bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can Recurrence After an Acute Episode of Low Back Pain Be Predicted?
Authors: Machado Gustavo C. , Maher Chris G. , Ferreira Paulo H. , Latimer Jane , Koes Bart W. , Steffens Daniel , Ferreira Manuela L. 
Published: June 2017

Abstract

Background
Although recurrence is common after an acute episode of low back pain, estimates of recurrence rates vary widely and predictors of recurrence remain largely unknown.

Objective
The purposes of the study were to determine the 1-year incidence of recurrence in participants who recovered from an acute episode of low back pain and to identify predictors of recurrence.

Design
The design was an inception cohort study nested in a case-crossover study.

Methods
For 12 months, 832 of the 999 participants who initially presented to primary care within the first 7 days of an episode of low back pain were followed. Of these participants, 469 recovered (1 month pain free) from the index episode within 6 weeks and were included in this study. Recurrence was defined as a new episode lasting more than 1 day, or as an episode of care seeking. Putative predictors were assessed at baseline and chosen a priori. Multivariable regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI).

Results
The 1-year incidence of recurrence of low back pain was 33%, and the 1-year incidence of recurrence of low back pain with care seeking was 18%. Participants reporting more than 2 previous episodes of low back pain had increased odds of future recurrences (OR = 3.18, CI = 2.11–4.78). This factor was also associated with recurrent episodes that led to care seeking (OR = 2.87, CI = 1.73–4.78). No other factors were associated with recurrences.

Limitations
There are limitations inherent in reliance on recall.

Conclusions
After an acute episode of low back pain, one-third of patients will experience a recurrent episode, and approximately half of those will seek care. Experiencing more than 2 previous episodes of low back pain triples the odds of a recurrence within 1 year.
Should Hyperoxia Be Avoided During Sepsis? An Experimental Study in Ovine Peritonitis*
Authors: He Xinrong , Su Fuhong , Xie Keliang , Taccone Fabio Silvio , Donadello Katia , Vincent Jean-Louis 
Published: June 2017

Objectives:
Optimizing oxygen delivery is an important part of the hemodynamic resuscitation of septic shock, but concerns have been raised over the potentially deleterious effects of hyperoxia. We evaluated the impact of hyperoxia on hemodynamics, the microcirculation, and cerebral and renal metabolism in an ovine model of septic shock.

Design:
Randomized animal study.

Setting:
University hospital animal research laboratory.

Subjects:
Fourteen adult female sheep.

Interventions:
After induction of fecal peritonitis, sheep were randomized to ventilation with an Fio
2 of 100% (n = 7) or an Fio
2 adjusted to maintain Pao
2 between 90 and 120 mm Hg (n = 7, control). All animals were fluid resuscitated and observed until death.

Measurements and Main Results:
In addition to hemodynamic measurements, we assessed the sublingual microcirculation, renal and cerebral microdialysis and microvascular perfusion, and brain tissue oxygen pressure. Hyperoxic animals initially had a higher mean arterial pressure than control animals. After onset of shock, hyperoxia blunted the decrease in stroke volume index observed in the control group. Hyperoxia was associated with a higher sublingual microcirculatory flow over time, with higher cerebral perfusion and brain tissue oxygen pressure and with a lower cerebral lactate-to-pyruvate ratio than in control animals. Hyperoxia was also associated with preserved renal microvascular perfusion, lower renal lactate-to-pyruvate ratio, and higher Pao
2/Fio
2 ratio.

Conclusions:
In this acute peritonitis model, hyperoxia induced during resuscitation provided better hemodynamics and peripheral microvascular flow and better preserved cerebral metabolism, renal function, and gas exchange. These observations are reassuring with recent concerns about excessive oxygen therapy in acute diseases.
Service line structure and decision-maker attention in three health systems: Implications for patient-centered care
Authors: Louis Christopher J. , Clark Jonathan R. , Gray Barbara , Brannon Diane , Parker Victoria 
Published: June 2017

Background:
Scholars have noted a disconnect between the level at which structure is typically examined (the organization) and the level at which the relevant coordination takes place (service delivery). Accordingly, our understanding of the role structure plays in care coordination is limited.

Purpose:
In this article, we explore service line structure, with an aim of advancing our understanding of the role service line structure plays in producing coordinated, patient-centered care. We do so by giving special attention to the cognitive roots of patient-centeredness.

Methodology/Approach:
Our exploratory study relied on comparative case studies of the breast cancer service lines in three health systems. Nonprobability discriminative snowball sampling was used to identify the final sample of key informants. We employed a grounded approach to analyzing and interpreting the data.

Results:
We found substantial variation across the three service lines in terms of their structure. We also found corresponding variation across the three case sites in terms of where informant attention was primarily focused in the process of coordinating care. Drawing on the attention-based view of the firm, our results draw a clear connection between structural characteristics and the dominant focus of attention (operational tactics, provider roles and relationships, or patient needs and engagement) in health care service lines.

Conclusion:
Our exploratory results suggest that service line structures influence attention in two ways: (a) by regulating the type and intensity of the problems facing service line participants and (b) by encouraging (or discouraging) a shared purpose around patient needs.

Practice Implications:
Patient-centered attention—a precursor to coordinated, patient-centered care—depends on the internal choices organizations make around service line structure. Moreover, a key task for organizational and service line leaders is to structure service lines to create a context that minimizes distractions and enables care providers to focus their attention on the needs of their patients.
Descemet's Membrane Dehiscence Resulting From Misdirected Viscoelastic During Anterior Chamber Reformation
Authors: Chay Edward , Dastgir Ghulam , Scott Wayne , Lazzaro Douglas 
Published: June 2017

Abstract:
We report a case of Descemet's membrane detachment after inadvertent intrastromal injection of hyaluronic acid. Surgical removal was attempted with minimal but slow improvement. Near-complete resolution occurred with subsequent conservative management within 6 weeks.
Liver Abscess in Patients With Leukemia and Prolonged Neutropenia
Authors: Grabau Michael , Pandya Shuchi , Nanjappa Sowmya , Shenoy Rahul , Aslam Sadaf , Greene John N. 
Published: June 2017

Abstract
Patients with leukemia are at a high risk of developing disseminated invasive fungal and/or bacterial infections due to prolonged neutropenia, which is usually caused by myelosuppressive chemotherapy. Disseminated fungal infections in the setting of prolonged neutropenia result in high mortality. The most effective means to improve patient outcome is early diagnosis and treatment when preventive measures have failed. The most common fungal pathogens are Candida spp and Aspergillus spp. Rare causes of such infection are by Mucor and Entomopthorales spp, Fusarium spp, and Scedosporium spp, each having unique epidemiology, pathophysiology, and treatment options. We present a case of disseminated hepatic, pulmonary, bowel, and appendix mucormycosis successfully treated with antifungal therapy and without surgical intervention. We also review the literature regarding hepatic abscesses and disseminated invasive fungal infections along with current treatment strategies for Mucor infections.
Epigenetics insights into chronic pain: DNA hypomethylation in fibromyalgia—a controlled pilot-study
Authors: Ciampi de Andrade Daniel , Maschietto Mariana , Galhardoni Ricardo , Gouveia Gisele , Chile Thais , Victorino Krepischi Ana C. , Dale Camila S. , Brunoni André R. , Parravano Daniella C. , Cueva Moscoso Ana S. , Raicher Irina , Kaziyama Helena H. S. , Teixeira Manoel J. , Brentani Helena P. 
Published: June 2017

Abstract
To evaluate changes in DNA methylation profiles in patients with fibromyalgia (FM) compared to matched healthy controls (HCs). All individuals underwent full clinical and neurophysiological assessment by cortical excitability (CE) parameters measured by transcranial magnetic stimulation. DNA from the peripheral blood of patients with FM (n = 24) and HC (n = 24) were assessed using the Illumina-HumanMethylation450 BeadChips. We identified 1610 differentially methylated positions (DMPs) in patients with FM displaying a nonrandom distribution in regions of the genome. Sixty-nine percent of DMP in FM were hypomethylated compared to HC. Differentially methylated positions were enriched in 5 genomic regions (1p34; 6p21; 10q26; 17q25; 19q13). The functional characterization of 960 genes related to DMPs revealed an enrichment for MAPK signaling pathway (n = 18 genes), regulation of actin cytoskeleton (n = 15 genes), and focal adhesion (n = 13 genes). A gene–gene interaction network enrichment analysis revealed the participation of DNA repair pathways, mitochondria-related processes, and synaptic signaling. Even though DNA was extracted from peripheral blood, this set of genes was enriched for disorders such as schizophrenia, mood disorders, bulimia, hyperphagia, and obesity. Remarkably, the hierarchical clusterization based on the methylation levels of the 1610 DMPs showed an association with neurophysiological measurements of CE in FM and HC. Fibromyalgia has a hypomethylation DNA pattern, which is enriched in genes implicated in stress response and DNA repair/free radical clearance. These changes occurred parallel to changes in CE parameters. New epigenetic insights into the pathophysiology of FM may provide the basis for the development of biomarkers of this disorder.
Soft-Tissue Reconstruction of Large Spinal Defects: A 12-Year Institutional Experience
Authors: Devulapalli Chris , Broyles Justin M. , Bello Ricardo , Elgendy Tarek , Yalanis Georgia , Redett Richard , Rosson Gedge D. , Sacks Justin M. 
Published: June 2017

Background:
Spinal resections can lead to defects requiring soft-tissue reconstruction. The purpose of this study was to review the authors’ institutional experience with reconstruction of spinal defects and identify risk factors predictive of wound complications, focusing on timing of reconstruction with ablative surgery.

Methods:
The authors retrospectively reviewed patients who underwent spinal resection and required soft-tissue reconstruction from 2002 to 2014. Logistic regression was performed to identify risk factors for complications.

Results:
Of 289 reconstructions performed in 259 patients, 64 cases (22.1 percent) had major wound complications requiring reoperation. Lumbosacral defects were the most common location (43.6 percent) and paraspinous muscle flaps were the preferred reconstructive method used for all defect regions. A total of 224 reconstructions (77.5 percent) were performed immediately at the time of spinal surgery, and 65 (22.5 percent) were performed in delayed fashion as a result of wound complications from previous spinal surgery. Patients undergoing immediate reconstruction had significantly lower rates of instrumentation removal (0.9 percent versus 4.6 percent; p = 0.043), unplanned reoperations (0.5 versus 1.3; p < 0.001), and mortality (0.9 percent versus 9.2 percent; p < 0.001) compared with those undergoing delayed reconstruction. On logistic regression analysis, presence of instrumentation (OR, 3.2; p = 0.012), requirement for a free flap (OR, 9.0; p = 0.016), and spinal cord exposure (OR, 2.6; p = 0.036) were associated with increased odds of a major wound complication.

Conclusion:
Spinal resections carry significant surgical-site morbidity, and selection of high-risk patients for immediate reconstruction with locoregional muscle flaps may be beneficial for improving wound-related outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Three-Dimensional Cone Beam Computed Tomography Volumetric Outcomes of rhBMP-2/Demineralized Bone Matrix versus Iliac Crest Bone Graft for Alveolar Cleft Reconstruction
Authors: Liang Fan , Yen Stephen L-K. , Imahiyerobo Thomas , Sanborn Luke , Yen Leia , Yen Daniel , Nazarian Sheila , Jedrzejewski Breanna , Urata Mark , Hammoudeh Jeffrey 
Published: June 2017

Background:
Recent studies indicate that recombinant human bone morphogenetic protein-2 (rhBMP-2) in a demineralized bone matrix scaffold is a comparable alternative to iliac bone autograft in the setting of secondary alveolar cleft repair. Postreconstruction occlusal radiographs demonstrate improved bone stock when rhBMP-2/demineralized bone matrix (DBM) scaffold is used but lack the capacity to evaluate bone growth in three dimensions. This study uses cone beam computed tomography to provide the first clinical evaluation of volumetric and density comparisons between these two treatment modalities.

Methods:
A prospective study was conducted with 31 patients and 36 repairs of the alveolar cleft over a 2-year period. Twenty-one repairs used rhBMP-2/DBM scaffold and 14 repairs used iliac bone grafting. Postoperatively, occlusal radiographs were obtained at 3 months to evaluate bone fill; cone beam computed tomographic images were obtained at 6 to 9 months to compare volumetric and density data.

Results:
At 3 months, postoperative occlusal radiographs demonstrated that 67 percent of patients receiving rhBMP-2/DBM scaffold had complete bone fill of the alveolus, versus 56 percent of patients in the autologous group. In contrast, cone beam computed tomographic data showed 31.6 percent (95 percent CI, 24.2 to 38.5 percent) fill in the rhBMP-2 group compared with 32.5 percent (95 percent CI, 22.1 to 42.9 percent) in the autologous population. Density analysis demonstrated identical average values between the groups (1.38 g/cc).

Conclusions:
These data demonstrate comparable bone regrowth and density values following secondary alveolar cleft repair using rhBMP-2/DBM scaffold versus autologous iliac bone graft. Cone beam computed tomography provides a more nuanced understanding of true bone regeneration within the alveolar cleft that may contribute to the information provided by occlusal radiographs alone.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
A multicenter, randomized study of decitabine as epigenetic priming with induction chemotherapy in children with AML
Authors: Gore Lia , Triche Timothy J. , Farrar Jason E. , Wai Daniel , Legendre Christophe , C Gooden Gerald , Liang Winnie S. , Carpten John , Lee David , Alvaro Frank , Macy Margaret E. , Arndt Carola , Barnette Philip , Cooper Todd , Martin Laura , Narendran Aru , Pollard Jessica , Meshinchi Soheil , Boklan Jessica , Arceci Robert J , Salhia Bodour 
Published: June 2017

ABSTRACTBackgroundDecitabine is a deoxycytidine nucleoside derivative inhibitor of DNA-methyltransferases, which has been studied extensively and is approved for myelodysplastic syndrome in adults but with less focus in children. Accordingly, we conducted a phase 1 multicenter, randomized, open-label study to evaluate decitabine pre-treatment before standard induction therapy in children with newly diagnosed AML to assess safety and tolerability and explore a number of biologic endpoints.ResultsTwenty-four patients were fully assessable for all study objectives per protocol (10 in Arm A, 14 in Arm B). All patients experienced neutropenia and thrombocytopenia. The most common grade 3 and 4 non-hematologic adverse events observed were gastrointestinal toxicities and hypophosphatemia. Plasma decitabine PK were similar to previously reported adult data. Overall CR/CRi was similar for the two arms. MRD negativity at end-induction was 85% in Arm A versus 67% in Arm B patients. DNA methylation measured in peripheral blood over the course of treatment tracked with blast clearance and matched marrow aspirates at day 0 and day 21. Unlike end-point marrow analyses, promoter methylation in blood identified an apparent reversal of response in the lone treatment failure, one week prior to the patient’s marrow aspirate confirming non-response. Decitabine-induced effects of end-induction marrows in Arm A were reflected by changes in DNA methylation and gene expression comparison with matched paired marrow diagnostic aspirates.ConclusionsThis first-in-pediatrics trial demonstrates that decitabine prior to standard combination chemotherapy is feasible and well tolerated in children with newly diagnosed AML. Pre-treatment with decitabine may represent a newer therapeutic option for pediatric AML, especially as it appears to induce important epigenetic alterations. The novel biological correlates studied in this trial offer a clinically relevant window into disease progression and remission. Additional studies are needed to definitively assess whether decitabine can enhance durability responses in children with AML. This trial was registered atwww.clinicaltrials.govasNCT01177540.
On the relative role of different age groups during influenza A epidemics in Germany, 2002-2017
Authors: Goldstein Edward 
Published: June 2017

AbstractBackgroundThere is limited information about the role of different age groups, particularly subgroups of school-age children and younger adults in propagating influenza epidemics.MethodsFor a communicable disease outbreak, some subpopulations may play a disproportionate role during the ascent of the outbreak due to increased susceptibility and/or contact rates. Such subpopulations can be identified by considering the proportion that cases in a subpopulation represent among all cases in the population occurring before the epidemic peak (Bp), the corresponding proportion after the epidemic peak (Ap), to calculate the relative risk for a subpopulation, RR=Bp/Ap. We estimated RR for several age groups using data on reported influenza A cases in Germany between 2002-2017.ResultsChildren aged 14-17y had the highest RR estimates for 7 out of 15 influenza A epidemics in the data, including the 2009 pandemic, and the large 2016/17, 2008/09, and 2006/07 seasons. Children aged 10-13y had the highest RR estimates during 3 epidemics, including the large 2014/15 and 2004/05 seasons. Children aged 6-9y had the highest RR estimates during two epidemics, including the large 2012/13 season. Children aged 2-5y had the highest RR estimate during the moderate 2015/16 season; adults aged 18-24y had the highest RR estimate during the small 2005/06 season; adults aged 25-34y had the highest RR estimate during the large, 2002/03 season.ConclusionsOur results support the prominent role of all school-age children, particularly the oldest ones, in propagating influenza epidemics in the community. We note that national vaccination coverage levels among older school-age children were lower than among younger school-age children during the recent influenza seasons in the US, and influenza vaccination program in England has not been phased in yet for secondary school students.
RecoverY: K-mer based read classification for Y-chromosome specific sequencing and assembly
Authors: Rangavittal Samarth , Harris Robert S. , Cechova Monika , Tomaszkiewicz Marta , Chikhi Rayan , Makova Kateryna D. , Medvedev Paul 
Published: June 2017

AbstractMotivationThe haploid mammalian Y chromosome is usually under-represented in genome assemblies due to high repeat content and low depth due to its haploid nature. One strategy to ameliorate the low coverage of Y sequences is to experimentally enrich Y-specific material before assembly. Since the enrichment process is imperfect, algorithms are needed to identify putative Y-specific reads prior to downstream assembly. A strategy that usesk-mer abundances to identify such reads was used to assemble the gorilla Y (Tomaszkiewicz et al 2016). However, the strategy required the manual setting of key parameters, a time-consuming process leading to sub-optimal assemblies.ResultsWe develop a method, RecoverY, that selects Y-specific reads by automatically choosing the abundance level at which a k-mer is deemed to originate from the Y. This algorithm uses prior knowledge about the Y chromosome of a related species or known Y transcript sequences. We evaluate RecoverY on both simulated and real data, for human and gorilla, and investigate its robustness to important parameters. We show that RecoverY leads to a vastly superior assembly compared to alternate strategies of filtering the reads or contigs. Compared to the preliminary strategy used in Tomaszkiewicz et al (2016), we achieve a 33% improvement in assembly size and a 20% improvement in the NG50, demonstrating the power of automatic parameter selection.AvailabilityOur tool RecoverY is freely available athttps://github.com/makovalab-psu/RecoverYContactkmakova@bx.psu.edu,pashadag@cse.psu.eduSupplementary informationAttached as an additional file.
Reduced chlorhexidine and daptomycin susceptibility arises in vancomycin-resistantEnterococcus faeciumafter serial chlorhexidine exposure
Authors: Bhardwaj Pooja , Hans Amrita , Ruikar Kinnari , Guan Ziqiang , Palmer Kelli L. 
Published: June 2017

AbstractVancomycin-resistantEnterococcus faecium(VREfm) are critical public health concerns because they are among the leading causes of hospital-acquired bloodstream infections. Chlorhexidine (CHX) is a bisbiguanide cationic antiseptic that is routinely used for patient bathing and other infection control practices. VREfm are likely frequently exposed to CHX; however, the long-term effects of CHX exposure have not been studied in enterococci. In this study, we serially exposed VREfm to increasing concentrations of CHX for a period of 21 days in two independent experimental evolution trials. Reduced CHX susceptibility emerged (4-fold shift in CHX MIC). Sub-populations with reduced daptomycin (DAP) susceptibility were detected, which were further analyzed by genome sequencing and lipidomic analysis. Across the trials, we identified adaptive changes in genes with predicted or experimentally confirmed roles in chlorhexidine susceptibility (efrE), global nutritional stress response (relA), nucleotide metabolism (cmk), phosphate acquisition (phoU), and glycolipid biosynthesis (bgsB), among others. Moreover, significant alterations in membrane phospholipids were identified. Our results are clinically significant because they identify a link between serial sub-inhibitory CHX exposure and reduced DAP susceptibility. In addition, the CHX-induced genetic and lipidomic changes described in this study offer new insights into the mechanisms underlying the emergence of antibiotic resistance in VREfm.