bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of asymptomatic bacteriuria treatment prior to total hip or knee arthroplasty on hospital outcomes: A retrospective cohort study
Authors: Peters Michael J. , Twilla Jennifer , Swanson Heather R. , Jacobs Anna 
Published: September 2019

Background:
Although treatment of asymptomatic bacteriuria (ASB) in patients undergoing total hip (THA) or knee (TKA) arthroplasty does not seem to effect the rate of secondary joint infections (SJI), the effect on hospital outcomes has yet to be evaluated. This study aimed to determine the clinical effect of ASB treatment in TKA or THA on hospital outcomes.

Methods:
A retrospective evaluation of patients undergoing TKA or THA with the presence of ASB was conducted. Inclusion criteria were TKA or THA and presence of ASB. Patients were excluded if symptomatic, receiving nonspecified antibiotics, catheterized, or pregnant. The primary outcome was comparing differences in time from admission to TKA or THA procedure in groups treated for ASB versus an untreated group. Secondary outcomes were length of stay (LOS) and rates of SJI.

Results:
A total of 1683 patients were screened, and 133 patients with ASB were included (53 treated; 80 untreated). Median time from admission to procedure was not statistically different between groups (3.63 hr [3.10-5.57 hr] treated vs. 3.68 hr [3.07-5.17 hr] untreated; P=0.412). An increase in LOS was observed in the treated group (3.4 days [3.15-4.36 days] treated vs. 2.36 days [2.21-3.35 days] untreated; P<0.0001). Rates of SJI were not different between groups (P=0.646).

Conclusions:
Although time from admission to TKA or THA procedure was not different between groups, a longer LOS was identified in the treated group. There was no difference in rates of SJI between groups. Larger studies are needed to determine if treating ASB for TKA or THA should be discontinued.

Level of Evidence:
Level III.
Early results of proximally inserted minimally invasive plate osteosynthesis for distal fibular fractures in unfavorable skin conditions: A case series
Authors: Zawam Sherif Hamdy , Shaheen Ayman Abdelsamee , Elnahal Walid A. , ElJeady Ibrahim Taha 
Published: September 2019

Background:
Operative fixation of fractures of the lateral malleolus may be complicated by skin complications and wound infection, especially in patients with an unfavorable skin condition or soft-tissue injury. The goal of this study was to assess a technique of minimally invasive, proximally inserted plate fixation for distal fibular fractures in unfavorable skin conditions, including superficial abrasions, blisters, and contusions.

Methods:
This prospective case series study included 20 patients with syndesmotic and suprasyndesmotic fractures of the distal fibula, with unfavorable skin conditions, presenting to the emergency department of a major trauma center between May, 2015 and May, 2016. All patients were followed for an average of 1 yr (range, 6 mo-2 yr).

Results:
All fractures united at an average of 9.4 wk (range, 8-12 wk). Functional assessment according to the American Orthopaedic Foot And Ankle Society Scoring system was 93.9 (range, 78-100). None of the cases was complicated by wound dehiscence or deep infection.

Conclusions:
Minimally invasive, proximally inserted plate fixation is a viable and safe technique that can avoid an incision over the skin of the distal fibula in patients with unfavorable skin conditions.

Level of Evidence:
Level IV.
Occupational Therapy in the ICU: A Scoping Review of 221 Documents
Authors: Costigan F. Aileen , Duffett Mark , Harris Jocelyn E. , Baptiste Susan , Kho Michelle E. 
Published: September 2019

Objectives:
Occupational therapists have specialized expertise to enable people to perform meaningful “occupations” that support health, well-being, and participation in life roles. Given the physical, cognitive, and psychologic disability experienced by ICU survivors, occupational therapists could play an important role in their recovery. We conducted a scoping review to determine the state of knowledge of interventions delivered by occupational therapists in adult ICU patients.

Data Sources:
Eight electronic databases from inception to 05/2018.

Study Selection:
We included reports of adult patients receiving direct patient care from an occupational therapist in the ICU, all study designs, and quantitative and qualitative traditions.

Data Extraction:
Independently in duplicate, interprofessional team members screened titles, abstracts, and full texts and extracted report and intervention characteristics. From original research articles, we also extracted study design, number of patients, and primary outcomes. We resolved disagreements by consensus.

Data Synthesis:
Of 50,700 citations, 221 reports met inclusion criteria, 74 (79%) published after 2010, and 125 (56%) appeared in critical care journals. The three most commonly reported types of interventions were mobility (81%), physical rehabilitation (61%), and activities of daily living (31%). We identified 46 unique original research studies of occupational therapy interventions; the most common study research design was before-after studies (33%).

Conclusions:
The role of occupational therapists in ICU rehabilitation is not currently well established. Current interventions in the ICU are dominated by physical rehabilitation with a growing role in communication and delirium prevention and care. Given the diverse needs of ICU patients and the scope of occupational therapy, there could be an opportunities for occupational therapists to expand their role and spearhead original research investigating an enriched breadth of ICU interventions.
Assessment of Ergonomic Strain and Positioning During Bronchoscopic Procedures
Authors: Gilbert Christopher R. , Thiboutot Jeffrey , Mallow Christopher , Chen Alexander , Pastis Nicholas J. , Argento A. Christine , Millar Jennifer , Lavin Robert A. , Lerner Andrew D. , Yu Diana H. , Salwen Ben , Lunz Daniel , Lee Hans J. , Yarmus Lonny B. 
Published: September 2019

Background:
Poor ergonomics place health care workers at risk for work-related overuse injuries. Repetitive and prolonged hand maneuvers, such as those performed during endoscopic procedures, may lead to musculoskeletal complaints and work-related injuries. However, the prevalence of health care–related work injuries among physicians is thought to be underreported and there is a paucity of literature investigating the impact of ergonomic strain on bronchoscopy. We designed a feasibility study to explore the differences in ergonomic strain and muscle activity of bronchoscopists.

Materials and Methods:
A prospective study of bronchoscopic procedures was performed in a simulated environment. Preselected target areas were identified and airway sampling was performed with real-time ergonomic assessment utilizing electromyogram (EMG), grip strength, and musculoskeletal use and motion analysis.

Results:
Procedural data was obtained for all procedures (78 bronchoscopies by 13 subjects) for both ergonomic and EMG scores. Experienced bronchoscopists demonstrated less EMG burden (P=0.007) and improved ergonomic positioning (P=0.007) during bronchoscopy when compared with less experienced bronchoscopists. Procedures performed with rotational-head bronchoscopes trended toward improved ergonomics (P=0.15) and lower EMG scores (P=0.88). A significant improvement in ergonomic scores was seen with the rotational-head bronchoscope when targeting the left upper lobe (P=0.036).

Conclusion:
Poor ergonomic positioning and excessive muscle strain appear present within bronchoscopy procedures but may be improved in those with more bronchoscopy experience. Technological advances in bronchoscope design may also have the potential to improve procedural ergonomics. Additional prospective studies are warranted to define the long-term impact on bronchoscopic ergonomics.
Clinical outcomes of SeQuent Please paclitaxel-coated balloons for de novo small coronary artery lesion in a Japanese multicenter post-approval registry
Authors: Funayama Naohiro , Muratsubaki Shingo , Kawahatsu Kandoh , Miyata Masahiro , Katou Yasuhiro , Oikawa Tatsuya 
Published: September 2019

Objective
Drug-coated balloon (DCB) angioplasty has emerged as an effective management strategy worldwide. In June 2016, DCB became available for the treatment of de novo small coronary lesions in Japan; however, there has been no multicenter analysis in a post-approval real-world clinical setting to date. The aim of this study was to evaluate the efficacy of DCB for de novo small coronary lesions based on a Japanese multicenter registry.

Methods and results
From June 2016 to July 2017, a total of 111 lesions (102 patients) treated with DCB for de novo small coronary lesions were enrolled at six Japanese institutions. The primary endpoint was the rate of target lesion revascularization (TLR) at 12 months. Angiographic follow-up endpoints were binary restenosis and late lumen loss (LLL). Clinical follow-up data at 12 months were available for 106 lesions, excluding five lesions that required bailout stenting. The TLR rate was 5.7% (6/106 lesions). No cardiac death or target lesion thrombosis was observed. The binary restenosis rate was 14.4% and LLL was 0.0017 ± 0.37 mm.

Conclusions
DCB angioplasty for de novo small coronary lesions in the real-world environment in Japan is effective with acceptable 12-month outcomes.
Status epilepticus - time is brain and treatment considerations
Authors: Der-Nigoghossian Caroline , Rubinos Clio , Alkhachroum Ayham , Claassen Jan 
Published: September 2019

Purpose of review
Status epilepticus is a neurological emergency associated with high morbidity and mortality. There is a lack of robust data to guide the management of this neurological emergency beyond the initial treatment. This review examines recent literature on treatment considerations including the choice of continuous anesthetics or adjunctive anticonvulsant, the cause of the status epilepticus, and use of nonpharmacologic therapies.

Recent findings
Status epilepticus remains undertreated and mortality persists to be unchanged over the past 30 years. New anticonvulsant choices, such as levetiracetam and lacosamide have been explored as alternative emergent therapies. Anecdotal reports on the use of other generation anticonvulsants and nonpharmacologic therapies for the treatment of refractory and super-refractory status epilepticus have been described.
Finally, recent evidence has examined etiology-guided management of status epilepticus in certain patient populations, such as immune-mediated, paraneoplastic or infectious encephalitis and anoxic brain injury.

Summary
Randomized clinical trials are needed to determine the role for newer generation anticonvulsants and nonpharmacologic modalities for the treatment of epilepticus remains and evaluate the long-term outcomes associated with continuous anesthetics.
Sudden unresponsive patient with normal vital signs: what is going on?
Authors: Smit Lisa , Foks Kelly A. , Hofmeijer Jeannette , van der Jagt Mathieu 
Published: September 2019

Purpose of review
To summarize the differential diagnosis and diagnostic approach of sudden unresponsiveness with normal vital signs in various settings, including the ICU.

Recent findings
Sudden unresponsiveness may be either transient or persistent, and may result from primary brain diseases or nonstructural systemic conditions. Life-threatening causes should always be discriminated from those more benign. Regional epidemiology, for example regarding intoxications, and evolving therapeutic management, for example for ischemic stroke, should always be taken into account for optimal opportunity for rapid diagnosis and best management.

Summary
Sudden unresponsiveness with normal vital signs should trigger immediate and focused diagnostic evaluation to find or exclude those conditions requiring urgent, and possibly life-saving, management.
Ultrasound in the surgical ICU: uses, abuses, and pitfalls
Authors: Johnson Garrett G.R.J. , Kirkpatrick Andrew W. , Gillman Lawrence M. 
Published: September 2019

Purpose of review
Point-of-care ultrasound (POCUS) has become an integral component of daily care in the surgical ICU. There have been many novel advancements in the past two decades, too numerous to count. Many are of critical importance to the intensive care physician, whereas others are still accumulating evidence. Without appropriate training, diligence, and incorporation of the ultrasound findings into the whole clinical picture, this technique can be gravely misused. This review examines POCUS use in the surgical ICU, as well as highlights potential hazards and common pitfalls.

Recent findings
POCUS is essential for guidance of vascular access procedures, as well as in the characterization and treatment of respiratory failure, shock, and unstable blunt abdominal trauma. Ultrasound has growing evidence for rapidly evaluating many other diseases throughout the entire body, as well as guidance for procedures. Using advanced ultrasound techniques should only be done with corresponding levels of training and experience.

Summary
Ultrasound in the critical care setting has become an essential component of the assessment of most ICU patients. As more evidence accumulates, along with ever-increasing availability of ultrasound technology, its use will continue to expand. It, thus, behoves clinicians to not only ensure they are adept at obtaining and interpreting POCUS images but also efficiently incorporate these skills into holistic bedside care without delaying lifesaving therapies.
Association Between Helicobacter pylori Infection and Short-segment/Long-segment Barrett’s Esophagus in a Japanese Population
Authors: Usui Genki , Sato Hajime , Shinozaki Tomohiro , Jinno Toyohisa , Fujibayashi Kazutoshi , Ishii Ken , Horiuchi Hajime , Morikawa Teppei , Gunji Toshiaki , Matsuhashi Nobuyuki 
Published: September 2019

Goal:The goal of this study was to investigate the relationship betweenHelicobacter pylori (H. pylori)infection and short-segment and long-segment Barrett’s esophagus (SSBE and LSBE).Background:H. pyloriinfection is reported to be inversely associated with Barrett’s esophagus (BE) in western countries. However, the impact of BE segment length on the association between BE andH. pyloriinfection has scarcely been investigated.Materials and Methods:The study subjects were 41,065 asymptomatic Japanese individuals who took medical surveys between October 2010 and September 2017. Using this large database of healthy Japanese subjects, we investigated the association betweenH. pyloriinfection and SSBE/LSBE. We used multivariable logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs).Results:Among the study subjects, 36,615 were eligible for the analysis.H. pyloriseropositivity was significantly associated with a lower rate of LSBE (OR: 0.42; 95% CI: 0.16-0.91) and a higher rate of SSBE (OR: 1.66; 95% CI: 1.56-1.78) after multivariate adjustment. In the subgroup analysis,H. pyloriseropositivity was significantly associated with a high rate of SSBE in subjects without reflux esophagitis (RE) (OR: 1.73; 95% CI: 1.61-1.85). However,H. pyloriseropositivity was not associated with SSBE in subjects with RE (OR: 1.07; 95% CI: 0.84-1.37).Conclusion:In a Japanese population,H. pyloriinfection was inversely associated with LSBE but significantly associated with SSBE only in subjects without RE.H. pylorimay be a risk factor for SSBE, especially in individuals without RE.
Annual contrast-enhanced magnetic resonance imaging is highly effective in the surveillance of hepatocellular carcinoma among cirrhotic patients
Authors: Demirtas Coskun Ozer , Gunduz Feyza , Tuney Davut , Baltacioglu Feyyaz , Kani Haluk Tarik , Bugdayci Onur , Alahdab Yesim Ozen , Ozdogan Osman Cavit 
Published: September 2019

Objectives
Biannual ultrasonography, a globally accepted surveillance method, has low sensitivity in detecting early-stage hepatocellular carcinoma (HCC). We aimed to investigate the effectiveness of a surveillance strategy using annual contrast-enhanced MRI to detect HCCs at early-stage.

Materials and methods
We reviewed the data of 294 patients with consistent annual contrast-enhanced MRI and biannual alpha fetoprotein (AFP) surveillance between 2008 and 2017. Patients were stratified for HCC risk as low-intermediate-high risk group using Toronto risk score. HCCs were classified according to Barcelona Clinic Liver Cancer staging system.

Results
Thirty-five (11.9%) HCCs were detected with annual surveillance MRI. Of those, 30 (85.8%) were early-stage and 15 (42.9%) were very early-stage. The majority of patients (82.9%) with surveillance detected HCC were high risk at the entry. MRI had sensitivity of 83.3 and 80% with a specificity of 95.4 and 91.4%, for detecting early and very early-stage HCC, respectively. Addition of AFP to MRI displayed similar sensitivity and specificity rates to detect early and very early HCCs. The area under the curve of MRI alone and combination with AFP was not statistically different (Any-HCC: 0.905 vs. 0.924; Early-HCC: 0.853 vs. 0.885; Very early-HCC: 0.838 vs. 0.885, respectively, all P values >0.2).

Conclusion
Annual MRI strategy demonstrated a satisfactory performance in the surveillance of HCC, in terms of detecting most of the lesions in earlier curable stages and indicating high sensitivity with no additional benefit of biannual AFP. New risk stratified screening algorithms may further increase the yield of HCC surveillance among cirrhotic patients.
Does melatonin addition to indomethacin decrease post endoscopic retrograde cholangiopancreatography pancreatitis? A randomized double-blind controlled trial
Authors: Sadeghi Amir , Abbasinazari Mohammad , Asadzadeh Aghdaei Hamid , Abdi Saeed , Hatami Behzad , Rasoolinezhad Mehrnaz , Jamshidzadeh Shaghayegh , Saadati Saeede 
Published: September 2019

Objective
Post-ERCP pancreatitis (PEP) is the most prevalent complication of endoscopic retrograde cholangiopancreatography (ERCP). Melatonin has been mentioned as a protective factor against acute pancreatitis. The present study was conducted to determine whether melatonin addition to indomethacin reduces the rate of PEP occurrence.

Methods
A double-blind randomized clinical trial was conducted on 411 patients undergoing ERCP. Baseline blood samples were collected, and the patients were given melatonin 3 mg tablets plus indomethacin suppository 100 mg or placebo plus indomethacin suppository 100 mg, 1 h before ERCP. The occurrence of PEP was the primary outcome. The concentrations of amylase and lipase were also measured 24 h after ERCP.

Results
Demographic characteristics of patients, characteristics of ERCP procedures, and baseline levels of amylase and lipase were found to be similar in both groups. The overall rate of PEP was equal to 9.5% in intention-to-treat (ITT) and 11.4% in per-protocol (PP) analyses. There was a significant difference in the rate of PEP between the melatonin and placebo groups (8.7% vs. 11.4% in ITT and 9.3% vs. 13.6% in PP, respectively). In addition, after 24 h, amylase and lipase levels were lower in the melatonin group than in the placebo group (P = 0.041 and 0.032, respectively).

Conclusion
The results of the present study showed that, administration of melatonin 3 mg tablets plus indomethacin suppository 100 mg 1 h before ERCP could decrease the PEP rate and amylase and lipase levels compared to administration of indomethacin suppository 100 mg alone.
Circulating methylated RUNX3 and SFRP1 genes as a noninvasive panel for early detection of colorectal cancer
Authors: Pasha Heba F. , Radwan Mohamed I. , Yehia Ahmed M. , Toam Mostafa M. 
Published: September 2019

Objective
This study was conducted to assess the methylation status of runt-related transcription factor 3 (RUNX3) and secreted frizzled-related protein 1 (SFRP1) genes in paired tissue and serum samples of colorectal cancer (CRC), adenomatous, and control subjects and elucidate the association between methylation status on RUNX3 and SFRP1 mRNA expression.

Methods
Methylation status of RUNX3 and SFRP1 in paired tissue and serum samples and RUNX3 and SFRP1 mRNA expression in tissue from 85 patients with CRC, 40 with adenoma, and 40 healthy controls were determined using methylation-specific PCR and reverse transcription PCR.

Results
The frequency RUNX3 and SFRP1 genes methylation was significantly higher in both tissues and serum of CRC patients and was significantly associated with absence of its corresponding mRNA expression. The concordance between tissue and serum methylation status was 94.4% for RUNX3 and 94.3% for SFRP1. Tissue RUNX3 methylation status detected CRC with 63.53% sensitivity and 80.00% specificity, while serum RUNX3 methylation status detected CRC with 60.00% sensitivity and 82.50% specificity. Tissue SFRP1 methylation status showed a sensitivity of 82.35% and specificity of 65.00%, while serum SFRP1 methylation status showed a sensitivity of 77.65% and specificity of 70.00% in detection of CRC. RUNX3/SFRP1/carcinoembryonic antigen (CEA) panel identified CRC with sensitivity of 89.41% in tissue and 84.71% in serum.

Conclusion
Our results verified the reliability of using serum RUNX3 and SFRP1 methylation status as a noninvasive biomarker for diagnosis of CRC and that combined detection of RUNX3/SFRP1/CEA panel might be a promising strategy for early detection of CRC.
The interaction between current smoking and hemoglobin on the risk of advanced fibrosis in patients with biopsy-proven nonalcoholic fatty liver disease
Authors: Enc Feruze Yilmaz , Ulasoglu Celal , Bakir Alev , Yilmaz Yusuf 
Published: September 2019

Background
Higher hemoglobin levels have been associated with an increased risk for nonalcoholic fatty liver disease. Although the mechanism underlying this association is elusive, smoking has been previously related to both higher hemoglobin concentrations and an increased risk of fibrosis in nonalcoholic fatty liver disease. The present study was conducted to investigate formally the interaction among current smoking, hemoglobin levels, and risk for advanced fibrosis in patients with biopsy-proven nonalcoholic fatty liver disease.

Patients and methods
We examined 433 Turkish patients with biopsy-proven nonalcoholic fatty liver disease. Advanced fibrosis (F ≥ 3) was identified on liver biopsy in 80 cases, whereas 84 patients were current smokers. Logistic regression models were used to evaluate the effect of current smoking on risk for advanced fibrosis, after adjusting for the effects of age, sex, BMI, diabetes, and metabolic syndrome.

Results
Preliminary analyses revealed the presence of substantial statistical interaction between current smoking and hemoglobin levels (P < 0.001). In separate multivariable analyses conducted in the entire cohort and in the subgroups of patients with high and low hemoglobin levels (according to median value in the study cohort: 14.4 g/l), current smoking was associated with increased risk for advanced fibrosis in patients with high hemoglobin (odds ratio: 3.32, 95% confidence interval: 1.23−7.21, P < 0.01) but neither in those with low hemoglobin (odds ratio: 0.71, 95% confidence interval: 0.28−1.81, P = 0.52) nor in the entire study cohort (odds ratio: 1.18, 95% confidence interval: 0.73−2.14, P = 0.79).

Conclusion
Hemoglobin acts as a modifier in the association between current smoking and advanced fibrosis in nonalcoholic fatty liver disease.