bluuebunny/crossref_metadata_2025_split huggingface dataset:
Central line bundle for prevention of central line–associated bloodstream infection for totally implantable venous access devices (ports) in pediatric cancer patients
Authors: Devrim İlker , Oruç Yeliz , Demirağ Bengü , Kara Ahu , Düzgöl Mine , Uslu Selma , Yaşar Nevbahar , Aydın Köker Sultan , Töret Ersin , Bayram Nuri , Vergin Canan 
Published: March 2018

Objective: The clinical impact of central line bundle programs for central line–associated bloodstream infections has been well demonstrated in intensive care units. However, the experience of central line bundle programs in totally implantable venous access devices (ports) in pediatric-hematology patients was limited. Methods: A retrospective study was designed to compare and evaluate the clinical impact of implementing a central line bundle for a 2-year 5-month period, including 10 months of prebundle period, 11 months of central line bundle (that includes needleless split-septum devices), and finally 8 months of central line bundle period in which single-use prefilled flushing devices were added to the previous central line bundle. Results: During the prebundle period, the rate of 14.5 central line–associated bloodstream infections per 1000 CL-days had decreased to 5.49 CLABSIs per 1000 CL-days in the first bundle period. The incidence rate ratio with these two groups was 0.379, indicating a relative risk reduction of 62% ( p = 0.005). By the addition of single-use prefilled flushing devices to the first bundle program, the central line–associated bloodstream infection rate decreased to 2.63 per 1000 CL-days. Port removal rate due to central line–associated bloodstream infections was 0.46 per 1000 catheter days in the bundle period, which was significantly lower than in the prebundle period in which port removal rate was 4.5 per 1000 catheter days ( p < 0.001). Conclusion: Central line bundle programs were found to be effective in decreasing central line–associated bloodstream infection rates, improving patients’ quality of life by preventing ports removal due in pediatric cancer patients.
Placement issues of hemodialysis catheters with pre-existing central lines and catheters
Authors: Aurshina Afsha , Hingorani Anil , Alsheekh Ahmad , Kibrik Pavel , Marks Natalie , Ascher Enrico 
Published: March 2018

Objective: It has been a widely accepted practice that a previous placed pacemaker, automatic implantable cardioverter defibrillators, or central line can be a contraindication to placing a hemodialysis catheter in the ipsilateral jugular vein. Fear of dislodging pacing wires, tunneling close to the battery site or causing venous obstruction has been a concern for surgeons and interventionalists alike. We suggest that this phobia may be unfounded. Methods: A retrospective review was conducted of patients in whom hemodialysis catheters were placed over a period of 10 years. For each hemodialysis catheter that was placed, perioperative chest X-ray performed was used to evaluate for pre-existing pacemakers and central lines. The position and laterality of placement of the hemodialysis catheter along with presence of arteriovenous fistula with functional capacity for access were noted. Results: A total of 600 hemodialysis catheters were placed in patients over the period of 10 years. The mean age of the patients was 73.6 ± 12 years with a median age of 76 years. We found 20 pacemakers or automatic implantable cardioverter defibrillators and 19 central lines on the same side of the neck as the hemodialysis catheter that was placed in the ipsilateral jugular vein. No patient exhibited malfunction or dislodgment of the central line, the pacemaker, or automatic implantable cardioverter defibrillator or evidence of upper extremity venous obstruction based upon signs symptoms or duplex exams. Conclusion: Based on our experience, we suggest that placement of hemodialysis catheter in the internal jugular vein ipsilateral to the pre-existing catheter/leads is safe and spares the contralateral limb for arteriovenous fistula creation.
Implanted ports in adults with primary immunodeficiency
Authors: Barton James C , Barton Jackson Clayborn , Bertoli Luigi F 
Published: March 2018

Background: We sought to learn more about the utility and safety of implanted ports for monthly immunoglobulin G infusions in adults with primary immune deficiency. Methods: We reviewed charts of adults who were referred to a single practice during the interval 2006–2016 for evaluation and management of frequent or severe upper and lower respiratory tract and other infections, subnormal total immunoglobulin G or immunoglobulin G subclasses, and suboptimal responses to polyvalent pneumococcal polysaccharide vaccinations; were diagnosed to have primary immune deficiency; and were advised to undergo immunoglobulin G therapy. Results: Of 606 patients, 20 (19 women, 1 man; 16 immunoglobulin G subclass deficiency, 4 common variable immunodeficiency; 3.3%) needed implanted ports because they had inadequate upper extremity superficial venous access. Median age at diagnosis was 48 years (range: 32–65 years). In total, 17 of the 20 patients preferred monthly in-office intravenous immunoglobulin G treatment to weekly at-home subcutaneous immunoglobulin G. The other three patients could not be treated with subcutaneous immunoglobulin G (unfavorable self-treatment experiences and insurance limitations). Median duration of treatment via implanted ports was 73 months (range: 10–153 months). In the man, the first implanted port was replaced after 26 months due to catheter fracture of unknown cause. His second port has been used for 112 months. We observed no other port-related failure, infections, thrombosis, or other adverse events. Conclusion: The utility and safety of implanted ports in adults with primary immune deficiency for whom subcutaneous immunoglobulin G therapy is not desired or feasible are probably similar to those of ports in patients without primary immune deficiency.
Restriction spectrum imaging of white matter and its relation to neurological disability in multiple sclerosis
Authors: Sowa Piotr , Harbo Hanne F , White Nathan S , Celius Elisabeth G , Bartsch Hauke , Berg-Hansen Pål , Moen Stine M , Bjørnerud Atle , Westlye Lars T , Andreassen Ole A , Dale Anders M , Beyer Mona K 
Published: March 2018

Background: Restriction spectrum imaging (RSI) is a recently introduced magnetic resonance imaging diffusion technique. The utility of RSI in multiple sclerosis (MS) is unknown. Objective: To investigate the association between RSI-derived parameters and neurological disability in MS. Methods: Seventy-seven relapsing–remitting MS patients were scanned with RSI on a 3-T scanner. RSI-derived parameters: fast and slow apparent diffusion coefficient (sADC), fractional anisotropy, restricted fractional anisotropy, neurite density (ND), cellularity, extracellular water fraction, and free water fraction, were obtained in white matter lesions (WML) and normal appearing white matter (NAWM). Patients were divided into three groups according to their expanded disability status scale (EDSS): with minimal, low, and substantial disability (<2.5, 2.5–3, and >3, respectively). Group comparisons and correlation analyses were performed. Results: All tested RSI-derived parameters differed between WML and NAWM ( p < 0.001 for all pairwise comparisons). The sADC in WML showed largest difference across disability subgroups (analysis of variance (ANOVA): F = 5.1, η2 = 0.12, p = 0.008). ND in NAWM showed strongest correlation with disability (ϱ = –0.39, p < 0.001). Conclusion: The strongest correlation with EDSS of ND obtained in NAWM indicates that processes outside lesions are important for disability in MS. Our study suggests that RSI-derived parameters may help understand the “clinico-radiological paradox” and improve disease monitoring in MS.
Prospective analysis of surfing and bodyboard injuries
Authors: Dimmick Simon , Gillett Mark , Buchan Craig , Sheehan Patrick , Franks Michelle , Ratchford Andrew , Porges Kate , Day Robert , Milne Tessa , Anderson Suzanne 
Published: March 2018

Objective To assess the differences in the types of injuries sustained by surfboard and bodyboard riders and to identify common mechanisms of injury. Methods Subjects were prospectively recruited to the study on presentation to one of the six hospital emergency departments. Consented subjects completed a questionnaire while in the emergency departments. Data regarding radiological investigations undertaken and their findings were collected retrospectively. Results A total of 224 males and 28 females in the surfing group and 14 males in the bodyboard group were recruited. In surfers, the most common injured body parts were the head/face (115; 45.6%) and lower limb (69; 27.4%). Surfers were most commonly injured by a surfboard, either their own (178; 70.6%) or someone else’s (18; 7.1%). Unfortunately, the small number of subjects recruited to the bodyboard group precluded meaningful comparison with the surfing group. Conclusions The most common body part injured in surfers is the head/face compared with the lower limbs in bodyboard riders. Contact with a surfer’s board (most commonly their own) is the most common cause of injury. Significant spinal fractures/injuries are sustained when the surfer (usually their head) strikes the seafloor. Head and facial fractures occur when the surfer is struck by their own board. Future research into surfboard design which incorporates softer compounds into the deck, rail, and fins is recommended. The need for local authorities and surf lifesavers to disseminate information relating to specific beaches to the general public regarding surf conditions, water depth, and the nature of the seafloor is also essential for injury prevention.
The Effect of Pelvic Floor Muscle Training On Incontinence Problems After Radical Prostatectomy
Authors: Aydın Sayılan Aylin , Özbaş Ayfer 
Published: March 2018

The aim of the current study was to determine the effect of pelvic floor muscle exercises (PFME/Kegel) training administered to patients scheduled for robot-assisted radical prostatectomy on postprocedural incontinence problems. This study was a randomized controlled trial. Pelvic floor muscle exercises were applied to the procedure group three times a day for 6 months. No exercises were applied to the control group. Incontinence and quality-of-life assessments of the 60 patients in the experimental and control groups were performed on months 0 (10 days after removal of the urinary catheter), 1, 3, and 6 through face-to-face and telephone interviews. Total Incontinence Consultation on Incontinence-Short Form scores, which provide an objective criterion for the evaluation of individuals with incontinence problems, decreased over time. This decrease was statistically highly significant in the third and sixth months. Pelvic muscle floor exercises are suitable for patients experiencing incontinence after radical prostatectomy.
Complex regional pain syndrome acute care pathways in England: Do they exist and what do they look like?
Authors: Gillespie Sharon , Cowell Fiona , McCabe Candy , Goebel Andreas 
Published: March 2018

Introduction Complex Regional Pain Syndrome is a condition with a high degree of morbidity and health costs to the National Health Service (NHS), characterised by persistent pain, sensory, motor, trophic and autonomic signs and symptoms. The British Orthopaedic Association (BOA) and the Royal College of Physicians (RCP) have recommended treatment guidelines and care pathways for the management of acute Complex Regional Pain Syndrome. The objective of this scoping exercise was to use Freedom of Information (FOI) requests to ascertain whether NHS Trusts in England had such pathways and what they looked like. Methods FOI requests were sent to 126 English NHS Trusts on 9 March 2017 on behalf of the Complex Regional Pain Syndrome Clinical and Research Network UK, asking: “What does your acute Complex Regional Pain Care Syndrome pathway look like?” Results Replies were received by 95 NHS Trusts and of these 84 had relevant services but (82%) had no pathway or agreed initial management. Conclusions It appears to be common for no acute care pathway to exist for CRPS in NHS Trusts in England despite it being a domain in BOA national guidelines. The Royal College of Physicians guidelines also recommend integrated MDT care. Consequentially, BOA and Royal College of Physicians standards in acute CRPS management are not yet being followed in most acute NHS Trusts in England providing trauma care. Where there is a pathway agreed, it is rarely integrated and truly multidisciplinary.
Accuracy Beyond ISO: Introducing a New Method for Distinguishing Differences Between Blood Glucose Monitoring Systems Meeting ISO 15197:2013 Accuracy Requirements
Authors: Pardo Scott , Shaginian Rimma M. , Simmons David A. 
Published: March 2018

Background: Diabetes treatment is intended to maintain near-normal glycemic levels. Self-monitoring of blood glucose (SMBG) allows patients to track their BG levels compared with glycemic targets and is associated with improved health outcomes. Because of the importance of SMBG, it is essential that results are accurate to prevent errors in nutritional intake and drug dosing. This study presents a new methodology to evaluate the accuracy of BG monitoring systems (BGMSs). Methods: Sensitivity analyses were performed using real and simulated BGMS data to compute probabilities that, for any BG value, the BGMS result would be within prescribed error bounds and confidence limits compared with laboratory reference values. Multiple BG value ranges were used. Results: Probability curves were created using data from 3 simulated BGMSs and anonymized data from 3 real-world BGMSs. Accuracy probability curves from capillary fingertip blood samples (actual clinical data) showed that all 3 real-world BGMSs met EN ISO 15197:2015 accuracy criteria, since 99.63%, 99.63%, and 99.81% of results from the 3 BGMSs were within ±15 mg/dL or ±15% of reference for BG <100 mg/dL and ≥100 mg/dL, respectively. However, there was identifiable variability between BGMSs if BG was <70 mg/dL; one BGMS showed further reductions in accuracy if BG was <50 mg/dL. Conclusions: Probability curves highlight the importance of BGMS accuracy to help achieve optimal glycemic control while avoiding hypoglycemia or hyperglycemia. This may be especially significant in very low BG ranges where small errors in BGMS measurements can have substantial impacts on patient-related outcomes, including hypoglycemia risk.
Effectiveness of Valgus Offloading Knee Braces in the Treatment of Medial Compartment Knee Osteoarthritis: A Systematic Review
Authors: Gohal Chetan , Shanmugaraj Ajaykumar , Tate Patrick , Horner Nolan S. , Bedi Asheesh , Adili Anthony , Khan Moin 
Published: March 2018

Context: Knee osteoarthritis affects 9.3 million adults over age 45 years in the United States. There is significant disability associated with this condition. Given the potential complications and the significant cost to the health care system with the dramatic increase in total knee arthroplasties performed for this condition, assessment of the efficacy of nonoperative modalities, such as offloading knee braces, is essential as part of optimizing nonoperative treatment for this condition. Objective: To determine the effectiveness of valgus offloader braces in improving clinical outcomes for patients with medial compartment knee osteoarthritis. Data Sources: Three databases (PubMed, MEDLINE, and EMBASE) were searched from database inception through July 28, 2017. Study Selection: Studies reporting outcomes of valgus offloader knee braces in the treatment of medial compartment knee osteoarthritis were included. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Data pertaining to demographics, descriptive statistics, and clinical outcomes were extracted from the included studies. The methodological quality of included studies was evaluated. Results: A total of 31 studies were included, with a total of 619 patients. The majority of studies reported improved pain outcomes using valgus offloader braces. However, variable results were reported as to whether valgus offloader braces significantly improved functional outcomes and stiffness. Offloader bracing was more effective at reducing pain when compared with neutral braces or neoprene sleeves. Conclusion: Valgus offloader bracing is an effective treatment for improving pain secondary to medial compartment knee osteoarthritis. The literature remains unclear on the effectiveness of valgus offloader braces with regard to functional outcomes and stiffness. Larger prospective randomized trials with consistent outcome assessment tools and consideration of patient compliance would be beneficial to more accurately determine treatment effects of valgus offloader bracing.
Guideline-adherence regarding critical time intervals in the German Chest Pain Unit registry
Authors: Vafaie Mehrshad , Hochadel Matthias , Münzel Thomas , Hailer Birgit , Schumacher Burghard , Heusch Gerd , Voigtländer Thomas , Mudra Harald , Haude Michael , Barth Sebastian , Schmitt Claus , Darius Harald , Maier Lars S , Katus Hugo A , Senges Jochen , Giannitsis Evangelos 
Published: March 2018

Background: Since 2008, the German Cardiac Society certified 256 Chest Pain Units (CPUs). Little is known about adherence to recommended performance measures in patients with suspected acute coronary syndrome (ACS) presenting to CPUs. We investigated guideline-adherence regarding critical time intervals and selected performance measures in German Chest Pain Units. Methods: From 2008 to 2014, 23,804 consecutive patients with suspected ACS were prospectively enrolled in the Chest Pain Unit registry of the German Cardiac Society. Results: Median time from symptom onset to first medical contact was 2 h in patients with ST-elevation myocardial infarction (STEMI) and 4 h in patients with unstable angina and non-STEMI (NSTEMI). In patients with STEMI, median time from hospital admission to percutaneous coronary intervention (PCI) was 40 min and median time from first medical contact to PCI was 1 h 35 min. Primary PCI was performed in 94.7% of patients with STEMI, 70.0% of patients with NSTEMI and 37.4% of patients with unstable angina. PCI was performed during the first 24 h in 79.5% of patients with NSTEMI and the first 72 h in 89.0% of patients with unstable angina. Electrocardiograms were performed in 99.5% after a median of 6 min after admission and obtained within 10 min in 71%. Interestingly, 56.1% of patients were found to have non-ACS diagnoses, underlining the importance of access to additional diagnostic modalities including echocardiography, stress testing or computed tomography. Conclusions: Guideline-adherence regarding critical time intervals and primary PCI rates is good in German Chest Pain Units. More than half of patients admitted with suspected ACS had non-ACS diagnoses. Improvements in pre-hospital time delays through public awareness programmes are warranted.
Scorpion Venom Causes Apoptosis by Increasing Reactive Oxygen Species and Cell Cycle Arrest in MDA-MB-231 and HCT-8 Cancer Cell Lines
Authors: Al-Asmari Abdulrahman Khazim , Riyasdeen Anvarbatcha , Islam Mozaffarul 
Published: March 2018

Objectives. The objective of this study was to examine the effect of scorpion venoms on cancer cell progression, apoptosis, and cell cycle arrest. Scorpion venoms are known to possess numerous bioactive compounds that act against cancer progression by inducing apoptosis. In this study, we have taken the venoms from the following 2 species of scorpion— Androctonus crassicauda and Leiurus quinquestriatus—and tested the anticancer properties of the venom against breast and colorectal cancer cell lines. Methods. Milking of scorpion venom and culturing the breast and colorectal cancer cell lines were done according to the standard procedure. The venom cytotoxicity was assessed by MTT methods, and the cellular and nuclear changes were studied with phase contrast and propidium iodide staining, respectively. The cell cycle arrest and accumulation of reactive oxygen species were analyzed on a Muse cell analyzer. Results. The venoms exerted cytotoxic effects on breast and colorectal cell lines in a dose- and time-dependent manner. Enhanced apoptotic cells, increase in reactive oxygen species, and cell cycle arrest were observed after challenging these cell lines with scorpion venoms. Conclusions. Scorpion venom induces apoptosis in breast and colorectal cell lines as reflected by the changes in the cell morphology and cell cycle studies. Furthermore, a high percentage of total reactive oxygen species as well as apoptotic cells also contribute to cell death as observed after venom treatments. To the best of authors’ knowledge, this is the first scientific evidence demonstrating the induction of apoptosis and cell cycle arrest by these species of scorpion venoms.
Protective Effect of Kolaviron on Cyclophosphamide-Induced Cardiac Toxicity in Rats
Authors: Omole Joseph Gbenga , Ayoka Oladele Abiodun , Alabi Quadri Kunle , Adefisayo Modinat Adebukola , Asafa Muritala Abiola , Olubunmi Babalola Olusegun , Fadeyi Benson Akinloye 
Published: March 2018

Background. Cyclophosphamide (CP) is a nitrogen mustard alkylating drug used for the treatment of chronic and acute malignant lymphomas, myeloma, leukemia, neuroblastoma, adenocarcinoma, retinoblastoma, breast carcinoma, and immunosuppressive therapy. Despite its vast therapeutic uses, it is known to cause severe cardiac toxicity. Kolaviron (KV), a Garcinia kola seed extract containing a mixture of flavonoids, is reputed for its antioxidant and membrane stabilizing properties. Objective. This study investigated the protective effect of KV on CP-induced cardiotoxicity in rats. Methods. Thirty rats were used, and they were divided into 6 groups of 5 rats each. Group I received 2 mL/kg propylene glycol orally for 14 days; group II received CP (50 mg/kg/d, intraperitoneally [i.p.]) for 3 days; groups III and IV received 200 and 400 mg/kg/d KV, respectively, orally for 14 days and groups V and VI were pretreated with 200 and 400 mg/kg/d KV, respectively, orally for 14 days followed by CP (50 mg/kg/d, i.p.) for 3 days. Results. CP treatment resulted in a significantly lower food consumption and body weight in rats. The lactate dehydrogenase and creatine kinase enzymes in cardiac tissues of rats treated with CP were significantly higher. In cardiac tissues, 3-day doses of CP resulted in significantly higher heart weight, cardiac troponin I, myeloperoxidase, malondialdehyde, hydrogen peroxide and lower superoxide dismutase, catalase, glutathione peroxidase activities, and reduced glutathione levels. Histological examination of cardiac tissues showed sign of necrosis of myocardium after CP treatment. However, administration of KV at 200 and 400 mg/kg for 14 days prior to CP treatment, increase food consumption, body weight, and attenuates the biochemical and histological changes induced by CP. Conclusions. These results revealed that KV attenuates CP-induced cardiotoxicity by inhibiting oxidative stress and preserving the activity of antioxidant enzymes.