bluuebunny/crossref_metadata_2025_split huggingface dataset:
Features of Adult Hyperammonemia Not Due to Liver Failure in the ICU
Authors: Sakusic Amra , Sabov Moldovan , McCambridge Amanda J. , Rabinstein Alejandro A. , Singh Tarun D. , Mukesh Kumar , Kashani Kianoush B. , Cook David , Gajic Ognjen 
Published: July 2018

Objectives:
To evaluate the epidemiology of hyperammonemia unrelated to liver failure in the critical care setting.

Design:
Retrospective case series.

Setting:
Critically ill patients admitted to ICUs at Mayo Clinic, Rochester, MN (medical ICU, two mixed medical-surgical ICUs, coronary care unit, or the cardiosurgical ICU) between July 1, 2004, and October 31, 2015.

Patients:
Adult critically ill patients with hyperammonemia not related to acute or chronic liver failure. We excluded patients with diagnosis of moderate or severe liver disease, hyperbilirubinemia, and patients who denied the use of their medical records.

Interventions:
None.

Measurements and Main Results:
Of 3,908 ICU patients with hyperammonemia, 167 (4.5%) had no evidence of acute or chronic liver failure. One-hundred one patients (60.5%) were male with median age of 65.7 years (interquartile range, 50–74.5 yr) and median serum ammonia level of 68 µg/dL (interquartile range, 58–87 µg/dL). Acute encephalopathy was present in 119 patients (71%). Predisposing conditions included malnutrition 27 (16%), gastric bypass six (3.6%), total parenteral nutrition four (2.4%); exposure to valproic acid 17 (10%); status epilepticus 11 (6.6%), high tumour burden 19 (11.3%), and renal failure 82 (49.1%). Urea cycle defects were diagnosed in seven patients (4.1%). Hospital mortality was high (30%), and median ammonia level was higher among the nonsurvivors (74 vs 67 µg/dL; p = 0.05). Deaths were more likely in hyperammonemic patients who were older (p = 0.016), had greater illness severity (higher Acute Physiology and Chronic Health Evaluation III score, p < 0.01), malignancy (p < 0.01), and solid organ transplantation (p = 0.04), whereas seizure disorder was more common in survivors (p = 0.02). After adjustment, serum ammonia level was not associated with increased mortality.

Conclusions:
Hyperammonemia occurs in a substantial minority of critically ill patients without liver failure. These patients have a poor prognosis, although ammonia level per se is not independently associated with mortality. Serum ammonia should be measured when risk factors are present, such as nutritional deficiencies and protein refeeding, treatment with valproic acid, high tumour burden, and known or suspected urea cycle abnormalities.
Benzodiazepine Use and Neuropsychiatric Outcomes in the ICU: A Systematic Review*
Authors: Kok Lotte , Slooter Arjen J. , Hillegers Manon H. , van Dijk Diederik , Veldhuijzen Dieuwke S. 
Published: July 2018

Objectives:
A systematic assessment of the role of benzodiazepine use during ICU stay as a risk factor for neuropsychiatric outcomes during and after ICU admission.

Data Sources:
PubMed/Medline, EMBASE, The Cochrane Library, CINAHL, and PsychINFO.

Study Selection:
Databases were searched independently by two reviewers for studies in adult (former) ICU patients, reporting benzodiazepine use, and neuropsychiatric outcomes of delirium, posttraumatic stress disorder, depression, anxiety, and cognitive dysfunction.

Data Extraction:
Data were extracted using a piloted extraction form; methodological quality of eligible studies was assessed by applying the Quality Index checklist.

Data Synthesis:
Forty-nine of 3,066 unique studies identified were included. Thirty-five studies reported on neuropsychiatric outcome during hospitalization, 12 after discharge, and two at both time points. Twenty-four studies identified benzodiazepine use as a risk factor for delirium, whereas seven studies on delirium or related outcomes did not; six studies reported mixed findings. Studies with high methodological quality generally found benzodiazepine use to be a risk factor for the development of delirium. Five studies reported an association between benzodiazepine use and symptoms of posttraumatic stress disorder, depression, anxiety, and cognitive dysfunction after ICU admission; five studies reported mixed findings, and in four studies, no association was found. No association was found with methodological quality and sample size for these findings. Meta-analysis was not feasible due to major differences in study methods.

Conclusions:
The majority of included studies indicated that benzodiazepine use in the ICU is associated with delirium, symptoms of posttraumatic stress disorder, anxiety, depression, and cognitive dysfunction. Future well-designed studies and randomized controlled trials are necessary to rule out confounding by indication.
The Impact of Early Adequate Treatment on Extubation and Discharge Alive of Patients With Pseudomonas aeruginosa-Related Ventilator-Associated Pneumonia*
Authors: Sommer Harriet , Timsit Jean-François , von Cube Maja , Schumacher Martin , Darmon Michael , Schwebel Carole , Ruckly Stéphane , Wolkewitz Martin 
Published: July 2018

Objectives:
We aim to examine the effect of early adequate treatment in comparison with inadequate or delayed treatment on being extubated or discharged alive over time, in patients with Pseudomonas aeruginosa-related ventilator-associated pneumonia.

Design:
Retrospective analyses of a prospective observational multicenter cohort study.

Setting:
ICU.

Patients:
Patients of the French prospective database (OUTCOMEREA) were included if they acquired a ventilator-associated pneumonia due to P. aeruginosa between 1997 and 2014 and were mechanically ventilated for more than 48 hours.

Interventions:
Early adequate treatment in comparison with inadequate or delayed adequate treatment.

Measurements and Main Results:
Multistate models were applied to estimate the time-dependent probability of being extubated or discharged alive, and separate Cox regression analyses were used to assess the treatment effect on all important events that influence the outcome of interest. A propensity score-adjusted innovative regression technique was used for a combined and comprehensive patient-relevant summary effect measure. No evidence was found for a difference between adequate and inadequate or delayed treatment on being extubated or discharged alive. However, for all patients, the probability of being extubated or discharged alive remains low and does not exceed 50% even 40 days after a P. aeruginosa-related ventilator-associated pneumonia.

Conclusions:
Early adequate treatment does not seem to be associated with an improved prognosis. Its potential benefit requires further investigation in larger observational studies.
Pollutant composition modification of the effect of air pollution on progression of coronary artery calcium
Authors: Keller Joshua P. , Larson Timothy V. , Austin Elena , Barr R. Graham , Sheppard Lianne , Vedal Sverre , Kaufman Joel D. , Szpiro Adam A. 
Published: July 2018

Background:
Differences in traffic-related air pollution (TRAP) composition may cause heterogeneity in associations between air pollution exposure and cardiovascular health outcomes. Clustering multipollutant measurements allows investigation of effect modification by TRAP profiles.

Methods:
We measured TRAP components with fixed-site and on-road instruments for two 2-week periods in Baltimore, Maryland. We created representative TRAP profiles for cold and warm seasons using predictive k-means clustering. We predicted cluster membership for 1005 participants in the Multi-Ethnic Study of Atherosclerosis and Air Pollution with follow-up between 2000 and 2012. We estimated cluster-specific relationships between coronary artery calcification (CAC) progression and long-term exposure to fine particulate matter (PM2.5) and oxides of nitrogen (NOX).

Results:
We identified two clusters in the cold season, notable for higher ratios of gases and ultrafine particles, respectively. A 5-μg/m3 difference in PM2.5 was associated with 17.0 (95% confidence interval [CI] = 7.2, 26.7) and 42.6 (95% CI = 25.7, 59.4) Agatston units/year CAC progression among participants in clusters 1 and 2, respectively (effect modification P = 0.006). A 40 ppb difference in NOX was associated with 22.2 (95% CI = 7.7, 36.7) and 41.9 (95% CI = 23.7, 60.2) Agatston units/year CAC progression in clusters 1 and 2, respectively (P = 0.08). Similar trends occurred using clusters identified from warm season measurements. Clusters correlated highly with baseline pollution level.

Conclusions:
Clustering TRAP measurements identified spatial differences in composition. We found evidence of greater CAC progression rates per unit PM2.5 exposures among people living in areas characterized by high ratios of ultrafine particle counts relative to NOX concentrations.
Safety and Efficacy in Prasugrel- Versus Ticagrelor-Treated Patients With ST-Elevation Myocardial Infarction
Authors: Dimitroulis Dimitrios , Golabkesh Milad , Naguib David , Knoop Betül , Dannenberg Lisa , Helten Carolin , Pöhl Martin , Jung Christian , Kelm Malte , Zeus Tobias , Polzin Amin 
Published: July 2018

Abstract:
Prasugrel and ticagrelor are recommended over clopidogrel in patients with ST-elevation myocardial infarction (STEMI). In this registry analysis, we compared efficacy and safety of ticagrelor and prasugrel P2Y12 inhibition in patients with STEMI. We included 318 patients in this single-center analysis. Twelve-month follow-up was conducted during ambulatory care at our department. Patients were on dual antiplatelet therapy with aspirin and ticagrelor or prasugrel during the follow-up period. Prescription of prasugrel or ticagrelor, respectively, was according to the preference of the treating physician. Major adverse cardiac and cerebrovascular events (MACCE) [death, myocardial infarction (MI), stroke, and unplanned reintervention] and thrombolysis in myocardial infarction (TIMI) bleeding (major/minor) were registered during hospitalization and follow-up. TIMI bleeding events were more frequent in ticagrelor-treated patients [17 vs. 5 patients, hazard ratio (HR) 2.85, 95% confidence interval (CI) 1.2–6.6; log-rank P value = 0.01]. Prasugrel-treated patients were significantly younger (ticagrelor 63 ± 12 years vs. prasugrel 57 ± 10; P < 0.0001). Besides that, patients' characteristics were similar in both groups. Multivariate analysis revealed that ticagrelor medication was independently associated with bleeding risk after adjustment for age, percutaneous coronary intervention approach (femoral vs. radial), diabetes mellitus, and kidney function (HR 3.01; 95% CI 1.0–7.4; P = 0.043). In patients treated with ticagrelor, 35 MACCE were detected. There was no difference as compared to prasugrel-treated patients (24 events, HR 1.24, 95% CI 0.79–2.09; log-rank P value = 0.41). TIMI bleeding events were more frequent in ticagrelor-treated patients with STEMI during 12-month follow-up. There were no differences in MACCE between groups in this registry analysis.
Simvastatin Treatment Protects Myocardium in Noncoronary Artery Cardiac Surgery by Inhibiting Apoptosis Through miR-15a-5p Targeting
Authors: Zhou Li , Liu Xiang , Wang Zhen-Qing , Li Yan , Shi Mao-Mao , Xu Zhe , Ou Zhi-Jun , Li Hua-Ming , Cheng Tian-Pu , Jian Yu-Peng , Zhang Wen , Liu Chen , Zhang Xi , Quon Michael J. , Zhang Chun-Xiang , Xu Ying-Qi , Wang Zhi-Ping , Ou Jing-Song 
Published: July 2018

Abstract:
Simvastatin treatment is cardioprotective in patients undergoing noncoronary artery cardiac surgery. However, the mechanisms by which simvastatin treatment protects the myocardium under these conditions are not fully understood. Seventy patients undergoing noncoronary cardiac surgery, 35 from a simvastatin treatment group and 35 from a control treatment group, were enrolled in our clinical study. Simvastatin (20 mg/d) was administered preoperatively for 5–7 days. Myocardial tissue biopsies were taken before and after surgery. Apoptosis was detected by TUNEL staining. The expressions of Bcl-2 and Bak in myocardial tissue were detected by immunoblotting. The expressions of miRNA and Bcl-2 mRNA were detected by quantitative real-time polymerase chain reaction assays. Cardiomyocytes were isolated from rat and cultured cells. MiR-15a-5p mimic was transfected into cardiomyocytes, and the Bcl-2 was detected by immunoblotting. TUNEL staining showed significantly less myocardial apoptosis in the simvastatin treatment group when compared with the control treatment group. Protein expression of Bcl-2 was increased in the simvastatin treatment group before surgery, and Bak expression was increased in the control treatment group after surgery. Further comparisons showed that Bcl-2/Bak ratios were reduced in the control treatment group but were not significantly changed in the simvastatin treatment group after surgery. Furthermore, microarray assays revealed that miR-15a-5p was significantly decreased by simvastatin treatment. This was validated by quantitative real-time polymerase chain reaction analysis. MiR-15a-5p was predicted to target Bcl-2 mRNA at nucleotide positions 2529–2536. This was validated by luciferase binding assays. Coincident with the change in miR-15a-5p, the mRNA expression of Bcl-2 was increased in the simvastatin treatment group. MiR-15a-5p mimic significantly inhibited Bcl-2 expression in cardiomyocytes. Our findings strongly suggest that simvastatin treatment preoperatively protected the myocardium in patients undergoing noncoronary artery cardiac surgery, at least in part, by inhibiting apoptosis via suppressing miR-15a-5p expression, leading to increasing expression of Bcl-2 and decreasing expression of Bak.
“Paying it forward”: The link between providers’ civility climate, civility toward patients and patient experience outcomes
Authors: Oppel Eva-Maria , Mohr David C. 
Published: July 2018

Background:
Interpersonal relationships are increasingly recognized as an important determinant for care performance and quality in the health care context. An unresolved issue in health care research is whether and to which extent providers’ perceptions of their work relationships are associated with their interactions with patients and, in turn, patient experience outcomes.

Purpose:
The aim of this study was to investigate the extent to which nurses’ experiences of their work relationship climate (i.e., civility climate) affect their interactions with patients (i.e., civility towards patients), which in turn contribute to patient experience outcomes (i.e., overall hospital rating, willingness to return, intent to recommend). Furthermore, we analyze the mediating role of civility toward patients in the relation between civility climate and patient experience outcomes.

Methodology:
The 2011 study sample comprised responses from 6,019 nurses and 38,619 patients at 123 Veterans Health Administration acute care inpatient hospitals located in the United States. We developed and empirically tested a theoretical model using multilevel regression modeling and assessing multilevel mediation.

Results:
The results indicate a positive association between civility climate and civility toward patients. With regard to patient experience outcomes, the analyses reveal a direct effect of civility climate on overall hospital rating, intent to recommend, and willingness to return and an indirect effect mediated by civility toward patients.

Conclusion and Practice Implications:
This is one of the first studies theorizing and testing the extent to which relationship climate among providers affect their interactions with patients. The findings provide support that providers who experience a positive civility climate are more likely to pay forward this relationship experience and engage in civility toward patients. The results point to the importance of a civility climate for ensuring and potentially improving patient experience of care.
High-Resolution Anterior Segment Optical Coherence Tomography in Intraepithelial Versus Invasive Ocular Surface Squamous Neoplasia
Authors: Singh Swati , Mittal Ruchi , Ghosh Arnav , Tripathy Devjyoti , Rath Suryasnata 
Published: July 2018

Purpose:
To evaluate the imaging characteristics of intraepithelial and invasive ocular surface squamous neoplasia (OSSN) on high-resolution anterior segment optical coherence tomography (ASOCT).

Methods:
In this prospective cross-sectional study, 17 consecutive patients (10 intraepithelial and 7 invasive) with histopathologically proven OSSN were included. All patients underwent slit-lamp imaging and time-domain ASOCT at premarked sites. Management included standard complete surgical excision with margin clearance and cryotherapy for all cases. The correlation between imaging characteristics and histopathology sections at the premarked sites was analyzed to determine surrogate markers that may help differentiate intraepithelial from invasive OSSN. In addition, 3 patients with presumed OSSN underwent serial ASOCT for surveillance.

Results:
All tumors were staged as T3N0M0 except 2 that were staged as T1N0M0 by the eighth edition of the American Joint Committee on Cancer (AJCC). Mean age was comparable between the 2 groups (56 years vs. 54 years for intraepithelial and invasive groups, respectively, P = 0.79). ASOCT characteristics included all cases (100%) showing a hyperreflective thickened epithelium and abrupt transition between normal and abnormal epithelium. Nine of 10 (90%) intraepithelial OSSN showed a clear plane of separation. A hyperreflective basal membrane was seen in 60% of intraepithelial OSSN, and hyporeflective zones were seen in 57% of invasive OSSN. Mean thickness was 924 and 1662 µm in intraepithelial and invasive OSSN, respectively (P = 0.02, Mann–Whitney test).

Conclusions:
A visible clear plane of separation and increased thickness on ASOCT may serve as surrogate markers of intraepithelial OSSN and help differentiate it from invasive OSSN.
Survival Analysis of Corneal Densitometry After Collagen Cross-Linking for Progressive Keratoconus
Authors: Chan Tommy C. Y. , Chan Jason C. K. , Wang Yu Meng , Rapuano Christopher J. 
Published: July 2018

Purpose:
To evaluate the history of densitometric data in patients with keratoconus undergoing corneal cross-linking.

Methods:
Twenty-two eyes of 22 patients with keratoconus were included. Corneal tomography and densitometry measurements were performed before and after accelerated corneal cross-linking. The duration of corneal haze was defined as the time between cross-linking and densitometry measurements returning to the preoperative value. Survival analysis of corneal haze after cross-linking was performed. Preoperative and postoperative corneal densitometry, maximum keratometry (Kmax), and central corneal thickness were compared.

Results:
The duration of corneal haze was 18.2 ± 3.8 months at the first zone of 0 to 2 mm and 10.9 ± 2.5 months at the second zone of 2 to 6 mm. There was no change in Kmax between the preoperative period and the time at which corneal haze resolved (P = 0.394 at the first zone; P = 0.658 at the second zone). Compared with the measurement taken at resolution of corneal haze, Kmax at 1 year after haze resolution was lower (62.0 ± 9.9 D to 61.2 ± 9.9 D, P = 0.008 at the first zone; 63.6 ± 10.9 D to 62.5 ± 10.1 D, P = 0.016 at the second zone). There was a decrease of central corneal thickness between the preoperative period and the time at which corneal haze resolved (470.8 ± 34.1 μm to 464.8 ± 34.5 μm, P = 0.047 at the first zone; 465.0 ± 35.3 μm to 454.7 ± 37.2 μm, P = 0.001 at the second zone), but it remained unchanged after haze resolution (P = 0.146 at the first zone; P = 0.067 at the second zone).

Conclusions:
Corneal cross-linking halted keratoconus progression when detectable haze was present. There was continuous corneal flattening measured at 1 year after haze resolution. Thinning of the cornea was seen only when haze was detectable after cross-linking.
Posttraumatic Growth of Stroke Survivors and Its Correlation With Rumination and Social Support
Authors: Peng Zhou-yuan , Wan Li-hong 
Published: July 2018

ABSTRACT

Objective: This study focused on gaining insight into the positive changes of stroke survivors. This study aimed to describe the level of posttraumatic growth (PTG) and explore its correlation with rumination and social support in stroke survivors. The impacts of individual characteristics on PTG were also discussed. Methods: A descriptive correlation design was used in this study. Stroke survivors from a tertiary hospital in Guangzhou City were investigated. The Posttraumatic Growth Inventory, Chinese version of Event Related Rumination Inventory, and Perceived Social Support Scale were used to assess the level of PTG, rumination, and social support. Results: The mean (SD) score of the Posttraumatic Growth Inventory was 61.12 (25.41). There were moderate positive correlations between PTG with rumination and social support among stroke survivors (r
1 = 0.392, r
2 = 0.336, P < .01). The level of education, support from family, and deliberate rumination accounted for 34.6% of the total variance in PTG (F = 11.554, P < .001). Conclusions: The phenomenon of PTG of stroke patients in hospital existed, but it was at a low level. Stroke survivors with a higher level of rumination, social support, and a university level education had a higher level of PTG.
Secondary Brain Injury: A Concept Analysis
Authors: Ortega-Pérez Stefany , Amaya-Rey María Consuelo 
Published: July 2018

ABSTRACT

Background: Traumatic brain injury and cerebrovascular disease may lead to motor, behavioral, and/or cognitive disabilities. The associated neurologic and vascular damage triggers a chain of events that lead to a secondary brain injury (SBI), a preventable cause of adverse neurological outcomes. Proper prevention of these factors may limit undesirable outcomes. This article presents a concept analysis that aims to form a single definition of the term secondary brain injury for nursing personnel. Methodology: Concept analysis was used to clarify the concept of SBI. An electronic search was performed on existing nursing literature dating from 1995 to 2016 on PubMed, MEDLINE, Ovid Journal, Wiley, and ProQuest. Results: A clear definition and description of the attributes, antecedents, and consequences of SBI increases the knowledge and level of recognition of the secondary injuries. This may lead to strategies that reduce the risk of long-term effects (disability) and poor clinical outcomes. Conclusions: This concept analysis contributes to the endeavor of identifying phenomena that are pertinent for nursing; it also provides a basis for future research that leads to improving nursing interventions and creating educational programs and healthcare policies that prevent or eliminate the consequences of SBI.