bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vecuronium- and Esmolol-Induced Pseudohypernatremia Due to Drug Interference With Ion-Selective Electrodes
Authors: Polsky Tracey G. , Salmon Eloise , Welsh Sarah S. , Lim Derick , Feng Sheng , Ballester Lance , Ehlayel Abdulla M. , Hewlett Jennifer L. , Denburg Michelle R. , Boyer Donald L. , Beier Ulf H. 
Published: January 2020

Objectives:
We observed that patients treated with continuous vecuronium or esmolol infusions showed elevated plasma sodium measurements when measured by the routine chemistry analyzer as part of the basic metabolic panel (Vitros 5600; Ortho Clinical Diagnostics, Raritan, NJ), but not by blood gas analyzers (RAPIDLab 1265; Siemens, Tarrytown, NY). Both instruments use direct ion-selective electrode technology, albeit with different sodium ionophores (basic metabolic panel: methyl monensin, blood gas: glass). We questioned if the basic metabolic panel hypernatremia represents artefactual pseudohypernatremia.

Design:
We added vecuronium bromide or esmolol hydrochloric acid to pooled plasma samples and compared sodium values measured by both methodologies. We queried sodium results from the electronic medical records of patients admitted at Children’s Hospital of Philadelphia from 2016 to 2018 and received vecuronium and/or esmolol infusion treatment during their admissions.

Setting:
PICU of a quaternary, free-standing children’s hospital.

Patients:
Children admitted to the hospital who received vecuronium and/or esmolol infusion.

Measurements and Main Results:
Sodium was measured in pooled plasma samples by basic metabolic panel and blood gas methodologies after adding vecuronium bromide or esmolol hydrochloric acid, leading to a dose-response increase in basic metabolic panel sodium measurements. A repeated measures regression analysis of our electronic medical records showed that the vecuronium dose predicted the Δ sodium (basic metabolic panel–blood gas) sodium within 12 hours of the vecuronium administration (p < 0.0018). Esmolol showed a similar trend (p = 0.13). This occurred primarily in central line samples with continuous vecuronium or esmolol infusions.

Conclusions:
Vecuronium and esmolol can falsely elevate direct ion-selective electrode sodium measurements on Vitros chemistry analyzers. Unexpectedly high sodium measurements in patients receiving vecuronium and/or esmolol infusions should be further investigated with an alternate sample type (i.e., peripheral blood) or measurement methodology (i.e., blood gas) to guide treatment decisions.
Inhaled Tranexamic Acid As a Novel Treatment for Pulmonary Hemorrhage in Critically Ill Pediatric Patients: An Observational Study
Authors: O’Neil Erika R. , Schmees Lindsay R. , Resendiz Karla , Justino Henri , Anders Marc M. 
Published: January 2020

Objectives:
To describe the use of inhaled or endotracheally instilled tranexamic acid in critically ill pediatric patients for the treatment of pulmonary hemorrhage, which can be severe, life-threatening, and include potentially high-risk management procedures.

Design:
Retrospective observational study from 2011-2018 with patients followed until hospital discharge.

Setting:
Free-standing children’s hospital with an annual ICU volume of more than 3,500 yearly admissions.

Patients:
Pediatric patients, ages 0 to 18 years, admitted to an ICU and who received at least one dose of inhaled or endotracheally instilled tranexamic acid were included.

Interventions:
Inhaled or endotracheally instilled tranexamic acid.

Measurements and Main Results:
This study described the efficacy and adverse effects of patients who received inhaled or endotracheally instilled tranexamic acid. A total of 19 patients met inclusion criteria; median age was 72 months (11–187 mo), most patients were female (11, 58%), and almost half our patients (8, 42%) had congenital heart disease. Nine of 19 encounters (47%) had diffuse alveolar hemorrhage, four (21%) had pulmonary hemorrhage related to major aortopulmonary collateral arteries, two (11%) had mucosal airway bleeding, two (11%) were iatrogenic, one had a pulmonary embolism, and one patient did not have their etiology of pulmonary hemorrhage determined. Cessation of pulmonary hemorrhage was achieved in 18 of 19 patients (95%) with inhaled tranexamic acid with no major adverse events recorded.

Conclusions and Relevance:
We demonstrate that inhaled tranexamic acid may be safely used to treat pulmonary hemorrhage from varied etiologies in critically ill pediatric patients. Prospective studies are required in this vulnerable population to determine optimal dosing and delivery strategies, as well as to define any differential effect according to etiology.
The Cumulative Effect of Prior Maltreatment on Emotional and Physical Health of Children in Informal Kinship Care
Authors: Lee Eunju , Kramer Catherine , Choi Mi Jin , Pestine-Stevens Althea , Huang Yufan 
Published: January 2020

ABSTRACT:Objective:Millions of children cared for by their grandparents or other kin without a biological parent present are not part of the foster care system. Maltreatment may have precipitated out-of-home care arrangements, but most children in informal kinship care are not being tracked or receiving services. Importantly, the extent of previous child welfare involvement and its association with well-being among this population are not well known.Methods:Kinship caregivers known to social service and community agencies were recruited for this study. Caregivers who agreed to participate rated the physical and emotional health of children under their care. Maternal mental health and demographic data were collected, and matched records of children were retrieved from the state child welfare database. The nested structure of children within families was addressed using a generalized estimating equation model.Results:The sample included 365 children from 274 families. Only 25% of the children were in private kinship care with no known Child Protective Services (CPS) involvement. An average of 2.37 open CPS cases were observed for those in voluntary kinship care. One out of 4 children scored below the clinical level of emotional health. The number of CPS cases and kin caregiver's parenting stress were inversely associated with child's physical and emotional health. The presence of maternal mental health problem was significantly associated with poor child emotional well-being.Conclusion:Many children in informal kinship care experienced multiple episodes of maltreatment. This study's results add further evidence of the cumulative negative effects of child maltreatment on child well-being. Children in informal kinship care are in need of services to mitigate their traumatic experiences.
A High Plasma Lamotrigine Concentration at Week 2 as a Risk Factor for Lamotrigine-Related Rash
Authors: Suzuki Takeshi , Mihara Kazuo , Nagai Goyo , Kagawa Shoko , Nakamura Akifumi , Nemoto Kenji , Kondo Tsuyoshi 
Published: January 2020

Background:
Reportedly, a high plasma concentration of lamotrigine plays a role in the development of lamotrigine-related rash. The relationship between plasma concentrations of lamotrigine at week 2 and the lamotrigine-related rash was prospectively studied in 84 patients (22 males and 62 females) with treatment-resistant depressive disorder during an 8-week treatment of lamotrigine augmentation.

Methods:
Eighty-four depressed patients with an insufficient response to at least 3 psychotropics, including antidepressants, mood stabilizers, and atypical antipsychotics, were included. The diagnoses were major depressive disorder (n = 39), bipolar I disorder (n = 10), and bipolar II disorder (n = 35). The final doses of lamotrigine were 100 mg/d for 57 subjects who were not taking valproate and 75 mg/d for 27 subjects taking valproate. Blood sampling was performed at week 2. Lamotrigine plasma concentrations were measured using high-performance liquid chromatography. The development of lamotrigine-related rash was assessed during the 8-week treatment.

Results:
Six females developed lamotrigine-related rash. The mean plasma lamotrigine concentrations at week 2 were significantly (P = 0.009) higher in the rash group (4.81 ± 1.23 μmol/L) than in the nonrash group (3.35 ± 1.39 μmol/L). Receiver-operating characteristic analysis indicated that a plasma lamotrigine concentration of 4.38 μmol/L or greater at week 2 was significantly (P < 0.0001) predictive of lamotrigine-related rash. The proportion of patients with a lamotrigine concentration of 4.38 μmol/L or greater was significantly divided by the cutoff point into the rash group and the nonrash group (5/1 versus 13/65, P = 0.001).

Conclusions:
This study suggests that a high plasma lamotrigine concentration during week 2 is a risk factor for lamotrigine-related rash and a plasma lamotrigine concentration of 4.38 μmol/L may be a considered a threshold for rash in treatment-resistant depressive disorder.
CHANGES IN CHORIOCAPILLARIS, SATTLER, AND HALLER LAYER THICKNESSES IN CENTRAL SEROUS CHORIORETINOPATHY AFTER HALF-FLUENCE PHOTODYNAMIC THERAPY
Authors: Flores-Moreno Ignacio , Arcos-Villegas Gabriel , Sastre Marina , Ruiz-Medrano Jorge , Arias-Barquet Luis , Duker Jay S. , Ruiz-Moreno José M. 
Published: January 2020

Purpose:
To determinate the variation in thickness of the individual choroidal layers in patients with central serous chorioretinopathy treated with half-fluence photodynamic therapy.

Methods:
Twenty-two eyes were evaluated with spectral-domain optical coherence tomography. The images were taken before photodynamic therapy, 3 months, and 6 months after the treatment. Two investigators performed these measurements: 1) choroidal thickness (CT), 2) Haller layer thickness, defined as the most external layer containing a 100-μm vessel, and 3) choriocapillaris + Sattler layer (C&S). Nine measurements were taken in the macular region.

Results:
Choroidal thickness before photodynamic therapy was 471.8 µm ± 145.8. The Haller layer was 358.4 µm ± 122.6, and C&S was 114.3 µm ± 27.8. At 3-month follow-up, CT was 441.1 µm ± 150.7, Haller layer 348.8 µm ± 127.6, and C&S 92.4 µm ± 27.9. At 6-month follow-up, CT was 420.4 µm ± 118.4, Haller layer 331.8 µm ± 97.2, and C&S 89.5 µm ± 28.0. Using a multilevel mixed-effects linear regression, CT was found to be reduced at both 3 months (P < 0.03) and at 6 months (P < 0.001), Haller layer showed no significant reduction at 3 months (P = 0.483) or at 6 months (P = 0.055), and C&S showed reduction at 3 months (P < 0.001) and at 6 months (P < 0.001). Fellow nonaffected eyes showed no statistical variation at 3-month and 6-month follow-up.

Conclusion:
Reduction in CT in patients affected by central serous chorioretinopathy after half-fluence photodynamic therapy occurs primarily in the choriocapillaris and medium diameter vessel layers of the choroid in a short- and medium-term follow-up.
Femtosecond laser-integrated anterior segment optical coherence tomography to detect preexisting posterior capsular dehiscence and increase safety in posterior polar cataracts
Authors: Sachdev Mahipal S. , Malik Raghav , Gupta Hemlata , Sachdev Ritika , Sachdev Gitansha Shreyas 
Published: January 2020

Purpose:
To determine the efficacy of the femtosecond laser with integrated anterior segment optical coherence tomography (AS-OCT) for the detection of posterior capsular dehiscence in posterior polar cataracts (PPCs). To evaluate the safety of phacoemulsification in these eyes undergoing femtosecond laser–assisted cataract surgery (FLACS).

Setting:
Centre For Sight Group of Eye Hospitals, a chain of tertiary eyecare hospitals in India.

Design:
Prospective interventional case series.

Methods:
The study included eyes with PPCs undergoing FLACS using the CATALYS femtosecond platform. Real-time OCT guidance was used to image the posterior capsule (PC), which was then classified as intact or dehiscent. The femtosecond laser was used for the creation of capsulotomy, nuclear fragmentation, and corneal incisions. In all eyes, the posterior offset (distance between the posterior extent of nucleotomy and the PC) was increased to enable a thick epinuclear cushion. Intraoperative status of the PC was noted, and the specificity and the sensitivity of AS-OCT to detect a preexisting posterior capsular defect was determined.

Results:
The cohort included 50 eyes (40 patients), in which a posterior capsular discontinuity on AS-OCT was observed in 7 eyes (14%). Five (10%) of these 7 eyes developed an intraoperative posterior capsular rent (PCR) A sensitivity and negative predictive value of 100% was noted. No case of nucleus drop was noted.

Conclusions:
Femtosecond laser with integrated AS-OCT is a relevant and helpful tool to detect and increase the safety in preexisting posterior capsular dehiscence, alerting the surgeon ahead of phacoemulsification.
Topical application of Heparanase-1 facilitates bone remodeling during the healing of bone defects in a mouse model
Authors: Chiu Po-Yu , HuangFu Wei-Chun , Liu I-Hsuan , Chang Ya-Pei 
Published: January 2020

Background:
Although previous studies have suggested a stimulatory role of heparanase in physiological bone turnover, the potential therapeutic role of heparanase in bone healing has not been elucidated. The purpose of this study was to assess the effect of topical application of heparanase-1 on bone healing.

Methods:
Two different dosages of recombinant mouse heparanase-1 and vehicle control were prepared and delivered via an osmotic pump to provide continuous topical infusion of the therapeutic reagent in a mouse bone defect model at the distal femoral metaphysis. The bone healing progress was evaluated by micro-computed tomography and histological examination at 7, 14, and 21 days after the bone defect was created.

Results:
The peak of trabecular bone generation was achieved earlier than anticipated with the use of heparanase as measured by medullary bone volume fraction and trabecular number observed in micro-computed tomography, while the remodeling of trabecular bone to cortical bone was also achieved earlier than anticipated with the use of heparanase as measured by connectivity density. Histopathological observation revealed a higher frequency of the presence of cartilaginous tissue in the heparanase-treated groups. Both bone mineral density and cortical bone volume fraction showed the best healing outcome with low-dose heparanase, implying a biphasic effect of its mode of action.

Conclusion:
These results indicated that with the appropriate dose of topical heparanase-1, the progress of bone healing could be accelerated in vivo.
Psychosocial Factors Related to Adverse Outcomes in Heart Failure Caregivers
Authors: Graven Lucinda J. , Azuero Andres , Abbott Laurie , Grant Joan S. 
Published: January 2020

Background
Heart failure (HF) caregivers experience increased demands and burden. Social support and problem solving may influence the effect of these variables on caregiver outcomes.

Objective
The aim of this study was to examine whether social support and problem solving mediate relationships among caregiver demands and burden, self-care, depression, and life changes in heart failure caregivers.

Methods
Using a cross-sectional, exploratory design, heart failure caregivers (n = 530) completed online questionnaires on caregiver demands and burden, social support, problem solving, depression, self-care, and life changes. Path analysis examined a hypothesized mediating role of social support and problem solving in the relationships among caregiver demands and burden and caregiver outcomes. The analysis included (1) a model-development phase (n = 329) to make data-based decisions on measurement indicators and model structure and (2) a confirmatory phase (n = 201) to provide unbiased inference on the model structure resulting from the initial phase.

Results
Participants were 41.39 (±10.38) years old and primarily white (78.3%) men (50.9%) caring for a spouse (44.9%). Per the magnitudes of the estimated path coefficients, social support mediated the relationship between caregiver burden and depression but did not relevantly mediate the relationship between caregiver burden and self-care or caregiver life changes. In the presence of social support as a parallel mediator, problem solving was not a relevant mediator between caregiver burden and demands and caregiver outcomes.

Conclusions
Social support mediates the effects of caregiver burden on depression but has little effect on self-care or life changes. In the presence of social support, problem solving does not mediate the effects of caregiver demands and burden on caregiver outcomes.
Prediction of Heart Failure Symptoms and Health-Related Quality of Life at 12 Months From Baseline Modifiable Factors in Patients With Heart Failure
Authors: Heo Seongkum , Moser Debra K. , Lennie Terry A. , Fischer Mary , Kim JinShil , Walsh Mary N. , Ounpraseuth Songthip , Turrise Stephanie 
Published: January 2020

Background
In patients with heart failure (HF), good health-related quality of life (HRQOL) is as valuable as, or more valuable than, longer survival. However, HRQOL is remarkably poor, and HF symptoms are strongly associated with poor HRQOL. Yet, the multidimensional, modifiable predictors have been rarely examined.

Objective
The aim of this study was to examine the baseline psychosocial, behavioral, and physical predictors of HF symptoms and HRQOL at 12 months and the mediator effect of HF symptoms in the relationship between depressive symptoms and HRQOL.

Methods
We collected data from 94 patients with HF (mean ± SD age, 58 ± 14 years). Data included sample characteristics, depressive symptoms, perceived control, social support, New York Heart Association (NYHA) functional class, medication adherence, sodium intake, self-care management, and HF symptoms at baseline, as well as HF symptoms and HRQOL at 12 months. Multiple regression analyses were performed to address the purpose.

Results
Baseline depressive symptoms (P < .001), medication adherence (P = .010), sodium intake (P = .032), and NYHA functional class (P = .040) significantly predicted 12-month HF symptoms, controlling for covariates (F = 7.363, R
2 = 47%, P < .001). Baseline medication adherence (P = .001), NYHA functional class (P < .001), and HF symptoms (P = .013) significantly predicted 12-month HRQOL (F = 10.701, R
2 = 59%, P < .001). Baseline HF symptoms fully mediated the relationship between baseline depressive symptoms and 12-month HRQOL.

Conclusion
Symptoms of HF and HRQOL could be improved by targeting multidimensional, modifiable predictors, such as self-care, depressive symptoms, and NYHA functional class.
Effects of Art and Reminiscence Therapy on Agitated Behaviors Among Older Adults With Dementia
Authors: HSIAO Chiu-Yueh , CHEN Shu-Li , HSIAO Yu-Shuang , HUANG Hsiu-Yun , YEH Shu-Hui 
Published: January 2020

ABSTRACT

Background
Cognitive degeneration and agitated behavior symptoms of dementia in older adults are the main causes of disability and inability and increase the cost of medical care. Agitated behavior symptoms of dementia are the main causes of early institutionalization and make caregivers exhausted.

Purpose
The aim of this study was to examine the effects of art therapy and reminiscence therapy on the alleviation of agitated behaviors in older adults with dementia.

Methods
An experimental research design with two experimental groups and one comparison group was conducted to examine the effects for each group on agitated behaviors. Participants were recruited from two dementia care centers in central and northern Taiwan. The study included 54 older individuals who met the sampling criteria and completed the data collection process. The participants were randomly allocated into the art therapy group (n = 24), the reminiscence therapy group (n = 22), and the comparison group (n = 8). The intervention consisted of 50-minute sessions conducted weekly for 12 weeks. Regular activities were continued in the comparison group. The structured questionnaires were completed, and observations of agitated behaviors were collected before the intervention and at 1 and 6 weeks after the intervention.

Results
Significant differences were found in agitated behavior symptoms at the three time points in the art therapy group, whereas reminiscence therapy was found to have had a clear and immediate effect on decreasing agitated behavior. The generalized estimating equation exchange model test revealed a significant and sustained, postintervention effect of art therapy on agitated behavior. In contrast, no significant and sustained effect on agitated behavior was observed in the reminiscence therapy group.

Conclusions
The findings of this study support that art therapy may have a positive effect on dementia-associated agitated behaviors in institutionalized older adults. Reminiscence therapy activities conducted weekly for 50 minutes each session did not reach statistically significant implications. It is suggested that future studies consider conducting art and reminiscence therapies for a 16-week duration with two weekly sessions to evaluate the effectiveness of the therapy. The duration of follow-up should be extended as well in future studies.
Roles of FGF21 and irisin in obesity-related diabetes and pancreatic diseases
Authors: Xie Ting , Leung Po Sing 
Published: January 2020

Abstract
In the past decades, skeletal muscle has become the focus of numerous studies due to its potential physiological role as an endocrine organ secreting hundreds of myokines. Among these myokines, fibroblast growth factor 21 (FGF21) and irisin are novel hormone polypeptides sending signals to regulate the function of specific organs, like skeletal muscle, liver, pancreas, and adipose tissue. Both hormones have been reported to normalize glucose, improve insulin resistance, and promote lipid homeostasis, thereby preventing the development of metabolic disorders, such as obesity and diabetes. Besides preserving pancreatic β-cell functions, FGF21 also protects pancreatic acini from inflammation and reduces proteotoxic stress via facilitating digestive enzyme secretion. Meanwhile, irisin is found to inhibit the pancreatic cancer cell growth as well. This review attempts to focus on the current knowledge of FGF21 and irisin and their effective roles in pancreas including pancreatic β- and acinar cells under various physiological conditions, its anti-diabetic actions, and the clinical implications.
Improving Microscopic Imaging in Otology and Neurotology
Authors: Saadi Robert , Liaw Jeffrey , Baker Aaron , Isildak Huseyin 
Published: January 2020

Objective:
Due to the microscopic nature of otologic surgery, photographic image quality suffers from an inherent inability to maintain all the planes of surgery in focus under binocular microscopy. Our goal was to perform simple editing techniques to create improved imaging for educational and research purposes in the field of Otology and Neurotology.

Patients/Design:
The study was a proof of concept performed with series of cases including patients undergoing transmastoid and transcanal otologic surgery over time period of December 1, 2018 to March 1, 2019 at an academic medical center. The Zeiss OPMI Pentero 800 operating microscope was used with a camera capturing 2.1 megapixel, 1098 × 1080 resolution images.

Intervention:
We created a systematic protocol for capturing images of multiple focal lengths during each surgery. With the image-editing technique of focus-stacking, multiple images of varying focal length, were spliced together to produce high-quality and high-fidelity composite images rendered using the Adobe Photoshop (San Jose, CA).

Outcomes:
Subjective comparisons of pre and post photo-edited photographs.

Results:
Composite, focus-stacked images with comparison to unedited microscopic pictures are reviewed in the manuscript.

Conclusion:
We describe a simple and objectively practical method for improving the quality of medical imaging in the field of Otology/Neurotology. To achieve this enhanced image quality, a relatively expeditious and reliable photographic protocol can be used for image capturing and editing, requiring little to no additional training for a physician in the field.