bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Brief Alcohol Withdrawal Scale Protocol at an Academic Medical Center
Authors: Lindner Brian K. , Gilmore Vi T. , Kruer Rachel M. , Alvanzo Anika AH. , Chen Edward S. , Murray Paula , Niessen Timothy , Perrin Keisha , Rastegar Darius A. , Young Samantha , Jarrell Andrew S. 
Published: February 2019

Objectives:
The standard of care for treatment of alcohol withdrawal is symptom-triggered dosing of benzodiazepines using a withdrawal scale. Abbreviated scales are desired for clinician efficiency. The objective of this study was to evaluate the use of the 5-item Brief Alcohol Withdrawal Scale (BAWS) protocol.

Methods:
This single-center, retrospective, observational, cohort study assessed patients ordered the BAWS protocol between August 1, 2016 and July 31, 2017. Data were collected on benzodiazepine exposure, duration of treatment, withdrawal severity, agitation, over-sedation, and delirium while being treated for alcohol withdrawal. Comparisons were made to analyze predetermined patient subgroups.

Results:
Seven hundred ninety-nine patients were initiated on the BAWS protocol. Patients received a median (IQR) of 0 (0–4) lorazepam equivalents (LEs) and were on the BAWS protocol for a median (IQR) of 44.9 (22.4–77.2) hours. Of the patients that received benzodiazepines while on the BAWS protocol, a median (IQR) of 4 (2–11) LEs were given. Seventeen (2.1%) patients had severe withdrawal. Days of agitation, over-sedation, and delirium were minimal, with the median (IQR) of 0 (0–0). Few patients received adjunctive medications for symptom management. Intensive care unit (ICU) patients had more severe withdrawal than non-ICU patients, but received the same cumulative benzodiazepine dose.

Conclusions:
Most patients on the BAWS protocol received little-to-no benzodiazepines; severe withdrawal, agitation, delirium, or over-sedation were uncommon. This is the first evaluation of the BAWS protocol on a diverse population of hospitalized patients.
Toward Understanding Cerebral Blood Flow during Cardiopulmonary Bypass
Authors: Reves J. G. 
Published: February 2019

Abstract

Factors and Their Influence on Regional Cerebral Blood Flow during Nonpulsatile Cardiopulmonary Bypass. By Govier AV, Reves JG, McKay RD, Karp RB, Zorn GL, Morawetz RB, Smith LR, Adams M, and Freeman AM. Ann Thorac Surg. 1984; 38:609–13. Reprinted with permission.
In this study, we examined the relationship of regional cerebral blood flow (CBF) to mean arterial pressure, systemic blood flow, partial pressure of arterial carbon dioxide (PaCO2), nasopharyngeal temperature, and hemoglobin during hypothermic nonpulsatile cardiopulmonary bypass (CPB). Regional CBF was determined by clearance of xenon 133 in 67 patients undergoing coronary bypass grafting procedures. There was a significant decrease in regional CBF (55% decrease) during CPB, with nasopharyngeal temperature and PaCO2 being the only two significant factors (p < 0.05). In a subgroup of 10 patients, variation of pump flow between 1.0 and 2.0 L/min/m2 did not significantly affect regional CBF. We conclude that cerebral autoregulation is retained during hypothermic CPB. Under the usual conditions of CPB, variations in flow and pressure are not associated with important physiologic or detrimental clinical effects.
Effects of Prophylactic Oxytocin on Bleeding Outcomes in Women Undergoing Dilation and Evacuation
Authors: Whitehouse Katherine , Tschann Mary , Soon Reni , Davis James , Micks Elizabeth , Salcedo Jennifer , Savala Michael , Kaneshiro Bliss 
Published: February 2019

OBJECTIVE:
To estimate whether routine use of intravenous oxytocin decreases the frequency of interventions to control excess blood loss during dilation and evacuation (D&E).

METHODS:
In this multisite, randomized, double-blind, placebo-controlled trial, women undergoing D&E at 18–24 weeks of gestation received 30 units of oxytocin in 500 mL of intravenous fluid or 500 mL of intravenous fluid alone initiated on speculum placement. The primary outcome was the frequency of interventions to control excess bleeding. A sample size of 75 patients per group was needed to detect a 15% decrease in intervention from 20% to 5% with 80% power and two-sided alpha 0.05. Secondary outcomes included measured blood loss, complications, procedure duration, postoperative pain, and patient satisfaction.

RESULTS:
From November 2014 to February 2018, we screened 337 women and randomized 160 to receive prophylactic oxytocin (n=82) or placebo (n=78). Demographic characteristics were similar between groups. The frequency of interventions for bleeding, our primary outcome, was 7.3% in the oxytocin group vs 16.7% in the placebo group, difference of 9.4% (95% CI −21.0% to 1.9%). Interventions primarily included uterine massage and uterotonic administration. Among our secondary outcomes, median measured blood loss was lower in the oxytocin group at 152 (interquartile range 98–235) mL vs 317 (interquartile range 168–464) mL (95% CI 71.6–181.5). Frequency of hemorrhage, defined as blood loss of 500 mL or more and 1,000 mL or more, was lower in the oxytocin group at 3.7% vs 21.8%, difference of 18% (95% CI −29 to −6.9%) and 1.2% vs 10.3%, difference of 9.0% (95% CI −17 to −0.7%), respectively. Procedures were shorter in the oxytocin group at a median of 11.0 (interquartile range 8.0–14.0) vs 13.5 (interquartile range 10.0–19.0) minutes in the placebo group (95% CI 1.0–4.0). We found no differences in the frequency of nonhemorrhage complications, pain scores, or satisfaction scores between groups.

CONCLUSION:
Prophylactic use of oxytocin during D&E at 18–24 weeks of gestation did not decrease the frequency of interventions to control bleeding. However, oxytocin did decrease blood loss and frequency of hemorrhage.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, www.clinicaltrials.gov, NCT02083809.
Medical Assessment and Triage of Pediatric Patients with Anorexia Nervosa in Primary Care
Authors: Homan Kendra J. , Sim Leslie A. , Crowley Susan L. , Lebow Jocelyn R. , Kransdorf Lisa N. 
Published: February 2019

ABSTRACT:

Objective:
To examine the medical assessment and triage of pediatric patients with anorexia nervosa (AN) initially seen in primary care.

Methods:
A retrospective cohort study was conducted for all pediatric patients with AN who had eating/weight concerns and initially identified symptoms in primary care in a single health care system between January 1, 2010, and December 31, 2016. Information on presenting concern, medical assessment/laboratory tests, clinical diagnoses, treatment recommendations, and referrals were abstracted from the medical record.

Results:
Forty-one (mean age = 13.7 years; SD = 2.2) pediatric patients with AN had eating/weight concerns and initially identified symptoms in a primary care. Overall, only 5% (n = 2/41) of patients received an AN diagnosis during the index visit; a minority were assessed for electrolyte disturbance (n = 20), electrocardiogram abnormality (n = 18), hypothermia (n = 13), binge/purge behaviors (n = 13), orthostatic hypotension (n = 2), or dehydration (n = 1), and only 56% (n = 23) received triage consistent with practice recommendations. Although 61% (n = 25) met criteria for inpatient admission, inpatient hospitalization was recommended for only 2 patients. Patients who received triage consistent with practice recommendations received AN diagnosis and treatment significantly earlier than those who did not (p < 0.01 and p = 0.001, respectively).

Conclusion:
Findings suggest that pediatric patients with AN may not be receiving medical assessment and triage per practice recommendations in the primary care setting. Understanding barriers to evidence-based care for pediatric eating disorders may inform provider education and system-wide changes to enhance outcomes in these patients.
Detection of Pathogenic Germline Variants Among Patients With Advanced Colorectal Cancer Undergoing Tumor Genomic Profiling for Precision Medicine
Authors: You Y. Nancy , Borras Ester , Chang Kyle , Price Brandee A. , Mork Maureen , Chang George J. , Rodriguez-Bigas Miguel A. , Bednarski Brian K. , Meric-Bernstam Funda , Vilar Eduardo 
Published: February 2019

BACKGROUND:
Genomic profiling of colorectal cancer aims to identify actionable somatic mutations but can also discover incidental germline findings.

OBJECTIVE:
The purpose of this study was to report the detection of pathogenic germline variants that confer heritable cancer predisposition.

DESIGN:
This was a retrospective study.

SETTINGS:
The study was conducted at a tertiary-referral institution.

PATIENTS:
Between 2012 and 2015, 1000 patients with advanced cancer underwent targeted exome sequencing of a 202-gene panel. The subgroup of 151 patients with advanced colorectal cancer who underwent matched tumor-normal (blood) sequencing formed our study cohort.

INTERVENTIONS:
Germline variants in 46 genes associated with hereditary cancer predisposition were classified according to a defined algorithm based on in silico predictions of pathogenicity. Patients with presumed pathogenic variants were examined for type of mutation, as well as clinical, pedigree, and clinical genetic testing data.

MAIN OUTCOME MEASURES:
We measured detection of pathogenic germline variants.

RESULTS:
A total of 1910 distinct germline variants were observed in 151 patients. After filtering, 15 pathogenic germline variants (9.9%) were found in 15 patients, arising from 9 genes of varying penetrance for colorectal cancer (APC (n = 2; 13%), ATM (n = 1; 6%), BRCA1 (n = 2; 13%), CDH1 (n = 2; 13%), CHEK2 (n = 4; 27%), MSH2 (n = 1; 7%), MSH6 (n = 1; 7%), NF2 (n = 1; 7%), and TP53 (n = 1; 7%)). Patients with pathogenic variants were diagnosed at a younger age than those without (median, 45 vs 52 y; p = 0.03). Of the 15 patients, 7 patients (46.7%) with variants in low/moderate- penetrant genes for colorectal cancer would likely have not been tested based on clinical and pedigree criteria, where 2 harbored clinically actionable variants (CDH1 and NF2, 28.5% of 7).

LIMITATIONS:
This study was limited by its small sample size and advanced-stage patients.

CONCLUSIONS:
Tumor-normal sequencing can incidentally discover clinically unsuspected germline variants that confer cancer predisposition in 9.9% of patients with advanced colorectal cancer. Precision medicine should integrate clinical cancer genetics to inform and interpret the actionability of germline variants and to provide follow-up care to mutation carriers. See Video Abstract at http://links.lww.com/DCR/A906.
Recent Advances in Fertility Preservation and Counseling for Reproductive-Aged Women with Colorectal Cancer: A Systematic Review
Authors: Shandley Lisa M. , McKenzie Laurie J. 
Published: February 2019

BACKGROUND:
The incidence of colorectal cancer among reproductive-aged women is increasing. Concerns regarding future fertility are secondary only to concerns regarding survival and may significantly impact quality of life among reproductive-aged female cancer survivors. Fertility preservation counseling reduces long-term regret and dissatisfaction among cancer survivors. Health care providers counseling patients with colorectal cancer must understand the impact of cancer treatment on future reproductive potential.

OBJECTIVE:
This review aims to examine the effects that colorectal cancer treatments have on female fertility and summarize existing and emerging options for fertility preservation.

DATA SOURCES:
EMBASE, National Library of Medicine (MEDLINE)/PubMed, Cochrane Review Library were the data sources for this review.

STUDY SELECTION:
A systematic literature review was performed using exploded MeSH terms to identify articles examining the effect of surgery, chemotherapy, and radiation, as well as fertility preservation options for colorectal cancer on female fertility. Relevant studies were included.

MAIN OUTCOME MEASURES:
The primary outcome was the effect of colorectal cancer treatment on fertility.

RESULTS:
There are limited data regarding the impact of colorectal surgery on fertility. The gonadotoxic effects of chemotherapy on reproductive capacity depend on age at the time of chemotherapy administration, cumulative chemotherapy, radiation dose, type of agent, and baseline fertility status. Chemotherapy-induced risks for colorectal cancers are considered low to moderate, whereas pelvic radiation with a dose of 45 to 50 Gray induces premature menopause in greater than 90% of patients. Ovarian transposition may reduce but not eliminate the damaging effect of radiation on the ovaries. Embryo and oocyte cryopreservation are considered standard of care for women desiring fertility preservation, with oocyte cryopreservation no longer being considered experimental. Ovarian tissue cryopreservation remains experimental but may be an option for select patients. The use of gonadotropin-releasing hormone agonists remains controversial and has not been definitively shown to preserve fertility.

LIMITATIONS:
The limitations of this review are the lack of randomized controlled trials and high-quality studies, as well as the small sample sizes and the use of surrogate fertility markers.

CONCLUSION:
Reproductive-aged women with colorectal cancer benefit from fertility preservation counseling before the initiation of cancer treatment.
Intravenous Drug Use–Related Complications of the Hand and Upper Extremity
Authors: Pong Taylor M. , Oflazoglu Kamilcan , Helliwell Lydia A. , Chen Neal C. , Eberlin Kyle R. 
Published: February 2019

Background:
In the last decade, there has been an increase in intravenous drug use (IVDU) and associated medical problems. Users commonly inject into their upper extremities, which can result in infection and other sequelae in this area. The goal of this study was to compare demographics and treatment for upper extremity infections between intravenous drug users and non-intravenous drug users over the past 10 years at 1 level I emergency department (ED).

Methods:
This was a retrospective case–control study. All patients presenting to the ED with an upper extremity infection in 2005, 2010, and 2015 were identified using the ninth revision of the International Statistical Classification of Diseases and Related Health Problems and Current Procedural Terminology codes. Patients with an IVDU-related infection were identified by manually reviewing the medical record and matched with patients with non-IVDU–related infection on demographics. Patient-related factors, infection specifics, and treatment parameters were compared in both groups.

Results:
The number of IVDU-related upper extremity infection cases presenting to the ED increased 126% over the 10-year period (65 cases in 2005, 109 cases in 2010, and 147 cases in 2015). The location of infection in the IVDU group was more likely to be in a typical injection site (forearm, P < 0.001; wrist, P = 0.002), and IVDU patients had 33% more hospital admissions and stayed in the hospital longer (3 days versus 0.59; P < 0.001). These patients also were more likely to have a computed tomography scan (P < 0.001) and have Methicillin-resistant Staphylococcus aureus (MRSA) or Methicillin-sensitive Staphylococcus aureus (MSSA) (P = 0.009).

Conclusions:
Over a 10-year period, the number of IVDU-related upper extremity infections more than doubled, with more severe infections that underwent advanced imaging and intensive treatment.
Low-Fidelity Spectral Analysis Utilizing a Binomial Discriminator for Weak-Source Detection Decisions
Authors: Lindsay J. , Meengs M. , Fischer J. C. , Brogan J. , Brandl A. 
Published: February 2019

Abstract
The identification of radiological sources by analysis of a gamma spectrum usually relies on the location of the set of radionuclide-specific electron energies corresponding to the incident photons interacting by photoelectric absorption in the detection medium. The challenge in low-level detection applications is the identification of these “photopeaks” above the background counts registered in the detector from the natural radiation environment and system noise. For source detection decisions, regions of the gamma spectrum other than at the photopeak energies may provide additional information about the presence of a source and allow for a higher rate of correct identification of a weak source. A statistical algorithm utilizing low-fidelity spectral data partitioned into three distinct regions and employing a binomial discriminator was tested in a laboratory setting against the traditional approach of source identification by exceeding a decision threshold within the photopeak region of interest. For an unshielded 137Cs source with no significant scatter between the source and the detector, the traditional peak identification method performs as well or better than most algorithm settings for various source strengths. However, an algorithm which also includes information in the energy range of Compton scattered photons provides improved detection capabilities for shielded weak sources. Such algorithms, including higher-fidelity developments, could be deployed to improve current tools for the search for orphan radiological sources and in the characterization of low-level environmental contamination.
Double-Line Reflection Pattern as a Simple Method to Determine Graft Orientation of Descemet Membrane Endothelial Keratoplasty
Authors: Berrospi Rubén D. , Galvis Virgilio , Bhogal Maninder , Tello Alejandro 
Published: February 2019

Purpose:
To describe a simple finding, consisting of a double-line reflection from the graft inside the anterior chamber, that can be used to determine the correct donor tissue orientation in Descemet membrane endothelial keratoplasty: which we would like to call Berrospi's sign.

Methods:
Evaluation of the presence of linear reflection from the donor tissue when implanted in the anterior chamber.

Results:
A distinctive double-line reflection pattern was identified when careful observation of the curls of the scroll was performed under the surgical microscope, which was a confirmatory sign that the graft was in the correct position.

Conclusions:
This method of confirming correct graft orientation requires no additional procedures, equipment, or manipulation of the donor tissue and can be used in conjunction with other marking methods already described.
Towards a neurobiological understanding of pain in neurofibromatosis type 1: mechanisms and implications for treatment
Authors: Bellampalli Shreya S. , Khanna Rajesh 
Published: February 2019

Abstract
Neurofibromatosis type 1 (NF1) is the most common of a group of rare diseases known by the term, “Neurofibromatosis,” affecting 1 in 3000 to 4000 people. NF1 patients present with, among other disease complications, café au lait patches, skin fold freckling, Lisch nodules, orthopedic complications, cutaneous neurofibromas, malignant peripheral nerve sheath tumors, cognitive impairment, and chronic pain. Although NF1 patients inevitably express pain as a debilitating symptom of the disease, not much is known about its manifestation in the NF1 disease, with most current information coming from sporadic case reports. Although these reports indicate the existence of pain, the molecular signaling underlying this symptom remains underexplored, and thus, we include a synopsis of the literature surrounding NF1 pain studies in 3 animal models: mouse, rat, and miniswine. We also highlight unexplored areas of NF1 pain research. As therapy for NF1 pain remains in various clinical and preclinical stages, we present current treatments available for patients and highlight the importance of future therapeutic development. Equally important, NF1 pain is accompanied by psychological complications in comorbidities with sleep, gastrointestinal complications, and overall quality of life, lending to the importance of investigation into this understudied phenomenon of NF1. In this review, we dissect the presence of pain in NF1 in terms of psychological implication, anatomical presence, and discuss mechanisms underlying the onset and potentiation of NF1 pain to evaluate current therapies and propose implications for treatment of this severely understudied, but prevalent symptom of this rare disease.
Insight into the genetic architecture of back pain and its risk factors from a study of 509,000 individuals
Authors: Freidin Maxim B. , Tsepilov Yakov A. , Palmer Melody , Karssen Lennart C. ,   CHARGE Musculoskeletal Working Group, Suri Pradeep , Aulchenko Yurii S. , Williams Frances M.K. 
Published: February 2019

Abstract
Back pain (BP) is a common condition of major social importance and poorly understood pathogenesis. Combining data from the UK Biobank and CHARGE consortium cohorts allowed us to perform a very large genome-wide association study (total N = 509,070) and examine the genetic correlation and pleiotropy between BP and its clinical and psychosocial risk factors. We identified and replicated 3 BP-associated loci, including one novel region implicating SPOCK2/CHST3 genes. We provide evidence for pleiotropic effects of genetic factors underlying BP, height, and intervertebral disk problems. We also identified independent genetic correlations between BP and depression symptoms, neuroticism, sleep disturbance, overweight, and smoking. A significant enrichment for genes involved in the central nervous system and skeletal tissue development was observed. The study of pleiotropy and genetic correlations, supported by the pathway analysis, suggests at least 2 strong molecular axes of BP genesis, one related to structural/anatomical factors such as intervertebral disk problems and anthropometrics, and another related to the psychological component of pain perception and pain processing. These findings corroborate with the current biopsychosocial model as a paradigm for BP. Overall, the results demonstrate BP to have an extremely complex genetic architecture that overlaps with the genetic predisposition to its biopsychosocial risk factors. The work sheds light on pathways of relevance in the prevention and management of low BP.
Effects of Cytochrome P450 2C19 Genetic Polymorphisms on Responses to Escitalopram and Levels of Brain-Derived Neurotrophic Factor in Patients With Panic Disorder
Authors: He Qianqian , Mei Yan , Liu Yuanyuan , Yuan Zhuo , Zhang Jian , Yan Hong , Shen Li , Zhang Yong 
Published: February 2019

Abstract

Purpose/Background
The purpose of this study was to examine the relationships between ytochrome P450 family 2 subfamily C member 19 (CYP2C19) polymorphisms, brain-derived neurotrophic factor (BDNF) plasma levels, and treatment responses to escitalopram in Chinese patients with panic disorder (PD).

Methods/Procedures
Ninety patients with PD were administered the Panic Disorder Severity Scale–Chinese Version (PDSS-CV) and Hamilton Anxiety Scale (HAMA-14) from baseline to 8 weeks. Escitalopram treatment (10 mg/d) was administered for 8 consecutive weeks. Three CYP2C19 metabolizers, including extensive metabolizers, intermediate metabolizers, and poor metabolizers (PMs), and 5 CYP2C19 genotypes were detected by polymerase chain reaction–genotyping microarray analysis. Baseline plasma BDNF levels were tested using human BDNF enzyme-linked immunosorbent assay kits.

Findings/Results
Our findings showed no significant differences in demographic data, baseline PDSS-CV scores, or HAMA-14 scores between the 3 CYP2C19 metabolizer groups (P's > 0.05). Repeated-measures analysis showed a significant reduction in PDSS-CV (F = 221.49, df = 3, P < 0.001) and HAMA-14 (F = 260.47, df = 3, P < 0.001) scores over 8 weeks in PD patients. In addition, patients with PMs had a greater reduction in HAMA-14 scores (F = 2.14, P = 0.049) than did those with extensive metabolizers and intermediate metabolizers. Moreover, our findings showed that patients with *2/*2 genotypes had a greater reduction in PDSS-CV scores than did those with other genotypes (F = 2.14, df = 12, P = 0.015).

Implications/Conclusions
Our study provides preliminary evidence of the effects of CYP2C19 PMs on treatment responses to escitalopram in Chinese PD patients, but no significant correlation between treatment responses and BDNF levels was found.