bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-Effectiveness Analysis of Combined Dual Motor Nerve Transfers versus Alternative Surgical and Nonsurgical Management Strategies to Restore Shoulder Function Following Upper Brachial Plexus Injury
Authors: Khalifeh Jawad M , Dibble Christopher F , Dy Christopher J , Ray Wilson Z 
Published: January 2018

Abstract

BACKGROUND
Restoration of shoulder function is an important treatment goal in upper brachial plexus injury (UBPI). Combined dual motor nerve transfer (CDNT) of spinal accessory to suprascapular and radial to axillary nerves demonstrates good functional recovery with minimal risk of perioperative complications.

OBJECTIVE
To evaluate the cost-effectiveness of CDNT vs alternative operative and nonoperative treatments for UBPI.

METHODS
A decision model was constructed to evaluate costs ($, third-party payer) and effectiveness (quality-adjusted life years [QALYs]) of CDNT compared to glenohumeral arthrodesis (GA), conservative management, and nontreatment strategies. Estimates for branch probabilities, costs, and QALYs were derived from published studies. Incremental cost-effectiveness ratios (ICER, $/QALY) were calculated to compare the competing strategies. One-way, 2-way, and probabilistic sensitivity analyses with 100 000 iterations were performed to account for effects of uncertainty in model inputs.

RESULTS
Base case model demonstrated CDNT effectiveness, yielding an expected 21.04 lifetime QALYs, compared to 20.89 QALYs with GA, 19.68 QALYs with conservative management, and 19.15 QALYs with no treatment. The ICERs for CDNT, GA, and conservative management vs nontreatment were $5776.73/QALY, $10 483.52/QALY, and $882.47/QALY, respectively. Adjusting for potential income associated with increased likelihood of returning to work after clinical recovery demonstrated CDNT as the dominant strategy, with ICER = –$56 459.54/QALY relative to nontreatment. Probabilistic sensitivity analysis showed CDNT cost-effectiveness at a willingness-to-pay threshold of $50 000/QALY in 78.47% and 81.97% of trials with and without income adjustment, respectively. Conservative management dominated in <1% of iterations.

CONCLUSION
CDNT and GA are cost-effective interventions to restore shoulder function in patients with UBPI.
National Parliaments in Subsidiarity Review: From Guardians to Partners
Authors: Pimenova Oxana 
Published: January 2018

Abstract
With a clear emphasis on substantive political value that national legislatures are able to bring to the EU legislative process, this paper attempts to overcome skepticism about deepening national parliaments’ direct involvement in the decision-making process at the European level. The role of national parliaments in advancing their subsidiarity concerns within European law-making may be strengthened through a more intensive political dialogue with the Commission, when the former acts not just as the ‘guardians’ of the subsidiarity principle (in the framework of the existing yellow and orange card schemes) but also as active contributors to the law-making process encouraging the Commission to leverage the so-called green card procedure. Complemented by the yellow and orange card provisions, it forms a three-element subsidiarity review mechanism perfectly capable of dealing with subsidiarity concerns of national parliaments at various stages of the EU law-making process, thus transforming the chambers from wardens into partners working together with the Commission to reshape EU legislative proposals for the sake of better regulation.
Association Between Alcohol Use and Angina Symptoms Among Outpatients From the Veterans Health Administration
Authors: Williams Emily C. , Bryson Chris L. , Sun Haili , Au David H. , Bradley Katharine A. 
Published: January 2018

Background:
Alcohol use is associated with angina incidence, but associations between alcohol use and experience of angina among patients with coronary artery disease (CAD) have not been described.

Methods:
Outpatients with CAD from 7 clinics in the Veterans Health Administration were surveyed; alcohol use was measured using the validated Alcohol Use Disorders Identification Test-Consumption scores categorized into 6 groups: nondrinking, low-risk drinking, and mild, moderate, severe, and very severe unhealthy alcohol use. Three domains of self-reported angina symptoms (frequency, stability, and physical function) were measured with the Seattle Angina Questionnaire. Linear regression models evaluated associations between alcohol use groups and angina symptoms. Models were adjusted first for age and then additionally for smoking, comorbidities, and depression.

Results:
Patients (n = 8303) had a mean age of 66 years. In age-adjusted analyses, a U-shaped association was observed between alcohol use groups and all angina outcomes, with patients in nondrinking and severe unhealthy alcohol groups reporting the greatest angina symptoms and lowest functioning. After full adjustment, no clinically important and few statistically important differences were observed across alcohol use in angina stability or frequency. Patients in the nondrinking group had statistically greater functional limitation from angina than those in all groups of unhealthy alcohol use, though differences were small. Patients in all groups of unhealthy alcohol use did not differ significantly from those with low-risk drinking.

Conclusions:
Alcohol use was associated with some small statistically but no clinically important differences in angina symptoms among patients with CAD. This cross-sectional study does not support a protective effect of low-level drinking on self-reported angina.
Overexpression of µ-Opioid Receptors in Peripheral Afferents, but Not in Combination with Enkephalin, Decreases Neuropathic Pain Behavior and Enhances Opioid Analgesia in Mouse
Authors: Klein Amanda H. , Mohammad Husam K. , Ali Rabiah , Peper Brad , Wilson Steven P. , Raja Srinivasa N. , Ringkamp Matthias , Sweitzer Sarah 
Published: January 2018

Abstract

Background
The current study used recombinant herpes simplex virus type I to increase expression of µ-opiate receptors and the opioid ligand preproenkephalin in peripheral nerve fibers in a mouse model of neuropathic pain. It was predicted that viral vector delivery of a combination of genes encoding the µ-opioid receptor and preproenkephalin would attenuate neuropathic pain and enhance opioid analgesia. The behavioral effects would be paralleled by changes in response properties of primary afferent neurons.

Methods
Recombinant herpes simplex virus type 1 containing cDNA sequences of the µ-opioid receptor, human preproenkephalin, a combination, or Escherichia coli lacZ gene marker (as a control) was used to investigate the role of peripheral opioids in neuropathic pain behaviors.

Results
Inoculation with the µ-opioid receptor viral vector (n = 13) reversed mechanical allodynia and thermal hyperalgesia and produced leftward shifts in loperamide (ED50 = 0.6 ± 0.2 mg/kg vs. ED50 = 0.9 ± 0.2 mg/kg for control group, n = 8, means ± SD) and morphine dose-response curves (ED50 = 0.3 ± 0.5 mg/kg vs. ED50 = 1.1 ± 0.1 mg/kg for control group). In µ-opioid receptor viral vector inoculated C-fibers, heat-evoked responses (n = 12) and ongoing spontaneous activity (n = 18) were decreased after morphine application. Inoculation with both µ-opioid receptor and preproenkephalin viral vectors did not alter mechanical and thermal responses.

Conclusions
Increasing primary afferent expression of opioid receptors can decrease neuropathic pain-associated behaviors and increase systemic opioid analgesia through inhibition of peripheral afferent fiber activity.
Incisional Negative Pressure Wound Therapy for Prevention of Wound Healing Complications Following Reduction Mammaplasty
Authors: Galiano Robert D. , Hudson Donald , Shin Joseph , van der Hulst René , Tanaydin Volkan , Djohan Risal , Duteille Franck , Cockwill John , Megginson Sarah , Huddleston Elizabeth 
Published: January 2018

Background:
It has been proposed that negative pressure wound therapy (NPWT) applied prophylactically to a closed incision may decrease the incidence of wound complications. Patients undergoing reduction mammaplasty are at risk of wound complications such as delayed healing, infection, and dehiscence, and the bilateral nature of the surgery allows for a within-patient randomized study to evaluate incisional NPWT’s effect in reducing healing complications.

Methods:
In this multicenter trial, 200 patients undergoing bilateral reduction mammaplasty were treated with PICO Single-Use NPWT System or standard wound-care dressings randomized to right or left breast for up to 14 days to enable within-patient comparison. Follow-up assessments were conducted to evaluate the difference in incision healing complications up to 21 days postsurgery. Healing complications (for the primary endpoint) were defined as delayed healing (incision not 100% closed by 7 days) and occurrence of dehiscence or infection within 21 days. Individual healing complications were assessed separately as secondary endpoints.

Results:
Significantly fewer healing complications (primary endpoint) were noted in NPWT-treated breasts [113 (56.8%)] versus standard care [123 (61.8%)]. The difference of 10 (5.0%) patients with fewer healing complications using NPWT was statistically significant (P = 0.004). NPWT also resulted in a significantly lower incidence of dehiscence (secondary endpoint) compared with standard care [32 patients (16.2%) versus 52 patients (26.4%)] by day 21, a relative reduction of 38% (P < 0.001).

Conclusions:
This is the first major prospective, within-patient, randomized, controlled, multicenter study to provide evidence for an incisional NPWT strategy to reduce healing complications.
V-shaped Internal Nasal Vestibular Flap for Reconstruction of Iatrogenic Columellar Defect
Authors: Tanini Sara , Lo Russo Giulia 
Published: January 2018

Summary:
Columella is an important structure in the center of the face, and its structural integrity has an important functional, social, and psychological role. Columella reconstruction can be very challenging for surgeons and the ideal technique remains elusive. This article describes a reconstruction technique in a young woman with columella necrosis due to nasal continuous positive airway pressure treatment. The method of reconstruction described here, with a V-shaped internal nasal vestibular flap and a cartilage grafts from lateral crura, is simple and easily reproducible, providing an optimal aesthetic result and in addition the donor site does not create a secondary deformity by disrupting normal anatomy.
Gelatin-Based Hemostatic Agents: Histopathologic Differences
Authors: Wolkow Natalie , Jakobiec Frederick A. , Yoon Michael K. 
Published: January 2018

Purpose:
To delineate the histopathologic appearance of gelatin-based hemostatic agents, Surgiflo, Gelfoam, and Floseal, which are used by ophthalmic plastic surgeons, and which may incidentally be found as foreign materials in histopathologic tissue samples.

Methods:
Histopathologic analysis was performed with hematoxylin-eosin, periodic acid-Schiff, Masson trichrome, and elastin staining on tissue samples in which gelatin-based agents were found. To better characterize these materials, similar analyses were performed on in vitro samples of commonly used gelatin-based hemostatic agents.

Results:
Surgiflo and Gelfoam are composed of small stellate pieces of gelatin with a smooth, homogeneous quality. In tissues, they are faintly positive with periodic acid-Schiff staining, amphophilic with Masson trichrome staining, and ink-black with elastin staining. Floseal has a distinctly different morphology of large rectangular sheets, yet almost identical in vitro staining properties.

Discussion:
While the morphology of the gelatin-based hemostatic agents is consistent under various conditions, the staining properties of these materials differ based on whether they have been in contact with human tissue.

Conclusions:
Gelatin-derived hemostatic agents are best identified based on their morphologic characteristics. Elastin staining highlights these materials prominently within tissue samples and may be helpful in distinguishing them from other foreign materials.
A Novel Technique for Measuring Eyelid Force
Authors: Ofir Shay , Belkin Avner , Nemet Arie Y. 
Published: January 2018

Purpose:
We present a novel technique to directly measure the eyelid upward force generation. This technique can be used during routine clinical examination using an inexpensive, portable force gauge.

Methods:
This prospective case series was conducted January to June 2015 in an ophthalmology clinic affiliated with a tertiary care medical center. A convenience sample of 42 patients (40–90 years of age) without known eyelid pathology participated. The eyelid upward net force generated was measured directly using a handheld dynamometer noninvasively attached to the upper eyelid. Comparison of the eyelid-brow upward force generated with eyelid upward net force generated allowed us to assess the contribution of levator and frontalis muscles to the force generated during upgaze. Data were evaluated with relation to gender and age.

Results:
Upper eyelid force generated was 53.3 g OD and 53.9 g OS; the generated force during frontalis muscle fixation was 38.4 g OD and 41.1 g OS. The levator and frontalis muscles showed a 3:1 ratio respectively in their contribution to the force generated during upgaze. Although no statistically significant differences were seen between eyes, gender, or within age groups, younger patients showed increased generating force which is attributed to the levator muscle. Interclass correlation coefficient showed virtually no correlation between clinical eyelid assessments and direct muscle force measurement. Reliability for repeated direct force measurements by the same physician was strong, with interclass correlation coefficient 0.951 to 0.969. No adverse events occurred.

Conclusions:
We describe a simple, reliable, inexpensive, new method for assessing upper eyelid upward force generation. Because the levator muscle serves as the primary contributor to eyelid elevation, this directly measurable eyelid assessment may help to increase understanding of its functional contribution and assessment when assessing eyelid pathologies.
New Educational Model to Promote Breast Cancer–Preventive Behaviors (ASSISTS)
Authors: Khazaee-Pool Maryam , Pashaei Tahereh , Alizadeh Rashin , Ponnet Koen 
Published: January 2018

Background
The prevalence of breast cancer in Iran has increased. An effective approach to decrease the burden of breast cancer is prevention.

Objective
The aim of this study was to develop and evaluate an educational model, called the ASSISTS, for promoting breast cancer–preventive behaviors in women.

Methods
A multiphase method was used to develop the model designed to promote breast cancer prevention behaviors. A conceptual model was generated based on a secondary analysis of qualitative data. Then, a structural equation model technique was used to test the relationships among the model constructs.

Results
The analysis revealed that 7 constructs could be extracted, namely, perceived social support, attitude, motivation, self-efficacy, information seeking, stress management, and self-care. Based on these constructs, a conceptual model was built and tested using structural equation modeling. The model fit was good, and the model confirmed significant relationships among the 7 constructs of breast cancer prevention.

Conclusion
Findings revealed that self-care behavior and stress management are influenced directly by attitude, motivation, self-efficacy, information seeking, and social support. In addition, women seek more information when they are motivated, have more self-efficacy, have a more positive attitude toward breast cancer prevention, and experience more social support.

Implication for Practice
Cancer nurses can be at the forefront of breast cancer prevention. Because they can play a pivotal role in providing information, they can reduce women's stress and increase their self-care behavior. In addition, their social support can positively influence Iranian women's attitude, motivation, and self-care behavior. Furthermore, implementing educational programs based on this model might encourage women to practice preventive behaviors.
Improved Long-Term Volume Retention of Stromal Vascular Fraction Gel Grafting with Enhanced Angiogenesis and Adipogenesis
Authors: Zhang Yuteng , Cai Junrong , Zhou Tao , Yao Yao , Dong Ziqing , Lu Feng 
Published: January 2018

Background:
The apoptosis of mature adipocytes after fat grafting can result in chronic inflammation, absorption, and fibrosis, leading to unpredictable outcomes. Selective elimination of mature adipocytes may result in better outcomes and a different underlying retention mode. The authors previously developed a mature adipocyte–free product, stromal vascular fraction gel, derived from lipoaspirate, which eliminates adipocytes and preserves the stromal vascular fraction. This study investigated the retention and regeneration mode of stromal vascular fraction gel grafting.

Methods:
Nude mice were grafted with human-derived stromal vascular fraction gel or Coleman fat. Detailed cellular events over 3 months were investigated histologically and immunohistochemically.

Results:
The retention rate 90 days after grafting was significantly higher for stromal vascular fraction gel grafts than for standard Coleman fat (82 ± 15 percent versus 42 ± 9 percent; p < 0.05). Histologic analysis suggested that, unlike Coleman fat grafts, stromal vascular fraction gel grafts did not include significant necrotic areas. Moreover, although adipose tissue regeneration was found in grafts of both groups, rapid angiogenesis and macrophage infiltration were observed at a very early stage after stromal vascular fraction gel grafting. The presence of small preadipocytes with multiple intracellular lipid droplets in stromal vascular fraction gel grafts on day 3 also suggested very early adipogenesis. Although some of the cells in the stromal vascular fraction survived in stromal vascular fraction gel grafts, most of the newly formed adipose tissue was host-derived.

Conclusion:
Stromal vascular fraction gel has a high long-term retention rate and a unique adipose regeneration mode, involving prompt inflammation and infiltration of immune cells, stimulating rapid angiogenesis and inducing host cell–mediated adipogenesis.
Sex Differences in Faculty Rank Among Academic Surgeons in the United States in 2014
Authors: Blumenthal Daniel M. , Bergmark Regan W. , Raol Nikhila , Bohnen Jordan D. , Eloy Jean Anderson , Gray Stacey T. 
Published: January 2018

Objective:
The aim of this study was to evaluate sex differences in full professorship among a comprehensive, contemporary cohort of US academic surgeons.

Summary of Background Data:
Previous work demonstrates that women are less likely than men to be full professors in academic medicine, and in certain surgical subspecialties. Whether sex differences in academic rank exist across all surgical fields, and after adjustment for confounders, is not known.

Methods:
A comprehensive list of surgeons with faculty appointments at US medical schools in 2014 was obtained from Association of American Medical Colleges (AAMC) faculty roster and linked to a comprehensive physician database from Doximity, an online physician networking website, which contained the following data for all physicians: sex, age, years since residency, publication number (total and first/last author), clinical trials participation, National Institutes of Health grants, and surgical subspecialty. A 20% sample of 2013 Medicare payments for care was added to this dataset. Multivariable regression models were used to estimate sex differences in full professorship, adjusting for these variables and medical school-specific fixed effects.

Results:
Among 11,549 surgeon faculty at US medical schools in 2014, 1692 (14.7%) were women. Women comprised 19.4% of assistant professors (1072/5538), 13.8% of associate professors (404/2931), and 7.0% of full professors (216/3080). After multivariable analysis, women were less likely to be full professors than men (adjusted odds ratio: 0.76, 95% confidence interval: 0.6–0.9).

Conclusion:
Among surgical faculty at US medical schools in 2014, women were less likely than men to be full professors after adjustment for multiple factors known to impact faculty rank.
Multi-institutional Analysis of Recurrence and Survival After Neoadjuvant Chemoradiotherapy of Esophageal Cancer
Authors: Xi Mian , Yang Yadi , Zhang Li , Yang Hong , Merrell Kenneth W. , Hallemeier Christopher L. , Shen Robert K. , Haddock Michael G. , Hofstetter Wayne L. , Maru Dipen M. , Ho Linus , Wu Carol C. , Liu Mengzhong , Lin Steven H. 
Published: January 2018

Objective:
To determine the impact of histology on pathologic response, survival outcomes, and recurrence patterns in patients with esophageal cancer (EC) who received neoadjuvant chemoradiotherapy (CRT).

Summary of Background Data:
There is a paucity of data regarding comparative outcomes after neoadjuvant CRT between esophageal squamous cell carcinoma (SCC) and adenocarcinoma.

Methods:
Between 2002 and 2015, 895 EC patients who underwent neoadjuvant CRT followed by esophagectomy at 3 academic institutions were retrospectively reviewed, including 207 patients with SCC (23.1%) and 688 patients with adenocarcinoma (76.9%). Pathologic response, survival, recurrence pattern, and potential prognostic factors were compared.

Results:
Pathologic complete response (pCR) rate was significantly higher for SCC compared with adenocarcinoma (44.9% vs 25.9%, P < 0.001). After a median follow-up of 52.9 months, 71 patients (34.3%) with SCC versus 297 patients (43.2%) with adenocarcinoma had recurrent disease (P = 0.023). For patients who achieved a pCR, no significant differences were found in recurrence pattern, sites, or survival end-points between the 2 histology groups. For non-pCR patients, the SCC group demonstrated significantly higher regional and supraclavicular recurrence rates but a lower hematogenous metastasis rate than adenocarcinoma patients, whereas the adenocarcinoma patients had a more favorable locoregional failure-free survival (P = 0.005) and worse distant metastasis-free survival (P = 0.024). No differences were found in overall survival (P = 0.772) or recurrence-free survival (P = 0.696) between groups.

Conclusions:
SCC was associated with a significantly higher pCR rate than adenocarcinoma. Recurrence pattern and survival outcomes were significantly different between the 2 histology subtypes in non-pCR patients.