bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinically Significant Pleural Effusion in Intensive Care: A Prospective Multicenter Cohort Study
Authors: Fysh Edward T. H. , Smallbone Portia , Mattock Nicholas , McCloskey Cassandra , Litton Edward , Wibrow Bradley , Ho Kwok M. , Lee Y. C. Gary 
Published: January 2020

Objectives:
The prevalence and optimal management of clinically significant pleural effusion, confirmed by thoracic ultrasound, in the critically ill is unknown. This study aimed to determine: 1) the prevalence, characteristics, and outcomes of patients treated in intensive care with clinically significant effusion and 2) the comparative efficacy and safety of pleural drainage or expectant medical management.

Design:
A prospective multicenter cohort study.

Setting:
ICUs in four teaching hospitals in Western Australia.

Patients:
Consecutive patients with clinically significant pleural effusions (depth ≥ 2 cm on thoracic ultrasound with clinician-determined adverse effects on patient progress).

Interventions:
None.

Measurements and Main Results:
Primary outcome was the change in Pao
2:Fio
2 (mm Hg) ratio from baseline to 24 hours. Changes in diagnosis and treatment based on pleural fluid analysis and pleural effusion related serious adverse events between those who underwent either drainage within 24 hours or expectant management were compared. Of the 7,342 patients screened, 226 patients (3.1%) with 300 pleural effusions were enrolled. Early drainage of pleural effusion occurred in 76 patients (34%) and significantly improved oxygenation (Pao
2:Fio
2 ratio 203 at baseline vs 263 at 24 hr, +29.6% increment; p < 0.01). This was not observed in the other 150 patients who had expectant management (Pao
2:Fio
2 ratio 250 at baseline vs 268 at 24 hr, +7.2% increment; p = 0.44). The improvement in oxygenation after early drainage remained unchanged after adjustment for a propensity score on the decision to initiate early drainage. Pleural effusion related serious adverse events were not different between the two groups (early drainage 10.5% vs no early drainage 16.0%; p = 0.32). Improvements in diagnosis were noted in 91 initial (nonrepetitive) drainages (76.5% out of 119); treatment strategy was optimized after 80 drainage episodes (59.7% out of 134).

Conclusions:
Early drainage of clinically significant pleural effusion was associated with improved oxygenation and diagnostic accuracy without increased complications.
A Carotid Doppler Patch Accurately Tracks Stroke Volume Changes During a Preload-Modifying Maneuver in Healthy Volunteers
Authors: Kenny Jon-Émile S. , Barjaktarevic Igor , Eibl Andrew M. , Parrotta Matthew , Long Bradley F. , Eibl Joseph K. , Michard Frederic 
Published: January 2020

Objectives:
Detecting instantaneous stroke volume change in response to altered cardiac preload is the physiologic foundation for determining preload responsiveness.

Design:
Proof-of-concept physiology study.

Setting:
Research simulation laboratory.

Subjects:
Twelve healthy volunteers.

Interventions:
A wireless continuous wave Doppler ultrasound patch was used to measure carotid velocity time integral and carotid corrected flow time during a squat maneuver. The Doppler patch measurements were compared with simultaneous stroke volume measurements obtained from a noninvasive cardiac output monitor.

Measurements and Main Results:
From stand to squat, stroke volume increased by 24% while carotid velocity time integral and carotid corrected flow time increased by 32% and 9%, respectively. From squat to stand, stroke volume decreased by 13%, while carotid velocity time integral and carotid corrected flow time decreased by 24% and 10%, respectively. Both changes in carotid velocity time integral and corrected flow time were closely correlated with changes in stroke volume (r
2 = 0.81 and 0.62, respectively). The four-quadrant plot found a 100% concordance rate between changes in stroke volume and both changes in carotid velocity time integral and changes in corrected flow time. A change in carotid velocity time integral greater than 15% predicted a change in stroke volume greater than 10% with a sensitivity of 95% and a specificity of 92%. A change in carotid corrected flow time greater than 4% predicted a change in stroke volume greater than 10% with a sensitivity of 90% and a specificity of 92%.

Conclusions:
In healthy volunteers, both carotid velocity time integral and carotid corrected flow time measured by a wireless Doppler patch were useful to track changes in stroke volume induced by a preload-modifying maneuver with high sensitivity and specificity.
Discrepancies in Control Group Mortality Rates Within Studies Assessing Topical Antibiotic Strategies to Prevent Ventilator-Associated Pneumonia: An Umbrella Review
Authors: Hurley James C. 
Published: January 2020

Objectives:
To test the postulate that concurrent control patients within ICUs studying topical oropharyngeal antibiotics to prevent ventilator-associated pneumonia and mortality would experience spillover effects from the intervention.

Data Sources:
Studies cited in 15 systematic reviews of various topical antibiotic and other infection prevention interventions among ICU patients.

Study Selection:
Studies of topical antibiotics, stratified into concurrent control versus nonconcurrent control designs. Studies of nondecontamination-based infection prevention interventions provide additional points of reference. Studies with no infection prevention intervention provide the mortality benchmark. Data from additional studies and data reported as intention to treat were used within sensitivity tests.

Data Extraction:
Mortality incidence proportion data, mortality census, study characteristics, group mean age, ICU type, and study publication year.

Data Synthesis:
Two-hundred six studies were included. The summary effect sizes for ventilator-associated pneumonia and mortality prevention derived in the 15 systematic reviews were replicated. The mean ICU mortality incidence for concurrent control groups of topical antibiotic studies (28.5%; 95% CI, 25.0–32.3; n = 41) is higher versus the benchmark (23.7%; 19.2–28.5%; n = 34), versus nonconcurrent control groups (23.5%; 19.3–28.3; n = 14), and versus intervention groups (24.4%; 22.1–26.9; n = 62) of topical antibiotic studies. In meta-regression models adjusted for group-level characteristics such as group mean age and publication year, concurrent control group membership within a topical antibiotic study remains associated with higher mortality (p = 0.027), whereas other group memberships, including membership within an antiseptic study, are each neutral (p = not significant).

Conclusions:
Within topical antibiotic studies, the concurrent control group mortality incidence proportions are inexplicably high, whereas the intervention group mortality proportions are paradoxically similar to a literature-derived benchmark. The unexplained ventilator-associated pneumonia and mortality excess in the concurrent control groups implicates spillover effects within studies of topical antibiotics. The apparent ventilator-associated pneumonia and mortality prevention effects require cautious interpretation.
Development of a Mass Spectrometry-Based Method for Quantification of Ustekinumab in Serum Specimens
Authors: Scheffe Nina , Schreiner Rupert , Thomann Anne , Findeisen Peter 
Published: January 2020

Background:
Ustekinumab (UST) is a human monoclonal antibody used to treat moderate-to-severe Crohn disease by blocking the interleukin-12/23 pathway. Although an optimized therapeutic concentration of UST is associated with clinical response and improved prognosis, the availability of clinical laboratory methods for UST monitoring is limited. Furthermore, the commercially available methods are immunoassays that are prone to interference of antidrug antibodies. This study aimed to develop a liquid chromatography-tandem mass spectrometry method for quantification of UST in human serum specimens.

Methods:
A tryptic peptide that is specific to the heavy chain variable region of UST was selected. Quantification of UST was performed by selective reaction monitoring on a quadrupole TQ-XS with an internal standard. After digestion with trypsin, peptides were separated by reverse-phase C18 liquid chromatography; peptides were detected by MS/MS, and analyte to internal standard peak area ratios were used for the quantification. Finally, serum samples from patients treated with UST were collected at trough levels (n = 66).

Results:
The assay showed a broad dynamic range with linearity between 0.4 and 20 mg/L (R2 = 0.995). The lower limit of quantification was found to be 0.4 mg/L. The reproducibility was tested with 3 different UST concentrations (2, 8, and 16 mg/L). The coefficients of intra-assay and interassay variations were 2.2%–4.0% and 2.7%–5.3%, respectively. UST serum concentrations of 2–16 mg/L were stable for up to 14 days when specimens were left at room temperature (20°C).

Conclusions:
The newly developed LC/MS-based method was shown to be feasible for UST quantification. This analytical approach may lead to individualized dosing and improved patient care.
Use of the Propeller Lumbar Perforator Flap: A Series of 32 Cases
Authors: Falinower Hugo , Herlin Christian , Laloze Jérome , Bodin Frédéric , Kerfant Nathalie , Chaput Benoit 
Published: January 2020

Introduction:
Lumbosacral substance defect is a challenge in reconstructive surgery because few coverage solutions are available in this anatomical region. Lumbar artery perforator flaps (LAPs) have been progressively developed and make it possible to solve very complex situations. We report a multicenter study on LAP performed to treat medium and low lumbar defects of various etiologies, to highlight the versatility of this flap as well as its robustness and reproducibility.

Methods:
Between 2012 and 2019, 32 LAPs were performed in the Toulouse and Strasbourg University hospitals. Etiologies of the defects encountered were diverse: chronic wounds following neurosurgery, oncodermatology, burn sequelae, and ballistic injury. All LAPs were used in their pedicled form, turned as propeller, and combined or not with other flaps.

Results:
We treated 31 patients with 32 LAPs. Average flap size was 14.3 cm (range 8–26) × 6.5 cm (range 5–10), and average arc of rotation was 131.3 degrees (range 70–180 degrees). Only 4 patients (12.9%) presented partial necrosis, but required no other covering procedure because secondary healing was sufficient. No coverage failure was reported. Average follow-up duration was 9.7 months (range 1–18).

Conclusions:
In the case of lumbosacral defects of various etiologies, propeller LAP is a reliable and efficient surgical procedure, offering the advantage of low donor site morbidity. The reconstructive surgeon should propose this technique to patients as a first-line option where surgery is indicated.
Neurotoxin Impurities: A Review of Threats to Efficacy
Authors: Park Je-Young , Sunga Owen , Wanitphakdeedecha Rungsima , Frevert Jürgen 
Published: January 2020

Summary:
Recently launched esthetic botulinum toxin serotype A (BoNT/A) products include Nabota/Jeuveau, Meditoxin/Neuronox, and Botulax, which contain nontoxic accessory proteins and excipients. Clinical evidence supporting these formulations, including their purity and potential immunogenicity or their link to treatment failures, is limited. Any nonhuman protein, including nontoxin accessory proteins, can initiate immune reactions, especially if administered repeatedly, yet the issue of BoNT/A-induced immunogenicity is widely contested. However, there have been multiple reports of treatment failures and observations of BoNT/A-induced neutralizing antibodies. Compared with the purified formulation in Xeomin, these recently launched toxins contain higher total neurotoxin quantities, much of which is inactive and exposes patients to potentially immunogenic nontoxin proteins or inactive neurotoxins that increase their risk of developing treatment failure. Well-established products [especially abobotulinumtoxinA (Dysport), onabotulinumtoxinA (Botox) and Xeomin] are accompanied by comprehensive and long-ranging clinical evidence on safety and efficacy in esthetic facial indications, which still remains undisclosed for many of the recently introduced toxins. Clinicians need this information as patients will require repeated BoNT treatments and may be unnecessarily but cumulatively exposed to potential immunogens. To underscore the need for caution and further evidence, we review some of the issues surrounding BoNT/A-induced immunogenicity and antibody-induced treatment failures and argue that using highly purified toxins that do not negatively impact patient outcomes is a prudent clinical decision.
VITRECTOMY FOR STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS ASSOCIATED WITH OUTER RETINAL LAYER DEFECT
Authors: Moraes Bernardo R. M. , Ferreira Bruno F. A. , Nogueira Thiago M. , Nakashima Yoshitaka , Júnior Hélio P. Primiano , Souza Eduardo C. 
Published: January 2020

Purpose:
To describe a case of stellate nonhereditary idiopathic foveomacular retinoschisis associated with outer retinal layer defect treated with pars plana vitrectomy, internal limiting membrane removal, and C3F8 tamponade.

Methods:
Spectral-domain optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany) scans of a 46-year-old woman with unilateral stellate nonhereditary idiopathic foveomacular retinoschisis were acquired at baseline and 1, 3, 6, and 12 months after surgery.

Results:
Pars plana vitrectomy was performed after phacoemulsification. The vitreous was circumcised, and the internal limiting membrane was removed with a Tano brush, releasing tangential forces. The patient experienced progressive recovery of the outer retinal layers and improvement of visual acuity during follow-up.

Conclusion:
Stellate nonhereditary idiopathic foveomacular retinoschisis may be associated with outer retinal layer defect and severe vision loss. Pars plana vitrectomy with internal limiting membrane removal and C3F8 infusion seems to be a safe and feasible treatment in such cases, with potentially good anatomical and functional outcome.
Outcomes of prescription opioid dose escalation for chronic pain: results from a prospective cohort study
Authors: Morasco Benjamin J. , Smith Ning , Dobscha Steven K. , Deyo Richard A. , Hyde Stephanie , Yarborough Bobbi Jo H. 
Published: January 2020

Abstract
The use of long-term opioid therapy for chronic pain remains common, yet data on long-term outcomes, especially after dose escalation, are sparse. This study examined potential benefits and harms associated with prescription opioid dose escalation. Participants from 2 institutions were enrolled in a 2-year prospective cohort study. All participants (n = 517) had a musculoskeletal pain diagnosis and were receiving a stable dose of long-term opioid therapy at baseline. Participants completed self-report measures of pain, disability, depression, and potential adverse effects at baseline and every 6 months for 2 years. We reviewed electronic health record data weekly to identify episodes of prescription opioid dose escalation; participants who had increases in their dose were seen for additional research visits within 1 month of dose escalation. Over 2 years, 19.5% of participants had prescription opioid dose increases. After controlling for covariates, there were no significant changes on any variable after dose escalation. Of those with a dose increase, 3% experienced a clinically meaningful improvement in pain after dose escalation. Participants in the entire sample had small improvements in pain intensity, depressive symptoms, medication-related side effects, and lower risk for prescription opioid misuse during the study period. Sexual functioning worsened over time. There were no significant changes in the full sample on pain disability, sleep functioning, or experiencing a fall. In summary, patients prescribed stable doses of long-term opioid therapy may demonstrate small changes in key pain-related outcomes over time, but prescription opioid dose escalation status is unrelated to clinical outcomes.
A Systematic Review on the Effects of Nonpharmacological Sleep Interventions on Cardiometabolic Risk or Disease Outcomes
Authors: Li Polly W.C. , Yu Doris S.F. , Chong Sherry O.K. , Lin Rose S. Y. 
Published: January 2020

Background
Many authors of epidemiological studies have documented the detrimental effects of insufficient or poor sleep on cardiometabolic health. However, little is known about the effects of sleep interventions on the individuals with cardiometabolic risks/diseases.

Objectives
This systematic review aimed to evaluate the mediating effects of nonpharmacological sleep interventions, which were defined as interventions not involving the use of medications or invasive methods to alter sleep, on cardiometabolic outcomes among adults with cardiometabolic risks/diseases.

Methods
A systematic search of randomized controlled trials was conducted in 5 electronic databases from inception to November 2019. The Population, Intervention, Comparison and Outcomes of this review was the effects of nonpharmacological sleep interventions on sleep and cardiometabolic outcomes among the adults with cardiometabolic risks/diseases as compared with any control methods. Two reviewers independently assessed eligibility for inclusion and methodological quality. Narrative analysis was performed when meta-analysis was not appropriate.

Results
Nine studies met the inclusion criteria. These studies included exercise-based, sleep hygiene, and cognitive behavioral therapy interventions to improve sleep among adults who are overweight or obese and patients with type 2 diabetes and hypertension. All of the exercise-based interventions were effective in improving sleep, but not to an extent that can positively influence cardiometabolic health. The mediating effects on cardiometabolic risks were more apparent for the sleep hygiene and cognitive behavioral therapy interventions, despite the small number of pilot-scale studies in this area.

Conclusion
The mediating effects of sleep improvement on cardiometabolic risk/disease control were inconclusive. More research to examine the effect of sleep-related risk-factor modification on cardiovascular health is warranted.
Learning About HIV: Predicting the Sources of Knowledge That Matter Regarding HIV Testing Among a National Sample of Black and Latinx Adolescents and Young Adults in the United States
Authors: Boyd Donte , Lea Charles , Quinn Camille 
Published: January 2020

Abstract
This study investigated the knowledge and beliefs of a nationally representative sample of youth and young adults about HIV based on the microsystems and mesosystems of the ecodevelopmental theory. We used a stratified sample (n = 538) of Black and Latinx adolescents and young adults in the United States, 15–24 years of age, at risk of becoming infected with HIV to assess the source of their HIV knowledge and its association with HIV testing to identify modifiable factors that can support the development of interventions addressing HIV-related risks. Using a logistic regression analysis, findings suggest that identifying protective health behaviors, such as providing adolescents and young adults with sexual health information that is accurate, trustworthy, and safe, could be one way to reduce their risk of HIV infection. Expanding knowledge about the important role and influence of sources of HIV-related knowledge on testing behaviors can inform HIV prevention and intervention programs specific to this population.
Comparison of Hearing Preservation Outcomes Using Extended Versus Single-Dose Steroid Therapy in Cochlear Implantation
Authors: Gotamco Giselle L. , Chou Yi-Fan , Sun Chuan-Hung , Hsu Chuan-Jen , Chen Peir-Rong , Wu Hung-Pin 
Published: January 2020

Objectives:
The purpose of this study was to compare the hearing preservation outcomes of patients who received extended versus single-dose steroid therapy in cochlear implant surgery.

Design:
Case–control.

Setting:
Tertiary referral centers in Taiwan from April 2017 to 2019.

Participants:
A total of 70 patients aged 1 to 78 years old (mean = 18.04, standard deviation [SD] = 21.51) who received cochlear implantation via the round window approach were included in the study. Prospectively, 35 cases were enrolled for cochlear implantation with single-dose therapy. Thirty-five controls who underwent cochlear implantation with extended therapy were retrospectively enrolled after frequency matching.

Outcome Measures:
The main outcome measure was the rate of hearing preservation. This was calculated based on the HEARRING Network formula and results were categorized as complete, partial, and minimal. Impedances served as secondary outcomes.

Results:
There was no significant difference in the complete hearing preservation rates between the extended and single-dose groups at 6 months postoperatively. Impedances were significantly lower in the extended group after 1 month and 6 months of follow up. When the complete and partial hearing preservation groups were compared, the size of round window opening and speed of insertion were found to be statistically significant.

Conclusions:
Both extended and single-dose therapies result in good hearing preservation in patients who undergo cochlear implantation. However, better impedances can be expected from patients who received extended therapy. A slower speed of insertion and a widely opened round window play a role in hearing preservation.
High-Dose Furosemide Enhances the Magnetic Resonance Signal of Systemic Gadolinium in the Mammalian Cochlea
Authors: Videhult Pierre Pernilla , Rasmussen Jesper Edvardsson , Nikkhou Aski Sahar , Damberg Peter , Laurell Göran 
Published: January 2020

Hypothesis:
Furosemide alters the permeability of the intrastrial fluid–blood barrier.

Background:
The cochlear sensory cells are protected by the blood-perilymph and intrastrial fluid–blood barriers, which hinder substances, including gadolinium-based contrast agents (GdCAs), to enter the endolymphatic space. High-dose furosemide causes transient shift of hearing thresholds and morphological changes in stria vascularis. Furosemide is also known to enhance drug-induced ototoxicity.

Methods:
Furosemide (400 mg/kg b.w.) was injected i.v. in Balb/C mice (n = 20). Twenty minutes later, the GdCA gadobutrol, gadopentetic acid, or gadoteric acid was injected i.v. The distribution of GdCA to the perilymphatic and endolymphatic spaces was studied with MRI (9.4 T) for 250 minutes.

Results:
The perilymphatic and endolymphatic spaces were signal-enhanced in all animals. Gadopentetic acid and gadoteric acid yielded similar signal enhancement in all three scalae, while gadobutrol yielded significantly higher enhancement in scala tympani than scala media (p = 0.043) and scala vestibuli (p = 0.043). The signal enhancement reached a plateau but did not decrease during the time of observation.

Conclusion:
Treatment with a high dose of furosemide before injection of a GdCA resulted in enhancement of the MRI signal in the endolymphatic space as well as the perilymphatic space, which supports our hypothesis that furosemide alters the permeability of the intrastrial fluid–blood barrier.