bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Treprostinil in Pediatric Pulmonary Hypertension: Case Reports and Review of the Literature
Authors: Gavotto Arthur , Thomas Fanny , Werner Oscar , Moreau Johan , Amedro Pascal 
Published: March 2020

Background:
Add-on therapy with prostacyclin in pediatric refractory pulmonary hypertension (PH) poses a challenge, especially when considering continuous intravenous administration in younger children. A search for alternate routes of drug delivery has led to the clinical investigation of stable and long-acting prostacyclin analogues, such as subcutaneous treprostinil. We reported 2 pediatric cases of PH treated with subcutaneous treprostinil and reviewed the literature on treprostinil use in children.

Method:
The literature review used 3 electronic databases and a combination of terms (treprostinil, pediatric, PH, prostanoid, etc). We also searched for pediatric clinical trials on treprostinil registered on international clinical trial registries.

Results:
The reported cases highlighted the multifactorial nature of PH in pediatrics: a female child with a giant omphalocele, and intracardiac and extracardiac shunts; and a male premature child with a congenital diaphragmatic hernia and long-term PH. The literature review identified 19 studies reporting treprostinil use in 421 children with various types of PH (groups 1 and 3). Subcutaneous treprostinil was the most administered formulation, at a mean dose of 40 ng/kg/min. Overall, 12 clinical trials on treprostinil for children with PH were registered on the clinical trial registries. Most authors concluded that subcutaneous treprostinil was effective, well tolerated, and represented an alternative to intravenous epoprostenol.

Conclusions:
Subcutaneous treprostinil may be a useful adjunct in the therapeutic algorithm for children with severe PH, refractory to oral drugs, and after a complete check-up for all PH etiologies.
Higenamine Improves Cardiac and Renal Fibrosis in Rats With Cardiorenal Syndrome via ASK1 Signaling Pathway
Authors: Deng Ting , Wei Zhenming , Gael Akindavyi , Deng Xiaofang , Liu Yunfeng , Lai Jun , Hang Liwei , Yan Quanneng , Fu Qiang , Li Zhiliang 
Published: March 2020

Abstract:
The pathogenesis of cardiorenal syndrome (CRS) is very complex, and currently there is no effective treatment for CRS. Higenamine (HI) has been shown to improve cardiac function in rats with heart failure. However, the role of higenamine in CRS remains unknown. Here, in vitro, higenamine treatment markedly reduced neonatal rat cardiac fibroblast collagen synthesis and inhibited neonatal rat cardiac myocyte hypertrophy. In our study, a rat model of type 2 CRS was induced by left anterior descending coronary artery ligation combined with 5/6 subtotal nephrectomy (STNx). Higenamine treatment decreased serum creatinine (Scr), blood urea nitrogen, and brain natriuretic peptide levels and was capable of improving left ventricular remodeling and systolic function in CRS rats, accompanied with decreased expression of transforming growth factor-β1 (TGF-β1), α–smooth muscle actin (α-SMA) and collagen I (Col1A1). Moreover, higenamine significantly inhibited the protein expression of phosphorylated apoptosis signal-regulated kinase 1 (p-ASK1) and downstream mitogen-activated protein kinases (MAPK) (ERK, P38)/NF-κB in cardiorenal tissues of CRS rats and neonatal rat cardiac fibroblast/neonatal rat cardiac myocyte cells. Our study demonstrated that higenamine improved cardiorenal function in CRS rats and attenuated heart and kidney fibrosis possibly via targeting ASK1/MAPK (ERK, P38)/NF-κB signaling pathway. This finding extends our knowledge on the role of higenamine in cardiorenal fibrosis, providing a potential target to prevent the progression of CRS.
Surgical Management of Hand Deformity in Epidermolysis Bullosa: Initial Experience and Technique
Authors: Anstadt Erin E. , Turer David M. , Spiess Alexander M. , Manders Ernest K. 
Published: March 2020

Summary:
Epidermolysis bullosa describes a rare group of genetic mucocutaneous disorders characterized by excessive epithelial fragility resulting in mechanically induced blistering and abnormal wound healing.
1,2
Its prevalence and incidence are 8.2 and 19.6 per 1,000,000 live births, respectively.
2
Gene therapy, protein replacement, and cell therapy strategies have been investigated, but there is currently no cure.
2
The Application of Posttransfer Free Flap Expansion for Management of Severe Foot Crush Injury with Extensive Soft Tissue Loss: A Case Report
Authors: Radwan Mohammad S. , Mashal Ashraf A. 
Published: March 2020

Summary:
Reconstruction of posttraumatic soft tissue defects has been revolutionized after the application of microvascular free flaps. However, standard flaps are limited in size and may not completely cover the defect. Flap expansion which is indicated in large defects with extensive soft tissue loss or shortage of donor tissue enables tension-free closure of large defects, minimal donor site morbidity, and better aesthetic outcomes. The literature review revealed a higher complication rate in the expansion of free flaps implanted in the extremities. A 7-year-old Palestinian girl presented with right foot crush injury and open multiple metatarsal and tarsal bone fractures with significant soft tissue loss. She underwent free latissimus dorsi flap transfer and overlying skin graft island application followed months later by expander implantation within the flap. This flap was serially expanded once a week for 4 months, until its dimension was declared to be large enough to cover the foot defect. We successfully transferred a free flap to a foot with extensive tissue loss. The overlying skin island contracted and minimized the defect size. The flap was serially expanded until completely covered the defect. No features of vascular compromise or other complications occurred; the flap remained viable with good aesthetic outcome. Posttransfer free flap expansion in lower limb defects can be utilized with meticulous care and follow-up for reconstruction of large defects.
Of barriers and bridges: Buyer–supplier relationships in health care
Authors: Abdulsalam Yousef J. , Schneller Eugene S. 
Published: March 2020

Background
As the second largest expense category after labor, supply expense has received more strategic attention in recent years. Collaborative buyer–supplier relationships play a significant role in strategic supply chain management. In the health sector, however, buyer–supplier relationships are generally perceived as adversarial and distrusting.

Purpose
The aim of this study was to investigate the major buyer–supplier relationship barriers, with an emphasis on the role of the physician as a surrogate buyer in the hospital’s procurement process.

Methodology
Semistructured interviews were conducted with informants from six health systems and five medical device manufacturers in the United States. Additional data were gathered through a focus group consisting of 10 senior-level physicians. A structured qualitative analysis identified important themes in buyer–supplier relationship factors.

Results
From the data, four major themes emerged regarding the barriers to collaborative buyer–supplier relationships: lack of information sharing, opportunistic pricing behavior, changing regulations, and physician–supplier alliances. Further investigation regarding the role of the physician in purchasing reveals triadic implications.

Conclusions
The medical device market continues to exhibit strained buyer–supplier relationships. The physician’s professional role in supply selection can undermine the hospital’s strategic supply management efforts.

Practice Implications
Both buyers and suppliers need to exhibit more information transparency in order to develop collaborative relationships with at least a small number of strategic partners. Supply chain executives at hospitals need to play a more active role in facilitating the link between the hospital’s physicians and suppliers. Alternatively, hospitals can provide physicians with substitute services to curb supplier influences on physician preferences.
The Shadow Rule, the UV Index, and the 5S Steps in the Tropics
Authors: Silva Abel Antônio 
Published: March 2020

Abstract
Solar ultraviolet radiation (UVR) induces the production of vitamin D (VD), but it also causes erythema and skin cancer among other diseases. The amount of UVR to get benefit and avoid harm is unknown. Some principles were proposed to provide accessible information on how to avoid overexposure to the Sun. They are (1) the Shadow Rule (SR); (2) the UV Index (UVI); and (3) the Slip, Slop, Slap, Seek, Slide (5S) steps. This work discusses these principles in the tropics, considering measurements of solar UVR, total ozone column, and cloudiness. Indeed, the SR leads to overexposures. The UVI is adequate for cloudless skies, but it does not consider radiation enhancement events by clouds. “Seek shade” in the 5S steps should be more emphasized as it is both the most efficient step in terms of avoiding direct sun and the friendliest step toward the environment. Therefore, photoprotection attitudes in the tropics should focus on the UVI and the 5S steps in addition to considering both VD sufficiency and environmental outcomes. The SR is clearly inaccurate.
Perimyocarditis Is a Rare Complication After Campylobacter-Associated Gastroenteritis
Authors: Mortensen Kasper Kjersgaard , Würtz Morten , Mohey Rajesh 
Published: March 2020

Abstract

Campylobacter species are a common cause of gastroenteritis globally, and the incidence is increasing worldwide. We present a rare case of perimyocarditis following Campylobacter-associated gastroenteritis. A 22-year-old man presented with diarrhea after returning from a vacation in the Philippines. Few days later, he developed chest pain, and based on biochemical measures, electrocardiography, and echocardiography, he was diagnosed with perimyocarditis. With this case story, we wish to emphasize that development of cardiac symptoms in patients with gastroenteritis should warrant clinicians to supplement the clinical assessment with cardiac measures. Perimyocarditis is a serious inflammation of the heart, and although perimyocarditis is rarely caused by Campylobacter infections, the potential severity makes the association between the 2 conditions important.
Impact of a Structured Response and Evidence-Based Checklist on In-hospital Stroke Outcomes
Authors: Snavely Joshua , Thompson Hilaire , Bridges Elizabeth , Fathi Joelle 
Published: March 2020

ABSTRACT

BACKGROUND
In-hospital stroke events account for 2% to 17% of all ischemic strokes in the United States. Current stroke guidelines do not provide guidance on how to care for in-hospital stroke. Use of checklists during high-acuity events reduces error and provides clarity for responding staff. We sought to determine whether the use of an evidence-based checklist to guide in-hospital stroke response improved intervention times and patient outcomes.

METHODS
This study used a retrospective chart review of patients hospitalized between January 1, 2016, and December 31, 2018, at a community hospital certified as a primary stroke center with the Joint Commission. Encounters were sorted into preintervention and postintervention groups to evaluate for change in treatment rates, new or worsened disability, and mortality. Nursing staff who respond to in-hospital stroke calls (“response staff”) were also surveyed regarding their perception of benefit and firsthand experience when using the checklist.

RESULTS
A total of 168 patient charts were reviewed (18 prechecklist, 150 postchecklist). After checklist implementation, treatment with intravenous thrombolytics for in-hospital stroke events increased from 0% to 11%. All-cause mortality decreased from 23.1% to 15.0%, whereas ambulatory disability at discharge increased from 38.0% to 62.1%. The increase in disability likely reflects the reduction in mortality, improved data collection, and the increase in postimplementation reporting.

CONCLUSIONS
Use of a checklist during inpatient stroke events can potentially increase adherence to guidelines for appropriate treatment and reduce mortality. Hospital response teams should consider use of a structured response system with an evidence-based checklist for high-acuity, low-frequency events such as in-hospital stroke.
The Relationship between Corneal Nerve Morphology and Inflammatory Mediators and Neuropeptides in Healthy Individuals
Authors: Markoulli Maria , Colorado Luisa H. , Edwards Katie 
Published: March 2020

SIGNIFICANCE
This study set out to explore the relationship between the ocular surface immune and nervous systems by exploring corneal nerve structure and the presence of inflammatory mediators and neuropeptides in the tear film.

PURPOSE
The purpose of this study was to determine the association between corneal nerve morphology and tear film inflammatory mediators and a neuropeptide in healthy individuals.

METHODS
Flush tears were collected from both eyes of 21 healthy participants aged 39.7 ± 9.9 years (10 females, 11 males) and analyzed for substance P, matrix metalloproteinase-9, tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), tumor necrosis factor α, and interleukin 6. In vivo central corneal confocal microscopy was performed on the right eye, and eight images were captured. Variables measured were corneal nerve fiber length (CNFL), corneal nerve density (CNFD), corneal nerve branch density, fiber total branch density, corneal nerve fiber area, corneal nerve fiber width (CNFW), and corneal nerve fractal dimension (CNFrac). For each eye, the average across the images and the maximum and minimum values were determined for each variable. Pearson correlation analysis was performed to test for associations.

RESULTS
Substance P correlated with CNFrac (max) (r = −0.48, P = .03) and CNFW (min) (r = −0.52, P = .02). TIMP-1 correlated with CNFD (average) (r = −0.53, P = .03), CNFL (average) (r = −0.49, P = .05), CNFrac (max) (r = −0.49, P = .05), and CNFD (min) (r = −0.55, P = .02). Interleukin 6 correlated with CNFW (average) (r = −0.49, P = .05), the standard deviation of CNFL (r = −0.51, P = .04), CNFL (max) (r = −0.50, P = .04), CNFrac (max) (r = −0.50, P = .04), and CNFW (min) (r = −0.55, P = .02). Tumor necrosis factor α, matrix metalloproteinase-9, and its ratio with TIMP-1 did not correlate with any corneal nerve parameters.

CONCLUSIONS
Both inflammatory mediators and neuropeptides correlated with measures of corneal nerve morphology, supporting the link between the inflammatory and nervous systems.
Population Pharmacokinetics of IV Phenobarbital in Neonates After Congenital Heart Surgery
Authors: Thibault Céline , Massey Shavonne L. , Naim Maryam Y. , Abend Nicholas S. , Zuppa Athena F. 
Published: March 2020

Objectives:
To develop a population pharmacokinetic model for IV phenobarbital in neonates following cardiac surgery and perform simulations to identify optimal dosing regimens.

Design:
Retrospective single-center pharmacokinetic study.

Setting:
Cardiac ICU at Children’s Hospital of Philadelphia.

Patients:
Consecutive neonates who received greater than or equal to one dose of IV phenobarbital and had greater than or equal to one phenobarbital concentration drawn per standard of care from June 15, 2012, to October 15, 2018.

Interventions:
None.

Measurements and Main Results:
A population pharmacokinetic model was developed using nonlinear mixed-effects modeling. Simulations were performed using the final model variables. Optimal phenobarbital loading doses were determined based on attainment of peak and maintenance concentrations between 20 and 40 mg/L. A total of 37 neonates contributed 159 pharmacokinetic samples. The median (range) weight, postmenstrual age, and postnatal age were 3.2 kg (1.3–3.8), 39 2/7 weeks (28 2/7 to 42 6/7), and 5 days (0–26 d), respectively. Twelve patients (32%) were on extracorporeal membrane oxygenation. An one-compartment model best described the data. The final population pharmacokinetic model included (1) weight and postnatal age for clearance and (2) weight, extracorporeal membrane oxygenation, and albumin for volume of distribution. In neonates not on extracorporeal membrane oxygenation, loading doses of 30 and 20 mg/kg reached goal concentration with albumin values less than or equal to 3 and 3.5 mg/dL, respectively. Loading doses of 30 mg/kg reached goal concentration on extracorporeal membrane oxygenation regardless of albumin values. Maintenance doses of 4–5 mg/kg/d reached goal concentration in all neonates.

Conclusions:
In neonates following cardiac surgery, phenobarbital clearance increased with postnatal age. Volume of distribution increased with extracorporeal membrane oxygenation and lower albumin values. Loading doses of 30 mg/kg on extracorporeal membrane oxygenation and 20–30 mg/kg without extracorporeal membrane oxygenation were needed to reach goal concentration based on simulations.
The Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment
Authors: Hill Mattias , Jörgensen Sophie , Engström Gunnar , Persson Margaretha , Lexell Jan 
Published: March 2020

Objective
The aim of the study was to present the methodology, cohort demographics, and initial results of the Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA).

Design
The SPICA is based on the Swedish CArdioPulmonary BioImage Study, a study on cardiopulmonary diseases in a cohort of 30,000 people. The assessments in the SPICA cover the structure and function of the cardiopulmonary and autonomic systems using bioimaging and functional analyses, together with a study-specific questionnaire and generic and spinal cord injury–specific assessment tools. The inclusion criteria were as follows: age 50–65 yrs, traumatic spinal cord injury of 5 yrs or more, and injury levels C1-T6, American Spinal Injury Association Impairment Scale A–C.

Results
Of 38 potential participants, 25 comprised the final sample (20% women, mean age 58 yrs, mean time since injury 28 yrs). Eight percent had sustained a cardiovascular event, and 72% were classified as a high risk for cardiovascular disease. Asthma was previously diagnosed in only 8%, and none had chronic obstructive pulmonary disease.

Conclusions
The risk for cardiovascular disease in people with severe high-level spinal cord injury is a major clinical concern. Forthcoming studies in the SPICA will provide new knowledge of cardiopulmonary health in this cohort, which can guide future research and be used to develop long-term management.
Associations Between Physical Activity Intensities and Physical Function in Stroke Survivors
Authors: Gothe Neha P. , Bourbeau Kelsey 
Published: March 2020

Purpose
Impairment caused by stroke is a major cause of disablement in older adults. Physical activity has been shown to improve physical functioning; however, little research has been done to explore how physical activity of different intensities may affect physical function among stroke survivors. The purpose of this study was to examine the patterns of accelerometer-measured physical activity and the relationship between physical activity intensities and objective physical functioning and perceived functional limitations in stroke survivors.

Methods
Stroke survivors (N = 30, mean age = 61.77 ± 11.17) completed the Short Physical Performance Battery and the Late-Life Function and Disability Instrument. Physical activity intensities were measured objectively using a 7-day actigraph accelerometer wear period and scored using the National Health and Nutrition Examination Survey cutoffs for sedentary (counts/minute ≤100), light (counts/minute 101–2019), and moderate to vigorous (moderate to vigorous physical activity counts/minute ≥2020) activity.

Results
Multiple linear regressions controlling for age and time since stroke demonstrated that higher levels of moderate to vigorous physical activity predicted better Short Physical Performance Battery performance (β = .43, P = 0.04). For self-reported physical function, light physical activity predicted better basic lower limb function (β = .45, P = 0.009), better advanced lower limb function (β = .53, P = 0.003), better upper limb function (β = .37, P = 0.04), and higher total function score (β = .52, P = 0.002) on the Late-Life Function and Disability Instrument.

Conclusions
These findings suggest that light activity as well as moderate to vigorous physical activity may contribute to better physical functioning in stroke survivors. Although moderate to vigorous physical activity significantly predicted the objective measure of physical function (Short Physical Performance Battery), light physical activity consistently predicted higher scores on all subscales of the Late-Life Function and Disability Instrument. Disabilities resulting from stroke may limit this population from engaging in moderate to vigorous physical activity, and these findings highlight the importance of light physical activity, which may offer similar perceived functional benefits. Future studies should focus on development of effective exercise interventions for stroke survivors by incorporating and comparing both moderate to vigorous physical activity and light-intensity physical activity.
Marital Status, Close Relationships, and All-Cause Mortality: Results From a 10-Year Study of Nationally Representative Older Adults
Authors: Manvelian Atina , Sbarra David A. 
Published: March 2020

ABSTRACT

Objective
Becoming widowed is associated with an increased risk of early mortality. Drawing on theoretical literature related to social support and health, the present study evaluated whether the quantity of close relationships might differentially moderate the relationship between marital status (widowed versus married) and mortality risk 10 years later.

Method
Data were obtained from the National Social Life Health and Aging Project. A diverse group of older adults (n = 2347) were interviewed three times for 10 years. Information on close friends/family, marital status, and mortality was gathered. Logistic regression and moderation analyses were used to test whether the quantity of close relationships conditioned the risk of death for married and widowed adults 10 years later.

Results
The quantity of close relationships moderated the association between marital status and mortality risk (B = −0.35, SE = 0.11, p = .002). Compared with their married counterparts, widowed older adults who had fewer than four to six close relationships had an increased risk of death 10 years later (B = −0.35, SE = 0.09, p < .001); similarly, among people who reported few close relationships, widowed adults had an increased risk of death compared with their married counterparts (B = 0.54, SE = 0.15, p < .001). These findings remained significant after accounting for demographics, health behaviors/chronic health conditions, and psychological distress. This effect is comparable to the increased mortality risk associated with smoking cigarettes.

Conclusions
Having fewer than four to six close relationships is associated with an increased mortality risk for widowed older adults.