bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anxiety, Depression, and Pain Symptoms: Associations With the Course of Marijuana Use and Drug Use Consequences Among Urban Primary Care Patients
Authors: Bertholet Nicolas , Cheng Debbie M. , Palfai Tibor P. , Lloyd-Travaglini Christine , Samet Jeffrey H. , Saitz Richard 
Published: October 2017

Objectives:
This exploratory study aims to investigate whether anxiety, depression, and pain are associated with changes in marijuana use and drug use consequences among primary care patients.

Methods:
In all, 331 adult primary care patients with marijuana as the only drug used were followed prospectively to investigate associations between anxiety/depression symptoms (no/minimal symptoms; anxiety or depression symptoms; symptoms of both) and pain (1–10 scale: none [0]; low [1–3]; medium [4–6]; high [7–10]) (independent variables) and substance use outcomes in regression models. These outcomes were changes (over 6 months) in primary outcomes: marijuana use days (past 30); and drug use consequences (Short Inventory of Problems—Drugs [SIP-D]); secondary outcomes—drug use risk (Alcohol, Smoking, and Substance Involvement Screening Test [ASSIST] score for drugs).

Results:
At baseline, 67% reported no/minimal anxiety/depression symptoms, 16% anxiety or depression symptoms, 17% both; 14% reported no pain, 16% low, 23% medium, 47% high pain level. Mean (SD) number of marijuana use days was 16.4 (11.6), mean SIP-D 5.9 (9.0), mean ASSIST 12.5 (7.8); no significant association was found between anxiety/depression and marijuana use changes. Given the same baseline status for SIP-D and ASSIST, respectively, those with anxiety or depression had greater increases in SIP-D (adjusted mean difference [95% confidence interval] +3.26 [1.20; 5.32], P = 0.004) and borderline significant increases in ASSIST (+3.27 [−0.12; 6.65], P = 0.06) compared with those without anxiety or depression; those with both anxiety and depression had greater increases in ASSIST (+5.42 [2.05; 8.79], P = 0.003), but not SIP-D (+1.80 [−0.46; 4.06], P = 0.12). There was no significant association between pain and marijuana use and SIP-D changes. Given the same baseline ASSIST level, those with high pain level had greater increases in ASSIST (+4.89 [1.05; 8.72], P = 0.04) compared with those with no pain.

Conclusion:
In these exploratory analyses, anxiety, depression, and high pain level appear to be associated with increases in drug-related harm among primary care patients using marijuana.
Variability in Assessing Spinopelvic Parameters With Lumbosacral Transitional Vertebrae
Authors: Khalsa Amrit S. , Mundis Gregory M. , Yagi Mitsuru , Fessler Richard G. , Bess Shay , Hosogane Naobumi , Park Paul , Than Khoi D. , Daniels Alan , Iorio Justin , Ledesma Justin B. , Tran Stacie , Eastlack Robert K. 
Published: October 2017

Study Design.
Prospectively collected survey study

Objective.
The aim of this study was to determine the consistency with which spinopelvic parameters (SPP) are determined in patients with lumbosacral transitional vertebrae (LSTV).

Summary of Background Data.
The incidence of LSTV in the general population is as high as 35.6%. The often fixed nature of LSTV relative to the pelvis, but lumbar-type appearance, may lead to differential use of the S1 endplate when performing SPP assessment. This could have significant impact on SPP derived from these landmarks, resulting in considerable variation in surgical planning and decision-making.

Methods.
Twenty patients demonstrating LSTV on standing lateral 36-inch spinal radiographs were randomly arranged and independently analyzed by 16 experienced spine surgeons using the same computer software. Pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), and T1 pelvic angle (TPA) were captured. Two weeks after the first assessment, surgeons repeated the measurements after image sequence re-randomization. Intraclass correlation coefficient (ICC) was calculated to evaluate interobserver reliability (IOR) for each SPP. Intraobserver reliability (IAOR) was assessed through an average Pearson correlation coefficient for each parameter for each surgeon.

Results.
Sixteen surgeons completed initial measurements. IOR was poor for TPA (0.35, 95% confidence interval [CI] 0.20, 0.58) and PI (0.42, 95% CI 0.26, 0.65) and fair for LL (0.67, 95% CI 0.51, 0.82), and PT (0.63, 95% CI 0.47, 0.81). Fourteen surgeons completed phase-2 measurements to assess IAOR. Average parameter PPC showed excellent IAOR (LL 0.86, TPA 0.77, PI 0.78, PT 0.86). Kappa coefficient showed fair agreement for raters choosing the same endplate for measurement (Phase 1: 0.38, Phase 2: 0.32). By patient, the percentage of raters that chose the S1 endplate for measurement varied from 6.3% to 85.7%.

Conclusion.
Significant variability exists when surgeons measure SPP in patients with LSTV. These parameters are critical in determining the goals of surgical reconstruction and such variability may have considerable implications for radiographic goals and outcomes of surgical reconstruction.

Level of Evidence: 4
Primary Cutaneous CD8+ T-cell Lymphoma, an Indolent and Locally Aggressive Form Mimicking Paronychia
Authors: Beggs Sarah M. , Friedman Ben J. , Kornreich Davida , Okon Lauren , Alpdogan Onder , Shi Wenyin , Sahu Joya 
Published: October 2017

Abstract:
CD8+ T-cell lymphomas comprise a wide spectrum of lymphomas, many which have yet to be formally classified. We present a case of a 43-year-old woman with an enlarging tumor distal to the distal interphalangeal joint of the fourth finger, compressing the underlying nail matrix. Magnetic resonance imaging showed bony involvement of the underlying distal phalanx. Histology showed a dense epidermotropic and pandermal infiltrate composed of medium-sized, uniformly pleomorphic lymphocytes with cleaved nuclei, which raised the possibility of primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma. However, the patient's clinical photograph was inconsistent with this diagnosis. Other diagnoses, such as primary cutaneous acral CD8+ T-cell lymphoma—a provisional entity, were also considered but did not capture all the features of this patient's lymphoma. We propose to classify this case as a primary cutaneous CD8+ T-cell lymphoma, an indolent and locally aggressive form.
Mixed Lichenoid and Follicular T- and B-Cell Lymphoid Reaction to Red Tattoos With Monoclonal T Cells
Authors: Zaaroura Hiba , Bergman Reuven 
Published: October 2017

Abstract:Pseudolymphomatous reactions have been described to occur in tattoos. Most cases have exhibited T-cell predominance and polyclonal T-cell receptor gene rearrangements. One case with monoclonal IgH gene rearrangements progressed into B-cell lymphoma. Lichenoid infiltrates are commonly described but lymphoid follicles much less frequently. We report a case with mixed lichenoid and follicular T- and B-cell reaction to red tattoos. The histopathology and the immunohistochemical studies were constant with a mixed T- and B-cell pseudolymphoma, the IgH gene rearrangement study was polyclonal, but the T-cell receptor gene rearrangement study was monoclonal. The patient who responded to intralesional corticosteroid injections remains under close scrutiny.
Family Members’ and Intensive Care Unit Nurses’ Response to the ECG Memento© During the Bereavement Period
Authors: Beiermann Mary , Kalowes Peggy , Dyo Melissa , Mondor Amanda 
Published: October 2017

Background
In the United States, 20% of patients die in the intensive care unit (ICU), yet little is known about bereavement strategies to aid grieving families.

Objective
The primary aim was to study the bereavement experience for families in the ICU; secondary aim was to measure nurses' perception of end-of-life care, and a third was to evaluate the impact of the ECG Memento© by families and nurses.

Methods
A prospective, descriptive study design was used, with a postsurvey methodology. Fifty ICU patient families agreed to participate, although only 28 returned the Satisfaction With Bereavement Experience Questionnaire. In addition, 38 of 100 eligible nurses completed the Quality of Dying and Death in the Intensive Care Unit survey.

Results
The Satisfaction With Bereavement Experience Questionnaire data showed families as highly satisfied with hospital (mean, 1.5), personal (mean, 1.6), ritual (mean, 1.3), and posthospital experiences (mean, 1.9). Quality of Dying and Death in the Intensive Care Unit results indicated that ideal control of patients' symptoms was reported by only 26% of nurses surveyed. Half of the families reported that the death was unexpected. Families (86%) responded positively to the ECG Memento©, and according to 98% of the nurses, the ECG Memento© was very well received.

Discussion
Despite most families reporting high satisfaction with the bereavement experience, nurses reported a low level of patient symptom control; also, families often found the death to be unexpected. This suggests that the bereavement experience is a complex process requiring nurses to implement various interventions during this vulnerable period. Most families responded positively to this novel bereavement tool, which may aid families as they transition from anticipatory grieving to bereaved status. Further studies are needed to evaluate the ECG Memento© as an innovation on a wider scale and to develop additional interventions to positively impact the grieving process for families.
Adjuvant Stromal Amphotericin B Injection for Late-Onset DMEK Infection
Authors: Tu Elmer Y. , Majmudar Parag A. 
Published: October 2017

Purpose:
To report the successful medical management of a late-onset Descemet membrane endothelial keratoplasty (DMEK)-related interface infection.

Methods:
A case of DMEK endothelial keratoplasty-related infection treated with intrastromal antifungal injection was identified. The following information was collected: demographic data, surgical indications, donor rim cultures, donor mate outcomes, clinical course, diagnostic tests, and clinical outcome.

Results:
A DMEK patient developed a single infiltrate approximately 1 month after uncomplicated DMEK. Donor rim culture was positive for Candida glabrata but no prophylactic treatment was initiated. Anterior segment optical coherence tomography confirmed the location of the infiltrate, and the patient was treated with oral fluconazole and an intrastromal injection of amphotericin B with an inadvertent, but negligible, intracameral volume of the same drug. The lesion significantly regressed on examination 2 days later with complete involution and excellent visual acuity to date.

Conclusions:
Medical therapy, including systemic and intrastromal application, is a viable initial treatment option for late-onset, presumed yeast interface keratitis in patients who have undergone DMEK.
Learning DMEK From YouTube
Authors: McKee Hamish D. , Jhanji Vishal 
Published: October 2017

Purpose:
To evaluate the outcomes of the first cases of Descemet membrane endothelial keratoplasty (DMEK) performed by an anterior segment surgeon, learning the procedure, including graft preparation, primarily from watching YouTube videos. DMEK surgery was not learned during fellowship training; there was no attendance at DMEK courses, no witnessing of live surgery, and no supervision by an experienced DMEK surgeon. All graft tissue was prepared by the surgeon on the day of surgery.

Methods:
This is a retrospective review of the 3-month postoperative results of the first 40 consecutive cases. The success rate of graft preparation, intraoperative and postoperative complications, spectacle-corrected visual acuity, endothelial cell density, and central corneal thickness were evaluated.

Results:
Grafts were successfully prepared in all cases with no loss of donor tissue. DMEK surgery was successful in 39 of 40 eyes with the one failure occurring in a vitrectomized eye without an intact iris–lens diaphragm. Spectacle-corrected visual acuity was ≥6/6 in 23 of the 25 eyes without comorbidity. Mean endothelial cell density was 1515 (±474) cells/mm2. Mean central corneal thickness decreased from 624 (±40) μm preoperatively to 513 (±34) μm postoperatively.

Conclusions:
Although formal training is desirable, good results can be obtained by an anterior segment surgeon learning DMEK, including graft preparation, without it. DMEK should no longer be considered a procedure with a long learning curve in routine cases.
Risk Factors Associated With Glaucomatous Progression in Pseudoexfoliation Patients
Authors: Moon Yeji , Sung Kyung Rim , Kim Joon Mo , Shim Seong Hee , Yoo Chungkwon , Park Ji Hye 
Published: October 2017

Purpose:
To investigate risk factors associated with glaucomatous progression in pseudoexfoliation glaucoma (PXG) patients.

Patients and Methods:
A retrospective observational study with a total of 48 PXG patients and age, sex, and visual field (VF) test mean deviation–matched 48 primary open-angle glaucoma (POAG) patients recruited from 3 university-based hospitals. Glaucomatous progression was defined by 2 criteria, either optic disc/retinal nerve fiber layer photographic assessment or serial VF data. Univariate and multivariate Cox proportional hazard models were used to detect associations between risk factors and progression in each subgroup and shared frailty model were used in total participants.

Results:
In total participants, PXG diagnosis [hazard ratio (HR), 7.245; P=0.050], a higher baseline intraocular pressure (IOP) (HR, 1.221; P=0.025) and a greater number of glaucoma medications (HR, 3.537; P=0.016) were significant factors for glaucoma progression. In the PXG group, a higher baseline IOP (HR, 1.131; P<0.001), a lower IOP reduction (HR, 0.966; P=0.027), a greater number of glaucoma medications (HR, 2.413; P=0.004), and worse baseline VF mean deviation (HR, 0.875; P=0.004) were significant factors, whereas the number of glaucoma medications (HR, 3.493; P=0.019) and disc hemorrhage (HR, 3.953; P=0.043) showed association in the POAG group.

Conclusions:
Factors associated with progression differed between PXG and POAG groups. Higher baseline IOP and requirement for a greater number of glaucoma medications were related with PXG progression.
High-risk prescribing and opioid overdose: prospects for prescription drug monitoring program–based proactive alerts
Authors: Geissert Peter , Hallvik Sara , Van Otterloo Joshua , O'Kane Nicole , Alley Lindsey , Carson Jody , Leichtling Gillian , Hildebran Christi , Wakeland Wayne , Deyo Richard A. 
Published: October 2017

Abstract
To develop a simple, valid model to identify patients at high risk of opioid overdose–related hospitalization and mortality, Oregon prescription drug monitoring program, Vital Records, and Hospital Discharge data were linked to estimate 2 logistic models; a first model that included a broad range of risk factors from the literature and a second simplified model. Receiver operating characteristic curves, sensitivity, and specificity of the models were analyzed. Variables retained in the final model were categories such as older than 35 years, number of prescribers, number of pharmacies, and prescriptions for long-acting opioids, benzodiazepines or sedatives, or carisoprodol. The ability of the model to discriminate between patients who did and did not overdose was reasonably good (area under the receiver operating characteristic curve = 0.82, Nagelkerke R
2 = 0.11). The positive predictive value of the model was low. Computationally simple models can identify high-risk patients based on prescription history alone, but improvement of the predictive value of models may require information from outside the prescription drug monitoring program. Patient or prescription features that predict opioid overdose may differ from those that predict diversion.
Long-term Hearing Preservation After Resection of Vestibular Schwannoma: A Systematic Review and Meta-analysis
Authors: Ahsan Syed F. , Huq Farhan , Seidman Michael , Taylor Andrew 
Published: October 2017

Objective:
The objective is to perform a systematic review and meta-analysis of the literature on the long-term results of hearing preservation after vestibular schwannoma resection.

Data Sources:
Ovid/Medline, PubMed, Embase, and the Cochrane library from January 1980 to January 2015.

Study Selection:
Inclusion criteria: age ≥18 years, minimum 10 patients in the treatment group, hearing preserving microsurgery, no previous radiation treatment, serviceable hearing at immediate postop follow-up, hearing outcomes reported using Gardner Robinson or the American Academy of Otolaryngology-Head and Neck Surgeons hearing grading scales, and average follow-up of 5 years. Preoperative, immediate postoperative, and last follow-up audiograms were required. Exclusion criteria included neurofibromatosis type 2 patients and surgery for salvage therapy or decompression.

Data Extraction:
Quality evaluated using Methodological Index for Non-Randomized Studies.

Data Synthesis:
Meta-analysis was performed using R v3.2.2, Metafor package v 1.9-7. Cohen's D was used to determine effect size. Ten reports had at least 5-year follow-up and used standardized hearing grading scales. The systematic review found that if hearing was preserved at Class A or B at early postop visit, the chance of preserving hearing at 5 years was excellent. Those who maintained speech discrimination score ≥ 89% at the early postoperative follow-up had better long-term hearing preservation. The meta-analysis reveals that only preoperative and postoperative pure-tone average was associated with long-term hearing preservation.

Conclusion:
Long-term (>5 yr) hearing durability rates are generally very good. Most studies do not report patient and tumor characteristics, therefore precluding combining studies for meta-analysis. Only preoperative and postoperative postoperative pure-tone average was associated with long-term hearing durability.
Influence of laboratory-related and endoscopy-related factors on the assessment of serum pepsinogens and gastrin-17
Authors: Goni Elisabetta , Venerito Marino , Schulz Christian , Weigt Jochen , Langner Cosima , Link Alexander , Malfertheiner Peter 
Published: October 2017

Background and aimSerum pepsinogen I (PGI) and pepsinogen II (PGII) are noninvasive parameters in the detection of atrophic gastritis. The diagnostic add-on value of serum gastrin-17 (G-17) remains uncertain. The aim of this study was to assess the stability of these serum parameters over time and to evaluate the influence of clinical factors, such as upper gastrointestinal (GI) endoscopy and bowel cleansing, on serum PGI, PGII, and G-17 assessment.Patients and methodsA prospective study was carried out in healthy individuals and patients. For the stability analyses, the plasma and serum samples from 23 individuals were processed at different time points with and without the addition of a stabilizer. Ten patients were included to evaluate the influence of upper GI endoscopy and 18 patients to evaluate the effect of bowel cleansing before colonoscopy.ResultsPGI, PGII, and G-17 levels were not statistically different in the serum and plasma. PGI and PGII serum levels were stable over time. G-17 is associated with time-dependent degradation (P=0.0001). The addition of the G-17 stabilizer showed no improvement in stability. Upper GI endoscopy and bowel preparation before colonoscopy were associated with minimal variations in PGI and PGII, whereas G-17 showed patient-specific alterations.ConclusionPGI and PGII serum levels are stable over time. However, G-17 stability is strongly dependent on the time of processing and storage; therefore, samples for G-17 analysis need to be processed no later than 6 h after blood collection. Upper GI endoscopy and colonoscopy preparation lead to minimal nonsignificant changes in basal PGI, PGII, and G-17 levels.
Rapid cardiothoracic ultrasound protocol for diagnosis of acute heart failure in the emergency department
Authors: Öhman Jonas , Harjola Veli-Pekka , Karjalainen Pasi , Lassus Johan 
Published: October 2017

Objectives
The aim of this study was to evaluate the performance of a rapid cardiothoracic ultrasound protocol (CaTUS), combining echocardiographically derived E/eʹ and lung ultrasound (LUS), for diagnosing acute heart failure (AHF) in patients with undifferentiated dyspnea in an emergency department (ED).

Patients and results
We enrolled 100 patients with undifferentiated dyspnea from a tertiary care ED, who all had CaTUS done immediately upon arrival in the ED. CaTUS was positive for AHF with an E/eʹ > 15 and congestion, that is bilateral B-lines or bilateral pleural fluid, on LUS. In addition, an inferior vena cava index was also recorded to analyze whether including a central venous pressure estimate would add diagnostic benefit to the CaTUS protocol. All 100 patients had a brain natriuretic peptide (BNP) sample withdrawn, and 96 patients underwent chest radiography in the ED, which was analyzed later by a blinded radiologist. The reference diagnosis of AHF consisted of either a BNP of more than 400 ng/l or a BNP of less than 100 ng/l in combination with congestion on chest radiography and structural heart disease on conventional echocardiography.
CaTUS had a sensitivity of 100% (95% confidence interval: 91.4–100%), a specificity of 95.8% (95% confidence interval: 84.6–99.3%), and an area under the curve of 0.979 for diagnosing AHF (P<0.001). The diagnostic accuracy of CaTUS was higher than of either E/eʹ or LUS alone. Adding the inferior vena cava index to CaTUS did not improve diagnostic accuracy. CaTUS seemed helpful also for differential diagnostics of dyspnea, mainly regarding pneumonias and pulmonary embolisms.

Conclusion
CaTUS, combining E/eʹ and LUS, provided excellent accuracy for diagnosing AHF.
Homeopathy as Boundary Object and Distributed Therapeutic Agency. A Discussion on the Homeopathic Placebo Response
Authors: Rughiniş Cosima , Ciocănel Alexandra , Vasile Sorina 
Published: October 2017

Background:
We discuss homeopathy's placebo effect as the result of a distributed therapeutic agency involving humans, objects, and texts. Homeopathy has been involved in controversies for centuries, and the dispute whether it is therapy or quackery is as lively as ever. Still, homeopathy has retained significant popularity and acceptance within the medical establishment.

Areas of Uncertainty:
We bracket the issue of biochemical effectiveness of homeopathic remedies as we only discuss homeopathy's potential to elicit a placebo response within its therapeutic alliance, in virtue of its social, symbolic, and material features.

Data Sources:
The review is based on literature discussing homeopathic effectiveness, including historical, biographical, sociological, and epistemological perspectives. We build upon research that clarifies the therapeutic relationship, examining its activities and meanings for practitioners and patients.

Results:
Previous analyses discussing homeopathy's placebo effect stress the importance of the individualized consultation that functions as psychotherapy and generates empathy and hope. We enlarge the discussion, highlighting homeopathy's distributed therapeutic agency across humans, texts, and materials. The historical evolution of homeopathy in relation to biomedicine and science is important to understand its institutional integration into mainstream medicine and its appeal to scientifically minded doctors. Anecdotes of healing and the message of no-harm encourage patients to try homeopathy and hope for the best. The esthetics and ritual of remedies, coupled with computers' scientific legitimacy and time-saving power constitute a material infrastructure of therapeutic persuasion.

Conclusions:
Through its relation with biomedicine, its doctrine, consultation design, and treatment rituals, homeopathy offers a powerful medium to elicit a placebo response in a therapeutic alliance. By virtue of its proximity and radical difference from the scientific and biomedical enterprises, its material and textual organization, its storytelling and esthetics, homeopathy offers doctors and patients the opportunity and the tools to collaborate, to witness healing, and to hope for success against adversity.