bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining the Role of the Lower Limbs in Compensating for Sagittal Malalignment
Authors: Lafage Renaud , Liabaud Barthelemy , Diebo Bassel G. , Oren Jonathan H. , Vira Shaleen , Pesenti Sébastien , Protopsaltis Themistocles S. , Errico Thomas J. , Schwab Frank J. , Lafage Virginie 
Published: March 2017

Study Design.
Retrospective review.

Objective.
To investigate the role of lower limbs compensation with progressive sagittal malalignment.

Summary of Background Data.
Although lower limb compensatory mechanisms are established response to progressive sagittal malalignment, their specific role and potential impact on surgical planning has not been evaluated.

Methods.
Single center retrospective review of full body x-rays was performed in patients of age >20 years. Parameters were measured with dedicated software. Population was stratified by 50 mm intervals of sagittal vertical axis (SVA) and one-way ANOVA was performed to compare P.shift (P.shift = anteroposterior translation of the pelvis vs. the feet) across SVA groups. Anteroposterior offset of each vertebra in relation to a vertical line extended from the distal tibial metaphysis (TM) was investigated. Linear regression was performed to predict pelvic tilt (PT) using Knee angle (KA) and P.shift, whereas controlling for pelvic incidence minus lumbar lordosis mismatch (PI-LL) and SVA.

Results.
A total of 2124 patient visits were included (PI = 55.1 ± 14.1°, PT=21.0 ± 11°, PI-LL=6.3 ± 17.3°, SVA = 29 ± 51 mm). With progressively increased SVA, P.shift decreased from 30 to −100 mm (all P < 0.005). Analysis of vertebral offset from the distal tibial metaphysis revealed that T9 was aligned with the TM line across all SVA groups. Prediction of PT based on PI-LL and SVA yielded R2=0.76 (P < 0.001). Subsequent addition of KA and P.shift as independent parameters using hierarchical multiple regression led to significant improvement in R2, demonstrating the independent role of lower limbs parameters in PT prediction. KA and P.shift had a positive standardized coefficient (all P < 0.05).

Conclusion.
Lower limb compensatory mechanisms increase with progressive sagittal malalignment. Anteroposterior translation of pelvis allows the T9 vertebra to remain in line with the ankle (“conus of economy”). Lower limb compensatory mechanisms are positive predictors of PT and thus do not require additional consideration in surgical realignment planning.

Level of Evidence: 3
Effects of IV Acetaminophen on Core Body Temperature and Hemodynamic Responses in Febrile Critically Ill Adults: A Randomized Controlled Trial
Authors: Schell-Chaple Hildy M. , Liu Kathleen D. , Matthay Michael A. , Sessler Daniel I. , Puntillo Kathleen A. 
Published: March 2017

Objective:
To determine the effects of IV acetaminophen on core body temperature, blood pressure, and heart rate in febrile critically ill patients.

Design:
Randomized, double-blind, placebo-controlled clinical trial.

Setting:
Three adult ICUs at a large, urban, academic medical center.

Patients:
Forty critically ill adults with fever (core temperature, ≥ 38.3°C).

Intervention:
An infusion of acetaminophen 1 g or saline placebo over 15 minutes.

Measurement and Main Results:
Core temperature and vital signs were measured at baseline and at 5–15-minute intervals for 4 hours after infusion of study drug. The primary outcome was time-weighted average core temperature adjusted for baseline temperature. Secondary outcomes included adjusted time-weighted average heart rate, blood pressure, and respiratory rate, along with changes-over-time for each. Baseline patient characteristics were similar in those given acetaminophen and placebo. Patients given acetaminophen had an adjusted time-weighted average temperature that was 0.47°C less than those given placebo (95% CI, –0.76 to –0.18; p = 0.002). The acetaminophen group had significantly lower adjusted time-weighted average systolic blood pressure (–17 mm Hg; 95% CI, –25 to –8; p < 0.001), mean arterial pressure (–7 mm Hg; 95% CI, –12 to –1; p = 0.02), and heart rate (–6 beats/min; 95% CI, –10 to –1; p = 0.03). Changes-over-time temperature, blood pressure, and heart rate outcomes were also significantly lower at 2 hours, but not at 4 hours.

Conclusions:
Among febrile critically ill adults, treatment with acetaminophen decreased temperature, blood pressure, and heart rate. IV acetaminophen thus produces modest fever reduction in critical care patients, along with clinically important reductions in blood pressure.
Changing face of metastatic prostate cancer: the law of diminishing returns holds true
Authors: Vaishampayan Ulka N. 
Published: March 2017

Purpose of review
Prostate cancer presents with a multitude of faces. It ranges from localized cancers staying quiescent for many years during active surveillance to the raging diffuse liver metastases causing terminal disease. The incidence of metastatic disease is increasing. This review will highlight some of the recent developments as well as ongoing challenges of managing advanced prostate cancer.

Recent findings
Significant strides are being made in managing metastatic prostate cancer. With the evolution of multiple new therapies, now the optimal use of these therapies and their proper sequencing is being addressed. Research is ongoing for mapping out pathways of resistance to therapies and for discovering new targets. Genomic alterations and abnormalities in circulating tumor DNA are being detected and will hopefully lead us more toward biomarker based therapies. The next era in oncology belongs to immune therapy. However, in prostate cancer the immune checkpoint inhibitors have shown modest responses and a phase III trial of radiation therapy ± ipilimumab revealed no benefit. Efforts are ongoing with combination trials of enzalutamide and atezolizumab or pembrolizumab. PARP inhibitors are gradually being established for therapeutic purposes, with olaparib achieving breakthrough status for prostate cancer patients with BRCA1 and 2 and ATM mutations.

Summary
The future will bring an era of personalized medicine in advanced prostate cancer as well as optimization and more strategic sequencing of existing therapies.
Clinical Features and Treatment of Dermatofibrosarcoma Protuberans Affecting the Vulva: A Literature Review
Authors: Nguyen Austin H. , Detty Shannon Q. , Gonzaga Maria I. , Huerter Christopher 
Published: March 2017

BACKGROUND
Dermatofibrosarcoma protuberans (DFSP) is a low-to-intermediate grade cutaneous neoplasm with a low propensity for metastasis and a high rate of local recurrence. It typically presents as a dermal plaque or nodule on the trunk, limbs, or head and neck region. Vulvar DFSP has also been described, although it is less common.

OBJECTIVE
To review the available literature and discuss the clinical course of DFSP affecting the vulva.

MATERIALS AND METHODS
We reviewed the existing English-language literature on DFSP of the vulva with respect to clinical presentation, diagnosis, treatment, and outcome.

RESULTS
Thirty three case reports and series were included (n = 54 patients). Vulvar DFSP most commonly presents as a slowly enlarging tender or asymptomatic mass on the labia majora, with histological findings of classic DFSP. Most patients were treated with wide local excision. Three patients were treated with Mohs micrographic surgery, which may decrease local recurrence and seems well suited for use in vulvar DFSP.

CONCLUSION
This literature review comprehensively reviews and describes the clinical presentation of vulvar DFSP and the treatment options for this rare vulvar neoplasm.
Voice outcomes post total laryngectomy
Authors: Hurren Anne , Miller Nick 
Published: March 2017

Purpose of review
A consensus and body of robust evidence has developed regarding optimal laryngeal voice outcome measures. This contrasts with a lack of clarity for equivalent assessments in alaryngeal voice. Addressing this situation would enable clinicians to select the best tools currently available to facilitate research, audit and clinical practice. This is important because of the limited knowledge regarding the optimal surgical or reconstruction techniques and rehabilitation regimes for the laryngectomy population.

Recent findings
There is currently no evidence to support the use of acoustic instrumental measures in terms of validity. Preliminary data support the validity of a new tracheoesophageal voice auditory–perceptual tool the SToPS, for professional and naive raters. Few specific self-rating tools exist with the Self Evaluation of Communication Experiences after Laryngectomy having the most evidence regarding validity, reliability and clinical utility. Laryngeal self-report questionnaires have been utilized, but concerns have been expressed regarding content validity. Patient self-report outcomes do not concur with professional or naive judgements, which reflect findings in the laryngeal voice literature.

Summary
Further research is needed to establish the optimal tools for research and clinical practice. Investigations should also incorporate assessments of real-life communication in daily living rather than solely focussing on recordings in laboratory conditions.
Rash diagnostics: an update on the diagnosis of allergic rashes
Authors: Happel Corinne Savides 
Published: March 2017

Purpose of review
The purpose of this review is to summarize recent research regarding the diagnosis of allergic rashes and to suggest future directions for the promotion of accurate diagnosis and endotype specification.

Recent findings
Multiple cohort studies demonstrate that with appropriate clinical evaluation, drug allergy labels can be removed in up to 90% of cases. Genetic tests can predict severe adverse cutaneous drug reactions in some cases and in vitro tests are being sought to identify causative drugs in others. Biomarkers to define endotypes of atopic dermatitis are needed to predict which patients will benefit from evolving targeted therapies. Hyperspectral imaging is a rapidly evolving technology in medical diagnostics; additional research is needed to demonstrate whether this promising technology can be used to distinguish allergic rashes and/or endotypes in atopic dermatitis.

Summary
Diagnostic tools for the assessment of allergic rashes are primitive in that they frequently rely on challenges to ascertain whether suspected allergens were causative. Validated in vitro tests with high sensitivity and specificity for drug allergies would benefit the field, particularly in delayed type reactions, as would identification of any hyperspectral signatures that could identify endotypes in atopic dermatitis.
Psychopathological Assessment of Risk of Restraint in Acute Psychiatric Patients
Authors: Dazzi Federico , Tarsitani Lorenzo , Di Nunzio Michele , Trincia Valeria , Scifoni Gabriella , Ducci Giuseppe 
Published: March 2017

Abstract
The study aims to identify independent predictors of physical restraint in acute psychiatric patients and to determine the predictive power of a risk assessment model centered on psychopathological dimensions. We included 1552 patients admitted to a psychiatric intensive care unit over a 5-year period. Patients were rated on the Brief Psychiatric Rating Scale (BPRS-E) at admission. Principal axis factoring (PAF) with varimax rotation was performed on BPRS-E items to identify psychopathological factors. Multiple logistic regression analysis was performed. PAF pointed six factors: positive symptoms, negative symptoms, resistance, activation, negative affect, and disorganization. Male sex, younger age, proposal for compulsory admission, severity of symptoms, resistance, activation, and disorganization were identified as independent predictors. Negative symptoms and negative affect were instead protective factors. The BPRS-E factors, when added to other sociodemographic and clinical variables, significantly increased the predictive power of the model. Our findings suggest that a systematic evaluation of the psychopathological dimensions can be usefully included in the early risk assessment of restraint.
Position Between Trunk and Pelvis During Gait Depending on the Gross Motor Function Classification System
Authors: Sanz-Mengibar Jose Manuel , Altschuck Natalie , Sanchez-de-Muniain Paloma , Bauer Christian , Santonja-Medina Fernando 
Published: March 2017

Purpose:
To understand whether there is a trunk postural control threshold in the sagittal plane for the transition between the Gross Motor Function Classification System (GMFCS) levels measured with 3-dimensional gait analysis.

Method:
Kinematics from 97 children with spastic bilateral cerebral palsy from spine angles according to Plug-In Gait model (Vicon) were plotted relative to their GMFCS level.

Results:
Only average and minimum values of the lumbar spine segment correlated with GMFCS levels. Maximal values at loading response correlated independently with age at all functional levels. Average and minimum values were significant when analyzing age in combination with GMFCS level.

Conclusion:
There are specific postural control patterns in the average and minimum values for the position between trunk and pelvis in the sagittal plane during gait, for the transition among GMFCS I-III levels. Higher classifications of gross motor skills correlate with more extended spine angles.
Antimicrobial-resistant Gram-negative infections in neonates: burden of disease and challenges in treatment
Authors: Folgori Laura , Bielicki Julia , Heath Paul T. , Sharland Mike 
Published: March 2017

Purpose of review
This review summarizes the main challenges of antimicrobial resistance (AMR) in the neonatal population with a special focus on multidrug-resistant (MDR) Gram-negative pathogens.

Recent findings
MDR-Gram-negative bacteria are a great concern in the neonatal population, with a worldwide rise in the reported incidence and with very limited therapeutic options. Extended-spectrum β-lactamase and carbapenem-resistant Enterobacteriaceae (CRE) have been reported as responsible for neonatal ICU outbreaks. Hospital data from low/middle-income countries show high proportions of isolates from neonates resistant to the WHO first-line and second-line recommended treatments. The spread of CRE has resulted in old antibiotics, such as colistin and fosfomycin, to be considered as alternative treatment options, despite the paucity of available data on safety and appropriate dosage.

Summary
Improved global neonatal AMR surveillance programmes including both epidemiology and clinical outcomes are critical for defining the burden and designing interventions. The optimal empiric treatment for neonatal sepsis in settings of high rates of AMR is currently unknown. Both strategic trials of older antibiotics and regulatory trials of new antibiotics are required to improve clinical outcomes in MDR-Gram-negative neonatal sepsis.
Dynamic Measurement of Arterial Liver Perfusion With an Interventional C-Arm System
Authors: Datta Sanjit , Müller Kerstin , Moore Terilyn , Molvin Lior , Gehrisch Sonja , Rosenberg Jarrett , Saenz Yamil , Manhart Michael , Deuerling-Zheng Yu , Kothary Nishita , Fahrig Rebecca 
Published: March 2017

Purpose
Objective intraprocedural measurement of hepatic blood flow could provide a quantitative treatment end point for locoregional liver procedures. This study aims to validate the accuracy and reproducibility of cone-beam computed tomography perfusion (CBCTp) measurements of arterial liver perfusion (ALP) against clinically available computed tomography perfusion (CTp) measurements in a swine embolization model.

Methods
Triplicate CBCTp measurements using a selective arterial contrast injection were performed before and after complete embolization of the left lobe of the liver in 5 swine. Two CBCTp protocols were evaluated that differed in sweep duration (3.3 vs 4.5 seconds) and the number of acquired projection images (166 vs 248). The mean ALP was measured within identical volumes of interest selected in the embolized and nonembolized regions of the perfusion map generated from each scan. Postembolization CBCTp values were also compared with CTp measurements.

Results
The 2 CBCTp protocols demonstrated high concordance correlation (0.90, P < 0.001). Both CBCTp protocols showed higher reproducibility than CTp in the nontarget lobe, with an intraclass correlation of 0.90 or greater for CBCTp and 0.83 for CTp (P < 0.001 for all correlations). The ALP in the embolized lobe was nearly zero and hence excluded for reproducibility. High concordance correlation was observed between the CTp and each CBCTp protocol, with the shorter CBCTp protocol reaching a concordance correlation of 0.75 and the longer achieving 0.87 (P < 0.001 for both correlations).

Conclusions
Dynamic blood flow measurement using an angiographic C-arm system is feasible and produces quantitative results comparable to CTp.
Breaking Down the Objective Structured Clinical Examination
Authors: Seto Teresa L. , Tabangin Meredith E. , Taylor Kathryn K. , Josyula Srirama , Vasquez Juan Carlos , Kamath-Rayne Beena D. 
Published: March 2017

Introduction
Helping Babies Breathe (HBB) is a simulation-based neonatal resuscitation curriculum designed for low-resource settings. At the completion of the workshop, learners complete the following four assessments: a multiple-choice question (MCQ) test, bag-mask ventilation (BMV) checklist, and two objective structured clinical examinations (OSCEs). Objective structured clinical examinations are clinical performance assessments that evaluate learners' skills in simulated scenarios. The aims of this study were (1) to evaluate the validity and reliability of the OSCEs used in the HBB curriculum, (2) to conduct an itemized analysis of the OSCEs to identify specific deficits in knowledge and performance, and to identify areas of improvement for future versions of HBB.

Methods
Seventy physicians and nurses completed an HBB workshop conducted in Spanish at a Honduran community hospital. Validity and reliability were examined using an item analysis of item difficulty, discrimination, correlation, and internal consistency/reliability.

Results
Posttest scores were higher for all assessments. Most items on the OSCEs were of low difficulty and low discrimination. Item agreement was lowest for multistep items.

Conclusions
As summative and formative assessments of performance in simulated neonatal resuscitation, the HBB OSCEs are effective because most learners were able to perform the skills correctly after an HBB workshop. On the basis of our results, we recommend changes to future editions of HBB, including the following: simplification of multistep items to single tasks, use of a global rating scale, provision of additional scenarios, and specific instructions to raters on how to grade OSCEs and promote self-reflection to enhance debriefings/feedback. Further validation and study of the OSCEs in the second edition of HBB would enhance their quality and translation into clinical performance.
Simulation Faculty Development
Authors: Peterson Dawn Taylor , Watts Penni I. , Epps Chad A. , White Marjorie Lee 
Published: March 2017

Summary Statement
Simulation faculty development has become a high priority for the past couple of years because simulation programs have rapidly expanded in health systems and universities worldwide. A formalized, structured model for developing quality facilitators of simulation is helpful to support and sustain this continued growth in the field of simulation. In this article, we present a tiered faculty development plan that has been implemented at a university in the United States and includes the essentials of faculty development. We discuss the rationale and benefits of a tiered faculty development program as well as describe our certification plan. The article concludes with lessons learned throughout the process of implementation.
Risk for Clostridium difficile Infection After Allogeneic Hematopoietic Cell Transplant Remains Elevated in the Postengraftment Period
Authors: Dubberke Erik R. , Reske Kimberly A. , Olsen Margaret A. , Bommarito Kerry M. , Seiler Sondra , Silveira Fernanda P. , Chiller Tom M. , DiPersio John , Fraser Victoria J. 
Published: March 2017

Background

Clostridium difficile infection (CDI) is a frequent cause of diarrhea among allogeneic hematopoietic cell transplant (HCT) recipients. It is unknown whether risk factors for CDI vary by time posttransplant.

Methods
We performed a 3-year prospective cohort study of CDI in allogeneic HCT recipients. Participants were enrolled during their transplant hospitalizations. Clinical assessments were performed weekly during hospitalizations and for 12 weeks posttransplant, and monthly for 30 months thereafter. Data were collected through patient interviews and chart review, and included CDI diagnosis, demographics, transplant characteristics, medications, infections, and outcomes. CDI cases were included if they occurred within 1 year of HCT and were stratified by time from transplant. Multivariable logistic regression was used to determine risk factors for CDI.

Results
One hundred eighty-seven allogeneic HCT recipients were enrolled, including 63 (34%) patients who developed CDI. 38 (60%) CDI cases occurred during the preengraftment period (days 0-30 post-HCT) and 25 (40%) postengraftment (day >30). Lack of any preexisting comorbid disease was significantly associated with lower risk of CDI preengraftment (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.1-0.9). Relapsed underlying disease (OR, 6.7; 95% CI, 1.3-33.1), receipt of any high-risk antimicrobials (OR, 11.8; 95% CI, 2.9-47.8), and graft-versus-host disease (OR, 7.8; 95% CI, 2.0-30.2) were significant independent risk factors for CDI postengraftment.

Conclusions
A large portion of CDI cases occurred during the postengraftment period in allogeneic HCT recipients, suggesting that surveillance for CDI should continue beyond the transplant hospitalization and preengraftment period. Patients with continued high underlying severity of illness were at increased risk of CDI postengraftment.
mTOR Inhibition by Everolimus Does Not Impair Closure of Punch Biopsy Wounds in Renal Transplant Patients
Authors: Dutt Shelley B. , Gonzales Josephine , Boyett Megan , Costanzo Anne , Han Peggy P. , Steinberg Steven , McKay Dianne B. , Jameson Julie M. 
Published: March 2017

Background
Mammalian target of rapamycin (mTOR) inhibitors are approved to prevent allograft rejection and control malignancy. Unfortunately, they are associated with adverse effects, such as wound healing complications that detract from more extensive use. There is a lack of prospective wound healing studies to monitor patients treated with mTOR inhibitors, such as everolimus or sirolimus, especially in nondiabetics.

Methods
Patients receiving everolimus with standard immunosuppressant therapy or standard immunosuppressant therapy without everolimus were administered 3-mm skin biopsy punch wounds in the left scapular region. Homeostatic gene expression was examined in the skin obtained from the biopsy and wound surface area was examined on day 7. Peripheral blood mononuclear cells were examined for cytokine production.

Results
There are no significant changes in autophagy related 13, epidermal growth factor, insulin-like growth factor binding protein 3, IL-2, kruppel-like factor 4, and TGFB1 gene expression in the skin suggesting that there is little impact of everolimus on these genes within nonwounded skin. Peripheral blood T cells are more sensitive to cell death in everolimus-treated patients, but they retain the ability to produce proinflammatory cytokines required for efficient wound repair. Importantly, there is no delay in the closure of biopsy wounds in patients receiving everolimus as compared to those not receiving mTOR inhibition.

Conclusions
Everolimus treatment is not associated with impaired closure of skin biopsy wounds in kidney transplant recipients. These data highlight the importance of exploring whether larger surgical wounds would show a similar result and how other factors, such as diabetes, impact wound healing complications associated with mTOR suppression.