bluuebunny/crossref_metadata_2025_split huggingface dataset:
Significance of Platelet and AFP Levels and Liver Function Parameters for HCC Size and Survival
Authors: Carr Brian I. , Guerra Vito , Giannini Edoardo G. , Farinati Fabio , Ciccarese Francesca , Rapaccini Gian Ludovico , Di Marco Maria , Benvegnù Luisa , Zoli Marco , Borzio Franco , Caturelli Eugenio , Chiaramonte Maria , Trevisani Franco ,   for the Italian Liver Cancer (ITA.LI.CA) group*
Published: October 2018

Background Hepatocellular carcinoma (HCC) is a heterogeneous disease with both tumor and liver factors being involved. Aims To investigate HCC clinical phenotypes and factors related to HCC size. Methods Prospectively-collected HCC patients' data from a large Italian database were arranged according to the maximum tumor diameter (MTD) and divided into tumor size terciles, which were then compared in terms of several common clinical parameters and patients' survival. Results An higer MTD tercile was significantly associated with increased blood alpha-fetoprotein (AFP), gamma-glutamyl transpeptidase (GGTP), and platelet levels. Patients with higher platelet levels had larger tumors and higher GGTP levels, with lower bilirubin levels. However, patients with the highest AFP levels had larger tumors and higher bilirubin levels, reflecting an aggressive biology. AFP correlation analysis revealed the existence of 2 different groups of patients: those with higher and with lower AFP levels, each with different patient and tumor characteristics. The Cox proportional-hazard model showed that a higher risk of death was correlated with GGTP and bilirubin levels, tumor size and number, and portal vein thrombosis (PVT), but not with AFP or platelet levels. Conclusions An increased tumor size was associated with increased blood platelet counts, AFP and GGTP levels. Platelet and AFP levels were important indicators of tumor size, but not of survival.
Opioid Prescribing Practices of Orthopaedic Surgeons: Results of a National Survey
Authors: Raneses Eli , Secrist Eric S. , Freedman Kevin B. , Sohn David H. , Fleeter Thomas B. , Aland Christopher M. 
Published: October 2018

Introduction:
Opioids are widely used after orthopaedic procedures. Nonmedical opioid use is a growing public health issue.

Methods:
An anonymous online survey was distributed by e-mail to the orthopaedic societies of all 50 states and several large private practices to assess practicing orthopaedic surgeons' opioid prescribing practices.

Results:
A total of 555 orthopaedic surgeons practicing in 37 states responded. The most commonly prescribed opioid for both teenagers and adults was hydrocodone/acetaminophen. Of note, 42.3% reported that a patient they have prescribed opioids for developed an opioid dependency, whereas 35.3% do not believe that opioid use is a problem in their practice. Of note, 30.3% reported prescribing refills, and factors significantly associated with increased prescribing of refills included a greater number of years in practice (P < 0.001) and practicing in a suburban rather than an urban or rural environment (P = 0.03).

Conclusion:
Orthopaedic surgeons rarely prescribe any refills, tend to prescribe less opioids to teenagers than adults, and prescribe fairly uniformly for patients who are treated nonsurgically or undergo minor or arthroscopic surgery. They exhibit considerable variation in prescribing for fractures and major procedures.
Implementation of a Hip Fracture Care Pathway Using Lean Six Sigma Methodology in a Level I Trauma Center
Authors: Sayeed Zain , Anoushiravani Afshin , El-Othmani Mouhanad , Barinaga Gonzalo , Sayeed Yousuf , Cagle Paul , Saleh Khaled J. 
Published: October 2018

Introduction:
The application of Lean Six Sigma (LSS) methodology with regard to hip fracture care remains unexamined. The aim of this study is to illustrate the application of LSS principles in the implementation of a hip fracture integrated care pathway (ICP).

Methods:
A multidisciplinary team at a level I trauma center formed a hip fracture ICP using LSS principles. An ICP aimed toward decreasing time to surgery to <48 hours was implemented in April 2012.

Results:
A total of 505 hip fracture patients met inclusion criteria. A total of 221 patients entered the preimplementation cohort, and 284 were incorporated in the postimplementation cohort. The percentage of patients who received surgical fixation beyond 48 hours significantly decreased (9.50% versus 4.23%; P = 0.01). Significantly more complications were detected in the postimplementation cohort (62.44% versus 80.10%; P < 0.01). The postimplementation cohort showed a significantly shorter length of stay (P = 0.02) and decreased hospital cost (P = 0.016).

Conclusion:
Our findings suggest that using LSS methods in an ICP at our institution resulted in markedly greater percentage of patients receiving surgical care within 48 hours, greater detection of complication, and reduced resource consumption.
Incidence and Risk Factors Associated with Venous Thromboembolism After Orthopaedic Below-knee Surgery
Authors: Heijboer Reinout R.O. , Lubberts Bart , Guss Daniel , Johnson A. Holly , DiGiovanni Christopher W. 
Published: October 2018

Introduction:
Among patients undergoing below-knee orthopaedic surgery, no consensus exists regarding the need for or type of postoperative prophylaxis to prevent venous thromboembolic (VTE) events. The purpose of this study was to assess the incidence and risk factors associated with symptomatic VTE among orthopaedic patients undergoing below-knee surgery who were subject to different types of pharmacologic thromboprophylactic strategies.

Methods:
A total of 20,043 adult patients who underwent surgery for a below-knee orthopaedic condition between August 2005 and August 2015 were identified. Retrospective chart review recorded patient demographics, comorbid data, and anatomic location of any procedures performed. Multivariable logistic regression analysis was used to determine factors associated with postoperative development of symptomatic VTE among patients receiving various thromboprophylactic regimens.

Results:
The incidence of symptomatic VTE in patients who underwent below-knee surgery was 2.5% (492/20,043). For patients who did not receive thromboprophylaxis, the incidence was 1.5% (134/9,127 patients). In this group, risk factors for developing VTE were male sex; nonwhite race; surgery performed below the knee but above the ankle; combination procedures of the forefoot/midfoot, hindfoot/ankle, and/or lower leg; history of VTE; and Charlson Comorbidity Index score greater than 2. Among patients who received an antiplatelet agent, the VTE incidence was 1.7% (33/1,992 patients). The incidence of VTE among patients who received an oral or injectable anticoagulant was 3.6% (325/8,924 patients). In this group, risk factors for developing VTE were male sex; surgery performed below the knee but above the ankle; combination procedures of the forefoot/midfoot, hindfoot/ankle, and/or lower leg; and history of VTE.

Conclusion:
Allowing for different types of thromboprophylactic strategies, the results of this study demonstrate a higher rate of symptomatic thromboembolic disease compared with previously reported <1% VTE incidence rates among orthopaedic patients undergoing below-knee surgery. Certain patients are at higher risk for thromboembolic disease after below-knee orthopaedic surgery. This risk was not found to be lowered by thromboprophylaxis as performed in patients in this database. Future research should be directed at determining what the best thromboprophylactic strategies are for lowering this risk.

Level of Evidence:
Therapeutic study level III
Ewings sarcoma as an etiology for persistent back pain in a 17-year-old girl after trauma to the back
Authors: Paul Frank A. 
Published: October 2018

Abstract
Back pain, a common complaint familiar to all physicians, can be either a manifestation of musculoskeletal dysfunction or a symptom of a more serious underlying disease. Unfortunately, the diagnosis can be difficult, and back pain that is not resolved by conservative treatment requires aggressive investigation. The author presents the case history of a 17-year-old patient whose back pain had been extensively evaluated by a series of specialists to no avail until further workup revealed the problem to be Ewing's sarcoma. The steps required to diagnose elusive back pain are presented, together with a brief discussion of cauda equina syndrome and conus medullaris syndrome, components of both of which were found in this patient.
Massive tissue necrosis after hydroxyzine injection
Authors: Tokodi George , Huber Frank C. 
Published: October 2018

Abstract
A 47-year-old man hospitalized for disk surgery received a preoperative injection of hydroxyzine hydrochloride in the upper outer quadrant of the gluteal region. The immediate pain decreased after 3 days but later became incapacitating. Substantial tissue necrosis in the region of the injection was confirmed 4 weeks after the injection, and 100 g of necrotic tissue was excised, leaving the patient with lost muscle mass and a definite limp 2 years later. During the injection of hydroxyzine, the needle penetrated through the gluteal muscle and entered the gluteal artery, causing thrombosis of the artery and necrosis of the gluteus maximus muscle. This case and other reported cases indicate that the use of intramuscular hydroxyzine is contraindicated.
Impact of antitrust laws on physician networking and rural communities
Authors: Ross-Lee Barbara , Kiss Lois E. , Bfa Michael Weiser, A. 
Published: October 2018

Abstract
Mter reviewing the history of antitrust legislation and established zones of safety for providers and the application of antitrust laws to the healthcare industry in two earlier installments, the authors explore the consequences of the vigorous application of antitrust laws to physician networking, with an emphasis on rural communities. They review common exemptions to antitrust laws that maintain the uneven distribution of power in the evolving healthcare market. Acknowledging the tenuous ground that providers hold in the struggle for control of the healthcare industry, the authors argue for greater consideration of the unique circumstances and barriers that tend to prohibit the formation of strong, physician-sponsored, integrated healthcare networks. The authors have tested the climate for relief from the antitrust enforcement agencies in Washington, DC, and have found no easing of antitrust legislation forthcoming. However, following the resolution of several antitrust cases in recent months, barriers to physician-led organizations appear to be lessening. The authors close with a review of several strategies to minimize the risk of antitrust challenges.
A trek to the top: a review of acute mountain sickness
Authors: Porcelli M. Jay , Gugelhcuk Gary M. 
Published: October 2018

Abstract
Acute mountain sickness (AMS) affects, to varying degrees, all travelers to high altitudes (elevations greater than 5280 feet). In a small percentage of patients, AMS can lead to high-altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE). Symptoms of AMS range from a combination of headache, insomnia, anorexia, nausea, and dizziness, to more serious manifestations, such as vomiting, dyspnea, muscle weakness, oliguria, peripheral edema, and retinal hemorrhage. Although the primary cause of these symptoms is related to the reduced oxygen content and humidity of the ambient air at high altitudes, the physiologic pathway relating hypoxemia to AMS and its sequelae remains unclear. Tips on self-diagnosis and symptom recognition are critical elements to be included in educating patients who are contemplating a trip to high altitudes. Preventive strategies include allowing 2 days of acclimatization before engaging in strenuous exercise at high altitudes, avoiding alcohol, and increasing fluid intake. Conditioning exercise for patients older than 35 years is also recommended before departure. A high-carbohydrate, low-fat, lowsalt diet can also aid in preventing the onset of AMS. Acetazolamide (125 mg two or three times daily, or once at bedtime) has also been shown to reduce susceptibility to AMS and the incidence of HAPE and HACE. Although effective in treating cerebral symptoms of AMS, dexamethasone is not routinely recommended as a prophylactic agent for AMS.
Bilateral subclavian vein thrombosis in a patient with acquired immunodeficiency syndrome
Authors: Bayer Deborah D. , Sorbello Alfred F. , Condoluci David V. 
Published: October 2018

Abstract
Bilateral subclavian vein thrombi developed, in the presence of a Groshong catheter, in a patient with the acquired immunodeficiency syndrome (AIDS) and disseminated cytomegalovirus infection. Thrombosis is an uncommon complication of AIDS, and bilateral subclavian thrombi are rare. Although localized, unilateral thrombi occur in patients with indwelling central venous catheters, unexpectedly extensive bilateral clot formation is seen to develop in patients with human immunodeficiency virus infection. Potentially predisposing factors for thrombosis in AIDS include central venous catheterization, malignancy, elevated anticardiolipin antibodies, alteration of vascular endothelial cell function reflected in low free protein S levels, and enhanced endothelial procoagulant activity related to cytomegalovirus. Anecdotal data strongly suggest that cytomegalovirus enhances the risk for thrombosis, but studies are needed to confirm the association. Physicians should be aware of the enhanced risk for extensive thrombi in AIDS, especially in patients with disseminated cytomegalovirus infection.
Making sense of federal GME reforms: The need for secondary reforms
Authors: Meyer Christopher T. 
Published: October 2018

Abstract
Physician workforce issues in the healthcare reform debate have led to considerable agreement on the need to reform graduate medical education (GME) in order to control the cost, mix and supply of physician manpower. The osteopathic medical profession's infrastructure is ill-prepared to respond to many of the changes that policymakers are suggesting. In last month's issue, the author reviewed the Gephardt and Mitchell bills, which emerged during the last Congress, identified the reforms recommended for GME, and examined the elements of agreement between the bills. The position of osteopathic medicine vis-a-vis healthcare reform was explored and distinctions between the two bills were drawn. In this article, the author recommends comprehensive secondary reforms in the osteopathic medical profession's three institutions-its colleges, its hospitals, and its political organization, the American Osteopathic Association.
Antitrust laws and zones of safety
Authors: Ross-Lee Barbara , Kiss Lois E. , Weiser Michael A. 
Published: October 2018

Abstract
As physicians explore areas of diversification and networking that can position them favorably for the changing healthcare environment, their fear of running afoul of antitrust legislation handicaps them. A basic understanding of the intent of antitrust legislation and its application to healthcare is essential to physicians' strategic planning. This article traces the development of antitrust legislation and the regulatory agencies charged with its oversight. The authors review the first application of this legislation to the professions; distinguish per se violations from the rule-of-reason process; and summarize recent attempts by the Department of Justice and the Federal Trade Commission to provide useful guidance to healthcare providers in the market revolution.
Hypothyroidism with concurrent Lyme disease
Authors: Paparone Philip W. 
Published: October 2018

Abstract
Lyme disease can be seen as localized, disseminated, acute, or chronic and can mimic other, more serious diseases. Even though it is a multi systemic illness, very few spirochetes are present; yet, once established in the host, it can persist for years. The antibody response is slow and variable, and the spirochete is difficult to isolate from clinical specimens, even those obtained from the pathognomonic skin lesion. These variables, together with nonspecific symptoms, make the diagnosis of Lyme disease difficult. The author describes an unusual case of Lyme disease superimposed on severe primary hypothyroidism in which the thyroid disorder was so advanced and pronounced that the diagnosis of Borrelia infection could easily have been missed.
Palpatory diagnosis and manipulative management of carpal tunnel syndrome: Part 2. 'Double crush' and thoracic outlet syndrome
Authors: Sucher Benjamin M. 
Published: October 2018

Abstract
The physician treating carpal tunnel syndrome needs to be aware of the possible concomitant occurrence of thoracic outlet syndrome, the so-called double crush syndrome. Palpation is used to differentiate carpal tunnel syndrome from thoracic outlet syndrome. Such palpatory examination assists the physician in planning the initial treatment, including osteopathic manipulation and self-stretching maneuvers, targeted specifically at the most clinically significant pathologic region. Supplemental physical medicine modalities such as ultrasound may enhance the treatment response. Some illustrative cases are reported.
Eustrongylidiasis--A parasitic infection acquired by eating live minnows
Authors: Narr Lois Lucente , O’Donnell James G. , Libster Boris , Alessi Paul , Abraham David 
Published: October 2018

Abstract
The objective of this study was to heighten physician awareness of eustrongylidiasis by investigating the epidemiology of this parasitic infection. The nematode Eustrongylides ignotus was recovered surgically from our patient, in whom eustrongylidiasis simulated acute appendicitis. The patient had consumed two live minnows obtained from Big Timber Creek of Belmawr, NJ. The authors determined the E ignotus infestation rate of free-living minnows at this creek. With this data, they approximate the probability of human infection with E ignotus after eating live minnows and attempt to evaluate the hypothesis that eating live minnows may lead to eustrongylidiasis.
Use of computed tomography guidance and mammographic hook wires to remove displaced, embedded contraceptive rods
Authors: Weiner Harvey M. , DiMarcangelo Mark T. , Heim John A. , Principato Robert 
Published: October 2018

Abstract
Because of dysfunctional uterine bleeding, a patient requested removal of levonorgestrel contraceptive rods. The patient was referred to a general surgeon by her gynecologist who was unable to palpate the rods in the region of implantation in her left upper arm. Initially, the surgeon was able to locate and remove four of the six previously implanted rods. Because these implants are not visible under convention radiography or fluoroscopy, computed tomography was used to locate the remaining two rods. After localization by use of mammographic hook wires, the remaining two rods were successfully removed surgically.
Linear and Third‐Order Nonlinear Optical Properties of Chalcogenopyrylium‐Terminated Heptamethine Dyes with Rigid, Bulky Substituents
Authors: Getmanenko Yulia A. , Allen Taylor G. , Kim Hyeongeu , Hales Joel M. , Sandhu Bhupinder , Fonari Marina S. , Suponitsky Kyrill Yu. , Zhang Yadong , Khrustalev Victor N. , Matichak Jonathan D. , Timofeeva Tatiana V. , Barlow Stephen , Chi San‐Hui , Perry Joseph W. , Marder Seth R. 
Published: October 2018

AbstractThe aggregation of chalcogenopyrylium‐terminated heptamethine dyes in high‐chromophore density films can be substantially suppressed by attachment of rigid, bulky substituents that project out of the plane of the conjugated π‐system of the dye, allowing the retention in the solid state of favorable linear and nonlinear optical properties relevant to all‐optical signal processing (AOSP). Dye structures are systematically engineered with a range of out‐of‐plane substituents to investigate the impacts on the optical properties at 1550 nm in the solid state. Large magnitudes of the third‐order susceptibility are obtained for solid films. Very high values of the two‐photon figure‐of‐merit (2PA‐FOM), an important parameter for AOSP, are observed in dilute solutions of seleno‐ and telluropyrylium dyes (in several cases >30). In the case of the telluropyrylium dye, the 2PA‐FOM is not measureable for 50 wt% blends with polymers. Blends of the selenopyrylium examples exhibit 2PA‐FOM values that, although decreased substantially relative to the solution values, in some cases meet the requirements for AOSP.
Soft Rectangular Sub‐5 nm Tiling Patterns by Liquid Crystalline Self‐Assembly of T‐Shaped Bolapolyphiles
Authors: Lehmann Anne , Scholte Alexander , Prehm Marko , Liu Feng , Zeng Xiangbing , Ungar Goran , Tschierske Carsten 
Published: October 2018

AbstractSquare and other rectangular nanoscale tiling patterns are of contemporary interest for soft lithography. Though soft square patterns on a ≈40 nm length scale can be achieved with block copolymers, even smaller tiling patterns below 5 nm can be expected for liquid crystalline phases of small molecules. However, these usually form lamellar and hexagonal morphologies and thus the challenge is to specifically design liquid crystal (LC) phases forming square and rectangular structures, being compatible with industrial standards. Here, two distinct types of liquid crystalline rectangular tiling patterns are reported occurring in a series of T‐shaped p‐terphenyl‐based bolapolyphiles. By directed side chain engineering sub‐5 nm sized quadrangular honeycombs with rhombic (c2mm), square (p4mm), and rectangular (p2mm) shapes of the cells are formed by spontaneous self‐assembly. The rectangular honeycomb with p2mm lattice represents a new mode of LC self‐assembly in polygonal honeycombs. In addition, pentagonal and hexagonal tiling motifs can be obtained by molecular fine tuning.
Surface Effect on 2D Hybrid Perovskite Crystals: Perovskites Using an Ethanolamine Organic Layer as an Example
Authors: Ho Kang‐Ting , Leung Siu‐Fung , Li Ting‐You , Maity Partha , Cheng Bin , Fu Hui‐Chun , Mohammed Omar F. , He Jr‐Hau 
Published: October 2018

AbstractDespite the remarkable progress of optoelectronic devices based on hybrid perovskites, there are significant drawbacks, which have largely hindered their development as an alternative of silicon. For instance, hybrid perovskites are well‐known to suffer from moisture instability which leads to surface degradation. Nonetheless, the dependence of the surface effect on the moisture stability and optoelectronic properties of hybrid perovskites has not been fully investigated. In this work, the influence of the surface effect of 2D layered perovskites before and after mechanical exfoliation, representing rough and smooth surfaces of perovskite crystals, are studied. It is found that the smooth 2D perovskite is less sensitive to ambient moisture and exhibits a considerably low dark current, which outperforms the rough perovskites by 23.6 times in terms of photodetectivity. The superior moisture stability of the smooth perovskites over the rough perovskites is demonstrated. Additionally, ethanolamine is employed as an organic linker of the 2D layered perovskite, which further improves the moisture stability. This work reveals the strong dependence of the surface conditions of 2D hybrid perovskite crystals on their moisture stability and optoelectronic properties, which are of utmost importance to the design of practical optoelectronic devices based on hybrid perovskite crystals.