bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Hospital-level Neuraxial Anesthesia Use for Hip Fracture Surgery with Outcomes
Authors: McIsaac Daniel I. , Wijeysundera Duminda N. , Huang Allen , Bryson Gregory L. , van Walraven Carl 
Published: September 2017

Abstract

Background
There is consistent and significant variation in neuraxial anesthesia use for hip fracture surgery across jurisdictions. We measured the association of hospital-level utilization of neuraxial anesthesia, independent of patient-level use, with 30-day survival (primary outcome) and length of stay and costs (secondary outcomes).

Methods
We conducted a population-based cohort study using linked administrative data in Ontario, Canada. We identified all hip fracture patients more than 65 yr of age from 2002 to 2014. For each patient, we measured the proportion of hip fracture patients at their hospital who received neuraxial anesthesia in the year before their surgery. Multilevel, multivariable regression was used to measure the association of log-transformed hospital-level neuraxial anesthetic-use proportion with outcomes, controlling for patient-level anesthesia type and confounders.

Results
Of 107,317 patients, 57,080 (53.2%) had a neuraxial anesthetic; utilization varied from 0 to 100% between hospitals. In total, 9,122 (8.5%) of patients died within 30 days of surgery. Survival independently improved as hospital-level neuraxial use increased (P = 0.009). Primary and sensitivity analyses demonstrated that most of the survival benefit was realized with increase in hospital-level neuraxial use above 20 to 25%; there did not appear to be a substantial increase in survival above this point. No significant associations between hospital neuraxial anesthesia-use and other outcomes existed.

Conclusions
Hip fracture surgery patients at hospitals that use more than 20 to 25% neuraxial anesthesia have improved survival independent of patient-level anesthesia type and other confounders. The underlying causal mechanism for this association requires a prospective study to guide improvements in perioperative care and outcomes of hip fracture patients.
Anterior cruciate ligament reconstruction in patients over age sixty years
Authors: Troyer Joshua D. , Flanigan David C. , Kaeding Christopher C. , Magnussen Robert A. 
Published: September 2017

Background:
We sought to determine outcomes of anterior cruciate ligament reconstruction (ACLR) in patients over 60 yr of age at the time of reconstruction.

Methods:
All patients over the age of 60 yr who underwent ACLR at our institution between 2005 and 2014 were identified. Patients were subsequently contacted and each completed a questionnaire that included a Knee injury and Osteoarthritis Outcome Score (KOOS), Marx and Tegner Activity Scores, patient satisfaction with the operation, and details of any subsequent surgical procedures on the index knee.

Results:
Ten patients met inclusion criteria, and all 10 were contacted at a mean of 4.4 yr after ACLR (range: 1.3-9.4 yr). The mean KOOS scores for each subscale were: pain 95.9, symptoms 90.4, activities of daily life 95.0, sport and recreation function 80.5, and knee-related quality of life 79.7. No patient underwent repeat surgery on the index knee. The median Tegner activity score was 3 (range, 2-6). Nine of the 10 patients reported that they were able to return to their preoperative activity level. All patients were subjectively satisfied with the results of their surgery and stated that they would do the operation again if given the choice.

Conclusions:
ACL reconstruction in patients over the age of 60 yr yields excellent patient-reported outcomes, high rates of return to preinjury activity level, and low revision risk when performed for symptomatic instability in the absence of significant osteoarthritis.
Clinical Characteristics of Patients Experiencing Pathologic Complete Response Following Neoadjuvant Therapy for Borderline Resectable/Locally Advanced Pancreatic Adenocarcinoma
Authors: Hashemi-Sadraei Neda , Gbolahan Olumide B. , Salfity Hai , O’Neil Bert , House Michael G. , Shahda Safi 
Published: September 2017

Objectives:
The purpose of this study is to describe clinical characteristics and outcomes of patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) who achieved pathologic complete response (pCR) following neoadjuvant therapy.

Materials and Methods:
A single institution clinical database for patients with pancreatic ductal adenocarcinoma was queried. Between 2008 and 2014 patients were identified with BRPC and LAPC, who underwent surgical resection after receiving neoadjuvant treatment. Clinical and pathologic features of the patients who achieved pCR were acquired retrospectively.

Results:
Six patients were identified to have pCR on pathology of the postoperative specimen. On the basis of pretreatment clinical staging, 2 patients were considered to have BRPC and 4 LAPC. Four patients received gemcitabine-based chemotherapy and 2 patients received FOLFIRINOX (5-fluorouracil, oxaliplatin, irinotecan, and leucovorin). Five of 6 patients received radiation therapy before operative resection. Operative procedures included distal pancreatectomy (n=3) and pancreatoduodenectomy (n=3). Pancreatic intraepithelial neoplasia 1 to 2 was present in 3 cases, and pancreatic intraepithelial neoplasia 3 in 1 case. During a median follow-up of 21.3 months, 2 patients died, with a median survival of 11.0 months (range, 10.4 to 11.6 mo). Four patients are alive and continue to follow-up with median survival of 28.7 months (range, 20.1 to 42.4 mo).

Conclusions:
Multimodality neoadjuvant therapy may lead to complete pathologic response in a small number of patients with borderline resectable/locally advanced pancreatic adenocarcinoma. pCR to neoadjuvant therapy does not lead to cure in most cases, and the majority of patients appear to relapse locally or systemically.
Interstitial Granulomatous Variant of Scleromyxedema—A Diagnostic Pitfall
Authors: Long Valencia , Tan Weisheng , Lee Siong See Joyce , Thng Tien Guan Steven 
Published: September 2017

Abstract:
Scleromyxedema is a rare disorder where patients may develop systemic manifestations such as monoclonal gammopathy, inflammatory polyarthritis, and esophageal and neurological dysfunction. Histologically, there may be atypical variants of scleromyxedema showing features resembling interstitial granuloma annulare. We report an unusual case of scleromyxedema with interstitial granulomatous pattern and highlight potential diagnostic pitfalls when encountered with such a variant.
Estimating Risk of Hematopoietic Acute Radiation Syndrome in Children
Authors: Adams Grace G. , Sumner Louise E. , Casagrande Rocco 
Published: September 2017

Abstract
Following a radiological terrorist attack or radiation accident, the general public may be exposed to radiation. Historically, modeling efforts have focused on radiation effects on a “reference man”—a 70‐kg, 180‐cm-tall, 20‐ to 30‐y-old male—which does not adequately reflect radiation hazard to special populations, particularly children. This work examines the radiosensitivity of children with respect to reference man to develop a set of parameters for modeling hematopoetic acute radiation syndrome in children. This analysis was performed using animal studies and the results verified using data from medical studies. Overall, the hematopoietic system in children is much more radiosensitive than that in adults, with the LD50 for children being 56% to 91% of the LD50 of adults, depending on age.
Integration of Mental and Behavioral Health in Pediatric Health Care Clinics
Authors: Hansel Tonya , Rohrer Glenn , Osofsky Joy , Osofsky Howard , Arthur Elizabeth , Barker Chikira 
Published: September 2017

Objective:
Integrating behavioral health services into primary and pediatric health care settings is important to increase availability and access to quality mental and behavioral health care for children and adolescents. The Mental and Behavioral Health Capacity Project implemented models of pediatric integrated health care at Federally Qualified Health Clinics covering largely rural communities in Louisiana and impacted communities on the Florida Panhandle. The objectives of this article are to describe the programs and demonstrate sustainability and effectiveness of services provided.

Design:
A subsample from the Louisiana clinics collected data at intake and follow-up at 1, 3, and 6-month intervals. The hypotheses were that child behavior problems and parenting stress would significantly decrease over the course of treatment.

Setting:
This study was conducted at 2 Federally Qualified Health Clinics in rural southeast Louisiana that provide pediatric primary health care.

Participants:
Sample parameters were child patients younger than 18 years presenting at primary health care clinics in Southeast Louisiana (N = 177); the mean age was 9.8 years (standard deviation = 4.3 years).

Intervention:
Brief behavioral health services included parental education, medication management, stress management, empowerment, and psychodynamic interventions.

Main Outcome Measure:
The main outcome measures were the Pediatric Symptom Checklist and the Parenting Stress Index.

Results:
Statistically significant decreases in child behavior problems and parenting stress were revealed, with 87% reporting satisfaction with services.

Conclusions:
Utilizing community-based and culturally sensitive approaches, mental and behavioral health integrated into pediatric health care clinics can be sustainable and effective at improving child behavior problems, parenting stress, and overall family functioning.
Utilizing Actionable Data Analytics to Support Patient Navigation Enrollment and Retention Within Federally Qualified Health Centers
Authors: Robinson Melody M. , Stone Gregory , Tokarz Stephanie , Wortham Benjamin 
Published: September 2017

Introduction:
Emergency departments (EDs) have become the primary source of care for increasing number of patients, leading to treatment of nonemergent cases, which divert resources from true emergency situations and represent poor cost-effectiveness for treating such cases. There is evidence that suggests that patient navigation (PN) integrated into the ED and other case management techniques can help reduce the number of primary care–related ED visits and these navigation programs are more cost-effective than the ED visits themselves. The Greater New Orleans Community Health Connection Primary Care Capacity Project Quality Improvement Initiative (GNOPQii) is a pilot project aimed at improving the efficiency of PN for patients who have had avoidable ED encounters or inpatient readmissions through applied data and technology program.

Methods:
Partnering Federally Qualified Health Centers were equipped with actionable ED utilization data to integrate with their own patient clinical data to track patient ED activity. The pilot design also included the use of patient navigators to address the nonclinical cultural and behavioral barriers to care. As part of the overall evaluation, comparisons of data utilization and PN services pre- and post-GNOPQii were conducted.

Results:
A total of 337 referrals were made, and 145 patients were enrolled into the GNOPQii pilot program. The direct services needed the most by patients were transportation and medication resources. Of those who enrolled (N = 145), 63 patients graduated, meaning program compliance and 90 days without visits to the ED, resulting in a 43% success rate.

Discussion:
If an estimated $1898 savings for every nonemergency ED encounter replaced by an office-based encounter is applied to our results, the GNOPQii program contributed to a minimum of $119 574.00 savings even if only 1 deterred ED visit per graduate is assumed. Future research is needed to systematically test the efficacy of GNOPQii in reducing nonemergent ED visits.
Planning and Implementing Immunization Billing Programs at State and Local Health Departments: Barriers and Possible Solutions
Authors: Corriero Rosemary , Redmon Ginger 
Published: September 2017

Context:
Before participating in a project funded by the Centers for Disease Control and Prevention, most state and local health departments (LHDs) were not seeking reimbursement or being fully reimbursed by insurance plans for the cost of immunization services (including vaccine costs and administration fees) they provided to insured patients. Centers for Disease Control and Prevention's Billables Project was designed to enable state and LHDs to bill public and private insurance plans for immunization services provided to insured patients.

Objective:
Identify and describe key barriers state and LHDs may encounter while planning and implementing a billing program, as well as possible solutions for overcoming those barriers.

Design:
This study used reports from Billables Project participants to explore barriers they encountered when planning and implementing a billing program and steps taken to address those barriers.

Setting and Participants:
Thirty-eight state immunization programs.

Results:
Based on project participants' reports, barriers were noted in 7 categories: (1) funding and costs, (2) staff, (3) health department characteristics, (4) third-party payers and insurance plans, (5) software, (6) patient insurance status, and (7) other barriers. Possible solutions for overcoming those barriers included hiring or seeking external help, creating billing guides and training modules, streamlining workflows, and modifying existing software systems.

Conclusion:
Overcoming barriers during planning and implementation of a billing program can be challenging for state and LHDs, but the experiences and suggestions of past Billables Project participants can help guide future billing program efforts.
A Comparative Study of the Aesthetic Outcome of Two Techniques for Unilateral Complete Cleft Lip Repair
Authors: Phillips Georgina S. A. , Swan Marc C. , Sawyer Adam R. , Goodacre Tim E. E. , Cadier Michael 
Published: September 2017

Background:
Cleft lip repair aims to create symmetric nasolabial morphology with minimal scarring. Poor aesthetic outcomes may have damaging psychosocial implications. Determining the optimal method of recreating lip symmetry is a major goal of applied cleft clinical research. This study aims to determine whether subjective assessment could differentiate aesthetic outcome between two surgeons who use two different surgical techniques for unilateral cleft lip repair.

Methods:
Surgeon A uses a modified rotation-advancement technique incorporating a supra–white roll flap and Noordhoff-style vermilion flap. Surgeon B uses an upper and lower triangle technique. Neither surgeon used presurgical orthopedics. Five-year postoperative frontal photographs (cropped according to the Asher-McDade aesthetic index) were analyzed by a panel of 40 blinded surgical and lay reviewers using a five-point Likert scale. The assessments were repeated after a 2-week interval to assess intrarater reliability.

Results:
Thirty-nine consecutive complete unilateral cleft lip and palate patients were assessed for each surgeon. The mean Likert score for surgical/lay assessors was 3.07/3.00 for surgeon A and 2.67/2.61 for surgeon B. This difference was statistically significant (p < 0.05). The interrater reliability was excellent and the intrarater reliability was fair. There was good correlation between lay and surgical assessors.

Conclusion:
Subjective assessment of clinical photography provides a reliable method of differentiating aesthetic outcome after unilateral cleft lip repair and presents a rapid and straightforward clinically relevant method of comparing surgical outcomes.
Unusual Aspergillus Infection After Dermal Filler Injection
Authors: Shin Jin Yong , An Mun-Young , Roh Si-Gyun , Chang Suk Choo , Lee Nae-Ho 
Published: September 2017

Abstract
According to a great desire for facial rejuvenation, dermal filler is promising for improving people's appearance without surgery. In a society of plastic surgery, injection of dermal filler is one of the most common procedures for a younger appearance. An increase in patients who have filler injection has been paralleled by a rise in various adverse reactions. Formation of inflammatory or infected nodules is one of the most common long-term complications. Infections can be increased because of improper disinfection of the patient's skin, a poor injection technique, decreased general immunity, and the presence of pathogens. The majority of bacteria are aerobic or facultative aerobic bacteria. This expectation of pathogens is critical for deciding on the antibiotic treatment before confirming the pathogen by microbial culture. The authors experienced unusual culture results in a patient with a chronic inflammatory nodule with abscess formation. The authors report a unique Aspergillus-cultured infection after filler injection.
Reconstruction of Mandibular Segmental Detects Using Transport Disk Distraction Osteogenesis
Authors: Li Tao , Man Yi , Bi Ruiye , Jiang Nan , Li Yunfeng , Zhu Songsong 
Published: September 2017

Background:
Distraction osteogenesis (DO) has become an important alternative for bone defect reconstruction. The study aims to investigate the clinical feasibility and efficiency of transport disc DO (TDDO) for reconstruction of segmental defect of mandible and further dental implant treatment.

Methods:
A serial of 6 patients diagnosed with ameloblastoma or keratocystic odontogenic tumor were included in this study. Computed tomography (CT) scanning and panoramic radiograph were performed for preoperative evaluation and surgery planning. Transport disc DO was applied simultaneously with tumor resection for reconstruction of mandibular defects. The postoperative panoramic radiographs and CT scans were taken for evaluation of the ossification level. Then a second surgery was performed for removal of the distraction apparatus. Bone graft and rigid internal fixation were also used to fill the gap between the transport disc and the stump of the residual ramus. Further dental implant treatment was also finished or in progress.

Results:
All patients finished the whole treatment period, and no distraction device failure or tumor recurrence occurred. The distraction length ranged from 35 to 48 mm and the whole treatment period of TDDO ranged from 21 to 33 weeks. High degree of ossification was confirmed at the end of treatment by postoperative radiographs and intraoperative observation. Infection occurred in 1 of the 6 patients, and the symptom was controlled by surgical dressing change and flushing. Results of final facial profile in all patients were good. Three patients finished dental implant treatment with good occlusion.

Conclusion:
Results in this study suggest the clinical feasibility and efficiency of TDDO for reconstruction of segmental defect of mandible and further dental implant treatment.
A Pediatric Patient With an Orbital Respiratory Epithelial Cyst
Authors: Cohn Jason E. , Bahrami Arash , Monteleone Christina , Pascasio Judy Mae , Davis Wellington J. 
Published: September 2017

Abstract
Respiratory epithelial cysts are rare orbital cysts that can arise secondary to choristomatous rests of respiratory epithelium. Approximately 15 congenital cases have been described in the literature, making it a rare disease entity. We present a case of a 14-month-old Middle Eastern male with a right infraorbital respiratory epithelial cyst. Magnetic resonance imaging of the brain and orbits revealed a right infraorbital cyst hyperintense on T1-weighted images and followed fluid density on T2-weighted images. This cyst was noted to displace the globe superiorly and inferior rectus muscle laterally. This cyst was excised using a transconjunctival approach. Histologically, the cyst wall was lined by ciliated columnar cells with interspersed mucus-containing cells and ciliated transitional epithelium was present, establishing the diagnosis of respiratory epithelial cyst. To our knowledge, this is the youngest patient with a respiratory epithelial cyst of the orbit reported in the literature.
Management of Zygomatic Fixture Complication Case Using Extra-Short Implants
Authors: Benatto Guilherme Bertolotti , Bueno Cleuber Rodrigo de Souza , Curvêllo Victor Prado , Nary Filho Hugo 
Published: September 2017

Abstract
The oral rehabilitation of a patient with atrophic maxilla is one of the main challenges in implant-supported rehabilitations. The implant placement in the posterior region of the maxilla is limited by a deficiency of bone quantity and quality, besides the anatomic restriction of the maxillary sinus. The use of zygoma fixtures, anchoraged in the zygomatic bone, is a useful technique to enable the full arch rehabilitation. However, complications related to this procedure bring a lot of difficulty in solving. This study presents the use of extra-short implants as a strategy to treat a patient in whom the zygoma fixture and the fixed prosthesis failed, associated with sinusitis and alveolar bone loss.
Metabolomics reveals that dietary xenoestrogens alter cellular metabolism induced by palbociclib/letrozole combination cancer therapy
Authors: Warth Benedikt , Raffeiner Philipp , Granados Ana , Huan Tao , Fang Mingliang , Forsberg Erica M , Benton H. Paul , Goetz Laura , Johnson Caroline H. , Siuzdak Gary 
Published: September 2017

HighlightsSynergism of combined palbociclib/letrozole chemotherapy was examined by global metabolomicsCombination therapy led to more pronounced effects on the MCF-7 metabolome than single agentsDietary phyto- and mycoestrogens significantly affected the metabolic and anti-oncogenic response of the drugsImplications of these bio-active chemicals on therapeutic success in breast cancer patients appear plausibleIn BriefWarth et al. used innovative global metabolomics and pathway prediction technology to describe the metabolic effects of the combined palbociclib/letrozole breast cancer therapy. Moreover, the role of dietary xenoestrogens on this treatment was examined by metabolite data, proliferation experiments, and functional assays.SummaryRecently, the palbociclib/letrozole combination therapy was granted accelerated FDA approval for the treatment of estrogen receptor (ER) positive breast cancer. Since the underlying metabolic effects of these drugs are yet unknown, we investigated their synergism at the metabolome level in MCF-7 cells. As xenoestrogens interact with the ER, we additionally aimed at deciphering the impact of the phytoestrogen genistein, and the estrogenic mycotoxin zearalenone on this treatment. A global metabolomics approach was applied to unravel metabolite and pathway modifications. The results clearly showed that the combined effects of palbociclib and letrozole on cellular metabolism were far more pronounced than that of each agent alone and potently influenced by xenoestrogens. This behavior was confirmed in proliferation experiments and functional assays. Specifically, amino acids and central carbon metabolites were attenuated while higher abundances were observed for fatty acids and most nucleic acid related metabolites. Interestingly, exposure to model xenoestrogens appeared to partially counteract these effects.