bluuebunny/crossref_metadata_2025_split huggingface dataset:
Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: A technical report
Authors: Lamanna Anthony , Maingard Julian , Bates Davina , Ranatunga Dinesh , Goodwin Mark 
Published: September 2019

SummaryAdvances in interventional radiology have seen the adaptation of urological endoscopic laser techniques to treat biliary tract calculi. Percutaneous transhepatic biliary laser lithotripsy provides an effective alternative procedure for the management of intrahepatic or conventionally refractory choledocholithiasis which would otherwise require invasive and high‐risk surgical intervention. Several small studies have validated the procedure for management in this subset of patients, with most achieving 100% calculi clearance with minimal complications. Most patients are suitable for percutaneous transhepatic biliary laser lithotripsy. Preprocedural imaging is useful for evaluating stone burden and planning percutaneous access. Holmium lasers are commonly used and act by vaporising water particles on and in the calculi, fragmenting the stone via thermal expansion. A series of catheters, wires, sheaths and dilators are used to allow introduction of the choledochoscope and laser so that calculi can be targeted. Percutaneous transhepatic biliary laser lithotripsy is often used in conjunction with balloon dredging and biliary stricture dilatation. Only experienced interventionalists should perform this procedure, and users should be aware of associated hazards. Repeat percutaneous transhepatic cholangiography is routinely performed to confirm eradication of stones. Treatment of biliary calculi and obstruction is important in preventing diseases such as cholangitis and cirrhosis. For patients unsuitable for conventional treatment, percutaneous transhepatic laser lithotripsy is a safe and effective alternative when performed by experienced interventional radiologists. Preprocedural planning is imperative to procedure success.
DEX‐2‐TKA—DEXamethasone twice for pain treatment after Total Knee Arthroplasty: A protocol for a randomized, blinded, three‐group multicentre clinical trial
Authors: Gasbjerg Kasper S. , Hägi‐Pedersen Daniel , Lunn Troels H. , Jakobsen Janus C. , Overgaard Søren , Pedersen Niels A. , Bagger Jens , Lindholm Peter , Brorson Stig , Schrøder Henrik M. , Thybo Kasper H. , Mathiesen Ole 
Published: September 2019

BackgroundMultimodal analgesia is considered the leading principle for post‐operative pain treatment, but no gold standard after total knee arthroplasty (TKA) exists.AimTo investigate the beneficial and harmful effects of one or two doses of 24 mg intravenous dexamethasone (DXM) as part of a multimodal analgesic regimen (paracetamol, NSAID and perioperative local infiltration analgesia) after TKA. We hypothesize that addition of DXM will reduce post‐operative opioid consumption.MethodsDEXamethasone twice for pain treatment after TKA is a randomized, blinded, three‐group multicentre clinical trial. Participants will be randomized to one of three groups: placebo, single dose of DXM or two consecutive doses of DXM. Participants, treatment providers and investigators will be blinded to the allocated intervention. The primary outcome is total opioid consumption (units of morphine equivalents) 0‐48 hours post‐operatively. Inclusion criteria: unilateral, primary TKA; age ≥18 years; American Society of Anesthesiologists‐Score 1‐3; Body Mass Index ≥18 and ≤40; for women—not pregnant; and written informed consent. Exclusion criteria: allergy or contraindications against trial medication; daily use of high dose opioid and/or use of methadone/transdermal opioids; daily use of systemic glucocorticoids; dysregulated diabetes; and patients suffering from alcohol and/or drug abuse. Four‐hundred‐and‐eighty‐six eligible participants are needed to detect or discard a difference of 10 mg morphine equivalents 0‐48 hours post‐operatively maintaining a familywise error rate of 0.05 and a power of 90% for the three possible pairwise comparisons.DiscussionRecruiting is planned to commence September 2018 and expected to finish March 2020.Trial RegistrationEudraCT: 2018‐001099‐39 (08/06‐18); ClinicalTrials.gov: NCT03506789 (24/04‐2019).
Editorial CommentThis is the protocol for the largest randomized clinical trial investigating the effect of one or two doses of dexamethasones on pain treatment after total knee arthroplasty. Due to the pragmatic and rigerous design this study will deliver results of high quality and external validity.
Exposure to risperidone versus other antipsychotics and risk of osteoporosis‐related fractures: a population‐based study
Authors: Clapham E. , Bodén R. , Reutfors J. , Svensson T. , Ramcharran D. , Qiu H. , Kieler H. , Bahmanyar S. 
Published: September 2019

ObjectiveAntipsychotics may increase serum prolactin, which has particularly been observed with risperidone. Further, hyperprolactinemia has been linked to osteoporosis‐related fractures. Therefore, we investigated fracture risk in a nationwide cohort exposed to antipsychotics.MethodsSwedish registers were used to identify adults with two consecutive dispensations of risperidone (n = 38 211), other atypical antipsychotics not including paliperidone (n = 60 691), or typical antipsychotics (n = 17 445) within three months between 2006 and 2013. An osteoporosis‐related fracture was defined as a non‐open hip/femur fracture in primary analyses. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsRisperidone users were on average older (mean age of 68, 44, and 63 years for risperidone, other atypical antipsychotics, and typical antipsychotics respectively). Compared with other atypical antipsychotics, there was no association between risperidone and osteoporosis‐related fractures in the overall (HR = 1.04, CI: 0.91–1.19) or age‐stratified analyses. A significantly increased risk of typical antipsychotics (HR = 1.24, CI: 1.07–1.45) compared with other atypical antipsychotics remained for ages >45 years.ConclusionRisperidone does not appear to be associated with an increased risk of osteoporosis‐related fracture compared with other atypical antipsychotic agents as a group. For typical antipsychotics, a moderately elevated risk of hip fractures was noted compared with other atypical antipsychotics, possibly because of residual confounding.
Amphibian chytrid fungus in Africa – realigning hypotheses and the research paradigm
Authors: Doherty‐Bone T. M. , Cunningham A. A. , Fisher M. C. , Garner T. W. J. , Ghosh P. , Gower D. J. , Verster R. , Weldon C. 
Published: September 2019

AbstractThe amphibian chytrid fungus Batrachochytrium dendrobatidis (Bd), responsible for numerous amphibian declines and extinctions, was previously thought to originate from the African continent. This was based on infected museum specimens from early 20th century South Africa, Cameroon and Uganda. Further research on archived specimens from other continents eventually revealed early 20th century records also in Brazil and Japan. Recent robust analysis of genomic diversity and phylogeny of Bd has shown origin from Asia to be more plausible. This raises the issue that the threat of Bd for African amphibians as a novel pathogen has been underestimated. There are now cases where dramatic amphibian declines in disparate mountains on the continent could be attributed to Bd, and this necessitates an urgent realigning of hypotheses and the research agenda for amphibian conservation on the continent. Notably, hotspots of amphibian host naivety include West Africa where this pathogen has so far not been detected. We discuss research gaps that amphibian conservationists might focus on, notably more genomic sequencing of the BdCAPE (the less virulent) lineage to determine its date of emergence, and assessing the susceptibility of different amphibian species to infection, disease and decline to better prioritize conservation actions.
Sex matching does not impact the outcome after simultaneous pancreas‐kidney transplantation
Authors: Messner Franka , Etra Joanna W. , Haugen Christine E. , Bösmüller Claudia , Maglione Manuel , Hackl Hubert , Riedmann Marina , Oberhuber Rupert , Cardini Benno , Resch Thomas , Scheidl Stefan , Margreiter Raimund , Öfner Dietmar , Schneeberger Stefan , Margreiter Christian 
Published: September 2019

AbstractBackgroundSeveral studies in solid organ transplantation have shown a correlation between donor and recipient sex mismatch and risk of graft loss. In this study, we aimed to analyze the impact of donor and recipient sex matching on patient and pancreas graft survival in a large single‐center cohort.MethodsWe retrospectively analyzed all first simultaneous pancreas‐kidney transplants performed between 1979 and 2017 at the Medical University of Innsbruck.ResultsOf 452 patients, 54.6% (247) received a sex‐matched transplant. Patient survival (P = .86), death‐censored pancreas graft survival (dcPGS, P = .26), and death‐censored kidney graft survival (dcKGS, P = .24) were similar between the sex‐matched and sex‐mismatched groups. Patient survival and dcPGS at 1, 5, and 15 years were 95.9%, 90.0%, and 62.1% and 86.1%, 77.1%, and 56.7% in the sex‐matched group and 93.6%, 86.2%, and 62.4% and 83.1%, 73.3%, and 54.3% in the sex‐mismatched group. Sex matching led to a lower odds of severe postoperative complications (41.2% vs 49.0%; OR 0.57, 95%CI 0.33‐0.97; P = .038); however, no increased odds of other adverse postoperative outcomes was detected.ConclusionOur study demonstrates that sex matching reduced the odds of postoperative complications but did not impact other early and late outcome parameters in our cohort.
Continuous glucose monitoring to assess glycemic control in the first 6 weeks after pancreas transplantation
Authors: Dadlani Vikash , Kaur Ravinder Jeet , Stegall Mark , Xyda Souzana‐Eirini , Kumari Kanchan , Bonner Keisha , Smith Byron , Thapa Prabin , Dean Patrick G. , Kudva Yogish C. 
Published: September 2019

AbstractBackgroundCurrent therapy for Type 1 diabetes (T1D) is characterized by significant glucose variability (GV). Pancreas transplantation (PT) is performed in certain T1D patients with and without end‐stage renal disease. To date, GV has been examined to a limited extent after PT.MethodsWe investigated GV using continuous glucose monitoring (CGM) 3‐6 weeks after PT.ResultsEleven patients had simultaneous kidney pancreas transplantation (SPK), nine pancreas after kidney (PAK), and six pancreas transplantation alone (PTA). Mean CGM showed no difference between SPK, 126.5 ± 13.9, PAK 119.9 ± 12.8, and PTA 131.1 ± 29 mg/dL (P value .6). Percentage of time in range (TIR, 70‐180 mg/dL) was 92% for SPK, 93.4% in PAK, and 88.5% in PTA with only 0.3%, 1.5%, and 0.3% of time <70 mg/dL. Percentage >180 mg/dL was 7.9% for SPK, 4.9% PAK, and 11% in PTA. Other measures of GV were similar in the three cohorts. In six patients, CGM was performed before and after PT and improved significantly. GV was also better compared with a matched cohort of T1D patients.ConclusionsAll 3 types of PT resulted in excellent glucose control 3‐6 weeks post‐procedure. CGM outcomes represent an important objective outcome after PT.
Local surgical treatment of cutaneous squamous cell carcinoma: deficits and controversies in the literature
Authors: Breuninger Helmut , Eigentler Thomas , Häfner Hans‐Martin , Leiter Ulrike 
Published: September 2019

SummaryThe prognostic impact of primary excision in the treatment of cutaneous squamous cell carcinoma depends on certain tumor characteristics (risk factors), the surgical approach chosen and the subsequent histological examination.For the development of the AWMF (Association of Scientific Medical Societies in Germany) guidelines for squamous cell carcinoma, the most conclusive guidelines available were evaluated using the DELBI tool (German Instrument for the Methodological Appraisal of Guidelines). These were the Scottish and Canadian guidelines as well as the joint guidelines published by EDF, EADO and EORTC. The primary literature on the aforementioned topics that was used for these guidelines included 49 studies and 9 reviews. None of the studies had a prospective, randomized design; 19 studies contained prospective data; 30 studies provided retrospective data. Overall, the results were heterogeneous. Not only were there discrepancies in terms of the validity of the various risk factors for locoregional disease progression – such as dedifferentiation, desmoplasia and perineural invasion – but also with respect to tumor thickness and surgical consequences. Differences were also found regarding the histological processing method used. In general, there are two such methods: conventional histology (bread loaf technique) and complete histological assessment of excision margins. The latter was found to be associated both with low recurrence rates and low metastatic rates, possibly due to the fact that patients treated with the latter method had lower‐risk tumors. Publications on bread loaf histology lacked precise information as to how the tissue was actually processed. Likewise, there was a lack of usable data in terms of the surgical margins used in the primary excision.Conclusion: The current literature is inconsistent and insufficient with regard to the various prognostic factors and the surgical approach to cutaneous squamous cell carcinoma.
Normal ranges for automatic measurements of tissue Doppler indices of mitral annular motion by echocardiography. Data from the HUNT3 Study
Authors: Grue Jahn Frederik , Storve Sigurd , Støylen Asbjørn , Torp Hans , Haugen Bjørn Olav , Mølmen Harald Edvard , Dalen Håvard 
Published: September 2019

AbstractBackgroundAutomatic quantification of left ventricular (LV) function could enhance workflow for cardiologists and assist inexperienced clinicians who perform focused cardiac ultrasound. We have developed an algorithm for automatic measurements of the mitral annular plane systolic excursion (MAPSE) and peak velocities in systole (S′) and early (e′) and late (a′) diastole. We aimed to establish normal reference values for the automatic measurements and to compare them with manual measurements.Methods and ResultsHealthy participants (n = 1157, 52.5% women) from the HUNT3 cross‐sectional population study in Norway were included. The mean age ± standard deviation (SD) was 49 ± 14 (range: 19–89) years. The algorithm measured MAPSE, S′, e′, and a′ from apical 4‐chamber color tissue Doppler imaging (cTDI) recordings. The manual measurements were obtained by two echocardiographers, who measured MAPSE by M‐mode and the velocities by cTDI. For men and women, age‐specific reference values were created for groups (mean ± 1.96SD) and by linear regression (mean, 95% prediction interval). Age was negatively correlated with MAPSE, S′, and e′ and positively correlated with a′. There were small differences between genders. Normal reference ranges were created. The coefficients of variation between automatic and manual measurements ranged from 5.5% (S′) to 11.7% (MAPSE).ConclusionNormal reference values for automatic measurements of LV function indices are provided. The automatic measurements were in line with the manual measurements. Implementing automatic measurements and comparison with normal ranges in ultrasound scanners can allow for quick and precise interpretation of LV function.
Obesity in pregnancy causes a volume overload in third trimester
Authors: Vonck Sharona , Lanssens Dorien , Staelens Anneleen Simone , Tomsin Kathleen , Oben Jolien , Bruckers Liesbeth , Gyselaers Wilfried 
Published: September 2019

AbstractBackgroundObesity is a major risk factor for cardiovascular diseases. In this study, we aimed to investigate the maternal circulatory differences during pregnancy between obese and normal weight women.Materials and methodsThe functioning of the maternal circulation (arteries, veins, heart and body fluid) was assessed by ECG‐Doppler ultrasound, impedance cardiography (ICG) and bio‐impedance during pregnancy in obese women (BMI ≥30 kg/m2) and normal weight, nonobese women (BMI 20‐25 kg/m2). In this observational study, 232 assessments were performed in the obese group, whereas 919 assessments were performed in the nonobese group.ResultsRelative to nonobese women, the overall cardiovascular function in obese women during first and second trimester is consistent with a high volume/low‐resistance circulation. In third trimester, cardiac output of obese women decreases from 9.2 (8.2‐10.7) L/min to 8.5 (7.6‐9.6) L/min (P = .037) whereas this is not true in the nonobese women (from 7.8 (7‐8.5) L/min to 7.8 (6.8‐8.9) L/min, P = .536). Simultaneously, the persistently lower peripheral vascular resistance in obese vs nonobese women disappears (880 (761‐1060) dyn.sec/cm5 vs 928 (780‐1067).ConclusionsThe circulatory gestational adaptations between nonobese and obese women were generally similar. The findings in the third trimester suggest that a pregnancy in obese women start as a state of high volume/low resistance, gradually shifting to a volume overload with decrease of cardiac output and disappearance of low vascular resistance. This evolution makes obese women vulnerable for gestational hypertensive diseases.
Disclosure strategies in adults with epilepsy when telling, “I have epilepsy”: The How2tell study
Authors: Elliott Naomi , Pembroke Sinead , Quirke Mary , Pender Niall , Higgins Agnes 
Published: September 2019

AbstractObjectiveTo generate evidence‐based knowledge about the strategies that adult people with epilepsy (PWEs) use in the process of telling others about their epilepsy.MethodsIn‐depth, one‐to‐one interviews explored PWEs’ first‐hand experiences of self‐disclosure (or not), and grounded theory methods of inductive‐deductive analysis were used to identify strategies used in disclosing. Interviews were audio‐recorded, transcribed, coded, and independently recoded by two researchers using a coding framework specifically developed in this study. To account for maximum variation, PWEs (aged 18+ years) with different life experiences and situations relating to (1) gender, (2) age, (3) employment status, (4) personal relationships, (5) family relationship, (6) support group involvement, and (7) seizure frequency were included. Given the many variables and psychosocial issues associated with epilepsy, demographic details and validated measures including Quality of Life in Epilepsy‐10‐P, Coping Inventory of Stressful Situations‐Adult, and Patient Health Questionnaire‐9 were used to describe the characteristics of participants and to contextualize the results.ResultsForty‐nine adults with epilepsy participated. Data analysis revealed six interrelated categories (with subcategories) of the strategies that PWEs reported using in the process of disclosure: (1) concerns about disclosing; (2) weighing up who and when to tell; (3) opportunities for telling; (4) moment of disclosure—how to construct the message; (5) tailoring the message to audience needs—altering the message when telling family members, partner, friends, children, or employer and workplace colleagues; and (6) managing reactions by making it ordinary.SignificancePeople with epilepsy use a range of different strategies during the process of disclosing their epilepsy. These strategies were used to inform the development of the How2tell multimedia self‐management resource for PWEs on self‐disclosure in everyday social and life situations. How2tell is designed to benefit PWEs by empowering them with practical information about the process of telling another person, “I have epilepsy.”
Formulation of survival acceptor medium able to maintain the viability of skin explants over in vitro dermal experiments
Authors: Tarnowska M. , Briançon S. , de Azevedo J. Resende , Chevalier Y. , Barratier C. , Pourcher T. , Bolzinger M.‐A. 
Published: September 2019

AbstractObjectiveIn vitro assessments of skin absorption of xenobiotics are essential for toxicological evaluations and bioavailability studies of cosmetic and pharmaceutical ingredients. Since skin metabolism can greatly contribute to xenobiotic absorption, experiments need to be performed with skin explants kept viable in suitable survival media. Existing protocols for non‐viable skin are modified to consider those conditions. The objective was to design a survival medium used as an acceptor fluid in Franz cells for testing cutaneous penetration of hydrophilic or lipophilic molecules. Their metabolism inside skin may be investigated under the same conditions. The determining factors involved in survival mechanisms in vitro are discussed. The consequences of short‐term skin preservation at 4°C were also evaluated.MethodsThe metabolic activity of fresh skin samples mounted in Franz cells was studied by measurement of lactate release over 24 h in order to assess the impacts of pH, buffering, osmolality, ionic strength, initial glucose supply and the addition of ethanol or non‐ionic surfactant in the acceptor part of Franz cells.ConclusionSurvival media must maintain physiological pH (>5.5) be isotonic with skin cells (300 mOsm kg−1) and contain at least 0.5 g L−1 glucose. Several compositions able to preserve skin metabolism are reported. Storage of skin explants overnight at 4°C impairs skin metabolic activity. The present work provides guidelines for designing survival media according to constraints related to the scientific requirements of the experiments.
Clinical and epidemiological characteristics of childhood vitiligo: a study of 701 patients from Brazil
Authors: Martins Clarissa Pereira dos Santos , Hertz Amanda , Luzio Paulo , Paludo Patricia , Azulay‐Abulafia Luna 
Published: September 2019

AbstractBackgroundVitiligo is an acquired pigmentary disorder that affects approximately 0.5–2% of the world's population, and 25% of cases begin before 10 years of age. Although prevalent, there are few studies on the characterization of childhood vitiligo.ObjectiveTo evaluate the clinical and epidemiological characteristics of childhood vitiligo.MethodsTransverse study conducted by reviewing data records of patients under the age of 18 in which disease onset occurred before 13 years of age.ResultsPredominance of females (62%). The most common subtype was generalized vitiligo (53.8%). The average age of disease onset was 5.9 years. The most affected initial site was head/neck (44.22%). The Koebner phenomenon was present in 38.2%, emotional triggering factors in 67.0% of the patients, halo nevus in 17.4%, and associated autoimmune disease in 6.5% of the patients. Family history of vitiligo was observed in 16.9% of the patients, and stability was reported by 20.1% of patients. The presence of positive family history did not significantly influence the age of onset. We found a significant difference between segmental vitiligo (SV) and nonsegmental vitiligo (NSV) regarding the age of onset, Koebner phenomenon, hypothyroidism, anti‐TPO antibodies, family history of psoriasis, and halo nevus.ConclusionChildhood vitiligo has its own characteristics. Vitiligo different subtypes have distinct characteristics. Our study presents a great number of patients, helping to elucidate the peculiarities of childhood vitiligo in the Brazilian population.