bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Obstructive Sleep Apnea on Corneal Morphological Characteristics
Authors: Bojarun Andrius , Vieversyte Zivile , Jaruseviciene Ruta , Galgauskas Saulius , Asoklis Rimvydas , Zablockis Rolandas 
Published: July 2019

Purpose:
To determine central corneal thickness (CCT) and the corneal parameters in patients with obstructive sleep apnea (OSA), evaluate the relationship between the severity of OSA, minimum peripheral capillary oxygen saturation (min. SpO2), and corneal morphological characteristics.

Methods:
Patients with OSA diagnosed by full-night polysomnography before treatment were included. Patients with OSA were divided into 3 groups according to the Apnea–Hypopnea Index (AHI). The control group (CG) was examined to exclude the possibility of OSA and ocular diseases. The following data were recorded: age, sex, body mass index, ophthalmologic evaluation, and the results of polysomnography.

Results:
A total of 114 eyes were studied: 74 eyes of patients with OSA and 40 eyes of the CG. The mean age was 57 ± 6 years. The mean values of CCT and endothelial cell density (ECD) varied significantly between the patients and the CG (P < 0.001). The mean values of CCT, ECD, cell variation coefficient (CV), and hexagonal cell percentage (HEX) in the group of patients with OSA were 535.28 ± 21.32 μm, 2632 ± 333, cells/mm2. 31.8 ± 3.9, and 55.6 ± 6.9%, respectively. The mean CCT and ECD values for each group were lower than those for the CG. A significant negative correlation was found between CCT and ECD for AHI values (r = −0.390, P = 0.011 and r = −0.109, P = 0.040, respectively), and a weak positive correlation between CCT and ECD was found for min. SpO2 (r = 0.282, P = 0.020 and r = 0.332, P = 0.018, respectively). CV and HEX did not significantly differ between the groups and did not correlate with the results of polysomnography.

Conclusions:
Hypoxia is associated with significant changes in CCT and ECD. In patients with OSA, these parameters varied significantly when compared with the subjects in the CG. The severity of hypoxemia and the increase in AHI values reduce CCT and ECD in patients.
Sustained efficacy of kangaroo care for repeated painful procedures over neonatal intensive care unit hospitalization: a single-blind randomized controlled trial
Authors: Campbell-Yeo Marsha , Johnston C. Celeste , Benoit Britney , Disher Timothy , Caddell Kim , Vincer Michael , Walker Claire-Dominique , Latimer Margot , Streiner David L. , Inglis Darlene 
Published: July 2019

Abstract
Preterm neonates hospitalized in the neonatal intensive care unit undergo frequent painful procedures daily, often without pain treatment, with associated long-term adverse effects. Maternal-infant skin-to-skin contact, or kangaroo care (KC), and sweet-tasting solutions such as sucrose are effective strategies to reduce pain during a single procedure; however, evidence of sustained efficacy over repeated procedures is limited. We aimed to determine the relative sustained efficacy of maternal KC, administered alone or in combination with 24% sucrose, to reduce behavioral pain intensity associated with routine neonatal procedures, compared with 24% sucrose alone. Stable preterm infants (n = 242) were randomized to receive KC and water, KC and 24% sucrose, or 24% sucrose before all routine painful procedures throughout their neonatal intensive care unit stay. Pain intensity, determined using the Premature Infant Pain Profile, was measured during 3 medically indicated heel lances distributed across hospitalization. Maternal and neonatal baseline characteristics, Premature Infant Pain Profile scores at 30, 60, or 90 seconds after heel lance, the distribution of infants with pain scores suggesting mild, moderate, or severe pain, Neurobehavioral Assessment of the Preterm Infant scores, and incidence of adverse outcomes were not statistically significantly different between groups. Maternal KC, as a pain-relieving intervention, remained efficacious over time and repeated painful procedures without evidence of any harm or neurological impact. It seemed to be equally effective as 24% oral sucrose, and the combination of maternal KC and sucrose did not seem to provide additional benefit, challenging the existing recommendation of using sucrose as the primary standard of care.
Repetitive transcranial magnetic stimulation of the primary motor cortex expedites recovery in the transition from acute to sustained experimental pain: a randomised, controlled study
Authors: Cavaleri Rocco , Chipchase Lucy S. , Summers Simon J. , Schabrun Siobhan M. 
Published: July 2019

Abstract
Repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex (M1) is increasingly being investigated as a means of alleviating chronic pain. However, rTMS interventions are typically initiated once pain has already become chronic and maladaptive patterns of neural activity are likely to have been established. A critical question is whether M1 rTMS applied soon after pain onset can prevent the development of maladaptive neural activity and promote recovery. This study investigated the effect of 5 consecutive days of excitatory M1 rTMS on pain, functional limitation, mechanical hyperalgesia, descending inhibitory pain control, and M1 organisation in the transition from acute to sustained pain. Thirty healthy participants attended 8 sessions over a 16-day period. On days 0, 2, and 4, nerve growth factor was injected into the right forearm to induce progressively developing muscle soreness and mechanical hyperalgesia. Active or sham excitatory rTMS was delivered on days 4 to 8. Clinical and neurophysiological outcomes were recorded on days 0, 2, 4, 6, 8, 11, and 14. Active rTMS promoted recovery of muscle soreness, pain, and mechanical hyperalgesia when compared with sham rTMS (all between-group P < 0.05). Corticomotor excitability and descending inhibitory pain control did not differ between groups. These findings suggest that active excitatory M1 rTMS promotes recovery of muscle soreness, pain, and mechanical hyperalgesia in the transition from acute to sustained experimental pain. The analgesic effects of M1 rTMS do not seem to be modulated by descending inhibitory pain control or local changes in corticomotor excitability.
Trigeminal Aδ- and C-afferent supply of lamina I neurons in the trigeminocervical complex
Authors: Luz Liliana L. , Fernandes Elisabete C. , Dora Fanni , Lukoyanov Nikolay V. , Szucs Peter , Safronov Boris V. 
Published: July 2019

Abstract
Nociceptive trigeminal afferents innervating craniofacial area, eg, facial skin and cranial meninges, project to a broad region in the medullary and upper cervical dorsal horn designated as the trigeminocervical complex. Lamina I neurons in the trigeminocervical complex integrate and relay peripheral inputs, thus playing a key role in both cranial nociception and primary headache syndromes. Because of the technically challenging nature of recording, the long-range trigeminal afferent inputs to the medullary and cervical lamina I neurons were not intensively studied so far. Therefore, we have developed an ex vivo brainstem–cervical cord preparation with attached trigeminal nerve for the visually guided whole-cell recordings from the medullary and cervical lamina I neurons. Two-thirds of recorded neurons generated intrinsic rhythmic discharges. The stimulation of the trigeminal nerve produced a complex effect; it interrupted the rhythmic discharge for hundreds of milliseconds but, if the neuron was silenced by a hyperpolarizing current injection, could elicit a discharge. The monosynaptic inputs from the trigeminal Aδ, high-threshold Aδ, low-threshold C, and C afferents were recorded in the medullary neurons, as well as in the cervical neurons located in the segments C1 to C2 and, to a lesser degree, in C3 to C4. This pattern of supply was consistent with our labelling experiments showing extensive cervical projections of trigeminal afferents. Excitatory inputs were mediated, although not exclusively, through AMPA/kainate and NMDA receptors, whereas inhibitory inputs through both GABA and glycine receptors. In conclusion, the trigeminocervical lamina I neurons receive a complex pattern of long-range monosynaptic and polysynaptic inputs from a variety of the trigeminal nociceptive afferents.
Motor simulation is disturbed when experiencing pain
Authors: Cracco Emiel , Clauwaert Amanda , Van den Broeck Yentl , Van Damme Stefaan , Brass Marcel 
Published: July 2019

Abstract
While the contribution of social processes to pain perception is well documented, surprisingly little is known about the influence of pain on social perception. In particular, an important question is how pain modulates the processing of other people's actions. To address this question, the current study tests, using automatic imitation, the hypothesis that pain interferes with motor simulation—that is, the processing of observed actions in the motor system. Participants in both experiments performed an automatic imitation task requiring them to abduct their index or little finger while they saw someone else performing either a congruent or incongruent action. Automatic imitation was measured in a pain-free context, a context where pain was coupled to the execution of a movement (experiment 1), and a context where pain occurred randomly (experiment 2). The results revealed that automatic imitation, indexed by slower responses on incongruent compared with congruent trials, was reduced when experiencing pain, both when pain was linked to movement execution and when it was not. Thus, the current study shows that pain leads to reduced motor processing of others' behavior and, as such, has important implications for understanding the social difficulties associated with pain.
Brain dysfunction in chronic pain patients assessed by resting-state electroencephalography
Authors: Ta Dinh Son , Nickel Moritz M. , Tiemann Laura , May Elisabeth S. , Heitmann Henrik , Hohn Vanessa D. , Edenharter Günther , Utpadel-Fischler Daniel , Tölle Thomas R. , Sauseng Paul , Gross Joachim , Ploner Markus 
Published: July 2019

Abstract
Chronic pain is a common and severely disabling disease whose treatment is often unsatisfactory. Insights into the brain mechanisms of chronic pain promise to advance the understanding of the underlying pathophysiology and might help to develop disease markers and novel treatments. Here, we systematically exploited the potential of electroencephalography to determine abnormalities of brain function during the resting state in chronic pain. To this end, we performed state-of-the-art analyses of oscillatory brain activity, brain connectivity, and brain networks in 101 patients of either sex suffering from chronic pain. The results show that global and local measures of brain activity did not differ between chronic pain patients and a healthy control group. However, we observed significantly increased connectivity at theta (4-8 Hz) and gamma (>60 Hz) frequencies in frontal brain areas as well as global network reorganization at gamma frequencies in chronic pain patients. Furthermore, a machine learning algorithm could differentiate between patients and healthy controls with an above-chance accuracy of 57%, mostly based on frontal connectivity. These results suggest that increased theta and gamma synchrony in frontal brain areas are involved in the pathophysiology of chronic pain. Although substantial challenges concerning the reproducibility of the findings and the accuracy, specificity, and validity of potential electroencephalography-based disease markers remain to be overcome, our study indicates that abnormal frontal synchrony at theta and gamma frequencies might be promising targets for noninvasive brain stimulation and/or neurofeedback approaches.
Deadoption of low-value practices in the ICU
Authors: Fung Christopher M. , Hyzy Robert C. 
Published: July 2019

Purpose of review
Change of practice in the ICU, particularly the discontinuation of approaches, which are no longer felt to be beneficial, can be challenging. This review will examine this issue and outline current thinking regarding how to best approach it.

Recent findings
Practices in medicine that do not provide patients benefit and possibly cause harm exist throughout medicine and are called low-value practices. Some low-value practices have successfully been removed from the ICU whereas others remain. The process of removing these practices from established care is often called deadoption. Low-value practices that are simply ineffective but produce comparatively less harm or cost, may represent a significant challenge to deadoption. Additionally, although no single intervention has been identified as the preferred method of deadoption of a low-value practice, we advocate for a multimodal approach.

Summary
Deadoption in the intensive care unit of practices that either cause harm or are significantly costly relative to their benefit remains an elusive goal. Attempts at deadoption should target local ICU circumstances, while still encompassing the spectrum of care outside the ICU, engage nursing more fully, promote the use of local champions, especially peers, and recognize the requirement to seek sustainability.
Thyroid nodules in children and adolescents
Authors: Bauer Andrew J. 
Published: July 2019

Purpose of review
Compared with adults, there is a two-fold to three-fold increased risk of malignancy for a pediatric patient undergoing evaluation of a thyroid nodule. In 2015, the American Thyroid Association published guidelines on the evaluation and management of pediatric patients with thyroid nodules and differentiated thyroid cancer. The goal of this clinical update is to review recent additions to the literature and propose opportunities how to best incorporate these findings into clinical practice.

Recent findings
Recent additions to the literature include assessment of ultrasound-based scoring systems to improve selection of patients for fine needle aspiration, defining the pediatric-specific risk of malignancy within The Bethesda System for Reporting Thyroid Cytopathology, and broadening our knowledge of the oncogene landscape that supports incorporation of adjunct oncogene testing to rule-in malignancy of nodules with indeterminate cytology.

Summary
There have been significant additions to the literature on the evaluation and management of children and adolescents with thyroid nodules since publication of the 2015 American Thyroid Association guidelines. Incorporating these changes into clinical care, within the setting of multidisciplinary, pediatric-specific, regional centers, will maximize ongoing efforts to improve the care of children and adolescents with thyroid nodules.
Systemic inflammation and portal vein thrombosis in cirrhotic patients with gastroesophageal varices
Authors: Huang Xiaoquan , Fan Xiaowen , Zhang Rui , Jiang Siyu , Yang Kaiqi , Chen Shiyao 
Published: July 2019

Background and aim
Cirrhotic patients with gastroesophageal varices and non-tumoral portal vein thrombosis have a higher risk of re-bleeding and poor prognosis. This study aimed to analyze inflammatory biomarkers and thromboelastography in cirrhotic patients with portal vein thrombosis.

Methods
A total of 385 consecutive cirrhotic patients with gastroesophageal varices were prospectively enrolled between 1 December 2016, and 31 August 2017. Of these, 231 were eligible for analysis and were divided into portal vein thrombosis (n = 103) and non-portal vein thrombosis (n = 128) groups based on computerized tomography angiography findings.

Results
Patients with portal vein thrombosis generally had higher Child-Pugh scores than those without portal vein thrombosis (6.38 ± 0.12 vs. 5.81 ± 0.09, P < 0.001). The serum albumin levels were significantly lower in patients with portal vein thrombosis (35.90 ± 0.52 vs. 38.52 ± 0.43, P < 0.001). The portal vein thrombosis group had significant higher serum levels of interleukin 6 [4.85 (3.15–6.99) vs. 3.09 (2.06–5.20) pg/ml, P < 0.001] and tumor necrosis factor alpha [10.70 (7.60–15.20) vs. 9.07 (7.03–11.60) pg/ml, P = 0.020]. The interleukin 6 level was 2.5-fold higher in patients with portal vein thrombosis (adjusted odds ratio: 2.574; 95% confidential interval: 1.248–5.310). Thromboelastography showed that TEG-R, the reaction time, was significantly lower in the portal vein thrombosis group [5.20 (4.80–6.30) vs. 6.00 (5.20–6.95), P = 0.009], indicating enhanced coagulation activity.

Conclusion
This study confirmed the important role of systemic inflammation in portal vein thrombosis. Interleukin 6, an important inflammatory cytokine, is independently associated with portal vein thrombosis. The correlation between the interleukin 6 level and portal vein thrombosis requires further investigation.
Prevalence of Colorectal Neoplasms and Mortality in New Users of Low-Dose Aspirin With Lower Gastrointestinal Bleeding
Authors: Troelsen Frederikke S. , Farkas Dóra K. , Ording Anne G. , Erichsen Rune , Jick Susan , Sørensen Henrik T. 
Published: July 2019

Background:
Aspirin inhibits platelet function and may therefore accelerate early lower gastrointestinal bleeding (LGIB) from colorectal cancer (CRC) precursor polyps. The bleeding may increase endoscopic polyp detection.

Study Question:
To estimate the prevalence of polyps and CRC comparing new users of low-dose aspirin with nonusers who all received a diagnosis of LGIB and to investigate the mortality among these patients.

Study Design:
Using Danish nationwide health registries, we conducted a cohort study (2006–2013) of all new aspirin users who also received a diagnosis of LGIB (n = 40,578). Each new user was matched with 5 nonusers with LGIB by gender and age at the LGIB diagnosis date.

Measures and Outcomes:
We computed the prevalence and prevalence ratios (PRs) of colorectal polyps and CRCs, and the mortality ratios within 6 months after the LGIB, comparing new users with nonusers.

Results:
We identified 1038 new aspirin users and 5190 nonusers with LGIB. We observed 220 new users and 950 nonusers recorded with endoscopically detected polyps. New aspirin users had a higher prevalence of conventional {PR = 1.28 [95% confidence interval (CI): 1.06–1.55]} and serrated [PR = 1.31 (95% CI: 0.95–1.80)] polyps. New users and nonusers had a similar prevalence of CRC [PR = 1.04 (95% CI: 0.77–1.39)]. However, after stratifying by location of CRC, the prevalence of proximal tumors was lower [PR = 0.71 (95% CI: 0.35–1.43)] in new users than in nonusers. No difference in mortality was observed.

Conclusions:
These findings indicate that new use of low-dose aspirin is associated with an increased detection of colorectal polyps compared with nonuse.
Etiological Classification of Cerebral Ischemic Stroke by the TOAST, SSS-TOAST, and ASCOD Systems
Authors: Yang Xiao-Li , Zhu De-Sheng , Lv Hui-Hui , Huang Xin-Xin , Han Yan , Wu Shuai , Guan Yang-Tai 
Published: July 2019

Purpose:
To assess the impact of observer’s experience on reliability of etiological classification systems in patients with ischemic stroke.

Patients and Methods:
We retrospectively reviewed medical records of 80 patients with ischemic stroke in hospitals from August 2016 to March 2017 consecutively. Patients were classified by 4 observers with different clinical experiences and backgrounds (A, B, C, and D) according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST), Stop Stroke Study TOAST (SSS-TOAST), and ASCOD (A-atherosclerosis, S-small vessel disease, C-cardiac pathology, O-other cause, and D-dissection). The intraobserver reliability was assessed based on the initial and a second delayed assessment after 3 months, and the interobserver reliability of different pairs (A-B and C-D) and overall (A, B, C, and D) were compared based on the initial classification.

Results:
The reliability values of the 3 classification systems were improved with observer’s experience increasing, particularly in the TOAST system, in which the intraobserver reliability values of observers A, B, C, and D were 0.62, 0.73, 0.80, and 0.88, respectively, and slight differences were observed between the SSS-TOAST and ASCOD systems. The A-B pair had lower interobserver reliability value than the C-D pair, particularly in TOAST system with reliability values of 0.36 and 0.74, respectively, and a slight variation of interobserver reliability values were noted in the SSS-TOAST and ASCOD system.

Conclusions:
Observer’s experience may affect the reliability of etiological classification systems in patients with ischemic stroke.
Recurrent Stroke in Giant Cell Arteritis Despite Immunotherapy
Authors: Cox Benjamin C. , Fulgham Jimmy R. , Klaas James P. 
Published: July 2019

Objective:
To describe rare but important cerebrovascular complications of giant cell arteritis (GCA).

Case Report:
We report a 59-year-old man who initially presented with vasculitis of the lower extremities. While on steroids, he developed strokes in multiple vascular territories. The conventional angiogram showed stenosis of bilateral carotid and vertebral vessels as they entered the dura. Temporal artery biopsy confirmed GCA. He began cyclophosphamide treatment, which stabilized his clinical course; however, this was switched to tocilizumab by an outside rheumatologist. Two months later, the patient had progression of vessel stenosis and suffered additional strokes. Despite interventions to augment cerebral perfusion, the infarctions continued to expand and the patient passed away.

Conclusions:
This case highlights several important features of strokes in GCA: the predilection for the dural entry point of cerebral blood vessels, the progression of disease despite steroids, and the need to quickly escalate treatment in these cases. As seen in our patient, however, this disease carries high morbidity and mortality and patients often have poor outcomes despite aggressive immunosuppression.
Quality of Life of Myasthenia Gravis Patients in Regard to Epidemiological and Clinical Characteristics of the Disease
Authors: Stojanov Aleksandar , Milošević Vuk , Đorđević Gordana , Stojanov Jelena 
Published: July 2019

Background:
Myasthenia gravis (MG) affects overall quality of life (QoL). The aim of the research was to evaluate QoL in patients suffering from MG in regard to epidemiological and clinical factors of the disease.

Methods:
The study included 70 patients. The severity of clinical manifestation was estimated using quantitative MG score and MG composite score. Patients were classified by using Myasthenia Gravis Foundation of America Classification. The Questionnaire of Life Quality Specific for Myasthenia Gravis-15 items (MGQOL15) is developed for QoL assessment in patients suffering from MG. In addition to the MGQOL15 revised version (MGQOL15r), a 36-item health survey of the Medical Outcomes Study Short Form (SF36) questionnaire, the Hamilton scales for the assessment of anxiety (HAM-A), and depression (HAM-D) were also used.

Results:
MGQOL15r scores are negatively correlated with SF36 scores and positively correlated with scores on HAM-A and HAM-D scales (P<0.001). Patients with longer disease duration and severe clinical manifestation often manifest anxiety, depression, and have poorer QoL (P<0.05). In relation to the presence of the anti-nAchR antibody, statistically significant differences were found in relation to the summed scores on scales for assessing QoL, as well as on a HAM-A scale (P<0.05). Physical workers and unemployed patients had worse scores in relation to retired and administrators/intellectual workers on all scales (P<0.001).

Conclusion:
MGQOL15r is a life quality assessment questionnaire that could be used in routine practice in patients with MG. It is much simpler for use in these patients than SF36 and provides relevant data.