bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rod Lengthening With the Magnetically Controlled Growing Rod
Authors: Cheung Jason P.Y. , Yiu Karen K.L. , Samartzis Dino , Kwan Kenny , Tan Boon-Beng , Cheung Kenneth M.C. 
Published: August 2017

Study Design.
Prospective study.

Objective.
To identify the factors that are associated with rod slippage and to study the pattern of achieved length gain with a standard distraction methodology.

Summary of Background Data.
Ability to achieve successful magnetically controlled growing rod (MCGR) distraction is crucial for gradual spine lengthening. Rod slippage has been described as a failure of internal magnet rotation leading to a slippage and an inability to distract the rod. However, its onset, significance, and risk factors are currently unknown. In addition, how this phenomenon pertains to actual distracted lengths is also unknown.

Methods.
A total of 22 patients with MCGR and at least six distraction episodes were prospectively studied. Patients with rod slippage occurring less than six distraction episodes were considered early rod slippage whereas those with more than six episodes or have yet to slip were grouped as late rod slippage. The association of parameters including body habitus, maturity status, age of implantation, total number of distractions, months of distraction from initial implantation, initial and postoperative Cobb angle, T1-T12, T1-S1, T5-T12 kyphosis, curve flexibility, instrumented length, and distance between magnets in dual rods and between the magnets and apex of the curve with early or late onset of rod slippage were studied. Differences between expected and achieved distraction lengths were assessed with reference to rod slippage episodes and rod exchanges to determine any patterns of diminishing returns.

Results.
Patients had mean age of 7.1 years at diagnosis with mean follow-up of 49.8 months. A mean 32.4 distractions were performed per patient. Early rod slippage occurred in 14 patients and late rod slippage occurred in eight patients. Increased height, weight, body mass index, older age, increased T1–12 and T1-S1 lengths, and less distance between magnets were significantly associated with early rod slippage. Expected distraction lengths did not translate to achieve distraction lengths and reduced gains were only observed after achieving one-third of the allowable distracted length in the MCGR. Length gains return to baseline after rod exchange.

Conclusion.
This is the first study to specifically analyze the impact of rod slippage on distraction lengths and the risk factors associated with its onset and frequency. Increased body habitus and reduced distance between internal magnets significantly influenced rod slippage events. Diminishing returns in distracted length gains were only observed after a period of usage.

Level of Evidence: 3
Modic Changes and Disc Degeneration of Nonfused Segments 27 to 45 Years After Harrington Instrumentation for Adolescent Idiopathic Scoliosis
Authors: Akazawa Tsutomu , Kotani Toshiaki , Sakuma Tsuyoshi , Minami Shohei , Orita Sumihisa , Inage Kazuhide , Fujimoto Kazuki , Shiga Yasuhiro , Torii Yoshiaki , Umehara Tasuku , Iinuma Masahiro , Kuroya Shingo , Niki Hisateru , Ohtori Seiji , Takahashi Kazuhisa 
Published: August 2017

Study Design.
A case-control study.

Objective.
The aim of this study was to investigate the long-term prevalence of the Modic changes and disc degeneration in the nonfused segments of the surgically treated adolescent idiopathic scoliosis (AIS) patients and compare with age- and sex-matched healthy controls.

Summary of Background Data.
No studies have looked at the association between Modic changes and low back pain in patients who underwent AIS surgery many years ago.

Methods.
Study subjects consisted of 194 patients with AIS who underwent spinal fusion with Harrington instrumentation between 1968 and 1987. Twenty-six patients (AIS group) underwent lumbar magnetic resonance imaging (MRI), whole spine X-ray, and patient-reported outcomes evaluations [Scoliosis Research Society-22 Patient Questionnaire (SRS-22), Oswestry Disability Index (ODI)]. The mean duration of follow-up observation was 36.1 years. The lowest fusion vertebra was used as follows: T12: 2 patients, L1: 4, L2: 11, L3: 6, L4: 2, L5: 1. Twenty-nine healthy age- and sex-matched individuals were selected as a control (CTR) group.

Results.
On the basis of MRI findings, a significantly higher percentage of subjects showed Modic changes in the AIS group (AIS group: 57.7%, CTR group: 13.8%). There were no significant differences in the percentage of subjects with disc degeneration rated Pfirrmann grade 4 or higher (AIS group: 61.5%, CTR group: 65.5%). SRS-22 scores for function and self-image were significantly lower in the AIS group. ODI was significantly worse in the AIS group. Modic changes in AIS group were found in the concave side of the curve in 61.9%. The magnitude of lumbar coronal curve was found to be a significant risk factor of Modic changes.

Conclusion.
Modic changes were observed in 57.7% of AIS patients 27 years or more after spinal fusion with Harrington instrumentation. The magnitude of lumbar coronal curve was found to be a significant risk factor of Modic changes. Modic change occurred at a higher frequency in AIS patients than CTR individuals, with lower function and worse ODI scores.

Level of Evidence: 4
Prevalence and Prognostic Association of Circulating Troponin in the Acute Respiratory Distress Syndrome
Authors: Metkus Thomas S. , Guallar Eliseo , Sokoll Lori , Morrow David , Tomaselli Gordon , Brower Roy , Schulman Steven , Korley Frederick K. 
Published: August 2017

Objective:
Circulating cardiac troponin has been associated with adverse prognosis in the acute respiratory distress syndrome in small and single-center studies; however, comprehensive studies of myocardial injury in acute respiratory distress syndrome using modern high-sensitivity troponin assays, which can detect troponin at much lower circulating concentrations, have not been performed.

Design:
We performed a prospective cohort study.

Setting:
We included patients enrolled in previously completed trials of acute respiratory distress syndrome.

Patients:
One thousand fifty-seven acute respiratory distress syndrome patients were included.

Interventions:
To determine the association of circulating high-sensitivity troponin I (Abbott ARCHITECT), with acute respiratory distress syndrome outcomes, we measured high-sensitivity troponin I within 24 hours of intubation. The primary outcome was 60-day mortality.

Measurements and Main Results:
Detectable high-sensitivity troponin I was present in 94% of patients; 38% of patients had detectable levels below the 99th percentile of a healthy reference population (26 ng/L), whereas 56% of patients had levels above the 99th percentile cut point. After multivariable adjustment, age, cause of acute respiratory distress syndrome, temperature, heart rate, vasopressor use, Sequential Organ Failure Assessment score, creatinine, and Pco
2 were associated with higher high-sensitivity troponin I concentration. After adjustment for age, sex, and randomized trial assignment, the hazard ratio for 60-day mortality comparing the fifth to the first quintiles of high-sensitivity troponin I was 1.61 (95% CI, 1.11–2.32; p trend = 0.003). Adjusting for Sequential Organ Failure Assessment score suggested that this association was not independent of disease severity (hazard ratio, 0.95; 95% CI, 0.64–1.39; p = 0.93).

Conclusions:
Circulating troponin is detectable in over 90% of patients with acute respiratory distress syndrome and is associated with degree of critical illness. The magnitude of myocardial injury correlated with mortality.
Emergency Airway Response Team Simulation Training: A Nursing Perspective
Authors: Crimlisk Janet T. , Krisciunas Gintas P. , Grillone Gregory A. , Gonzalez R. Mauricio , Winter Michael R. , Griever Susan C. , Fernandes Eduarda , Medzon Ron , Blansfield Joseph S. , Blumenthal Adam 
Published: August 2017

Background:
Simulation-based education is an important tool in the training of professionals in the medical field, especially for low-frequency, high-risk events. An interprofessional simulation-based training program was developed to enhance Emergency Airway Response Team (EART) knowledge, team dynamics, and personnel confidence. This quality improvement study evaluated the EART simulation training results of nurse participants.

Method:
Twenty-four simulation-based classes of 4-hour sessions were conducted during a 12-week period. Sixty-three nurses from the emergency department (ED) and the intensive care units (ICUs) completed the simulation. Participants were evaluated before and after the simulation program with a knowledge-based test and a team dynamics and confidence questionnaire. Additional comparisons were made between ED and ICU nurses and between nurses with previous EART experience and those without previous EART experience.

Results:
Comparison of presimulation (presim) and postsimulation (postsim) results indicated a statistically significant gain in both team dynamics and confidence and Knowledge Test scores (P < .01). There were no differences in scores between ED and ICU groups in presim or postsim scores; nurses with previous EART experience demonstrated significantly higher presim scores than nurses without EART experience, but there were no differences between these nurse groups at postsim.

Conclusions:
This project supports the use of simulation training to increase nurses' knowledge, confidence, and team dynamics in an EART response. Importantly, nurses with no previous experience achieved outcome scores similar to nurses who had experience, suggesting that emergency airway simulation is an effective way to train both new and experienced nurses.
Family Satisfaction With End-of-Life Care in the Intensive Care Unit
Authors: DeSanto-Madeya Susan , Safizadeh Parissa 
Published: August 2017

Background:
Assessment of family satisfaction after the death of a loved one in the intensive care unit (ICU) provides a way to determine whether quality end-of-life care was received by the patient and family. The purpose of this systematic review was to explore the factors associated with family satisfaction with end-of-life care in the ICU.

Methods:
A systematic literature review was conducted using electronic databases CINAHL, MEDLINE, EMBASE, and PsychINFO. Databases were searched using a combination of search terms: “family satisfaction,” “end of life,” “intensive care unit,” and “family.” Results were limited to English-language reports of empirical studies published from January 2000 to January 2016. Studies describing adult family members’ satisfaction with end-of-life care of patients admitted or transferred to an ICU were included in the review.

Results:
The search yielded 466 articles. Review of the titles and abstracts resulted in 122 articles that underwent full review; 30 articles met study inclusion and were included in the final analysis. Major themes identified from the literature reviewed included communication, decision making, nursing care, ICU environment, and spiritual care.

Conclusions:
Families can provide valuable insight and information on the quality of care provided in the ICU at end of life. Their perceptions of communication, decision making, nursing care, the ICU environment, and spiritual support strongly influence their satisfaction or dissatisfaction with end-of-life care in the ICU. Personalized and frequent communication; assistance in the decision-making process; compassionate nursing care; a warm, family-friendly environment; and spiritual support can help alleviate the sequelae and enhance family satisfaction with end-of-life care in the ICU.
MiR-30e Attenuates Isoproterenol-induced Cardiac Fibrosis Through Suppressing Snai1/TGF-β Signaling
Authors: Zhang Wenqi , Chang Hong , Zhang Hexun , Zhang Lei 
Published: August 2017

Background:
MicroRNAs are a class of small RNA molecules that inhibit protein expression through either degradation of messenger RNA or interference with protein translation. Our previous work suggested an involvement of miR-30e in myocardial fibrosis; however, the exact role of miR-30e in the pathogenesis of cardiac fibrosis and the underlying mechanisms are not known.

Methods:
Male Sprague Dawley rats were treated with isoproterenol (ISO) to induce cardiac remodeling and fibrosis and treated with either miR-30e agomir (AG) or antagomir and respective controls. The expression of miR-30e was evaluated by reverse transcription and quantitative polymerase chain reaction. Myocardial fibrosis was assessed by Masson's trichrome staining, and the level of oxidative stress and the expression of Snai1 and transforming growth factor-beta (TGF-β) were detected using Western blots.

Results:
A significant downregulation of miR-30e was found in the hearts of ISO-treated rats with cardiac fibrosis compared with nontreated controls. In vivo administration of miR-30e AG increased the survival of ISO-treated rats compared with AG-negative control administration, which was associated with reduced oxidative stress. We further identified Snai1 as a novel miR-30e target. Snai1 expression was significantly increased in hearts from ISO-treated rats, which coincided with decreased miR-30e expression and increased TGF-β expression. An miR-30e putative target sequence was identified in the 3′-untranslated region (UTR) Snai1. In a reporter assay, miR-30e greatly suppressed the activity of wild-type 3′-UTR–fused luciferase reporter, but showed no significant effect with the mutated 3′-UTR–fused reporter.

Conclusion:
MiR-30e attenuated ISO-induced cardiac dysfunction and cardiac fibrosis in a rat cardiac remodeling model. Mechanistically, miR-30e suppressed Snai1/TGF-β pathway which was involved in ISO-induced cardiac remodeling.
Intraoperative Evaluation of Body Surface Improvement by an Augmented Reality System That a Clinician Can Modify
Authors: Mitsuno Daisuke , Ueda Koichi , Itamiya Tomoki , Nuri Takashi , Otsuki Yuki 
Published: August 2017

Background:
Augmented reality (AR) technology that can combine computer-generated images with a real scene has been reported in the medical field recently. We devised the AR system for evaluation of improvements of the body surface, which is important for plastic surgery.

Methods:
We constructed an AR system that is easy to modify by combining existing devices and free software. We superimposed the 3-dimensional images of the body surface and the bone (obtained from VECTRA H1 and CT) onto the actual surgical field by Moverio BT-200 smart glasses and evaluated improvements of the body surface in 8 cases.

Results:
In all cases, the 3D image was successfully projected on the surgical field. Improvement of the display method of the 3D image made it easier to distinguish the different shapes in the 3D image and surgical field, making comparison easier. In a patient with fibrous dysplasia, the symmetrized body surface image was useful for confirming improvement of the real body surface. In a patient with complex facial fracture, the simulated bone image was useful as a reference for reduction. In a patient with an osteoma of the forehead, simultaneously displayed images of the body surface and the bone made it easier to understand these positional relationships.

Conclusions:
This study confirmed that AR technology is helpful for evaluation of the body surface in several clinical applications. Our findings are not only useful for body surface evaluation but also for effective utilization of AR technology in the field of plastic surgery.
COMPARISON OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHIC CHANGES AFTER ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY ALONE OR IN COMBINATION WITH PHOTODYNAMIC THERAPY IN POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Teo Kelvin Yi Chong , Yanagi Yasuo , Lee Shu Yen , Yeo Ian Yew San , Tan Gavin Siew Wei , Mathur Ranjana , Chan Choi Mun , Wong Tien Yin , Cheung Chui Ming Gemmy 
Published: August 2017

Purpose:
To compare changes in optical coherence tomography angiography in eyes with polypoidal choroidal vasculopathy after treatment with anti–vascular endothelial growth factor monotherapy or combined with photodynamic therapy.

Methods:
This is a longitudinal case-controlled study. The authors performed optical coherence tomography angiography at baseline and Month 3 in patients with treatment-naive polypoidal choroidal vasculopathy undergoing monotherapy (n = 10) or combination therapy (n = 13). We analyzed flow signal within the outer retina and choriocapillaris using automated segmentation. The authors analyzed the presence of pachyvessels using a 10.4-μm segment through Haller layer. The changes in each layer were compared between treatments.

Results:
At Month 3, both groups showed similar improvement in best-corrected visual acuity and central retinal thickness. However, flow signal within the polypoidal choroidal vasculopathy complex was decreased in more eyes after combination therapy than after monotherapy (84.6% vs. 40.0%, P = 0.04). Patchy reduction in flow signal within the choriocapillaris layer was noted in 15.4% and 10.0% after combination therapy and monotherapy, respectively (P = 0.61). Significant reduction in pachyvessel caliber was seen only after combination therapy but not after monotherapy (75.0% vs. 0.0%, P = 0.01).

Conclusion:
Longitudinal optical coherence tomography angiography demonstrates more significant reduction in lesion flow and pachyvessels in the short term after combination therapy than after monotherapy, although visual and structural OCT showed similar improvement.
FOVEAL AVASCULAR ZONE AREA AFTER INTERNAL LIMITING MEMBRANE PEELING FOR EPIRETINAL MEMBRANE AND MACULAR HOLE COMPARED WITH THAT OF FELLOW EYES AND HEALTHY CONTROLS
Authors: Kumagai Kazuyuki , Furukawa Mariko , Suetsugu Tetsuyuki , Ogino Nobuchika 
Published: August 2017

Purpose:
To measure the foveal avascular zone (FAZ) area after internal limiting membrane (ILM) peeling and to determine the factors significantly correlated with the FAZ area.

Methods:
This was a retrospective, observational, and cross-sectional study. The affected and normal fellow eyes of 102 patients with unilateral macular diseases and 169 healthy subjects were studied. The patients underwent successful vitrectomy with internal limiting membrane peeling for an epiretinal membrane (n = 56) or a macular hole (n = 46). The superficial FAZ area and average foveal (within 1 mm) thickness were measured. The main outcome measures were the en face FAZ area measured in the optical coherence tomography angiographic images.

Results:
The FAZ area in the epiretinal membrane group (0.148 ± 0.094 mm2) and in the macular hole group (0.255 ± 0.111 mm2) were significantly smaller than that in the healthy control group (0.358 ± 0.118 mm2; all, P < 0.0001). Multiple regression analysis showed that a thicker fovea was significantly correlated with a smaller FAZ area in the epiretinal membrane group (r = −0.799, P < 0.0001), macular hole group (r = −0.473, P = 0.0042), and control group (r = −0.612, P < 0.0001).

Conclusion:
The FAZ area after internal limiting membrane peeling was smaller than that of the controls. A smaller FAZ area was correlated with a thicker fovea both in internal limiting membrane–peeled eyes and normal eyes.
EFFICACY AND FREQUENCY OF INTRAVITREAL AFLIBERCEPT VERSUS BEVACIZUMAB FOR MACULAR EDEMA SECONDARY TO CENTRAL RETINAL VEIN OCCLUSION
Authors: Lotfy Ayman , Solaiman Kamal A. M. , Abdelrahman Ayman , Samir Ahmed 
Published: August 2017

Purpose:
To compare the safety, efficacy, and frequency of intravitreal injection of aflibercept and bevacizumab for treatment of macular edema secondary to central retinal vein occlusion.

Design:
Prospective, comparative, randomized, interventional study.

Patients and Methods:
Eyes with macular edema secondary to central retinal vein occlusion were randomized between two groups according to the intravitreal injection used. Group A included eyes treated with intravitreal aflibercept, and Group B included eyes treated with intravitreal bevacizumab injections. The inclusion criteria were macular edema secondary to central retinal vein occlusion and follow-up duration of at least 12 months after the first injection. Exclusion criteria were macular ischemia, associated diabetes, hypertensive or renal retinopathy, other retinal disease, and previous anti–vascular endothelial growth factor injection. The main outcome measures are central foveal thickness, best-corrected visual acuity, time intervals between injections, improved retinal nonperfusion, and any reported complication.

Results:
Group A included 39 patients with a mean age of 57.4 ± 8.2 years. Group B included 40 eyes with a mean age of 56.5 ± 9.1 years. Twelve months after the first injection, central foveal thickness significantly improved from 475.45 ± 71.05 m to 259.11 ± 20.67 m in Group A and from 460.22 ± 89.38 m to 264.29 ± 32.05 m in Group B; best-corrected visual acuity significantly improved from 0.81 ± 0.16 logarithm of the minimum angle of resolution (20/125) to 0.34 ± 0.14 logarithm of the minimum angle of resolution (20/40) in Group A and from 0.73 ± 0.15 logarithm of the minimum angle of resolution (20/100) to 0.33 ± 0.17 logarithm of the minimum angle of resolution (20/40) in Group B; the mean number of injections was 3.72 ± 2.93 in Group A and was 5.44 ± 2.85 in Group B (P < 0.05); and the mean interval between injections was 54.23 ± 8.47 days in Group A and was 35.12 ± 7.76 days in Group B (P < 0.05). Retinal nonperfusion improved in 9/12 eyes in Group A and in 3/8 eyes in Group B (P < 0.05).

Conclusion:
Both aflibercept and bevacizumab are comparably effective for treatment of macular edema secondary to central retinal vein occlusion without significant complications. However, the burden of frequent intravitreal injections could be significantly reduced when using aflibercept.