bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Varenicline Alone and in Combination With Low-dose Naltrexone on Alcohol-primed Smoking in Heavy-drinking Tobacco Users: A Preliminary Laboratory Study
Authors: Roberts Walter , Shi Julia M. , Tetrault Jeanette M. , McKee Sherry A. 
Published: February 2018

Objectives:
Heavy-drinking tobacco users are less likely to successfully quit smoking than their moderate-drinking counterparts, even when they are prescribed smoking cessation medication. One strategy for improving treatment outcomes in this subgroup of tobacco users may be to combine medication therapies to target both alcohol and tobacco use simultaneously. Adding naltrexone to frontline smoking cessation treatments may improve treatment outcomes in this group.

Method:
This double-blind, placebo-controlled human laboratory study examined the effects of varenicline (2 mg/d) and varenicline (2 mg/d), combined with a low dose of naltrexone (25 mg/d) on alcohol-primed smoking behavior in a laboratory model of smoking relapse in heavy-drinking tobacco users (n = 30). Participants attended a laboratory session and received an alcohol challenge (target breath alcohol concentration = 0.030 g/dL). They completed a smoking delay task that assessed their ability to resist smoking followed by an ad libitum smoking phase (primary outcomes). They also provided ratings of subjective drug effects and craving, and carbon monoxide levels were measured after smoking (secondary outcomes).

Results:
Participants receiving varenicline monotherapy delayed smoking longer and smoked fewer cigarettes than those on placebo. Participants receiving varenicline + low-dose naltrexone did not delay smoking longer than those receiving varenicline alone. Participants in both active medication arms smoked fewer cigarettes ad libitum than those receiving placebo.

Conclusions:
Varenicline can improve smoking outcomes even after an alcohol prime, supporting its use in heavy drinkers who wish to quit smoking. Findings did not support increased efficacy of combined varenicline + low-dose naltrexone relative to varenicline monotherapy.
New Nitric Oxide Donor NCX 1443: Therapeutic Effects on Pulmonary Hypertension in the SAD Mouse Model of Sickle Cell Disease
Authors: Abid Shariq , Kebe Kanny , Houssaïni Amal , Tomberli Françoise , Marcos Elisabeth , Bizard Emilie , Breau Marielle , Parpaleix Aurelien , Tissot Claire-Marie , Maitre Bernard , Lipskaia Larissa , Derumeaux Genevieve , Bastia Elena , Mekontso-Dessap Armand , Adnot Serge 
Published: February 2018

Abstract:
Nitric oxide (NO) donors may be useful for treating pulmonary hypertension (PH) complicating sickle cell disease (SCD), as endogenous NO is inactivated by hemoglobin released by intravascular hemolysis. Here, we investigated the effects of the new NO donor NCX1443 on PH in transgenic SAD mice, which exhibit mild SCD without severe hemolytic anemia. In SAD and wild-type (WT) mice, the pulmonary pressure response to acute hypoxia was similar and was abolished by 100 mg/kg NCX1443. The level of PH was also similar in SAD and WT mice exposed to chronic hypoxia (9% O2) alone or with SU5416 and was similarly reduced by daily NCX1443 gavage. Compared with WT mice, SAD mice exhibited higher levels of HO-1, endothelial NO synthase, and PDE5 but similar levels of lung cyclic guanosine monophosphate. Cultured pulmonary artery smooth muscle cells from SAD mice grew faster than those from WT mice and had higher PDE5 protein levels. Combining NCX1443 and a PDE5 inhibitor suppressed the growth rate difference between SAD and WT cells and induced a larger reduction in hypoxic PH severity in SAD than in WT mice. By amplifying endogenous protective mechanisms, NCX1443 in combination with PDE5 inhibition may prove useful for treating PH complicating SCD.
Traits associated with central pain augmentation in the Knee Pain In the Community (KPIC) cohort
Authors: Akin-Akinyosoye Kehinde , Frowd Nadia , Marshall Laura , Stocks Joanne , Fernandes Gwen S. , Valdes Ana , McWilliams Daniel F. , Zhang Weiya , Doherty Michael , Ferguson Eamonn , Walsh David A. 
Published: February 2018

Abstract
This study aimed to identify self-report correlates of central pain augmentation in individuals with knee pain. A subset of participants (n = 420) in the Knee Pain and related health In the Community (KPIC) baseline survey undertook pressure pain detection threshold (PPT) assessments. Items measuring specific traits related to central pain mechanisms were selected from the survey based on expert consensus, face validity, item association with underlying constructs measured by originating host questionnaires, adequate targeting, and PPT correlations. Pain distribution was reported on a body manikin. A “central pain mechanisms” factor was sought by factor analysis. Associations of items, the derived factor, and originating questionnaires with PPTs were compared. Eight self-report items measuring traits of anxiety, depression, catastrophizing, neuropathic-like pain, fatigue, sleep disturbance, pain distribution, and cognitive impact were identified as likely indices of central pain mechanisms. Pressure pain detection thresholds were associated with items representing each trait and with their originating scales. Pain distribution classified as “pain below the waist additional to knee pain” was more strongly associated with low PPT than were alternative classifications of pain distribution. A single factor, interpreted as “central pain mechanisms,” was identified across the 8 selected items and explained variation in PPT (R
2 = 0.17) better than did any originating scale (R
2 = 0.10-0.13). In conclusion, including representative items within a composite self-report tool might help identify people with centrally augmented knee pain.
Better compliance with triage criteria in trauma would reduce costs with maintained patient safety
Authors: Linder Fredrik , Holmberg Lina , Eklöf Hampus , Björck Martin , Juhlin Claes , Mani Kevin 
Published: February 2018

ObjectiveTo evaluate trauma triage criteria in terms of compliance, undertriage, and overtriage and identify risk factors for mistriage.MethodsIn a retrospective cohort study, all consecutive trauma patients at a University Hospital in Sweden in 2012 were included. Patients were stratified into three groups on the basis of trauma team activation (full trauma team, limited trauma team, and no trauma team). Case records were reviewed for mechanism of injury, vital signs, and injuries. Compliance with alert criteria was evaluated and injury severity score combined with the Matrix method was used for assessment of overtriage and undertriage.ResultsA total of 1424 trauma patients were included in the study. Seventy-three (5.1%) patients activated a full trauma team, 732 (51.4%) a limited trauma team, and 619 (43.5%) did not activate any trauma team. Undertriage was 2.7% [95% confidence interval (CI): 1.9–3.8%] and overtriage was 34.2% (95% CI: 23.5–46.3%) in the complete cohort. Compliance with ‘trauma triage criteria’ was assessed by comparing actual alerts with what was estimated to be the correct alert levels on the basis of prehospital case records. Compliance with full trauma team criteria was 80% (68–88%), limited trauma team was 54% (51–58%), and no trauma team was 79% (76–82%). Assuming full compliance with trauma criteria, the Matrix method resulted in an undertriage of 2.3% (95% CI: 1.6–3.3%) and an overtriage of 42.6% (95% CI: 32.4–53.2%).ConclusionThe overtriage and undertriage in this study is in line with the recommendations of the American College of Surgeons Committee on Trauma. However, better compliance with trauma alert criteria would result in fewer trauma team activations without affecting patient safety.
Accuracy of ultrasound exam performed by emergency medicine versus radiology residents in the diagnosis of acute appendicitis
Authors: Shahbazipar Marzieh , Seyedhosseini Javad , Vahidi Elnaz , Motahar Vahedi Hojat Sheikh , Jahanshir Amirhossein 
Published: February 2018

Background
Although the traditional approach to the diagnosis of acute appendicitis (AA) is using clinical methods, experience has shown that strict reliance on clinical data can lead to mismanagement or unnecessary surgery.

Objective
The objective of this study was to determine the total agreement of ultrasound (US) results in AA performed by emergency medicine (EM) versus radiology residents in emergency department.

Patients and methods
In this cross-sectional study, 121 patients with AA suspicion underwent an US exam by both trained EM and radiology residents in emergency department. The training course for EM residents consisted of attending an 8-h-workshop and then practicing an US exam on real patients within a 2-month period. The gold standards were either histopathologic or follow-up results. Total agreement of the results in both specialties was compared.

Results
There were 67 men and 54 women, with a mean age of 33.6 ± 16.1 years (18.2–88.7 years). Fifty-four (44.6%) patients underwent surgery with the initial diagnosis of AA and the rest were evaluated by follow-ups. On the basis of our gold standards, the diagnosis was finally confirmed in 46 (38%) cases. There was a high total agreement in AA diagnosis [96% agreement, κ = 0.90; 95% confidence interval (CI) = 0.81–0.99] between the two groups. The specificity and sensitivity of EM and radiology groups were 99% (95% CI = 93–100), 63% (95% CI = 48–77), 97% (95% CI = 91–100), and 72% (95% CI = 57–84), respectively.

Conclusion
US has a high diagnostic specificity in patients suspected of having AA and EM residents can perform this modality as accurately as radiologists after training in the emergency setting.
Intravenous Lidocaine for Intractable Renal Colic Unresponsive to Standard Therapy
Authors: Sin Billy , Cao John , Yang David , Ambert Karen , Punnapuzha Sheena 
Published: February 2018

Clinical Features:
Renal colic is defined as a flank pain radiating to the groin caused by kidney stones in the ureter (urolithiasis). Renal colic is a frequent cause of Emergency Department visits. Most renal colic cases present as acute distress and severe back and/or abdominal pain that require prompt treatment with analgesics.

Therapeutic Challenge:
Nonsteroidal anti-inflammatory drugs and opioids are traditionally used for renal colic in the Emergency Department. This trend of practice is based on clinical experience and expert opinion. Consensus guidelines that provide evidence-based approach for the management of renal colic are limited. One consensus guideline from Europe provides a systematic approach for the management of pain with the use of nonsteroidal anti-inflammatory drugss and opioids. However, no guidance is provided on how to manage patients who do not respond to these agents.

Solution:
Intravenous lidocaine 120 mg in 100 mL normal saline was infused over 10 minutes for pain management for intractable renal colic unresponsive to standard therapy. Three minutes after initiation of lidocaine infusion, the patient reported numeric pain rating scale 1/10. At 5 minutes, the reported numeric pain rating scale was 0/10 and remained for 60 minutes after initiation of lidocaine infusion. No adverse events were reported during or after the infusion, and no subsequent analgesia was required.
Defining and Assessing Geriatric Risk Factors and Associated Health Care Utilization Among Older Adults Using Claims and Electronic Health Records
Authors: Kan Hong J. , Kharrazi Hadi , Leff Bruce , Boyd Cynthia , Davison Ashwini , Chang Hsien-Yen , Kimura Joe , Wu Shannon , Anzaldi Laura , Richards Tom , Lasser Elyse C. , Weiner Jonathan P. 
Published: February 2018

Background:
Using electronic health records (EHRs), in addition to claims, to systematically identify patients with factors associated with adverse outcomes (geriatric risk) among older adults can prove beneficial for population health management and clinical service delivery.

Objective:
To define and compare geriatric risk factors derivable from claims, structured EHRs, and unstructured EHRs, and estimate the relationship between geriatric risk factors and health care utilization.

Research Design:
We performed a retrospective cohort study of patients enrolled in a Medicare Advantage plan from 2011 to 2013 using both administrative claims and EHRs. We defined 10 individual geriatric risk factors and a summary geriatric risk index based on diagnosed conditions and pattern matching techniques applied to EHR free text. The prevalence of geriatric risk factors was estimated using claims, structured EHRs, and structured and unstructured EHRs combined. The association of geriatric risk index with any occurrence of hospitalizations, emergency department visits, and nursing home visits were estimated using logistic regression adjusted for demographic and comorbidity covariates.

Results:
The prevalence of geriatric risk factors increased after adding unstructured EHR data to structured EHRs, compared with those derived from structured EHRs alone and claims alone. On the basis of claims, structured EHRs, and structured and unstructured EHRs combined, 12.9%, 15.0%, and 24.6% of the patients had 1 geriatric risk factor, respectively; 3.9%, 4.2%, and 15.8% had ≥2 geriatric risk factors, respectively. Statistically significant association between geriatric risk index and health care utilization was found independent of demographic and comorbidity covariates. For example, based on claims, estimated odds ratios for having 1 and ≥2 geriatric risk factors in year 1 were 1.49 (P<0.001) and 2.62 (P<0.001) in predicting any occurrence of hospitalizations in year 1, and 1.32 (P<0.001) and 1.34 (P=0.003) in predicting any occurrence of hospitalizations in year 2.

Conclusions:
The results demonstrate the feasibility and potential of using EHRs and claims for collecting new types of geriatric risk information that could augment the more commonly collected disease information to identify and move upstream the management of high-risk cases among older patients.
Changes in Health Insurance Coverage Associated With the Affordable Care Act Among Adults With and Without a Cancer History
Authors: Davidoff Amy J. , Guy Gery P. , Hu Xin , Gonzales Felisa , Han Xuesong , Zheng Zhiyuan , Parsons Helen , Ekwueme Donatus U. , Jemal Ahmedin 
Published: February 2018

Background:
The Affordable Care Act (ACA) improved health care coverage accessibility by expanding Medicaid eligibility, creating insurance Marketplaces, and subsidizing premiums. We examine coverage changes associated with ACA implementation, comparing adults with and without a cancer history.

Methods:
We included nonelderly adults from the 2012 to 2015 National Health Interview Survey. Using information on state Medicaid policies (2013), expansion decisions (2015), family structure, income, insurance offers, and current coverage, we assigned adults in all 4 years to mutually exclusive eligibility categories including: Medicaid-eligible pre-ACA; expansion eligible for Medicaid; and Marketplace premium subsidy eligible. Linear probability regressions estimated pre-post (2012–2013 vs. 2014–2015) coverage changes by eligibility category, stratified by cancer history.

Results:
The uninsured rate for cancer survivors decreased from 12.4% to 7.7% (P<0.001) pre-post ACA implementation. Relative to income >400% of the federal poverty guideline, the uninsured rate for cancer survivors decreased by an adjusted 8.4 percentage points [95% confidence interval (CI), 1.3–15.6] among pre-ACA Medicaid eligible; 16.7 percentage points (95% CI, 9.0–24.5) among expansion eligible, and 11.3 percentage points (95% CI, −0.8 to 23.5, with a trend P=0.069) for premium subsidy eligible. Decreases in uninsured among expansion-eligible adults without a cancer history [9.7 percentage points (95% CI, 7.4–12.0), were smaller than for cancer survivors (with a trend, P=0.086)]. Despite coverage gains, ∼528,000 cancer survivors and 19.1 million without a cancer history remained uninsured post-ACA, yet over half were eligible for Medicaid or subsidized Marketplace coverage.

Conclusions:
ACA implementation was associated with large coverage gains in targeted expansion groups, including cancer survivors, but additional progress is needed.
Presumed Systemic Inflammatory Response Syndrome in the Pediatric Emergency Department
Authors: Foo Cheryl P.Z. , Seabrook Jamie A. , Sangha Gurinder , Foster Jennifer Ruth 
Published: February 2018

Objective
The aim of this study was to examine the incidence and outcomes of patients presenting with systemic inflammatory response syndrome (SIRS) in the pediatric emergency department (PED).

Methods
This was a descriptive, retrospective cohort study of all patients from birth to 18 years presenting to the PED of a single center on 16 days distributed over 1 year. The presence of presumed SIRS (pSIRS, defined as noncore temperature measurement and cell count when clinically indicated) and sepsis was determined for all study patients. Patients were followed up for 1 week.

Results
The incidence of pSIRS was 15.3% (216/1416). Suspected or proven infection was present in 37.1% (n = 525) of the study population and 76.4% (n = 165) with pSIRS, with no cases of severe sepsis or septic shock. Sensitivity and specificity of pSIRS for predicting infection were 31.4% (95% confidence interval [CI], 27.5%–35.6%) and 94.3% (95% CI, 92.5%–95.7%), respectively. Although patients with pSIRS had a relative risk of 2.4 (95% CI, 1.6–3.5; P < 0.0001) for admission, 74% were discharged home with no subsequent PED visits. Of defined sepsis cases, 75% were discharged home without return.

Conclusions
Presumed SIRS and sepsis are relatively common in the PED. Use of pSIRS to screen for sepsis risks missing infection, whereas using pSIRS in the current sepsis definition results in overinclusion of nonsevere illness.
Sonographic Evaluation and Monitoring of Pneumoperitoneum After Air Enema Reduction for Intussusception
Authors: Zhou Amy Z. , Toporowski Amy , Tsung James W. 
Published: February 2018

Abstract
Abdominal radiography and computed tomography scans are standard tests to diagnose pneumoperitoneum. With the growing availability of point-of-care ultrasound, pneumoperitoneum may be diagnosed in settings without easy access to radiography or computed tomography, such as in overcrowded emergency departments or resource-poor environments. The use of point-of-care ultrasound to diagnose or monitor pneumoperitoneum has been described in adult but not pediatric patients. We present a case of point-of-care ultrasound detection of pneumoperitoneum and monitoring for tension pneumoperitoneum, after failed air enema reduction for intussusception in an infant.
Power-Assisted Particulate Bone Grafting Effectively Prevents Osseous Defects After Cranial Vault Reconstruction
Authors: Gandolfi Brad M. , Hirji Sameer A. , Sobol Danielle L. , Allori Alexander C. , Marcus Jeffrey R. 
Published: February 2018

Background:
Cranial vault reconstruction (CVR) is the gold standard in the operative treatment of craniosynostosis. Full thickness osseous defects (FTOD) of the calvaria have been observed in 5% to 15% patients after CVR, with higher rates cited in the fronto-orbital advancement (FOA) subset. Particulate bone graft (PBG) harvested manually has been shown to decrease FTOD after FOA from 24% to 5.5%. The authors used a modified technique using a powered craniotome, with the hypothesis that the technique would also improve outcomes.

Methods:
A retrospective review was performed of patients who underwent CVR for craniosynostosis between 2004 and 2014. Patient demographics, diagnosis, age, operative details, and postoperative care were reviewed in detail. Categorical, nonparametric variables were compared by Fisher exact tests.

Results:
A total of 135 patients met inclusion criteria. The most common diagnoses were metopic (n = 41), sagittal (n = 33), and unilateral coronal craniosynostosis (n = 31); 65% (n = 88) underwent FOA, 29% (n = 39) underwent single-stage total vault reconstruction, and 6% (n = 8) had a posterior vault reconstruction. CVR was performed without PBG in 95 patients and with PBG in 40 patients. Without PBG, FTOD were discovered on clinical examination in 18% of patients (n=17): 11 presented with subcentimeter defects, while 6 had larger defects requiring revision cranioplasty (6% operative revision rate). Among those receiving PBG, 1 patient presented a subcentimeter FTOD (2.5% FTOD incidence and 0% operative revision rate).

Conclusion:
Particulate bone graft harvested with a powered device decreases the rate of FTOD and reoperation rate after CVR for craniosynostosis.
Evaluation of Postoperative Stability After Open Reduction and Internal Fixation of Zygomaticomaxillary Complex Fractures Using Cone Beam Computed Tomography Analysis
Authors: Kim Hyo-Jung , Bang Kyung-Hwan , Park Eun-Ji , Cho Yeong-Cheol , Sung Iel-Yong , Son Jang-Ho 
Published: February 2018

Abstract
The aim of this study was to evaluate whether the amount of fracture displacement affects postoperative stability of isolated zygomaticomaxillary complex fractures and to determine whether the 1-point fixation method is as stable as 2- or 3-point fixation methods. The authors investigated 14 patients with 1-point fixation in the zygomaticomaxillary area (group A), 14 patients with 2-point fixation in the zygomaticomaxillary and frontozygomatic area (group B), and 13 patients with 3-point fixation in the zygomaticomaxillary, frontozygomatic, and infraorbital rim area (group C). Stability of the reduced zygomaticomaxillary complex was assessed by comparing immediate postoperative cone beam computed tomography images with those obtained at least 3 months later. Preoperatively, the total mean displacement was 3.79 ± 1.36 mm in group A, 3.43 ± 0.89 mm in group B, and 3.86 ± 1.57 mm in group C. The total postoperative orbital and screw changes were 0.91 ± 0.18 and 0.72 ± 0.08 mm, respectively, in group A; 0.92 ± 0.19 and 0.68 ± 0.09 mm, respectively, in group B; and 0.91 ± 0.11 and 0.66 ± 0.10 mm, respectively, in group C. There were no significant relationships between postoperative stability and amount of fracture displacement in any of the 3 groups, or between the 3 groups (P > 0.05). There was little difference in postoperative stability between the 3 groups. Hence, the amount of displacement is not a very important consideration when deciding the fixation method, including the number and location of miniplates applied for fixation.