bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early echocardiographic signs of diastolic dysfunction predict acute kidney injury in cirrhotic patients
Authors: Wu Pei-Shan , Wang Ying-Wen , Tai Cheng-Chun , Hsieh Yun-Cheng , Lee Pei-Chang , Huang Chin-Chou , Huang Yi-Hsiang , Hou Ming-Chih , Lin Han-Chieh , Lee Kuei-Chuan 
Published: September 2020

Background:
Cardiovascular dysfunction in cirrhotic patients affects survival and the development of cirrhotic complications. We aimed to evaluate potential echocardiographic parameters to predict mortality and acute kidney injury (AKI) in cirrhotic patients.

Methods:
A total of 103 cirrhotic patients who underwent echocardiography between February 2009 and August 2016 in Taipei Veterans General Hospital were retrospectively enrolled. Cardiac function was evaluated using transthoracic two-dimensional echocardiography with tissue Doppler imaging. Cox hazard regression analysis was used for assessing predictors for 1-year mortality and AKI within 1 year.

Results:
Baseline echocardiographic parameters were similar between survivors (n = 92) and nonsurvivors (n = 11). Lower serum levels of albumin, as well as higher albumin-bilirubin (ALBI) scores, Child-Pugh scores, and model for end-stage liver disease scores were observed in nonsurvivors. Cox proportional hazard regression analysis revealed Child-Pugh score as the only predictor of 1-year mortality. Baseline serum creatinine (Cr) > 1.5 mg/dL, total bilirubin > 2 mg/dL, and a higher E/e′ ratio predict occurrence of AKI within 1 year. Among patients with serum Cr < 1.5 mg/dL, an increased atrial filling velocity and higher ALBI scores predict AKI occurrence within 1 year.

Conclusion:
Severity of underlying liver disease but not echocardiographic parameters predicts 1-year mortality in cirrhosis. Early echocardiographic signs of diastolic dysfunction and higher ALBI scores may predict development of AKI in cirrhotic patients with serum Cr < 1.5 mg/dL.
Desflurane protects against liver ischemia/reperfusion injury via regulating miR-135b-5p
Authors: Zhong Mengxia , Che Lei , Du Meiqing , Liu Ke , Wang Dalong 
Published: September 2020

Background:
A number of anesthetics have protective effect against ischemia-reperfusion (I/R) injury, including desflurane. But the function and molecular mechanism of desflurane in liver I/R injury have not been fully understood. The aim of this study was to investigate the effect of desflurane on liver I/R injury and further investigated the molecular mechanisms involving in miR-135b-5p.

Methods:
The models of liver I/R injury in rats were established, and received desflurane treatment throughout the injury. Serum alanine transaminase (ALT) and aspartate transaminase (AST) were measured and compared between groups. H/R-induced cell model in L02 was established, and were treated with desflurane before hypoxia. Quantitative real-time polymerase chain reaction was performed to determine the expression of miR-135b-5p in different groups. The cell apoptosis was detected using flow cytometry assay. Western blot was used for the measurement of protein levels.

Results:
I/R significantly increased serum levels of ALT and AST in rats, which were reversed by desflurane treatment. Desflurane also significantly attenuated the increase of cell apoptosis induced by I/R in both vivo and vitro. MiR-135b-5p significantly reversed the protective effect of desflurane against liver I/R injury. Additionally, Janus protein tyrosine kinase (JAK)2 was shown to be a target gene of miR-135b-5p, and miR-135b-5p overexpression significantly decreased the protein levels of p-JAK2, JAK2, p-STAT3.

Conclusion:
Desflurane attenuated liver I/R injury through regulating miR-135b-5p, and JAK2 was the target gene of mIR-135b-5p. These findings provide references for further development of therapeutic strategies in liver injury.
The Utility of Numeric Grading Scales of Middle Ear Risk in Predicting Ossiculoplasty Hearing Outcomes
Authors: Judd Ryan T. , Imbery Terence E. , Gluth Michael B. 
Published: September 2020

Objective:
To assess the usefulness of numeric grading scales of middle ear risk in predicting ossiculoplasty hearing outcomes.

Study Design:
Retrospective review.

Setting:
Tertiary care, academic medical center.

Patients:
Adults and children undergoing ossiculoplasty between May 2013 and May 2019 including: synthetic ossicular replacement prosthesis, autograft interposition, bone cement repair, and mobilization of lateral chain fixation.

Intervention:
Cases were scored via middle ear risk index (MERI), surgical prosthetic infection tissue eustachian tube (SPITE) method, and ossiculoplasty outcome scoring parameter (OOPS) scale. Preoperative and postoperative hearing outcomes were recorded.

Main Outcome Measure:
Statistical correlation between risk score and postoperative pure-tone average air-bone gap (PTA-ABG).

Results:
The 179 included cases had average pre and postoperative PTA-ABGs of 30.3dB (standard deviation [SD] 12.7) and 20.3dB (SD 11.1), respectively. Mean MERI, SPITE, and OOPS scores were 4.5 (SD 2.3), 2.8 (SD 1.7), and 3.1 (SD 1.8), respectively. Statistically significant correlations with hearing outcome were noted for all three methods (MERI r = 0.22, p = 0.003; OOPS r = 0.19, p = 0.012; SPITE r = 0.27, p < 0.001). No scale predicted poor (PTA-ABG > 30dB) outcomes; only low SPITE scores predicted excellent (PTA-ABG < 10dB) outcomes (odds ratio [OR] 0.74 [Confidence Interval: 0.57 – 0.97], p = 0.032).

Conclusions:
Significant weak correlations between each middle ear risk score and hearing outcomes were encountered. Although only the SPITE method predicted postoperative PTA-ABG, it was not overwhelmingly superior. Current grading scale selection may be justified by familiarity or ease of use.
Increasing Frailty, Not Increasing Age, Results in Increased Length of Stay Following Vestibular Schwannoma Surgery
Authors: Casazza Geoffrey C. , McIntyre Matthew K. , Gurgel Richard K. , McCrary Hilary C. , Shelton Clough , Couldwell William T. , Bowers Christian A. 
Published: September 2020

Objective:
Understand the frailty of vestibular schwannoma surgical patients and how frailty impacts clinical course.

Study Design:
Retrospective Cohort.

Setting:
Single-tertiary academic hospital.

Patients:
All patients undergoing vestibular schwannoma surgery.

Intervention:
The modified frailty index (mFI) was calculated for all patients undergoing surgery for vestibular schwannoma between 2011 and 2018. Patient demographics and medical history, perioperative course, and postoperative complications were obtained from the medical record.

Main Outcome Measures:
The primary endpoint was hospital length of stay (LOS). Secondary endpoint was postoperative complications. Basic statistical analysis was performed including multivariate linear regressions to determine independent predictors of LOS.

Results:
There were 218 patients included and the mean age was 48.1 ± 0.9 (range 12–77). One-hundred ten patients were male (50.5%). The mean ICU LOS was 1.6 ± 0.1 days while mean total hospital LOS was 4.3 ± 0.2. There were 145 patients (66.5%) who were robust (nonfrail) with an mFI of 0, while 73 (33.5%) had an mFI of ≥1. Frailty (mFI≥2) was associated with longer hospital LOS compared with the prefrail (p = 0.0014) and robust (p = 0.0004) groups, but was not associated with increased complications (OR = 1.3; 95% CI: 0.5–3.7; p = 0.5925) or ICU LOS (p > 0.05). In multivariate analysis, increased mFI, and NOT increased age, was an independent risk factor for increased hospital LOS (p = 0.027).

Conclusion:
Increasing frailty, and not increasing age, is an independent risk factor for longer hospital LOS, but not for increased postoperative complications. Patients’ frailty status may be useful preoperatively in counselling patients about postoperative expectations and frail vestibular schwannoma patients may require increased health spending costs given their increased hospital LOS.
Cost-effectiveness of Pediatric Unilateral/Bilateral Cochlear Implant in a Developing Country
Authors: Swami Himanshu , AP Arjun , Shivanand Shyamal 
Published: September 2020

Objective:
To determine the cost-effectiveness of unilateral and bilateral cochlear implantation (CI) for children suffering from bilateral profound SNHL.

Study Design:
This was a cost benefit analysis study where quality-adjusted life years (QALY) and the expenditure involved post unilateral and bilateral CI were calculated to assess the cost per QALY gained.

Setting:
The study was conducted in a tertiary-care hospital in a city of a developing country.

Patients:
A total of 59 patients were studied during the years 2015 to 2019 of which a study cohort of 29 patients underwent bilateral cochlear implantation and a control cohort of 30 patients received U/L CI but did not undergo B/L CI.

Main Outcome:
The QALY parameters HUI3 and VAS when patient had no implant, post unilateral and bilateral CI were calculated along with the total lifelong expenditure involved. The outcomes improvement post CI was compared in the study and control groups. The discounted net cost per QALY gained was assessed and compared with the PCGDP of the country for cost effectiveness.

Results:
Significant QALY was gained post unilateral and bilateral CI and the expenditure for both was within the cost thresholds. The net costs per QALY gained post the discounting in unilateral and bilateral CI were found to be 1,345 US$ and 1,977 US$ respectively. The PCGDP (nominal) of India in 2018 was 2,016 US$. The cost involved per QALY gained was found to be lesser than the per capita GDP of India.

Conclusion:
Unilateral CI was found to be highly cost effective with bilateral CI involving a little higher cost per QALY gained but well within the cost effectiveness threshold.
Second Victim Support
Authors: Stone Misty 
Published: September 2020

OBJECTIVE
The purpose of this study was to describe hospital nurses’ experiences with organizational support after an adverse event (AE).

BACKGROUND
Most hospital staff nurses will experience an AE, being left and feeling traumatized.

METHODS
Data collection and analysis followed a qualitative descriptive approach.

RESULTS
Nurses yearn to feel valued and to receive timely support from nurse executives after an AE.

CONCLUSIONS
To help lessen the suffering of the nurse after an AE, healthcare organizations and nurse executives must support the nurse in the aftermath.
Factors Influencing Functional Outcome at Discharge
Authors: Pellicciari Leonardo , Agosti Maurizio , Goffredo Michela , Pournajaf Sanaz , Le Pera Domenica , De Pisi Francesco , Franceschini Marco , Damiani Carlo 
Published: September 2020

Objective
Functional outcome represents the most central objective of rehabilitation programs. Understanding which factors could affect functional status at discharge is crucial for the planning of appropriate treatments in both neurologic and orthopedic patients. The aim of this study was to investigate which clinical and demographic variables, collected at the patient’s admission, could influence the functional outcome, assessed by the modified Barthel Index (mBI), at discharge.

Design
A retrospective study was conducted on a large cohort (n = 3548) of orthopedic and neurologic patients. Functional, demographic, and clinical records at patient admission and mBI score at discharge were collected. General linear model analysis was performed to assess the influence of these variables on functional outcome at discharge.

Results
The results reported a significant effect of mBI score at admission (P < 0.0001), age (P < 0.0001), and time from the acute event (P < 0.0001) on mBI score at discharge. Moreover, the disease type (neurologic or orthopedic) adjusted by sex (male or female) and presence of different impairments (cognitive and behavioral impairments) and complications (hypertension and cardiovascular diseases) significantly influenced mBI score at discharge (P < 0.05) (R
2 = 0.497). No significant interactions between other factors were found (P > 0.05).

Conclusion
Several prognostic factors should be considered when planning an appropriate tailored rehabilitation program.
Research on the Effects of a Web-Based System With Oculomotor and Optokinetic Stimuli on Vestibular Rehabilitation
Authors: Ertunc Gulcelik Gonul , Tarakci Devrim , Gedik Soyuyuce Ozlem , Gence Gumus Zeynep , Korkut Nazım , Algun Zeliha Candan 
Published: September 2020

Objective
The variety and use of technologies used in vestibular rehabilitation are very limited. The purpose of this study was to investigate the effects of a Web-based system on vestibular rehabilitation in patients with vestibular hypofunction.

Design
A total of 20 patients with unilateral vestibular hypofunction were randomly assigned to two groups. Conventional vestibular rehabilitation was applied to the control group, whereas the study group received treatment with the Web-based system supporting the vestibulo-ocular reflex with oculomotor and optokinetic stimulus (Simulation of Vestibulo-Ocular Reflex Exercises). Vestibular and balance tests, oculomotor level, the Tampa Kinesiophobia Scale, and the Dizziness Handicap Inventory were used to evaluate the treatment’s efficacy.

Results
Vestibular symptoms and findings, balance tests, oculomotor functions, Tampa Kinesiophobia Scale, and Dizziness Handicap Inventory improved significantly in both groups after the interventions (P < 0.05). In the intergroup analysis, improvement was found in eyes closed Romberg, semitandem, and left one-foot position balance tests in favor of the study group (P < 0.05).

Conclusion
The new vestibular technology, Simulation of Vestibulo-Ocular Reflex Exercises, was found to be effective in vestibular rehabilitation.
Room of Hazards: An Interprofessional Evaluation of Safety Risks in a Simulated Patient Room
Authors: Wang Melinda , Bilan Victor P. , McCullough Megan , Banda Barbara , Merchant Naseema B. , Rodwin Benjamin A. 
Published: September 2020

Objectives
Approximately 3.7% of patients experience adverse events in health care facilities, many of which are preventable. Patient safety requires effective training and an interprofessional culture of safety, but few studies compare the safety skills of different hospital professions. We sought to assess skills in safety hazards identification among staff from different health care disciplines with a pilot study.

Methods
An exercise with a simulated room of an inpatient ward with a patient mannequin in a hospital bed with 34-intentionally planted safety hazards was set up. Health care staff members from various professions walked around the room and independently documented observed safety hazards. Identified hazards were separated based on staff disciplines, grouped into 5 categories (patient, medications, equipment, environment, care processes), and analyzed using analysis of variance. Because participants identified more hazards than the 34 intentionally planted hazards, these were analyzed separately.

Results
The study included 111 staff: nurses (n = 68), nursing students (n = 5), medical students (n = 3), physicians (n = 11), social workers (n = 5), pharmacists (n = 6), certified nursing assistants (n = 9), and psychologists (n = 4). There were significant differences among professions in the following categories: medications, equipment, and total number of safety hazards (P < 0.05 for all). Nurses found more intended equipment hazards than did social workers (38.8% versus 4.4%, P < 0.001), pharmacists (38.8% versus 11.1%, P = 0.004), medical students (38.8% versus 7.4%, P = 0.021), and psychologists (38.8% versus 8.3%, P = 0.001) and more medication hazards than nursing students (20.3% versus 16.7%, P = 0.008), whereas certified nursing assistants also found more equipment hazards than did social workers (25.9% versus 4.4%, P = 0.016).

Conclusions
There were significant differences in patterns of safety hazards identified among health care professions, with nurses identifying more hazards than several other professions. This finding suggests that each health care profession’s unique training and responsibilities result in varying ability to identify safety hazards and that interdisciplinary safety teams may be more effective than those from only a single profession. Our study provides a starting point to encourage diversification of hospital professions in simulation-based safety trainings, although further work is needed to validate these findings moving forward.
Safety and Efficacy of the Under-Corrected Frontalis Sling in Myogenic Ptosis Accompanying Extraocular Muscle Paralysis
Authors: Lu Yi , Zhang Yidan , Wu Yu , Sun Jing , Zhou Huifang 
Published: September 2020

Objective:
The surgical treatment of myogenic ptosis accompanying extraocular muscle paralysis is an intractable problem in the field of oculoplastic surgery due to the severe complications such as exposure keratopathy. It is promising to find an appropriate procedure to treat this kind of patients, which is able to ensure the safety and efficacy.

Methods:
The authors retrospectively reviewed 12 eyes of 6 patients who underwent the under-corrected “double V-Loop” frontalis suspension sling procedure for myogenic ptosis accompanying extraocular muscle paralysis and access the safety and efficacy of this kind of surgery. All the patients underwent corneal fluorescein staining and confocal microscopy before and after the surgery to inspect the corneal condition. The density of central corneal epithelial cells and endothelial cells were observed.

Results:
After the surgery, the eyelids contour was natural, and the symmetry was achieved in these cases. The average palpebral fissures height changed from 2.75 ± 1.41 mm to 4.50 ± 0.35 mm (P = 0.0007) and margin reflex distance 1 changed from −1.25 ± 1.22 mm to +0.50 ± 0.35 mm (P = 0.0002). Out of 12 operated eyes, mild postoperative lagophthalmos was present in 4 cases but without exposure keratopathy during the follow-up, the confocal microscopy showed that there were no significant differences in central corneal superficial epithelial cells (P = 0.93) and endothelial cells (P = 0.90) before and after the surgery.

Conclusion:
The under-corrected “double V-Loop” frontalis suspension sling is a proper surgery in myogenic ptosis accompanying extraocular muscle paralysis, which leads to a low occurrence of exposure keratopathy, maintains the integrity of the cornea, and remains the patients’ vision function.
Assessment of the Outcome of Calvarial Vault Remodeling and Spring-Mediated Cranioplasty in the Correction of Isolated Sagittal Suture Synostosis
Authors: Hassanein Ahmed Gaber , Fadle Khalid Nasser 
Published: September 2020

Background:
Sagittal synostosis is the commonest form of nonsyndromic isolated craniosynostosis. Calvarial vault remodeling (CVR) and spring-mediated cranioplasty (SMC) are the commonly used correction techniques.

Aim of the Work:
To study and compare clinical and radiographic outcomes of CVR and SMC in the correction of isolated sagittal suture synostosis.

Methods:
A prospective cohort with the patients were divided into group; I (SMC) and II (CVR), each 15 patients. They were observed to evaluate the outcome and detect complications.

Results:
Mean operative time was 59.2 minutes in SMC and 184 minutes in CVR. Mean intraoperative blood loss was 26 mL in SMC and 64.7 mL in CVR. Intraoperative complications in SMC were dural tear in 1 patient and superior sagittal sinus injury in another patient, while in CVR 2 patients with dural tears and a 3rd with superior sagittal sinus injury. Postoperative complications in SMC were exposed spring, gaped wound, and parietal eminence elevation, while in CVR 2 patients needed blood transfusion. The mean hospital stays was 1.4 days in SMC and 4.1 days in CVR. In SMC, the relative increase in cephalic index varied between 5.5% and 8.2%, while for CVR, it varied between 5.1% and 7.9%.

Conclusion:
The SMC and CVR are safe procedures, with good long-term results and significant objective changes toward normalization of the skull morphology in isolated sagittal craniosynostosis. The SMC is less invasive and associated with reduced hospital stays, decreased blood loss, and can be performed at a younger age than CVR with a lower morbidity.
The Effect of Bone Morphogenetic Protein-2 on the Irradiated Allogenic Cartilage of Rats
Authors: Kim Kyu Nam , Jeon Dong Nyeok , Kim Young Min , Choi Jong Woo 
Published: September 2020

Abstract
Autogenous cartilage graft is associated with the problem of chondrocyte dedifferentiation. Bone morphogenetic protein-2 (BMP-2) plays an important role in the differentiation and matrix maturation of chondrocytes, and preventing their dedifferentiation.
This study was performed on 48 rats, divided equally into 3 groups. In group I, the xiphoid process cartilage was harvested and irradiated, and broken into 2 pieces. Each piece was implanted on the back. The same process was performed in Groups II and III, but further treated with BMP-2, Group II with 25 μg, and Group III with 50 μg. The implanted cartilage pieces were reharvested at postoperative weeks 2 and 4. The weight change was measured and histological evaluation was performed.
The extent of the weight change was higher in Groups II and III than in Group I. The extracellular matrix between the chondrocytes showed increased in Groups II and III. The fibrous tissue on the surface of the cartilage increased in Groups II and III. Ossification of the chondrocytes was observed in Groups II and III.
The use of BMP-2 increased the matrix between chondrocytes and the fibrous tissue of the cartilage and facilitated the ossification of chondrocytes. The effect of BMP-2 increased with its increasing concentration, and maintenance of its effectiveness over time was confirmed.
Craniofacial Collaboration UK: Developmental Outcomes in 5-Year-Old Children With Sagittal Synostosis
Authors: Care Helen , Kennedy-Williams Patrick , Culshaw Laura , Cunliffe Alexandra , Denly Susie , Horton Jo , Kearney Anna , O’Leary Gemma , Piggott Katie , Pinckston Molly , Rooney Natasha , Wall Steven , Johnson David , Dalton Louise 
Published: September 2020

Abstract
The Craniofacial Collaboration UK (CC-UK) is a joint initiative that seeks to address some of the limitations of previous developmental research with this patient group by providing systematically collected, robust data from clinically and chronologically homogenous representative samples of children. The current paper outlines the developmental outcomes at the age of 5 for children who had previously undergone primary surgery for single-suture sagittal synostosis (SS). It shows broad consistencies with the previous CC-UK work, indicating that the majority of children with SS will perform within the average range compared to peers across a number of developmental, behavioral and emotional domains. However, the group mean for children with SS indicates significantly greater difficulties with fine motor skills and hyperactivity, relative to normative data. Unexpectedly, children with SS had significantly better problem solving skills. While it is reassuring that the majority of children are broadly developing in line with their unaffected peers, these small but significant differences may be early indicators of some of the subtle difficulties documented in older children with craniosynostosis. Longitudinal follow up is therefore important to understand the developmental trajectory for children with SS and identification of potentially ‘at risk’ sub groups within this diagnostic cohort.