bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pneumocephalus and Seizures Following Combined Spinal-epidural for Labor
Authors: Jones J.M. , Gouveia J.P. , Rodrigues N.M. 
Published: August 2018

(J Clin Anesth. 2018;44:123–124)
In this correspondence, the authors described a patient who presented with simultaneous pneumocephalus and cavernoma after receiving combined spinal-epidural analgesia for labor. However, unlike most cases of combined spinal-epidural analgesia for labor, which use loss of resistance to air to identify the epidural space, the authors used loss of resistance to saline. To the author’s knowledge, there are no published reports of the use of loss of resistance to saline for this purpose. Identification of the epidural space was successful upon the fourth attempt with the patient in a sitting position. Upon injection of local anesthetic, the patient immediately complained of a severe headache, that was unremitting with postural changes and continued into the postpartum period. On postpartum day 2, the patient presented with a tonic-clonic seizure. Magnetic resonance imaging showed intraventricular pneumocephalus and cavernoma in the right frontal region, and electroencephalogram showed abundant epileptic activity. Oxygen was added to the patient’s therapy with clinical improvement; complete reabsorption of air on radiologic examination was seen on the sixth day and the asymptomatic patient was discharged.
Improving Obstetric Hypertensive Emergency Treatment in a Tertiary Care Women's Emergency Department
Authors: Froehlich Rosemary J. , Maggio Lindsay , Has Phinnara , Vrees Roxanne , Hughes Brenna L. 
Published: August 2018

OBJECTIVE:
To assess treatment outcomes associated with an obstetric hypertensive emergency quality improvement intervention instituted in a tertiary care women's emergency department.

METHODS:
We conducted a cohort study of pregnant (20 weeks of gestation or greater) and postpartum (6 weeks of gestation or less) women treated for hypertensive emergency (systolic blood pressure [BP] 160 mm Hg or greater, diastolic 110 mm Hg or greater, or both) before and after a quality improvement intervention. A multidisciplinary task force revised clinical guidelines and nursing policy, updated electronic order sets, and provided staff education and clinical management aids. Data were collected by electronic chart review. The primary outcome was achieving goal BP (systolic 150 mm Hg or less and diastolic 100 mm Hg or less) within an hour of initial therapy. Secondary outcomes included time from first severe BP to 1) first antihypertensive treatment and 2) goal BP.

RESULTS:
There were no significant differences in baseline characteristics in the preintervention (n=173; September 2014 to September 2015) and postintervention (n=173; December 2015 to November 2016) groups, including gestational age, days postpartum, maternal age, race–ethnicity, or comorbidities. We found no significant difference in primary outcome frequency: 41% achieved goal BP within 60 minutes preintervention vs 47% postintervention (P=.28). Median time from first severe BP to first treatment was unchanged (30 minutes preintervention vs 29 minutes postintervention, P=.058); however, median time from first severe BP to goal BP decreased significantly (122 vs 95 minutes, P=.04). Confirmation of hypertensive emergency within 15 minutes (recommended) was only achieved in approximately 20% of women in either group. More women initially received intravenous antihypertensive treatment after the intervention (52% preintervention vs 80% postintervention, P<.001).

CONCLUSION:
A quality improvement initiative was not associated with more women achieving BP control within an hour of obstetric hypertensive emergency treatment, but was associated with decreased time to achieve control. This suggests improved clinical practice after the intervention.
Antenatal Testing for Women With Preexisting Medical Conditions Using Only the Ultrasonographic Portion of the Biophysical Profile
Authors: Zafman Kelly B. , Bruck Efrat , Rebarber Andrei , Saltzman Daniel H. , Fox Nathan S. 
Published: August 2018

OBJECTIVE:
To report the utility of the ultrasonographic biophysical profile, which includes all the components of a biophysical profile minus the nonstress test, in women with maternal indications for antepartum surveillance.

METHODS:
We conducted a case series reviewing the records of all women at 32 weeks of gestation or greater with at least one indication for antenatal testing (per the American College of Obstetricians and Gynecologists) delivered by a single maternal–fetal medicine practice between 2006 and 2018. Indications included diabetes, hypertension, lupus, antiphospholipid syndrome, sickle cell disease, renal disease, heart disease, hyperthyroidism, isoimmunization, inherited thrombophilia, and prior intrauterine fetal demise. Weekly ultrasonographic biophysical profiles were initiated at 32 weeks of gestation. We calculated the test-positive rate, the percentage of women delivered for an abnormal ultrasonography biophysical profile, and the intrauterine fetal demise rate (false-negative rate).

RESULTS:
Nine hundred eighty-five women underwent 3,981 ultrasonographic biophysical profiles (four per woman; range 1–11). Sixteen women had an abnormal ultrasonographic biophysical profile, for a test positive rate of 1.6% (95% CI 1.0–2.6%) per woman, or 0.4% (95% CI 0.3–0.7%) per ultrasonographic biophysical profile. Of the 16 women with abnormal ultrasonographic biophysical profiles, 13 were delivered with good outcomes and three women had normal follow-up testing and uncomplicated deliveries at a later date. There were three women with intrauterine fetal demise (false-negative rate of 0.3%, 95% CI 0.1–0.9%). One woman with intrauterine fetal demise had a factor V Leiden mutation, fetal ventriculomegaly, and fetal growth restriction. The second woman with intrauterine fetal demise had advanced maternal age, a factor V Leiden mutation, and fetal growth restriction. The third woman with intrauterine fetal demise had class B diabetes. All three intrauterine fetal demises were diagnosed antepartum with an interval from normal ultrasonographic biophysical profile to intrauterine fetal demise of 7, 7, and 6 days, respectively.

CONCLUSION:
The use of ultrasonographic biophysical profile in a high-risk cohort is associated with a very low test-positive rate and a very low incidence of intrauterine fetal demise. In women with preexisting medical conditions that place them at higher risk for intrauterine fetal demise, ultrasonographic biophysical profile can be used for antenatal testing.
Hormone therapy in postmenopausal women associated with risk of stroke and venous thromboembolism: a population-based cohort study in Taiwan
Authors: Chang Wei-Chuan , Wang Jen-Hung , Ding Dah-Ching 
Published: August 2018

Abstract

Objective:
The aim of the study was to evaluate the risks and benefits of hormone therapy (HT) in postmenopausal women in Taiwan.

Methods:
A retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database, a population-based healthcare claims dataset. Eligible women, aged 40 to 65, were matched 1:1 by age and menopause year to avoid confounding through imbalanced baseline characteristics among the two groups (2,491 pairs). The primary outcomes were acute coronary syndrome (ACS), venous thromboembolism (VTE), and ischemic stroke (IS).

Results:
Mean follow-up in the HT group was 30 months. Mean age of the HT group was 50 years. After adjusting for age, statin and anticoagulant use, hyperlipidemia, diabetes, and hypertension, the hazard ratios (95% CIs) for the HT group were increased: ACS, 3.73 (2.01-6.91); IS, 3.51 (2.41-5.11); and VTE, 2.51 (1.15-5.47).

Conclusions:
In postmenopausal Taiwanese women, HT may be associated with an increased risk of cardiovascular disease. Although the women in our population receiving HT were near menopausal age, their risk of cardiovascular disease was still higher than in the non-HT group.
WISDOM survey: attitudes and behaviors of physicians toward vulvar and vaginal atrophy (VVA) treatment in women including those with breast cancer history
Authors: Kingsberg Sheryl A. , Larkin Lisa , Krychman Michael , Parish Sharon J. , Bernick Brian , Mirkin Sebastian 
Published: August 2018

Abstract

Objective:
To evaluate and compare physicians’ behaviors and attitudes regarding vulvar and vaginal atrophy (VVA) treatment in menopausal women, including women with breast cancer, using an internet-based survey.

Methods:
The WISDOM survey queried obstetricians and gynecologists (OB/GYNs) and primary care physicians (PCPs) with 23 multipart questions assessing behaviors and attitudes towards VVA treatment.

Results:
Of 2,424 surveys sent, 945 (39%) responded and 644 (27%) were completed. Of the menopausal women seen by OB/GYNs and PCPs, 44% to 55% reported having VVA symptoms. Physicians prescribed VVA treatments primarily because of effectiveness. Only 34% of OB/GYNs and 17% of PCPs felt comfortable prescribing VVA therapies to women with a personal history of breast cancer. In general, the most common VVA treatment recommended by all was prescription therapy (49%; with or without other therapies) in the form of US Food and Drug Administration-approved vaginal estrogen creams. More OB/GYNs (72%) than PCPs (47%) disagreed that VVA was best treated with over the counter than prescription products. Out-of-pocket cost and fear of risks associated with estrogens were believed to be the main barriers for why women choose not to get treated and why they discontinue treatment.

Conclusions:
More OB/GYNs than PCPs prescribed VVA treatment, especially vaginal estrogens, for menopausal women, but both groups generally had similar attitudes and behaviors regarding VVA treatment. Physician comfort was low when prescribing to women with a history of breast cancer, despite women's health medical societies supporting vaginal estrogen use in women with a history of estrogen-dependent breast cancer who were unresponsive to nonhormonal therapies when offered in consultation with their oncologist.
Investigation of Corneal Astigmatism in Chinese Patients With Primary Angle Closure Disease
Authors: Zuo Chengguo , Gong Ruowen , Chen Weirong , Chen Chuyin , Su Jinai , Wei Kun , Gao Xinbo , Lin Mingkai , Ge Jian 
Published: August 2018

Purpose:
The purpose of this study was to analyze the demographics and distribution of corneal astigmatism before lens extraction in patients with primary angle closure disease (PACD).

Methods:
Preoperative partial coherence interferometry was performed in patients with PACD. The demographic and biometric data, including corneal astigmatism and keratometry (K), were recorded.

Results:
The study comprised 808 cases (1001 eyes) with a mean age of 67.66±9.07 years, and the mean axial length was 22.55±0.89 mm. The mean corneal astigmatism was 1.08±0.78 diopter (D). Corneal astigmatism was between 0.25 D and 1.25 D in 66.50% of the eyes, 1.25 D or higher in 29.68% of the eyes and <0.25 D in 3.82% of the eyes. The corneal astigmatism of primary angle closure suspect (PACS), primary angle closure (PAC) and primary angle closure glaucoma (PACG) were 1.08±0.77 D, 0.98±0.62 D, and 0.89±0.69 D, respectively. In total, 50.60% of the eyes were classified as astigmatism against the rule (ATR), 28.69% of the eyes were with the rule, and 20.71% of the eyes were oblique. ATR astigmatism increased significantly with age (P<0.001). After matching, corneal astigmatism of PACD was 1.07±0.77 D, although it was statistically significantly higher than that of ARC (0.98±0.66 D, P=0.018), the 2 demonstrated no clinical difference.

Conclusions:
The results provide normative data of corneal astigmatism for PACD patients. Corneal astigmatism was mainly distributed between 0.25 D and 1.25 D. The findings largely concur with published results in age-related cataract subjects.
Factors Associated With Continued Smoking in Lebanese Patients With Acute Coronary Syndrome
Authors: Noureddine Samar , Massouh Angela 
Published: August 2018

Background:
Smoking in patients with acute coronary syndrome (ACS) increases their risk for recurrent events and death.

Objectives:
The aim of this study was to describe the smoking trajectory among patients hospitalized with ACS and associated factors.

Methods:
Forty patients with ACS who were smokers were interviewed in the hospital about smoking history, nicotine dependence, depression, self-efficacy, and social support. Phone interviews at 1, 3, 6, and 12 months after discharge assessed smoking status and related factors.

Results:
Most patients (≥80%) were middle-aged married men, with high nicotine dependence (52.5%) and low self-efficacy for smoking cessation (mean [SD], 38.3 [27.19]) at baseline. Although 85% intended to quit after discharge, 62.5% continued smoking after 1 year. Persistent smoking was associated with lower self-efficacy (P < .01) and higher depression (P = .025).

Conclusion:
Smoking cessation intervention must start in the hospital and continue for 6 months. The program must target self-efficacy, manage depression, and involve the patient’s family.
Type 1 and Type 2 Autoimmune Pancreatitis
Authors: Negrelli Riccardo , Boninsegna Enrico , Avesani Giacomo , Zamboni Giulia A. , Brozzi Lorenzo , Frulloni Luca , Manfredi Riccardo , Pozzi Mucelli Roberto 
Published: August 2018

Objectives
This study aimed to evaluate magnetic resonance imaging findings of autoimmune pancreatitis (AIP) and to find radiological patterns that could differentiate type 1 and type 2 AIP.

Methods
Eighty-four patients with diagnosis of AIP were enrolled. Image analysis included pancreatic signal intensity abnormalities, enhancement pattern, extrapancreatic involvement, and main pancreatic duct alterations.

Results
Pancreatic parenchyma resulted in hypointensity on T1-weighted images in 65 (98.5%) of 66 cases in type 1 and in 17 (94.5%) of 18 in type 2 (P > 0.05) and in hyperintensity on T2-weighted images in 41 (62%) of 66 and in 15 (83.4%) of 18, respectively (P > 0.05). Lesions were hypovascular in 64 (97%) of 66 cases in type 1 and in 16 (88.9%) of 18 in type 2 with delayed contrast retention in 56 (84.8%) of 66 and in 17 (94.5%) of 18, respectively (P > 0.05). Autoimmune cholangitis was found in 29 (43.9%) of 66 patients with type 1 and in 3 (16.7%) of 18 with type 2 (P = 0.02); renal involvement was observed in 20 (30.3%) of 66 and 1 (5.5%) of 18, respectively (P = 0.02). Both subtypes presented with multiple stenoses (P > 0.05). Dilation of upstream duct was more frequent in type 1 (P = 0.02).

Conclusions
Magnetic resonance imaging is useful in detecting extrapancreatic involvement, typically seen in type 1. Dilation of the upstream duct suggests type 1 AIP.
Reduced Fear-Conditioned Pain Modulation in Experienced Meditators: A Preliminary Study
Authors: Taylor Véronique A. , Roy Mathieu , Chang Luke , Gill Louis-Nascan , Mueller Christian , Rainville Pierre 
Published: August 2018

ABSTRACT

Objective
Mindfulness-based practice is a form of cognitive/affective training that may help reduce suffering by attenuating maladaptive anticipatory processes. This study's objective was to examine the pain modulating impact of classical fear learning in meditation practitioners.

Methods
The hyperalgesic effects of pain expectation and uncertainty were assessed outside formal meditation in 11 experienced meditators (>1000 hours) compared with meditation-naive controls during a Pavlovian classical fear-conditioning paradigm involving two visual stimuli (CS+/CS−), one of which (CS+) co-terminated with a noxious electrical stimulus (unconditioned stimulus) on 50% of trials. A Rescorla-Wagner/Pearce-Hall hybrid model was fitted onto the conditioned skin conductance responses using computational modeling to estimate two learning parameters: expected shock probability and associability (i.e., uncertainty).

Results
Using a scale ranging between 0 (no pain) and 100 (extremely painful), meditators reported less pain (M = 19.9, SE = 5.1 for meditators, M = 32.4, SE = 2.4 for controls) but had comparable spinal motor responses (nociceptive flexion reflex) to the unconditioned stimulus. Multilevel mediation analyses revealed that meditators also exhibited reduced hyperalgesic effects of fear learning on higher-order pain responses but comparable effects on the nociceptive flexion reflex. These results suggest that mindfulness affects higher-order perceptual processes to a greater extent than from descending inhibitory controls. Furthermore, meditators showed reduced hyperalgesic effects of fear conditioning with no significant group difference in conditioned learning as evidenced by discriminative anticipatory skin conductance responses and learning parameters derived from computational modeling.

Conclusions
These results highlight potential mechanisms underlying mindfulness-related hypoalgesia, relevant to clinical conditions in which repeated pain exposure might reinforce hyperalgesic processes through fear conditioning.
Therapeutic Duplication of Long-Acting Injectable Drugs
Authors: Shao Shih-Chieh , Lai Edward Chia-Cheng , Chan Yuk-Ying , Hung Ming-Jui , Chen Hui-Yu 
Published: August 2018

Abstract
Long-acting medications are widely used to provide convenient ways of managing diseases, but they may cause serious harm to patients when prescribed erroneously. We present a case of hypocalcaemia as a result of therapeutic duplication of 2 long-acting bisphosphonates prescribed within days of each other by different physicians. We describe how we prevented similar medication errors through improvements in medical informatics systems. This case emphasizes the need for enhancements in medical informatics systems to avoid therapeutic duplication of long-acting medications in the interest of patient safety.
The Effect of Histidine-tryptophan-ketoglutarate Solution and University of Wisconsin Solution: An Analysis of the Eurotransplant Registry
Authors: de Boer Jacob D. , Strelniece Agita , van Rosmalen Marieke , de Vries Erwin , Ysebaert Dirk , Guba Markus , Braat Andries Erik , Samuel Undine 
Published: August 2018

Background
Both University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are currently used in the Eurotransplant region for preservation of liver allografts. Previous studies on their effect have led to a lot of discussion. This study aims to compare the effect of HTK and UW on graft survival.

Methods
First liver transplantations in recipients 18 years or older from January 1, 2007, until December 31, 2016, were included. Graft survival was compared for livers preserved with HTK and UW at 30 days, 1, 3, and 5 years. Multivariable analysis of risk factors was performed and outcome was adjusted for important confounders.

Results
Of all 10 628 first liver transplantations, 8176 (77%) and 2452 (23%) were performed with livers preserved with HTK and UW, respectively. Kaplan-Meier curves showed significant differences in graft survival between HTK and UW at 30 days (89% vs 93%, P=<0.001), 1 year (75% vs 82%, P=<0.001), 3 years (67% vs 72%, P<0.001), and at 5 years (60% vs 67%, P<0.001). No significant differences in outcome were observed in separate analyses of Germany or non-German countries. In multivariable analysis, UW was associated with a decreased risk of graft loss at 30 days (HR 0.772, P=0.002) and at 1 year (0.847 (0.757-0.947). When adjusted for risk factors, no differences in long term outcome could be detected.

Conclusions
Because the use of preservation fluids is clustered geographically, differences in outcome by preservation fluids are strongly affected by regional differences in donor and recipient characteristics. When adjusted for risk factors, no differences in graft survival exist between transplantations performed with livers preserved with either HTK or UW.
Outcomes in Third and Fourth Kidney Transplants Based on the Type of Donor
Authors: Dabare Dilan , Kassimatis Theodoros , Hodson James , Khurram Muhammad Arslan , Papadakis Georgios , Rompianesi Gianluca , Shaw Olivia , Karydis Nikolaos , Callaghan Chris , Olsburgh Jonathon , Mamode Nizam , Kessaris Nicos , Loukopoulos Ioannis 
Published: August 2018

Background.
An increasing number of patients are requiring multiple retransplants. We assessed outcomes of third and fourth kidney transplants, to aid decision making on the most suitable donor type.

Methods.
Data were collected retrospectively for 2561 transplants, including 69 third and 8 fourth, performed from 2000 to 2017. Demographics and outcomes for the combined third/fourth group were compared to first and second transplants. Within the third/fourth kidney transplant group, comparisons were made between deceased donors (n = 39), live donor HLA-compatible (n = 23) and -incompatible (n = 13) transplants, as well as between standard (n = 25) and extended-criteria (n = 14) deceased donor transplants.

Results.
Patient survival did not differ significantly by transplant number (P = 0.532), whereas death-censored graft survival declined progressively, from 89% at 5 years in first, 85% in second and 74% in the third/fourth transplant group (P < 0.001). Within the combined third/fourth transplant subgroup, 5-year graft survival was found to be 100% in recipients of HLA-compatible live donors, compared to 75% in deceased donors and 53% in HLA-incompatible live donors, although this difference did not reach statistical significance (P = 0.083). No significant difference in patient survival (P = 0.356) or complication rates (P = 0.757) were detected between these groups. For recipients of deceased donors in the third/fourth transplant group, there were no significant differences between standard versus extended-criteria donors for any of the outcomes considered.

Conclusions.
Despite variable functional outcomes, third and fourth kidney transplant recipients experience comparable patient survival rates to first and second transplants, regardless of the donor type. In selected patients, HLA-incompatible live donors and extended-criteria deceased donors should be considered.
Movement context modulates neuronal activity in motor and limbic-associative domains of the human subthalamic nucleus
Authors: Marmor Odeya , Rappel Pnina , Valsky Dan , Bick Atira S , Arkadir David , Linetzky Eduard , Peled Or , Tamir Idit , Bergman Hagai , Israel Zvi , Eitan Renana 
Published: August 2018

AbstractTo better understand the mechanism of movement facilitation and inhibition in the subthalamic nucleus (STN), we recorded subthalamic multiunit activity intra-operatively while parkinsonian patients (n=43 patients, 173 sites) performed increasingly complex oddball paradigms: auditory (‘None-Go’, n=7, 28), simple movement (‘All-Go’, n=7, 26) and movement inhibition (‘Go-NoGo’, n=29, 119) tasks. To enable physiological sampling of the different subthalamic nucleus domains in both hemispheres, each patient performed one of the oddball paradigms several times.The human STN responded mainly to movement-involving tasks: movement execution at the motor STN and movement planning at the limbic-associative STN. In the limbic-associative STN, responses to the inhibitory cue (deviant tone) in the movement inhibition task were not significantly different from the simple movement task. However, responses to the go cue (frequent tone) were significantly reduced. The reduction was mainly in the negative component of the evoked response amplitude. Successful movement inhibition was correlated with higher baseline activity before the inhibitory cue.We suggest that the STN adapts to movement inhibition context by selectively decreasing the amplitude of neuronal activity. Thus, the STN enables movement inhibition not by increasing responses to the inhibitory cue but by reducing responses to the release cue. The negative component of the evoked response probably facilitates movement and a higher baseline activity enables successful inhibition of movement. These discharge modulations were found in the ventromedial, non-motor domain of the STN and therefore suggest a significant role of the associative-limbic domains in movement planning and in global movement regulation.