bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lower Genital Tract Dysplasia in Female Solid Organ Transplant Recipients
Authors: Thimm Matthew A. , Rositch Anne F. , VandenBussche Christopher , McDonald Lynn , Garonzik Wang Jacqueline M. , Levinson Kimberly 
Published: July 2019

OBJECTIVE:
To examine the incidence of lower genital tract dysplasia in women after solid organ transplantation, to evaluate risk factors associated with development of dysplasia, and to assess the timeline of disease development.

METHODS:
This was a retrospective study of female patients who underwent solid organ transplantation at a large-volume tertiary care center between 2000 and 2015. Demographic and clinicopathologic factors were extracted from electronic medical records. Cumulative incidence of lower genital tract dysplasia was calculated, and univariate and multivariable logistic regression were performed to identify risk factors for the development of dysplasia.

RESULTS:
Among 394 female solid organ transplant recipients, the median age was 41 years (interquartile range 29–53). Forty-seven (11.9%; 95% CI 8.8–15.9%) women developed lower genital tract dysplasia over a median follow-up of 7.8 years (interquartile range 4.6–12.9). Thirty-eight (9.6%) developed cervical intraepithelial neoplasia (CIN), with 14 (3.6%) diagnosed with CIN 2 or worse (one was cervical carcinoma). Nineteen (4.8%) developed noncervical lower genital tract dysplasia, including vulvar, vaginal, or anal dysplasia, with 13 (3.3%) diagnosed with high-grade dysplasia or worse (five were lower genital tract carcinoma [three anal, one vulvar, and one vaginal]). Ten (2.5%) developed both cervical and noncervical lower genital tract dysplasia. Black race was significantly associated with developing dysplasia (odds ratio [OR] 2.86; 95% CI 1.33–6.13) as was hydroxychloroquine use (OR 5.95; 95% CI 1.96–18.09). High-grade cervical dysplasia was diagnosed at a median interval of 3.18 years after transplant; noncervical high-grade lower genital tract dysplasia was diagnosed at a median interval of 3.94 years.

CONCLUSIONS:
One in eight transplant recipients developed lower genital tract dysplasia and approximately half were high-grade dysplasia or cancer. Black race and hydroxychloroquine use were associated with an increased risk of dysplasia. Yearly cervical screening and comprehensive lower genital examination beyond the cervix is indicated in this population.
Evaluation of opioid disposal opportunities in the United States
Authors: Iobst Christopher A. , Singh Satbir , Balch Samora Julie 
Published: July 2019

Background:
We sought to determine whether caregivers, pharmacies, and law enforcement authorities would accept the return of unused opioids, and whether pharmacies provide patient education regarding the return of unused opioids.

Methods:
The pharmacies of every children’s hospital in the United States, along with a large sample of chain pharmacies, nonchain pharmacies, and police stations in every state were contacted to determine if their facility would accept unused opioids.

Results:
One thousand four hundred and seventy-seven phone calls were successfully placed to 858 pharmacies (436 chain, 422 nonchain), 431 police stations, and 188 children’s hospitals in all 50 states. Overall, only 415 of the 1477 (28%) of the contacted locations offered to take the medication. Police stations offered to take the opioids at a significantly higher rate (60%, P<0.001) than pharmacies (15%) or children’s hospitals (11%). There was also a significant difference in pharmacy types, with independent pharmacies having a higher take-back rate (24%, P<0.001) than retail chain pharmacies (7%). Finally, 78% of children’s hospital pharmacies reported that they recommend proper disposal of any unused opioids at the time the medication is dispensed compared to only 29% of chain and nonchain pharmacies (P<0.0001).

Conclusions:
This study demonstrated that only 28% of children’s hospital pharmacies, police stations, and commercial pharmacies across the country would accept the return of unused opioids. Only 29% of commercial pharmacies reported educating patients about options to return unused opioids. Patients would benefit from more consistent and better-publicized efforts to secure the return of unused medications.
The Community Orthopaedic Surgeon Taking Trauma Call: Radial Neck Fracture Pearls and Pitfalls
Authors: Gibly Romie F. , Garg Sumeet , Mehlman Charles T. 
Published: July 2019

Summary:
Pediatric radial neck fractures will inevitably be encountered by the general orthopaedist, and they carry great potential for poor outcomes. Acceptable displacement varies by age, and unlike adults, most of these injuries can be managed by closed means. If they are taken to the operating room, the mainstays of treatment are percutaneous techniques. Increasing patient age, inadequate reduction, unnecessary open reductions, and prolonged immobilization are all associated with worse outcomes, most commonly manifesting as significant elbow stiffness. Knowledge of the age-specific acceptable displacement criteria, a stepwise approach to closed and percutaneous techniques, and safe strategies for open reduction when needed as a last resort will greatly improve treatment success.
Atorvastatin Attenuates Cold-Induced Hypertension by Preventing Gut Barrier Injury
Authors: Zhang Song , Zhang Yun , Ahsan Mian Zeeshan , Yuan Yue , Liu Guangzhong , Han Xuejie , Zhang Jiawei , Zhao Xinbo , Bai Bing , Li Yue 
Published: July 2019

Abstract:
Chronic exposure to cold causes arterial hypertension [cold-induce hypertension (CIH)]. Emerging data have indicated that gut barrier dysfunction is involved in the pathogenesis of hypertension. In this study, we explored the effect of gut barrier dysfunction on vascular inflammation induced by cold exposure and the therapeutic effect of atorvastatin in a CIH rat model. The CIH was established by cold exposure for 2 weeks. Two groups of Sprague Dawley rats were exposed to moderate cold (4 ± 1°C), whereas the control group was maintained at room temperature (23 ± 1°C) (10 rats/group). The 2 groups received atorvastatin or vehicle at the beginning of cold exposure, respectively, for 2 weeks. Cold exposure increased mean arterial pressure compared with room temperature group, indicating that animals developed arterial hypertension. Cold exposure induced vascular dysfunction due to decreasing phosphorylated endothelial nitric oxide synthase protein expression in aorta, and these were blunted by atorvastatin. Cold exposure increased the levels of gut-derived inflammatory cytokines, tumor necrosis factor-α, and interleukin-6 production in aorta and resulted in vascular inflammation, whereas atorvastatin prevented these effects. Cold exposure also increased gut permeability, inhibited tight junction protein expression in proximal colon, and resulted in gut barrier dysfunction. Interestingly, atorvastatin eliminated increasing gut permeability, decreasing tight junction protein expression, and gut pathology and reversed gut barrier dysfunction. Atorvastatin attenuated CIH and improved gut barrier function; the beneficial effects might be via inhibiting gut-derived inflammatory cytokines and reversing cold-induced vascular inflammation, suggesting that gut barrier dysfunction may be involved in the pathogenesis of CIH.
Role of Cytochrome p450 and Soluble Epoxide Hydrolase Enzymes and Their Associated Metabolites in the Pathogenesis of Diabetic Cardiomyopathy
Authors: Maayah Zaid H. , McGinn Erica , Al Batran Rami , Gopal Keshav , Ussher John R. , El-Kadi Ayman O. S. 
Published: July 2019

Abstract:A plethora of studies have demonstrated that cardiomyopathy represents a serious source of morbidity and mortality in patients with diabetes. Yet, the underlying mechanisms of diabetic cardiomyopathy are still poorly understood. Of interest, cytochrome P450 2J (CYP2J) and soluble epoxide hydrolase (sEH) are known to control the maintenance of cardiovascular health through the regulation of cardioprotective epoxyeicosatrienoic acids (EETs) and its less active products, dihydroxyeicosatrienoic acids (DHETs). Therefore, we examined the role of the aforementioned pathway in the development of diabetic cardiomyopathy. Our diabetic model initiated cardiomyopathy as indexed by the increase in the expression of hypertrophic markers such asNPPA. Furthermore, diabetic cardiomyopathy was associated with a low level of cardiac EETs and an increase of the DHETs/EETs ratio both in vivo and in cardiac cells. The modulation in EETs and DHETs was attributed to the increase of sEH and the decrease of CYP2J. Interestingly, the reduction of sEH attenuates cardiotoxicity mediated by high glucose in cardiac cells. Mechanistically, the beneficial effect of sEH reduction might be due to the decrease of phosphorylated ERK1/2 and p38. Overall, the present work provides evidence that diabetes initiates cardiomyopathy through the increase in sEH, the reduction of CYP2J, and the decrease of cardioprotective EETs.
Chimeric Antigen Receptor T‐Cell Therapy Clinical Results in Pediatric and Young Adult B‐ALL
Authors: DiNofia Amanda M. , Maude Shannon L. 
Published: July 2019

AbstractChimeric antigen receptor (CAR)‐modified T‐cell therapy has revolutionized the care of patients with relapsed and refractory B‐cell acute lymphoblastic leukemia (B‐ALL). Results from clinical trials across multiple institutions report remarkable remission rates with CD19‐directed CAR‐modified T‐cell therapy. These remissions are also proving to be durable in many patients with a relapse‐free survival (RFS) of approximately 50% to 60% at 1 year across several trials and institutions in this population that has been historically very difficult to treat. In addition, new products are being developed to enhance upon the original CAR T‐cell products, which include a humanized CAR, allogeneic CARs, and both CD22 and biallelic CD19 and CD22 constructs. Toxicity after CAR‐modified T‐cell therapy is characterized by cytokine release syndrome (CRS) and neurotoxicity in the acute post‐infusion period and B‐cell aplasia as a long‐term consequence of treatment. This review will summarize the published data thus far on the use of CAR‐modified T‐cell therapy in pediatric B‐ALL and outline the various CAR products now being developed for this population. Delivery of this therapy and the decision to pursue hematopoietic stem cell transplant (HSCT) after treatment will be discussed.
Blue-Enriched White Light Therapy Reduces Fatigue in Survivors of Severe Traumatic Brain Injury: A Randomized Controlled Trial
Authors: Quera Salva Maria-Antonia , Azabou Eric , Hartley Sarah , Sauvagnac Rebecca , Leotard Antoine , Vaugier Isabelle , Pradat Diehl Pascale , Vallat-Azouvi Claire , Barbot Frederic , Azouvi Philippe 
Published: July 2019

Objective:
Fatigue is one of the disabling sequelae of traumatic brain injury (TBI), with repercussions on quality of life, rehabilitation, and professional reintegration. Research is needed on effective interventions. We evaluated efficacy of blue-enriched white light (BWL) therapy on fatigue of patients with severe TBI.

Setting:
Physical Medicine and Rehabilitation and Physiology departments of University hospitals.

Participants:
Adult patients with fatigue symptoms following severe TBI, Fatigue Severity Scale (FSS) score 4 or more, Epworth Sleepiness Scale (ESS) score 10 or more, and/or Pittsburgh Sleep Quality Index (PSQI]) more than 5 were randomly assigned to one of 2 parallel groups: a BWL therapy group, with 30-minute exposure to waking white light enriched with blue for 4 weeks, and a group without light therapy (N-BWL), no light.

Design:
Randomized controlled trial. ClinicalTrials.gov number: NCT02420275.

Main Measures:
The primary outcome measure was the response of the FSS to 4 weeks of treatment. In addition, we assessed latency change of the P300 component of event-related potentials before and after therapy.

Results:
Significant improvement in the FSS score (P = .026) was found in the BWL group compared with the N-BWL group.

Conclusion:
BWL phototherapy reduces fatigue in patients with severe TBI.
Characterizing Comorbid Cerebrovascular Insults Among Patients With TBI at a TBI Model Systems Rehabilitation Center
Authors: Jenkins Randolph M. , Manche Nathaniel L. , Sima Adam P. , Marwitz Jennifer H. , Walker William C. 
Published: July 2019

Objective:
Determine incidence and predictors of comorbid cerebrovascular injuries in patients with moderate to severe traumatic brain injury (TBI) and whether it influences rehabilitation outcomes.

Setting:
Inpatient Rehabilitation Facility (IRF) brain injury unit participating in NIDILRR TBI Model Systems (TBIMS).

Participants:
A total of 663 patients with moderate to severe TBI.

Design:
Observational study with prospective and retrospective data collection.

Main Measures:
New traumatic cerebral artery injury (TCAI) lesions of head/neck and new cerebral infarcts (CIs) abstracted from neuroimaging reports and clinical notes.

Results:
The incidence of comorbid CI was 8%, among whom 19% also had TCAI identified. The incidence of TCAI increased over time from 2% before 2008 to 10% after, probably from greater screening. Both CI and TCAI were associated with longer acute care stay. Cerebral infarct was also associated with longer posttraumatic amnesia and lower rate of functional gains.

Conclusions:
Using in-depth abstraction of imaging findings, the incidence of traumatic head/neck artery injuries, and CIs in patients with moderate to severe TBI were both higher than a recent TBIMS-wide study utilizing ICD coding. Cerebral infarct was associated with longer posttraumatic amnesia duration and slower functional gains. Further research is recommended on the outcome implications of concomitant cerebrovascular injury in patients with TBI.
Postdecisional Processing Delays in Metacognitive Monitoring After Traumatic Brain Injury
Authors: Chiou Kathy S. , Genova Helen M. , Lengenfelder Jean , Chiaravalloti Nancy D. 
Published: July 2019

Objective:To document the process by which metacognitive judgments (“online” monitoring of one's own cognitive performance during task completion) are made after traumatic brain injury (TBI).Participants:Sixteen community-dwelling adults with moderate to severe TBI and 16 matched healthy controls.Design:Prospective, cross-sectional design.Measures:Metacognitive retrospective confidence judgments and reaction times were collected as participants performed a metamemory task.Results:Adults with TBI did not differ from healthy peers in metacognitive accuracy; however, they took significantly longer to make retrospective confidence judgments. Retrospective confidence judgment reaction times were not consistently correlated to measures of processing speed in either sample.Conclusions:Adults with TBI engage in different postdecisional processes to make metacognitive judgments compared with healthy controls. Findings suggest that reaction times may be an important dimension of metacognition to assess clinically after TBI.
Clinical Presentation of Influenza in Children 6 to 35 Months of Age
Authors: Danier Jasur , Rivera Luis , Claeys Carine , Dbaibo Ghassan , Jain Varsha K. , Kosalaraksa Pope , Woo Wayne , Yanni Emad , Zaman Khalequ , Acosta Beatriz , Amanullah Arshad , Ariza Miguel , Arroba Basanta Maria L. , Bavdekar Ashish , Carmona Alfonso , Cousin Luis , Diaz Adolfo , Diez-Domingo Javier , Dinleyici Ener C. , Faust Saul N. , Garcia-Sicilia Jose , Gomez-Go Grace D. , Gonzales Maria L. A. , Hacimustafaoglu Mustafa , Hughes Stephen M. , Izu Allen , Jackowska Teresa , Kant Shashi , Lucero Marilla , Mares Bermudez Josep , Martinón-Torres Federico , Montellano May , Prymula Roman , Puthanakit Thanyawee , Ruzkova Renata , Sadowska-Krawczenko Iwona , Soni Jyoti , Szymanski Henryk , Ulied Angels , Schuind Anne , Innis Bruce L. 
Published: July 2019

Background:
In an exploratory analysis of an inactivated quadrivalent influenza vaccine (IIV4) trial in children 6–35 months without risk factors for influenza, we evaluated clinical presentation of influenza illness and vaccine impact on health outcomes.

Methods:
This phase III trial was conducted in 13 geographically diverse countries across 5 influenza seasons (2011–2014). Children were randomized 1:1 to IIV4 or control. Active surveillance was performed for influenza-like episodes (ILE); influenza was confirmed by reverse transcription polymerase chain reaction (RT-PCR). The total vaccinated cohort was evaluated (N = 12,018).

Results:
5702 children experienced ≥1 ILE; 356 (IIV4 group) and 693 (control group) children had RT-PCR-confirmed influenza. Prevalence of ILE was similar in RT-PCR-positive and RT-PCR-negative cases regardless of vaccination. Breakthrough influenza illness was attenuated in children vaccinated with IIV4; moderate-to-severe illness was 41% less likely to be reported in the IIV4 group than the control group [crude odds ratio: 0.59 (95% confidence intervals: 0.44−0.77)]. Furthermore, fever >39°C was 46% less frequent following vaccination with IIV4 than with control [crude odds ratio: 0.54 (95% confidence intervals: 0.39−0.75)] in children with breakthrough illness. Health outcome analysis showed that, each year, IIV4 would prevent 54 influenza cases per 1000 children and 19 children would need to be vaccinated to prevent 1 new influenza case.

Conclusions:
In addition to preventing influenza in 50% of participants, IIV4 attenuated illness severity and disease burden in children who had a breakthrough influenza episode despite vaccination.
Safety and Efficacy of Ceftazidime-Avibactam Plus Metronidazole in the Treatment of Children ≥3 Months to <18 Years With Complicated Intra-Abdominal Infection: Results From a Phase 2, Randomized, Controlled Trial
Authors: Bradley John S. , Broadhurst Helen , Cheng Karen , Mendez Maria , Newell Paul , Prchlik Martin , Stone Gregory G. , Talley Angela K. , Tawadrous Margaret , Wajsbrot Dalia , Yates Katrina , Zuzova Antonina , Gardner Annie 
Published: July 2019

Background:
Ceftazidime-avibactam plus metronidazole is effective in the treatment of complicated intra-abdominal infection (cIAI) in adults. This single-blind, randomized, multicenter, phase 2 study (NCT02475733) evaluated the safety, efficacy and pharmacokinetics of ceftazidime-avibactam plus metronidazole in children with cIAI.

Methods:
Hospitalized children (≥3 months to <18 years) with cIAI were randomized 3:1 to receive intravenous ceftazidime-avibactam plus metronidazole, or meropenem, for a minimum of 72 hours (9 doses), with optional switch to oral therapy thereafter for a total treatment duration of 7–15 days. Safety and tolerability were assessed throughout the study, along with clinical and microbiologic outcomes, and pharmacokinetics. A blinded observer determined adverse event (AE) causality, and clinical outcomes up to the late follow-up visit.

Results:
Eighty-three children were randomized and received study drug (61 ceftazidime-avibactam plus metronidazole and 22 meropenem); most (90.4%) had a diagnosis of appendicitis. Predominant Gram-negative baseline pathogens were Escherichia coli (79.7%) and Pseudomonas aeruginosa (33.3%); 2 E. coli isolates were ceftazidime-non-susceptible. AEs occurred in 52.5% and 59.1% of patients in the ceftazidime-avibactam plus metronidazole and meropenem groups, respectively. Serious AEs occurred in 8.2% and 4.5% of patients, respectively; none was considered drug related. No deaths occurred. Favorable clinical/microbiologic responses were observed in ≥90% of patients in both treatment groups at end-of-intravenous treatment and test-of-cure visits.

Conclusions:
Ceftazidime-avibactam plus metronidazole was well tolerated, with a safety profile similar to ceftazidime alone, and appeared effective in pediatric patients with cIAI due to Gram-negative pathogens, including ceftazidime-non-susceptible strains.
In the pursuit of partnership: patient and family engagement in critical care medicine
Authors: Farrier Christian E. , Stelfox Henry T. , Fiest Kirsten M. 
Published: July 2019

Purpose of review
Patient and family partnership in critical care medicine research and clinical care is essential to achieve patient and family-centered care. Although there is an increasing interest in patient and family engagement, research is lacking to direct clinicians and researchers on how to provide opportunities for meaningful engagement. We review the recent literature and provide examples from our own experiences to guide all parties in this important and emerging area.

Recent findings
Though the literature is relatively nascent, studies suggest that there is a desire to engage patients and families in critical care medicine research and clinical care, however, uncertainty exists on how to achieve this goal. Engagement exists on a spectrum from presence to shared decision-making and direct contributions to care; most engagement in critical care medicine involves participation in research and presence at the bedside. Expectation management is essential for meaningful engagement and true partnership. Challenges to patient and family engagement exist, including determining appropriate compensation, aligning engagement with needs and skills, and recruitment, training and retention. These challenges can be mitigated with thoughtful planning and management.

Summary
Patient and family engagement in critical care medicine is an emerging field that requires further study to support definitive conclusions. Until then, it is important to match interested patients and family members with appropriate opportunities and provide training and support to ensure meaningful engagement.
Effect of chest compression on skeletal chest injuries: a retrospective study
Authors: Kim Hyung Il , Cha Kyoung-Chul , Chung Woo Jin , Noh Young Il , Kim Oh Hyun , Cha Yong Sung , Kim Hyun , Lee Kang Hyun , Kim Hye Sim , Hwang Sung Oh 
Published: July 2019

Objective
Reports indicate that chest compression may induce skeletal chest injuries. We aimed to assess the factors associated with skeletal chest injuries and the probability of skeletal chest injuries following cardiopulmonary resuscitation (CPR) in patients who were successfully resuscitated after cardiac arrest.

Methods
This retrospective analysis used data from adult patients who were successfully resuscitated after cardiac arrest. Skeletal chest injuries were assessed by chest computed tomography images. Multiple logistic regression analysis was used to identify factors associated with skeletal chest injuries and a cubic spline was fitted to visualize the predicted probability of skeletal chest injuries.

Results
Among 274 patients (mean age: 62.6 years, 180 males), 185 (68%) had skeletal chest injuries. Patients with skeletal chest injuries were older in age (66.4 ± 12 vs 54.7 ± 17 years, P < 0.001), had a higher frequency of prehospital CPR (78.9 vs 66.3%, P = 0.024), and had a longer CPR duration (26.3 ± 19.4 vs 21.5 ± 14.8 minutes, P = 0.022). Multiple logistic regression analysis showed that age and CPR duration were associated with skeletal chest injuries [odds ratio (OR): 1.06, 95% confidence interval (CI): 1.04–1.08, P < 0.001 for age; OR: 1.03, 95% CI: 1.01–1.04, P = 0.006 for CPR duration). The probability of skeletal chest injuries was higher in patients over 60 years of age than those in patients under 60 years.

Conclusion
In our study, advanced age and CPR duration were factors associated with a greater risk of skeletal chest injuries in adult patients who were resuscitated after cardiac arrest.