bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extracellular Glutamate Concentration Increases Linearly in Proportion to Decreases in Residual Cerebral Blood Flow After the Loss of Membrane Potential in a Rat Model of Ischemia
Authors: Kawase Hirokazu , Takeda Yoshimasa , Mizoue Ryoichi , Sato Sachiko , Fushimi Miki , Murai Satoshi , Morimatsu Hiroshi 
Published: December 2019

Background:
Brain ischemia due to disruption of cerebral blood flow (CBF) results in increases in extracellular glutamate concentration and neuronal cell damage. However, the impact of CBF on glutamate dynamics after the loss of the membrane potential remains unknown.

Materials and Methods:
To determine this impact, we measured extracellular potential, CBF, and extracellular glutamate concentration in the parietal cortex in male Sprague-Dawley rats (n=21). CBF was reduced by bilateral occlusion of the common carotid arteries and exsanguination until loss of extracellular membrane potential was observed (low-flow group), or until CBF was further reduced by 5% to 10% of preischemia levels (severe-low-flow group). CBF was promptly restored 10 minutes after the loss of membrane potential. Histologic outcomes were evaluated 5 days later.

Results:
Extracellular glutamate concentration in the low-flow group was significantly lower than that in the severe-low-flow group. Moreover, increases in extracellular glutamate concentration exhibited a linear relationship with decreases in CBF after the loss of membrane potential in the severe-low-flow group, and the percentage of damaged neurons exhibited a dose-response relationship with the extracellular glutamate concentration. The extracellular glutamate concentration required to cause 50% neuronal damage was estimated to be 387 μmol/L, at 8.7% of preischemia CBF. Regression analyses revealed that extracellular glutamate concentration increased by 21 μmol/L with each 1% decrease in residual CBF and that the percentage of damaged neurons increased by 2.6%.

Conclusion:
Our results indicate that residual CBF is an important factor that determines the extracellular glutamate concentration after the loss of membrane potential, and residual CBF would be one of the important determinants of neuronal cell prognosis.
Uterine fibroids in menopause and perimenopause
Authors: Ulin Mara , Ali Mohamed , Chaudhry Zunir Tayyeb , Al-Hendy Ayman , Yang Qiwei 
Published: December 2019

Abstract
Uterine fibroids (UFs) are benign tumors that arise from a single genetically altered mesenchymal stem cell under the influence of gonadal hormones. UFs are the most common benign gynecologic tumors in premenopausal women worldwide. It is estimated that nearly 70% to 80% of women will develop UFs at some point during their lifetime. UFs often present with abnormal uterine bleeding (AUB), pelvic fullness, and may have deleterious effects on fertility. The natural regression of UFs begins in menopause. This is, however, a generality as this pathology may still be present in this age group. Many clinicians are concerned about hormone therapy (HT) because of UFs regrowth; nevertheless, research of this subject remains inconclusive. If UFs are present in perimenopause or menopause, they typically manifest as AUB, which represents up to 70% of all gynecological consultations in perimenopausal and postmenopausal women. As AUB is a broad symptom and may not be specific to UFs, a thorough evaluation is required for correct diagnosis and proper treatment accordingly. Understanding the unique characteristics of the available treatment modalities is crucial in deciding the appropriate treatment approach. Decision on treatment modality should be made based on selection of the least morbidity and lowest risk for each patient. Multiple modalities are available; however, surgery remains the method of choice, with the best cure rates. Various attempts to create an inexpensive, safe, and effective drug for the treatments of UFs are still in the early stages of the clinical trials with some showing great promise. Treatment options include tibolone, aromatase inhibitors, selective estrogen receptor modulators, uterine artery embolization, and selective progesterone receptor modulators.

Video Summary:
http://links.lww.com/MENO/A493.
Traumatic Brain Injury and Opioid Overdose Among Post-9/11 Veterans With Long-Term Opioid Treatment of Chronic Pain
Authors: Fonda Jennifer R. , Gradus Jaimie L. , Brogly Susan B. , McGlinchey Regina E. , Milberg William P. , Fredman Lisa 
Published: December 2019

Objective:
To evaluate the association between traumatic brain injury (TBI) and nonfatal opioid overdose, and the role of psychiatric conditions as mediators of this association.

Setting:
Post-9/11 veterans receiving care at national Department of Veterans Affairs (VA) facilities from 2007 to 2012.

Participants:
In total, 49 014 veterans aged 18 to 40 years receiving long-term opioid treatment of chronic noncancer pain.

Design:
Longitudinal cohort study using VA registry data.

Main Measures:
TBI was defined as a confirmed diagnosis (28%) according to VA comprehensive TBI evaluation; no TBI was defined as a negative primary VA TBI screen (ie, no head injury). Nonfatal opioid overdose was defined using ICD-9 (International Classification of Diseases, Ninth Revision) codes. We performed demographic-adjusted Cox proportional hazards regression. We quantified the impact of co-occurring and individual psychiatric conditions (mood, anxiety, substance use, and posttraumatic stress disorder) on this association using mediation analyses.

Results:
Veterans with TBI had more than a 3-fold increased risk of opioid overdose compared with those without (adjusted hazards ratio [aHR] = 3.22; 95% confidence interval [CI], 2.13-4.89). This association was attenuated in mediation analyses of any co-occurring psychiatric condition (aHR = 1.77; 95% CI, 1.25-2.52) and individual conditions (aHR range, 1.52-2.95).

Conclusion:
TBI status, especially in the context of comorbid conditions, should be considered in clinical decisions regarding long-term use of opioids in patients with chronic pain.
The Influence of Evidence-Based Design on Staff Perceptions of a Supportive Environment for Person-Centered Care in Forensic Psychiatry
Authors: Degl' Innocenti Alessio , Wijk Helle , Kullgren Anette , Alexiou Eirini 
Published: December 2019

ABSTRACT
This prospective longitudinal study aimed to examine the relocation of three forensic psychiatric hospitals in Sweden into new facilities. The research focused on the effects of the physical and psychosocial environment and other staff-related parameters on the delivery of person-centered care after relocation. In forensic psychiatry, most relocations to new environments are to support a person-centered approach and to promote patients' rehabilitation and reintegration into society. Hopefully, this is undertaken in accordance with an evidence-based design strategy allowing improvement in staff satisfaction and working conditions as well as their capacity to provide individualized care. All staff members working on the wards of the facilities in question were invited to participate in the study. Data were collected prospectively between 2010 and 2014, before and after relocation of the forensic psychiatric clinics to new buildings. Structured validated questionnaires were employed. Staff members' job satisfaction and perceptions of a person-centered physical and psychosocial environment increased after relocation and provide evidence that staff perceptions of ward atmosphere in forensic psychiatric clinics are susceptible to factors in the physical and psychosocial environment. The importance of always taking the environmental factors into consideration, to achieve greater staff well-being and capacity to accomplish goals in forensic psychiatry, is emphasized.
99mTc-D(RGD): molecular imaging probe for diagnosis of αvβ3-positive tumors
Authors: Ramezanizadeh Mohammadali , Masterifarahani Arezou , Sadeghzadeh Nourollah , Abediankenari Saied , Mardanshahi Alireza , Maleki Fariba 
Published: December 2019

Objective
Arginine–glycine–aspartic acid (RGD) peptide with its specific binding affinity to integrin αvβ3, is widely investigated for the development of molecular imaging probes for diagnosis of αvβ3-positive tumors. The aim of this work was to evaluate the ability of 99mTc- HYNIC-D(RGD), a novel retro-inverso peptidomimetic derivative for U87MG tumor (αvβ3-positive) imaging.

Methods
HYNIC-D(RGD) labeled with 99mTc using tricine/EDDA as an exchange coligands. Single-photon emission computed tomography imaging and biodistribution study were performed in nude mice bearing U87MG xenograft tumor.

Results
The labeling yield was >95%. The radiopeptide showed high uptake value in the U87MG tumor relative to muscle after 2 hours (1.43 ± 0.05 vs. 0.22 ± 0.11 %ID/g). The tumor/muscle ratio was 6.5. Blocking experiment showed specific binding towards tumor. Single-photon emission computed tomography imaging study revealed that radiopeptide had prominent uptake in U87MG tumor.

Conclusion
The novel 99mTc HYNIC- D(RGD) was demonstrated to be a useful radiotracer for the assessment of αvβ3-positive tumor in animal model. Therefore, further clinical and preclinical studies are required.
Frontal sinus fractures and cerebrospinal fluid leaks: a change in surgical paradigm
Authors: Banks Catherine , Grayson Jessica , Cho Do Yeon , Woodworth Bradford A. 
Published: December 2019

Purpose of review
Traditionally, frontal sinus trauma has been treated using open incisions to access the anterior and/or posterior table. Mounting evidence indicates frontal sinus trauma can be managed using an endoscopic endonasal approach (EEA) with less morbidity. Such an approach permits preservation of a functional sinus and less reliance on computed tomography for postoperative follow up. The goal of this article is to highlight a shift in paradigm away from open approaches using external incisions towards an EEA to repair cerebrospinal fluid (CSF) leaks and fractures of the frontal sinus.

Recent findings
In a prospective case series of 46 patients undergoing EEA to frontal sinus fractures, 41 patients had active CSF leaks arising from the posterior table of the frontal sinus. A successful endoscopic repair was achieved in 97.6% with only one patient requiring revision Draf IIB surgery. Anterior table fractures were also successfully reduced with excellent cosmesis.

Summary
Endoscopic repair of frontal sinus fractures and CSF leaks is effective and well tolerated. In select patients, it is the preferred treatment as it maintains normal sinus structure and function, minimizing both early and late complications.
Direct Health Care Costs, Health Services Utilization, and Outcomes of Biliary Atresia
Authors: Siddiq Shabnaz , Jimenez‐Rivera Carolina , Kuenzig M. Ellen , Lima Isac , Geraghty Michael T. , Ng Vicky L. , Tam Karen , Benchimol Eric I. 
Published: December 2019

ABSTRACTObjectives:Biliary atresia (BA) is the most common reason for liver transplant in childhood, and outcomes worsen with older age at hepatoportoenterostomy (HPE). We determined direct health care costs in children with BA, compared to controls in a population‐based cohort of children in Ontario, Canada.Methods:We used health administrative data to identify all children diagnosed with BA between 2002 and 2016 (n = 121) and matched controls (n = 602). We determined annual direct healthcare costs, and rates of health services utilization, liver transplantation, death, portal hypertension, cirrhosis, esophageal varices, and major upper gastrointestinal bleeding requiring hospitalization. Multivariable regression models determined the association between age at HPE, risk of liver transplant, and direct costs.Results:Incidence of BA was 6.07 (4.99–7.15) per 100,000 live births. The annual median (interquartile range) direct health care costs were higher in BA cases ($4210; interquartile range $1091–$16,765) compared to controls ($283; $112–$634). Compared to age at HPE <45 days, there was no significant association between direct costs and HPE ≥90 days (rate ratio 1.24, 95% confidence interval [CI] 0.78–1.97) or 45 to 90 days (rate ratio 1.05, 95% CI 0.73–1.50). Age at HPE ≥90 days was significantly associated with risk of undergoing liver transplant compared to age <45 days (hazard ratio 5.27, 95% CI 2.45–11.34). Direct costs were higher in patients with BA who underwent liver transplantation compared to those who did not ($39,476±$84,367 vs $22,579 ± $67,913).Conclusions:Direct ealth care costs were high in patients with BA, especially in those who underwent liver transplantation. Age at HPE was associated with risk of liver transplantation, but not direct health care costs, utilization, or other risk outcomes.
Positive Psychological Change Following a Cancer Diagnosis in Old Age
Authors: Hoogland Aasha I. , Jim Heather S. L. , Schoenberg Nancy E. , Watkins John F. , Rowles Graham D. 
Published: December 2019

Background
Despite the stress inherent in a cancer diagnosis, many cancer survivors report benefits, including perceptions of personal growth and well-being. Among adults 60 years or older, for whom cancer diagnoses are most prevalent, there is a notable lack of research on positive psychological change.

Objective
This mixed-methods study was designed to advance current understanding of positive psychology (ie, posttraumatic growth, well-being) in older adults with cancer.

Methods
Fifty-six older adult cancer survivors were recruited through a statewide cancer registry and the community. Participants completed questionnaires on posttraumatic growth, well-being, coping, and quality of life, as well as a series of open-ended questions via mail.

Results
Participants reported high posttraumatic growth and well-being and primarily adaptive and emotion-focused coping strategies. They also reported better mental quality of life (P = .0001) but not physical quality of life (P = .31) compared with age-adjusted population norms. Older age was associated with less posttraumatic growth (r = −0.32, P = .02) but not well-being (P = .34). Qualitative responses emphasized appreciation and acceptance and a reliance on faith and social support and provided context for quantitative results.

Conclusions
This mixed-methods study suggests that older adults report positive psychological change and adaptive coping with cancer, demonstrating their high level of emotional resilience.

Implications for Practice
Mental health screenings should be provided as appropriate, but oncology nurses should also consider the potential for positive psychological change postdiagnosis. The provision of care and social support may need to be modified to accommodate older cancer survivors’ needs.
Childhood Trauma and Childhood Mental Disorder in Military and Employed Civilian Men
Authors: Syed Sheriff Rebecca , Van Hooff Miranda , Malhi Gin , Grace Blair , McFarlane Alexander 
Published: December 2019

Abstract
We aimed to retrospectively investigate childhood trauma and childhood mental disorder in military and employed civilian men aged 18 to 54 years. Data, derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study and the 2007 Australian Bureau of Statistics National Survey of Mental Health and Wellbeing Study, were analyzed and compared using direct age standardization and logistic regression. A greater proportion of ADF reported childhood trauma, multiple trauma types, trauma onset below 12 years of age, and interpersonal trauma than civilian employed men. A greater proportion of ADF reported childhood noninterpersonal trauma, such as accidents, than civilian employed men, with a marked difference in those aged 45 to 54 years. In both populations, childhood disorder was associated with childhood trauma; however, childhood depression was not associated with childhood noninterpersonal trauma in either population. A deeper understanding of the longer-term risk and resilience conferred by different childhood trauma profiles is needed.
Zolpidem-Associated Consequences
Authors: Westermeyer Joseph , Carr Tegan M. 
Published: December 2019

Abstract
A post-2000 literature search reviewed prevalence of health consequences associated with zolpidem, plus two salient case reports. Common zolpidem-related harms encompassed accidents, falls, overdoses, delirium, and infections. Risks to others included assaults, vehicular accidents, various crimes, and civil actions that occurred during zolpidem-induced delirium, withdrawal, and other impediments. Remarkably, much harm occurred while patients were taking therapeutic doses of licitly prescribed zolpidem (10–30 mg). Zolpidem-associated health, behavioral, and social problems comprise an international pandemic of preventable heath misfortunes.
Increased Psychiatric Risk in Children After Pediatric Intensive Care Unit Admission
Authors: Rady Hanaa I. , Ismail Omnia Raafat , Abdelkader Mohammed Safwat , Abdelgalil Abobakr Abosree 
Published: December 2019

Abstract
We aimed to assess psychiatric risk in children after admission to pediatric intensive care units (PICUs) and its association with greater psychiatric morbidity. We examined 130 children aged 6 to 13 years in a cross-sectional study divided into two groups: 65 children discharged from PICU and another 65 from general wards. The PICU group scored worse on all measured scales of psychiatric morbidities. The child-specific assessment methods included the posttraumatic stress disorder (PTSD) scale as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and Impact of Event Scale Revised for PTSD; Revised Children's Manifest Anxiety Scale for anxiety; and Birleson Depression Scale for depression. The PICU group had significantly higher frequencies of PTSD compared with the general ward group (84.6% vs. 6.2%, respectively; p < 0.001). Hence, PICU survivors have higher risk of psychiatric morbidities such as PTSD, anxiety, and depression compared with general ward patients.
Case Report: Bilateral Horizontal Gaze Palsy (1 + 1 Syndrome): A Supranuclear Gaze Palsy
Authors: Borgman Christopher J. 
Published: December 2019

SIGNIFICANCE
A rare case of bilateral horizontal gaze palsy with intact vertical gaze eye movements and largely intact vestibulo-ocular reflex is presented owing to demyelinating lesions of the patient's bilateral paramedian pontine reticular formations and left infranuclear abducens nerve from the patient's recently diagnosed multiple sclerosis.

PURPOSE
The purpose of this study was to report on a rare case of bilateral horizontal gaze palsy from a supranuclear lesion in a patient with a recent diagnosis of multiple sclerosis.

CASE REPORT
A 43-year-old African American woman presented urgently for evaluation of her inability to move her eyes into either horizontal gaze. Vertical conjugate movements remained intact, as did three of four extraocular muscles with horizontal vestibulo-ocular reflex testing, suggesting a supranuclear palsy. Magnetic resonance imaging revealed two demyelinating lesions in her inferior pons, which spared her nuclear and internuclear horizontal gaze pathways, as well as three of four extraocular muscles of her infranuclear horizontal gaze pathway as evidenced by her largely intact vestibulo-ocular reflex. This suggested bilateral paramedian pontine reticular formation lesions (supranuclear) and a mild left abducens nerve palsy (infranuclear).

CONCLUSIONS
Close evaluation of extraocular motilities and a solid understanding of the supranuclear, nuclear, internuclear, and infranuclear components of the horizontal gaze pathway can help identify challenging gaze palsies when encountered in a clinical setting. Appropriate neuroimaging can then be performed with an emphasis on the suspected location of the lesion(s) based on the patient's clinical findings.
Two drugs regimens for HIV
Authors: Waters Laura , Church Hannah 
Published: December 2019

Purpose of review
As the evidence for two-drug regimens (2DR) for HIV treatment accumulates and 2DR start to enter consensus guidelines, this review covers the history, rationale and current evidence for 2DR in first-line and switch settings.

Recent findings
Until recently, most evidence for 2DR was for boosted protease inhibitor-based therapies but now we have large, randomized trials to support the use of dolutegravir (DTG)-based 2DR, both for initial therapy and suppressed switch, with high efficacy and no emergent resistance at failure.

Summary
2DR will increasingly form part of the choice we are able to offer people with HIV but we must consider some of the limitations to ensure these regimens are used in the most clinically appropriate manner.
Gastric 99mTc-Methylene Diphosphonate Accumulation in a Patient With Primary Upper Gastrointestinal Tract Melanoma
Authors: Zhou Yi , Fan Qiu-ping , Tian Rong , Su Ming-gang 
Published: December 2019

Abstract
Unexpected extraosseous uptake is common on 99mTc–methylene diphosphonate bone scintigraphy, but accumulation by primary upper gastrointestinal tract malignant melanoma is rarely reported. The present case is a 58-year-old woman with a 10-day history of diffuse bone pain and weakness. Her bone scintigraphy showed unexpected diffuse gastric tracer uptake. Subsequent gastroscopy revealed a number of hyperpigmented lesions in the stomach and duodenal bulb. Malignant melanoma was confirmed by histopathology and immunohistochemistry. Because extensive physical examination failed to identify any other site of ocular and cutaneous melanoma, a diagnosis of primary upper gastrointestinal tract malignant melanoma was established.
Dissection in the Pyramidal Space for Effective Relief of Tension in Cleft Palate Repair
Authors: Jung Soyeon , Lo Lun-Jou 
Published: December 2019

Objective
Although several methods of note have been reported for the repair of cleft palate, wound separation and oronasal fistula can still occur. This study reports a useful technique of dissection in the pyramidal space for adequate release of tension and the prevention of palatal fistula.

Methods
A total of 404 consecutive patients with cleft palate with or without cleft lip who had received standard surgical repair were evaluated. The mucoperiosteal flaps were raised from the hard palate. Dissection was performed in the pyramidal space to expose the greater palatine foramen, neurovascular pedicle, pyramidal process of the palatine bone, opening to the space of Ernst, and hamulus with tensor veli palatini aponeurosis. The restricting ligamentous fibers lateral and posterior to the pedicle were released. The hamulus process was divided at its root and pushed medially for further relief and medial mobilization of the flap. Closure of the flaps was achieved with minimal tension in the midline. The patients received regular postoperative follow-ups.

Results
Only 1 case was found to have postoperative palatal fistula, resulting in a fistula rate of 0.25% during the 11-year study period.

Conclusion
Adequate dissection in the pyramidal space helped to close the palatal flaps with minimal tension and prevent the formation of palatal fistula.