bluuebunny/crossref_metadata_2025_split huggingface dataset:
First-Trimester and Second-Trimester Maternal Serum Biomarkers as Predictors of Placental Abruption
Authors: Ananth Cande V. , Wapner Ronald J. , Ananth Srinidhi , D'Alton Mary E. , Vintzileos Anthony M. 
Published: February 2017

OBJECTIVE:
We hypothesized that the origins of abruption may extend to the stages of placental implantation; however, there are no reliable markers to predict its development. Based on this hypothesis, we sought to evaluate whether first-trimester and second-trimester serum analytes predict placental abruption.

METHODS:
We performed a secondary analysis of data of 35,307 women (250 abruption cases) enrolled in the First and Second Trimester Evaluation of Risk cohort (1999–2003), a multicenter, prospective cohort study. Percentiles (based on multiples of the median) of first-trimester (pregnancy-associated plasma protein A and total and free β-hCG) and second-trimester (maternal serum alpha-fetoprotein, unconjugated estriol, and inhibin-A) serum analytes were examined in relation to abruption. Associations are based on risk ratio (RR) and 95% confidence interval (CI).

RESULTS:
Women with an abnormally low pregnancy-associated plasma protein A (fifth percentile or less) were at increased risk of abruption compared with those without abruption (9.6% compared with 5.3%; RR 1.9, 95% CI, 1.2–2.8). Maternal serum alpha-fetoprotein 95th percentile or greater was more common among abruption (9.6%) than nonabruption (5.1%) pregnancies (RR 1.9, 95% CI 1.3–3.0). Inhibin-A fifth percentile or less (8.0% compared with 5.1%; RR 1.8, 95% CI 1.1–2.9), and 95th percentile or greater (9.6% compared with 5.0%; RR 2.0, 95% CI 1.3–3.1) were associated with abruption. Women with all three abnormal pregnancy-associated plasma protein A, maternal serum alpha-fetoprotein, and inhibin-A analytes were at 8.8-fold (95% CI 2.3–34.3) risk of abruption. No associations were seen with other analytes.

CONCLUSION:
These data provide support for our hypothesis that the origins of placental abruption may extend to the early stages of pregnancy.
Single Health System Adherence to 2012 Cervical Cancer Screening Guidelines at Extremes of Age and Posthysterectomy
Authors: Teoh Deanna , Isaksson Vogel Rachel , Hultman Gretchen , Monu Minnu , Downs Levi , Geller Melissa A. , Le Chap , Melton-Meaux Genevieve , Kulasingam Shalini 
Published: February 2017

OBJECTIVE:
To estimate the proportion of guideline nonadherent Pap tests in women aged younger than 21 years and older than 65 years and posthysterectomy in a single large health system. Secondary objectives were to describe temporal trends and patient and health care provider characteristics associated with screening in these groups.

METHODS:
A retrospective cross-sectional chart review was performed at Fairview Health Services and University of Minnesota Physicians. Reasons for testing and patient and health care provider information were collected. Tests were designated as indicated or nonindicated per the 2012 cervical cancer screening guidelines. Point estimates and descriptive statistics were calculated. Patient and health care provider characteristics were compared between indicated and nonindicated groups using χ2 and Wilcoxon rank-sum tests.

RESULTS:
A total of 3,920 Pap tests were performed between September 9, 2012, and August 31, 2014. A total of 257 (51%; 95% confidence interval [CI] 46.1–54.9%) of tests in the younger than 21 years group, 536 (40%; 95% CI 37.7–43.1%) in the older than 65 years group, and 605 (29%; 95% CI 27.1–31.0%) in the posthysterectomy group were not indicated. White race in the older than 65 years group was the only patient characteristic associated with receipt of a nonindicated Pap test (P=.007). Health care provider characteristics associated with nonindicated Pap tests varied by screening group. Temporal trends showed a decrease in the proportion of nonindicated tests in the younger than 21 years group but an increase in the posthysterectomy group.

CONCLUSION:
For women aged younger than 21 years and older than 65 years and posthysterectomy, 35% of Pap tests performed in our health system were not guideline-adherent. There were no patient or health care provider characteristics associated with guideline nonadherent screening across all groups.
Posterior Fourchette Fissure Resolution After Injection of Autologous Adipose-Derived Regenerative Cells
Authors: Andjelkov Katarina , Maricic Zoran 
Published: February 2017

BACKGROUND:
Posterior fourchette fissures can recur and become chronic despite multiple medical and surgical treatments. We report the case of a recurrent posterior fourchette fissure that resolved after subdermal injection with adipose-derived regenerative cells.

CASE:
A 44-year-old primiparous patient experienced severe dyspareunia for 10 years as a result of a recurrent posterior fourchette fissure that began after a vaginal delivery with episiotomy. She was treated unsuccessfully with topical antibiotics, estrogen, and steroids and ultimately with a perineoplasty at the age of 42 years. Adipose-derived regenerative cells were extracted enzymatically from her adipose tissue and injected subdermally and submucosally beneath the fissure and surrounding area. The fissure completely resolved within 3 months after treatment and has not recurred after more than 1 year of follow-up.

CONCLUSION:
Subdermal injection of autologous adipose-derived regenerative cells may be a treatment option for treatment of recurrent fourchette fissures that do not respond to standard medical and surgical therapies.
Longitudinal monitoring of patient limb loading throughout ankle fracture rehabilitation using an insole load monitoring system: a case series
Authors: North Kylee , Kubiak Erik N. , Rothberg David L. , Lajevardi-Khosh Arad , Petelenz Tomasz J. , Hitchcock Robert W. , Stuart Ami R. 
Published: February 2017

Background:
The purpose of this prospective, direct observational study was to evaluate limb loading in lower extremity orthopaedic trauma patients using a novel insole sensor, the Ambulatory Tibial Load Analysis System (ATLAS).

Methods:
Three patients from a level I trauma center, one with a trimalleolar ankle fracture, one with a distal, spiral fracture of the tibia and fibula at the same level, and one with a bimalleolar ankle fracture were observed using an insole load monitoring system to record their weight bearing during standard of care rehabilitation. No clinical decisions were made based on the limb loading data. The primary study measures were limb-loading data provided by the ATLAS and patient reported physical function as measured by the PROMIS Physical Function Computer Adapted Test.

Results:
The ATLAS provided 8-12 wk of continuous limb loading data, with raw loading data, duration of insole sensor and CAM walker wear, daily step count, median load per day, and periods of static and dynamic loading for three patients with varying ankle fractures.

Conclusions:
The findings of this case study support the use of the ATLAS sensor in evaluation of limb loading in patients with lower extremity fracture. The data suggest that the current weight bearing prescription may not be sufficient for all patients and that personalized protocols are warranted.
Global Sagittal Imbalance Due to Change in Pelvic Incidence After Traumatic Spinopelvic Dissociation
Authors: Lee Han-Dong , Jeon Chang-Hoon , Won Suk-Hyeong , Chung Nam-Su 
Published: February 2017

Objectives:
To examine how spinopelvic morphology changes after traumatic spinopelvic dissociation and whether these changes affect the sagittal balance of the spine.

Design:
Retrospective analysis.

Setting:
Level I trauma center.

Patients:
Thirty-nine consecutive patients who were diagnosed with traumatic spinopelvic dissociation and had a minimum 2-year radiological follow-up were included.

Intervention:
Nineteen patients underwent spinopelvic pedicle screw fixation, 11 patients underwent percutaneous iliosacral screw fixation, and 9 patients were treated conservatively.

Main Outcome Measurements:
The main outcome measurements are as follows: (1) injury morphology (injury type and kyphotic angulation) at the initial and follow-up visits; (2) sagittal vertical axis (SVA) at the 2-year follow-up; (3) spinopelvic parameters [pelvic incidence (PI), sacral slope, pelvic tilt, lumbar lordosis, and thoracic kyphosis] at the 2-year follow-up; and (4) bodily pain and Oswestry Disability Index at the 2-year follow-up.

Results:
There were 21 men and 18 women, with a mean age of 28.3 years (15–62 years). At the 2-year follow-up, the mean SVA was 5.4 ± 4.1 cm and the mean PI was 76.9 ± 24.6 degrees. Factors related to SVA after traumatic spinopelvic dissociation were PI (r = 0.441, P = 0.017), pelvic tilt (r = 0.387, P = 0.038), and injury type of complete displacement (r = 0.372, P = 0.047). The bodily pain and Oswestry Disability Index was significantly poorer in patients with SVA modifier “+” than in patients with SVA modifier “0.”

Conclusions:
Lumbosacral kyphosis after traumatic spinopelvic dissociation increases PI, which can affect the sagittal balance of the spine and clinical outcome. Restoration of lumbosacral orientation is important for preventing sagittal imbalance.

Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Comparison of the Conventional Dresden Protocol and Accelerated Protocol With Higher Ultraviolet Intensity in Corneal Collagen Cross-Linking for Keratoconus
Authors: Choi Moonjung , Kim Jiwon , Kim Eung Kweon , Seo Kyoung Yul , Kim Tae-im 
Published: February 2017

Purpose:
To compare the accelerated corneal cross-linking (CXL) protocol and the conventional Dresden protocol in patients with keratoconus in terms of visual acuity, keratometric values, and topographic parameters.

Methods:
Twenty-eight eyes of 25 patients with primary keratoconus were divided into 2 groups; 15 eyes in group 1 received CXL under the standard Dresden protocol (3 mW/cm2 for 30 min, dose 5.4 J/cm2) and 13 eyes in group 2 were treated with the accelerated protocol (30 mW/cm2 for 3 min 40 s, dose 6.6 J/cm2). Visual acuity, refractive error, keratometry values obtained by both Pentacam and Auto Kerato-Refractometer, corneal thickness, and topometric indexes were compared 6 months postoperatively.

Results:
The visual acuity improved significantly from 0.17 ± 0.16 to 0.08 ± 0.09 logarithm of the minimum angle of resolution in group 1 (P = 0.009). The cylindrical refractive error improved in both groups (P = 0.05 in group 1 and P = 0.011 in group 2), and the spherical equivalent increased in group 1 (P = 0.021). In group 1, the maximum keratometry value decreased by 0.55 ± 0.89 diopters (P = 0.03), and the mean keratometry value decreased by 0.44 ± 0.63 diopters (P = 0.017), whereas the changes in visual acuity, spherical and spherical equivalent refractive errors, and keratometric values in group 2 were not statistically significant. The corneal thickness at the apex decreased significantly in group 1 (P = 0.001), but the change was not significant in group 2.

Conclusions:
Despite a higher UV dose (6.6 J/cm2), accelerated CXL with higher UV intensity and reduced irradiation time showed a smaller topographic flattening effect than did the conventional Dresden protocol in primary keratoconus with documented progression.
Functional Gastrointestinal Disorders in Children
Authors: Scarpato Elena , Quitadamo Paolo , Roman Enriqueta , Jojkic‐Pavkov Danijela , Kolacek Sanja , Papadopoulou Alexandra , Roma Eleftheria , Shamir Raanan , Lev Michal R.B. , Lutovac Branko , Djurisic Veselinka , Orel Rok , Koleilat Aziz , Mneimneh Sirin , Coppola Vincenzo , Corazziari Enrico , Staiano Annamaria 
Published: February 2017

ABSTRACTObjectives:Childhood functional gastrointestinal disorders (FGIDs) are common conditions associated with significant morbidity and high healthcare costs. This multicenter study aimed at assessing the clinical approach to infants (0–6 months) and children/adolescents (4–18 years) with suspected FGIDs by pediatricians from the Mediterranean Area.Methods:A survey evaluating the diagnostic approach, including the use of Rome II and III criteria, and the therapeutic management of some of the most prevalent FGIDs, such as irritable bowel syndrome (IBS), functional constipation (FC), and functional regurgitation (FR), was distributed to a sample of pediatricians.Results:We collected 278 questionnaires from 9 countries (Croatia, Greece, Israel, Italy, Lebanon, Montenegro, Serbia, Slovenia, and Spain). Rome III criteria are used to diagnose FC by 28.8%. Treatment of FC is based on dietary modifications (97.5%) and osmotic laxatives (93.5%). Rome III criteria are used to diagnose FR by 22.3% of the responders, in contrast to 79.5% who rely on personal experience for diagnosis. Reported treatments mainly consist of reassurance (96.8%) and thickened feedings (77.3%). Nevertheless, 21.2% prescribe proton pump inhibitors or H2‐blockers to infants with FR. Rome III criteria are used to diagnose IBS by only 25.9%. Moreover, 86% of the pediatricians base IBS therapy on the predominant symptom. The most prescribed treatments are analgesics (36.6%) for pain control, dietary advice (41.5%) for diarrhea‐predominant IBS, and dietary advice (47.8%) for constipation‐predominant IBS.Conclusions:Our data show that the use of Rome III diagnostic criteria is not sufficiently widespread among pediatricians, and that large variability remains in the management of FGIDs within the different Mediterranean countries surveyed.
Designing Human Immunodeficiency Virus Counselling and Testing Services to Maximize Uptake Among High School Learners in South Africa: What Matters?
Authors: Strauss Michael , George Gavin , Rhodes Bruce 
Published: February 2017

Background
Increasing human immunodeficiency virus (HIV) testing in South Africa is vital for the HIV response. Targeting young people is important as they become sexually active and because HIV risk rapidly increases as youth enter their 20s. This study aims to increase the understanding of high school learners' preferences regarding the characteristics of HIV testing service delivery models and to inform policy makers and implementers regarding potential barriers to and facilitators of HIV testing.

Methods
An attitudinal survey was used to examine HIV testing preferences among 248 high school learners in KwaZulu-Natal. Statistical tests were used to identify the most favored characteristics of testing service delivery models and examine key differences in preferences based on demographic characteristics and testing history.

Results
Most learners were found to prefer testing offered at a clinic on a Saturday (43%), using a finger prick test (59%), conducted by a doctor (61%) who also provides individual counselling (60%). Shorter testing times were preferred, as well as a monetary incentive to cover any associated expenses. Time, location, the type of test, and who conducts the test were most important. However, stratified analysis suggests that preferences diverge, particularly around gender, grade, but also sexual history and previous testing experience.

Conclusions
Human immunodeficiency virus testing services can be improved in line with preferences, but there is no single optimal design that caters to the preferences of all learners. It is unlikely that a “one-size-fits-all” approach will be effective to reach HIV testing targets. A range of options may be required to maximize coverage.
Motivating Physicians to Report Adverse Medical Events in China: Stick or Carrot?
Authors: Xue Yajiong , Yang Jing , Zhang Jing , Luo Mengyun , Zhang Zhiruo , Liang Huigang 
Published: February 2017

Background
Adverse medical events (AMEs) pose serious threats to patient safety. One of the major challenges of AME reporting is low physician engagement. This study attempted to examine how punishment and reward can improve physicians’ AME reporting in China.

Methods
A survey was conducted in a large hospital with 1693 beds in China. Data were collected from 311 physicians. Ordinal and binary logistic regression was used for data analysis.

Results
This study reveals that both punishment and reward are positively associated with intention to report AMEs. There is a negative interaction effect between punishment and reward. Although collective punishment is positively associated with intention to report AMEs, collective reward is not. Moreover, the physicians who have fear of negative consequences of AMEs and lack knowledge of AME reporting have lower intention to report AMEs. These findings do not differ between male and female physicians.

Conclusions
This survey suggests that punishment and reward have potential to motivate Chinese physicians to report AMEs. However, the implementation strategies of these control mechanisms may not be universally applicable and should be carefully designed on the basis of the specific characteristics of the practice site.
Experimental Texture Analysis in Glioblastoma
Authors: Hainc Nicolin , Stippich Christoph , Stieltjes Bram , Leu Severina , Bink Andrea 
Published: February 2017

Objectives
Analysis of a single slice of a tumor to extract biomarkers for texture analysis may result in loss of information. We investigated correlation of fractional volumes to entire tumor volumes and introduced expanded regions of interest (ROIs) outside the visual tumor borders in glioblastoma.

Materials and Methods
Retrospective slice-by-slice volumetric texture analysis on 46 brain magnetic resonance imaging subjects with histologically confirmed glioblastoma was performed. Fractional volumes were analyzed for correlation to total volume. Expanded ROIs were analyzed for significant differences to conservative ROIs.

Results
As fractional tumor volumes increased, correlation with total volume values for mean, SD, mean of positive pixels, skewness, and kurtosis increased. Expanding ROI by 2 mm resulted in significant differences in all textural values.

Conclusions
Fractional volumes may provide an optimal trade-off for texture analysis in the clinical setting. All texture parameters proved significantly different with minimal expansion of the ROI, underlining the susceptibility of texture analysis to generating misrepresentative tumor information.
Validating the Postdischarge Surgical Recovery Scale 13 as a Measure of Perceived Postoperative Recovery After Laparoscopic Sacrocolpopexy
Authors: Carpenter Janet S. , Heit Michael , Chen Chen X. , Stewart Ryan , Hamner Jennifer , Rand Kevin L. 
Published: February 2017

Objectives
No postoperative recovery measurement tools have been validated among women undergoing laparoscopic sacrocolpopexy for pelvic organ prolapse, which impedes development and testing of strategies to improve recovery. The purpose of this study was to evaluate the performance of the Postdischarge Surgical Recovery Scale (PSR) as a measure of perceived recovery in laparoscopic sacrocolpopexy patients.

Methods
Women (N = 120) with stage 2 or higher pelvic organ prolapse undergoing laparoscopic sacrocolpopexy completed a 15-minute postoperative survey (days 7, 14, 42, and 90 [each ± 3 days]) which included the 15-item PSR. A confirmatory factor analysis was conducted using data from 14 days postsurgery, when patients would have begun to recover, but there was likely to be substantial variability in recovery across patients. We also assessed validity and explored sensitivity to change over time and minimally important difference values.

Results
Confirmatory factor analysis indicated a good fitting model for a reduced version of the PSR (ie, PSR13). Regressions showed that the PSR13 prospectively predicted single-item recovery scores. The PSR13 recovery significantly improved from days 7 to 42, suggesting the PSR13 is sensitive to change. Descriptive statistics including minimally important differences are reported. The minimally important difference was estimated to be around 5 points.

Conclusions
The PSR13 is a psychometrically sound tool for measuring recovery over time in this population. Its short length makes it an ideal postoperative recovery measure in clinical practice or research.
Direct and Indirect Effects of Personality Traits on Psychological Distress in Women With Pelvic Floor Disorders
Authors: Yaakobi Tal , Handelzalts Jonathan E. , Peled Yoav , Levy Sigal , Wiznitzer Arnon , Krissi Haim 
Published: February 2017

Objectives
The diagnosis and treatment of pelvic floor disorders may involve subjective self-report symptom measures that may be related to personality traits. We aimed to construct a model that integrates pelvic floor disorders, personality variables (optimism and neuroticism), psychological distress, and related demographic variables.

Methods
In a cross-sectional study, conducted between August 2014 and June 2015, 155 women following an intake to an urogynecology outpatient clinic of a tertiary health center completed personality questionnaires of optimism and neuroticism (Life Orientation Test–Revised, 10-item Big Five Inventory), pelvic floor symptoms (Pelvic Floor Distress Inventory Short Form), psychological distress (18-item Brief Symptom Inventory), and a demographic questionnaire.

Results
A path analysis mediation model showed that patients who had more pelvic floor symptoms felt more psychological distress and that psychological distress increased as the level of neuroticism increased. As for optimism, the correlation to pelvic floor symptoms was nearly significant. Optimism and neuroticism had indirect effects on psychological distress through pelvic floor symptoms in women with urinary incontinence and pelvic organ prolapse. Neuroticism had a direct effect on psychological distress in these women as well.

Conclusions
Our suggested statistical path analysis model supports the important role of personality traits in pelvic floor disorder self-reports and the effect of these traits on psychological distress. Therefore, the optimal treatment for pelvic floor symptoms should include psychological interventions in addition to traditional medical or surgical therapy in hope of reducing psychology distress associated with urinary incontinence and pelvic organ prolapse.
Single Port Robotic Assisted Sacrocolpopexy: Our Experience With the First 25 Cases
Authors: Matanes Emad , Lauterbach Roy , Mustafa-Mikhail Susana , Amit Amnon , Wiener Zeev , Lowenstein Lior 
Published: February 2017

Objectives
In single-port surgery, the surgeon operates almost exclusively through a single entry point, typically the patient's navel, leaving only a single small scar. The aims of this study were to share some tips and tricks of single-port robotic-assisted sacrocolpopexy and to evaluate the learning curve of mastering the skills to operate this procedure.

Methods
This is a retrospective study of the first 25 single-port; robotic-assisted sacrocolpopexy surgeries performed during July to December 2015 at Rambam Health Care Campus by a single surgeon.
Primary points of interest included intraoperative bleeding, length of surgery, length of hospitalization, and surgical complications.

Results
The median age was 59 years (range, 35–74); the median “pelvic organ prolapse quantification” stage was 3 (range, 2–4). The median total operative time was 190 minutes (range, 114–308), and console time was 130 minutes (85–261). Comparisons between the first 15 cases and the following 10 cases demonstrated significant decreases in median total operative and console times: 226 minutes (range, 142–308) versus 156 minutes (range, 114–180), and 170 minutes (range, 85–261) versus 115 minutes (range, 90–270), respectively (P < 0.008). There were no intraoperative adverse events. Postoperative adverse events were also rare, including 1 case of small bowel adhesions that required a second laparoscopic surgery for adhesiolysis. After this incident, we peritonalized the mesh in all 13 successive cases; median time was 8 minutes (range, 5–15 minutes).

Conclusions
Single-port robotic-assisted sacrocolpopexy is a feasible procedure with low complication rates, minimal blood loss and postsurgical pain, fast recovery, short hospitalization, and virtually scar-free results. Outcomes of long-term follow-up should be investigated.