bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of corticosteroids in patients with sepsis or septic shock using the new third international consensus definitions (Sepsis-3): A retrospective observational study
Authors: Wu Yu-Pu , Lauffenburger Julie C. 
Published: December 2020

BackgroundThe effects of intravenous corticosteroids in patients with sepsis remain controversial due to mixed results from randomized trials. Moreover, updated definitions of sepsis, Sepsis-3, were proposed in 2016, and findings related to the effects of corticosteroids in patients defined by the Sepsis-3 criteria are scarce.ObjectiveTo investigate the effectiveness of corticosteroids in patients with sepsis or septic shock using real-world data to complement the findings of randomized controlled trials, and to determine whether the treatment effects differ by sepsis definitions.MethodsWe conducted this study by utilizing a large, multi-center healthcare database, eICU, in which we identified patients with sepsis admitted to 208 intensive care units across the US from 2014 to 2015 based on two different definitions: prior explicit definitions (i.e., based on diagnosis codes) and the Sepsis-3 definitions (i.e., based on SOFA score). The association between intravenous corticosteroids and in-hospital survival up to 50 days in patients with sepsis was retrospectively analyzed. A parametric hazard model with stabilized inverse probability of treatment weight adjustment was used to control for baseline confounders.ResultsOf the 7,158 patients identified based on the explicit definition, 562 (7.9%) received corticosteroids; of the 5,009 patients identified based on the Sepsis-3 definition, 465 (9.3%) received corticosteroids. In the explicit cohort, adjusted in-hospital survival at day 50 was 0.62 in the treated vs 0.57 in the non-treated, with a survival difference of 0.05 (95%CI: -0.11, 0.17). Similar results were seen in the Sepsis-3 cohort (0.58 vs 0.56 in treated and non-treated, respectively), with a 50-day survival difference of 0.02 (95%CI: -0.19, 0.17).ConclusionsIn patients with sepsis or septic shock, intravenous corticosteroids were not associated with a higher in-hospital survival up to 50 days regardless of the sepsis definitions. Further research may be necessary to definitively confirm effectiveness in real-world practice.
Endothelial function is preserved in light to moderate alcohol drinkers but is impaired in heavy drinkers in women: Flow-mediated Dilation Japan (FMD-J) study
Authors: Oda Nozomu , Kajikawa Masato , Maruhashi Tatsuya , Kishimoto Shinji , Yusoff Farina Mohamad , Goto Chikara , Nakashima Ayumu , Tomiyama Hirofumi , Takase Bonpei , Yamashina Akira , Higashi Yukihito 
Published: December 2020

Light to moderate alcohol consumption has protective effects on all-cause death and coronary artery disease in women. It is thought that light to moderate alcohol consumption has a beneficial effect on vascular function in women. We measured flow-mediated vasodilation (FMD) in 702 women aged 17–86 years who provided information on alcohol consumption. We divided the subjects into four groups: non-drinkers (0 g/week), light drinkers (>0 to 140 g/week), moderate drinkers (>140 to 280 g/week) and heavy drinkers (>280 g/week). There was no significant difference in FMD among the four groups. Multivariate regression analysis revealed that alcohol consumption in non-drinkers and light drinkers was not an independent predictor of FMD (β = −0.001, P = 0.98). We compared 50 moderate drinkers and 50 non-drinkers matched for age and medical histories and 22 heavy drinkers and 22 non-drinkers in matched pair analysis. There was no significant difference in FMD between moderate drinkers and non-drinkers (8.2±4.3% vs. 8.1±3.5, P = 0.91), while FMD in heavy drinkers was significantly lower than that in non-drinkers (5.9±2.5% vs. 8.9±3.5%, P = 0.002). These findings suggest that heavy alcohol consumption is associated with endothelial dysfunction but that light to moderate alcohol consumption is not associated with endothelial dysfunction in women.
Clinical trial registration information This study was approved by principal authorities and ethical issues in Japan (University Hospital Medical Information Network UMIN000012952, 01/12/2009). www.umin.ac.jp/.
Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward
Authors: Segher Kristof , Huys Liesbeth , Desmet Tania , Steen Evi , Chys Stefanie , Buylaert Walter , De Paepe Peter 
Published: December 2020

ObjectivesDisulfiram is an adjunct in the treatment of alcohol use disorders, but case reports indicate that disulfiram ethanol reactions are not always recognized in the emergency department. Our first aim is to remind of this risk with two case reports of life-threatening reactions not immediately considered by the emergency physician. The second aim is to estimate the probability that a disulfiram reaction goes unrecognized with the use of a retrospective study of patients admitted to the emergency department.MethodsClinical files of patients admitted between October 1, 2010 and September 30, 2014 to the emergency department were retrospectively screened for the key words “ethanol use” and “disulfiram”. Their diagnoses were then scored by a panel regarding the probability of an interaction.ResultsSeventy-nine patients were included, and a disulfiram-ethanol reaction was scored as either ‘highly likely’, ‘likely’ or ‘possible’ in 54.4% and as ‘doubtful’ or ‘certainly not present’ in 45.6% of the patients. The interrater agreement was 0.71 (95% CI: 0.64–0.79). The diagnosis was not considered or only after a delay in 44.2% of the patients with a ‘possible’ to ‘highly likely’ disulfiram interaction. One patient with a disulfiram overdose died and was considered as a ‘possible’ interaction.Discussion and conclusionsA disulfiram ethanol interaction can be life threatening and failure to consider the diagnosis in the emergency department seems frequent. Prospective studies with documentation of the intake of disulfiram and evaluation of the value of acetaldehyde as a biomarker are needed to determine the precise incidence. Improving knowledge of disulfiram interactions and adequate history taking of disulfiram intake may improve the care for patients.
Added diagnostic values of three-dimensional high-resolution proton density-weighted magnetic resonance imaging for unruptured intracranial aneurysms in the circle-of-Willis: Comparison with time-of-flight magnetic resonance angiography
Authors: Yim Younghee , Jung Seung Chai , Kim Jung Youn , Kim Seon-Ok , Kim Byung Jun , Lee Deok Hee , Park Wonhyoung , Park Jung Cheol , Ahn Jae Sung 
Published: December 2020

Background
Advanced imaging methods can enhance the identification of aneurysms of the infundibula, which can reduce unnecessary follow-ups or further work-up, fear, and anxiety in patients.

Purpose
This study aimed to evaluate the added diagnostic value of three-dimensional proton density-weighted vessel wall magnetic resonance imaging (3D-PD MRI) in identifying aneurysms from index lesions refer to vascular bulging lesions without vessels arising from the apex, observed using volume-rendered TOF-MRA in the circle-of-Willis compared with time-of-flight magnetic resonance angiography (TOF-MRA).

Study type
Retrospective.

Population
A total of 299 patients who underwent 3D-PD MRI, digital subtraction angiography (DSA), and TOF-MRA between January 2012 and December 2016 were retrospectively enrolled in this study.

Field strength/sequence
3 Tesla, 3D-PD MRI.

Assessment
Three neuroradiologists independently evaluated TOF-MRA and 3D-PD MRI combined with TOF-MRA for the determination of intracranial aneurysms in patients with index lesions within the circle of Willis. Final diagnoses were made by another neuroradiologist and neurointerventionist in consensus using DSA as the reference standard. The diagnostic performance and proportions of undetermined lesions on TOF-MRA and 3D-PD MRI with TOF-MRA were assessed based on the final diagnoses.

Statistical tests
The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of unruptured intracranial aneurysms were calculated for each imaging modality.

Results
Of 452 lesions identified on volume-rendered TOF-MRA images, 173 (38%) aneurysms and 276 (61%) infundibula were finally diagnosed on DSA. 3D-PD MRI with TOF-MRA showed superior diagnostic performance (p = .001; accuracy, 85.5% versus 95.4%), superior area under the receiver operating characteristic curve over TOF-MRA (p = .001; 0.837 versus 0.947), and a lower proportion of undetermined lesions than TOF-MRA (p = .001; 25.1% versus 2.3%).

Data conclusion
For unruptured intracranial aneurysms in the circle of Willis, 3D-PD MRI can complement TOF-MRA to improve diagnostic performance and lower the proportion of undetermined lesions.
Medical students in distress: The impact of gender, race, debt, and disability
Authors: Rajapuram Nikhil , Langness Simone , Marshall Megan R. , Sammann Amanda 
Published: December 2020

Background
In 2012, over half of US medical students experienced burnout and depression. Since that time, there have been many changes to student demographics, school resources and awareness of burnout in the medical field altogether. New tools are also available to screen for student distress, a condition that correlates with low mental quality-of-life, suicidal ideation and serious thoughts of dropping out. Despite increased attention on wellbeing and improved screening methods, no large-scale studies have evaluated student distress in the modern era of medical education. The objective of this study was to determine the current prevalence of medical student distress and contributing risk factors.

Methods
Student wellbeing from a national cohort of US medical students was measured with an electronic survey in a prospective, observational survey study from 2019–2020. Medical student distress was defined as a Medical Student Wellbeing Index (MS-WBI) of ≥4. Demographic details including age, race, gender, marital status, disability, desired specialty, and debt burden were evaluated in a multivariate logistic regression model to determine possible risk factors for the development of distress.

Results
A total of 3,162 students responded to the survey, representing 110 unique medical schools. Of these respondents, 52.9% met criteria for distress and 22% had either taken or considered taking a leave of absence for personal wellbeing. Independent risk factors for distress included involvement in the clinical phase of medical school (OR 1.37); non-male gender (OR 1.6); debt burden >$20,000 (OR 1.37), >$100,000 (OR 1.81), and >$300,000 (OR 1.96); and disability status (OR 1.84).

Conclusions
Medical student wellbeing remains poor in the modern era of medical education despite increased attention to wellbeing and increased availability of wellbeing resources. Disability status is a novel risk factor for distress identified in this study. The persistence of previously identified risk factors such as non-male gender, debt burden and clinical phase of school suggest that efforts to curb medical student distress have been inadequate to date.
The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts
Authors: Myong Catherine , Hull Peter , Price Mary , Hsu John , Newhouse Joseph P. , Fung Vicki 
Published: December 2020

Importance
Federally qualified health centers (FQHCs) receive federal funding to serve medically underserved areas and provide a range of services including comprehensive primary care, enabling services, and behavioral health care. Greater funding for FQHCs could increase the local availability of clinic-based care and help reduce more costly resource use, such as emergency department visits (ED).

Objective
To examine the impact of funding increases for FQHCs after the ACA on the use of FQHCs and EDs.

Methods
Retrospective study using the Massachusetts All Payer Claims Database (APCD) 2010–2013 that included APCD enrollees in 559 Massachusetts ZIP codes (N = 6,173,563 in 2010). We calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year, 2010–13 (N = 31). Outcomes were the number of ZIP code enrollees with visits to FQHCs and EDs, overall and for emergent and non-emergent diagnoses.

Results
In 2010, 4% of study subjects visited a FQHC, and they were more likely to be younger, have Medicaid, and live in low-income areas. We found that a standard deviation increase in prior year FQHC funding (+31 percentage point (pp)) at the ZIP code level was associated with a 2.3pp (95% CI 0.7pp to 3.8pp) increase in enrollees with FQHC visits and a 1.3pp (95% CI -2.3pp to -0.3pp) decrease in enrollees with non-emergent ED visits, but no significant change in emergent ED visits (0.3pp, 95% CI -0.8pp to 1.4pp).

Conclusions
We found that areas exposed to greater FQHC funding increases had more growth in the number of enrollees seen by FQHCs and greater reductions in ED visits for non-emergent conditions. Investment in FQHCs could be a promising approach to increase access to care for underserved populations and reduce costly ED visits, especially for primary care treatable or non-emergent conditions.
Rates, costs and determinants of lumbar spine imaging in population-based women born in 1973–1978: Data from the Australian Longitudinal Study on Women’s Health
Authors: Wang Yuanyuan , Hussain Sultana Monira , Wluka Anita E. , Lim Yuan Z. , Urquhart Donna M. , Mishra Gita D. , Teede Helena , Doust Jenny , Brown Wendy J. , Cicuttini Flavia M. 
Published: December 2020

Objective
There are concerns that lumbar spine imaging represents low value care. Our aim was to examine the use of lumbar spine imaging [radiography, computed tomography (CT), magnetic resonance imaging (MRI)] over 20 years, and costs and person-level characteristics of imaging in a large cohort of Australian women.

Methods
The Australian Longitudinal Study on Women’s Health (ALSWH) is a longitudinal population-based survey of women randomly selected from national health insurance scheme (Medicare) database. This study examined 13458 women born in 1973–1978 who consented to link their ALSWH and Medical Benefits Scheme records. Self-reported data on demographics, body mass index, depression, physical and mental health, and back pain were collected in each survey performed in 1996, 2000, 2003, 2006, 2009, 2012, and 2015. Data on lumbar spine imaging from 1996 to 2015 were obtained from the Medical Benefits Scheme database.

Results
38.9% of women underwent some form of lumbar spine imaging over 20 years. While radiography increased from 1996 to 2011 and decreased thereafter, CT and MRI continued to increase from 1996 to 2015. In women with self-reported back pain, depression and poorer physical health were associated with imaging, with no significant differences in types of imaging. Based on imaging rates in ALSWH, the estimated costs for Australian women aged 30–39 years were AU$51,735,649 over 2011–2015.

Conclusions
Lumbar spine imaging was common in population-based Australian women, with rates increasing over 20 years. Depression and poor physical health were associated with lumbar spine imaging. Raising awareness of this in clinicians is likely to result in significant cost savings if clinical guidelines are followed, with the potential of freeing resources for high value care and health outcomes.
Corneal thickness evaluation in healthy eyes: Comparison between two different Scheimpflug devices
Authors: Rosa Nicola , De Bernardo Maddalena , Pepe Angela , Vitiello Livio , Marotta Giuseppe , Imparato Roberto , Capasso Luigi 
Published: December 2020

Purpose
To evaluate the correlation between corneal thickness (CT) measurements obtained with two Scheimpflug devices, Pentacam HR and Precisio, and to elaborate, if necessary, a regression formula which could make these results comparable.

Design
Retrospective, Comparative, Observational study.

Setting
Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana” University of Salerno, Italy

Methods
One hundred twenty four healthy eyes of 124 volunteers (65 males; range: 20–32 years; mean age of 24.8 ± 1.7) were included in this study. CT was measured using Pentacam HR and Precisio in three different points: the pupil center (PC), the corneal apex (CA) and the thinnest point (TP).

Results
CT obtained with both devices at the PC, at the CA and at the TP showed a good correlation (r = 0.97, r = 0.97, r = 0.97, respectively), but Pentacam HR measurements were significantly thicker than those provided by Precisio (p < 0.01). The differences between Pentacam HR and Precisio were 21.9 ± 8.8 μm at the PC, 21.9 ± 8.9 μm at the CA, 19.1 ± 9.0 μm at the TP. The calculated regression formulas were: y = 0.9558x + 2.3196 for the PC, y = 0.9519x + 4.5626 for the CA, y = 0.9364x + 15.436 for the TP, where x is the CT measured with Pentacam HR and y is the Precisio measurement.

Conclusions
The findings provided by this study highlight that Precisio measures thinner corneas compared to Pentacam HR. The identified regression formulas could be utilized to make interchangeable the results obtained with these two devices.
Translumbosacral Neuromodulation Therapy Is a Promising Option for Fecal Incontinence
Authors: Bharucha Adil E. , Oblizajek Nicholas R. 
Published: December 2020

Abstract
Fecal incontinence is a common symptom that can significantly impair quality of life. The treatment options range from conservative measures (e.g., Kegel exercises, pelvic floor biofeedback therapy, fiber supplementation, or medications) to noninvasive nerve stimulation (e.g., posterior tibial nerve stimulation and transcutaneous tibial nerve stimulation), implanted neurostimulation (i.e., sacral nerve stimulation), perianal injection of dextranomer, and anal sphincteroplasty. In this issue of the journal, a promising, uncontrolled study suggests that noninvasive, repetitive magnetic stimulation of the lumbosacral nerves significantly improved symptoms, increased anal squeeze pressure, and increased rectal compliance in patients with fecal continence. Sham-controlled studies are necessary to confirm these findings.
Clinical Course of Chronic Pancreatitis During Pregnancy and its Effect on Maternal and Fetal Outcomes
Authors: Mahapatra Soumya Jagannath , Midha Shallu , Teja Gadella Varun , Vajpai Tanmay , Singh Nilanchali , Sahoo Sushree Monika , Pandey Shivam , Elhence Anshuman , Sethia Rahul , Garg Pramod Kumar 
Published: December 2020

Introduction:
There are limited data on the effect of chronic pancreatitis (CP) on pregnancy outcomes and vice versa. Our aim was to evaluate the clinical trajectory of CP during pregnancy and its effect on pregnancy outcomes.

Methods:
All female patients of child-bearing age (≥15 years) diagnosed with CP were studied from January 2004 to July 2019. The change in frequency of painful episodes was assessed before, during, and after pregnancy. Maternal and fetal outcomes were compared between pregnant women (early onset) and women presenting with CP after completion of all pregnancies (late onset).

Results:
Of 187 women with CP, pregnancy outcomes and clinical course were assessed in 99 patients. The frequency of painful exacerbations was significantly lower during pregnancy compared with prepregnancy and postpregnancy periods (P < 0.001). The median pain score decreased significantly to 0 (0–2) during pregnancy from 3 (0–6) before conception and increased to 4 (0–8) after pregnancy (P = 0.002). Women with early onset CP (n = 57) had their first child later and had fewer pregnancies compared with those with late onset CP (n = 42). There was no difference in maternal outcomes such as gestational diabetes, hypertension, and preterm delivery, and fetal outcomes such as abortion, low birth weight, and still birth between the groups. There was no reported congenital anomaly.

DISCUSSION:
Younger patients with CP had later and fewer pregnancies, but there was no increased risk of adverse maternal and fetal outcomes. The clinical course of CP was usually benign during pregnancy with decreased frequency and severity of pain.
Short-term outcomes of treatment of active stage of Charcot foot in outpatient setting
Authors: Demina Anastasia G. , Bregovskiy Vadim B. , Karpova Irina A. 
Published: December 2020

Background: Treatment options in patients with an acute Charcot foot is not well standardized and still challenging.Aims: To evaluate the results of the non-operative treatment of patients with active stage of diabetic charcot arthropathy in outpatient foot clinic and to identify factors influenced on treatment results.Materials and methods: Medical files of 141 patients with unilateral ulcer-free active charcot arthropathy were reviewed. 78 patients agreed for treatment (total contact cast or walker), 63 patients refused of treatment (follow-up only). The time of resolution of the acute stage, severity of final deformities and foot-related complications were evaluated. Refusers were asked about the cause of their decision.Results: Mean delay of the diagnosis was 3,2±2,8 months. Main causes of the refuse were: mistrust to doctor - 38%, problems with employment - 33%, home/family problems - 18%, medical reasons - 11%. Median healing times (months) in the treatment group vs controls: 9 (6 - 19) 15 (13 - 25) (p=0,001) and progression of the initial deformity: 14% and 35%, respectively (p=0,01). Foot-related complications: 17,5% in the treatment group and in 55,6% of controls (including 6 amputations) (p=0,001). Frequency of breaking the cast/walker - 32%/16,6%. Foot lesions due to cast/walker: 13,6%/41,7% (p<0,01). Median healing times (months) with walkers - 13 (11 - 19), with casts - 9 (6 - 15) months (р=0,02). The use of crutches shortened healing time.Conclusions: The significant delay of diagnosis was revealed. The refuse rate in our cohort was high and main causes of the refuse were social and psychological. Neglect of treatment leads to high frequency and severity of foot-related complications. We noticed high rate of breaking of walkers and casts and device-related foot lesions. Total contact casts were more effective and safe compared with walkers.
The Effect of Paracetamol and Codeine Analgesic Combination on Creatinine Levels in Male Wistar Rats
Authors: Natasaputra Vianney , Nugroho Taufik Eko 
Published: December 2020

Background : Pain is one of the most common complaint in patients. Combination of paracetamol and codeine is an alternative analgesic combination in chronic pain management. They belong to different group of analgesic and have different mechanism of action. Combination of these drugs give a better potential in pain management. However, these drugs also have potential side effect on the kidney.Methods : An experimental study of post-test only control group design. The sample were 20 Wistar rats, randomized into 4 groups: control group, a group receiving paracetamol 32 mg/kg body weight, a group receiving codeine 1,9 mg/kg body weight, and a group receiving paracetamol 32 mg/kg body weight and codeine 1,9 mg combination, administered 4 times a day orally using gastric instillation for 28 days. At the 29th day, blood is collected from retro orbital vessel to measure the serum creatinine levels. Statistical analysis was conducted using ANOVA TestResult : Obtained from statistical analysis there is no significant difference in serum creatinine levels in Wistar rats given all treatment group (p > 0,05).Conclusion : There is no significant difference in serum creatinine levels between administration of paracetamol and codeine combination compared to the control group.