bluuebunny/crossref_metadata_2025_split huggingface dataset:
General Health Status After Nonoperative Versus Operative Treatment for Acute, Complete Acromioclavicular Joint Dislocation: Results of a Multicenter Randomized Clinical Trial
Authors: Mah Jeffrey M. ,   the Canadian Orthopaedic Trauma Society (COTS)
Published: May 2017

Objective:
To assess the general health status of patients after nonoperative (Non-op) versus operative (OP) treatment for acromioclavicular (AC) joint dislocations.

Design:
Multicenter randomized controlled clinical trial conducted in 11 Canadian trauma centers. A total of 83 patients with acute (≤28 days old), complete (Rockwood grades III, IV, or V) dislocations of the AC joint were included in this study.

Intervention:
Participants were randomized to Non-op treatment or OP treatment with hook plate fixation.

Main Outcome Measures:
Physical and mental health were evaluated using the Short Form-36 version 2 survey at baseline, 6 weeks, 3 months, 6 months, 1 year, and 2 years.

Results:
In the Non-op group, 33 patients had grade III injuries, 3 patients had grade IV injuries, 5 patients had grade V injuries, and the injury grade was unknown for 2 patients. In the OP group, 37 patients had grade III injuries and 3 patients had grade V injuries (no difference in Type IV and V Non-op vs. OP, P = 0.12). Fifty-eight percent of patients in the Non-op group and 63% of patients in the OP group completed the 2-year follow-up. The Non-op group had better physical health scores than the OP group at 3 months after treatment (52.13 vs. 45.75, P < 0.001). There were no significant differences between the physical health scores of the 2 groups at any other point (6 weeks, 45.81 vs. 41.21, P = 0.03; 6 months, 54.50 vs. 51.61, P = 0.02; 1 year, 55.10 vs. 53.96, P = 0.37; 2 years, 55.24 vs. 57.13, P = 0.17). Mental health scores were similar between the Non-op and OP groups at each follow-up interval (6 weeks, 49.29 vs. 51.27, P = 0.49; 3 months, 52.24 vs. 55.84, P = 0.13; 6 months, 54.89 vs. 55.05, P = 0.93; 1 year, 55.35 vs. 56.72, P = 0.35; 2 years, 56.41 vs. 55.43, P = 0.56). In both treatment groups, the preinjury physical and mental health scores were better than published population norms before declining to a level equal to or below the norm after dislocation. Physical health recovered to a level above the norm at 6 months in the Non-op group and 2 years in the OP group. Mental health recovered at 3 months in the OP group and 6 months in the Non-op group.

Conclusions:
Hook plate fixation does not lead to improved general health status compared with Non-op treatment. Presently, there is no definitive evidence that hook plate fixation is superior to Non-op treatment for acute complete AC joint dislocations.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Clinical Experience With IV Angiotensin II Administration: A Systematic Review of Safety
Authors: Busse Laurence W. , Wang Xueyuan Shelly , Chalikonda Divya M. , Finkel Kevin W. , Khanna Ashish K. , Szerlip Harold M. , Yoo David , Dana Sharon L. , Chawla Lakhmir S. 
Published: May 2017

Objective:
Angiotensin II is an endogenous hormone with vasopressor and endocrine activities. This is a systematic review of the safety of IV angiotensin II.

Data Sources:
PubMed, Medline, Scopus, and Cochrane.

Study Selection:
Studies in which human subjects received IV angiotensin II were selected whether or not safety was discussed.

Data Extraction:
In total, 18,468 studies were screened by two reviewers and one arbiter. One thousand one hundred twenty-four studies, in which 31,281 participants received angiotensin II (0.5–3,780 ng/kg/min), were selected. Data recorded included number of subjects, comorbidities, angiotensin II dose and duration, pressor effects, other physiologic and side effects, and adverse events.

Data Synthesis:
The most common nonpressor effects included changes in plasma aldosterone, renal function, cardiac variables, and electrolytes. Adverse events were infrequent and included headache, chest pressure, and orthostatic symptoms. The most serious side effects were exacerbation of left ventricular failure in patients with congestive heart failure and bronchoconstriction. One patient with congestive heart failure died from refractory left ventricular failure. Refractory hypotensive shock was fatal in 55 of 115 patients treated with angiotensin II in case studies, cohort studies, and one placebo-controlled study. One healthy subject died after a pressor dose of angiotensin II was infused continuously for 6 days. No other serious adverse events attributable to angiotensin II were reported. Heterogeneity in study design prevented meta-analysis.

Conclusion:
Adverse events associated with angiotensin II were infrequent; however, exacerbation of asthma and congestive heart failure and one fatal cerebral hemorrhage were reported. This systematic review supports the notion that angiotensin II has an acceptable safety profile for use in humans.
EFFICACY OF INTRAVITREAL RANIBIZUMAB INJECTIONS IN THE TREATMENT OF VITREOUS HEMORRHAGE RELATED TO PROLIFERATIVE DIABETIC RETINOPATHY
Authors: Chelala Elias , Nehme Joseph , El Rami Hala , Aoun Roni , Dirani Ali , Fadlallah Ali , Jalkh Alex 
Published: May 2017

Purpose:
To investigate the efficacy of intravitreal ranibizumab injections in proliferative diabetic retinopathy associated with vitreous hemorrhage (VH).

Methods:
A prospective study including patients with proliferative diabetic retinopathy who presented with persistent VH. Vitreous hemorrhage was graded into mild, moderate, and severe. Patients were randomized into two groups: the ranibizumab group was treated with intravitreal injections of ranibizumab and the control group was assigned to observation alone. Vitrectomy was performed if there was any aggravation of the VH in patients with mild, moderate, and severe VH or in the absence of improvement by 16 weeks in patients with moderate and severe VH.

Results:
The ranibizumab group included 71 patients and the control group included 62 patients. There was a statistically significant difference in the vitrectomy rate in patients with mild-to-moderate VH (5 patients [7.04%] and 12 patients [19.35%], respectively; P = 0.04). However, there was no statistically significant difference in the overall vitrectomy rate, and in the vitrectomy rate in severe VH (17 [23.94%] and 12 [16.90%] patients in the ranibizumab group vs. 22 [35.48%] and 10 [16.13%] patients in the control group, P = 0.14 and P = 0.83, respectively). Recurrence of the VH occurred in 22 patients in the ranibizumab group and 29 patients in the control group (P = 0.06). Better visual acuity measurements were recorded on all follow-up visits in the ranibizumab group (P ≤ 0.04).

Conclusion:
Intravitreal ranibizumab injections could be considered in proliferative diabetic retinopathy patients with mild and moderate VH.
INTRAVITREAL DEXAMETHASONE (OZURDEX) IMPLANT FOR RADIATION MACULOPATHY SECONDARY TO STEREOTACTIC RADIOTHERAPY FOR POSTERIOR UVEAL MELANOMA
Authors: Koc Irem , Kadayifcilar Sibel , Kiratli Hayyam , Eldem Bora 
Published: May 2017

Purpose:
To evaluate the efficacy of 0.7 mg intravitreal dexamethasone implant in the treatment of radiation maculopathy after stereotactic radiotherapy for posterior uveal melanoma.

Methods:
Retrospective chart review of seven eyes of seven consecutive patients was performed. Extracted data included age, sex, initial and follow-up visual acuities and central macular thickness values, intraocular pressure, follow-up time, number of implants, and time elapsed from radiotherapy to implantation. Main outcome measures were visual acuity and central macular thickness. Glaucoma, cataract formation, or systemic side effects, if any, were recorded.

Results:
Female to male ratio was 4:3. Mean age was 49.9 ± 17.0 (range: 27–73). Initial mean visual acuity was 20.4 ± 12.5 Early Treatment Diabetic Retinopathy Study letters and initial central macular thickness measured 514.1 ± 135.1 μm on spectral domain optical coherence tomography. All patients except one showed improvement in visual acuity and a mean improvement of 7.4 ± 6.2 letters was observed in the whole group (range: 0–16). The mean reduction in central macular thickness was 226.7 ± 157.0 μm after a mean 9.1 ± 3.4 months of follow-up. On average, implantation of intravitreal dexamethasone was performed 35.2 ± 16.5 months after radiotherapy. Four patients were treatment naive and three had previous intravitreal bevacizumab injections with limited response. Ozurdex reimplantations were performed in four patients and the mean number of injections was 1.7 ± 0.8. Mean time to reimplantation was 5.0 ± 2.12 months. Only one patient developed posterior subcapsular cataract and all patients had intraocular pressures within normal limits. No systemic side effects were observed.

Conclusion:
In our experience, intravitreal implantation of 0.7 mg dexamethasone is an anatomically, and to a lesser extent functionally effective procedure for radiation maculopathy after stereotactic radiotherapy for posterior uveal melanoma.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF CONGENITAL SIMPLE HAMARTOMA OF THE RETINAL PIGMENT EPITHELIUM
Authors: Arjmand Parnian , Elimimian Elizabeth B. , Say Emil A. T. , Shields Carol L. 
Published: May 2017

Purpose:
To describe the optical coherence tomography angiography features of congenital simple hamartoma of the retinal pigment epithelium.

Methods:
Case report.

Results:
A 14-year-old boy was referred for an asymptomatic fundus tumor in the left eye. Visual acuity was 20/20 in the right eye and 20/40 in the left eye. The right fundus was normal. The left fundus disclosed a gray-white nodular retinal mass of 2-mm diameter in the juxtafoveal region, protruding into the vitreous cavity and causing radial retinal folds. The mass demonstrated echodensity without calcification on ultrasonography, hypoautofluorescence on short-wavelength autofluorescence, and mixed hyporeflective and hyperreflective areas on near-infrared reflectance imaging. By fluorescein angiography, the mass showed absolute hypofluorescence through the arteriovenous phase and diffuse late hyperfluorescence and staining. Optical coherence tomography revealed an optically dense lesion with abrupt posterior shadowing, whereas optical coherence tomography angiography showed an extensive haphazard intratumoral vascular network with fairly large-caliber (100–200 microns) vessels occupying full-thickness tumor, demonstrating more vascular details than visualized on fluorescein angiography. Serial segmental evaluation of the optical coherence tomography angiography en face images confirmed an intratumoral vascular network for full tumor depth down to retinal pigment epithelium, not related to projection artifact. Final diagnosis was congenital simple hamartoma of the retinal pigment epithelium. Considering the benign tumor, observation was recommended.

Conclusion:
Optical coherence tomography angiography of congenital simple hamartoma of the retinal pigment epithelium revealed an extensive intratumoral, haphazard, large-caliber vascular network, more evident than seen on fluorescein angiography. Optical coherence tomography angiography has added new insight into this rare tumor.
Consequences of Traumatic Brain Injury in Professional American Football Players: A Systematic Review of the Literature
Authors: Vos Bodil C. , Nieuwenhuijsen Karen , Sluiter Judith K. 
Published: May 2017

Objective:
The purpose of this study was to systematically review the literature for the consequences Traumatic brain injury (TBI) has on cognitive, psychological, physical, and sports-related functioning in professional American Football players.

Data Sources:
We performed a systematic search in 2 databases, PubMed and SPORTDiscus, to obtain literature from January 1990 to January 2015. To be eligible for inclusion, a study had to examine the relationship between TBI and the consequences for several aspects of functioning in professional American football players older than 18 years. Methodological quality was assessed using a 5-item checklist which assessed selection bias, information bias, and correct reporting of the population and exposure characteristics.

Main Results:
The search yielded 21 studies that met our inclusion criteria. An evidence synthesis was performed on the extracted data and resulted in 5 levels of evidence. The evidence synthesis revealed that there is strong evidence that concussions are associated with late-life depression and short-term physical dysfunctions. Evidence for the relationship between concussion and impaired sports-related function, prolonged reaction time, memory impairment, and visual-motor speed was inconclusive. Moderate evidence was found for the association between TBI and mild cognitive impairment (MCI), and limited evidence was found for the association between TBI and executive dysfunction.

Conclusions:
There is strong evidence that a history of concussion in American football players is associated with depression later in life and short-term physical dysfunctions. Also cognitive dysfunctions such as MCI are seen in older players with a history of TBI. These results provide input for actions to prevent TBI and their consequences in (retired) American football players.
Drivers and Barriers for Adopting Accreditation at Local Health Departments for Their Performance Improvement Effort
Authors: Liu Sandra S. , Meyerson Beth , King Jerry , Yih Yuehwern , Ostovari Mina 
Published: May 2017

Context:
A national system of voluntary public health accreditation for state, local, and tribal health departments (local health departments [LHDs]) is part of a movement that aims to improve public health performance with ultimate impact on population health outcomes. Indiana is a good setting for the study of LHD accreditation adoption because several LHDs reported de-adopting accreditation in a recent statewide survey and because 71% of Indiana counties serve populations of 50 000 or less.

Design:
A systematic method of analyzing qualitative data based on the Performance Improvement Model framework to expand our understanding of de-adoption of public health accreditation.

Setting/Participants:
In 2015, we conducted a key informant interview study of the 3 LHDs that decided to delay their engagement in the accreditation based on findings from an Indiana survey on LHD accreditation adoption. The study is an exploration of LHD accreditation de-adoption and of the contributions made to its understanding by the Performance Improvement Model.

Result:
The study found that top management team members are those who champion accreditation adoption, and that organizational structure and culture facilitate the staff's embracing of the change. The Performance Improvement Model was found to enhance the elucidation of the inner domain elements of Consolidated Framework for Implementation Research in the context of de-adoption of public health accreditation.

Conclusion:
Governing entities' policies and priorities appear to mediate whether the LHDs are able to continue accreditation pursuit. Lacking any of these driving forces appears to be associated with decisions to de-adoption of accreditation. Further work is necessary to discern specific elements mediating decisions to pursue accreditation. This study demonstrates the added knowledge of Performance Improvement Model (PIM) to the CFIR framework. A large scale study is called to further clarify and discern supports of specific to the needs of individual LHDs for their performance improvement effort.
The Disease of the Italian Poet Giacomo Leopardi (1798–1837)
Authors: Sganzerla Erik Pietro , Riva Michele Augusto 
Published: May 2017

Abstract
Some authors sustained that the pessimistic thought of the Italian writer and philosopher Giacomo Leopardi (1798–1837) may be attributed to his unhappy life, characterized by several health problems. His philosophical theories appear as the result of depressive and melancholic state, related to his precarious health conditions, so limiting their intrinsic values. Several authors formulated various hypotheses on the diseases that Leopardi suffered from and postulated different theories on the cause of his early death. This article assumed that Leopardi may have been affected by juvenile ankylosing spondylitis, conditioning spinal deformities, relapsing-remitting uveitis, urinary tract and bowel tract problems, and acute arthritis. Chest deformity, as a complication of juvenile ankylosing spondylitis, may have caused progressive cardiorespiratory failure, worsened by recurrent bronchial and pulmonary complications, until his death caused by acute right ventricular heart failure. The acknowledgment of a physical cause of Leopardi’s disease contributes to reevaluate his “cosmic pessimism” as an original expression of his thought, so leading a general revaluation of the figure of one of the most important European thinkers of the 19th century.
Neuro-Ophthalmology: Transitioning From Old to New Models of Health Care Delivery
Authors: Frohman Larry P. 
Published: May 2017

Abstract:
In contradiction to fundamental laws of supply and demand, 2 decades of payment policies have led to some medical specialties experiencing declines in both manpower and reimbursement. This paradox has resulted in increasingly long wait times to see some specialists, some specialties becoming less attractive to potential trainees, and a dearth of new trainees entering these fields. Evolving models of health care delivery hold the promise of increasing patient access to most providers and may diminish costs and improve outcomes for most patients/conditions. However, patients who need care in understaffed fields may, in the future, be unable to quickly access a specialist with the requisite expertise. Impeding the sickest and most complex patients from seeing physicians with appropriate expertise may lead to increased costs and deleterious outcomes—consequences contrary to the goals of health care reform. To ensure appropriate access for these patients requires 2 conditions: 1. Compensation models that do not discourage trainees from pursuing nonprocedural specialties, and 2. A care delivery model that expediently identifies and routes these patients to the appropriate specialist.
Evolution of Hierarchy in Bacterial Metabolic Networks
Authors: Goodman Aaron , Feldman Marcus 
Published: May 2017

AbstractBackgroundIn self-organized systems, the concept of flow hierarchy is a useful way to characterize the movement of information throughout a network. Hierarchical network organizations are shown to arise when there is a cost of maintaining links in the network. A similar constraint exists in metabolic networks, where costs come from reduced efficiency of nonspecific enzymes or from producing unnecessary enzymes. Previous analyses of bacterial metabolic networks have been used to predict the minimal nutrients that a bacterium needs to grow, its mutualistic relationships with other bacteria, and its major ecological niche. Using flow hierarchy, we can also infer the tradeoffs between growth rate and metabolic efficiency that bacteria make given their environmental constraints.ResultsUsing a comparative approach on 2,935 bacterial metabolic networks, we show that flow hierarchy in bacterial metabolic networks tracks a fundamental tradeoff between growth rate and biomass production, and reflects a bacterium’s realized ecological strategy. Additionally, by inferring the ancestral metabolic networks, we find that hierarchy decreases with distance from the root of the tree, suggesting the important pressure of increased growth rate relative to efficiency in the face of competition.ConclusionsJust as hierarchical character is an important structural property in efficiently engineered systems, it also evolves in self-organized bacterial metabolic networks, reflects the life-history strategies of those bacteria, and plays an important role in network organization and efficiency.
Duplication and Sub/neofunctionalization ofmalvolio, an Insect Homolog ofnramp, in the Subsocial BeetleNicrophorus vespilloides
Authors: Mehlferber Elijah C. , Benowitz Kyle M. , Roy-Zokan Eilleen M. , McKinney Elizabeth C. , Cunningham Christopher B. , Moore Allen J. 
Published: May 2017

ABSTRACTGene duplication has long been thought to play a facilitating role in evolution. With growing numbers of sequenced genomes, increasing numbers of duplicate genes are uncovered with unknown functions. Here we examinemalvolio, a gene involved in heavy metal transport but that also affects behavior in honey bees andDrosophila. There is only one copy of malvolio in honey bees and Drosophila despite its different roles. A phylogenetic analysis in insects suggests thatmalvoliohas duplicated multiple times in different orders. To test if the two copies might have different functions, we examined expression levels ofmalvolioin brain, fat bodies, Malpighian tubules, midgut, ovaries, testes and thoracic musculature in the beetleNicrophorus vespilloides. We found thatmvl1was expressed in all tissues, with highest expression in fat bodies and relatively lower expression in testes, Malpighian tubules, and brain, and ovaries. Expression ofmvl2differed, with significant expression only seen in brain and midgut. Becausemalvoliohas been implicated in behavior, and these beetles have highly developed parenting behavior, we next examined expression during different behavioral states including virgin, mating, preparing resources for offspring, feeding offspring and post care. We found differing expression patterns for the two copies, withmvl1increasing in expression during resource preparation and feeding offspring, andmvl2decreasing in these same states. Given these patterns of expression, we suggest thatmalvolioinN. vespilloideshas experienced sub/neofunctionalization following its duplication, and is evolving differing and tissue-specific roles in behavior and physiology.
Towards an understanding of spiral patterning in theSargassum muticumshoot apex
Authors: Linardić Marina , Braybrook Siobhan A. 
Published: May 2017

AbstractIn plants and parenchymatous brown algae the body arises through the activity of an apical meristem (a niche of cells or a single cell). The meristem produces lateral organs in specific patterns, referred to as phyllotaxis. In plants, two different control mechanisms have been proposed – one is position-dependent and relies on morphogen accumulation at future organ sites whereas the other is a lineage-based system which links phyllotaxis to the apical cell division pattern. Here we examine the apical patterning of the brown alga,Sargassum muticum, which exhibits spiral phyllotaxis (137.5° angle) and an unlinked apical cell division pattern. TheSargassumapex presents characteristics of a self-organising system, similar to plant meristems. We were unable to correlate the plant morphogen auxin with bud positioning in Sargassum, nor could we predict cell wall softening at new bud sites. Our data suggests that inSargassum muticumthere is no connection between phyllotaxis and the apical cell division pattern indicating a position-dependent patterning mechanism may be in place. The underlying mechanisms behind the phyllotactic patterning appear to be distinct from those seen in plants.SummaryThe brown algaSargassum muticumdisplays spiral phyllotaxis developed from a position-dependent self-organising mechanism, different from that understood in plants.