherapy significant differences were noted between the chemotherapy versus no chemotherapy groups with respect to age (62 vs. 76 y), poor performance status (18% vs. 58%), comorbid illness (24% vs. 63%), low albumin (61% vs. 89%), anemia (61% vs. 87%), elevated alkaline phosphatase (53% vs. 84%), elevated creatinine (6% vs. 11%), hyponatremia (20% vs. 14%), primary tumor resection (61% vs. 47%), metastasectomy (21% vs. 9%), mean distance to cancer center (98.7±113.6 vs. 127.8±124.6 km), married/partnered (67% vs. 33%), and having children (64% vs. 36%). On multivariate logistic regression analysis, low performance status (odds ratio [OR], 5.1; 95% confidence interval [CI]: 3.1-8.1), not having children (OR, 3.3; 95% CI: 1.78-6.2), hyponatremia (OR, 2.9; 95% CI: 1.6-5.1), elevated alkaline phosphatase (OR, 2.9; 95% CI: 1.8-4.8), and low albumin (OR, 2.2; 95% CI: 1.2-3.8) were correlated with low rates of chemotherapy use.

Conclusions:
Our results showed that the use of chemotherapy in patients with mCRC significantly varies between those with and without children.
Sex Differences in Treatment Strategies Among Patients With Ulcerative Colitis: A Retrospective Cohort Analysis of Privately Insured Patients
Authors: Sceats Lindsay A. , Morris Arden M. , Bundorf M. Kate , Park K.T. , Kin Cindy 
Published: February 2019

BACKGROUND:
Sex-based treatment disparities occur in many diseases. Women undergo fewer procedural interventions, and their care is less consistent with guideline-based therapy. There is limited research exploring sex-based differences in ulcerative colitis treatment. We hypothesized that women are less likely to be treated with strategies consistent with long-term disease remission, including surgery and maintenance medications.

OBJECTIVE:
The aim of this study was to determine if patient sex is associated with choice of treatment strategy for ulcerative colitis.

DESIGN:
This is a retrospective cohort analysis.

SETTING:
Data were gathered from a large commercial insurance claims database from 2007 to 2015.

PATIENTS:
We identified a cohort of 38,851 patients newly diagnosed with ulcerative colitis, aged 12 to 64 years with at least 1 year of follow-up.

MAIN OUTCOME MEASURES:
The primary outcomes measured were the differences between male and female patients in 1) rates and types of index ulcerative colitis operations, 2) rates and types of ulcerative colitis medication prescriptions, and 3) rates of opioid prescriptions.

RESULTS:
Men were more likely to undergo surgical treatment for ulcerative colitis (2.94% vs 1.97%, p < 0.001, OR 1.51, p < 0.001). The type of index operation performed did not vary by sex. Men were more likely to undergo treatment with maintenance medications, including biologic (12.4% vs 10.2%, p < 0.001, OR 1.22, p < 0.001), immunomodulatory (16.3% vs 14.9%, p < 0.001, OR 1.08, p = 0.006), and 5-aminosalicylate medications (67.0% vs 63.2%, p < 0.001, OR 1.18, p < 0.001). Women were more likely to undergo treatment with rescue therapies and symptomatic control with corticosteroids (55.5% vs 54.0%, p = 0.002, OR 1.07, p = 0.002) and opioids (50.2% vs 45.9%, p < 0.001, OR 1.17, p < 0.001).

LIMITATIONS:
Claims data lack clinical characteristics acting as confounders.

CONCLUSIONS:
Men with ulcerative colitis were more likely to undergo treatment consistent with long-term remission or cure, including maintenance medications and definitive surgery. Women were more likely to undergo treatment consistent with short-term symptom management. Further studies to explore underlying mechanisms of sex-related differences in ulcerative colitis treatment strategies and disease trajectories are warranted. See Video Abstract at http://links.lww.com/DCR/A943.
A Retrospective Cohort Study of Cutaneous Squamous Cell Carcinoma With Lymph Node Metastasis: Risk Factors and Clinical Course
Authors: Feinstein Shera , Higgins Shauna , Ahadiat Omeed , Wysong Ashley 
Published: February 2019

BACKGROUND
The single most important prognostic indicator for mortality in patients with cutaneous squamous cell carcinoma (SCC) is the development of nodal metastasis (NM).

OBJECTIVE
To characterize the risk factors for and clinical course of cutaneous SCC with NM.

METHODS
Ten-year retrospective cohort study (2006–2017) at an academic tertiary care center reviewing 53 cutaneous SCC tumors with NM.

RESULTS
Most patients were men (84.6%, 44/52), and almost all primary tumors were on the head and neck (96.2%, 51/53). Most primary tumors were characterized by known “high-risk features” including perineural invasion (56.6%, 30/53), diameter ≥2 cm (54.7%, 29/53), invasion beyond subcutaneous fat (43.4%, 23/53), and poor differentiation (32.1%, 17/53). In addition, many tumors were recurrent (52.8%, 28/53), and many patients were immunosuppressed (30.8%, 16/52). Disease-free survival after treatment of nodal disease was 7.5% (4/53) at 5 years.

CONCLUSION
To the best of the authors' knowledge, this study is the largest retrospective cohort of cutaneous SCC with NM to date. The results verify the significance of “high-risk features” used by current staging systems while highlighting additional features that may have prognostic value. This study may be used to refine current staging systems, improve early detection, and optimize management for these aggressive tumors.
Potential Country-level Health and Cost Impacts of Legalizing Domestic Sale of Vaporized Nicotine Products
Authors: Petrović-van der Deen Frederieke S. , Wilson Nick , Crothers Anna , Cleghorn Christine L. , Gartner Coral , Blakely Tony 
Published: February 2019

Background:
The net impact on population health and health system costs of vaporized nicotine products is uncertain. We modeled, with uncertainty, the health and cost impacts of liberalizing the vaporized nicotine market for a high-income country, New Zealand (NZ).

Methods:
We used a multistate life-table model of 16 tobacco-related diseases to simulate lifetime quality-adjusted life-years (QALYs) and health system costs at a 0% discount rate. We incorporated transitions from never, former, and current smoker states to, and from, regularly using vaporized nicotine and literature estimates for relative risk of disease incidence for vaping compared with smoking.

Results:
Compared with continuation of baseline trends in smoking uptake and cessation rates and negligible vaporized nicotine use, we projected liberalizing the market for these products to gain 236,000 QALYs (95% uncertainty interval [UI] = 27,000 to 457,000) and save NZ$3.4 billion (2011 NZ$) (95% UI = NZ$370 million to NZ$7.1 billion) or US$2.5 billion (2017 NZ$). However, estimates of net health gains for 0- to 14-year olds and 65+ year olds had 95% UIs including the null. Uncertainty around QALYs gained was mainly driven by uncertainty around the impact of vaporized nicotine products on population-wide cessation rates and the relative health risk of vaping compared with smoking.

Conclusions:
This modeling suggested that a fairly permissive regulatory environment around vaporized nicotine products achieves net health gain and cost savings, albeit with wide uncertainty. Our results suggest that optimal strategies will also be influenced by targeted smoking cessation advice, regulations around chemical constituents of these products, and marketing and age limits to prevent youth uptake of vaping.
Attitude toward livestock farming does not influence the earlier observed association between proximity to goat farms and self-reported pneumonia
Authors: Borlée Floor , Yzermans C. Joris , Oostwegel Floor S. M. , Schellevis François , Heederik Dick , Smit Lidwien A. M. 
Published: February 2019

Background:
Attitudes toward environmental risks may be a source of bias in environmental health studies because concerns about environmental hazards may influence self-reported outcomes.

Objective:
The main aim was to assess whether earlier observed associations between proximity to goat farms and self-reported pneumonia were biased by participants’ attitude toward farming.

Methods:
We developed an attitude-score for 2,457 participants of the Dutch Livestock Farming and Neighbouring Residents’ Health Study (veehouderij en gezondheid omwonenden) by factor analysis of 13 questionnaire items related to attitude toward livestock farming. Linear regression analysis was used to assess associations between attitude and potential determinants. The effect of attitude on the association between goat farm proximity and pneumonia was analyzed by evaluating (1) misclassification of the outcome, (2) effect modification by attitude, and (3) exclusion of participants reporting health problems due to farms in their environment.

Results:
In general, the study population had a positive attitude toward farming, especially if participants were more familiar with farming. Older participants, females, ex-smokers, and higher-educated individuals had a more negative attitude. Both self-reported respiratory symptoms and exposure to livestock farms were associated with a more negative attitude. Misclassification of self-reported pneumonia was nondifferential with regard to participants’ attitude. Furthermore, no indication was found that the association between proximity to goat farms and pneumonia was modified by attitude. Excluding subjects who attributed their health symptoms to livestock farms did also not change the association.

Conclusions:
The association between goat farm proximity and pneumonia was not substantially biased by study participants’ attitude toward livestock farming.