bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and Safety of Pirfenidone in Patients with Second-Degree Burns: A Proof-of-Concept Randomized Controlled Trial
Authors: Mecott Gabriel A. , González-Cantú Iván , Dorsey-Treviño Edgar Gerardo , Matta-Yee-Chig Daniel , Saucedo-Cárdenas Odila , Montes de Oca-Luna Roberto , Pérez-Porras Sergio , García-Pérez Mauricio M. 
Published: March 2020

ABSTRACT

OBJECTIVE
Several studies suggest that pirfenidone may have a potential off-label use for wound healing. However, the effectiveness of this medication in patients with burns remains uncertain. Accordingly, investigators sought to assess wound re-epithelialization in patients with second-degree burns after adding pirfenidone to usual care.

DESIGN AND SETTING
Single-center pilot, proof-of-concept, single-blind randomized controlled trial.

PATIENTS AND INTERVENTION
Eight patients with second-degree burns were treated with occlusive hydrocolloid dressings and were randomly allocated to receive either no additional treatment or pirfenidone.

OUTCOME MEASURES
The primary outcome of the study was to evaluate wound healing between groups based on the thickness of the re-epithelialized epidermis at day 7. Secondary outcomes were to qualitatively assess the development of fibrotic tissue in the dermis, anomalies in the basal membrane, and the development of collagen fibers by histologic analysis. Liver and renal functions were measured daily to assess the overall safety of oral pirfenidone.

MAIN RESULTS
Patients treated with pirfenidone showed a remarkable improvement in wound re-epithelialization at day 7 (148.98 ± 13.64 vs 119.27 ± 15.55 μm; P = .029; 95% confidence interval, 4.14-55.29). Histologic evaluations showed less wound fibrosis in the pirfenidone group.

CONCLUSIONS
A decrease in wound healing time by enhancing wound re-epithelialization was observed with pirfenidone. Larger clinical trials are needed to reach more reliable conclusions.
Unique features of non-IgE-mediated gastrointestinal food allergy during infancy in Japan
Authors: Yamada Yoshiyuki 
Published: March 2020

Purpose of reviewAn increase in incidence of unique phenotypic non-IgE-mediated gastrointestinal food allergies (non-IgE GIFAs) has occurred in Japan ahead of Western countries. There are differences in clinical features of non-IgE GIFAs in Western and Japanese patients. As this phenotype has now come to be recognized internationally, we describe it in this review.Recent findingsA large number of Japanese patients with non-IgE GIFAs present with vomiting accompanied by bloody stool, putting them between food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis. Some neonates and early infants with non-IgE GIFAs who present with fever and elevated C-reactive protein have symptoms consistent with severe systemic bacterial infections (e.g., sepsis). Some of these cases have now been defined in international guidelines as chronic FPIES. Eosinophils might be involved in the inflammatory process observed. The incidence of FPIES and food protein-induced allergic proctocolitis is increasing in Western countries and likely worldwide, after it has increased in Japan.SummaryThe phenotype observed in Japan shows distinct clinical features compared with the classical phenotype, that is, increased levels of eosinophils, suggestive of ‘eosinophilic shift’ alongside symptomatic differences, making it difficult to categorize.
Altered Global Brain Signal during Physiologic, Pharmacologic, and Pathologic States of Unconsciousness in Humans and Rats
Authors: Tanabe Sean , Huang Zirui , Zhang Jun , Chen Yali , Fogel Stuart , Doyon Julien , Wu Jinsong , Xu Jianghui , Zhang Jianfeng , Qin Pengmin , Wu Xuehai , Mao Ying , Mashour George A. , Hudetz Anthony G. , Northoff Georg 
Published: March 2020

Abstract

Background
Consciousness is supported by integrated brain activity across widespread functionally segregated networks. The functional magnetic resonance imaging–derived global brain signal is a candidate marker for a conscious state, and thus the authors hypothesized that unconsciousness would be accompanied by a loss of global temporal coordination, with specific patterns of decoupling between local regions and global activity differentiating among various unconscious states.

Methods
Functional magnetic resonance imaging global signals were studied in physiologic, pharmacologic, and pathologic states of unconsciousness in human natural sleep (n = 9), propofol anesthesia (humans, n = 14; male rats, n = 12), and neuropathological patients (n = 21). The global signal amplitude as well as the correlation between global signal and signals of local voxels were quantified. The former reflects the net strength of global temporal coordination, and the latter yields global signal topography.

Results
A profound reduction of global signal amplitude was seen consistently across the various unconscious states: wakefulness (median [1st, 3rd quartile], 0.46 [0.21, 0.50]) versus non-rapid eye movement stage 3 of sleep (0.30 [0.24, 0.32]; P = 0.035), wakefulness (0.36 [0.31, 0.42]) versus general anesthesia (0.25 [0.21, 0.28]; P = 0.001), healthy controls (0.30 [0.27, 0.37]) versus unresponsive wakefulness syndrome (0.22 [0.15, 0.24]; P < 0.001), and low dose (0.07 [0.06, 0.08]) versus high dose of propofol (0.04 [0.03, 0.05]; P = 0.028) in rats. Furthermore, non-rapid eye movement stage 3 of sleep was characterized by a decoupling of sensory and attention networks from the global network. General anesthesia and unresponsive wakefulness syndrome were characterized by a dissociation of the majority of functional networks from the global network. This decoupling, however, was dominated by distinct neuroanatomic foci (e.g., precuneus and anterior cingulate cortices).

Conclusions
The global temporal coordination of various modules across the brain may distinguish the coarse-grained state of consciousness versus unconsciousness, while the relationship between the global and local signals may define the particular qualities of a particular unconscious state.

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Individualized Fluid Management Using the Pleth Variability Index
Authors: Fischer Marc-Olivier , Lemoine Sandrine , Tavernier Benoît , Bouchakour Chems-Eddine , Colas Vincent , Houard Marion , Greub William , Daccache Georges , Hulet Christophe , Compère Vincent , Taing Diane , Lorne Emmanuel , Parienti Jean-Jacques , Hanouz Jean-Luc ,   for the Optimization using the Pleth Variability Index (OPVI) Trial Group
Published: March 2020

Background
The present trial was designed to assess whether individualized strategies of fluid administration using a noninvasive plethysmographic variability index could reduce the postoperative hospital length of stay and morbidity after intermediate-risk surgery.

Methods
This was a multicenter, randomized, nonblinded parallel-group clinical trial conducted in five hospitals. Adult patients in sinus rhythm having elective orthopedic surgery (knee or hip arthroplasty) under general anesthesia were enrolled. Individualized hemodynamic management aimed to achieve a plethysmographic variability index under 13%, and the standard management strategy aimed to maintain a mean arterial pressure above 65 mmHg during general anesthesia. The primary outcome was the postoperative hospital length of stay decided by surgeons blinded to the group allocation of the patient.

Results
In total, 447 patients were randomized, and 438 were included in the analysis. The mean hospital length of stay ± SD was 6 ± 3 days for the plethysmographic variability index group and 6 ± 3 days for the control group (adjusted difference, 0.0 days; 95% CI, −0.6 to 0.5; P = 0.860); the theoretical postoperative hospital length of stay was 4 ± 2 days for the plethysmographic variability index group and 4 ± 1 days for the control group (P = 0.238). In the plethysmographic variability index and control groups, serious postoperative cardiac complications occurred in 3 of 217 (1%) and 2 of 224 (1%) patients (P = 0.681), acute postoperative renal failure occurred in 9 (4%) and 8 (4%) patients (P = 0.808), the troponin Ic concentration was more than 0.06 μg/l within 5 days postoperatively for 6 (3%) and 5 (2%) patients (P = 0.768), and the postoperative arterial lactate measurements were 1.44 ± 1.01 and 1.43 ± 0.95 mmol/l (P = 0.974), respectively.

Conclusions
Among intermediate-risk patients having orthopedic surgery with general anesthesia, fluid administration guided by the plethysmographic variability index did not shorten the duration of hospitalization or reduce complications.

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An Effective and Efficient Testing Protocol for Diagnosing Iron-deficiency Anemia Preoperatively
Authors: Okocha Obianuju , Dand Hardik , Avram Michael J. , Sweitzer BobbieJean 
Published: March 2020

Background
Iron-deficiency anemia is a common perioperative condition and increases perioperative morbidity and mortality. Timely diagnosis and treatment are important. This retrospective cohort study tested the hypothesis that a newly developed preprocedure evaluation protocol diagnoses more patients with iron-deficiency anemia than the traditional practice of obtaining a complete blood count followed by iron studies.

Methods
The preprocedure anemia evaluation is an order for a complete blood count and reflex anemia testing, which can be completed with a single patient visit. A hemoglobin concentration of 12 g/dl or less with serum ferritin concentration less than 30 ng/ml or transferrin saturation less than 20% defined iron-deficiency anemia. Northwestern Medicine’s database was queried for preoperative clinic patients, age 16 to 89 yr, before (2015 to 2016) and after (2017 to 2018) protocol implementation. The proportion of patients diagnosed with iron-deficiency anemia before and after the preprocedure anemia evaluation implementation was compared.

Results
Before implementing the protocol, 8,816 patients were screened with a traditional complete blood count. Subsequent iron studies at the providers’ discretion diagnosed 107 (1.2%) patients with iron-deficiency anemia. Some patients were still screened with a complete blood count after implementing the protocol; 154 of 4,629 (3.3%) patients screened with a complete blood count and 738 of 2,828 (26.1%) patients screened with the preprocedure anemia evaluation were diagnosed with iron-deficiency anemia. The preprocedure anemia evaluation identified a far larger proportion of patients with iron-deficiency anemia than did the traditional complete blood count when compared both before (relative risk [95% CI], 21.5 (17.6 to 26.2); P < 0.0001) and after (7.8 [6.6 to 9.3]; P < 0.0001) its implementation.

Conclusions
The preprocedure anemia evaluation improved identification of iron-deficiency anemia preoperatively. It is more effective and efficient, allowing anemia evaluation with a single patient visit.

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Response of Chinese Anesthesiologists to the COVID-19 Outbreak
Authors: Zhang Hong-Fei , Bo Lulong , Lin Yun , Li Feng-Xian , Sun Shujun , Lin Hong-Bin , Xu Shi-Yuan , Bian Jinjun , Yao Shanglong , Chen Xiangdong , Meng Lingzhong , Deng Xiaoming 
Published: March 2020

Abstract
The coronavirus disease 2019, named COVID-19 officially by the World Health Organization (Geneva, Switzerland) on February 12, 2020, has spread at unprecedented speed. After the first outbreak in Wuhan, China, Chinese anesthesiologists encountered increasing numbers of infected patients since December 2019. Because the main route of transmission is via respiratory droplets and close contact, anesthesia providers are at a high risk when responding to the devastating mass emergency. So far, actions have been taken including but not limited to nationwide actions and online education regarding special procedures of airway management, oxygen therapy, ventilation support, hemodynamic management, sedation, and analgesia. As the epidemic situation has lasted for months (thus far), special platforms have also been set up to provide free mental health care to all anesthesia providers participating in acute and critical caring for COVID-19 patients. The current article documents the actions taken, lesson learned, and future work needed.
Perioperative Management of Patients Infected with the Novel Coronavirus
Authors: Chen Xiangdong , Liu Yanhong , Gong Yahong , Guo Xiangyang , Zuo Mingzhang , Li Jun , Shi Wenzhu , Li Hao , Xu Xiaohan , Mi Weidong , Huang Yuguang 
Published: March 2020

Abstract
The outbreak of the new Coronavirus disease, COVID-19, has been involved in 77,262 cases in China as well as in 27 other countries as of February 24, 2020. Because the virus is novel to human beings, and there is no vaccine yet available, every individual is susceptible and can become infected. Healthcare workers are at high risk, and unfortunately, more than 3,000 healthcare workers in China have been infected. Anesthesiologists are among healthcare workers who are at an even higher risk of becoming infected because of their close contact with infected patients and high potential of exposure to respiratory droplets or aerosol from their patients’ airways. In order to provide healthcare workers with updated recommendations on the management of patients in the perioperative setting as well as for emergency airway management outside of the operating room, the two largest anesthesia societies, the Chinese Society of Anesthesiology (CSA) and the Chinese Association of Anesthesiologists (CAA) have formed a task force to produce the recommendations. The task force hopes to help healthcare workers, particularly anesthesiologists, optimize the care of their patients and protect patients, healthcare workers, and the public from becoming infected. The recommendations were created mainly based on the practice and experience of anesthesiologists who provide care to patients in China. Therefore, adoption of these recommendations outside of China must be done with caution, and the local environment, culture, uniqueness of the healthcare system, and patients’ needs should be considered. The task force will continuously update the recommendations and incorporate new information in future versions.
Medial patellofemoral ligament reconstruction using a partial-thickness quadriceps tendon graft: Short-term clinical outcome retrospective case series
Authors: Elbarbary Ahmed Naser , Fotoh Dina Salem , Badr Ismail Tawfeek 
Published: March 2020

Background:
The medial patellofemoral ligament (MPFL) is considered the primary restraint to lateral patellar translation. Many of the reconstruction techniques proposed recently for patellar instability require bony procedures and implant use on the patellar or femoral side. The aim of this study was to describe the short-term clinical outcomes of MPFL reconstruction using a partial-thickness quadriceps tendon graft.

Methods:
Seven patients (two men, five women; mean age 23.7±4.1 yr) with chronic patellar instability had MPFL reconstruction using a partial-thickness quadriceps tendon graft. Patients were clinically and radiographically evaluated, and a Tegner-Lysholm score obtained preoperatively and at 6 and 12 mo postoperatively.

Results:
The mean follow-up period was 18.8 mo (range, 12–30 mo). The mean Tegner-Lysholm score improved from 63±7.9 preoperatively to 89.2±6.1 postoperatively (at 12 mo). Apprehension test was negative in all patients. No redislocation, subluxation, or complications were reported during the follow-up period.

Conclusions:
MPFL reconstruction with a partial-thickness quadriceps tendon graft was effective and was associated with good short-term clinical outcomes without the need for patellar bone tunnels and without complications.

Level of Evidence:
Level IV.
Therapeutic Drug Monitoring of Dalbavancin Treatment in Severe Necrotizing Fasciitis in 3 Critically Ill Patients: A Grand Round
Authors: Corona Alberto , Agarossi Andrea , Veronese Alice , Cattaneo Dario , D'Avolio Antonio 
Published: March 2020

Background:
Dalbavancin, albeit indicated for the treatment of skin structure infections, is used for a much wider range of infections. This drug is characterized by a long half-life (more than 200 hours), a favorable safety profile, and an activity against a wide array of gram-positive organisms, including several strains of Staphylococci and Enterococci.

Methods:
In this study, we presented 3 cases of critically ill patients treated with dalbavancin. All patients were therapeutically monitored for plasma dalbavancin concentrations; ultrafiltrate dalbavancin concentrations were assessed in a patient undergoing continuous renal-replacement therapy. Dalbavancin concentrations were measured using a validated liquid chromatographic method coupled with mass spectrometry.

Results:
All 3 severely ill patients experiencing necrotizing fasciitis were successfully treated during the acute phase with dalbavancin. Dalbavancin clearance in patient 3 (0.334 L/h) was considerably increased compared with values measured in the other 2 patients (0.054 and 0.075 L/h) and with data reported in the literature (0.04–0.06 L/h).

Conclusions:
Our case reports presented preliminary evidence that dalbavancin can be considered a therapeutic option for necrotizing fasciitis in intensive care unit patients. The role of hypoalbuminemia during dalbavancin exposure merits further investigation.
Reconstruction of Upper Extremity Defects by Random Pedicle Abdominal Flaps: Is It Still a Valid Option?
Authors: Jabaiti Samir , Ahmad Muayyad , AlRyalat Saif Aldeen 
Published: March 2020

Background:
Traumatic soft tissue defects of the hand and upper extremities are common and may be challenging to the reconstructive surgeon. Several reconstructive procedures such as use of local, regional, distant, and free flaps have been described. This study aimed to report the techniques, outcomes, and complications of pedicle abdominal flaps in reconstructing hand and upper extremity defects.

Methods:
In this retrospective study, we included patients with different traumatic defects in the hand and upper extremities who underwent reconstruction by random pedicle abdominal flaps between 2002 and 2017 at Jordan University Hospital, Jordan. Data were collected and analyzed, and the variables studied included patient age and sex, etiology and size of the defect, complications, outcomes, and the need for further revision procedures. Appropriate statistical analysis was used to examine the potential factors affecting flap survival.

Results:
We included a total of 34 patients with a mean age of 22.2 years, ranging from 1 to 54 years. Finger degloving was seen in approximately half of the patients. Flap survival rate was 85.3%. A small area of defect was the only risk factor that significantly affected the flap failure rate.

Conclusions:
Thin pedicle abdominal flaps are a valid, affordable, and safe option in upper extremity traumatic defects, especially in situations where microsurgical techniques are unavailable or contraindicated. Extra care should be taken when the defect surface area is small.
Evaluation of elevated heart rate as a sympathetic nervous system biomarker in essential hypertension
Authors: Esler Murray , Lambert Gavin , Esler Danielle , Ika Sari Carolina , Guo Ling , Jennings Garry 
Published: March 2020

Background:
There is a need for an easily accessible biomarker of sympathetic nervous activation in essential hypertension, but none exists. Heart rate (HR) has been suggested, but requires validation, now doubly important as an elevated HR in hypertension has emerged as an independent cardiovascular risk factor.

Methods:
Isotope dilution methodology was used to measure total and regional noradrenaline spillover and adrenaline secretion rates in 30 patients with unmedicated essential hypertension and in a comparator group of 48 healthy participants with normal blood pressure. The particular interest was in the relationship of measured HR to cardiac noradrenaline spillover, the measure of cardiac sympathetic activity.

Results:
Sympathetic activation was present in the patients with essential hypertension, evident in significantly increased mean cardiac, renal and total noradrenaline spillover rates. Adrenaline secretion was normal. HR in hypertension correlated directly with cardiac noradrenaline spillover (r = 0.82, P = 9.3 × 10–5), but not with renal noradrenaline spillover or adrenaline secretion. 67% of the variance in HR was attributable to differences in cardiac sympathetic activity. Among hypertensive patients there was no internal correlation between cardiac noradrenaline spillover, renal noradrenaline spillover and adrenaline secretion; the sympathetic activation commonly was not ‘global’. In healthy participants HR did not correlate with measures of sympathetic activity or adrenaline secretion.

Conclusion:
When sympathetic activation exists in essential hypertension it is differentiated, not necessarily involving all sympathetic outflows. An elevated HR proved to be a biomarker of cardiac sympathetic activation but not activation of the renal sympathetic outflow. Identifying activation of the cardiac sympathetic outflow as the prime mechanism of hypertension tachycardia is relevant to therapies which should now be considered to minimize cardiovascular risk in this clinical setting. Is an elevated HR a valid biomarker of sympathetic activation in essential hypertension? Yes, but only for the cardiac sympathetic outflow. The unavoidable principle is that regional differentiation of sympathetic responses in essential hypertension means that no simple test can ever represent each and every sympathetic outflow.
PARACENTRAL ACUTE MIDDLE MACULOPATHY IN A CASE OF HIGH-FLOW DIRECT CAROTID CAVERNOUS FISTULA
Authors: Ho Chi Yun Doreen , Yan Bernard , Symons Robert C. Andrew , Hardy Thomas G. 
Published: March 2020

Purpose:
To report a case of paracentral acute middle maculopathy in a patient with high-flow carotid cavernous fistula.

Methods:
A case report of a 53-year-old male patient who sustained an iatrogenic high-flow carotid cavernous fistula and secondary paracentral acute middle maculopathy.

Results:
At review 1-week postembolization of the carotid cavernous fistula, there was no significant improvement in visual acuity, tests of optic nerve function, external ophthalmoplegia, and ptosis. Spectral domain optical coherence tomography was performed, which revealed hyperreflectivity of the parafoveal plexiform layers of the right eye with ill-defined margins straddling the inner nuclear layer.

Conclusion:
We suggest that spectral domain optical coherence tomography be performed in cases of high-flow direct carotid cavernous fistula where the best-corrected visual acuity is reduced out of keeping with other ophthalmic manifestations.