bluuebunny/crossref_metadata_2025_split huggingface dataset:
Living conditions of patients with schizophrenia spectrum disorders in the region of ‘Tâmega e Sousa’ (Portugal)
Authors: Barranha Rui , Teixeira Tânia , Quarenta João , von Doellinger Orlando 
Published: October 2020

Background: Schizophrenia spectrum disorders (SSD) are the most impairing psychiatric disorders and are a major cause of social exclusion. Despite that, there are only two studies published assessing the socioeconomic characteristics of SSD patients living in Portugal. Aims: The purpose of this study is to assess the degree of social and family support for SSD patients living in the region of ‘Tâmega e Sousa’, in northern Portugal. Method: We conducted a cross-sectional observational study using patients under home-based care provided by the Department of Psychiatry and Mental Health of Centro Hospitalar do Tâmega e Sousa. We retrieved sociodemographic data from clinical records. The study was approved by the Hospital Ethics Committee. Results: Our sample consists on 67 patients with SSD, mostly men (74.6%). Although the majority was single (69.2%) and childless (85.7%), only a minority lived alone (21.2%). In relation to their professional status, only 5.0% were employed and 78.3% got a disability pension. Among the patients that lived accompanied, 68% lived with their parents or grandparents, and a quarter lived with family members affected by psychiatric disorders. Conclusions: These findings highlight the dependence of SSD patients on their family’s support. Lack of labour market integration, economic dependence and difficulty establishing stable relationships further aggravate their social exclusion. Although our results are consistent with a previous observational study held in Portugal, our patients display a worse functional status. Even considering the possible patient selection bias, there is evidence supporting the need for more investment in psychosocial rehabilitation that should take into account the sociodemographic idiosyncrasies of this Portuguese region.
Precondition of sevoflurane upregulates TIMP3 expression to alleviate myocardial ischemia/reperfusion injury
Authors: Wang Fen , Tong Hua 
Published: October 2020

Background: Previous studies have pointed out that sevoflurane (Sef) preconditioning could relieve myocardial ischemia/reperfusion (I/R) injury, but the mechanisms is still unknown. Methods: C57BL/6 mice model of myocardial I/R injury was established to evaluate the function of Sef. Briefly, Sef was inhaled before I/R operation. The levels of TIMP3, oxidative damage-related factors, and mitogen activated protein kinases (MAPKs) pathway-related factors were measured by qRT-PCR and western blot. Myocardial infarction (MI) area was detected by triphenyl tetrazolium chloride (TTC) staining assay. Results: Sef preconditioning reduced MI area in myocardial I/R injury mice and upregulated TIMP3 expression in myocardial tissues of I/R mice. In addition, downregulation of TIMP3 reversed the alleviating effects of Sef pretreatment on myocardial oxidative damage and inhibited the effect of Sef pretreatment on MAPKs pathway activity. Conclusion: Sef preconditioning ameliorated myocardial I/R injury by modulating MAPKs pathway activity via upregulating TIMP3.
Off-pump versus on-pump redo coronary artery bypass grafting: a systematic review and meta-analysis
Authors: Zhang Pengbin , Wang Liping , Zhai Kerong , Huang Jian , Wang Weifan , Ma Qi , Liu Debin , Gao Bingren , Li Yongnan 
Published: October 2020

Background: Redo coronary artery bypass grafting (redo CABG) is associated with increased mortality and morbidity. The aim of this study was to systematically evaluate the evidence comparing the outcomes of off-pump with on-pump redo CABG. Methods: Studies were systematically searched and identified using PubMed, EMBASE, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP) by two researchers independently. The primary outcome was 30-day mortality, and the secondary outcomes were in-hospital mortality, post-operative complications, completeness of revascularization, blood transfusion rate, duration of mechanical ventilation, intensive care unit and hospital stays. Results: The 21 studies including 4,889 patients were enrolled in our meta-analysis. Compared with on-pump, the off-pump technique was associated with significantly reduced 30-day mortality (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.26-0.72, p = 0.001). Moreover, a notably decreased in-hospital mortality (OR = 0.55, 95% CI = 0.39-0.76, p = 0.0004) and incidence of post-operative new-onset atrial fibrillation, myocardial infarction, acute kidney injury, low cardiac output state, blood transfusion rate (OR = 0.46, 95% CI = 0.35-0.60, p < 0.00001; OR = 0.54, 95% CI = 0.38-0.78, p = 0.0007; OR = 0.51, 95% CI = 0.37-0.70, p < 0.0001; OR = 0.31, 95% CI = 0.20-0.47, p < 0.00001; OR = 0.29, 95% CI = 0.14-0.61, p = 0.001) and significantly shortened duration of mechanical ventilation, intensive care unit and hospital stays (mean difference [MD] = −8.21 h, 95% CI = −11.74 to −4.68, p < 0.00001; MD = −0.77 d, 95% CI = −0.81 to −0.73, p < 0.00001; MD = −2.24 d, 95% CI = −3.17 to −1.32, p < 0.00001) could be observed when comparing the outcomes of off-pump with on-pump redo CABG. There was nonsignificant difference between off-pump and on-pump redo CABG in completeness of revascularization. Conclusion: In patients undergoing redo CABG surgery, the off-pump technique was associated with decreased mortality, less post-operative complications when compared to on-pump.
Mechanical thrombectomy for acute ischemic stroke in the posterior circulation: assessment of efficacy and outcome and identification of prognostic factors
Authors: Szmygin Maciej , Sojka Michał , Pyra Krzysztof , Tarkowski Piotr , Luchowski Piotr , Wojczal Joanna , Drelich-Zbroja Anna , Jargiełło Tomasz 
Published: October 2020

Background Mechanical thrombectomy (MT) is well-established in the treatment of acute ischemic anterior circulation stroke. However, there is no evidence from randomized trials or meta-analyses that MT is safe and effective in the treatment of patients with acute ischemic posterior circulation stroke (PCS). Purpose To evaluate the clinical and procedural factors associated with recanalization and outcome of patients with PCS treated with MT. Material and Methods Forty-three patients with PCS (median age 73 years) who underwent treatment with MT were included. Data including demographics, baseline stroke severity, radiological imaging, procedure and post-procedure complications were documented. Clinical outcome was evaluated using the modified Rankin Scale (mRS). The patients were classified into two groups based on clinical outcome (favorable vs. unfavorable mRS after 90 days). Results Median baseline National Institute of Health Stroke Scale (NIHSS) was 17. Twenty patients were eligible for intravenous thrombolysis and received recombinant tissue plasminogen activator before MT. Successful recanalization was observed in 88.4% of patients. After 90 days, favorable outcome (defined as mRS 0–2) was achieved in 26 patients; six patients had an unfavorable outcome (mRs >2). Final mortality rate was 25.5%. Baseline NIHSS, onset to reperfusion time, procedure duration, and successful recanalization had a statistically significant association with outcome. Failed recanalization and occurrence of intracranial hemorrhage were found to be associated with a higher mortality rate. Conclusion MT is feasible and effective method in treatment of PCS. Baseline NIHSS and onset to reperfusion time were found to be independent predictive factors of clinical outcome.
Stroke survivors’ occupational performance and cognitive strategy use: A pilot exploration of strengths and difficulties using the Perceive Recall Plan Perform System of Task Analysis
Authors: White Jocelyn , Nott Melissa T , Barr Chris , Chapparo Christine J , George Stacey 
Published: October 2020

Introduction The Perceive Recall Plan Perform System of Task Analysis is an ecological assessment of occupational performance and cognitive strategy application. This study aimed to describe occupational performance and cognitive strategies of stroke survivors in an early supported discharge service, compare the assessment with global measures of function and evaluate the feasibility of implementing the assessment in the early supported discharge setting. Method This study was a pilot study design and used consecutive sampling. Participants were assessed with the Perceive Recall Plan Perform System of Task Analysis and two global measures: the Functional Independence Measure and the Australian Modified Lawton’s Instrumental Activities of Daily Living Scale. Scores from the Perceive Recall Plan Perform System of Task Analysis were analysed by task mastery, sub-quadrants and quadrants, and correlations between the assessment and global measures were examined. Findings In this cohort ( n = 10), the Perceive Recall Plan Perform System of Task Analysis assessment required 47 minutes per task and identified reduced task mastery (mean = 55%, SD = 10%) with common difficulties in the perceive and plan domains. High to moderate correlations were identified between the plan quadrant and global measures ( p < 0.05). Conclusion Perceive Recall Plan Perform System of Task Analysis assessment can be successfully implemented by occupational therapists with stroke survivors receiving early supported discharge to measure occupational performance and identify strengths and difficulties in cognitive strategy application.
Evidence-Based Clinical Anatomy of the Popliteofibular Ligament and Its Importance in Orthopaedic Surgery: Cadaveric Versus Magnetic Resonance Imaging Meta-analysis and Radiological Study
Authors: Pękala Przemysław A. , Mann Mitchell R. , Pękala Jakub R. , Tomaszewski Krzysztof A. , LaPrade Robert F. 
Published: October 2020

Background: The popliteofibular ligament (PFL) is a static stabilizer of the posterolateral corner of the knee, preventing varus angulation, tibial rotation, and posterior translation. The PFL is anatomically variable, and there is no current review that outlines its prevalence rate and morphological variations. Purpose: To investigate the anatomic prevalence and morphological qualities of the PFL in various global patient populations via a meta-analysis of relevant literature involving both cadaveric dissections and patient-based research using magnetic resonance imaging (MRI) scans. Study Design: Meta-analysis. Methods: We pooled literature data detailing PFL prevalence rates and performed a retrospective MRI study of 100 knees to determine the overall PFL prevalence. Data searches and analyses were performed according to Anatomical Quality Assurance and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: There were 30 cadaveric studies and 11 MRI studies (including our radiological investigation), representing a total of 1595 lower limbs. The meta-analysis of cadaveric studies showed a higher prevalence of the PFL than the meta-analysis of MRI studies, with 98.4% (95% CI, 97.5%-99.2%) and 89.0% (95% CI, 73.9%-98.6%), respectively. Our MRI investigation reported a PFL prevalence of 92.0%. Conclusion: The PFL was found to be a constant or rarely absent anatomic structure of the human knee according to the analysis of cadaveric dissection studies, and it was identified notably less on MRI, albeit not significantly. Increasing PFL anatomic knowledge, including awareness of its prevalence and morphological diversity, will improve injury diagnoses, treatment methods, and prognoses.
Impacts of age, diabetes, gender, and access type on costs associated with vascular access among Chinese patients on hemodialysis
Authors: Xiong Yuqin , Yu Yang , Yang Yuan , Wang Liya , Shi Ping , Deng Yuchen , Li Yi , Fu Ping 
Published: October 2020

Objectives: Examine the impacts of age, diabetes, gender, and access type on vascular access (VA) associated costs among Chinese hemodialysis (HD) patients. Methods: We retrospectively included patients whose first permanent VA was created at the West China Hospital. Clinical characteristics, maturation, intervention, utilization, and exchange of every VA, as well as VA-related infection were collected. The study period for each patient was from HD initiation to the last follow-up. VA-related costs, including those for placement and intervention procedures, were calculated according to the standards set in 2019 for Chinese tertiary hospitals. Mann-Whitney U and Chi-square tests were conducted for comparisons between groups. Results: A total of 358 Chinese HD patients experienced functionally 143 arteriovenous fistula (AVF), 22 arteriovenous graft (AVG), and 439 tunneled cuffed central venous catheter (tcCVC) during a median study period of 26 (IQR 13–44) months, of which 42.5% used more than one permanent VA. The median annual VA-related cost in the groups of age >75 years and ⩽75 years, diabetes and non-diabetes, male and female, was $525 and $397 ( p = 0.016), $459 and $462 ( p = 0.64), $476 and $445 ( p = 0.94), respectively. The median monthly costs for AVF ($18), AVG ($289), and tcCVC ($37) were significantly different. Conclusion: HD patients aged >75 years had significantly higher annual VA-related costs. However, the annual VA-related costs did not differ across the diabetes groups or the gender groups. AVF was the most cost-effective permanent VA type in China, partly due to the inexpensive materials used compared to AVG or tcCVC.
“Endourological closure of a malformative vascular source of bleeding using the VortX 0.018” coil®”
Authors: De Gobbi Alberto , Barbisan Davide , Ciaccia Matteo , Cova Giandavide , Farneti Fabrizio , Maccatrozzo Luigino , Mangano Mario Salvatore 
Published: October 2020

Aims: Renal vascular malformations, congenital or acquired, are sometimes challenging for urologists and interventional radiologists to resolve. Arterovenous fistulas and pseudoaneuryms are usually embolized by interventional radiologists, with a low rate of complications. We propose a new endourological/interventional radiology technique to treat a source of arterovenous bleeding coming from a renal calyx in a minimally invasive way. Methods: A combined endourological and interventional radiology procedure is described, using a Flexible Fiberoptic Ureteroscopes to undertake a retrograde intrarenal surgery (RIRS) to identify the source of bleeding; subsequently the VortX Coil® is inserted through a microcatheter to stop the bleeding and the correct position of the VortX coil is evaluated. Furthermore, we made a literature research on Pubmed and Medline to look for similar procedures. Results: In case of a renal bleeding that could not be treated by endovascular way, a combined urological and interventional radiology procedure can be undertaken. We did not find similar endourological and interventional radiology procedure on Pubmed and Medline, so this is the first tecnique of endourological closure of a bleeding point using a coil. Conclusion: From our experience this could be a mininvasive technique to solve renal bleedings coming from a calyx that are not found by endovascular approach. Indeed, in our knowledge, the technique here described is the first that provides the use of an endovascular coil by endourological way in renal vascular malformations.
Patterns of Primary Care Use Prior to a First Diagnosis of Nonaffective Psychotic Disorder in Ontario, Canada: Modèles d’utilisation des soins de première ligne avant un premier diagnostic de trouble psychotique non affectif en Ontario, Canada
Authors: Schoer Nicole , Rodrigues Rebecca , Reid Jennifer , Ryan Bridget L. , Lizotte Daniel J. , Booth Richard , MacDougall Arlene G. , Kurdyak Paul , Anderson Kelly K. 
Published: October 2020

Background: Many people experience early signs and symptoms before the onset of psychotic disorder, suggesting that there may be help-seeking prior to first diagnosis. The family physician has been found to play a key role in pathways to care. This study examined patterns of primary care use preceding a first diagnosis of psychotic disorder. Methods: We used health administrative data from Ontario (Canada) to construct a population-based retrospective cohort. We investigated patterns of primary care use, including frequency and timing of contacts, in the 6 years prior to a first diagnosis of psychosis, relative to a general population comparison group matched on age, sex, geographic area, and index date. We used latent class growth modeling to identify distinct trajectories of primary care service use, and associated factors, preceding the first diagnosis. Results: People with early psychosis contacted primary care over twice as frequently in the 6 years preceding first diagnosis (RR = 2.22; 95% CI, = 2.19 to 2.25), relative to the general population, with a sharp increase in contacts 10 months prior to diagnosis. They had higher contact frequency across nearly all diagnostic codes, including mental health, physical health, and preventative health. We identified 3 distinct service use trajectories: low-, medium-, and high-increasing usage. Discussion: We found elevated patterns of primary care service use prior to first diagnosis of psychotic disorder, suggesting that initiatives to support family physicians in their role on the pathway to care are warranted. Earlier intervention has implications for improved social, educational, and professional development in young people with first-episode psychosis.
Time to First Culture Positivity for Gram-Negative Rods Resistant to Ceftriaxone in Critically Ill Adults
Authors: Buell Kevin G. , Casey Jonathan D. , Noto Michael J. , Rice Todd W. , Semler Matthew W. , Stollings Joanna L. 
Published: October 2020

Background: The optimal timing for the de-escalation of broad-spectrum antibiotics with activity against Pseudomonas aeruginosa and resistant Gram-negative rods (GNRs) in critically ill adults remains unknown. Research Question: We tested the hypothesis that cultures will identify GNRs that ultimately demonstrate resistance to ceftriaxone within 48 hours, potentially allowing safe de-escalation at this time point. Study Design and Methods: We conducted a secondary analysis of data from the Isotonic Solutions and Major Adverse Renal Events Trial: a pragmatic, cluster-randomized, multiple-crossover trial comparing balanced crystalloids versus saline for intravenous fluid administration in 15,802 critically ill adults at 5 intensive care units (ICUs) at Vanderbilt University Medical Center in Nashville, TN, USA. The primary endpoint was the time-to-positivity of respiratory and blood cultures that ultimately demonstrated growth of GNRs resistant to ceftriaxone. Multivariable logistic regression modeling was used to examine risk factors for the growth of cultures after 48 hours. Results: A total of 524 respiratory cultures had growth of GNRs, of which 284 (54.2%) had resistance to ceftriaxone. A total of 376 blood cultures grew GNRs, of which 70 (18.6%) had resistance to ceftriaxone. At 48 hours, 87% of respiratory cultures and 85% of blood cultures that ultimately grew GNRs resistant to ceftriaxone had demonstrated growth. Age, gender, predicted risk of inpatient mortality and prior use of antibiotics did not predict the growth of cultures after 48 hours. Interpretation: Among a cohort of critically ill adults, 13% of respiratory cultures and 15% of blood cultures that ultimately grew GNRs resistant to ceftriaxone did not demonstrate growth until at least 48 hours after collection. Further work is needed to determine the ideal time for critically ill adults to de-escalate from broad-spectrum antibiotics targeting Pseudomonas aeruginosa and extended-spectrum β-lactamase-producing gram-negative pathogens.
Palliative Care Consultation Affects How and Where Heart Failure Patients Die
Authors: Pham Richard , McQuade Casey , Somerfeld Alex , Blakowski Sandra , Hickey Gavin W. 
Published: October 2020

Objective: Determine the role of palliative care on terminal code status and setting of death for those with heart failure. Background: Although palliative care consultation (PCC) has increased for many conditions, PCC has not increased in those with cardiovascular disease. While it has been shown that the majority of those with heart failure die in medical facilities, the impact of PCC on terminal code status and setting of death requires further analysis. Methods: Patients admitted with heart failure between 2014-2015 at an academic VA Healthcare System were reviewed. Primary outcome was terminal code status. Secondary outcomes included setting of death, hospice utilization, and mortality scores. Student t-testing and Chi-square testing were performed where appropriate. Results: 334 patients were admitted with heart failure and had a median follow up time of 4.3 years. 196 patients died, with 122 (62%) receiving PCC and 74 (38%) without PCC. Patients were more likely to have terminal code statuses of comfort measures with PCC (OR = 4.6, p = 0.002), and less likely to be full code (OR = 0.09, p < 0.001). 146 patients had documented settings of death and were more likely to receive hospice services with PCC (OR 6.76, p < 0.001). A patient’s chance of dying at home was not increased with PCC (OR 0.49, p = 0.07), but they were more likely to die with inpatient hospice (OR = 17.03; p < 0.001). Conclusion: Heart failure patients who received PCC are more likely to die with more defined care preferences and with hospice services. This does not translate to dying at home.
Management of Velopharyngeal Insufficiency in Cleft Patients With and Without Multidisciplinary Team Care
Authors: Torrecillas Vanessa , Pollard Sarah Hatch , McCrary Hilary , Taylor Helene M. , Palmer Alexandra , Meier Jeremy , Muntz Harlan , Skirko Jonathan R. 
Published: October 2020

Objective: To evaluate the effect of an American Cleft Palate-Craniofacial Association (ACPA)–approved multidisciplinary team on velopharyngeal insufficiency (VPI) diagnosis and treatment. Design: Retrospective cohort setting; tertiary children’s hospital patients; children with cleft palate repair identified through procedure codes. Main Outcome Measures: Velopharyngeal insufficiency diagnosis was assigned based on surgeon or team assessment. Age at diagnosis and surgery was recorded. Difference in age and rate of VPI diagnosis and surgery was analyzed with t test. Multivariate linear and logistic regression adjusted for confounding variables. Results: Nine hundred forty patients were included with 71.5% cared for by an ACPA-approved multidisciplinary team. More (38.8% ) team care patients were found to have a diagnosis of VPI in comparison to 10% in independent care ( P < .001). Team care was associated with an almost 6-fold increase in VPI diagnosis ( P < .001). Team care was associated with a higher proportion of speech surgery (21% vs 10%, P < .001). Among children receiving team care, each visit was associated with 25% increased odds of being diagnosed with VPI ( P < .001) and 20% increased odds of receiving speech surgery ( P < .001). Age at VPI diagnosis and speech surgery were similar between groups ( P = .55 and .29). Discussion: Team care was associated with more accurate detection of VPI, resulting in more VPI speech therapy visits and surgical management. A higher number of team visits were similarly associated. Conclusion: Further studies of the clinical implication of timely and accurate VPI diagnosis, including quality of life assessments, are recommended to provide stronger guidance on team visit and evaluation planning.