bluuebunny/crossref_metadata_2025_split huggingface dataset:
A brief treatment for fear of heights
Authors: Arroll Bruce , Henwood Suzanne M , Sundram Fred I , Kingsford Douglas W , Mount Vicki , Humm Steve P , Wallace Henry B , Pillai Avinesh 
Published: April 2017

Objective To assess the effectiveness of a novel imaginal intervention for people with acrophobia. Methods The design was a randomized controlled trial with concealed randomization and blinded to other participants’ intervention. The intervention was a single novel imaginal intervention session or a 15-min meditation. The setting was in Auckland, New Zealand. The participants were a convenience sample of the public with a score >29 on the Heights Interpretation Questionnaire (HIQ), a questionnaire validated against actual height exposure. The primary outcomes were the proportion of participants with a score <26 on the HIQ at eight weeks and difference between the HIQ scores between the two arms of the study. Results Ninety-eight participants (92%) returned their questionnaire and were included in the intention to treat analysis. The HIQ score <26 was 34.6% (18/52) in the intervention group and 15.2% (7/46) in the control group RR = 2.26, 95% CI (1.05, 4.95) and p = 0.028. The numbers needed to treat is six 95% CI (3 to 36). Participants with scores <26 report their fear of heights is very much improved. There was a 4.5-point difference in the HIQ score at eight weeks (p = 0.055) on the multiple regression analysis. Conclusions This is the first randomized trial of this novel imaginal intervention which is probably effective, brief, easily learnt, and safe. It may be worth considering doing this prior to some of the longer or more expensive exposure therapies. This study will be of interest to family doctors, psychiatrists, and psychologists.
Bone morphogenetic protein-9 increases the functional expression of organic anion transporting polypeptide 1a4 at the blood–brain barrier via the activin receptor-like kinase-1 receptor
Authors: Abdullahi Wazir , Brzica Hrvoje , Ibbotson Kathryn , Davis Thomas P , Ronaldson Patrick T 
Published: April 2017

Targeting uptake transporters such as organic anion transporting polypeptide 1a4 (Oatp1a4) at the blood–brain barrier (BBB) can facilitate central nervous system (CNS) drug delivery. Effective blood-to-brain drug transport via this strategy requires characterization of mechanisms that modulate BBB transporter expression and/or activity. Here, we show that activation of activin receptor-like kinase (ALK)-1 using bone morphogenetic protein (BMP)-9 increases Oatp1a4 protein expression in rat brain microvessels in vivo. These data indicate that targeting ALK1 signaling with BMP-9 modulates BBB Oatp1a4 expression, presenting a unique opportunity to optimize drug delivery and improve pharmacotherapy for CNS diseases.
Iron in deep brain nuclei in migraine? CAMERA follow-up MRI findings
Authors: Palm-Meinders Inge H , Koppen Hille , Terwindt Gisela M , Launer Lenore J , van Buchem Mark A , Ferrari Michel D , Kruit Mark C 
Published: April 2017

Introduction In the CAMERA population-based MRI study, migraineurs below the age of 50 had decreased T2-values indicative of increased iron deposition in several deep brain nuclei. Longer migraine history was associated with lower T2-values, suggesting an association between migraine attacks and iron accumulation. In the present nine-year follow-up study of the CAMERA cohort we re-measured the T2-values in deep brain nuclei to assess the evolution over time. Methods Baseline and follow-up T2-values measured in several basal ganglia of 128 participants (38 control, 90 migraine) were analyzed using quantitative T2 measurements and multivariate regression analysis. Results T2-values of most deep brain nuclei were increased – instead of an expected further decrease when only age-related iron accumulation would have played a role – compared to baseline (both among controls and migraineurs) and were not different in either group. In migraineurs, no differences were found by gender, migraine severity or subtype. Conclusion This study did not provide supportive data for migraine related increased iron accumulation in deep brain nuclei, but neither is it able to reject such hypotheses. Increased T2-values probably point at microstructural tissue changes that counteracted earlier accumulated iron effects. We hypothesize that, with aging, migraine-induced iron-related brain changes are obscured by other age-related tissue changes.
pH Sensitive phosphorylated chitosan hydrogel as vaccine delivery system for intramuscular immunization
Authors: Wei Jianye , Xue Wei , Yu Xifei , Qiu Xiaozhong , Liu Zonghua 
Published: April 2017

In the field of immunotherapy, immune vaccinations have received more and more attention for disease prevention and treatment. In immune vaccination, efficient vaccine adjuvants are necessary due to the weak immunogenicity of vaccines. Some traditional vaccine adjuvants have been widely used but have shown obvious limitations such as poor biosafety. Therefore, researchers make a great effort to develop more functional novel immune adjuvants such as chitosan-based immune adjuvants. However, chitosan is poorly water soluble, which greatly limits its application as immune adjuvants, regardless of its good biocompatibility, biodegradability, and other biological activities. In this work, we prepared a water-soluble chitosan derivative phosphorylated chitosan (PCS) and evaluated its potential as a novel immune adjuvant. PCS was found to be pH sensitive: specifically, it was water soluble at pH < 7.0 but began to gel at pH >7.0. By virtue of this, neutral PCS aqueous solutions containing ovalbumin (OVA) antigen was intramuscularly injected into test mice, which would transform to an OVA-containing gel network for OVA immunization. The results showed that the use of 30 mg/mL PCS-based hydrogel as vaccine delivery system contributed to significantly higher level of antigen-specific immune responses, including higher level of antigen-specific IgG antibodies, IFN-γ and IL-4 cytokines secretion by splenocytes, as well as memory CD4+ and CD8+ T cells. In vivo imaging and immunohistochemistry assays suggest that the improved immunization efficacy may be attributed to the controlled release of antigen from injection site by PCS gel network, and then prolonged antigen stimuli to the immune system. From the results, PCS could be developed as a promising vaccine delivery system for immunotherapy.
Retinal nerve fiber layer thickness and neuropsychiatric manifestations in systemic lupus erythematosus
Authors: Shulman S , Shorer R , Wollman J , Dotan G , Paran D 
Published: April 2017

Background Cognitive impairment is frequent in systemic lupus erythematosus. Atrophy of the corpus callosum and hippocampus have been reported in patients with systemic lupus erythematosus, and diffusion tensor imaging studies have shown impaired white matter integrity, suggesting that white matter damage in systemic lupus erythematosus may underlie the cognitive impairment as well as other neuropsychiatric systemic lupus erythematosus manifestations. Retinal nerve fiber layer thickness, as assessed by optical coherence tomography, has been suggested as a biomarker for white matter damage in neurologic disorders such as multiple sclerosis, Alzheimer’s disease and Parkinson’s disease. Retinal nerve fiber layer thinning may occur early, even in patients with mild clinical symptoms. Aim The objective of this study was to assess the association of retinal nerve fiber layer thickness, as a biomarker of white matter damage in systemic lupus erythematosus patients, with neuropsychiatric systemic lupus erythematosus manifestations, including cognitive impairment. Methods Twenty-one consecutive patients with systemic lupus erythematosus underwent neuropsychological testing using a validated computerized battery of tests as well as the Rey-Auditory verbal learning test. All 21 patients, as well as 11 healthy, age matched controls, underwent optical coherence tomography testing to assess retinal nerve fiber layer thickness. Correlations between retinal nerve fiber layer thickness and results in eight cognitive domains assessed by the computerized battery of tests as well as the Rey-Auditory verbal learning test were assessed in patients with systemic lupus erythematosus, with and without neuropsychiatric systemic lupus erythematosus, and compared to retinal nerve fiber layer thickness in healthy controls. Results No statistically significant correlation was found between retinal nerve fiber layer thickness in patients with systemic lupus erythematosus as compared to healthy controls. When evaluating by subgroups, no correlation was found between patients with or without neuropsychiatric systemic lupus erythematosus or cognitive impairment and retinal nerve fiber layer thickness. Conclusion Retinal nerve fiber layer thickness of systemic lupus erythematosus patients was not found to be statistically different compared to controls. Within systemic lupus erythematosus patients there was no correlation between retinal nerve fiber layer thickness and cognitive impairment or other neuropsychiatric systemic lupus erythematosus manifestations.
Review of Mechanical, Processing, and Immunologic Factors Associated With Outcomes of Fresh Osteochondral Allograft Transplantation of the Talus
Authors: Okeagu Chikezie N. , Baker Erin A. , Barreras Nicholas A. , Vaupel Zachary M. , Fortin Paul T. , Baker Kevin C. 
Published: April 2017

Osteochondral lesions of the talus (OLTs) are an increasingly implicated cause of ankle pain and instability. Several treatment methods exist with varying clinical outcomes. Due in part to successful osteochondral allografting (OCA) in other joints, such as the knee and shoulder, OCA has gained popularity as a treatment option, especially in the setting of large lesions. The clinical outcomes of talar OCA have been inconsistent relative to the positive results observed in other joints. Current literature regarding OCA failure focuses mainly on 3 factors: the effect of graft storage conditions on chondrocyte viability, graft/lesion size, and operative technique. Several preclinical studies have demonstrated the ability for bone and cartilage tissue to invoke an immune response, and a limited number of clinical studies have suggested that this response may have the potential to influence outcomes after transplantation. Further research is warranted to investigate the role of immunological mechanisms as an etiology of OCA failure. Level of Evidence: Level V, expert opinion.
Neighborhood socioeconomic status at the age of 40 years and ischemic stroke before the age of 50 years: A nationwide cohort study from Sweden
Authors: Carlsson Axel C , Li Xinjun , Holzmann Martin J , Ärnlöv Johan , Wändell Per , Gasevic Danijela , Sundquist Jan , Sundquist Kristina 
Published: April 2017

Objective We aimed to study the association between neighborhood socioeconomic status at the age of 40 years and risk of ischemic stroke before the age of 50 years. Methods All individuals in Sweden were included if their 40th birthday occurred between 1998 and 2010. National registers were used to categorize neighborhood socioeconomic status into high, middle, and low and to retrieve information on incident ischemic strokes. Hazard ratios and their 95% confidence intervals were estimated. Results A total of 1,153,451 adults (women 48.9%) were followed for a mean of 5.5 years (SD 3.5 years), during which 1777 (0.30%) strokes among men and 1374 (0.24%) strokes among women were recorded. After adjustment for sex, marital status, education level, immigrant status, region of residence, and neighborhood services, there was a lower risk of stroke in residents from high-socioeconomic status neighborhoods (hazard ratio 0.87, 95% confidence interval 0.78–0.96), and an increased risk of stroke in adults from low-socioeconomic status neighborhoods (hazard ratio 1.16, 95% confidence interval 1.06–1.27), compared to their counterparts living in middle-socioeconomic status neighborhoods. After further adjustment for hospital diagnoses of hypertension, diabetes, heart failure, and atrial fibrillation prior to the age of 40, the higher risk in neighborhoods with low socioeconomic status was attenuated, but remained significant (hazard ratio 1.12, 95% confidence interval 1.02–1.23). Conclusions In a nationwide study of individuals between 40 and 50 years, we found that the risk of ischemic stroke differed depending on neighborhood socioeconomic status, which calls for increased efforts to prevent cardiovascular diseases in low socioeconomic status neighborhoods.
Reliability of functioning free muscle transfer and vascularized ulnar nerve grafting for elbow flexion in complete brachial plexus palsy
Authors: Potter S. M. , Ferris S. I. 
Published: April 2017

We compared outcomes of primary vascularized ulnar nerve grafts from the C5 root neurotizing biceps and brachialis muscles, and gracilis functioning free muscle transfer neurotized by the distal spinal accessory nerve, as a primary or salvage procedure after complete brachial plexus injury. At 45 months, three of eight primary vascularized ulnar nerve graft patients regained grade 4 elbow flexion, while one regained grade 3. All 13 primary gracilis transfer patients regained grade 4 elbow flexion. Four patients with vascularized ulnar nerve grafts failed and subsequently had salvage functioning free muscle transfer procedures resulting in delayed recovery. Although vascularized ulnar nerve graft-based primary reconstructions can provide useful elbow flexion, this was achieved in less than half the cases. We consider primary gracilis functioning free muscle transfer neurotized by the distal spinal accessory nerve as the most reliable reconstruction for the restoration of elbow flexion in complete brachial plexus injury. Level of evidence: IV
A Retrospective Analysis of Complications Associated With Bone Morphogenetic Protein 2 in Anterior Lumbar Interbody Fusion
Authors: Hindoyan Kevork , Tilan Justin , Buser Zorica , Cohen Jeremiah R. , Brodke Darrel S. , Youssef Jim A. , Park Jong-Beom , Yoon S. Tim , Meisel Hans-Joerg , Wang Jeffrey C. 
Published: April 2017

Study Design: Retrospective review. Objective: The aim of our study was to quantify the frequency of complications associated with recombinant human bone morphogenetic protein 2 (rhBMP-2) use in anterior lumbar interbody fusion (ALIF). Methods: The orthopedic subset of the Medicare database (PearlDiver) was queried for this retrospective cohort study using International Statistical Classification of Diseases 9 (ICD-9) and Current Procedure Terminology (CPT) codes for ALIF procedures with and without rhBMP-2 between 2005 and 2010. Frequencies of complications and reoperations were then identified within 1 year from the index procedure. Complications included reoperations, pulmonary embolus, deep vein thrombosis, myocardial infarction, nerve-related complications, incision and drainage procedures, wound, sepsis, pneumonia, urinary tract infections, respiratory, heterotopic ossification, retrograde ejaculation, radiculopathy, and other medical complications. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess the statistical significance. Results: We identified a total of 41 865 patients who had an ALIF procedure. A total of 14 384 patients received rhBMP-2 while 27 481 did not. Overall, 6016 (41.8%) complications within 1 year from surgery were noted within the group who received rhBMP-2 and 12 950 (47.1%) complications within 1 year from surgery were recorded in those who did not receive rhBMP-2 (OR = 0.81, CI = 0.77-0.84). Overall, exposure to rhBMP-2 was associated with significantly decreased odds of complications with exception to reoperation rates (0.9% rhBMP-2 vs 1.0% no rhBMP-2; OR = 0.88, CI = 0.71-1.09) and radiculopathy (4.4% rhBMP-2 vs 4.3% no rhBMP-2; OR = 1.02, CI = 0.93-1.13). Conclusions: The use of rhBMP-2 in patients undergoing ALIF procedure was associated with a significantly decreased rate of complications. Further studies are needed to elucidate a true incidence of complication.
Is Cervical Bracing Necessary After One- and Two-Level Instrumented Anterior Cervical Discectomy and Fusion? A Prospective Randomized Study
Authors: Overley Samuel C. , Merrill Robert K. , Baird Evan O. , Meaike Joshua J. , Cho Samuel K. , Hecht Andrew C. , Qureshi Sheeraz A. 
Published: April 2017

Study Design: Prospective randomized control trial. Objective: To investigate the role of cervical collars in postoperative care following 1- and 2-level instrumented anterior cervical discectomy and fusion (ACDF). Methods: The Cervical Spine Research Society Resident Fellow Grant funded this project. Fifty consecutive patients undergoing 1- or 2-level ACDF surgery were randomized into groups receiving either no brace or a cervical brace for 6 weeks postoperatively. Neck Disability Index scores were recorded preoperatively and at regular follow-up visits up to 1 year. Computed tomography scans were read 1 year postoperatively to determine fusion rates, and subsidence was measured as change in middle vertebral distance between initial postoperative and 6-month follow-up lateral cervical radiographs. Results: Twenty-two patients were in the no-brace group, and 22 patients were in the brace group at final follow-up, with an average age of 50 and 55 years, respectively. The no-brace group had a total of 32 operative levels, whereas the brace group had 38 operative levels. There was no statistically significant difference in 1-year postoperative Neck Disability Index scores between the brace (9.30) and no-brace (6.95) groups ( P = .28), in 6-month subsidence of all operative levels between the brace (0.85 mm) and no-brace (0.79 mm) groups ( P = .72), or in the proportion of fused levels between the brace (89%) and no-brace (97%) groups ( P = .37). Conclusions: Our results suggest no advantage in wearing a cervical brace following 1- or 2-level ACDF surgery with respect to 1-year outcome scores, 1-year fusion rates, and 6-month subsidence.
Short Posterior Stabilization in Combination With Cement Augmentation for the Treatment of Thoracolumbar Fractures and the Effects of Implant Removal
Authors: Hoppe Sven , Aghayev Emin , Ahmad Sufian , Keel Marius Johann Baptist , Ecker Timo Michael , Deml Moritz , Benneker Lorin Michael 
Published: April 2017

Study Design: Retrospective case series. Objective: Short posterior stabilization with vertebroplasty is one treatment option for thoracolumbar burst fractures (AO A3). Whether it avoids progression in segmental kyphosis, especially after implant removal, is unclear. In a retrospective case-control study, its stability and the effect on intervertebral discs with and without implant removal was studied. Methods: Fifty-nine consecutive patients were treated with bisegmental short posterior instrumentation and additional vertebroplasty of the fractured vertebra. Twenty-nine patients (male/female 17/12; age: 41.7 ± 15.4 years) underwent implant removal. Changes of segmental kyphosis and disc heights between both groups (with and without implant removal) were compared on lateral X-rays preoperative, postoperative, after 1 year and after implant removal. Risk factors for loss of reduction were analyzed. Results: Kyphosis increased up to 12 months after implant removal. The loss of bisegmental correction was 6.0 ± 4.2 (range 0° to 16°) 12 months after implant removal. Risk factors for loss of reduction are younger patient age, fractures of the thoracolumbar junction (Th12), and degree of traumatic kyphosis. Intervertebral discs traversed by the stabilization lose height and don’t recover within 1 year after implant removal. Without implant removal, disc height of the lower adjacent level is reduced after 24 months. Conclusions: Short posterior stabilization in combination with vertebroplasty is a treatment alternative for thoracic and lumbar AO A3 fractures. After implant removal kyphosis increases, predominantly in the segment above the augmented vertebra. Risk factors for loss of reduction include younger age, fractures of the thoracolumbar junction (T12), and higher fracture kyphosis.
Performance and Return to Sport After Sports Hernia Surgery in NFL Players
Authors: Jack Robert A. , Evans David C. , Echo Anthony , McCulloch Patrick C. , Lintner David M. , Varner Kevin E. , Harris Joshua D. 
Published: April 2017

Background: Recognition, diagnosis, and treatment of athletic pubalgia (AP), also known as sports hernia, once underrecognized and undertreated in professional football, are becoming more common. Surgery as the final treatment for sports hernia when nonsurgical treatment fails remains controversial. Given the money involved and popularity of the National Football League (NFL), it is important to understand surgical outcomes in this patient population. Hypothesis: After AP surgery, players would: (1) return to sport (RTS) at a greater than 90% rate, (2) play fewer games for fewer years than matched controls, (3) have no difference in performance compared with before AP surgery, and (4) have no difference in performance versus matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: Internet-based injury reports identified players who underwent AP surgery from January 1996 to August 2015. Demographic and performance data were collected for each player. A 1:1 matched control group and an index year analog were identified. Control and case performance scores were calculated using a standardized scoring system. Groups were compared using paired Student t tests. Results: Fifty-six NFL players (57 AP surgeries) were analyzed (mean age, 28.2 ± 3.1 years; mean years in NFL at surgery, 5.4 ± 3.2). Fifty-three players were able to RTS. Controls were in the NFL longer ( P < .05) than players who underwent AP surgery (3.8 ± 2.4 vs 3.2 ± 2.1 years). Controls played more games per season ( P < .05) than post-AP players (14.0 ± 2.3 vs 12.0 ± 3.4 games per season). There was no significant ( P > .05) difference in pre- versus post-AP surgery performance scores and no significant ( P > .05) difference in postoperative performance scores versus controls post-index. Conclusion: There was a high RTS rate after AP surgery without a significant difference in postoperative performance, though career length and games per season after AP surgery were significantly less than that of matched controls.