bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Fever As a Predictor of Paroxysmal Sympathetic Hyperactivity in Traumatic Brain Injury
Authors: Hinson Holly E. , Schreiber Martin A. , Laurie Amber L. , Baguley Ian J. , Bourdette Dennis , Ling Geoffrey S. F. 
Published: January 2017

Objective:
Paroxysmal sympathetic hyperactivity (PSH) is characterized by episodic, hyperadrenergic alterations in vital signs after traumatic brain injury (TBI). We sought to apply an objective scale to the vital sign alterations of PSH in order to determine whether 1 element might be predictive of developing PSH.

Setting/Participants/Design:
We conducted an observational study of consecutive TBI patients (Glasgow Coma Scale score ≤12) and monitored the cohort for clinical evidence of PSH. PSH was defined as a paroxysm of 3 or more of the following characteristics: (1) tachycardia, (2) tachypnea, (3) hypertension, (4) fever, (5) dystonia (rigidity or decerebrate posturing), and (6) diaphoresis, with no other obvious causation (ie, alcohol withdrawal, sepsis).

Main Measures:
The Modified Clinical Feature Severity Scale (mCFSS) was applied to each participant once daily for the first 5 days of hospitalization.

Results:
Nineteen (11%) of the 167 patients met criteria for PSH. Patients with PSH had a higher 5-day cumulative mCFSS score than those without PSH (median [interquartile range] = 36 [29-42] vs 29 [22-35], P = .01). Of the 4 components of the mCFSS, elevated temperature appeared to be most predictive of the development of PSH, especially during the first 24 hours (odds ratio = 1.95; 95% confidence interval, 1.12-3.40).

Conclusion:
Early fever after TBI may signal impending autonomic dysfunction.
Epidemiology of Comorbid Conditions Among Adults 50 Years and Older With Traumatic Brain Injury
Authors: Kumar Raj G. , Juengst Shannon B. , Wang Zhensheng , Dams-O'Connor Kristen , Dikmen Sureyya S. , O'Neil-Pirozzi Therese M. , Dahdah Marie N. , Hammond Flora M. , Felix Elizabeth R. , Arenth Patricia M. , Wagner Amy K. 
Published: January 2017

Objectives:
Aging individuals with traumatic brain injury (TBI) experience multiple comorbidities that can affect recovery from injury. The objective of this study was to describe the most commonly co-occurring comorbid conditions among adults 50 years and older with TBI.

Setting:
Level I Trauma centers.

Participants:
Adults 50 years and older with moderate/severe TBI enrolled in the TBI-Model Systems (TBI-MS) from 2007 to 2014 (n = 2134).

Design:
A TBI-MS prospective cohort study.

Main Measures:

International Classification of Disease–9th Revision codes collapsed into 45 comorbidity categories. Comorbidity prevalence estimates and trend analyses were conducted by age strata (50-54, 55-64, 65-74, 75-84, ≥85 years). A dimension reduction method, Treelet Transform, classified clusters of comorbidities that tended to co-occur.

Results:
The 3 most commonly occurring comorbid categories were hypertensive disease (52.6/100 persons), other diseases of the respiratory system (51.8/100 persons), and fluid component imbalances (43.7/100 persons). Treelet Transform classified 3 clusters of comorbid codes, broadly classified as (1) acute medical diseases/infections, (2) chronic conditions, and (3) substance abuse disorders.

Conclusion:
This study provides valuable insight into comorbid conditions that co-occur among adults 50 years and older with TBI and provides a foundation for future studies to explore how specific comorbidities affect TBI recovery.
The Relationship Between Traumatic Brain Injury and Criminality in Juvenile Offenders
Authors: Gordon Wayne A. , Spielman Lisa A. , Hahn-Ketter Amanda E. , Sy Karla Therese L. 
Published: January 2017

Objective:
To examine the relationship between traumatic brain injury (TBI) and criminal behavior in youth who are incarcerated or on probation in Texas.

Setting:
Seven juvenile justice facilities.

Participants:
Juvenile offenders in state or county correctional facilities or on probation.

Design:
Screening for TBI was conducted among adolescents at 7 juvenile justice centers.

Main Measures:
Participants were administered the Brain Injury Screening Questionnaire, and results were linked to participants' offense history and psychiatric diagnoses.

Results:
One in 4 juvenile offenders met criteria for TBI, and the majority of injuries occurred prior to the adolescents' criminal offenses. A history of TBI was related to more violent crimes, as well as more mental health diagnoses and symptoms.

Conclusion:
The high rates of TBI and levels of distress found in juvenile offenders suggest a need for preventive actions, interventions to compensate for challenges related to TBI, and programs to assist individuals' transitions into the community.
Reductions in Alexithymia and Emotion Dysregulation After Training Emotional Self-Awareness Following Traumatic Brain Injury: A Phase I Trial
Authors: Neumann Dawn , Malec James F. , Hammond Flora M. 
Published: January 2017

Objectives:
To examine the acceptability and initial efficacy of an emotional self-awareness treatment at reducing alexithymia and emotion dysregulation in participants with traumatic brain injury (TBI).

Setting:
An outpatient rehabilitation hospital.

Participants:
Seventeen adults with moderate to severe TBI and alexithymia. Time postinjury ranged 1 to 33 years.

Design:
Within subject design, with 3 assessment times: baseline, posttest, and 2-month follow-up.

Intervention:
Eight lessons incorporated psychoeducational information and skill-building exercises teaching emotional vocabulary, labeling, and differentiating self-emotions; interoceptive awareness; and distinguishing emotions from thoughts, actions, and sensations.

Measures:
Toronto Alexithymia Scale-20 (TAS-20); Levels of Emotional Awareness Scale (LEAS); Trait Anxiety Inventory (TAI); Patient Health Questionnaire-9 (PHQ-9); State-Trait Anger Expression Inventory (STAXI); Difficulty With Emotion Regulation Scale (DERS); and Positive and Negative Affect Scale (PANAS).

Results:
Thirteen participants completed the treatment. Repeated-measures analysis of variance revealed changes on the TAS-20 (P = .003), LEAS (P < .001), TAI (P = .014), STAXI (P = .015), DERS (P = .020), and positive affect (P < .005). Paired t tests indicated significant baseline to posttest improvements on these measures. Gains were maintained at follow-up for the TAS, LEAS, and positive affect. Treatment satisfaction was high.

Conclusion:
This is the first study published on treating alexithymia post-TBI. Positive changes were identified for emotional self-awareness and emotion regulation; some changes were maintained several months posttreatment. Findings justify advancing to the next investigational phase for this novel intervention.
Branched Chain Amino Acids (BCAAs) and Traumatic Brain Injury: A Systematic Review
Authors: Sharma Bhanu , Lawrence David W. , Hutchison Michael G. 
Published: January 2017

Background:
Despite the prevalence of traumatic brain injury (TBI), pharmaceutical treatment options for brain injury remain limited. However, nutritional intervention (such as with branched chain amino acids [BCAAs]) has emerged as a promising treatment option for TBI.

Objectives:
(1) To determine whether TBI patients have lower levels of endogenous BCAAs postinjury; and (2) to evaluate whether post-TBI BCAA supplementation improves clinical outcome.

Design:
A systematic review of primary research articles examining the relationship between BCAAs and TBI recovery indexed in Ovid/MEDLINE, EMBASE, and PsycINFO.

Results:
Of the 11 studies identified, 3 examined the effects of TBI on endogenous BCAA levels and consistently reported that BCAA concentrations were depressed postinjury. The remaining 8 studies examined the effects of BCAA supplementation on TBI outcome in animals (n = 3) and humans (n = 5). The animal studies (in mild-to-moderate TBI) showed that BCAAs improved post-TBI outcome. Similar results were found in human trials (conducted primarily in patients with severe TBI), with 4 of the 5 studies reporting improved outcome with BCAA supplementation.

Conclusion:
Although our review demonstrates an overall positive association between BCAAs and TBI outcome, the evidence of the efficacy of supplementation has been limited to severe TBI. To date, there is insufficient evidence to determine the benefits of BCAAs in mild TBI. Given the high frequency of mild TBI and the promise of BCAAs as an intervention in severe TBI, future research should examine the effects of BCAAs in milder brain injury.
DEXAMETHASONE INTRAVITREAL IMPLANT FOR X-LINKED (JUVENILE) RETINOSCHISIS
Authors: Mukhtar Sabrina , Potter Stephen M. , Khurshid Syed G. 
Published: January 2017

Purpose:
Dexamethasone intravitreal corticosteroid implants (OZURDEX) have been used to treat subretinal fluid associated with several retinal diseases. We describe the use of a dexamethasone intravitreal implant for symptomatic management in a case of X-linked (juvenile) retinoschisis (XLRS).

Methods:
A 19-year-old man diagnosed with XLRS was treated with a dexamethasone intravitreal implant for his newly symptomatic subretinal fluid.

Conclusion:
Dexamethasone intravitreal implant treatment in the setting of XLRS has not been previously described. To the authors' knowledge, this is the first description of the use of corticosteroid implants to treat symptomatic subretinal fluid in XLRS. Further studies are warranted to investigate the role of corticosteroid implant treatment in XLRS.
LINCOFF RULES ARE NOT FOLLOWED IN RETINAL DETACHMENT WITH POSTERIOR BREAKS AND ATTACHED CORTICAL VITREOUS
Authors: Azad Shorya V. , Takkar Brijesh , Bhatia Indrish , Azad Rajvardhan 
Published: January 2017

Purpose:
1) To evaluate factors governing flow of subretinal fluid and validate Lincoff rules (LRs) in cases of rhegmatogenous retinal detachment. 2) To identify cases of rhegmatogenous retinal detachment where LRs are not followed.

Method:
This was a retrospective study where 253 patients of rhegmatogenous retinal detachment were identified through surgery records. Two hundred and twenty-nine case sheets with complete record of ocular examination and surgical findings were analyzed. Seventy-five of the 229 patients, having subtotal rhegmatogenous retinal detachment where LR could be applied were included for analysis. Validity of LR was analyzed about location of break, lattice degeneration, posterior vitreous detachment (PVD), proliferative vitreoretinopathy, lens status, myopia, and trauma.

Result:
The mean age of the patients was 40.12 years. Sixty-one were men. Lincoff rule was validated in 59 of the 75 patients. Anterior breaks (P < 0.008) and PVD (P < 0.001) were found to have a significant association with validity of LR. Other attributes did not have a statistically significant association with validity of LR.

Conclusion:
Presence of posterior retinal breaks and absent PVD is associated with unusual flow of subretinal fluid. Lincoff rules are valid in most of the clinical scenarios.
Combined Effect of Ocular and Multifocal Contact Lens Induced Aberrations on Visual Performance: Center-Distance Versus Center-Near Design
Authors: Lopes-Ferreira Daniela , Fernandes Paulo , Queirós António , González-Meijome José M. 
Published: January 2017

Purpose:
To evaluate the combined effects of inherent ocular aberrations and induced aberrations with a multifocal soft contact lens (MFCL) after 15 days of lens wear in presbyopic participants and their influence on visual performance at distance and near under high and low contrast conditions.

Methods:
Forty presbyopic participants (mean age, 48.7±3.4) presenting a mean addition of 1.53±0.58 D were fitted with Biofinity Multifocal (CooperVision) and included in the study. Measurements comprised distance and near monocular high (100%) and low contrast (10%) logMAR visual acuity (VA). Ocular aberrations were obtained with Hartmann–Shack aberrometer (IRX3, Imagine Eyes) and analyzed for 2 mm and maximum round natural pupil.

Results:
Distance VA was significantly higher in dominant eye, whereas near VA was significantly better in the non-dominant eye (P<0.05 in all conditions). For a 2-mm pupil in the dominant eye fitted with MFCL, spherical-like aberration significantly increased (P=0.027) so as higher-order aberrations (HOA) (P=0.002). A significant increase was also observed in spherical-like aberrations (P=0.001), coma-like aberrations (P=0.006) and HOA (P=0.004) in non-dominant eye. For the maximum round natural pupil size, a significant decrease in vertical coma was observed (P=0.018) in dominant eye, whereas a significant increase in spherical-like (P<0.001) and coma-like aberrations (P=0.007) was observed in non-dominant eye. A negative significant correlation was found between vertical coma and high contrast VA (Rho=−0.405, P=0.011) in dominant eye; whereas in non-dominant eye, a significant correlation was found between induced secondary astigmatism and distance VA under high (Rho=0.556, P<0.001) and low contrast (Rho=0.448, P=0.005).

Conclusions:
On-eye visual performance of MFSCL is dependent on the high-order aberrations induced by dominant and non-dominant design coupled with the wearer's inherent aberrations.
Exponential Decay Metrics of Topical Tetracaine Hydrochloride Administration Describe Corneal Anesthesia Properties Mechanistically
Authors: Ethington Jason , Goldmeier David , Gaynes Bruce I. 
Published: January 2017

Purpose:
To identify pharmacodynamic (PD) and pharmacokinetic (PK) metrics that aid in mechanistic understanding of dosage considerations for prolonged corneal anesthesia.

Methods:
A rabbit model using 0.5% tetracaine hydrochloride was used to induce corneal anesthesia in conjunction with Cochet–Bonnet anesthesiometry. Metrics were derived describing PD-PK parameters of the time-dependent domain of recovery in corneal sensitivity. Curve fitting used a 1-phase exponential dissociation paradigm assuming a 1-compartment PK model. Derivation of metrics including half-life and mean ligand residence time, tau (τ), was predicted by nonlinear regression. Bioavailability was determined by area under the curve of the dose–response relationship with varying drop volumes.

Results:
Maximal corneal anesthesia maintained a plateau with a recovery inflection at the approximate time of predicted corneal drug half-life. PDs of recovery of corneal anesthesia were consistent with a first-order drug elimination rate. The mean ligand residence time (tau, τ) was 41.7 minutes, and half-life was 28.89 minutes. The mean estimated corneal elimination rate constant (ke) was 0.02402 minute−1. Duration of corneal anesthesia ranged from 55 to 58 minutes. There was no difference in time domain PD area under the curve between drop volumes.

Conclusions:
Use of a small drop volume of a topical anesthetic (as low as 11 μL) is bioequivalent to conventional drop size and seems to optimize dosing regiments with a little effect on ke. Prolongation of corneal anesthesia may therefore be best achieved with administration of small drop volumes at time intervals corresponding to the half-life of drug decay from the corneal compartment.
A novel inhibitor of active protein kinase G attenuates chronic inflammatory and osteoarthritic pain
Authors: Sung Ying-Ju , Sofoluke Nelson , Nkamany Mary , Deng Shixian , Xie Yuli , Greenwood Jeremy , Farid Ramy , Landry Donald W. , Ambron Richard T. 
Published: January 2017

Abstract
Activating PKG-1α induces a long-term hyperexcitability (LTH) in nociceptive neurons. Since the LTH correlates directly with chronic pain in many animal models, we tested the hypothesis that inhibiting PKG-1α would attenuate LTH-mediated pain. We first synthesized and characterized compound N46 (N-((3R,4R)-4-(4-(2-fluoro-3-methoxy-6-propoxybenzoyl)benzamido)pyrrolidin-3-yl)-1H-indazole-5-carboxamide). N46 inhibits PKG-1α with an IC50 of 7.5 nmol, was highly selective when tested against a panel of 274 kinases, and tissue distribution studies indicate that it does not enter the CNS. To evaluate its antinociceptive potential, we used 2 animal models in which the pain involves both activated PKG-1α and LTH. Injecting complete Freund's adjuvant (CFA) into the rat hind paw causes a thermal hyperalgesia that was significantly attenuated 24 hours after a single intravenous injection of N46. Next, we used a rat model of osteoarthritic knee joint pain and found that a single intra-articular injection of N46 alleviated the pain 14 days after the pain was established and the relief lasted for 7 days. Thermal hyperalgesia and osteoarthritic pain are also associated with the activation of the capsaicin-activated transient receptor protein vanilloid-1 (TRPV1) channel. We show that capsaicin activates PKG-1α in nerves and that a subcutaneous delivery of N46 attenuated the mechanical and thermal hypersensitivity elicited by exposure to capsaicin. Thus, PKG-1α appears to be downstream of the transient receptor protein vanilloid-1. Our studies provide proof of concept in animal models that a PKG-1α antagonist has a powerful antinociceptive effect on persistent, already existing inflammatory pain. They further suggest that N46 is a valid chemotype for the further development of such antagonists.
Can We Identify Minority Patients at Risk of Nonadherence to Antiplatelet Medication at the Time of Coronary Stent Placement?
Authors: Palacio Ana M. , Vidot Denise C. , Tamariz Leonardo J. , Uribe Claudia , Hazel-Fernandez Leslie , Li Hua , Garay Sylvia D. , Carrasquillo Olveen 
Published: January 2017

Background:
Lack of medication adherence is associated with significant morbidity and mortality, particularly among minorities. We aim to identify predictors of nonadherence to antiplatelet medications at the time of percutaneous coronary intervention (PCI) with stent among African American and Hispanic patients.

Methods:
We used data collected for a randomized clinical trial that recruited 452 minority patients from a large US health insurance organization in 2010 post-PCI to compare telephone-based motivational interviewing by trained nurses with an educational video. The primary outcome was 12-month adherence to antiplatelet medications measured by the claims-based medication possession ratio (MPR). Adequate adherence was defined as an MPR of 0.80 or higher.

Results:
More than half of the sample (age, 69.52 ± 8.8 years) was male (57%) and Hispanic (57%). Most (78%) had a median income below $30 000 and 22% completed high school or higher. Univariate analyses revealed that symptoms of depression (<.01) and not having a spouse (P = .03) were associated with inadequate adherence. In multivariate analysis, baseline self-reported adherence (1.4; 95% confidence interval [CI], 1.05–1.89), depressive symptoms (0.49; 95% CI, 0.7–0.90), comorbidity (0.89; 95% CI, 0.80–0.98), and telephone-based motivational interviewing by trained nurses (3.5; 95% CI, 1.9–2.70) were associated with adherence.

Conclusions:
Having multiple comorbidities, depression, suboptimal adherence to medications, and low English proficiency at the time of PCI increase the risk of poor 12-month adherence to antiplatelets among minorities. Identifying these risk factors can guide PCI therapy and the use of evidence-based strategies to improve long-term adherence.
Pilot Study Evaluating the Impact of Otology Surgery Videos on Otolaryngology Resident Education
Authors: Poon Charles , Stevens Shawn M. , Golub Justin S. , Pensak Myles L. , Samy Ravi N. 
Published: January 2017

Objectives:Use of videos as educational tools is not a novel concept; however, there is a paucity of high-quality video resources available to otolaryngology trainees. We hypothesized that residents would deem surgical-videos using a multimedia-style format more valuable as preparatory tools. Aims of this study: 1) develop portfolio of otology/neurotology videos overviewing key steps, anatomy, and pearls by a senior surgeon; 2) have residents rate the effectiveness of the videos as a preoperative tool.Study Design:Prospective study.Methods:A video-library of procedures at (https://www.youtube.com/user/cisurgeon) was formatted via time-stamping to coincide expert level narration with closed captioning, critical procedural steps, relevant instrumentation, radiographic pictures, orientation cues, and anatomical highlights. Otolaryngology trainees of postgraduate years 2 through 5 (n = 13) watched a minimum of three videos and completed an assessment addressing: current resource identification/usefulness comparison, self-efficacy, impact on preparation time, and prioritization of resources.Results:The videos rated as highly useful compared with current resources (p = 0.002) and capable of promoting self-efficacy. Residents reported moderate-high prioritization of our multi-media formatted resource (scores >6) among their current preoperative regimen.Conclusion:The varied videos were rated highly in terms of usefulness, promoting self-efficacy and as a high-priority for a resident's surgical preparation. Multimedia-formatted training videos should be further explored for this generation of electronic-learners. Future studies with a larger cohort, objective approaches, and multidisciplinary involvement are needed to determine the full impact of this education medium on surgical-training.
Early Postoperative Imaging of the Labyrinth by Cone Beam CT After Stapes Surgery for Otosclerosis With Correlation to Audiovestibular Outcome
Authors: Vandevoorde Aurélie , Williams Marc T. , Ukkola-Pons Elsa , Daval Mary , Ayache Denis 
Published: January 2017

Background:
Sensorineural complications of stapes surgery are rare but potentially serious. Imaging is usually performed to identify an underlying cause, such as excessive intravestibular penetration of the prosthesis or pneumolabyrinth suggesting perilymphatic fistula. Unfortunately, there is very little data in an unselected series of uneventful patients.
The aim of this study was to analyze the depth of prosthesis penetration within the vestibule and the rate of pneumolabyrinth the day or the day after the procedure by performing a cone beam computed tomography of the temporal bone in a cohort of unselected patients, and to correlate imaging findings to clinical outcome.

Methods:
A prospective monocentric study was conducted in a tertiary referral medical center. A cone beam computed tomography was performed in 80 consecutive patients having undergone stapes surgery for otosclerosis, the day or the day after the procedure. Penetration length and location of the prosthesis within the vestibule, as well as presence or absence of a pneumolabyrinth, were recorded, and compared with clinical data (vertigo, nystagmus, hearing measurement).

Results:
Pneumolabyrinth was found in 15% of the patients. The mean penetration length of the prosthesis within the vestibule was 1 mm (0–1.9 mm). No serious complication occurred during the study period. No correlations were found when comparing imaging findings to clinical outcome.

Conclusion:
Our results do not support empirically insights into detrimental effects of postoperative pneumolabyrinth or too long prosthesis after stapes surgery. Further studies are needed to better understand the causes of postoperative complications of stapes surgery.