bluuebunny/crossref_metadata_2025_split huggingface dataset:
Avoiding Opioid Misuse After Surgery in the Era of the Opioid Epidemic
Authors: Petersen Michael J. , Adams Kathryne W. , Siparsky Nicole F. 
Published: August 2020

Background Chronic pain patients at risk of addiction can be identified through pre-prescription screening with the opioid risk tool (ORT); there is no equivalent for surgical patients. Our aims were to validate the ORT in the surgical population and assess the impact of patient education on compliance with proper storage and disposal (S&D) of unused opioid therapy (UOT). Methods Each subject completed the ORT, prevideo and postvideo surveys, educational video viewing, and compliance survey. Aberrant behavior was assessed by questionnaire, chart review, and Illinois Prescription Monitoring Program review. Results We recruited 24 subjects who underwent emergency surgery; 18 (of 24) were prescribed an opioid on discharge and 15 (of 18) were followed for 1 month. Before education, 38% (n = 9 of 24) of subjects identified proper UOT disposal and 63% (n = 15 of 24) identified safe handling of opioids. After education, 75% (n = 18 of 24) identified proper S&D. On ORT, 9 of 24 subjects (38%) scored moderate-risk to high-risk for opioid misuse. Half of subjects who demonstrated aberrant behavior (n = 7 of 12, 58%) scored in the low-risk range on ORT; 67% of subjects (n = 10 of 15) retained UOT, and 67% (n = 10 of 15) safely stored UOT. Few subjects (30%; n = 3 of 10) who stored their UOT reported proper disposal of UOT. Discussion The ORT is not useful in identifying acute pain surgical patients at risk for aberrant behavior. An educational video increased awareness of, but not compliance with, safe S&D of UOT. Opioid overprescription continues to contribute to opioid misuse.
Patient Contact Time and Prehospital Interventions in Hypotensive Trauma Patients: Should We Reconsider the “ABC” Algorithm When Time Is of the Essence?
Authors: Ninokawa Scott , Friedman Jessica , Tatum Danielle , Smith Alison , Taghavi Sharven , McGrew Patrick , Duchesne Juan 
Published: August 2020

Introduction There is disagreement in the trauma community concerning the extent to which emergency medical services (EMS) should perform on-scene interventions. Additionally, in recent years the “ABC” algorithm has been questioned in hypotensive patients. The objective of this study was to quantify the delay introduced by different on-scene interventions. Methods A retrospective analysis of hypotensive trauma patients brought to an urban level 1 trauma center by EMS from 2007 to 2018 was performed, and patients were stratified by mechanism of injury and new injury severity score (NISS). Independent samples median tests were used to compare median on-scene times. Results Among 982 trauma patients, median on-scene time was 5 minutes (interquartile range 3-8). In penetrating trauma patients ( n = 488) with NISS of 16-25, intubation significantly increased scene time from 4 to 6 minutes ( P < .05). In penetrating trauma patients with NISS of 10-15, wound care significantly increased scene time from 3 to 6 minutes ( P < .05). Tourniquet use, interosseous (IO) access, intravenous (IV) access, and needle decompression did not significantly increase scene time. Conclusion Understanding that intubation increases scene time in penetrating trauma, while IV and IO access do not, alterations to the traditional “ABC” algorithm may be warranted. Further investigation of prehospital interventions is needed to determine which are appropriate on-scene.
The Rise and Fall of Marcha Verde in the Dominican Republic
Authors: Betances Emelio 
Published: August 2020

The Marcha Verde movement emerged in 2017 to protest bribery on the part of the Brazilian transnational Odebrecht. It conducted 25 protests in the provinces and large marches in July 2017 and August 2018 but ultimately failed to force the government to try those responsible. As a movement for the democratization of democracy through the construction of citizens’ rights, it was a watershed moment in Dominican political history. However, it did not have time to build the social base that would have allowed it to challenge the authorities. The political parties that supported it were only interested in weakening the official party, and the electoral race intervened as the way to channel the movements’ demands, leaving the radicals alone in calling for a transformation of the political sphere. El movimiento Marcha Verde surgió en 2017 en protesta contra los sobornos efectuados por la transnacional brasileña Odebrecht. Aunque organizó 25 protestas en las provincias y grandes marchas en julio de 2017 y agosto de 2018, no logró forzar al gobierno a enjuiciar a los responsables. En tanto se trata de un movimiento para la democratización de la democracia a través de la construcción de los derechos ciudadanos, este fue un momento decisivo en la historia política dominicana. Sin embargo, no tuvo tiempo de construir la base social que le hubiera permitido desafiar a las autoridades. Los partidos políticos que lo apoyaron sólo estaban interesados en debilitar al partido oficial, y las elecciones que intervinieron en el proceso se convirtieron en la vía de canalización para las demandas del movimiento, dejando a los elementos radicales solos en su exigencia por una genuina transformación de la esfera política.
Proximal hyper-intense vessel sign on initial FLAIR MRI in hyper-acute middle cerebral artery ischemic stroke: a retrospective observational study
Authors: Shin Dong Hyuk , Han Sang Kuk , Lee Jang Hee , Choi Pil Cho , Park Sang O , Lee Young Hwan , Ung Na Ji 
Published: August 2020

Background A hyper-intense vessel sign on fluid attenuated inversion recovery magnetic resonance imaging (FHV) represents slow blood flow in the cerebral arteries. Purpose To investigate the relationship between the proximal FHV (pFHV) on initial magnetic resonance imaging (MRI) and the status of the culprit vessel (stenosis, obstruction) in hyper-acute strokes affecting the territory of the middle cerebral artery (MCA). Material and Methods The study participants consisted of 105 patients presenting to the emergency department (ED) with acute MCA infarction within 4.5 h of onset of symptoms. Patients underwent brain MRI within 45 min of arrival at the ED and angiography within 2 h of arrival. Culprit vessel status and presence of a pFHV on initial MRI were investigated retrospectively. Results The pFHV was observed in 71/105 (67.6%) patients who presented with a hyper-acute MCA infarction. All patients with hyper-acute MCA infarction caused by internal carotid artery (90.6% caused by M1 occlusion, 92.9% caused by M2 occlusion) showed a pFHV on initial MRI. After logistic regression analysis, the presence of a pFHV showed significant positive correlation with large vessel occlusion (adjusted odds ratio [OR] 34.533, 95% confidence interval [CI] 9.781–121.926; P < 0.001). A pFHV was not associated with severe large vessel stenosis. Conclusion A pFHV is independently representative of the acute occlusion of intervention-eligible proximal arteries within the territory of the MCA. If a patient with a hyper-acute MCA infarction shows a pFHV, aggressive flow augmentation strategies and early activation of intervention team should be warranted for best patient outcome.
Drug-coated balloons used in peripheral artery disease: experience from a single center
Authors: Liu Jinbo , Li Tianrun , Huang Wei , Zhao Na , Liu Huan , Zhao Hongwei , Xu Jiufeng , Wang Hongyu 
Published: August 2020

Objective This retrospective single-center study aimed to analyze immediate and follow-up results of using drug-coated balloons (DCBs) for treating peripheral arterial disease. Methods In this study, we identified a total of 75 patients who underwent DCB therapy at our institution. The ankle–brachial index (ABI) was measured before and after intervention. Intermittent claudication and whether there was healing of ulcers were determined by telephone. Results The cohort consisted of 56 men and 19 women aged 38 to 87 years (68 ± 12 years). Twenty-three patients had Rutherford grade III, 15 had Rutherford grade IV, and 37 had Rutherford grade V. Seventeen patients had stents and 18 had the Rotarex system used. The postoperative ABI was significantly greater than the preoperative ABI (0.911 ± 0.173 vs 0.686 ± 0.249). Good results for treatment were obtained. Intermittent claudication and rest pain did not occur in subjects with Rutherford grades III and IV during follow-up. The amputation rate was 4.1% among all patients using DCB therapy during follow-up. Conclusions DCB therapy is safe and effective for treating peripheral arterial disease in real-world patients. Future prospective studies on this issue are recommended.
Advanced pneumonic type of lung adenocarcinoma: survival predictors and treatment efficacy of the tumor
Authors: Zong Qiu , Zhu Feng , Wu Shimin , Peng Li , Mou Yong , Miao Kang , Wang Qi , Zhao Jianping , Xu Yongjian , Zhou Min 
Published: August 2020

Purpose: To retrospectively explore the survival predictors and treatment efficacy of advanced pneumonic-type lung adenocarcinoma (P-ADC). Methods: Retrospective analysis of clinical data and survival follow-up was undertaken on 41 patients with advanced P-ADC from January 1, 2009, to April 30, 2019. Analysis on tumor biomarkers such as carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and the cytokeratin-19-fragment (Cyfra21-1) were undertaken. The patients in this study were divided into three groups based on usage of tyrosine kinase inhibitor (TKI): TKI therapy group (including combination with chemotherapy), non-TKI therapy group (chemotherapy alone), and palliative care group. Results: More than half of the patients had higher levels of tumor biomarkers and the incidence of NSE was highest (81.8%), followed by CEA (74.4%) and Cyfra21-1 (74.1%). All patients had abnormal findings on chest computed tomography and with adenocarcinoma pathology. The overall survival (OS) time was 10.4 months in TKI group, 8.8 months in the non-TKI group, and 2.1 months in the palliative care group. Patients with higher level of serum Cyfra21-1 had insignificantly shorter survival time compared to those with normal Cyfra21-1 ( p = 0.067). TKI therapy and non-TKI therapy provided a better prognosis prediction compared to palliative care. TKI therapy improved prognosis compared to non-TKI therapy. The comprehensive based TKI therapy provided improved OS vs the non-TKI therapy. Conclusion: TKI-based therapy could improve the prognosis and OS for advanced P-ADC. This study recommends the analysis of EGFR mutations for all patients with advanced P-ADC.
The socioeconomic burden of migraine: An evaluation of productivity losses due to migraine headaches based on a population study in Germany
Authors: Seddik Ahmed H , Branner Jennifer C , Ostwald Dennis A , Schramm Sara H , Bierbaum Martin , Katsarava Zaza 
Published: August 2020

Background This study estimates the socioeconomic impact of migraine headaches on paid and unpaid work productivity in the adult German population in 1 year. Methods We used data on headache frequency (days per month) from a longitudinal population-based study. Prevalence estimates of migraine were derived from the Global Burden of Disease Collaborative Network. Demography data were derived from official statistics in 2017. Aggregate headache days in 1 year were translated to losses in paid and unpaid productive hours based on estimates of presenteeism and absenteeism along with other socioeconomic parameters. Paid hours lost were distributed across the industry sectors. In this way, an age-, gender- and industry sector-specific monetary value was calculated for paid hours lost. Unpaid hours lost were valued by assigning the unpaid activities to their nearest market substitute. In a last step, value-added multipliers derived from input-output tables were used to calculate the economic value chain effects. Results A total of 15.5 million persons (20 years or older) suffer from migraine in Germany. Our analysis shows that 60% of those have three or fewer headache days per month, while patients suffering chronic migraine (15+ headache days per month) account for 5.4% of the adult migraine population. Females bear 65% of the total 836 million headache days per year. The socioeconomic losses due to migraine amount to €100.4 billion (€6493 on average per patient) in one year. Conclusion In addition to time losses in paid work, migraine causes substantial socioeconomic losses to unpaid work activities due to its disproportionate prevalence among females. Economic value chain effects provide a novel perspective on losses beyond a patient’s time loss. Overall, the elements of socioeconomic burden provide a strong rationale that innovative migraine therapies could be of high value to society.
Sleep Architecture in Valproate-Induced Nocturnal Enuresis in Primary School and Preschool Children
Authors: Esmael Ahmed , Elsherief Mohammed , Abdelsalam Mohamed , Bendary Lotfy , Egila Hossam 
Published: August 2020

Nocturnal enuresis is one of the side effects of valproic acid treatment, and generally underdiagnosed by clinicians. Studies reported that a variable incidence of valproic acid–induced nocturnal enuresis is 2.2% to 24% with unclear explanations of the reasons behind valproic acid–induced nocturnal enuresis. A retrospective study was carried out on 260 children (aged 5-12 years) diagnosed with idiopathic epilepsy, treated with valproic acid to evaluate the nocturnal enuresis secondary to valproic acid, and to discuss the characteristics of their sleep architecture. Nocturnal enuresis was reported in 28 (10.7%) patients after a mean exposure time to valproate of 18.78±8.4 days. Nocturnal enuresis was significantly associated with younger age and serum level of valproate ( P = .05). The polysomnographic study suggested that the underlying mechanism may be related to impaired sleep efficiency, frequent arousals, prolonged sleep latency, snoring, or increased sleep depth which may impair a child’s ability to awaken to the sense of bladder fullness or contractions. Clinical trial registration: ClinicalTrials.gov identifiers: NCT04191863
Outcomes Following Revision Surgery After Failed Kidner Procedure for Painful Accessory Navicular
Authors: Kim Jaeyoung , Day Jonathan , Seilern und Aspang Jesse 
Published: August 2020

Background: The Kidner procedure is performed to treat painful accessory navicular syndrome, with varying results. Recurrent pain remains a complication, and to date, there is a paucity of literature regarding the causes of recurrent pain and surgical outcomes of revision. Methods: Twenty-one patients who underwent revision surgery for recurrent pain after the Kidner procedure were identified. All patients had their tendon inspected and treated, and all had a medial displacement calcaneal osteotomy. Revision was indicated after 6 months of failed conservative therapy. Pre- and postrevision radiographic measurements included lateral talo–first metatarsal angle (Meary’s angle), talonavicular coverage angle, calcaneal pitch, and hindfoot moment arm (HMA). Meary’s angle >4 degrees was considered a planus deformity and HMA >9.1 mm was considered a hindfoot valgus deformity; patients fulfilling both criteria were categorized as having planovalgus deformity. Measurements in the contralateral foot were performed to determine whether alignment of the involved side was attributed to failed treatment or a preexisting deformity. Visual analog scale and Foot and Ankle Outcome Scores were compared and average follow-up was 20.1 months (range, 14-26). Results: Preoperatively, 20 of 21 (95%) patients had a form of valgus heel alignment (planovalgus, n = 11; hindfoot valgus only, n = 9), and 1 had an isolated planus deformity. The contralateral side revealed similar deformity, with 17 of 21 (81%) patients having a form of valgus heel alignment (planovalgus, n = 13; hindfoot valgus only, n = 4) and 4 patients with an isolated planus deformity. All patients underwent realignment surgery with medial displacement calcaneal osteotomy. All radiographic parameters except Meary’s angle ( P = .885) significantly improved postoperatively along with significantly improved clinical outcomes. Conclusion: Recurrent pain following the Kidner procedure was associated with valgus heel alignment. Revision surgery including realignment procedure alleviated pain and improved functional outcomes with minimal complications. Therefore, we recommend assessing heel alignment in patients presenting with recurrent pain following the Kidner procedure. Level of Evidence: Level IV, case series.
Predicting factors of ocular hypertension following keratoplasty: Indications versus the procedure
Authors: Busool Abu Eta Yumna , Tomkins-Netzer Oren , Mimouni Micheal , Hamed Azzam Shireen , Shehadeh Mashour Raneen 
Published: August 2020

Purpose: To assess the incidence of ocular hypertension (OHTN) following penetrating keratoplasty (PKP) versus deep anterior lamellar keratoplasty (DALK) corneal transplant surgeries, and to assess the impact of indication for transplantation versus surgery type on OHTN development. Methods: A retrospective study of 76 eyes of 76 patients who underwent PKP or DALK between 1 January 2009 and 1 September 2014. Data included: preoperative intraocular pressure (IOP), indication and type of surgery, post-surgical IOP at 1 to 5, 14 to 21 days, 3, 6 months, 1 year and at the last follow up. Primary outcome was post-operative OHTN (defined as IOP >21 mm Hg). Results: A total of 13 patients (17.1%) developed OHTN of whom 9 (20.45%) underwent PKP and 4 (12.5%) DALK ( p = 0.33). OHTN occurred after an average of 16.46 ± 8.47 months (0.1–58 months). Twenty-one keratoconus patients (39.62%) underwent PKP and 32 (60.37%) underwent DALK. Patients with indications other than keratoconus all underwent PKP. Keratoconus patients were less likely to develop OHTN (9.43% vs 34.78%, p = 0.02). Among patients developing OHTN, mean age of the non-keratoconus group was significantly higher (63.25±16.7 vs 33 ± 10, p = 0.01). No significant difference in OHTN among keratoconus patients undergoing DALK versus PKP (12.5% vs 4.76%, respectively, p = 0.35) was found. PKP was associated with less OHTN in keratoconus eyes (4.76% vs 34.78%, p = 0.02). Conclusion: Patients who underwent keratoplasty due to keratoconus are at a lower risk to develop OHTN than those who underwent surgery for other indications.
Medication use, renin–angiotensin system inhibitors, and acute care utilization after hospitalization in patients with chronic kidney disease
Authors: Neumiller Joshua J , Daratha Kenn B , Alicic Radica Z , Short Robert A , Miller Haleigh M , Gregg Liza , Gates Brian J , Corbett Cynthia F , McPherson Sterling M , Tuttle Katherine R 
Published: August 2020

Objectives: The aims of this secondary analysis were to: (a) characterize medication use following hospital discharge for patients with chronic kidney disease (CKD), and (b) investigate relationships of medication use with the primary composite outcome of acute care utilization 90 days after hospitalization. Methods: The CKD-Medication Intervention Trial (CKD-MIT) enrolled acutely ill hospitalized patients with CKD stages 3–5 not dialyzed (CKD 3–5 ND). In this post hoc analysis, data for medication use were characterized, and the relationship of medication use with the primary outcome was evaluated using Cox proportional hazards models. Results: Participants were taking a mean of 12.6 (standard deviation=5.1) medications, including medications from a wide variety of medication classes. Nearly half of study participants were taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB). ACE inhibitor/ARB use was associated with decreased risk of the primary outcome (hazard ratio=0.51; 95% confidence interval 0.28–0.95; p=0.03) after adjustment for baseline estimated glomerular filtration rate, age, sex, race, blood pressure, albuminuria, and potential nephrotoxin use. Conclusions: A large number, variety, and complexity of medications were used by hospitalized patients with CKD 3–5 ND. ACE inhibitor or ARB use at hospital discharge was associated with a decreased risk of 90-day acute care utilization.
Perampanel Increases Cortical EEG Fast Activity in Child and Adult Patients Affected by Epilepsy: A Quantitative EEG Study
Authors: Liguori Claudio , Spanetta Matteo , Izzi Francesca , Russo Angelo , Guerra Angelo , Mercuri Nicola Biagio , Placidi Fabio 
Published: August 2020

Objective Quantitative EEG (qEEG) is an established technique used as objective measure for evaluating the effect of antiseizure medications (ASMs) on EEG background activity and monitoring cognitive effects of ASMs. Perampanel (PER) has been associated with relatively more tolerable cognitive effects in patients with epilepsy. The primary aim of the present study was to verify the effect of PER as first add-on ASM on qEEG in child and adult patients affected by epilepsy. The secondary aim of this study was to verify the effectiveness of the drug as first add-on treatment in both child and adult patients with epilepsy. Methods We collected data from 17 adults and 10 children treated with PER as first add-on treatment, who underwent qEEG analysis before starting PER and at 3-month follow-up under stable treatment. Results PER resulted with significant effectiveness in reducing seizures in both children and adults. Considering qEEG analysis, we observed at follow-up the significant increase in beta1 and beta total bands both in children and adult patients. In particular, children showed the significant increase of beta band frequencies predominantly in the occipital regions, whereas adults showed a widespread increase of beta activity. Moreover, we documented in both child and adult patients the global reduction of delta bands activity. Conclusions This qEEG study documented the relative increase of cortical EEG fast activity in both children and adult patients affected by epilepsy and treated by PER. This result may suggest a potential less negative impact of PER on cognition in patients affected by epilepsy, other than demonstrating effectiveness of the drug when used as first add-on treatment in both children and adult patients.