bluuebunny/crossref_metadata_2025_split huggingface dataset:
UK Helicopter Emergency Medical Services’ use of circulatory access devices, blood product transfusion and fluid warmers – a cross-sectional survey
Authors: Morris Jonathan , Hughes Simon 
Published: December 2018

Introduction The pre-hospital environment provides significant challenges to clinicians who wish to rapidly administer warmed blood products and fluids to patients with haemorrhagic shock. Large-bore circulatory access is required with the use of devices that will successfully warm cold blood with minimal impact on flow rates. Until now, no information has been available that defines UK Helicopter Emergency Medical Services’ (HEMS) use of circulatory access and fluid warming devices, nor the recent adoption of pre-hospital blood product transfusion. Methods A survey was sent to all 22 UK HEMS asking which circulatory access devices crews have available, whether blood products are being transfused and if fluid warming devices are used as part of their resuscitations. Results All services responded. All UK HEMS use peripheral intravenous cannulae and intraosseous access. In addition, seven use central venous catheters and three use large-bore peripheral access (the Arrow Rapid Infusion Catheter®). Three services use landmark technique alone to gain central venous access, whereas four use a combination of landmark and ultrasound-guided techniques. Different sites for central venous access are used: subclavian (seven services), internal jugular (four) and femoral (four). Fourteen services carry pre-hospital blood products of which six transfuse packed red blood cells; four transfuse packed red blood cells and fresh frozen plasma; four transfuse packed red blood cells and lyophilised plasma. Eight services carry no pre-hospital blood products. Seventeen HEMS use fluid warmers; 13 use the Belmont® buddy lite™ and four use the QinFlow Warrior. Conclusion The use of a variety of policies and range of equipment has evolved across UK HEMS, demonstrating a lack of consensus on best practice. This is the first study to record a complete picture of current UK HEMS practice with regard to the use of circulatory access devices, fluid warmers and blood product administration.
Validation of ICD-10 codes shows intracranial venous thrombosis incidence to be higher than previously reported
Authors: Handley Joel D , Emsley Hedley CA 
Published: December 2018

Background: Intracranial venous thrombosis (ICVT) accounts for around 0.5% of all stroke cases. There have been no previously published studies of the International Classification of Diseases, Tenth Edition (ICD-10) validation for the identification of ICVT admissions in adults. Objective: The aims of this study were to validate and quantify the performance of the ICD-10 coding system for identifying cases of ICVT in adults and to derive an estimate of incidence. Method: Administrative data were collected for all patients admitted to a regional neurosciences centre over a 5-year period. We searched for the following ICD-10 codes at any position: G08.X (intracranial and intraspinal phlebitis and thrombophlebitis), I67.6 (non-pyogenic thrombosis of intracranial venous system), I63.6 (cerebral infarction due to cerebral venous thrombosis, non-pyogenic), O22.5 (cerebral venous thrombosis in pregnancy) and O87.3 (cerebral venous thrombosis in the puerperium). Results: Sixty-five admissions were identified by at least one of the relevant ICD-10 codes. The overall positive predictive value (PPV) for confirmed ICVT from all of the admissions combined was 92.3% (60 out of 65) with the results for each code as follows: G08.X 91.5% (54 of 59), O22.5 100% (4 of 4), I67.6 100% (1 of 1), I63.6 100% (1 of 1) and O87.3 100% (1 of 1). There were 40 unique cases of ICVT over a 5-year period giving an annual incidence of ICVT of 5 per million. Conclusions: All codes gave a high PPV. Implications for practice: As demonstrated in previous studies, the incidence of ICVT may be higher than previously thought.
Investigating Mechanisms of Stillbirth in the Setting of Prenatal Substance Use
Authors: Miller Corrie B. , Wright Tricia 
Published: December 2018

Introduction: Intrauterine fetal demise affects between 0.4-0.8% of pregnancies worldwide. This significant adverse pregnancy outcome continues to be poorly understood. In utero exposure to substances increases the risk of stillbirth to varying degrees according to the type of substance and degree of exposure. The aim of this qualitative narrative review is to investigate common biologic relationships between stillbirth and maternal substance use. Methods: A PubMed literature search was conducted to query the most commonly used substances and biologic mechanisms of stillbirth. Search terms included “stillbirth,” “intrauterine fetal demise,” “placenta,” “cocaine,” “tobacco,” “alcohol,” “methamphetamines,” “opioids/ opiates,” and “cannabis.” Results: There are very few studies identifying a direct link between substance use and stillbirth. Several studies demonstrate associations with placental lesions of insufficiency including poor invasion, vasoconstriction, and sequestration of toxic substances that inhibit nutrient transport. Restricted fetal growth is the most common finding in pregnancies complicated by all types of substance use. Discussion: More research is needed to understand the biologic mechanisms of stillbirth. Such knowledge will be foundational to understanding how to prevent and treat the adverse effects of substances during pregnancy.
Maternal Death and Its Investigation
Authors: Garland Jack , Little Dianne 
Published: December 2018

Maternal deaths are a leading cause of death in young females worldwide, particularly in developing countries. Maternal mortality ratio, the number of maternal deaths per 100 000 live births, averages 240 in developing regions, but only 16 in developed regions. Causes of maternal and pregnancy-related deaths can be subdivided into three broad categories. Direct maternal deaths result from obstetric complications of the pregnant state (i.e., pregnancy, labor, and puerperium) from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above. Indirect maternal deaths result from previously existing diseases or diseases that developed during pregnancy, and which are not due to a direct obstetric cause, but are aggravated by the physiologic effects of pregnancy. Incidental maternal deaths are those from causes unrelated to pregnancy or the puerperium, including accidental deaths and homicide. Maternal deaths carry significant short- and long-term impacts for family members and the role of the pathologist is an important part of the wider knowledge-gathering process that can contribute to changes in maternal mortality rates. This paper reviews the clinical and pathological features of common pregnancy-related disorders and gives guidelines for performing an autopsy related to maternal death.
A Review of Sexually Transmitted Infections in Australia – Considerations in 2018
Authors: Thng Caroline Chun Mei 
Published: December 2018

Sexually transmitted infections (STIs) bear a high burden of disease and, subsequently, high health costs globally. Chlamydia, gonorrhoea, syphilis, and trichomoniasis contribute to nearly one million infections every day worldwide. Sexually transmitted infections continue to be the most frequently notified condition to the Australian National Notifiable Diseases Surveillance System and the numbers continue to increase. Australia has achieved several significant successes in reducing STIs and blood-borne viruses (BBV) including the significant decrease in genital warts in those less than 30 years old since 2007 following the launch of human papillomavirus vaccines in women, the virtual elimination of mother to child transmission of HIV, and the increased uptake of successful hepatitis C treatment following the availability of direct acting antiviral treatment on the Pharmaceutical Benefits Scheme. However, several challenges remain, including the ongoing rise of chlamydia, gonorrhoea, and syphilis over the last five years; the emergence of antibiotic resistance; and the increasing disparity in the prevalence of STIs and BBV in men who have sex with men, young people, and Aboriginal and Torres Strait Islander people, and challenges in the delivery of services to rural and remote Australia. In this paper, we aim to provide a snapshot of the current landscape and challenges for chlamydia, gonorrhoea, mycoplasma, syphilis and HIV infections in Australia.
Metatarsal Osteotomies for Treating Neuropathic Diabetic Foot Ulcers: A Meta-analysis
Authors: Yammine Kaissar , Nahed Marc , Assi Chahine 
Published: December 2018

Diabetic foot ulcers (DFUs) are usually treated with conservative management based on debridement, topical agents, and nonsurgical off-loading; however, the recurrence rate following such standard care is reported to be high. In the case of recalcitrant or recurrent ulcers, a surgical off-loading technique such as the metatarsal osteotomy (MO) is indicated. Thus, the aim of this study is to conduct a meta-analysis evaluating the efficacy of MO in treating DFUs. Four relevant studies were identified, including 119 patients with 129 DFUs; all wounds were refractory to a previous conservative treatment of a mean duration of 10.9 ± 4.2 months. With a mean follow-up period of 18.2 ± 5.7 months, the weighted pooled rates were as follows: 98.7% for ulcer healing (in a mean time to heal of 6.5 ± 1.2 weeks), 4.3% for ulcer recurrence, 10.3% for ulcer transfer, 3.7% for infection, and 3.4% for nonunion. These findings were found to be noticeably better than those reported in the literature following standard care, whether associated or not to nonsurgical off-loading methods and that for all the studied outcomes. Knowing the dismal natural history of recalcitrant DFUs treated conservatively, the results of the MO techniques seems to offer a promising alternative in terms of ulcer healing and ulcer complications. In addition to complicated wounds, the indications for MO could include noncomplicated ulcers with healing delay. Level of Evidence: Level IV
Wiping out MRSA: effect of introducing a universal disinfection wipe in a large UK teaching hospital
Authors: Garvey Mark I. , Wilkinson Martyn A. C. , Bradley Craig W. , Holden Kerry L. , Holden Elisabeth 
Published: December 2018

Abstract
Background
Contamination of the inanimate environment around patients constitutes an important reservoir of MRSA. Here we describe the effect of introducing a universal disinfection wipe in all wards on the rates of MRSA acquisitions and bacteraemias across a large UK teaching hospital.

Methods
A segmented Poisson regression model was used to detect any significant changes in the monthly numbers per 100,000 bed days of MRSA acquisitions and bacteraemias from April 2013 - December 2017 across QEHB.

Results
From April 2013 to April 2016, cleaning of ward areas and multi-use patient equipment by nursing staff consisted of a two-wipe system. Firstly, a detergent wipe was used, which was followed by a disinfection step using an alcohol wipe. In May 2016, QEHB discontinued the use of a two-wipe system for cleaning and changed to a one wipe system utilising a combined cleaning and disinfection wipe containing a quaternary ammonium compound. The segmented Poisson regression model demonstrated that the rate of MRSA acquisition/100,000 patient bed days was affected by the introduction of the new wiping regime (20.7 to 9.4 per 100,000 patient bed days; p <0.005).

Discussion
Using a Poisson model we demonstrated that the average hospital acquisition rate of MRSA/100,000 patient bed days reduced by 6.3% per month after the introduction of the new universal wipe.

Conclusion
We suggest that using a simple one wipe system for nurse cleaning is an effective strategy to reduce the spread and incidence of healthcare associated MRSA.
The papilla as a biomarker in the molecular era of bladder oncology
Authors: Schultz Luciana 
Published: December 2018

Abstract
Background
Conventional optical microscopy has been fundamental in the diagnosis of cancer for over a century. Tumor morphology has prognostic value and impact on treatment choice, but integration with molecular knowledge can enhance the correlation with clinical behavior. A papillary structure implies that the proliferating epithelium has been able to interact with its microenvironment to conceive a fibrovascular core, suggesting a fair degree of differentiation.

Main body
In the bladder, a papillary architecture carries a favorable outcome and its presence is uniform in all non-invasive urothelial lesions, except for carcinoma in situ. Despite the increase in bladder cancer incidence, mortality has remained fairly stable for the last three decades, raising concern for overdiagnosis. Therefore, bladder cancer nomenclature has evolved to better communicate with the clinical scenario, including clinicians and patients. During this time, the need to incorporate new tools into morphology has raised a search for molecular biomarkers that grew exponentially with technology and scientific foment. Activating mutations in oncogenes like HRAS, PIK3 and FGFR3 are a hallmark of non-invasive papillary neoplasms, and their detection in advanced carcinomas is a favorable predictor of outcome. These alterations result in sustained proliferative stimuli and independent control of metabolism. Through the amplified interface of a papillary axis, the lamina propria can continue to supply nutrients, oxygen, hormones and other vital cellular needs to an increasing population of urothelial cells. mTOR regulates processes that require a substantial amount of matter and energy and alterations in this pathway are among the most frequent in urothelial tumors. Recent genomic landscape studies have provided data for molecularly subtyping urothelial cancers as luminal and basal. Within the luminal subtype, a p53-like signature is associated with chemoresistance. Luminal tumors, which phenotype is reminiscent of mature differentiated superficial cells, are enriched for papillary morphology and downregulation of miRNA involved in mTOR pathway regulation.

Conclusion
Because the papillary structure is the result of a transcriptional program and its post-transcriptional modifications, it is likely that its presence will be maintained in classification schemes as a powerful tool for clinical translation.
Structural complexity inferred from anisotropic resistivity: Example from airborne EM and compilation of historical resistivity/induced polarization data from the gold-rich Canadian Malartic district, Québec, Canada
Authors: Mir Reza , Perrouty Stéphane , Astic Thibaut , Bérubé Charles L. , Smith Richard S. 
Published: December 2018

Structurally complex zones within orogenic terranes typically correspond to areas where there is interference between multiple fold generations and are known to be favorable pathways for fluid flow because of their higher permeability. In the Canadian Malartic district, gold anomalies have been linked with zones of structural complexity that have been quantified by outcrop bedding orientation measurements and calculation of bedding variance maps. In this work, historical apparent resistivity and induced polarization data in the Canadian Malartic district were reprocessed and combined with new surveys to create a compilation of inverted chargeability and resistivity, which were then interpreted together with airborne electromagnetics and outcrop structural data. The results indicate chargeability anomalies, up to five times the background value, associated with the sulfide mineral content in monzodioritic dikes that are thickened in folds and hydrothermally altered. Although the airborne apparent half-space resistivity is mostly sensitive to conductive surficial cover, the inverted ground resistivity method is sensitive to deeper structure and likely represents bedrock signal at depths greater than 25 m. Inverted ground resistivity exhibits strong anisotropy in areas of subvertical bedding, where measured resistivities can vary by up to a factor of two, over the same location, depending on whether the survey lines are perpendicular or parallel to the strike of bedding. This result is observed at scales of 50 cm up to 100 m. Analysis of inverted ground resistivity together with bedding variance indicates a strong correlation between structurally complex zones with high bedding variance and a decrease in resistivity at depths greater than 25 m. This suggests that in places where the presence of disseminated gold cannot be directly detected, or where the outcrop exposure is limited due to overburden cover, geophysical data may still succeed in identifying structural complexity zones that could potentially host mineralization.
Intestine-Specific Overexpression of LDLR Enhances Cholesterol Excretion and Induces Metabolic Changes in Male Mice
Authors: Meoli Luca , Ben-Zvi Danny , Panciotti Courtney , Kvas Stephanie , Pizarro Palmenia , Munoz Rodrigo , Stylopoulos Nicholas 
Published: December 2018

AbstractRoux-en-Y gastric bypass (RYGB) surgery is one of the most effective treatment options for severe obesity and related comorbidities, including hyperlipidemia, a well-established risk factor of cardiovascular diseases. Elucidating the molecular mechanisms underlying the beneficial effects of RYGB may facilitate development of equally effective, but less invasive, treatments. Recent studies have revealed that RYGB increases low-density lipoprotein receptor (LDLR) expression in the intestine of rodents. Therefore, in this study we first examined the effects of RYGB on intestinal cholesterol metabolism in human patients, and we show that they also exhibit profound changes and increased LDLR expression. We then hypothesized that the upregulation of intestinal LDLR may be sufficient to decrease circulating cholesterol levels. To this end, we generated and studied mice that overexpress human LDLR specifically in the intestine. This perturbation significantly affected intestinal metabolism, augmented fecal cholesterol excretion, and induced a reciprocal suppression of the machinery related to luminal cholesterol absorption and bile acid synthesis. Circulating cholesterol levels were significantly decreased and, remarkably, several other metabolic effects were similar to those observed in RYGB-treated rodents and patients, including improved glucose metabolism. These data highlight the importance of intestinal cholesterol metabolism for the beneficial metabolic effects of RYGB and for the treatment of hyperlipidemia.
Hepatic Insulin Extraction in NAFLD Is Related to Insulin Resistance Rather Than Liver Fat Content
Authors: Utzschneider Kristina M , Kahn Steven E , Polidori David C 
Published: December 2018

Abstract

Context
Total insulin clearance is decreased in nonalcoholic fatty liver disease (NAFLD), but the relationship between liver fat and hepatic insulin extraction (HIE) is unknown.

Objective
This cross-sectional study addresses the hypothesis that HIE is reduced in NAFLD and investigates metabolic and/or anthropometric characteristics most closely associated with insulin clearance.

Participants
Nondiabetic subjects with NAFLD (n = 13) and age- and body mass index (BMI)-matched controls with normal liver enzymes (n = 15) underwent abdominal CT, dual-energy X-ray absorptiometry, oral glucose tolerance test (OGTT), and labeled two-step hyperinsulinemic-euglycemic clamps.

Outcome Measurements
Liver fat was estimated by the CT liver/spleen ratio. Hepatic and extrahepatic insulin clearances were modeled using clamp and OGTT data.

Results
Extrahepatic insulin clearance and HIE were not different between NAFLD and controls and did not correlate with liver fat. HIE was positively correlated with insulin sensitivity [rate of glucose disposal (Rd; low r = +0.7, P &lt; 0.001; high r = +0.6, P = 0.001), adiponectin (r = +0.55, P = 0.004), and insulin-mediated suppression of clamp nonesterified free fatty acid (NEFA; r = +0.67, P &lt; 0.001)] but was not associated with fasting NEFA, insulin-mediated suppression of glucose production, or measures of adiposity. Extrahepatic insulin clearance was positively associated with percent body fat (r = +0.44, P = 0.02) and subcutaneous fat (r = +0.42, P = 0.03) but not BMI, intra-abdominal fat, liver fat, Rd, adiponectin, or NEFA.

Conclusions
HIE is not directly associated with hepatic steatosis but is associated with muscle and adipose tissue insulin resistance. The data suggest differential regulation of insulin clearance with extrahepatic insulin clearance being associated with body fat and not insulin sensitivity.
Frequency of Hypocalcaemia following Total Thyroidectomy
Authors: Baloch Naseem , Taj Saima , Anwer Mariyah , Naseem Masooma 
Published: December 2018

Background & Objective: Patients who undergo Total thyroidectomy are at higher risk for postoperative hypocalcaemia, which can lead to significant short and long term morbidity. The aim of this study was to determine the frequency of postoperative hypocalcaemia undergoing Total thyroidectomy.
Methods: A total of 854 patients who underwent Total thyroidectomy and completion thyroidectomy between January 2003 to December 2016 at Endocrine Surgical unit, Jinnah Postgraduate Medical Centre, Karachi, were included in this retrospective study. Data were obtained for demographics, preoperative diagnosis, postoperative calcium levels, extent of surgery and final surgical pathology.
Results: A total of 854 patients underwent Total thyroidectomy. Of these 87.58% (n=748) were malignant and 12.41% (n=106) were benign. Among the malignant and benign patients, 47.3% (n=404) underwent Total thyroidectomy and 52.69% (n=450) underwent completion thyroidectomy. Overall incidence of transient hypocalcaemia was 7% (n=60) and that of permanent hypocalcaemia was 0.11% (n= 1).
Conclusion: Hypocalcaemia is one of major concern following total- thyroidectomy. Meticulous surgical techniques, identification and preservation of vascularity of parathyroid glands are essential in preventing postoperative hypocalcaemia following total thyroidectomy.
How to cite this:Baloch N, Taj S, Anwer M, Naseem M. Frequency of Hypocalcaemia following Total Thyroidectomy. Pak J Med Sci. 2019;35(1):262-265. doi: https://doi.org/10.12669/pjms.35.1.93
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Comparison of tillage costs among eight paddy farm regions in East Kalimantan, Indonesia
Authors: Karmini Karmini 
Published: December 2018

Background: Tillage is done to prepare land for wetland paddy farming, and it is commonly done by hand tractor. The purposes of this study were to identify the levels of ownership of hand tractor by paddy farmers, to describe the rental of hand tractor in rural areas, to calculate and compare the tillage costs on eight paddy farm regions, and to understand the utilization of farm machinery for paddy farming in East Kalimantan, Indonesia. Methods: The study areas were Subcities/Subdistricts of North Bontang, South Bontang, Muara Muntai, Loa Janan, Tenggarong Seberang, Waru, Penajam, and Babulu. Data collection was done by interviewing 380 respondents. Analysis of data used the Chi Square test. Results: The number of hand tractor renters (87.37%) in East Kalimantan 2014 was bigger than that of hand tractor owners (12.63%). The tillage costs in Tenggarong Seberang, Loa Janan, and Muara Muntai in 2014 were IDR700,000.00 ha-1, IDR750,000.00 ha-1, and IDR700,000.00 ha-1, respectively. Tillage costs were the same in Babulu, Penajam, Waru, South Bontang, and North Bontang (IDR1,000,000.00 ha-1 in each district). Conclusions: There are significant differences the number of hand tractor owners, the number of hand tractor renters, and the tillage costs among the eight paddy farm regions in East Kalimantan, Indonesia.