bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Overview of Chronic Spinal Pain
Authors: Sharan Ashwini , Riley Jonathan , Hoelscher Christian 
Published: April 2017

Study Design.
Topic overview.

Objective.
To describe the varied etiologies resulting in chronic spinal pain and review the current available evidence for treatments.

Summary of Background Data.
Chronic pain conditions, especially those that affect the axial back and radiate to the extremities, affect a large population. This results in pronounced disability and a high socioeconomic burden. Our understanding of the underlying mechanisms for chronic pain is limited. This prevents a comprehensive diagnostic approach. Evidence from high-level clinical trials supporting treatments for chronic spinal pain is also limited.

Methods.
Articles were identified through PubMed searches or already known to the author. The literature was reviewed and summarized, indicating the strength of evidence available for many treatment modalities.

Results.
There are very few studies published that evaluate behavioral modifications for chronic spinal pain and only one long-term study investigating chronic pharmacological treatments. The data on the success of spinal surgeries to relieve chronic spinal pain suggest an unacceptably high failure rate. The best evidence (Level I) currently available suggests that spinal cord stimulation is a safe, effective, and durable treatment for chronic spinal pain. Recent clinical data support further investigation of new innovations and earlier therapeutic consideration of currently employed approaches.

Conclusion.
Currently, physicians are limited in the practice of evidence-based medicine regarding chronic spinal pain treatments due to both the paucity of data available and an inconsistent diagnostic nomenclature. The introduction of new neurostimulation modalities is promising but requires better characterization through ongoing prospective clinical investigation.

Level of Evidence: 5
Diaphragm Activation in Ventilated Patients Using a Novel Transvenous Phrenic Nerve Pacing Catheter
Authors: Reynolds Steven , Ebner Adrian , Meffen Tracy , Thakkar Viral , Gani Matt , Taylor Kaity , Clark Linda , Sadarangani Gautam , Meyyappan Ramasamy , Sandoval Rodrigo , Rohrs Elizabeth , Hoffer Joaquín A. 
Published: April 2017

Objectives:
Over 30% of critically ill patients on positive-pressure mechanical ventilation have difficulty weaning from the ventilator, many of whom acquire ventilator-induced diaphragm dysfunction. Temporary transvenous phrenic nerve pacing using a novel electrode-bearing catheter may provide a means to prevent diaphragm atrophy, to strengthen an atrophied diaphragm, and mitigate the harms of mechanical ventilation. We tested the initial safety, feasibility, and impact on ventilation of this novel approach.

Design:
First-in-Humans case series.

Setting:
Angiogram suite.

Patients:
Twenty-four sedated, mechanically ventilated patients immediately prior to an elective atrial septal defect repair procedure.

Interventions:
A 9.5-Fr central venous catheter with 19 embedded electrodes was placed via Seldinger technique into the left subclavian vein and superior vena cava and evaluated for up to 90 minutes. The electrode combinations determined to provide best transvenous stimulation of the right and left phrenic nerves were activated in synchrony with mechanically ventilated breaths.

Measurements and Main Results:
One patient could not be tested for reasons unrelated to the device. In the 23 patients who underwent the full protocol, transvenous stimulation activated the diaphragm in 22 of 23 (96%) left phrenic capture attempts and 20 of 23 (87%) right phrenic capture attempts. In one subject, a congenital left-sided superior vena cava precluded right-sided capture. Significant reductions in ventilator pressure-time-product were achieved during stimulation assisted breaths in all 22 paced subjects (range, 9.9–48.6%; p < 0.001). There were no adverse events either immediately or at 2-week follow-up.

Conclusions:
In this First-in-Human series, diaphragm pacing with a temporary catheter was safe and effectively contributed to ventilation in conjunction with a mechanical ventilator.
Atriobronchial Fistula Complicated by Septic Cerebral Air Emboli After Pulmonary Vein Ablation
Authors: Velghe David , Apers Thomas , Devriendt Stefanie , Deblier Ivo , Hendriks Bart , Nieuwendijk Rogier , Rogiers Peter 
Published: April 2017

Objective:
To describe a case of an infected atriobronchial fistula as a late complication after pulmonary vein ablation, leading to septic air emboli and requiring urgent cardiac surgery.

Data Sources:
Clinical observation.

Study Selection:
Case report.

Data Extraction:
Relevant clinical information. PubMed was searched for relevant literature.

Data Synthesis:
Given its high success and low complication rate, pulmonary vein isolation is expected to be increasingly performed worldwide. Despite its success, some of its rare complications are potentially devastating and are difficult to diagnose early. In this report, we present the case of a 32-year-old woman, who was readmitted to hospital 2 months after pulmonary vein ablation. The clinical picture resembled meningococcemia with spreading petechiae on legs and arms raising concern for Waterhouse-Friderichsen syndrome. Further echocardiographic investigation led to the discovery of massive amounts of intracardiac air which demanded urgent lung isolation and sternotomy. Intraoperatively a small infected left atrial perforation was oversewn and a fistula to the right main bronchus was closed by means of an autologous pericardial patch. One month later, still revalidating, she could be discharged home with only minor neurologic sequelae.

Conclusions:
Clinicians should be aware of the dramatic complications of invasive antiarrhythmic procedures and their atypical and late presentations. Better preprocedural appreciation of cardiac wall thickness, early echocardiographic diagnosis, and swift referral for cardiac surgery might impact outcome dramatically.
Adnexal Carcinomas Treated With Mohs Micrographic Surgery: A Comprehensive Review
Authors: Tolkachjov Stanislav N. 
Published: April 2017

BACKGROUND
Adnexal carcinomas (ACs) are rare cutaneous malignancies of sweat gland or pilosebaceous origin. Optimal treatment and metastatic potential of AC are poorly defined. Mohs micrographic surgery (MMS) has been increasingly used to treat AC.

OBJECTIVE
To review selected primary cutaneous AC and their treatment outcomes with MMS.

MATERIALS AND METHODS
Literature review using PubMed search for articles related to primary cutaneous ACs.

RESULTS
Sebaceous carcinoma treated with MMS recurred and metastasized in 6.4% and 3.7%, respectively. Primary cutaneous mucinous carcinoma treated with MMS recurred and metastasized in 9.6% and 6.4%, respectively. After MMS, 4.7% of microcystic AC recurred with no reported metastases. After MMS, recurrences and metastases of trichilemmal carcinoma or hidradenocarcinoma have not been reported. Two (4.2%) regional lymph node metastases but no distant metastases or local recurrences have been reported in eccrine porocarcinoma. Squamoid eccrine duct tumor, pilomatrix carcinoma, and spiradenocarcinoma treated with MMS are also reviewed.

CONCLUSION
The rarity of ACs and the lack of comparative data on treatment makes conclusive recommendations on treatment difficult. Recent large case series and reviews suggest MMS is a useful and possibly superior treatment for AC and should be considered if primary cutaneous disease is suspected.
Examination of the relationship between management and clinician perception of patient safety climate and patient satisfaction
Authors: Mazurenko Olena , Richter Jason , Kazley Abby Swanson , Ford Eric 
Published: April 2017

Purpose:
The aim of this study was to explore the relationship between managers and clinicians' agreement on deeming the patient safety climate as high or low and the patients' satisfaction with those organizations.

Data Sources/Study Setting:
We used two secondary data sets: the Hospital Survey on Patient Safety Culture (2012) and the Hospital Consumer Assessment of Healthcare Providers and Systems (2012).

Methodology/Approach:
We used ordinary least squares regressions to analyze the relationship between the extent of agreement between managers and clinicians' perceptions of safety climate in relationship to patient satisfaction. The dependent variables were four Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction scores: communication with nurses, communication with doctors, communication about medicines, and discharge information. The main independent variables were four groups that were formed based on the extent of managers and clinicians' agreement on four patient safety climate domains: communication openness, feedback and communication about errors, teamwork within units, and teamwork across units.

Findings:
After controlling for hospital and market-level characteristics, we found that patient satisfaction was significantly higher if managers and clinicians reported that patient safety climate is high or if only clinicians perceived the climate as high. Specifically, manager and clinician agreement on high levels of communication openness (β = 2.25, p = .01; β = 2.46, p = .05), feedback and communication about errors (β = 3.0, p = .001; β = 2.89, p = .01), and teamwork across units (β = 2.91, p = .001; β = 3.34, p = .01) was positively and significantly associated with patient satisfaction with discharge information and communication about medication. In addition, more favorable perceptions about patient safety climate by clinicians only yielded similar findings.

Practice Implications:
Organizations should measure and examine patient safety climate from multiple perspectives and be aware that individuals may have varying opinions about safety climate. Hospitals should encourage multidisciplinary collaboration given that staff perceptions about patient safety climate may be associated with patient satisfaction.
LABORATORY EVALUATION OF HYPERCOAGULABLE STATES IN PATIENTS WITH CENTRAL RETINAL VEIN OCCLUSION WHO ARE LESS THAN 56 YEARS OF AGE
Authors: Liu Qingyun , Lahey J. Michael , Karlen Rachel , Stewart Jay M. 
Published: April 2017

Purpose:
To investigate whether the results of early tests for hypercoagulability are correlated with the development of central retinal vein occlusion risk factors later in life and to evaluate the necessity of these tests in younger patients.

Methods:
This was a retrospective, observational case series. From January 1995 to December 2014, 55 patients aged below 56 years with central retinal vein occlusion (CRVO) were enrolled in the study. Laboratory evaluations for homocysteine, activated protein C resistance, protein C activity, protein S activity, antithrombin III activity, antiphospholipid antibodies, and anticardiolipin antibodies were obtained at the onset of CRVO. After 24 to 205 months, the presence of risk factors for CRVO such as hypertension, obesity, hyperlipidemia, diabetes mellitus, sleep apnea, and glaucoma was determined. Bilateral correlation and logistic regression were performed to determine the correlations between the results of the initial laboratory tests and the diagnosis of CRVO risk factors.

Results:
The median follow-up was 168.5 months. Five patients completed at least 24 months of follow-up, 9 patients completed at least 5 years, and 36 patients completed at least 10 years. Five patients had no or less than 24 months' follow-up. Fourteen of 50 patients (28%) had at least one positive test result at the onset of CRVO. At the end of follow-up, 11 patients had been diagnosed with obesity (22%), 29 with hypertension (58%), 21 with hyperlipidemia (42%), 24 with diabetes (8%), 5 with sleep apnea (10%), and 8 with glaucoma (16%). Among 36 patients with a minimum 10 years' follow-up, 30 (83%) developed at least one common risk factor, and none experienced any thromboembolic events. There were no correlations between test results and the diagnosis of any risk factors in patients with a minimum of 2, 5, or 10 years' follow-up (P > 0.05).

Conclusion:
The results of laboratory tests evaluating hypercoagulability in young patients with CRVO are not correlated with later-developed commonly known risk factors. Many of the common risk factors were present by the end of the study, suggesting that they still remain the core etiology for the disease. The value of the thrombophilic tests is brought into question, as none of the patients demonstrated further clotting or any unusual thrombi with long-term follow-up.
Enteric Fever in Children in Western Sydney, Australia, 2003–2015
Authors: Khatami Ameneh , Khan Fouzia , Macartney Kristine K. 
Published: April 2017

Background:
Enteric fever is a vaccine-preventable disease with cases in Australia predominantly acquired overseas. The aim of this study was to define the burden of enteric fever in children presenting to a pediatric hospital in Western Sydney between 2003 and 2015.

Methods:
Cases between January 2003 and December 2013 were ascertained through medical records using International Classification of Disease–coded discharge diagnoses, cross-referenced with microbiology laboratory data for all isolates of Salmonella enterica serovar typhi and S. enterica serovar paratyphi. Prospective cases from January 2014 to April 2015 were additionally captured through records maintained by the infectious diseases team.

Results:
Seventy-one cases of enteric fever were identified in 12.3 years with an average of 4 cases per year between 2003 and 2008 and 7 cases per year between 2009 and 2014. Two were visitors to Australia, 8 were recent migrants, and 59 were Australian residents returning from overseas travel. Two children had no history of overseas travel. Countries of travel predominantly included the Indian subcontinent (60/69) and Southeast Asia (7/69). Of 30 children with information available on pretravel medical consultation, 1 was offered and received typhoid vaccine. Ninety-four percent of children (67) required admission for 1–28 days (median: 5 days). Three children required readmission, with 1 case of presumed relapse. Ninety percent (64) were diagnosed by blood or stool culture with S. enterica serovar typhi the predominant organism (54/64).

Conclusions:
In Australia, hospitalizations for pediatric enteric fever appear to be increasing; predominantly occurring in Australian-resident children. Greater awareness and education are required for parents and clinicians regarding travel health risks and prevention strategies.
Long-term follow-up of patients with chronic hepatitis C treated with α-interferon and ribavirin antiviral therapy: clinical and fibrosis impact of treatment response
Authors: Cordero-Ruiz Patricia , Carmona-Soria Isabel , Rodríguez-Téllez Manuel , Caunedo-Alvarez Angel , Quezada-Pacheco Roberto H. , Flores-Cucho Alexander , Romero-Gómez Manuel , Vilches-Arenas Ángel 
Published: April 2017

Background and goals
The slow progression of chronic hepatitis C (CHC) infection requires long observation periods to detect clinical changes. We compare the incidence of clinical events, hepatocellular carcinoma (HCC), overall mortality, liver-related mortality, and fibrosis progression between patients with a sustained virological response (SVR) and nonresponders (NR) after a 13-year follow-up period.

Study
One hundred and eighty-two CHC patients, who received interferon and ribavirin treatment between 1996 and 2000, were included. Clinical events were evaluated during follow-up. At the end of follow-up, transient elastography was used to assess fibrosis progression.

Results
Of the 182 patients, 46.7% (n=85) achieved an SVR. Twenty-seven patients developed hepatic decompensation (one SVR) and 15 developed HCC (three SVR). Twenty-nine patients died (eight SVR). Twelve of the 29 deaths were liver related (two SVR). Independent factors associated with hepatic decompensation were NR to treatment [hazard ratio (HR)=23.35; 95% confidence interval (CI): 2.90–189.25; P=0.003], advanced fibrosis at baseline (HR=9.11; 95% CI: 4.13–20.09), and treatment delay after diagnosis (HR=1.02; 95% CI: 1.00–1.03; P=0.012). Only the latter two were associated with HCC development and liver-related mortality. An assessment of liver fibrosis was performed on 125 patients (66 SVR). Fibrosis values were significantly lower in SVR patients, showing less progression to advanced stages of fibrosis [SVR: 6.6 (2.8); 95% CI: 5.8–7.3] than NR [NR: 14.0 (11.1); 95% CI: 11.1–16.9; P<0.001].

Conclusion
In patients with CHC, SVR is durable and reduces clinical events. The risk of HCC development is lower, but not eliminated. Sustained responders showed fibrosis stabilization or improved fibrosis values.
Emergency Department Management of Bronchiolitis in the United States
Authors: Gong Constance , Byczkowski Terri , McAneney Constance , Goyal Monika K. , Florin Todd A. 
Published: April 2017

Objective
The aim of this study was to examine differences between general and pediatric emergency departments (PEDs) in adherence to the American Academy of Pediatrics bronchiolitis management guidelines.

Methods
We conducted a nationally representative study of ED visits by infants younger than 24 months with bronchiolitis from 2002 to 2011 using the National Hospital Ambulatory Medical Care Survey. Diagnostic testing (complete blood counts, radiographs) and medication use (albuterol, corticosteroids, antibiotics and intravenous fluids) in general emergency departments (GEDs) were compared with those in PEDs before and after 2006 American Academy of Pediatrics guideline publication. Weighted percentages were compared, and logistic regression evaluated the association between ED type and resource use.

Results
Of more than 2.5 million ED visits for bronchiolitis from 2002 to 2011, 77.3% occurred in GEDs. General emergency departments were more likely to use radiography (62.7% vs 42.1%; adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.4–4.1), antibiotics (41.3% vs 18.8%; aOR, 2.8; 95% CI, 1.5–5.2), and corticosteroids (24.3% vs 12.5%; aOR, 2.1; 95% CI, 1.0–4.5) compared with PEDs. Compared with preguideline, after guideline publication PEDs had a greater decrease in radiography use (−19.7%; 95% CI, −39.3% to −0.03%) compared with GEDs (−12.2%; 95% CI, −22.3% to −2.1%), and PEDs showed a significant decline in corticosteroid use (−12.4%; 95% CI, −22.1% to −2.8%), whereas GEDs showed no significant decline (−4.6%; 95% CI, −13.5% to 4.3%).

Conclusions
The majority of ED visits for bronchiolitis in the United States occurred in GEDs, yet GEDs had increased use of radiography, corticosteroids, and antibiotics and did not show substantial declines with national guideline publication. Given that national guidelines discourage the use of such tests and treatments in the management of bronchiolitis, efforts are required to decrease ED use of these resources in infants with bronchiolitis, particularly in GEDs.
Pelvic Inflammatory Disease in a Pediatric Emergency Department
Authors: Solomon Michelle , Tuchman Lisa , Hayes Katie , Badolato Gia , Goyal Monika K. 
Published: April 2017

Objectives
Most adolescent cases of pelvic inflammatory disease (PID) are diagnosed in the emergency department (ED). An important step to prevent PID-related morbidity among this high-risk population is to quantify prevalence and microbial patterns and identify testing and treatment gaps.

Methods
We performed a retrospective, cross-sectional study of all visits by adolescents to an urban children's ED with an International Classification of Diseases, Ninth Revision, diagnosis of PID in 2012. We used standard descriptive statistics to quantify PID diagnoses, sexually transmitted infections (STI) testing, and treatment.

Results
Pelvic inflammatory disease was diagnosed in more than 9% of women with a chief complaint of abdominal/pelvic pain. Most diagnosed cases underwent some STI testing, and 40% tested positive. Seventy percent of cases received antibiotics recommended by the Centers for Disease Control and Prevention.

Conclusions
There is a high prevalence of PID among adolescents in the pediatric ED. Rates of STI testing and appropriate treatment reveal gaps in diagnosis and management, representing a lost opportunity for identification and treatment of PID/STIs among high-risk adolescents.
Traumatic Abdominal Wall Hernia in Children by Handlebar Injury: When to Suspect, Scan, and Call the Surgeon
Authors: Rinaldi Victoria Elisa , Bertozzi Mirko , Magrini Elisa , Riccioni Sara , Di Cara Giuseppe , Appignani Antonino 
Published: April 2017

Abstract
Traumatic abdominal wall hernias (TAWHs) can be defined as a herniation through disrupted musculature and fascia associated with blunt trauma. They are seen in approximately 1% of patients with blunt abdominal trauma. Data on TAWH in the pediatric population are very limited and principally based on case reports and a few case series. Past reports have indicated that the presence of the “handlebar sign” confers an increased risk of internal injury. Concomitant internal injuries are reported with an incidence between 25% and 70%, and occult hernias may also occur and are usually detected only by abdominal computed tomography scan and ultrasonography. The treatment of TAWH consists in surgical exploration through closure of the defect. We describe 2 cases of TAWH due to blunt impact by bicycle handlebars that occurred in our department with a brief literature review. Our objectives are to describe the variable clinical presentations and management of these events. We hope to provide a useful tool for the clinician to increase early clinical suspicion and detection of this insidious injury.
Emergency Point-of-Care Ultrasound Diagnosis of Retained Soft Tissue Foreign Bodies in the Pediatric Emergency Department
Authors: Varshney Terry , Kwan Charisse W. , Fischer Jason W. , Abo Alyssa 
Published: April 2017

Abstract
The presence of a foreign body (FB), its depth and size, is often indeterminate by clinical examination. Conventional imaging such as a radiograph can fail to visualize soft tissue FBs. We present 2 cases where point-of-care ultrasound was used to detect previously unidentified FBs.
Phonetic characteristics of vocalizations during pain
Authors: Lautenbacher Stefan , Salinas-Ranneberg Melissa , Niebuhr Oliver , Kunz Miriam 
Published: April 2017

Abstract

Introduction and Objectives:
There have, yet, been only few attempts to phonetically characterize the vocalizations of pain, although there is wide agreement that moaning, groaning, or other nonverbal utterance can be indicative of pain. We studied the production of vowels “u,” “a,” “i”, and “schwa” (central vowel, sounding like a darker “e” as in hesitations like “ehm”)—as experimental approximations to natural vocalizations.

Methods:
In 50 students vowel production and self-report ratings were assessed during painful and nonpainful heat stimulation (hot water immersion) as well as during baseline (no-stimulation). The phonetic parameters extracted were pitch (mean F0), phonatory fluctuations (range F0) and loudness (acoustic energy level).

Results:
Only for the vowels “u” and “schwa,” which might be considered best approximations to moaning and groaning, did pitch and loudness increase during pain. Furthermore, changes from nonpainful to painful stimulations in these parameters also significantly predicted concurrent changes in pain ratings.

Conclusion:
Vocalization characteristics of pain seem to be best described by an increase in pitch and in loudness. Future studies using more specific and comprehensive phonetic analyses will surely help to provide an even more precise characterization of vocalizations because of pain.