bluuebunny/crossref_metadata_2025_split huggingface dataset:
The ED-SED Study: A Multicenter, Prospective Cohort Study of Practice Patterns and Clinical Outcomes Associated With Emergency Department SEDation for Mechanically Ventilated Patients
Authors: Fuller Brian M. , Roberts Brian W. , Mohr Nicholas M. , Knight William A. , Adeoye Opeolu , Pappal Ryan D. , Marshall Stacy , Alunday Robert , Dettmer Matthew , Goyal Munish , Gibson Colin , Levine Brian J. , Gardner-Gray Jayna M. , Mosier Jarrod , Dargin James , Mackay Fraser , Johnson Nicholas J. , Lokhandwala Sharukh , Hough Catherine L. , Tonna Joseph E. , Tsolinas Rachel , Lin Frederick , Qasim Zaffer A. , Harvey Carrie E. , Bassin Benjamin , Stephens Robert J. , Yan Yan , Carpenter Christopher R. , Kollef Marin H. , Avidan Michael S. 
Published: August 2019

Objectives:
To characterize emergency department sedation practices in mechanically ventilated patients, and test the hypothesis that deep sedation in the emergency department is associated with worse outcomes.

Design:
Multicenter, prospective cohort study.

Setting:
The emergency department and ICUs of 15 medical centers.

Patients:
Mechanically ventilated adult emergency department patients.

Interventions:
None.

Measurements and Main Results:
All data involving sedation (medications, monitoring) were recorded. Deep sedation was defined as Richmond Agitation-Sedation Scale of –3 to –5 or Sedation-Agitation Scale of 2 or 1. A total of 324 patients were studied. Emergency department deep sedation was observed in 171 patients (52.8%), and was associated with a higher frequency of deep sedation in the ICU on day 1 (53.8% vs 20.3%; p < 0.001) and day 2 (33.3% vs 16.9%; p = 0.001), when compared to light sedation. Mean (sd) ventilator-free days were 18.1 (10.8) in the emergency department deep sedation group compared to 20.0 (9.8) in the light sedation group (mean difference, 1.9; 95% CI, –0.40 to 4.13). Similar results according to emergency department sedation depth existed for ICU-free days (mean difference, 1.6; 95% CI, –0.54 to 3.83) and hospital-free days (mean difference, 2.3; 95% CI, 0.26–4.32). Mortality was 21.1% in the deep sedation group and 17.0% in the light sedation group (between-group difference, 4.1%; odds ratio, 1.30; 0.74–2.28). The occurrence rate of acute brain dysfunction (delirium and coma) was 68.4% in the deep sedation group and 55.6% in the light sedation group (between-group difference, 12.8%; odds ratio, 1.73; 1.10–2.73).

Conclusions:
Early deep sedation in the emergency department is common, carries over into the ICU, and may be associated with worse outcomes. Sedation practice in the emergency department and its association with clinical outcomes is in need of further investigation.
Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock
Authors: Kuttab Hani I. , Lykins Joseph D. , Hughes Michelle D. , Wroblewski Kristen , Keast Eric P. , Kukoyi Omobolawa , Kopec Jason A. , Hall Stephen , Ward Michael A. 
Published: August 2019

Objectives:
Rapid fluid resuscitation has become standard in sepsis care, despite “low-quality” evidence and absence of guidelines for populations “at risk” for volume overload. Our objectives include as follows: 1) identify predictors of reaching a 30 mL/kg crystalloid bolus within 3 hours of sepsis onset (30by3); 2) assess the impact of 30by3 and fluid dosing on clinical outcomes; 3) examine differences in perceived “at-risk” volume-sensitive populations, including end-stage renal disease, heart failure, obesity, advanced age, or with documentation of volume “overload” by bedside examination.

Design:
Retrospective cohort study. All outcome analyses controlled for sex, end-stage renal disease, heart failure, sepsis severity (severe sepsis vs septic shock), obesity, Mortality in Emergency Department Sepsis score, and time to antibiotics.

Setting:
Urban, tertiary care center between January 1, 2014, and May 31, 2017.

Patients:
Emergency Department treated adults (age ≥18 yr; n = 1,032) with severe sepsis or septic shock.

Interventions:
Administration of IV fluids by bolus.

Measurements and Main Results:
In total, 509 patients received 30by3 (49.3%). Overall mortality was 17.1% (n = 176), with 20.4% mortality in the shock group. Patients who were elderly (odds ratio, 0.62; 95% CI, 0.46–0.83), male (odds ratio, 0.66; CI, 0.49–0.87), obese (odds ratio, 0.18; CI, 0.13–0.25), or with end-stage renal disease (odds ratio, 0.23; CI, 0.13–0.40), heart failure (odds ratio, 0.42; CI, 0.29–0.60), or documented volume “overload” (odds ratio, 0.30; CI, 0.20–0.45) were less likely to achieve 30by3. Failure to meet 30by3 had increased odds of mortality (odds ratio, 1.52; CI, 1.03–2.24), delayed hypotension (odds ratio, 1.42; CI, 1.02–1.99), and increased ICU stay (~2 d) (β = 2.0; CI, 0.5–3.6), without differential effects for “at-risk” groups. Higher fluid volumes administered by 3 hours correlated with decreased mortality, with a plateau effect between 35 and 45 mL/kg (p < 0.05).

Conclusions:
Failure to reach 30by3 was associated with increased odds of in-hospital mortality, irrespective of comorbidities. Predictors of inadequate resuscitation can be identified, potentially leading to interventions to improve survival. These findings are retrospective and require future validation.
Intratumor Heterogeneity of KIT Gene Mutations in Acral Lentiginous Melanoma
Authors: Comodo-Navarro Andréia Neves , Fernandes Mariana , Barcelos Denise , Carapeto Fernando Cintra Lopes , Guimarães Daiane Pereira , de Sousa Moraes Lais , Cerutti Janete , Iwamura Edna Sadayo Miazato , Landman Gilles 
Published: August 2019

Abstract:
Melanoma is an aggressive skin malignancy, and the acral lentiginous melanoma (ALM) subtype affects non–sun-exposed sites such as the volar surface of the hands and feet and the subungual region and is most common in Asians, Hispanics, and Afro-descendants. The presence of different clones within the same tumor seems to influence the aggressiveness of tumors. Patients with mutations in the KIT gene have shown a good response to tyrosine kinase inhibitor therapy. We tested the hypothesis of intratumor heterogeneity through analysis of KIT gene mutations in ALM and determined the correlation between KIT mutations and demographic, clinical, and histopathological variables. Twenty-five ALM samples were examined. We selected up to four different regions per tumor for sequencing by the Sanger method for analysis of KIT gene exon 11 and exon 13 mutations. Advanced lesions were predominant, and the main histopathological characteristics of lesions were Breslow index >4.0 mm (17/25, 68%), Clark level IV/V (21/25, 84%), ulceration (16/25, 64%), and >3 mitoses/mm2 (8/25, 32%). KIT gene mutations were detected in 11/25 cases (44%), and all these 11 cases displayed intratumor heterogeneity, that is, at least 2 tumor regions had different mutational profiles. The predicted effect of most mutations detected was detrimental to protein function. No significant correlations between histopathological variables and either KIT mutations or intratumor heterogeneity were observed. The hypothesis of intratumor heterogeneity of KIT gene mutations in acral lentiginous melanoma was supported.
A Systematic Review of the Treatment of Superficial Leiomyosarcoma With Mohs Micrographic Surgery
Authors: Murphy‐Chutorian Blair , Routt Ethan , Vinelli Gian , Ciocon David 
Published: August 2019

BACKGROUNDWide local excision (WLE) with 2 to 5 cm margins has been conventionally used for the treatment of superficial leiomyosarcoma (LMS). Because margin control is the strongest predictor of clinical recurrence, many dermatologic surgeons have recently recommended Mohs micrographic surgery (MMS) over wide local excision (WLE) as the primary treatment modality.OBJECTIVETo determine the aggregate rate of local recurrence after treatment of superficial LMS with MMS among the few reports in the literature.METHODSA systematic literature search using the PubMed/MEDLINE database and the Cochrane Library was performed from inception to June 2017. One case report from our institution was included.RESULTSA meta‐analysis of 14 reports of 48 cases of superficial LMS treated with MMS showed a mean recurrence rate of 2.08% to 6.25% with a mean follow‐up period of 1570.9 days, compared to reported recurrence rates of 30% to 50% for WLE. Among these cases there were no reports of distant metastases.CONCLUSIONTreatment of superficial leiomyosarcoma with MMS shows markedly lower rates of recurrence compared to reported rates of recurrence after WLE. Further prospective trials with larger sample sizes are needed to compare both modalities.
Antimicrobial Irrigation and Technique during Breast Augmentation: Survey of Current Practice
Authors: Epps Mathew T. , Langsdon Sarah , Pels Taylor K. , Lee Tara M. , Thurston Todd , Brzezienski Mark A. 
Published: August 2019

Background:
Breast augmentation is among the most common procedures performed in the United States. Though bacterial contamination of breast prostheses is associated with adverse sequelae, there are no universally accepted guidelines and limited best practice recommendations for antimicrobial breast pocket irrigation. We designed a survey to identify pocket irrigation preferences and antimicrobial techniques during implant-based breast augmentation among American Society of Plastic Surgeons (ASPS) members.

Methods:
In January 2018, a random cohort of 2,488 ASPS members was surveyed. Questions queried breast pocket irrigation methods and surgical techniques including implant placement, incision location, and implant soaking agents. An extensive literature review of breast pocket irrigation practices was completed and used as a basis for the survey.

Results:
The survey response rate was above the ASPS average at 16% (n = 407). Respondents preferred an inframammary incision (90%) and submuscular implant placement (92%). Triple antibiotic solution (TAS) and TAS + Betadine ± Bacitracin were preferred by 61% and Betadine variants by 11%. Preferred dwell times stratified to 30 seconds (39%), 1 minute (18%), 2–5 minutes (21%), and >5 minutes (22%). Among those employing a TAS variant, 53% preferred a suboptimal dwell time of ≤1 minute. Prostheses were soaked in TAS (42%), TAS + Betadine ± Bacitracin (15%), a Betadine variant (12%), or other (31%).

Conclusions:
Periprosthetic bacterial contamination leads to comorbidity following breast augmentation. Our results reveal significant variability regarding breast pocket irrigation techniques among ASPS members during cosmetic breast augmentation. These data suggest the need for best practice guidelines regarding breast pocket irrigation and implant soaking agents.
People With COPD Who Respond to Ground-Based Walking Training Are Characterized by Lower Pre-training Exercise Capacity and Better Lung Function and Have Greater Progression in Walking Training Distance
Authors: Ho Jian Ping , Alison Jennifer A. , Ng L. W. Cindy , Wootton Sally L. , McKeough Zoe J. , Jenkins Sue C. , Eastwood Peter R. , Hillman David R. , Jenkins Christine , Spencer Lissa M. , Cavalheri Vinicius , Hill Kylie 
Published: August 2019

Purpose:
To investigate the characteristics that distinguish responders from nonresponders to ground-based walking training (GBWT) in people with chronic obstructive pulmonary disease (COPD).

Methods:
An analysis was undertaken of data collected during a trial of GBWT in people with COPD. Responders to GBWT were defined in 2 ways: (1) improved time on the endurance shuttle walk test of ≥190 sec (criterion A); or (2) improved ability to walk, perceived by the participant to be at least “moderate” (criterion B). Differences in participant characteristics, pre-training exercise capacity, health-related quality of life, and the improvement in the distance walked during the training program were examined between responders and nonresponders.

Results:
Of the 95 participants randomized to GBWT (age 69 ± 8 yr, forced expiratory volume in 1 sec [FEV1] % predicted = 43% ± 15%), data were available for analysis on 78 and 73 patients by criterion A and criterion B, respectively. According to criterion A, 32 (41%) participants were responders. The odds of being a responder increased with increasing FEV1 % predicted (OR = 1.2; 95% CI, 1.0-1.5, for every 5% increase) and increased with decreasing pre-training incremental shuttle walk distance (OR = 1.4; 95% CI, 1.0-1.8, for every 50-m decrement). According to criterion B, 42 (58%) participants were responders. There were no differences in characteristics or pre-training measures between the responders and nonresponders. For both criteria, responders demonstrated greater change in the distance walked during the training program (P < .05).

Conclusion:
Responders to GBWT had lower pre-training exercise capacity, had better lung function, and demonstrated greater change in the distance walked during the training program.
A Randomized Study Examining the Effects of Mild-to-Moderate Group Exercises on Cardiovascular, Physical, and Psychological Well-being in Patients With Heart Failure
Authors: Redwine Laura S. , Wilson Kathleen , Pung Meredith A. , Chinh Kelly , Rutledge Thomas , Mills Paul J. , Smith Barbara 
Published: August 2019

Purpose:
To compare 2 mild-to-moderate group exercises and treatment as usual (TAU) for improvements in physical function and depressive symptoms.

Methods:
Patients with heart failure (n = 70, mean age = 66 yr, range = 45-89 yr) were randomized to 16 wk of tai chi (TC), resistance band (RB) exercise, or TAU.

Results:
Physical function differed by group from baseline to follow-up, measured by distance walked in the 6-min walk test (F = 3.19, P = .03). Tai chi participants demonstrated a nonsignificant decrease of 162 ft (95% confidence interval [CI], 21 to −345, P = .08) while distance walked by RB participants remained stable with a nonsignificant increase of 70 ft (95% CI, 267 to −127, P = .48). Treatment as usual group significantly decreased by 205 ft (95% CI, −35 to −374, P = .02) and no group differences occurred over time in end-systolic volume (P = .43) and left ventricular function (LVEF) (P = .67). However, groups differed over time in the Beck Depression Inventory (F = 9.2, P < .01). Both TC and RB groups improved (decreased) by 3.5 points (95% CI, 2-5, P < .01). Treatment as usual group decreased insignificantly 1 point (95% CI, −1 to 3, P = .27).

Conclusions:
Tai chi and RB participants avoided a decrease in physical function decrements as seen with TAU. No groups changed in cardiac function. Both TC and RB groups saw reduced depression symptoms compared with TAU. Thus, both TC and RB groups avoided a decrease in physical function and improved their psychological function when compared with TAU.
Development of New Pharmaceutical Candidates With Antioxidant Activity for the Treatment of Corneal Disorders
Authors: Higuchi Akihiro 
Published: August 2019

Abstract:
The ocular surface is continuously exposed to physical and chemical factors in the environment. Oxidative stress, which strongly affects the ocular surface, is caused by several factors, including ultraviolet irradiation, fine particles, and tobacco smoke. Oxidative stress is one of the pathogeneses for corneal disorders. Thus, corneal epithelium and tear fluid contain antioxidants and antioxidative enzymes to protect the cornea against oxidative stress. Because autologous serum eye drops are useful for the treatment of corneal disorders caused by dry eye, these eye drops are globally used as a therapeutic intervention in patients with dry eye. We investigated the serum components that exert antioxidative effects to clarify the mechanism of action for serum antioxidants on corneal epithelial cells and to apply these components as drugs for the treatment of corneal disorders. We found that selenoprotein P, a known selenium-transfer plasma glycoprotein, was secreted into the tear fluid to supply the corneal epithelium with selenium. Selenium participates in the regulation of oxidative stress in many tissues, including the cornea. We subsequently developed selenium compounds for application in eye drops and successfully prepared Se-COMP as a new candidate for the treatment of corneal disorders.
Case Report
Authors: Torres-Luna Jonathan , del Olmo-Arroyo Francisco , Mercader-Pérez Mariana , Rodríguez-Cintrón William 
Published: August 2019

Abstract

Mycoplasma pneumoniae is a well-known cause of community-acquired respiratory tract infection, specifically in the childhood population, and represents approximately 15% of all community-acquired pneumonia cases. Mycoplasma pneumoniae is also known for its extrapulmonary manifestations, with cardiovascular presentation being one of the most common. Gastrointestinal manifestations of the disease have been described as well, and evidence stipulates that it could be the first presentation of a M. pneumoniae infection. In our case, a cholestatic pattern was documented initially prior to pulmonary manifestations. Reviewed literature described this presentation as a possible early presentation in patients, but predominant in the pediatric population. Evidence-based data reveal that there is only 1 case reported in the adult population with above gastrointestinal manifestation.
Failure of Doxycycline Postexposure Prophylaxis in Human Brucellosis Contracted Through Needlestick Injury
Authors: Al Mayahi Zayid K. 
Published: August 2019

Abstract
Although brucellosis has a relatively high global prevalence rate, the highest number of reports is often presented in developing countries. Occupational risk factors for brucellosis are well recognized, with individuals working directly or indirectly with animals or in laboratories classified as high risk. This article presents the case of a high-risk male patient who incurred a needlestick injury as part of his work as a veterinary assistant. The patient was treated with a 21-day course of doxycycline upon first presentation but nonetheless developed brucellosis infection.
It is proposed that a dual prophylaxis of doxycycline and rifampin prescribed on the day of exposure would have been a more effective intervention compared with monotherapy of doxycycline and that symptom monitoring and serological follow-up should have been carried out to reduce the risk of complications. This article recommends improvements in the enforcement of prevention procedures within high-risk occupational settings to reduce the risk of brucellosis infection, and adds a value to the importance of the prophylaxis for the countries that do not follow postexposure prophylaxis.
Hepatitis B and C prevalence and risk factors among young men presenting to the Brazilian Army
Authors: da Motta Leonardo Rapone , Adami Aline De Gregori , Sperhacke Rosa Dea , Kato Sérgio Kakuta , Paganella Machline Paim , Pereira Gerson Fernando Mendes , Benzaken Adele Schwartz 
Published: August 2019

Abstract
Viral hepatitis is caused by different etiological agents with distinct epidemiological, clinical, and laboratory characteristics accounting for significant worldwide morbidity and mortality. Since 1996, the Brazilian Department of Sexually Transmitted Infections (STIs), Acquired Immune Deficiency Syndrome (AIDS) and Viral Hepatitis (DIAHV) in collaboration with the Ministry of Defense has been conducting periodic serosurveys of conscripts enlisted for the Brazilian army to assess STI prevalence and obtain data on knowledge and risk factors pertaining to STIs. This article aims to present the hepatitis B (hepatitis B surface antigen - HBsAg) and C (anti-HCV) seroprevalence estimates and risk factors as per the 8th edition of the Conscript Survey performed in 2016.
This cross-sectional study was conducted among conscripts across Brazil aged 17 to 22 years from August to December 2016. It included a self-reported questionnaire and blood testing for syphilis, human immunodeficiency virus (HIV), and hepatitis B and C.
In total 38,247 conscripts were enrolled; after applying exclusion criteria, 37,282 conscripts were included. The estimated HBsAg and anti-HCV prevalence rates were 0.22% and 0.28%, respectively. Higher HBsAg and anti-HCV prevalence rates were observed in the North Region (0.49%) and in the Central-west Region (0.65%), respectively. Regarding hepatitis B vaccination, 23.5% (n = 8412) of the individuals reported being unvaccinated and 47.4% (n = 16,970) did not know if they had been vaccinated. Among the anti-HCV positive conscripts, 53% (n = 51, 0.56%, P = .049) reported that they had never had sexual intercourse. Regarding self-reported STI status, most of the positive anti-HCV (n = 100, 0.29%, P < .01) and positive HBsAg (n = 76, 0.22%, P = .205) conscripts reported not having a STI. From those who tested positive for HBsAg, 89% (n = 42, 0.28%, P = .005) reported not making consistent use of condoms with steady partners.
Our data suggest a low prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among Brazilian young men, and relatively low rates of self-reported HBV immunization. History of STIs, higher number of partners, inconsistent use of condoms, and lack of awareness of routes of transmission were significantly associated with HBV and HCV infections. To achieve the World Health Organization's goal of viral hepatitis elimination, access to hepatitis information, testing, and surveillance need to be improved.
Genetic polymorphisms and pancreatic cancer risk
Authors: Dai Peng , Li Jing , Li Weibin , Qin Xueliang , Wu Xiaoyong , Di Weidong , Zhang Yanzhong 
Published: August 2019

AbstractBackgrounds:Previous investigations yielded inconsistent results for the associations between pancreatic cancer (PC) risk and genetic polymorphisms. The study aimed to perform a systematic review and meta-analysis of studies exploring association of some genetic polymorphisms and PC risk.Methods:We systematically searched on PubMed and Web of Science for association of genetic polymorphisms and PC risk published from 1969 to January 2019. We computed the multivariate odd ratio (OR) and 95% confidence intervals (CI), comparing different genetic types.Results:The present meta-analysis showed significant associations between deoxyribonucleic acid (DNA) repair gene (X-ray repair cross-complementing group 1 (XRCC1)Arg399GInandArg194Trp, excision repair cross complementation 1 (ERCC1) rs11615 and rs3212986, ERCC2 rs13181) polymorphisms and PC risk.Conclusions:Because of the limited sample size and ethnicity enrolled in the present meta-analysis, further larger scaled studies should be performed to demonstrate the association.