bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thalamocortical Tracts, but not the Putamen, Present Microstructural Abnormalities in Juvenile Myoclonic Epilepsy: A Diffusion Tractography Study
Authors: Esmail Eman , Yassine Inas , Zakaria Rania , El Dein Hadeel 
Published: March 2018

Background and Purpose The pathology of juvenile myoclonic epilepsy (JME) is related to thalamocortical dysfunction, and the putamen is closely related to the thalamocortical circuit. The purpose of this study is to evaluate the microstructure of the thalamo-cortico-striatal circuit in JME patients using diffusion tensor imaging (DTI).
Materials and Methods This case–control study was conducted on 13 patients with JME (10 females and 3 males with a mean age of 23.38 ± 4.75 years) and 9 age- and sex-matched volunteers as control subjects. All subjects underwent DTI and conventional magnetic resonance imaging. The data were then processed via denoising, registration, and segmentation of the internal capsule and right and left putamen using the FMRIB Software Library (FSL). The FSL was also used to calculate the different anisotropy measures: the fractional anisotropy (FA), mean diffusivity (MD), longitudinal diffusivity (LD), and radial diffusivity (RD).
Results The patients with JME had lower FA and higher LD in the thalamocortical tracts and lower MD in the frontal corticospinal tracts than the control subjects (p = 0.014, 0.001, and 0.04, respectively). No other significant differences were detected between the patients with JME and control subjects. The values measured in the right putamen were not significantly different from those measured in the left putamen in either the patients or controls.
Conclusion This study demonstrates that microstructural abnormalities occur in the thalamocortical tracts but not the putamen of patients with JME. Nevertheless, microstructural asymmetry was not observed in the patients with JME.
International Normalized Ratio Targets for Left-Sided Mechanical Valve Replacement
Authors: Gupta Saurabh , Belley-Cote Emilie , Sarkaria Anisha , Pandey Arjun , Spence Jessica , McClure Graham , Panchal Puru , Jaffer Iqbal , An Kevin , Eikelboom John , Whitlock Richard 
Published: April 2018

Background Guidelines recommend higher international normalized ratio (INR) targets for patients with mechanical valves believed to be at higher risk for thromboembolism. Higher INR targets are associated with increased bleeding risk. We performed a systematic review and meta-analysis assessing effects of lower and higher INR targets on thromboembolic and bleeding risk in patients with mechanical heart valves.
Methods We searched Cochrane CENTRAL, MEDLINE and EMBASE for randomized controlled trials (RCTs) evaluating lower versus higher INR targets for adults with bileaflet mechanical valves. We performed title and abstract screening, full-text review, risk of bias evaluation and data collection independently and in duplicate. We pooled data using a random effects model and used the Grading of Recommendations Assessment, Development and Evaluation framework to evaluate overall quality of evidence.
Results We identified six RCTs (n = 5,497). Lower INR targets were associated with significantly less bleeding—22% versus 40% (relative risk [RR]: 0.54, 95% confidence interval [CI]: 0.31, 0.93, p = 0.03, very low quality). There was no difference in thromboembolism—2% in both groups (RR: 1.28, 95% CI: 0.88, 1.85, p = 0.20, very low quality) or mortality—5.5% with lower INR targets versus 8.5% (RR: 1.00, 95% CI: 0.82, 1.21, p = 0.47, moderate quality).
Conclusion In patients with mechanical valves, higher INR targets are not supported by current evidence, which is of very low quality. In fact, our systematic review suggests that lower INR targets offer significantly lower bleeding risks with no significant difference in thromboembolic risk.
Vorgehen bei gastrointestinaler Blutung – die neue Leitlinie
Authors: Trebicka Jonel , Götz Martin 
Published: April 2018

Was ist neu?
Präendoskopisches Management Bei Verdacht auf gastrointestinale Blutung sind strukturierte Abläufe zu Risikostratifizierung, initialer Stabilisierung und Endoskopie definiert. Der Verdacht auf variköse Blutung erfordert neben dem Standard (PPI i. v., Erythromycin vor Endoskopie, ggf. Transfusion) spezifische medikamentöse Maßnahmen (Vasokonstriktoren, Antibiotika) bereits vor der Endoskopie, die bei Bestätigung für bis zu 5 bzw. 7 Tage durchgeführt werden.
Gerinnungsstatus und Antikoagulanzien Eine Notfallendoskopie zur Blutstillung soll unabhängig vom Gerinnungsstatus erfolgen.
Diagnostik Die Endoskopie ist diagnostisches und therapeutisches Verfahren der ersten Wahl bei der gastrointestinalen Blutung. Propofol ist auch im Notfall sicher zur Sedierung.
Therapie nicht variköser Blutungen Die alleinige endoskopische Injektionstherapie wird nicht empfohlen, sondern sollte mit einem mechanischen oder thermischen Verfahren kombiniert werden. Für neuere Therapieverfahren (großlumige Clips, Hämostasesprays, Stents) existieren vorläufige, gute Wirksamkeitsdaten in definierten Indikationen. Eine Biopsieentnahme ist auch während der Indexendoskopie möglich und sinnvoll zur Malignom- oder H.-pylori-Diagnostik. Bei schwerer unterer GI-Blutung verbessert eine zeitnahe Koloskopie nach intensivierter Darmvorbereitung die Detektion der Blutungsquelle.
Therapie der varikösen Blutung Bei Hochrisikopatienten mit Varizenblutung sollte die frühzeitige Anlage eines beschichteten TIPS erwogen werden. Bei refraktärer Blutung sollte ein Danis-Stent bei Ösophagusvarizen oder eine Linton-Nachlas-Sonde bei Fundusvarizen eingelegt und immer die Möglichkeit der TIPS-Implantation geprüft werden, ebenso bei Rezidivblutung bei fehlenden Kontraindikationen.
Doppler-Duplex-Sonografie der hirnversorgenden Gefäße – Fallstricke
Authors: Uphaus Timo , Gröschel Klaus 
Published: April 2018

ZusammenfassungDieser CME-Fortbildungsartikel soll einen strukturierten Untersuchungsgang der Doppler- und Duplexsonografie der hirnversorgenden Gefäße vermitteln und dabei auf besondere Schwierigkeiten/Fallstricke hinweisen. Im Einzelnen werden Kriterien zur Stenosegraduierung, häufig auftretende Fehlermöglichkeiten sowie anatomische und methodische Besonderheiten dargestellt.
Gonioscopy-assisted Transluminal Trabeculotomy: An Ab Interno Circumferential Trabeculotomy: 24 Months Follow-up
Authors: Grover Davinder S. , Smith Oluwatosin , Fellman Ronald L. , Godfrey David G. , Gupta Aditi , Montes de Oca Ildamaris , Feuer William J. 
Published: April 2018

Purpose:
The purpose of this study was to provide 24-month follow-up on surgical success and safety of an ab interno circumferential 360-degree trabeculotomy.

Methods:
Chart review of patients who underwent a gonioscopy-assisted transluminal trabeculotomy (GATT) procedure was performed by 4 of the authors (D.S.G., O.S., R.L.F., and D.G.G.). The surgery was performed in adults with various types of open-angle glaucoma with preoperative intraocular pressures (IOPs) of ≥18 mm Hg.

Results:
In total, 198 patients aged 24 to 89 years underwent the GATT procedure with at least 18 months follow-up. Patients with primary open-angle glaucoma had an average IOP decrease of 9.2 mm Hg at 24 months with an average decrease of 1.43 glaucoma medications. The mean percentage of IOP decrease in these primary open-angle glaucoma groups at 24 months was 37.3%. In secondary open-angle glaucoma, at 24 months there was an average decrease in IOP of 14.1 mm Hg on an average of 2.0 fewer medications. The mean percentage of IOP decrease in the secondary open-angle glaucoma groups at 24 months was 49.8%. The cumulative proportion of failure at 24 months ranged from 0.18 to 0.48, depending on the group. In all 6 study groups, at all 5 postoperative time points (3, 6, 12, 18, and 24 mo) the mean IOP and reduction in glaucoma medications was significantly reduced from baseline (P<0.001) with the exception of one time point.

Conclusions:
The 24-month results demonstrate that GATT is relatively safe and effective in treating various forms of open-angle glaucoma. The long-term results for GATT are relatively equivalent to those previously reported for GATT and ab externo trabeculotomy studies.
Scanning Behavior and Daytime Driving Performance of Older Adults With Glaucoma
Authors: Lee Samantha Sze-Yee , Black Alex A. , Wood Joanne M. 
Published: April 2018

Purpose:
The purpose of this study was to assess the link between visual scanning behavior and closed-road driving performance in older drivers with glaucomatous visual impairment.

Materials and Methods:
Participants included 13 older drivers with glaucoma [mean age=71.6±7.1 y; average better-eye mean deviation (MD)=−2.9±2.1 dB, average worse-eye MD=−12.5±7.1 dB] and 10 visually normal controls (mean age=70.6±7.4 y). Visual acuity, contrast sensitivity, visual fields, useful field of view, and motion sensitivity were assessed. Participants drove around a closed-road circuit while their eye movements were recorded with an ASL Mobile Eye-XG, and head movements recorded using the gyroscope sensors of a smart phone. Measures of driving performance included hazards hit, sign recognition, and lane-crossing time; an overall driving score was derived from these component measures.

Results:
Participants with glaucoma had significantly poorer overall driving scores (P=0.026) and hit more hazards (P=0.043) than controls. The glaucoma group also exhibited larger saccades (P<0.001) and horizontal (P<0.001) and vertical search variances (P=0.002) than controls. Larger saccades were associated with better driving scores in the glaucoma group (P=0.001), but not the controls (P=0.75). Head movements did not differ between groups. For all participants, better-eye MD was the strongest visual predictor of overall driving score (P<0.001), followed by the other measures of visual fields, motion sensitivity, contrast sensitivity, and useful field of view (P<0.05).

Conclusions:
Older drivers with glaucoma had poorer driving performance than controls and demonstrated differences in eye movement patterns. The association between larger saccades and better driving scores in those with glaucoma suggests that altering scanning behavior may benefit driving performance and safety in this group.
Cognitive impairment in a rat model of neuropathic pain: role of hippocampal microtubule stability
Authors: You Zerong , Zhang Shuzhuo , Shen Shiqian , Yang Jinsheng , Ding Weihua , Yang Liuyue , Lim Grewo , Doheny Jason T. , Tate Samuel , Chen Lucy , Mao Jianren 
Published: April 2018

Abstract
Clinical evidence indicates that cognitive impairment is a common comorbid condition of chronic pain. However, the cellular basis for chronic pain–mediated cognitive impairment remains unclear. We report here that rats exhibited memory deficits after spared nerve injury (SNI). We found that levels of stable microtubule (MT) were increased in the hippocampus of the rats with memory deficits. This increase in stable MT is marked by α-tubulin hyperacetylation. Paclitaxel, a pharmacological MT stabilizer, increased the level of stable MT in the hippocampus and induced learning and memory deficits in normal rats. Furthermore, paclitaxel reduced long-term potentiation in hippocampal slices and increased stable MT (evidenced by α-tubulin hyperacetylation) levels in hippocampal neuronal cells. Intracerebroventricular infusion of nocodazole, an MT destabilizer, ameliorated memory deficits in rats with SNI-induced nociceptive behavior. Expression of HDAC6, an α-tubulin deacetylase, was reduced in the hippocampus in rats with cognitive impairment. These findings indicate that peripheral nerve injury (eg, SNI) affects the MT dynamic equilibrium, which is critical to neuronal structure and synaptic plasticity.
The Relationship Between Nursing Workload, Quality of Care, and Nursing Payment in Intensive Care Units
Authors: CHANG Li-Yin , YU Hsiu-Hui , CHAO Yann-Fen C. 
Published: April 2018

ABSTRACT

Background:
Nursing workload is highly associated with patient safety. It has been argued that the imbalance between nursing payment and nursing workload in Taiwan National Health Insurance (NHI)-covered intensive care units (ICUs) has resulted in the inadequate allocation of nursing manpower. However, limited empirical data are currently available to support this argument.

Purpose:
The aim of this study was to investigate the correlation between nursing workload, quality of care, and NHI-covered nursing payments in ICU settings.

Methods:
This macrodata analysis study retrieved data from the existing ICU patient classification system, nursing quality monitoring system, and infection control monitoring system of a medical center in central Taiwan. Data on the Therapeutic Intervention Scoring System-28 (TISS-28) and non-TISS-28 scores, nursing hours, and nursing labor utilization rate were retrieved for the 23-month period beginning in January 2013 and ending in November 2014. The indices of care quality used in this study included incidence of falls, pressure sore density, incidence of restraint use, incidence of tube self-extraction, and infection density.

Results:
A total of 92,442 data sets were collected from eight ICUs, with 61% of the direct ICU nursing hours categorized as TISS-28 and 39% categorized as non-TISS-28. Mean nursing hours totaled 12.5 hours. The direct nursing hours, the total nursing hours, the bed occupancy rate, the nursing hours calculated by patient classification system, and the nursing hours calculated by nurse–patient ratio were statistically, significantly correlated respectively with all of the care quality indices except for incidence of falls. The number of items of patient care in the patient classification records was greater than that of NHI-covered nursing payments. The NHI-covered nursing payment for every patient accounted for only 4.77% of the total medical expenses in the ICU.

Conclusions/Implications for Practice:
Data from the patient classification database, quality monitoring database, and medical cost database indicate excessive nursing workload and underpayment from the Taiwan NHI program. Current nursing workload was significantly associated with care quality. This study provides empirical data for administrators to consider when revising nursing staffing and NHI payment policies.
Quality of Primary Care Provided to Medicare Beneficiaries by Nurse Practitioners and Physicians
Authors: Buerhaus Peter , Perloff Jennifer , Clarke Sean , O’Reilly-Jacob Monica , Zolotusky Galina , DesRoches Catherine M. 
Published: April 2018

Objective:
To examine differences in the quality of care provided by primary care nurse practitioners (PCNPs), primary care physicians (PCMDs), or both clinicians.

Data Sources:
Medicare part A and part B claims during 2012–2013.

Study Design:
Retrospective cohort design using standard risk-adjustment methodologies and propensity score weighting assessing 16 claims-based quality measures grouped into 4 domains of primary care: chronic disease management, preventable hospitalizations, adverse outcomes, and cancer screening.

Extraction Methods:
Continuously enrolled aged, disabled, and dual eligible beneficiaries who received at least 25% of their primary care services from a random sample of PCMDs, PCNPs, or both clinicians.

Principal Findings:
Beneficiaries attributed to PCNPs had lower hospital admissions, readmissions, inappropriate emergency department use, and low-value imaging for low back pain. Beneficiaries attributed to PCMDs were more likely than those attributed to PCNPs to receive chronic disease management and cancer screenings. Quality of care for beneficiaries jointly attributed to both clinicians generally scored in the middle of the PCNP and PCMD attributed beneficiaries with the exception of cancer screening.

Conclusions:
The quality of primary care varies by clinician type, with different strengths for PCNPs and PCMDs. These comparative advantages should be considered when determining how to organize primary care to Medicare beneficiaries.
Perforation of a Peptic Ulcer in a Hiatal Hernia Into the Left Ventricle With Systemic Air and Food Embolism
Authors: Igarashi Ikumi , Suzuki Keishi , Hosono Fumi , Ichinose Azusa , Abe Shoko , Sugiyama Akira , Sekido Yasutomo 
Published: April 2018

Abstract
Perforation of a peptic ulcer into the ventricle is uncommon, and the definitive diagnosis is difficult in living patients. We herein report a case of perforation of a peptic ulcer in a hiatal hernia into the left ventricle with systemic air and food embolism. This is the first case report of the perforation diagnosed by computed tomography and confirmed by autopsy. Computed tomography was useful for the diagnosis of perforation into the ventricle.
Left ventricular compressions improve return of spontaneous circulation and hemodynamics in a swine model of traumatic cardiopulmonary arrest
Authors: Anderson Kenton L. , Fiala Kristin C. , Castaneda Maria G. , Boudreau Susan M. , Araña Allyson A. , Bebarta Vikhyat S. 
Published: April 2018

BACKGROUND
Prehospital cardiopulmonary resuscitation, including closed chest compressions, has commonly been considered ineffective in traumatic cardiopulmonary arrest (TCPA) because traditional chest compressions do not produce substantial cardiac output. However, recent evidence suggests that chest compressions located over the left ventricle (LV) produce greater hemodynamics when compared to traditional compressions. We hypothesized that chest compressions located directly over the LV would improve return of spontaneous circulation (ROSC) and hemodynamics when compared with traditional chest compressions, in a swine model of TCPA.

METHODS
Transthoracic echocardiography was used to mark the location of the aortic root (traditional compressions), and the center of the LV on animals (n = 26) which were randomized to receive chest compressions in one of the two locations. After hemorrhage, ventricular fibrillation was induced. After 10 minutes of ventricular fibrillation, basic life support (BLS) with mechanical cardiopulmonary resuscitation was initiated and performed for 10 minutes followed by advanced life support (ALS) for an additional 10 minutes. During BLS, the area of maximal compression was verified using transesophageal echocardiography. Hemodynamic variables were averaged over the final 2 minutes of the BLS and ALS periods.

RESULTS
Five (38%) of the LV group achieved ROSC compared with zero of the aortic root group (p = 0.04). Additionally, there was an increase in aortic systolic blood pressure (SBP), aortic diastolic blood pressure (DBP) and coronary perfusion pressure (CPP) at the end of both the BLS (95% confidence interval, SBP, −49 to −21; DBP, −14 to −5.6; and CPP, −15 to −7.4) and ALS (95% confidence interval: SBP, −66 to −21; DBP, −49 to −6.8; and CPP, −51 to −7.5) resuscitation periods among the LV group.

CONCLUSION
In our swine model of TCPA, chest compressions performed directly over the LV improved ROSC and hemodynamics when compared with traditional chest compressions.
Patient Experience of Electroconvulsive Therapy
Authors: Brown Sarah K. , Nowlin Rachel B. , Sartorelli Rebecca , Smith Johan , Johnson Karen 
Published: April 2018

Objective
The aim of the study was to explore patient perception and perceived benefit of electroconvulsive therapy (ECT) by assessing the real-world experience of adult patients who received ECT, focusing on clinical outcomes and patient satisfaction.

Methods
This retrospective study analyzed patient self-report of depressive symptoms (Patient Health Questionnaire), perception of physical and cognitive ECT adverse effects (ECT Outcomes Survey) and satisfaction with treatment (Patient Satisfaction Survey). Symptoms and adverse effects were measured at both intake and final ECT session for comparison over time. Data were collected from 1089 adult patients with depression, bipolar disorder, or schizoaffective disorder in 23 psychiatric facilities in the United States and its territories from 2014 to 2015.

Results
On average, patient scores reflect satisfaction with treatment and reduction in depressive symptoms and adverse effects across the course of ECT treatment. Patients reported a decrease in depression, with an average Patient Health Questionnaire change of 13.2 from intake to final ECT session (P < 0.001). Furthermore, 85.5% of patients indicated on the Patient Satisfaction Survey that they benefited or improved as a result of their ECT. Subsequent analyses revealed alleviation of depressive symptoms and ability to return to social, and work life tasks are significant contributors to satisfaction with treatment, whereas adverse effects including memory problems have less influence on satisfaction.

Conclusions
Patients tend to perceive ECT as a safe and beneficial treatment option for severe mood disorders, even when considering adverse effects. This study reinforces the value of standardized data collection and outcomes measures to better monitor patient response to treatment, refine the clinical practice of ECT, and provide data to support patient education.
Neurocognitive Effects of Repetitive Transcranial Magnetic Stimulation With a 2-Coil Device in Treatment-Resistant Major Depressive Disorder
Authors: Kavanaugh Brian C. , Aaronson Scott T. , Clarke Gregory N. , Holtzheimer Paul E. , Johnson Clark W. , McDonald William M. , Schneider M. Bret , Carpenter Linda L. 
Published: April 2018

Background
Neurocognitive dysfunction is an understudied and undertreated aspect of psychiatric research and treatment. There is emerging evidence to suggest that repetitive transcranial magnetic stimulation (rTMS) may possess neurocognition-enhancing capabilities.

Methods
This study examined the neurocognitive data from a randomized, double-blind, sham-controlled trial of an investigational 2-coil rTMS device in antidepressant treatment or treatment-intolerant major depressive disorder patients. This device has the potential to stimulate deeper areas of the brain than the Food and Drug Administration–approved TMS devices, which primarily stimulate cortical brain areas and may therefore have different neurocognitive adverse effects. Patients received 20 daily rTMS treatments (10-Hz stimulation; either active or sham) with coil centers positioned over the left dorsolateral prefrontal cortex and dorsomedial prefrontal cortex. Neurocognitive safety was evaluated at baseline and within 72 hours of final treatment session with a computerized battery assessing aspects of attention and memory in 84 participants.

Results
There were no observed negative neurocognitive effects of the 2-coil rTMS device. A significant effect of active rTMS was observed on the quality of episodic memory. There were no observed effects for attention or working memory. Baseline quality of episodic memory predicted depression treatment response and remission, in that lower baseline episodic memory was associated with greater likelihood of depression response/remission. This was observed in logistic regression analyses controlling for treatment and baseline depressive symptoms.

Conclusions
The 2-coil rTMS device is a cognitively safe treatment for treatment-resistant depression that may possess episodic memory-enhancing capabilities. Furthermore, baseline episodic memory may reflect an important predictor of subsequent depression treatment response/remission to rTMS.