bluuebunny/crossref_metadata_2025_split huggingface dataset:
Successfully Managing Impending Skin Necrosis following Hyaluronic Acid Filler Injection, using High-Dose Pulsed Hyaluronidase
Authors: Loh Kwok Thye David , Phoon Yi Shan , Phua Vanessa , Kapoor Krishan Mohan 
Published: February 2018

Summary:
Facial fillers are becoming increasingly popular as aesthetic procedures to temporarily reduce the depth of wrinkles or to contour faces. However, even in the hands of very experienced injectors, there is always a small possibility of vascular complications like intra-arterial injection of filler substance. We present a case report of a patient who developed features of vascular obstruction in right infraorbital artery and tell-tale signs of impending skin necrosis, after hyaluronic acid filler injection by an experienced injector. The diagnosis of a vascular complication was made quickly with the help of clinical features like blanching, livedo reticularis, and poor capillary refill. Patient was treated promptly with “high-dose pulsed hyaluronidase protocol” comprising three 1,000-unit pulses of hyaluronidase, administered hourly. There was no further increase in size of the involved area after the first dose of hyaluronidase. All of the involved area, along with 1 cm overlapping in uninvolved skin area, was injected during each injection pulse, using a combination of cannula and needle. Complete reperfusion and good capillary filling were achieved after completion of 3 pulses, and these were taken as the end-point of high-dose pulsed hyaluronidase treatment. Immediate skin changes after filler injections, as well as after hyaluronidase injections and during the 3-week recovery period, were documented with photographs and clinical notes. Involved skin was found to have been fully recovered from this vascular episode, thus indicating that complete recovery of the ischemic skin changes secondary to possible intra-arterial injection could be achieved using high-dose pulsed hyaluronidase protocol.
Spindle Cell Lipoma of the Thumb
Authors: Ebisudani Shogo , Osugi Ikuko , Inagawa Kiichi , Suzuki Yoshinori , Kimura Tomomi 
Published: February 2018

Summary:
We report the case of a 34-year-old man who presented with a 4-year history of a soft tissue on the palmar aspect of the thumb. Magnetic resonance imaging demonstrated the presence of a mass with heterogeneous high intensities on T1-weighted images and high intensities on T2-weighted images. We performed excisional biopsy. Histologically, the tumor was composed of mature adipocytes and spindle cells in a collagen background. Immunohistochemically, the tumor cells showed strong expression of CD34. Therefore, we diagnosed it as spindle cell lipoma. To the best of our knowledge, only 2 cases of spindle cell lipoma of the thumb have previously been reported.
Complementary Diagnostic Value of Heart Type Fatty Acid-binding Protein in Early Detection of Acute Myocardial Infarction
Authors: Sotoudeh Anvari Maryam , Karimi Mahsa , Shafiee Akbar , Boroumand Mohammadali , Bozorgi Ali , Sedaghat Reza , Jalali Arash 
Published: February 2018

Background:
Heart-type fatty acid-binding protein (H-FABP) is a novel biomarker for myocardial injury. We compared the use of H-FABP with serum levels of cardiac troponin-T (cTnT) and creatine kinase-MB (CK-MB) in the diagnosis of patients suspicious to acute myocardial infarction (AMI).

Methods:
From October 2013 to December 2014, 182 consecutive patients suspicious to acute coronary syndrome were enrolled in this study, who presented within the past 6 hours from the onset of symptoms. Venous blood samples were drawn at baseline to measure serum biochemistry, high-sensitive cardiac troponin T (hs-cTNT), creatine kinase-MB, and H-FABP, and the measurements were repeated after 8 hours. The patients were categorized into 3 groups based on the baseline and second measurements of cTnT and general characteristics, and changes of H-FABP levels were then compared between the groups. Sensitivity and specificity of H-FABP in predicting the presence of AMI was calculated.

Results:
A total of 91 patients had AMI. Changes of H-FABP through time were also significantly different between the AMI and non-AMI patients (P < 0.001). A cutoff point of 7.15 for H-FABP could predict AMI with a sensitivity of 51.5%, specificity of 96.3%, and diagnostic accuracy of 68.3%. The area under the receiver operating characteristic curve for H-FABP at 8 hours was 79.4% (95% confidence interval: 73.0–85.9; P < 0.001). Positive predictive value and negative predictive value for H-FABP were 85% and 60%, respectively.

Conclusions:
H-FABP can be used as an additional cardiac biomarker in the diagnosis of AMI.
Contrast-Induced Nephropathy in STEMI Patients With and Without Chronic Kidney Disease
Authors: Jain Tarun , Shah Sunay , Shah Jainil , Jacobsen Gordon , Khandelwal Akshay 
Published: February 2018

Introduction:
Contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) is associated with adverse outcomes; however, there are scarce data comparing clinical outcomes of post-PCI CIN in ST elevation myocardial infarction (STEMI) patients with and without chronic kidney disease (CKD). We sought to assess the incidence, clinical predictors, and short-term and long-term clinical outcomes of post-PCI CIN in STEMI patients with and without CKD.

Methods:
We performed a retrospective observational cohort study involving 554 patients who underwent PCI for STEMI from February 2010 to November 2013. CKD was defined as estimated glomerular filtration rate ≤60 mL/min and CIN as creatinine increase by ≥25% or ≥0.5 mg/dL from baseline within 72 hours after catheterization contrast exposure.

Results:
In the entire population, CIN developed in 89 (16%) patients. The incidence of CIN was 19.7% (27/137) in CKD patients and 11.1% (62/417) in non-CKD patients, P < 0.05. Univariate analysis predictors of CIN were older age (65 vs. 60 years), diabetes (35% vs. 21%), peripheral artery disease (11% vs. 5%), cardiogenic shock (24% vs. 13%), hemodynamic support placement (34% vs. 14%), and Mehran score (9.4 ± 7 vs. 5.4 ± 5.2) with all P < 0.05. The predictors of CIN were the same across the CKD and non-CKD cohort with the exception of diabetes. In multivariate analysis, the strongest predictor of CIN in CKD patients was diabetes (odds ratio, 5.8; CI, 1.8–18.6); however, diabetes was not a predictor in the non-CKD population. In the non-CKD population, each single unit increase in the Mehran score was associated with a 1.1 times greater likelihood of CIN (odds ratio, 1.1; CI, 1.01–1.2). Patients with CIN had higher rates of inpatient mortality (14.6% vs. 2.8%), longer length of hospitalization (8 ± 11 vs. 3.4 ± 4.4 days), need for inpatient dialysis (11.2% vs. 0%), higher 30-day mortality (14.6% vs. 3.0%), and higher incidence of long-term serum creatinine >0.5 mg/dL from baseline (16.9% vs. 2.4%) with all P < 0.05.

Conclusions:
Overall, we found that CKD patients undergoing PCI for STEMI have a higher incidence of CIN than non-CKD patients. CIN confers worse short-term and long-term outcomes irrespective of baseline renal function.
Implementation of an Early Discharge Protocol and Chest Pain Clinic for Low-Risk Chest Pain in the Emergency Department
Authors: Kashef Mohammad Amin , Garb Jane , Kugelmass Aaron , Lotfi Amir 
Published: February 2018

Background:
Most of the patients presenting to emergency department with chest pain are at low risk of adverse events. Identifying high-risk patients can be challenging and resource intensive.

Methods:
We created a protocol to assist early discharge of low-risk adults with chest pain from emergency department. Also a chest pain clinic (CPC) was started for cardiology follow-up within 72 hours. In a retrospective cohort study, primary outcome of major adverse cardiac events (MACEs) of death, myocardial infarction, or revascularization was compared between CPC patients and those hospitalized for observation. In addition, rate of observation admissions and MACE were compared in the pre- and postintervention periods using piecewise regression and multiple logistic regression, respectively.

Results:
A total of 1422 patients were admitted for observation, and 290 were seen in CPC in the 1-year postintervention period. Thirty-day MACE was very low (0.7% in observation and 0.3% in CPC) postintervention. A total of 3637 patients were admitted for observation over the 2-year preintervention period. Thirty-day–adjusted MACE rate was not significantly different between pre- and postintervention periods (0.4% vs. 0.6%, P = 0.3), also monthly observation admissions did not change significantly; however, utilization of stress testing (57.2% vs. 41.0%, P < 0.001) and cardiac catheterization (2.3% vs. 1.6%, P = 0.036) was reduced.

Conclusion:
Chest pain patients admitted for observation and risk stratification are at very low risk of 30-day MACE. An intervention based on a chest pain protocol and availability of early cardiology follow-up did not change the admission rate of these patients. This intervention was not associated with increased risk of adverse outcomes.
Experiences of a One-hour Algorithm in Chest Pain Patients With a Nonelevated Troponin T at Presentation
Authors: Pettersson Anna , Ljung Lina , Johansson Caroline , Heilborn Umut , Jernberg Tomas , Frick Mats , Eggers Kai M. , Lindahl Bertil , Linder Rikard , Martinsson Arne , Svensson Per 
Published: February 2018

Background:
We aimed to evaluate the use of a 1-hour measurement of high-sensitivity cardiac troponin T (hs-cTnT) in an emergency department (ED) population of chest pain patients with a nonelevated baseline hs-cTnT and to examine the prevalence of early dynamic changes in hs-cTnT and the association with admission rate, diagnosis, and outcome.

Methods:
All patients with a chief complaint of chest pain presenting to the ED of Karolinska University Hospital, Solna, Sweden, from December 2014 to September 2015 who had a baseline hs-cTnT of ≤14 ng/L and a second value obtained within >30 to ≤90 minutes were followed for 30 days regarding admission, readmission, myocardial infarction (MI), and death.

Results:
A total of 1091 patients were included. Dynamic 1-hour changes in hs-cTnT defined as an increase or decrease of ≥3 ng/L occurred in 23 patients (2.1%). Fifteen patients (65.2%) in the dynamic group were admitted, compared with 148 patients (13.9%) in the nondynamic group (P < 0.001). Four of the admitted patients (26.7%) in the dynamic and 1 (0.7%) in the nondynamic group were diagnosed with an MI (P < 0.001). No death or MI occurred within 30 days among those discharged from the ED.

Conclusions:
Dynamic 1-hour changes in hs-cTnT were uncommon but associated with a higher rate of admission and of MI in an unselected population of chest pain patients with a nonelevated hs-cTnT at presentation. Lack of dynamic changes makes MI highly unlikely, and a 1-hour measurement may facilitate an early rule out of MI but should be used together with clinical assessment.
Mixed-methods development of a new patient-reported outcome instrument for chronic low back pain: part 1—the Patient Assessment for Low Back Pain - Symptoms (PAL-S)
Authors: Martin Mona L. , Blum Steven I. , Liedgens Hiltrud , Bushnell Donald M. , McCarrier Kelly P. , Hatley Noël V. , Ramasamy Abhilasha , Freynhagen Rainer , Wallace Mark , Argoff Charles , Eerdekens Mariёlle , Kok Maurits , Patrick Donald L. 
Published: February 2018

Abstract
We describe the mixed-methods (qualitative and quantitative) development and preliminary validation of the Patient Assessment for Low Back Pain–Symptoms (PAL-S), a patient-reported outcome measure for use in chronic low back pain (cLBP) clinical trials. Qualitative methods (concept elicitation and cognitive interviews) were used to identify and refine symptom concepts and quantitative methods (classical test theory and Rasch measurement theory) were used to evaluate item- and scale-level performance of the measure using an iterative approach. Patients with cLBP participated in concept elicitation interviews (N = 43), cognitive interviews (N = 38), and interview-based assessment of paper-to-electronic mode equivalence (N = 8). A web-based sample of patients with self-reported cLBP participated in quantitative studies to evaluate preliminary (N = 598) and revised (n = 401) drafts and a physician-diagnosed cohort of patients with cLBP (N = 45) participated in preliminary validation of the measure. The PAL-S contained 14 items describing symptoms (overall pain, sharp, prickling, sensitive, tender, radiating, shocking, shooting, burning, squeezing, muscle spasms, throbbing, aching, and stiffness). Item-level performance, scale structure, and scoring seemed to be appropriate. One-week test–retest reproducibility was acceptable (intraclass correlation coefficient 0.81 [95% confidence interval, 0.61-0.91]). Convergent validity was demonstrated with total score and MOS-36 Bodily Pain (Pearson correlation −0.79), Neuropathic Pain Symptom Inventory (0.73), Roland-Morris Disability Questionnaire (0.67), and MOS-36 Physical Functioning (−0.65). Individual item scores and total score discriminated between numeric rating scale tertile groups and painDETECT categories. Respondent interpretation of paper and electronic administration modes was equivalent. The PAL-S has demonstrated content validity and is potentially useful to assess treatment benefit in cLBP clinical trials.
Evaluation of the Effect of Fluvoxamine in Patients With Schizophrenia Under Risperidone Treatment
Authors: Haji Seyed Javadi Alireza , Shafikhani Ali Akbar , Zamir Seyed Mohsen , Khanshir Zahra Farzane 
Published: February 2018

Abstract

Purpose/Background
The effectiveness of selective-serotonin reuptake inhibitors in the improvement of schizophrenia is a controversial issue. The aim of this study was to evaluate the effect of fluvoxamine on the symptoms of schizophrenia including positive and negative symptoms, cognitive impairment, and quality of life.

Methods/Procedures
This clinical trial was performed on 68 patients with chronic schizophrenia, treated with risperidone at 22 Bahman Hospital of Qazvin, Iran during 2015 to 2016. The patients were randomly divided into control and intervention groups (34 patients per group). The control group was treated with risperidone and biperiden, whereas the intervention group received fluvoxamine, besides risperidone, and biperiden. The participants completed the Wechsler Memory Scale, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms (SANS), and the World Health Organization Quality of Life Scale, and the findings were statistically analyzed at baseline and postintervention (8 and 10 weeks).

Findings/Results
The mean ± SD Wechsler Memory Scale scores in the evaluated intervals (baseline, week 8, and week 10), respectively, were 70.58 ± 11.51, 70.76 ± 11.36, and 70.88 ± 11.40 in the control group and 74.76 ± 10.56, 77.76 ± 10.56, and 77.76 ± 10.73 in the intervention group (F = 126.73, P ≤ 0.001). The difference between the groups in terms of SANS and quality of life scores was significant in the specified intervals, SANS (F = 6.36, P = 0.004), and quality of life (F = 15.13, P ≤ 0.001). Nevertheless, no difference was observed in terms of Scale for the Assessment of Positive Symptoms scores (P > 0.05).

Implications/Conclusions
The results indicated that risperidone augmentation with fluvoxamine could significantly improve cognitive impairments and negative symptoms among patients with schizophrenia. Moreover, this augmentation led to higher quality of life among these patients.
An Outpatient Heart Failure Clinic Reduces 30-Day Readmission and Mortality Rates for Discharged Patients: Process and Preliminary Outcomes
Authors: KOSER Kristin Danielle , BALL Lisa S. , HOMA Jennifer K. , MEHTA Vinay 
Published: February 2018

ABSTRACT

Background:
The first outpatient heart failure clinic (HFC) in Western New York was developed within a large private cardiology practice with the objective of reducing 30-day all-cause rehospitalization and inpatient mortality.

Purpose:
The aim of this study was to analyze the process and patient outcomes of this independent outpatient HFC. The specific aims were to (a) describe the outpatient care strategies employed and (b) determine whether the HFC reduced 30-day all-cause rehospitalizations and inpatient mortality by comparing HFC data with census data.

Methods:
This study used a retrospective chart analysis of 415 adults who had been enrolled in the target HFC after hospitalization for HF. Data were summarized using frequency comparisons and descriptive statistics. One-sample chi-square tests were conducted to test the observed values in the study sample against census data.

Results:
Patients in the HFC were less likely to experience a readmission to hospital within 30 days of discharge (69% reduction within the study period, p < .001). Patients were seen acutely after discharge, had multiple medication adjustments, and received ongoing telephonic follow-up. The HFC had statistically lower inpatient mortality rates (1.2% vs. 11.6% national average, p < .001), likely a result of the HFC care regimen and referrals for palliative care (17%).

Conclusions:
The results of this analysis highlight the importance of developing an outpatient HFC in collaboration with hospitals that is aimed at reducing 30-day all-cause readmissions and inpatient mortality, with referral to palliative care when indicated.
Should fecal microbial transplantation be used in the ICU?
Authors: McClave Stephen A. , Patel Jayshil , Bhutiani Neal 
Published: February 2018

Purpose of review
Maintaining gut barrier defenses, modulating immune responses, and supporting the role of commensal microbiota are major factors influencing outcome in critical illness. Of these, maintaining a commensal ‘lifestyle’ and preventing the emergence of a virulent pathobiome may be most important in reducing risk of infection and multiple organ failure.

Recent findings
The polymeric formulas utilized for enteral nutrition in the ICU are absorbed high in the gastrointestinal tract and may not reach the microbial burden in the cecum where their effect is most needed. The provision of a few select probiotic organisms may be insufficient to refaunate the gut and establish a ‘recovery pattern,’ propelling the patient toward health and homeostasis. Use of fecal microbial transplantation (FMT) appears to be a more successful strategy for replenishing the intestinal microbiome and maintaining its commensal phenotypic expression.

Summary
FMT has become an attractive option to mitigate multiple organ dysfunction in the ICU. This article discusses the physiology, rationale, early experience, and expectations for such therapy in the critically ill patient.
Regulation of intestinal lipid and lipoprotein metabolism by the proglucagon-derived peptides glucagon like peptide 1 and glucagon like peptide 2
Authors: Mulvihill Erin E. 
Published: February 2018

Purpose of review
The intestine is highly efficient at absorbing and packaging dietary lipids onto the structural protein apoB48 for distribution throughout the body. Here, we summarize recent advances into understanding the physiological and pharmacological actions of the proglucagon-derived peptides: glucagon like peptide 1 (GLP-1) and glucagon like peptide 2 (GLP-2) on intestinal lipoprotein secretion.

Recent findings
Several recent studies have elucidated mechanisms underlying the paradoxical effects of GLP-1 and GLP-2 on intestinal production of triglyceride-rich lipoproteins (TRLs). Both gut-derived peptides are secreted on an equimolar basis in response to the same nutrient stimulus. Despite neither receptor demonstrating clear localization to enterocytes, a single injection of a GLP-1R agonist rapidly decreases delivery of intestinally packaged fatty acids into the plasma, while conversely GLP-2 receptor (GLP-2R) activation acutely increases TRL concentrations in plasma.

Summary
The regulation of TRL secretion is dependent on the coordination of many processes: fatty acid availability uptake, assembly onto the apoB48 polypeptide backbone, secretion and reuptake, which the hormonal, neural, inflammatory and metabolic milieu can all strongly influence. Understanding of how GLP-1 and GLP-2 receptor agonists control TRL production has clinical importance given that GLP1R agonists were recently demonstrated not only to provide glycemic control but also to prevent major adverse cardiovascular events in patients with T2DM and the success of GLP-2R agonists in treating short bowel disease.
13C‐Mixed Triglyceride Breath Test and Fecal Elastase as an Indirect Pancreatic Function Test in Cystic Fibrosis Infants
Authors: Kent Dorothea Stark , Remer Thomas , Blumenthal Caron , Hunt Sharon , Simonds Sharon , Egert Sarah , Gaskin Kevin J. 
Published: February 2018

ABSTRACTBackground:The ‘gold standard’ test for the indirect determination of pancreatic function status in infants with cystic fibrosis (CF), the 72‐hour fecal fat excretion test, is likely to become obsolete in the near future. Alternative indirect pancreatic function tests with sufficient sensitivity and specificity to determine pancreatic phenotype need further evaluation in CF infants.Objective:Evaluation of the clinical utility of both the noninvasive, nonradioactive 13C‐mixed triglyceride (MTG) breath test and fecal elastase‐1 (FE1) in comparison with the 72‐hour fecal fat assessment in infants with CF.Methods:13C‐MTG breath test and the monoclonal and polyclonal FE1 assessment in stool was compared with the 72‐hour fecal fat assessment in 24 infants with CF. Oral pancreatic enzyme substitution (PERT; if already commenced) was stopped before the tests.Results:Sensitivity rates between 82% and 100% for CF patients with pancreatic insufficiency assessed by both the 13C‐MTG breath test and the FE1 tests proved to be high and promising. The 13C‐MTG breath test (31%–38%) as well as both FE1 tests assessed by the monoclonal (46%–54%) and the polyclonal (45%) ELISA kits, however, showed unacceptably low‐sensitivity rates for the detection of pancreatic‐sufficient CF patients in the present study.Conclusions:The 13C‐MTG breath test with nondispersive infrared spectroscopy (NDIRS) technique, as well as both FE1 tests, are not alternatives to the fecal fat balance test for the evaluation of pancreatic function in CF infants during the first year of life.