bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of hepatitis delta virus among hemodialysis and renal transplant patients
Authors: Pierre Alessandra Maria Mont`Alverne , Feldner Ana Cristina de Castro Amaral , Carvalho Filho Roberto José de , Lopes Edmundo Pessoa de Almeida , Gouvea Michele Soares Gomes , Pinho João Renato Rebello , Carvente Claudia Teresa , Emori Christini Takemi , Silva Genimari Arruda da , Ferraz Maria Lúcia Cardoso Gomes 
Published: March 2018

Introduction: Hepatitis B virus infection is an important cause of liver disease in hemodialysis patients and renal transplant recipients. Hepatitis Delta virus is a defective virus transmitted by the same route of hepatitis B virus, which requires the helper function of hepatitis B virus. Data about hepatitis B virus/hepatitis delta virus coinfection are scarce and there are no studies regarding the coinfection among hemodialysis patients and renal transplant in our country. Objective: This study aimed to investigate the prevalence of hepatitis delta virus infection among hemodialysis patients and renal transplant recipients. Methods: Cross-sectional study analyzing virological markers of hepatitis B virus and hepatitis delta virus infection and biochemical and clinical features of liver disease of patients infected with hepatitis B virus in hemodialysis and renal transplant. Results: A total of 117 HBsAg-positive patients (46 hemodialysis and 71 renal transplant) were included. The mean age was 48.5 ± 11.8 years and 67% were males. Antiviral therapy was given to 74% of patients. Liver function tests were within the normal range. HBeAg-positive was found in 35% of patients and median hepatitis B virus DNA was 2.98 log (IU/mL). Cirrhosis was detected in 26.5% of patients. The prevalence of anti–hepatitis delta virus total antibody (+) was 1.7% (2/117). None of the 2 patients had active hepatitis delta virus infection, since all samples tested negative for hepatitis delta virus–RNA. Conclusion: The results suggest a low prevalence rate of coinfection B and D in hemodialysis and renal transplant recipients in this population.
Complications and adequacy of transplant kidney biopsies: A comparison of techniques
Authors: Plattner Brett W , Chen Pauline , Cross Richard , Leavitt Matthew A , Killen Paul D , Heung Michael 
Published: March 2018

Introduction: Kidney biopsies are an essential tool in the diagnosis and management of kidney diseases, particularly in kidney transplant recipients. Biopsies carry a risk for serious complications and not all biopsies achieve adequate tissue. We examined the impact of kidney biopsy technique on complications and biopsy adequacy. Methods: The cohort consisted of consecutive kidney transplant patients undergoing biopsy by one of three techniques: ultrasound localization, real-time ultrasound guidance, and ultrasound-guided trocar placement. Variables of interest included patient characteristics and procedural characteristics. The primary outcome was serious complication attributable to kidney biopsy, and the secondary outcome was biopsy adequacy as defined by Banff criteria. Results: Among 263 patients undergoing biopsy, 27 (10.3%) had a complication (14 with gross hematuria, 10 requiring blood transfusion, 3 requiring an unplanned interventional radiology procedure, 1 kidney loss; no deaths). Complications were more common among patients biopsied using ultrasound-guided trocar compared to real-time ultrasound and ultrasound localization (21.4% vs 7.9% vs 7.1%, respectively, p = 0.008). After adjusting for patient and procedure characteristics, technique was no longer significantly associated with complication. Biopsy adequacy was significantly higher when using ultrasound localization and real-time ultrasound compared to ultrasound-guided trocar (84.6% vs 86.8% vs 69.6%, p = 0.029), and this finding persisted in adjusted analysis. Conclusion: Kidney biopsy complications appear to be similar when using any of the three techniques examined in our study. However, ultrasound-guided trocar technique may yield lower biopsy adequacy when compared to non-trocar techniques.
Peripherally inserted central catheters in the treatment of children with cancer: Results of a multicenter study
Authors: Rykov Maxim Yu , Zaborovskij Sergei V , Shvecov Alexander N , Shukin Vladimir V 
Published: March 2018

Purpose: To review our experience with peripherally inserted central catheters in pediatric cancer patients. Methods: The analysis included 353 patients (3 months up to 17 years, mean age 11.2 years) with a variety of cancers diseases, which in 2011–2016, 354 peripherally inserted central catheters were placed. All settings are carried out using ultrasound guidance. In 138 (39%) patients, external anatomical landmarks were used and in 216 (61%) intraoperative fluoroscopy. Results: Maximal duration of the line was 1.3 years, the lowest 1.5 months, and average 6.3 months. Among the technical difficulties during placement, most frequently have been the migration of the distal end of the catheter into the internal jugular vein against blood flow—32 (9%) patients. In one (0.3%) case, we were unable to catheterize the patient’s vein. Among the most common complications of operation were marked peripherally inserted central catheter clot occlusion of the lumen—26 (7.3%) cases. Symptomatic catheter-related thrombosis was observed in 16 (4.5%) cases. Catheter-related blood stream infections were not reported. Removal of peripherally inserted central catheters related to the complications was performed in 30 (8.5%) patients who were later implanted venous ports. Conclusion: Peripherally inserted central catheters are recommend to use in the treatment of children with cancer. There should be trained nursing staff to minimize the risk of complications.
Feasibility of using the Fitbit® Charge HR in validating self-reported exercise diaries in a community setting in patients with heart failure
Authors: Deka Pallav , Pozehl Bunny , Norman Joseph F , Khazanchi Deepak 
Published: March 2018

Background: Use of wrist-worn activity monitors has increased over the past few years; however, the use of the Fitbit® Charge HR (FCHR) in a community setting in patients with heart failure has not been tested. Purpose: The purpose of the study was to assess the feasibility, practicality and acceptability of utilizing the FCHR to validate self-reported exercise diaries and monitor exercise in community dwelling patients with heart failure. Methods: Thirty heart failure patients (12 females and 18 males) aged 64.7 ± 11.5 years were provided with a FCHR. Participants were provided with an exercise routine and for eight weeks, recorded their exercise sessions in self-reported exercise diaries and used the FCHR to record those exercise sessions. Results: Exercise data from the self-reported exercise diaries were validated with data from the FCHR. Participants’ perception and acceptance of using the FCHR was positive. Validation of exercise and physical activity interventions using the FCHR appears feasible and acceptable in patients with heart failure. Conclusion: Wrist-worn activity monitors can be useful for objective measurement of exercise adherence and monitoring of physical activity in patients with heart failure in a community setting.
Tele-Savvy: An Online Program for Dementia Caregivers
Authors: Griffiths Patricia C. , Kovaleva Mariya , Higgins Melinda , Langston Ashley H. , Hepburn Kenneth 
Published: March 2018

Introduction: This study examined the feasibility and efficacy of Tele-Savvy, an online version of the Savvy Caregiver Program, a psychoeducation program for caregivers caring for a person with dementia. Methods: A convenience sample of 22 caregivers from the Atlanta VA and 42 caregivers from 14 different states enrolled in Tele-Savvy. Pre- and post-program evaluations assessed caregiver burden, caregiver competency, and frequency of behavioral and psychological symptoms of dementia (BPSD). Results: Fifty-seven caregivers completed the 6-week Tele-Savvy program. Caregivers whose care recipients exhibited higher average BPSD frequency at baseline demonstrated significantly greater burden decreases post-program. Caregivers of care recipients in more advanced dementia stages demonstrated a significantly greater improvement in caregiver competence. Discussion: The results point to the feasibility of achieving significant results in caregivers’ well-being and care recipients’ BPSD with a fully online program. Tele-Savvy may be particularly efficacious for caregivers whose care recipients exhibit higher BPSD frequency and are in later dementia stages.
Preoperative Embolization of Venous Malformations Using n-Butyl Cyanoacrylate
Authors: Uller Wibke , El-sobky Sherif , Alomari Ahmad I. , Fishman Steven J. , Spencer Samantha A. , Taghinia Amir H. , Chaudry Gulraiz 
Published: March 2018

Purpose: The purpose of this study was to evaluate the safety and efficacy of preoperative percutaneous n-butyl cyanoacrylate (nBCA) embolization of venous malformations in children. Material and Methods: Clinical data were retrospectively reviewed in children who underwent embolization using nBCA followed by resection of venous malformations. Results: A total of 17 embolizations were performed in 14 patients (9 females, mean age: 5.5 years; median age: 3 years; range 0.1-16 years). The venous malformations involved the lower extremity and the knee joint (n = 7), the trunk (n = 4), head and neck (n = 2), and hand (n = 1). n-Butyl cyanoacrylate was diluted with iodized oil at a ratio of 1:3 to 1:5. The mean and median volume of nBCA per procedure were 2.1 and 2 mL, respectively (range: 0.5-8 mL). There were no complications associated with the procedures. The mean and median time between final embolization and resection were 3.6 and 2 days, respectively. All children underwent successful resection of the symptomatic lesions. The estimated mean and median blood loss were 75 and 50 mL, respectively (range: 5-350 mL). The postprocedure course was uneventful, the days to discharge ranged between 1 and 6 days (mean 3 days). Conclusion: Initial results suggest that preoperative percutaneous n-butyl cyanoacrylate embolization of venous malformations is safe and effective in children, with the potential for minimizing blood loss and inpatient stay.
Targeting macrophage and microglia activation with colony stimulating factor 1 receptor inhibitor is an effective strategy to treat injury-triggered neuropathic pain
Authors: Lee SeungHwan , Shi Xiang Qun , Fan Anni , West Brian , Zhang Ji 
Published: March 2018

Introduction Neuropathic pain is a debilitating condition. The importance of neuroimmune interactions in neuropathic pain has been evidenced by the involvement of different immune cells in peripheral and central sensitization of pathological pain. Macrophages and microglia are the most abundant immune cells activated in injured nerves and spinal cord, respectively. Several lines of evidence showed that macrophage/microglia survival, activation, proliferation, and differentiation require the involvement of macrophage-colony stimulating factor. In this study, we investigated whether blocking macrophage-colony stimulating factor/colony stimulating factor 1 receptor signaling can be effective in relieving neuropathic pain. Materials and methods Partial sciatic nerve ligation was performed in mice to induce neuropathic pain behavior. Mice were orally treated with a selective colony stimulating factor 1 receptor inhibitor, PLX5622, daily in both preventive (two days prior to surgery until D14 post-partial sciatic nerve ligation) and reversal paradigms (D28–D33 post-partial sciatic nerve ligation). Animal neuropathic pain behavior was monitored using von Frey hairs and acetone application. Phenotype of macrophages in injured nerves was analyzed at D3 and D33 post-injury using flow cytometry analysis. The effect of PLX5622 on microglia activation in lumbar spinal cord was further examined by immunohistochemistry using Iba-1 antibody. Results Significant alleviation of both mechanical and cold allodynia was observed in PLX5622-treated animals, both in preventive and reversal paradigms. PLX5622 treatment reduced the total number of macrophages in injured nerves, it appears colony stimulating factor 1 receptor inhibition affected more specifically CD86+ (M1 like) macrophages. Consequently, the expression of various pro-inflammatory cytokines (TNF-α, IL-1β) was reduced. Microglia activation in dorsal horn of lumbar spinal cord following partial sciatic nerve ligation was significantly inhibited with PLX5622 treatment in both preventive and reversal paradigms. Conclusion Macrophages in peripheral nerve and microglia in the spinal cord are required in the generation and maintenance of injury-associated neuropathic pain. Blocking macrophage-colony stimulating factor/colony stimulating factor 1 receptor signaling on these myeloid cells along the pain transmission pathway is an effective strategy to alleviate neuropathic pain.
Does the Design of Settings Where Acute Care Is Delivered Meet the Needs of Older People? Perspectives of Patients, Family Carers, and Staff
Authors: Haywood Annette , Barnes Sarah , Marsh Hazel , Parker Stuart G. 
Published: March 2018

Background: Older people with an acute illness, many of whom are also frail, form a significant proportion of the acute hospital inpatient population. Attention is focusing on ways of improving the physical environment to optimize health outcomes and staff efficiency. Purpose: This article explores the effects of the physical environment in three acute care settings: acute hospital site, in-patient rehabilitation hospital, and intermediate care provision (a nursing home with some beds dedicated to intermediate care) chosen to represent different steps on the acute care pathway for older people and gain the perspectives of patients, family carers, and staff. Methods: Semi structured interviews were undertaken with 40 patient/carer dyads (where available) and three staff focus groups were conducted in each care setting with a range of staff. Results: Multiple aspects of the physical environment were reported as important by patients, family carers, and staff. For example, visitors stressed the importance of access and parking, patients valued environments where privacy and dignity were protected, storage space was poor across all sites, and security was important to patients but visitors want easy access to wards. Conclusions: The physical environment is a significant component of acute care for older people, many of whom are also frail, but often comes second to organization of care, or relationships between actors in an episode of care.
Mortality predictors in an acute care geriatric unit in Singapore
Authors: Goh Kiat Sern , Low Serena Kiat Mun , Zhang Di , Png Gek Kheng , Lin Huimin , Ang Wendy Swee Tee , Lim Jim Kim Hwa 
Published: March 2018

Aim: Admission to an acute care geriatric unit may lead to adverse outcomes. It is therefore important to identify high-risk patients early so that appropriate management can be instituted to prevent or delay onset of adverse events. The aim of this study is to evaluate one-year mortality and its associated risk factors among hospitalized patients. Methods: This is a retrospective cohort study on consecutive patients admitted to an acute geriatric ward in a Singapore hospital from March to April 2013.Demographic and clinical information was collected from patient medical records. Linkage with death records from a national registry was performed. Results: Of the 196 patients assessed, 4.6%, 20.9% and 35.7% died during admission, within six months post-admission and within one year post-admission respectively. Pneumonia and cardiovascular diseases accounted for most of the death cases. In the multivariable logistic regression adjusted by age and gender, abbreviated mental test (AMT) score, admission for falls and depression were found to be significantly associated with death within one year post-admission. In the analysis stratified by gender, AMT score and depression were found to be significantly associated with death in males whereas AMT score and admission for falls were significantly associated with death in females. Conclusions: This study offers significant insight into mortality trends and risk factors for clinicians, hence guiding them in individualizing their management plan for acutely ill geriatric patients. Predicting long-term prognosis will enhance rehabilitation goal-setting and advance care-planning.
Surveillance for colorectal cancer survivors in an integrated safety-net health system in the United States
Authors: Balasubramanian Bijal A , Jetelina Katelyn K , Bowen Michael , Santini Noel O , Craddock Lee Simon 
Published: March 2018

Introduction Guideline-recommended surveillance reduces the likelihood of colorectal cancer recurrence, yet surveillance rates are low in the United States. Little is known about colorectal cancer surveillance rates among patients without health insurance and their primary care clinicians/oncologists’ attitudes toward surveillance care. Methods A retrospective study of 205 patients diagnosed with Stage I–III colorectal cancer from 2008 to 2010 was conducted in an integrated system with a network of clinics and health care providers, delivering care to patients lacking health insurance coverage. Surveillance patterns were characterized from medical records, and logistic regression models examined correlates of guideline-concordant surveillance. Forty-four Parkland primary care physicians (PCPs) and 24 oncologists completed surveys to assess their attitudes and practices regarding colorectal cancer surveillance. Results Thirty-eight percent of colorectal cancer patients received guideline-concordant surveillance; those with early stage cancers were less likely to receive surveillance (odds ratio = 0.35; 95 confidence interval: 0.14, 0.87). PCPs and oncologists differed markedly on who is responsible for cancer surveillance care. Seventy-seven percent of oncologists responded that PCPs evaluated patients for cancer recurrence, while 76% of PCPs responded that these services were either ordered by oncologists or shared with PCPs. Sixty-seven percent of oncologists said that they rarely provide a treatment and surveillance care plan to survivors, and over half said that they infrequently communicate with patients’ other physicians about who will follow patients for their cancer and other medical issues. Discussion Care coordination between PCP and oncologist is needed to improve colorectal cancer surveillance. New models of shared care clearly delineating roles for oncologists and PCPs are needed to improve colorectal cancer survivorship care.
Novel, 3D Display of Heart Models in the Postoperative Care Setting Improves CICU Caregiver Confidence
Authors: Olivieri Laura J. , Zurakowski David , Ramakrishnan Karthik , Su Lillian , Alfares Fahad A. , Irwin Matthew R. , Heichel Jenna , Krieger Axel , Nath Dilip S. 
Published: March 2018

Background: Postoperative care delivered in the pediatric cardiac intensive care unit (CICU) relies on providers’ understanding of patients’ congenital heart defects (CHDs) and procedure performed. Novel, bedside use of virtual, three-dimensional (3D) heart models creates access to patients’ CHD to improve understanding. This study evaluates the impact of patient-specific virtual 3D heart models on CICU provider attitudes and care delivery. Methods: Virtual 3D heart models were created from standard preoperative cardiac imaging of ten patients with CHD undergoing repair and displayed on a bedside tablet in the CICU. Providers completed a Likert questionnaire evaluating the models’ value in understanding anatomy and improving care delivery. Responses were compared using two-tailed t test and Mann-Whitney U test and were also compared to previously collected CICU provider responses regarding use of printed 3D heart models. Results: Fifty-three clinicians (19 physicians, 34 nurses/trainees) participated; 49 (92%) of 53 and 44 (83%) of 53 reported at least moderate to high satisfaction with the virtual 3D heart’s ability to enhance understanding of anatomy and surgical repair, respectively. Seventy-one percent of participants felt strongly that virtual 3D models improved their ability to manage postoperative problems. The majority of both groups (63% physicians, 53% nurses) felt that virtual 3D heart models improved CICU handoffs. Virtual 3D heart models were as effective as printed models in improving understanding and care delivery, with a noted provider preference for printed 3D heart models. Conclusions: Virtual 3D heart models depicting patient-specific CHDs are perceived to improve understanding and postoperative care delivery in the CICU.
Optimization of the Assisted Bidirectional Glenn Procedure for First Stage Single Ventricle Repair
Authors: Verma Aekaansh , Esmaily Mahdi , Shang Jessica , Figliola Richard , Feinstein Jeffrey A. , Hsia Tain-Yen , Marsden Alison L. 
Published: March 2018

Background: First-stage single-ventricle palliation is challenging to manage, and significant interstage morbidity and mortality remain. Prior computational and in vitro studies of the assisted bidirectional Glenn (ABG), a novel first-stage procedure that has shown potential for early conversion to a more stable augmented Glenn physiology, demonstrated increased pulmonary flow and oxygen delivery while decreasing cardiac work, as compared to conventional stage-1 alternatives. This study aims to identify optimal shunt designs for the ABG to improve pulmonary flow while maintaining or decreasing superior vena caval (SVC) pressure. Methods: A representative three-dimensional model of a neonatal bidirectional Glenn (BDG) was created, with a shunt connecting the innominate artery to the SVC. The shunt design was studied as a six-parameter constrained shape optimization problem. We simulated hemodynamics for each candidate designs using a multiscale finite element flow solver and compared performance against designs with taper-less shunts, the standalone BDG, and a simplified control volume model. Three values of pulmonary vascular resistance (PVR) of 2.3, 4.3, and 7.1 WUm2 were studied. Results: Increases in pulmonary flow were generally accompanied by increases in SVC pressure, except at low PVR (2.3 WUm2), where the optimal shunt geometry achieved a 13% increase in pulmonary flow without incurring any increase in SVC pressure. Shunt outlet area was the most influential design parameter, while others had minimal effect. Conclusion: Assisted bidirectional Glenn performance is sensitive to PVR and shunt outlet diameter. An increase in pulmonary flow without a corresponding increase in SVC pressure is possible only when PVR is low.