bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of an Outpatient Pulmonary Rehabilitation Program on Exercise Tolerance and Asthma Control in Obese Asthma Patients
Authors: Türk Yasemin , van Huisstede Astrid , Franssen Frits M. E. , Hiemstra Pieter S. , Rudolphus Arjan , Taube Cristian , Braunstahl Gert-Jan 
Published: April 2017

PURPOSE:To compare the effects of an outpatient pulmonary rehabilitation (PR) program on exercise tolerance and asthma control in obese and nonobese patients with asthma.METHODS:Nonobese (body mass index [BMI] <30 kg/m2) and obese (BMI ≥ 30 kg/m2) patients with asthma who participated in a local multidisciplinary 12-week PR program were analyzed retrospectively. Effects of PR were assessed by changes in 6-minute walking distance (6MWD) and Asthma Control Questionnaire (ACQ).RESULTS:A total of 138 asthma patients were included: 53 (38.4%) obese and 85 (61.6%) nonobese. At baseline, obese patients with asthma had a lower level of exercise tolerance reflected by a lower 6MWD (525 m vs 621 m;P< .001). After PR, the 6MWD improved significantly in both groups (≥50 m in nonobese vs ≥45 m in obese;P< .001 in both groups). The improvement in 6MWD was clinically relevant in 71% of the nonobese and 60% of the obese patients. These patients had lower 6MWD (P= .024), higher usage of long-acting β-agonist (P= .034) and oral corticosteroids (P= .033). Asthma control also improved in both groups (ΔACQ −0.3 in nonobese vs ΔACQ −0.4 in obese;P= .021 andP= .019, respectively). Clinically relevant improvement was achieved by 46.5% of nonobese and 51.9% of obese patients with asthma. The improvements between the groups were not statistically different.CONCLUSIONS:A standardized PR program is feasible in obese patients with asthma and they benefit as much as nonobese patients with asthma. However, there are still a large number of patients who show no clinically significant improvement. Patients with more severe asthma seem to benefit the most from PR.
Effectiveness of a Posterior Shoulder Stretching Program on University-Level Overhead Athletes: Randomized Controlled Trial
Authors: Chepeha Judy C. , Magee David J. , Bouliane Martin , Sheps David , Beaupre Lauren 
Published: April 2017

Objective:
To determine whether a posterior shoulder stretch was effective in increasing internal rotation (IR) and horizontal adduction (HAd) range of motion (ROM) in overhead athletes identified as having reduced mobility.

Design:
Randomized controlled trial (parallel design).

Setting:
University-based sports medicine clinic.

Participants:
Thirty-seven university-level athletes in volleyball, swimming, and tennis, with IR ROM deficits ≥15°, were randomized into intervention or control groups. No subjects withdrew or were lost to follow-up.

Intervention:
The intervention group performed the “sleeper stretch” daily for 8 weeks, whereas the control group performed usual activities.

Main Outcome Measures:
Independent t tests determined whether IR and HAd ROM differences between groups were significant at 8 weeks and 2-way repeated-measures analysis of variance tests measured the rate of shoulder ROM change. Subject-reported shoulder pain and function were obtained at each evaluation.

Results:
Significant differences were found between the intervention and control groups' IR and HAd ROM at 8 weeks (P < 0.001 and P = 0.003, respectively) compared with baseline (zero weeks) (P = 0.19 and P = 0.82, respectively). Significant improvements in IR were detected in the intervention group at 4 weeks (P < 0.001), whereas HAd demonstrated significant changes only at 8 weeks (P = 0.003). Reported shoulder function (P = 0.002) was different between study groups at 8 weeks.

Conclusion:
Overhead, university-level athletes with an IR deficit ≥15° significantly increased their IR and HAd ROM after performing a posterior shoulder stretch for 8 weeks.

Clinical Relevance:
Effective management of posterior shoulder tightness through stretching may reduce the incidence of shoulder pathology in overhead athletes.
Early Empiric Antibiotic Use Is Associated With Delayed Feeding Tolerance in Preterm Infants
Authors: Martinez Francisco E. , Ferri Walusa A.G. , Leone Clea R. , de Almeida Maria Fernanda Branco , Guinsburg Ruth , Meneses Jucille do Amaral , Vale Marynéa Silva do , Marba Sergio Tadeu Martins , de Carvalho Werther Brunow , de Souza Rugolo Ligia Maria Suppo , de Andrade Lopes José Maria , Ribeiro Manoel A. , Procianoy Renato S. , Duarte José Luiz Muniz Bandeira , Bouzada Maria Cândida Ferrarez , de Lima Mota Ferreira Daniela Marques , Filho Navantino Alves , de Albuquerque Diniz Edna Maria , Zanardi Dulce Maria Toledo , Testoni Daniela , Santos Cristina Nunes dos , Gomzález Maria Rafaela Conde , Venzon Paulyne Stadler , Belik Jaques ,   Brazilian Neonatal Research Network
Published: April 2017

ABSTRACTThe causative factors of neonatal feeding intolerance are poorly understood, but potentially related to clinical practices such as empiric antibiotic usage. The objective of this study was to evaluate whether early empiric antibiotic exposure negatively affects preterm infants’ enteral feeding tolerance. Data from infants without risk factors for sepsis, 500 to 1499 g birth weight and 24 to 34 weeks gestational age were analyzed. The primary outcomes were the empiric antibiotic exposure effects on the infants’ total parenteral nutrition usage duration and prevalence of necrotizing enterocolitis (NEC). Among the 901 infants included, 67 were exposed to early empiric antibiotic. A 50% increase in parenteral nutrition usage duration and a 4‐fold greater prevalence of NEC was seen in the early empiric antibiotic‐exposed neonates, when compared with control infants (P < 0.01). Early empiric antibiotic exposure appears to negatively influence preterm infant feeding tolerance and possibly contributes to NEC.
Reduced Functional Connectivity Between the Hypothalamus and High‐order Cortical Regions in Adolescent Patients With Irritable Bowel Syndrome
Authors: Liu Xiaolin , Li Shi‐Jiang , Shaker Reza , Silverman Alan , Kern Mark , Ward Douglas B. , Li Wenjun , Xu Zhan , Chelimsky Gisela , Sood Manu R. 
Published: April 2017

ABSTRACTThe hypothalamus plays a critical role in maintaining visceral homeostasis. Altered hypothalamus activation has been implicated in functional gastrointestinal disorders, including irritable bowel syndrome (IBS). One important aspect of homeostatic regulation is the cortical modulation of limbic and paralimbic subsystems, including the hypothalamus, which in turn affects the descending regulatory processes mediating visceral homeostasis. Using neuroimaging, we evaluated hypothalamus functional connectivity in adolescent patients with IBS and age‐matched healthy controls who received rectal distension stimulations. More extensive hypothalamus connectivity was observed in liminal than subliminal condition in controls, but not in patients with IBS. Compared with controls, patients with IBS showed significantly reduced hypothalamus connectivity in the bilateral prefrontal cortices, supplementary motor and premotor areas, bilateral sensorimotor cortex, and limbic subareas, which are specifically involved in homeostatic regulation. The findings support the generalized homeostatic regulation model that reduced cortical and limbic modulations of hypothalamus functioning underlies disrupted visceral homeostasis in patients with IBS.
Modification of Ganglioside Content of Human Gastric Epithelial Cell Membrane Decreases Helicobacter pylori Adhesion
Authors: Rivas‐Serna Irma Magaly , Mazurak Vera C. , Keelan Monika , Clandinin Michael Thomas 
Published: April 2017

ABSTRACTBackground:In polarized cells, ganglioside location determines ganglioside function. Diet alters ganglioside content and composition in cell membranes. Ganglioside acts as a receptor for Helicobacter pylori. H pylori infects the stomach epithelium and may cause peptic ulcer disease and gastric cancer. The present study used purified gangliosides to modify the ganglioside composition of human gastric epithelial cells in vitro to reduce H pylori adhesion.Methods:A human gastric epithelial cell line (NCI‐N87) was cultured with a ganglioside mix or with pure ganglioside (GM3 or GD3) at different concentrations (0–30 μg/mL) and ganglioside membrane content of gastric cells was determined after 48 hours. LC/triple quadrupole MS was used to analyse ganglioside concentration. H pylori was inoculated into the culture media of gastric cells previously treated with gangliosides GM3 or GD3 or a combination of GM3 and GD3.Results:GD3 and GM3 content increased in the plasma membrane in a dose‐dependent manner. Gastric cells treated with GD3 showed more GM3 content than GD3 (P < 0.01). Ganglioside content was modified in the apical membrane, but GM3 and GD3 were also found in the basolateral membrane after treatments. Gastric cells treated with GM3, GD3 or the combination of GM3:GD3 decreased H pylori adhesion to gastric cells at all ganglioside concentrations tested by 80% compared with untreated gastric cells (P < 0.05).Conclusions:These observations suggest that GD3 and GM3 present in the stomach lumen may be taken up into the apical gastric membrane and decrease H pylori adhesion to the epithelium.
Consensus Review of Optimal Perioperative Care in Breast Reconstruction: Enhanced Recovery after Surgery (ERAS) Society Recommendations
Authors: Temple-Oberle Claire , Shea-Budgell Melissa A. , Tan Mark , Semple John L. , Schrag Christiaan , Barreto Marcio , Blondeel Phillip , Hamming Jeremy , Dayan Joseph , Ljungqvist Olle 
Published: April 2017

Background:Enhanced recovery following surgery can be achieved through the introduction of evidence-based perioperative maneuvers. This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery and to provide evidence-based recommendations for an enhanced perioperative protocol.Methods:A systematic review of meta-analyses, randomized controlled trials, and large prospective cohorts was conducted for each protocol element. Smaller prospective cohorts and retrospective cohorts were considered only when higher level evidence was unavailable. The available literature was graded by an international panel of experts in breast reconstructive surgery and used to form consensus recommendations for each topic. Each recommendation was graded following a consensus discussion among the expert panel. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society.Results:High-quality randomized controlled trial data in patients undergoing breast reconstruction informed some of the recommendations; however, for most items, data from lower level studies in the population of interest were considered along with extrapolated data from high-quality studies in non–breast reconstruction populations. Recommendations were developed for a total of 18 unique enhanced recovery after surgery items and are discussed in the article. Key recommendations support use of opioid-sparing perioperative medications, minimal preoperative fasting and early feeding, use of anesthetic techniques that decrease postoperative nausea and vomiting and pain, use of measures to prevent intraoperative hypothermia, and support of early mobilization after surgery.Conclusion:Based on the best available evidence for each topic, a consensus review of optimal perioperative care for patients undergoing breast reconstruction is presented.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, V.
Adolescent Desire for Cosmetic Surgery: Associations with Bullying and Psychological Functioning
Authors: Lee Kirsty , Guy Alexa , Dale Jeremy , Wolke Dieter 
Published: April 2017

Background:
Adolescent bullying may be a key driver of interest in cosmetic surgery. This study examined the extent of such interest and whether any effect was sex-specific, and examined psychological functioning as a potential mechanism through which bullying involvement may lead to a wish for cosmetic surgery.

Methods:
A two-stage design was used. In the first stage, 2782 adolescents (aged 11 to 16 years) were screened for bullying involvement using self-reports and peer nominations. In the second stage, 752 adolescents who were bullies, victims, bully-victims, or uninvolved in bullying reported their desire for cosmetic surgery. Psychological functioning was constructed as a composite of self-esteem and emotional problems (assessed at stage 1) and body-esteem scores (assessed at stage 2).

Results:
Adolescents involved in bullying in any role were significantly more interested in cosmetic surgery than uninvolved adolescents. Desire for cosmetic surgery was greatest in adolescents who were bullied (victims and bully-victims) and girls. Desire for cosmetic surgery was highest in girls, but sex did not interact with bullying role. Being victimized by peers resulted in poor psychological functioning, which increased desire for cosmetic surgery. In contrast, desire for cosmetic surgery in bullies was not related to psychological functioning, which was in the normal range.

Conclusions:
Bullying victimization is related to poor psychological functioning, and both are related to a greater desire for cosmetic surgery in adolescents. Cosmetic surgeons should screen candidates for psychological vulnerability and may want to include a short screening questionnaire for a history of peer victimization.
Treatment of Isolated Zygomatic Arch Fracture: Improved Outcomes with External Splinting
Authors: Hindin David I. , Muetterties Corbin E. , Mehta Chirag , Boukovalas Stefanos , Lee Justine C. , Bradley James P. 
Published: April 2017

Background:
The various approaches to reduction and fixation of isolated displaced zygomatic arch fractures have not been well studied. The authors compared established treatment methods for zygomatic arch fractures for both aesthetic and functional outcomes.

Methods:
Consecutive patients with isolated zygomatic arch fractures with a minimum of 6 months’ follow-up were studied in five groups: group 1, intraoral approach (no fixation); group 2, temporal approach (no fixation); group 3, coronal flap plate fixation; group 4, external splint fixation; and group 5, no surgery. Perioperative complications, facial contour symmetry (aesthetic outcome), improvement in mouth opening (functional outcome), and reoperations were compared.

Results:
Patients undergoing external splint fixation had no perioperative complications. Coronal flap plate fixation had the highest rate of perioperative complications (46 percent), with facial nerve injury (4 percent), hematoma (8 percent), and persistent hyperesthesia (8 percent). Reoperations (fat grafting or bony reconstruction) were highest with coronal flap plate fixation (23 percent) and the temporal approach (7.7 percent); external splint fixation and the intraoral approach required no reinterventions. Patients treated with external splint fixation had the largest improvement in mean interincisor mouth opening. Mean postoperative interincisor opening in decreasing order was as follows: external splint fixation (51.6 mm), coronal flap plate fixation (47.1 mm), no surgery (39.8 mm), intraoral approach (39.6 mm), and temporal approach (38.9 mm). The highest volumetric symmetry was seen in external splint fixation (97.9 percent), followed by coronal flap plate fixation (94 percent), temporal approach (76.2 percent), intraoral approach (73 percent), and no surgery (68.3 percent).

Conclusion:
For isolated zygomatic arch fracture, patients undergoing external splint fixation had the lowest risk of perioperative complications and the greatest improvement in functional and aesthetic outcomes compared with the intraoral approach (no fixation), the temporal approach (no fixation), coronal flap plate fixation, and no surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
First Lower Two-Thirds Osteomyocutaneous Facial Allograft Perfused by a Unilateral Facial Artery: Outcomes and Vascularization at 1 Year after Transplantation
Authors: Fischer Sebastian , Lee Thomas C. , Krezdorn Nicco , Alhefzi Muayyad , Kueckelhaus Maximilian , Bueno Ericka M. , Pomahac Bohdan 
Published: April 2017

Background:
Facial allotransplantation provides a unique opportunity to restore facial form and function in severely disfigured patients. Using a single unilateral facial artery for vascularization can significantly reduce surgical duration and thus facilitate the practice of face transplantation.

Methods:
A 33-year-old man with a history of high-energy ballistic trauma received a facial allograft comprising the lower two-thirds of the face, including maxilla and mandible. Vascular anastomoses involved one unilateral facial artery and two veins. Vascularization patterns, airway volume, and facial functions were assessed before and 1 year after transplantation. In addition, immunosuppressive therapy and rejection episodes were recorded.

Results:
One year after transplantation, the facial allograft is well perfused and gradually improving in function. Unilateral facial artery anastomosis remains patent and collateralization with the contralateral side is taking place through collaterals of the submental arteries. Bony perfusion of the maxilla and mandible is provided periosteally. Bilateral venous outflow is evident. Airway volume is significantly increased compared with before transplantation, and gastrostomy and tracheostomy tubes have been securely removed. The recipient has gained the abilities to smell, speak, feel, and grimace 1 year after transplantation. Steroids were successfully weaned after 9 months, leaving the patient on dual immunosuppressive therapy with tacrolimus and mycophenolate mofetil. Two rejection episodes occurred, of which one was treated by steroid pulse and the other by adjusting the maintenance therapy.

Conclusions:
In this patient, a facial allograft comprising the lower two-thirds of the face including the maxilla and mandible is sufficiently perfused by one unilateral facial artery. Bilateral venous outflow, however, seems to be necessary. Facial allotransplantation can significantly and securely improve facial form and function.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Defining Temporal Hairline Landmarks
Authors: Nagarkar Purushottam A. , Cheng Jonathan 
Published: April 2017

Summary:
Brow dermoids are benign pediatric neoplasms. Endoscopic resection requires incisions placed within the temporal hairline, which is often difficult to reliably locate in infants. The authors studied adult and pediatric patients to define the location of the hairline in relationship to simple facial landmarks. Adult and pediatric patients who were seen in preoperative consultation for facial surgical procedures were identified and included in the study. Patients with a history of facial trauma, surgery, or congenital anomalies were excluded. Digital photographs were analyzed to measure corneal white-to-white diameter. Lines were drawn connecting the tragus to the lateral canthus and from the inferiormost aspect of the earlobe bisecting the first line (line A). The maximal distance between line A and the temporal hairline was recorded. One hundred sixteen patients met the inclusion criteria, 81 adults and 35 pediatric patients. Average age was 55.9 years in adults and 3.2 years in the pediatric group. Measurements were normalized to the corneal diameter. Average temporal hairline distance from line A was 25.0 mm in adults and 21.8 mm in the pediatric group. Hairline position was not correlated with age or sex. The temporal hairline can be reliably located relative to a line drawn from the inferior aspect of the earlobe to the midpoint of the line connecting the lateral canthus and tragus. The temporal hairline is within 30 mm of this line. When designing a temporal hairline incision in infants, it can be safely placed 30 mm or more posterior to this line to ensure a well-hidden scar.
Effects of a Brief Team Training Program on Surgical Teams’ Nontechnical Skills: An Interrupted Time-Series Study
Authors: Gillespie Brigid M. , Harbeck Emma , Kang Evelyn , Steel Catherine , Fairweather Nicole , Panuwatwanich Kriengsak , Chaboyer Wendy 
Published: April 2017

Background
Up to 60% of adverse events in surgery are the result of poor communication and teamwork. Nontechnical skills in surgery (NOTSS) are critical to the success of surgery and patient safety. The study aim was to evaluate the effect of a brief team training intervention on teams’ observed NOTSS.

Methods
Pretest-posttest interrupted time-series design with statistical process control analysis was used to detect longitudinal changes in teams’ NOTSS. We evaluated NOTSS using the revised NOTECHS weekly for 20 to 25 weeks before and after implementation of a team training program.

Results
We observed 179 surgical procedures with cardiac, vascular, upper gastrointestinal, and hepatobiliary teams. Mean posttest NOTECHS scores increased across teams, showing special cause variation. There were also significant before and after improvements in NOTECHS scores in respect to professional role and in the use of the Surgical Safety Checklist.

Conclusions
Our results suggest associated improvements in teams’ NOTSS after implementation of the team training program.
Automated Attenuation Based Tube Potential Selection of the Lower Extremity Runoff: A Comparison to Fixed Kilovolt with Automated Tube Current Modulation
Authors: Beeres Martin , Juhee Kang , Bucher Andreas M. , Frellesen Claudia , Albrecht Moritz , Wichmann Julian L. , Park Clara , Kaup Moritz , Scholtz Jan Erik , Vogl Thomas J. , Gruber-Rouh Tatjana , Bodelle Boris 
Published: April 2017

Purpose
The aim of this study was to evaluate the impact of automated attenuation-based tube potential selection (ATPS) on image quality and radiation dose exposure parameters at a computed tomography angiography (CTA) lower-extremity runoff.

Materials and Methods
Two hundred forty patients (156 men, 84 women) underwent CTA examinations of the lower-extremity runoff on a second-generation dual-source computed tomography system: 120 patients at a fixed tube potential of 120 kV and a tube current of 180 reference mAs, another 120 patients using automated ATPS. Volume computed tomography dose index (CTDIvol), dose-length-product (DLP), body diameters, noise, signal-to-noise ratio, and subjective image quality were compared.

Results
In the ATPS group, 80 kV was automatically selected in 102 patients, 100 kV in 15 patients, and 120 kV in 3 patients; 140 kV was not chosen in any of the cases. The median CTDIvol of 4.81 mGy (2.2–10.6 mGy) and DLP of 568 mGy⋅cm (203–1324 mGy⋅cm) in the ATPS group were significantly lower compared with the CTDIvol of 8.1 mGy (4.4–14.4 mGy) and DLP of 1027.5 mGy⋅cm (509–1806 mGy⋅cm) in the fixed 120-kV group (P < 0.01). Image quality was comparable (P > 0.05).

Conclusion
Automated ATPS allows for significant dose savings in lower-extremity runoff CTA, whereas image quality remains constant at a high level.