bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Iliac Instrumentation on the Quality of Life of Patients With Adult Spine Deformity
Authors: Martín-Buitrago Mar Pérez , Pizones Javier , Sánchez Pérez-Grueso Francisco Javier , Díaz Almirón Mariana , Vila-Casademunt Alba , Obeid Ibrahim , Alanay Ahmet , Kleinstück Frank , Acaroglu Emre R. , Pellisé Ferran 
Published: November 2017

Study Design.
Retrospective comparative analysis of data collected prospectively in an adult spine deformity (ASD) multicenter database.

Objective.
To evaluate the impact of the iliac screws on the quality of life of ASD patients compared with those instrumented above the pelvis (L5/S1/S2).

Summary of Background Data.
The impact on patient's daily activities and functions, of immobilizing the sacroiliac joint with iliac screws for the treatment of ASD is still underexplored.

Methods.
Inclusion criteria were ASD patients with a long arthrodesis of at least eight levels and whose lowest instrumented vertebrae (LIV) were L5 or below. We analyzed the following preoperative and 2 years’ follow-up variables: age, Cobb angle, coronal and sagittal alignment, number of instrumented levels, Oswestry Disability Index (ODI), Core Outcome Measures Index (COMI), Scoliosis Research Society-22 (SRS-22), and Short Form 36 (SF-36) questionnaires. Statistical analysis was performed with Mann–Whitney U test, and Wilcoxon test.

Results.
A total of 129 patients were included, and separated into two groups: “Iliac Yes,” with the LIV at the Ilium (N = 104), and “iliac No,” with the LIV at L5/S1/S2 (N = 25). Patients instrumented with Iliac screws were older (x = 66 vs. 56 yr, P = 0.008), and had lower Cobb magnitude (x = 31° vs. 45°, P = 0.019). No statistically significant differences were found in the health related quality of life (HRQOL) questionnaires prior to surgery or at 2-years’ follow up. The “Iliac Yes” group significantly improved all radiographic and HRQOL scores parameters 2 years after surgery (P < 0.005). While the “Iliac No” group failed to significantly improve (coronal balance, sagittal vertical axis, SF-36 Physical functioning, SF-36 General health, and COMI) (P > 0.05)

Conclusion.
ASD patients instrumented with iliac screws significantly improved all their HRQOL questionnaires 2 years after surgery. The 2 years’ postoperative HRQOL scores were similar in both groups, regardless of the sacroiliac joint immobilization. Therefore, with the currently available tools, we cannot state that iliac instrumentation has a negative influence on patient's quality of life.

Level of Evidence: 4
Improvement of Blood-Brain Barrier Integrity in Traumatic Brain Injury and Hemorrhagic Shock Following Treatment With Valproic Acid and Fresh Frozen Plasma
Authors: Nikolian Vahagn C. , Dekker Simone E. , Bambakidis Ted , Higgins Gerald A. , Dennahy Isabel S. , Georgoff Patrick E. , Williams Aaron M. , Andjelkovic Anuska V. , Alam Hasan B. 
Published: November 2017

Objective:
Combined traumatic brain injury and hemorrhagic shock are highly lethal. Following injuries, the integrity of the blood-brain barrier can be impaired, contributing to secondary brain insults. The status of the blood-brain barrier represents a potential factor impacting long-term neurologic outcomes in combined injuries. Treatment strategies involving plasma-based resuscitation and valproic acid therapy have shown efficacy in this setting. We hypothesize that a component of this beneficial effect is related to blood-brain barrier preservation.

Design:
Following controlled traumatic brain injury, hemorrhagic shock, various resuscitation and treatment strategies were evaluated for their association with blood-brain barrier integrity. Analysis of gene expression profiles was performed using Porcine Gene ST 1.1 microarray. Pathway analysis was completed using network analysis tools (Gene Ontology, Ingenuity Pathway Analysis, and Parametric Gene Set Enrichment Analysis).

Subjects:
Female Yorkshire swine were subjected to controlled traumatic brain injury and 2 hours of hemorrhagic shock (40% blood volume, mean arterial pressure 30-35 mmHg).

Interventions:
Subjects were resuscitated with 1) normal saline, 2) fresh frozen plasma, 3) hetastarch, 4) fresh frozen plasma + valproic acid, or 5) hetastarch + valproic acid (n = 5 per group). After 6 hours of observation, brains were harvested for evaluation.

Measurements and Main Results:
Immunofluoroscopic evaluation of the traumatic brain injury site revealed significantly increased expression of tight-junction associated proteins (zona occludin-1, claudin-5) following combination therapy (fresh frozen plasma + valproic acid and hetastarch + valproic acid). The extracellular matrix protein laminin was found to have significantly improved expression with combination therapies. Pathway analysis indicated that valproic acid significantly modulated pathways involved in endothelial barrier function and cell signaling.

Conclusions:
Resuscitation with fresh frozen plasma results in improved expression of proteins essential for blood-brain barrier integrity. The addition of valproic acid provides significant improvement to these protein expression profiles. This is likely secondary to activation of key pathways related to endothelial functions.
Low-dose Sinapic Acid Abates the Pyroptosis of Macrophages by Downregulation of lncRNA-MALAT1 in Rats With Diabetic Atherosclerosis
Authors: Han Yong , Qiu Hong , Pei Xing , Fan Yigang , Tian Hongyan , Geng Jie 
Published: November 2017

Abstract:
Pyroptosis is a type of programmed cell death, which has been associated with multiple inflammatory diseases including diabetic atherosclerosis (DA). This study aims to explore the role of sinapic acid (SA) in the pyroptosis of macrophages in DA. Our results from the in vivo experiments showed that low-dose (≤50 mg/kg) chronic SA administration suppressed serum endothelin 1 (ET-1) and interleukin-1β (IL-1β) contents, pyroptotic death of bone marrow–derived macrophages, and the expression of pyroptotic proteins ASC, NRLP3, and caspase-1. Besides, lncRNA-metastasis associated lung adenocarcinoma transcript 1 (MALAT1) was robustly upregulated in the macrophages of rats with DA and could be lowered by low-dose SA administration. Gene overexpression and knockdown experiments showed that MALAT1 had a modestly positive effect on the pyroptosis of normal macrophages. Moreover, in macrophages incubated with high-glucose and Ox-LDL, 1-μM SA treatment displayed a suppressive effect on the cell pyroptosis similar to that of MALAT1 knockdown. Transfection of the pcDNA-MALAT1 expression vector counteracted the decrease in MALAT1 expression and macrophage pyroptosis caused by SA. In conclusion, low-dose SA can abate the pyroptosis of macrophages by downregulation of lncRNA-MALAT1 in rats with DA.
OCULAR PERFUSION PRESSURE AND CHOROIDAL THICKNESS IN CENTRAL SEROUS CHORIORETINOPATHY AND PIGMENT EPITHELIOPATHY
Authors: Yun Cheolmin , Han Ji Yun , Cho Sungwon , Hwang Soon-Young , Kim Seong-Woo , Oh Jaeryung 
Published: November 2017

Purpose:
To investigate ocular perfusion pressure (OPP) in patients with central serous chorioretinopathy (CSC) and pigment epitheliopathy (PE).

Methods:
In this retrospective study, we included patients with acute idiopathic unilateral CSC and age- and sex-matched normal controls. The patients with CSC were classified into two groups according to the PE presence on their fellow eyes. We compared OPP among CSC patients with or without PE and normal controls.

Results:
Among a total of 47 patients with CSC, 21 were classified into the PE group and 26 into the non-PE group. The mean OPP (±SD) of CSC and fellow eyes in the PE group (50.02 ± 4.98 and 50.83 ± 4.12 mmHg, respectively) was greater than that in the non-PE group (43.69 ± 6.88 and 44.0 ± 6.57 mmHg, respectively) and normal controls (45.64 ± 8.73 mmHg) (all, P < 0.05). The mean macular choroidal thickness of CSC and fellow eyes in the PE group (344.4 ± 31.8 and 310.1 ± 37.0 μm, respectively) was thicker than that in the non-PE group (318.5 ± 43.8 and 282.8 ± 36.1 μm, respectively) (all, P < 0.05). Greater macular choroidal thickness and higher OPP were associated with PE (P = 0.002 and P = 0.003).

Conclusion:
Forty-five percent of the patients with acute unilateral CSC had PE in their fellow eyes. Increased OPP may influence the development of bilateral CSC characteristics.
INTRAOCULAR PRESSURE CHANGES AFTER DEXAMETHASONE IMPLANT IN PATIENTS WITH GLAUCOMA AND STEROID RESPONDERS
Authors: Srinivasan Rekha , Sharma Unnati , George Ronnie , Raman Rajiv , Sharma Tarun ,   for the Sankara Nethralaya Vitreoretinal Study Group (SNVR Study Group)
Published: November 2017

Purpose:
To assess the changes in intraocular pressure (IOP) after dexamethasone (DEX) implant in patients with glaucoma or history of steroid responders.

Methods:
A retrospective study of patients who received DEX implant was conducted in a tertiary care center in India. Demographic details and IOP measurements at preinjection and postinjection were collected. The proportion of patients with and without IOP rise after DEX implant was noted, and the number of antiglaucoma medications to control the IOP was analyzed. The changes in IOP were also compared in the group with no glaucoma/steroid responder.

Results:
A total of 815 patients, 767 patients in the nonglaucoma group and 48 patients in the glaucoma referral group, who underwent DEX implant were included in this study. The overall mean (SD) age of study participants was 56.3 (SD = 12.6) years. The overall mean (SD) IOP at baseline and at follow-up after injection for both nonglaucoma and glaucoma referral groups was found to be significant (P < 0.001). The differences in IOP measurements across follow-ups after DEX implant were found to be significant in both nonglaucoma (P < 0.001) and glaucoma referral groups (P < 0.001). Among the study patients in the IOP-rise group, 46.43% had maximum IOP rise in 1-week follow-up and 39% in 2-week follow-up, where 78.6% showed IOP controlled with 1 antiglaucoma medication.

Conclusion:
The rise in IOP after DEX implant was noted within first 2 weeks, which can be managed with topical antiglaucoma medications. Hence, with a close early follow-up monitoring of IOP, and timely medical intervention, DEX implant can be performed in patients with glaucoma.
Effect of Suture Removal on Refraction and Graft Curvature After Deep Anterior Lamellar Keratoplasty in Patients With Keratoconus
Authors: Feizi Sepehr , Javadi Mohammad Ali , Behnaz Nazanin , Fani-Hanife Sadaf , Jafarinasab Mohammad Reza 
Published: November 2017

Purpose:
To evaluate the effect of suture removal on refraction and keratometry measurements after deep anterior lamellar keratoplasty (DALK).

Methods:
This retrospective study enrolled 54 keratoconus-affected eyes that underwent DALK. A combined suturing technique consisting of a 16-bite single running and 8-bite interrupted 10-0 nylon sutures was used at the time of keratoplasty. Selective interrupted suture removal was performed in a subgroup of patients to reduce postkeratoplasty astigmatism. In another subgroup, all sutures were removed at a single session. Adjustment of the running suture tension was not performed in any case. The effect of suture removal on refractive outcomes was investigated in the entire study group, and the 2 subgroups were compared.

Results:
Mean patient age was 26.6 ± 6.7 years at the time of keratoplasty. The mean interval from surgery to complete suture removal was 17.4 ± 5.9 months. Compared with the pre-suture removal values, there was a significant increase in the magnitude of myopia (−1.12 ± 1.73 D, P = 0.001), refractive astigmatism (−0.89 ± 2.47 D, P = 0.04), mean keratometry (1.39 ± 1.64 D, P = 0.001), and keratometric astigmatism (2.61 ± 2.43 D, P < 0.001) after complete suture removal. Subgroup analysis revealed that selective removal of interrupted sutures was effective as long as remaining interrupted and running sutures were left in place.

Conclusions:
Complete suture removal was followed by an unpredictable and significant increase in post-DALK refraction and keratometry readings. In the subgroup that underwent early selective removal of interrupted sutures before complete suture removal, the desirable effects of this procedure significantly diminished after all remaining sutures were completely removed.
Di (2‐Ethylhexyl) Phthalate and Its Role in Developing Cholestasis
Authors: Gaitantzi Haristi , Hakenberg Priska , Theobald Jannick , Heinlein Hagen , Cai Chen , Loff Steffan , Wölfl Stefan , Ebert Matthias P. , Breitkopf‐Heinlein Katja , Subotic Ulrike 
Published: November 2017

ABSTRACTObjectives:Di(2‐ethylhexyl) phthalate (DEHP) is a plasticizer used in many polyvinylchloride medical devices and is washed out easily. Thereby critically ill infants can become exposed to DEHP concentrations significantly exceeding the recommended threshold. We suspect DEHP to play an important role in the development of intestinal failure‐associated liver disease. The aim of this study was therefore to determine the direct influence of DEHP on different liver cell types.Methods:HepG2, human upcyte hepatocytes, primary murine hepatocytes, LX‐2, human upcyte hepatic stellate cells, and liver organoids were cultured with DEHP (0.5–500 μmol/L) and parameters including cytotoxicity, cell–cell interactions, and expression of metabolizing enzymes were investigated.Results:DEHP modulated the expression of xenobiotic metabolizing enzymes, reduced the formation of bile canaliculi and cell polarity, and inhibited Cyp‐activity in hepatocytes. DEHP had a toxic effect on LX‐2 and induced the fibrogenic activation of hepatic stellate cells. The mode of action of DEHP was different in monolayer cultures compared to 3D‐liver organoids, which were more sensitive to DEHP.Conclusions:This study suggests that DEHP modulates expression and activity of drug‐detoxifying liver enzymes in humans at a clinically relevant concentration. Furthermore, it may contribute to the development of cholestasis and fibrosis. These findings strongly support the opinion, that there is a significant potential for serious adverse effects of DEHP derived from medical devices on human health, especially in very young infants with immature livers.
Identifying Nonprovider Factors Affecting Pediatric Emergency Medicine Provider Efficiency
Authors: Saleh Fareed , Breslin Kristen , Mullan Paul C. , Tillett Zachary , Chamberlain James M. 
Published: November 2017

Objective
The aim of this study was to create a multivariable model of standardized relative value units per hour by adjusting for nonprovider factors that influence efficiency.

Methods
We obtained productivity data based on billing records measured in emergency relative value units for (1) both evaluation and management of visits and (2) procedures for 16 pediatric emergency medicine providers with more than 750 hours worked per year. Eligible shifts were in an urban, academic pediatric emergency department (ED) with 2 sites: a tertiary care main campus and a satellite community site. We used multivariable linear regression to adjust for the impact of shift and pediatric ED characteristics on individual-provider efficiency and then removed variables from the model with minimal effect on productivity.

Results
There were 2998 eligible shifts for the 16 providers during a 3-year period. The resulting model included 4 variables when looking at both ED sites combined. These variables include the following: (1) number of procedures billed by provider, (2) season of the year, (3) shift start time, and (4) day of week. Results were improved when we separately modeled each ED location. A 3-variable model using procedures billed by provider, shift start time, and season explained 23% of the variation in provider efficiency at the academic ED site. A 3-variable model using procedures billed by provider, patient arrivals per hour, and shift start time explained 45% of the variation in provider efficiency at the satellite ED site.

Conclusions
Several nonprovider factors affect provider efficiency. These factors should be considered when designing productivity-based incentives.
Clinical Experience in a Community Setting During Pediatric Emergency Medicine Fellowship Training
Authors: Marchese Ronald F. , Gala Payal K. , Seiden Jeffrey A. , Scarfone Richard , Belfer Robert A. , Posner Jill 
Published: November 2017

Objectives
The aim of this study is to explore current community emergency department (ED) experiences available to pediatric emergency medicine (PEM) trainees and estimate the proportion of graduates taking positions that involve working in a community ED setting.

Methods
We conducted an e-mail–based survey among PEM fellowship directors and assistant directors.

Results
There were 55 program director respondents (74% response rate). Thirty-one percent of the surveyed PEM fellowship programs provide training exposure to a community ED setting. Twenty-nine percent of the surveyed programs reported that 25% to 49% of graduating trainees accepted positions that involve working in a community hospital ED setting, 13% responded 50% to 74%, and 4% report 75% to 100% from 2012 to 2016.

Conclusions
There is an overall paucity of a dedicated community rotation for PEM trainees, yet many graduates are seeking employment in community-based EDs. Because the need for community-based PEM physicians continues to rise and to adequately prepare the PEM workforce, PEM fellowship training should consider a curriculum that includes community-based ED clinical experiences.
HIV outcomes among migrants from low-income and middle-income countries living in high-income countries: a review of recent evidence
Authors: Ross Jonathan , Cunningham Chinazo O. , Hanna David B. 
Published: November 2017

Purpose of review
Migrants living in high-income countries are disproportionately affected by HIV infection and frequently have characteristics associated with poor HIV clinical outcomes. HIV epidemiology among migrants is influenced by changes in migration patterns and variations in transmission risk behaviors. Here we review the recently published literature on known HIV outcomes among migrants from low-income and middle-income countries living in high-income countries.

Recent findings
High proportions of migrants acquire HIV after migration, and this group frequently presents to care late. Once established in care, migrants are often more likely to experience worse HIV treatment outcomes compared with native populations. Multiple individual and structural factors influence HIV diagnosis and treatment outcomes among migrants, including disruption of social networks, increased sexual risk behaviors, communication barriers, limited access to care, and stigma. Few studies have examined interventions targeted at improving HIV outcomes among migrants.

Summary
Stigma and limited access to care appear to be primary drivers of poor HIV outcomes among migrants in high-income countries. Addressing these disparities is limited by difficulties in identifying and monitoring this population as well as a lack of evidence regarding appropriate interventions for migrants living with HIV. Improving outcomes for this group requires interventions that are specifically targeted at this marginalized and growing population.
Safety of Revision Sleeve Gastrectomy Compared to Roux-Y Gastric Bypass After Failed Gastric Banding
Authors: Janik Michał R. , Rogula Tomasz G. , Mustafa Rami R. , Alhaj Saleh Adel , Khaitan Leena 
Published: November 2017

Objective:
The aim of this study was to assess the safety of revisional surgery to laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-Y gastric bypass (LRYGB) after failed laparoscopic adjustable gastric banding (LAGB).

Background:
The number of reoperations after failed gastric banding rapidly increased in the United States during the last several years. A common approach is band removal with conversion to another weight loss procedure such as gastric bypass or sleeve gastrectomy in a single procedure. The safety profile of those procedures remains controversial.

Methods:
Preoperative characteristics and 30-day outcomes from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Files 2015 were selected for all patients who underwent a 1-stage conversion of LAGB to LSG (conv-LSG) or LRYGB (conv-LRYGB). Conv-LSG cases were matched (1:1) with conv-LRYGB patients by age (±1 year), body mass index (±1 kg/m2), sex, and comorbidities including diabetes, hypertension, hyperlipidemia, venous stasis, and sleep apnea.

Results:
A total of 2708 patients (1354 matched pairs) were included in the study. The groups were closely matched as intended. The mean operative time in conv-LRYGB was significantly longer in comparison to conv-LSG patients (151 ± 58 vs 113 ± 45 minutes, P < 0.001). No mortality was observed in either group. Patients after conv-LRYGB had a clinically increased anastomotic leakage rate (2.07% vs 1.18%, P = 0.070) and significantly increased bleed rate (2.66% vs 0.44%, P < 0.001). Thirty-day readmission rate was significantly higher in conv-LRYGB patients (7.46% vs 3.69%, P < 0.001), as was 30-day reoperation rate (3.25% vs 1.26%, P < 0.001). The length of hospital stay was longer in conv-LRYGB.

Conclusions:
A single-stage conversion of failed LAGB leads to greater morbidity and higher complication rates when converted to LRYGB versus LSG in the first 30 days postoperatively. These differences are particularly notable with regards to bleed events, 30-day reoperation, 30-day readmission, operative time, and hospital stay.
Elevated
p
CO
2
affects tissue biomass composition, but not calcification, in a reef coral under two light regimes
Authors: Wall C. B. , Mason R. A. B. , Ellis W. R. , Cunning R. , Gates R. D. 
Published: November 2017

Ocean acidification (OA) is predicted to reduce reef coral calcification rates and threaten the long-term growth of coral reefs under climate change. Reduced coral growth at elevated
p
CO
2
may be buffered by sufficiently high irradiances; however, the interactive effects of OA and irradiance on other fundamental aspects of coral physiology, such as the composition and energetics of coral biomass, remain largely unexplored. This study tested the effects of two light treatments (7.5 versus 15.7 mol photons m
−2
d
−1
) at ambient or elevated
p
CO
2
(435 versus 957 µatm) on calcification, photopigment and symbiont densities, biomass reserves (lipids, carbohydrates, proteins), and biomass energy content (kJ) of the reef coral
Pocillopora acuta
from Kāne‘ohe Bay, Hawai‘i. While
p
CO
2
and light had no effect on either area- or biomass-normalized calcification, tissue lipids gdw
−1
and kJ gdw
−1
were reduced 15% and 14% at high
p
CO
2
, and carbohydrate content increased 15% under high light. The combination of high light and high
p
CO
2
reduced protein biomass (per unit area) by approximately 20%. Thus, under ecologically relevant irradiances,
P. acuta
in Kāne‘ohe Bay does not exhibit OA-driven reductions in calcification reported for other corals; however, reductions in tissue lipids, energy content and protein biomass suggest OA induced an energetic deficit and compensatory catabolism of tissue biomass. The null effects of OA on calcification at two irradiances support a growing body of work concluding some reef corals may be able to employ compensatory physiological mechanisms that maintain present-day levels of calcification under OA. However, negative effects of OA on
P. acuta
biomass composition and energy content may impact the long-term performance and scope for growth of this species in a high
p
CO
2
world.