bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anticholinergic Medication Burden in Pediatric Prolonged Critical Illness: A Potentially Modifiable Risk Factor for Delirium
Authors: Madden Kate , Hussain Kinza , Tasker Robert C. 
Published: July 2018

Objectives:
It is important to describe and understand the prevalence and risk factors for the syndrome of delirium in critical illness. Since anticholinergic medication may contribute to the development of delirium in the PICU, we have sought to quantify anticholinergic medication exposure in patients with prolonged admission. We have used Anticholinergic Drug Scale scores to quantify the magnitude or extent of this burden.

Design:
Retrospective cohort study, January 2011 to December 2015.

Setting:
Single academic medical center PICU.

Patients:
Children under 18 years old with a PICU admission of 15 days or longer, requiring mechanical ventilation.

Interventions:
None.

Measurements and Main Results:
Daily Anticholinergic Drug Scale scores for the first 15 days of admission, in each of 88 subjects (total of 1,320 PICU days), were collected and assessed in relation to demographic data, severity of illness, and medication use. Median (interquartile range) of daily Anticholinergic Drug Scale score was 5 (interquartile range, 3–7). Anticholinergic Drug Scale score was not associated with age, sex, medical history, presenting Severity of Illness score, PICU length of stay, ventilator hours, or hospital mortality. Medications most frequently associated with high Anticholinergic Drug Scale score were low potency anticholinergic drugs such as morphine, midazolam, vancomycin, steroids, and furosemide, with the exception of ranitidine (Anticholinergic Drug Scale score 2). Patients receiving high doses of midazolam infusion had significantly higher Anticholinergic Drug Scale scores compared with those receiving lower or no midazolam dosing.

Conclusions:
A high number of medications with anticholinergic effects are administered to PICU patients receiving prolonged mechanical ventilation. These exposures are much higher than those reported in adult intensive care patients. Since anticholinergic drug exposure is associated with delirium, further study of this exposure in PICU patients is needed.
Mitral Annular Plane Systolic Excursion as a Predictor of Mortality in Children With Septic Shock
Authors: EL-Zayat Rania Salah , Shalaby Awny Gamal 
Published: July 2018

Objectives:
Myocardial dysfunction is well recognized in severe sepsis and septic shock. Echocardiography provides rapid, noninvasive, and bedside evaluation of cardiac function in patients with hemodynamic instability. Mitral annular plane systolic excursion is an M-mode–derived echocardiographic variable used to assess longitudinal left ventricular systolic function. No data are available about the uses of mitral annular plane systolic excursion in children with septic shock. Therefore, we aimed to assess the prognostic significance of mitral annular plane systolic excursion in children with septic shock and to correlate it with the most commonly used measures of left ventricular systolic function and myocardial injury.

Design:
A prospective cohort study.

Setting:
The study carried out at the PICU of Menoufia University Hospital in the period from March 2015 to September 2016.

Patients:
We serially enrolled 50 children with septic shock.

Interventions:
Complete diagnostic workup was performed for each patient including calculation of Pediatric Risk of Mortality III score. Transthoracic echocardiography was done to obtain mitral annular plane systolic excursion and the left ventricular ejection fraction measurement within 24 hours of inclusion then repeated on third and fifth days. Patients were followed up until hospital discharge or death. The predictive power of mitral annular plane systolic excursion was determined using the receiver operating characteristic curve.

Measurements and Main Results:
Mitral annular plane systolic excursion was significantly lower in nonsurvivors compared with survivors (p < 0.001). Receiver operating characteristic curve analysis showed an area under the curve of 0.892 for mitral annular plane systolic excursion on day 1. The cut-off point was 7.9 mm with 82.76% sensitivity and 80.95% specificity. Furthermore, follow-up of the patient’s systolic function showed that mitral annular plane systolic excursion was significantly lower in nonsurvivors compared with survivors on days of follow-up, whereas left ventricular ejection fraction was not significantly different between survivors and nonsurvivors at any day. Mitral annular plane systolic excursion was positively correlated with left ventricular ejection fraction (p = 0.044) and duration of hospital stay (p < 0.001) and negatively correlated with Pediatric Risk of Mortality III score (p < 0.001) and cardiac troponin I level (p < 0.001).

Conclusions:
Measurement of mitral annular plane systolic excursion at admission added a prognostic value in septic shock children. Compared with the left ventricular ejection fraction, longitudinal systolic function might be more sensitive in the detection of myocardial dysfunction in critically ill children and should receive more attention.
Surgical Management of Strabismus in Patients With Orbital Fracture
Authors: Xia Qing , Wang Zhonghao , Yan Jianhua 
Published: July 2018

Purpose:
Till date, the surgical policy of strabismus in patients with orbital fracture is scarcely described in literature. The purpose of this study was to describe the clinical features and surgical experience in patients with strabismus and persistent diplopia after orbital fracture repair, or in patients who need not receive surgery for orbital fracture.

Patients and Methods:
Retrospective review was performed on patients with orbital fracture who received strabismus surgery between 2004 and 2016 in Eye Hospital, Zhongshan Ophthalimc Center, Sun Yat-sen University, China. The following clinical data were recorded from the patients’ charts: the nature of fracture, age at surgery, preoperative motor alignment, stereoacuity, surgical methods, surgical outcomes, and complications. Deviations of 10 prism diopter (PD) or less of horizontal angle and deviation of 5 PD or less of vertical angle in the primary position were considered to be a successful outcome.

Results:
A total of 29 patients (23 males and 6 females) with an average age of 32.4 ± 16.6 years (2–61 years) were recruited in this study. The strabismus was paralytic in 16 patients, restrictive in 2 patients, and both paralytic and restrictive in 11 patients. The surgical methods were quite various in each patient; however, all patients underwent either rectus recession or rectus recession plus resection. With at least 6 months of follow-up, preoperative horizontal deviation of 32.79 ± 22.84 PD was reduced to 6.69 ± 13.01 PD (P < 0.01). The vertical deviation was reduced from 22.76 ± 17.66 PD to 6.59 ± 7.98 PD (P < 0.01). Sixteen patients (55.2%) were considered as success, whereas a surgical undercorrection was observed in 44.8%. There were no surgical complications.

Conclusions:
The clinical manifestations of strabismus in patients with orbital fracture or after fracture repair are quite complex, often involving both paralytic and restrictive factors. The surgical treatment of each patient needs to be individualized. The rectus muscle recession and resection seems to be predictable, effective, and stable.
Evaluation of Heart Functions With Detailed Echocardiogram in Patients With Septum Deviation
Authors: Caglar Ozge , Aksit Ercan 
Published: July 2018

Background:One of the most important reasons for nasal congestion is septum deviation. Nasal septal deviation increases airway resistance and can cause systemic problems. In this study, echocardiographic findings were compared with the normal population to see how cardiac function was affected in patients with obstructive nasal septum deviation.Methods:This study included a young patient group with 44 obstructive septum deviation patients and 30 healthy individuals with no nasal-related problems. Echocardiography was performed by the same cardiologist and results were compared with normal patients. The authors got permission from the ethics committee of faculty for the study (E. 116795).Results:In the patient group with septum deviation, pulmonary artery pressure was high. In addition, the size of the right heart chambers was also increased. TAPSE, pulmonary acceleration time, ejection fraction, and right ventricular outflow tract-fractional shortening were found to be lower than the normal group.Conclusion:Patients with obstructive septum deviations should be evaluated early for cardiologic functions.
Association of pain after trauma with long-term functional and mental health outcomes
Authors: Herrera-Escobar Juan Pablo , Apoj Michel , Weed Christina , Harlow Alyssa Fitzpatrick , Al Rafai Syeda Sanam , Lilley Elizabeth , Kasotakis George , Brasel Karen , Kaafarani Haytham M.A. , Velmahos George , Salim Ali , Haider Adil Hussain 
Published: July 2018

BACKGROUND
Chronic pain after trauma is associated with serious clinical, social, and economic burden. Due to limitations in trauma registry data and previous studies, the current prevalence of chronic pain after trauma is unknown, and little is known about the association of pain with other long-term outcomes. We sought to describe the long-term burden of self-reported pain after injury and to determine its association with positive screen for posttraumatic stress disorder (PTSD), functional status, and return to work.

METHODS
Trauma survivors with moderate or severe injuries and one completed follow-up interview at either 6 months or 12 months after injury were identified from the Functional Outcomes and Recovery after Trauma Emergencies project. Multivariable logistic regression models clustered by facility and adjusting for confounders were used to obtain the odds of positive PTSD screening, not returning to work, and functional limitation at 6 months and 12 months after injury, in trauma patients who reported to have pain on a daily basis compared to those who did not.

RESULTS
We completed interviews on 650 patients (43% of eligible patients). Half of patients (50%) reported experiencing pain daily, and 23% reported taking pain medications daily between 6 months and 12 months after injury. Compared to patients without pain, patients with pain were more likely to screen positive for PTSD (odds ratio [OR], 5.12; 95% confidence interval [CI], 2.97–8.85), have functional limitations for at least one daily activity (OR, 2.42; 95% CI, 1.38–4.26]), and not return to work (OR, 1.86; 95% CI, 1.02–3.39).

CONCLUSIONS
There is a significant amount of self-reported chronic pain after trauma, which is in turn associated with positive screen for PTSD, functional limitations, and delayed return to work. New metrics for measuring successful care of the trauma patient are needed that span beyond mortality, and it is important we shift our focus beyond the trauma center and toward improving the long-term morbidity of trauma survivors.

LEVEL OF EVIDENCE
Therapeutic/Care management, level III.
Efficacy of Parenteral Amantadine Therapy in the Treatment of Multiple System Atrophy With Predominant Parkinsonism
Authors: Friedberg Adit , Erikh Ilana , Nassar Maria , Sprecher Elliot , Schlesinger Ilana 
Published: July 2018

Objective
The aim of this study was to assess clinical response to a high-dose intravenous (IV) amantadine given for 5 consecutive days in patients with multiple system atrophy parkinsonism (MSA-P).

Methods
Subjects with a diagnosis of MSA-P treated with IV amantadine were included. Patients' disease severity before and after therapy was evaluated using the Unified Multiple System Atrophy Rating Scale (UMSARS).

Results
Fourteen subjects (8 females) were included. In 10 subjects (71.4%), clinical improvement was noted. The UMSARS score after treatment decreased by 2 points (median [interquartile range, 0–3]) when compared with UMSARS score at baseline (P = 0.0020). Upon examining the walking parameter, a trend of improvement was shown (P = 0.0625) (range, 0–1 points). Neither specific demographic parameters nor occurrence of adverse effects was found to be a predictive factor for improvement. Adverse events were mild and transient except for one patient who experienced acute psychosis prompting treatment cessation, upon which psychosis resolved.

Conclusions
Our preliminary data show that IV amantadine may be a safe and effective therapy in MSA-P. A double-blind placebo-controlled trial is needed to establish the true benefit of amantadine therapy.
Visual and Positional Modulation of Pendular Seesaw Nystagmus: Implications for the Mechanism
Authors: Kim Sung-Hee , Kim Hyo-Jung , Oh Sea-Won , Kim Ji-Soo 
Published: July 2018

Background:
The mechanisms of pendular seesaw nystagmus (SSN) remain unknown.

Methods:
We evaluated modulation of pendular SSN by removal of visual fixation, convergence, and positional changes in 2 patients, one with bitemporal hemianopia due to a traumatic damage of the optic chiasm and the other with platybasia compressing the medulla and lower cerebellum.

Results:
In both patients, the pendular SSN markedly decreased or disappeared with convergence, without visual fixation in darkness, during static head tilt toward each shoulder while sitting and while supine.

Conclusions:
The similar patterns of nystagmus modulation observed in our patients with a different etiology indicate a common role of both visual and otolithic inputs in generating pendular SSN.
Trigeminal Hyperexcitability in Idiopathic Intracranial Hypertension: A Blink Reflex Study
Authors: Samanci Bedia , Altıokka-Uzun Güneş , Kocasoy Orhan Elif , Ekizoğlu Esme , Öge Ali Emre , Baykan Betül 
Published: July 2018

Purpose:
To compare blink reflex examination findings in patients with idiopathic intracranial hypertension (IIH) with migraineurs and controls and to investigate the role of blink reflex data in the follow-up by evaluating their relationship with clinical symptoms.

Methods:
We included 23 patients with IIH, 15 migraineurs, and 16 controls. Blink reflex was studied with bilateral paired stimulations, and the 2R2/1R2 and 2R2c/1R2c area ratios, 1R2, 2R2, 1R2c, and 2R2c latencies were compared (R2:ipsilateral R2 response, R2c:contralateral R2 response).

Results:
2R2/1R2 area ratios at 200, 300, and 500 ms interstimulus intervals were significantly higher in the IIH group compared with the controls, and significantly higher 2R2/1R2 area ratio at 200 ms interstimulus interval was also detected in the IIH group compared with the migraine group. Significantly shorter 2R2 latencies were found at 500 and 800 ms interstimulus intervals in IIH group compared with the migraine group and controls. Significantly higher 2R2/1R2 area ratios at 500, 800 ms, and 2R2c/1R2c area ratios at 300, 500, and 800 ms were detected in patients with IIH in remission compared with patients with attacks.

Conclusions:
The significant increase in R2 recovery rates in patients with IIH in remission suggests that there is an increased excitability in the trigeminal pathways. Our findings may provide a new perspective for IIH mechanism related to trigeminal hyperexcitability and evaluating new management strategies.
Influence of the Montage of Stimulation Electrodes for Intraoperative Neuromonitoring During Orthopedic Spine Surgery
Authors: Berends Hanneke I. , Journée Henricus L. 
Published: July 2018

Purpose:
In transcranial electrical stimulation, induced motor evoked potentials (MEPs) are influenced by the montage of stimulation electrodes. Differences are to be examined between coronal and sagittal stimulation.

Methods:
Forty-five patients with idiopathic scoliosis were included. Coronal and sagittal montages were obtained by electrode placement at C3C4 and Cz'F using large contact electrodes. Corkscrew and short needle electrodes were additionally placed at C3C4 in five patients. Voltage motor thresholds (MTvoltage) and MEP amplitudes at 2 times MTvoltage (MEP2MTvoltage) were obtained of upper and lower extremity muscles. Differences of MTvoltage and MEP2MTvoltage at Cz'F and C3C4 and between electrodes were analyzed.

Results:
MEP2MTvoltage benefits from coronal positioning. Correlations between MTvoltage and impedance were not significant for large electrodes at Cz'F, very low for C3C4, and high for short needles or corkscrew electrodes. MTvoltage of short needles and corkscrews was up to 200% higher compared with MTvoltage of long needles. MTcurrent is increased by 20% to 30% and 2% to 10% for the arm and leg muscles, respectively.

Conclusions:
Biphasic stimulation at C3C4 is advised when constant voltage stimulation is used to monitor the spinal cord during orthopedic spine surgery. MTvoltage of corkscrew and small needle electrodes are highly sensitive to electrode impedances.
Overview of the SAMPL6 host-guest binding affinity prediction challenge
Authors: Rizzi Andrea , Murkli Steven , McNeill John N. , Yao Wei , Sullivan Matthew , Gilson Michael K. , Chiu Michael W. , Isaacs Lyle , Gibb Bruce C. , Mobley David L. , Chodera John D. 
Published: July 2018

AbstractAccurately predicting the binding affinities of small organic molecules to biological macro-molecules can greatly accelerate drug discovery by reducing the number of compounds that must be synthesized to realize desired potency and selectivity goals. Unfortunately, the process of assessing the accuracy of current computational approaches to affinity prediction against binding data to biological macro-molecules is frustrated by several challenges, such as slow conformational dynamics, multiple titratable groups, and the lack of high-quality blinded datasets. Over the last several SAMPL blind challenge exercises, host-guest systems have emerged as a practical and effective way to circumvent these challenges in assessing the predictive performance of current-generation quantitative modeling tools, while still providing systems capable of possessing tight binding affinities. Here, we present an overview of the SAMPL6 host-guest binding affinity prediction challenge, which featured three supramolecular hosts: octa-acid (OA), the closely related tetra-endo-methyl-octa-acid (TEMOA), and cucurbit[8]uril (CB8), along with 21 small organic guest molecules. A total of 119 entries were received from 10 participating groups employing a variety of methods that spanned from electronic structure and movable type calculations in implicit solvent to alchemical and potential of mean force strategies using empirical force fields with explicit solvent models. While empirical models tended to obtain better performance than first-principle methods, it was not possible to identify a single approach that consistently provided superior results across all host-guest systems and statistical metrics. Moreover, the accuracy of the methodologies generally displayed a substantial dependence on the system considered, emphasizing the need for host diversity in blind evaluations. Several entries exploited previous experimental measurements of similar host-guest systems in an effort to improve their physical-based predictions via some manner of rudimentary machine learning; while this strategy succeeded in reducing systematic errors, it did not correspond to an improvement in statistical correlation. Comparison to previous rounds of the host-guest binding free energy challenge highlights an overall improvement in the correlation obtained by the affinity predictions for OA and TEMOA systems, but a surprising lack of improvement regarding root mean square error over the past several challenge rounds. The data suggests that further refinement of force field parameters, as well as improved treatment of chemical effects (e.g., buffer salt conditions, protonation states) may be required to further enhance predictive accuracy.
Oxytocin modulates the intrinsic dynamics between attention-related large scale networks
Authors: Xin Fei , Zhou Feng , Zhou Xinqi , Ma Xiaole , Geng Yayuan , Zhao Weihua , Yao Shuxia , Dong Debo , Biswal Bharat B. , Kendrick Keith M. , Becker Benjamin 
Published: July 2018

AbstractAttention and salience processing have been linked to the intrinsic between- and within-network dynamics of large scale networks engaged in internal (default mode network, DN) and external attention allocation (dorsal attention, DAN, salience network, SN). The central oxytocin (OXT) system appears ideally organized to modulate widely distributed neural systems and to regulate the switch between internal attention and salient stimuli in the environment. The current randomized placebo (PLC) controlled between-subject pharmacological resting-state fMRI study in N = 187 (OXT, n = 94; n = 93; single-dose intranasal administration) healthy male and female participants employed an independent component analysis (ICA) approach to determine the modulatory effects of OXT on the within- and between-network dynamics of the DAN-SN-DN triple network system. OXT increased the functional integration between subsystems within SN and DN and increased functional segregation of the DN with the SN and DAN engaged in attentional control. Whereas no sex differences were observed, OXT effects on the DN-SN interaction were modulated by autism traits. Together, the findings suggest that OXT may facilitate efficient attentional allocation towards social cues by modulating the intrinsic functional dynamics between DN components engaged in social processing and large-scale networks involved in external attentional demands (SN, DAN).
Coping with stress: morphological changes in response to environmental stimuli in a fungal plant pathogen
Authors: Francisco Carolina Sardinha , Ma Xin , Zwyssig Maria Manuela , McDonald Bruce A. , Palma-Guerrero Javier 
Published: July 2018

AbstractDuring their life cycles, pathogens have to adapt to many biotic and abiotic environmental stresses to maximize their overall fitness. Morphological transitions are one of the least understood of the many strategies employed by fungal plant pathogens to adapt to constantly changing environments, even though different morphotypes may play important biological roles. We characterized the responses of the wheat pathogen Zymoseptoria tritici to a series of environmental stresses in order to understand the effects of changing environments on fungal morphology and adaptation. We found that all tested stresses induced morphological changes, but different responses were found among four different strains. A transcription analysis showed that morphogenesis and virulence factors are co-regulated. We discovered that Z. tritici forms chlamydospores and demonstrated that these structures are better able to survive extreme cold, heat and drought than other cell types. We also show that blastospores (the “yeast-like” form of the pathogen typically found only in laboratory conditions) can form from germinated pycnidiospores on the surface of wheat leaves, suggesting that this morphotype can play an important role in the natural history of Z. tritici. Our findings illustrate how changing environmental conditions can affect cellular morphology and lead to the formation of new morphotypes, with each morphotype having a potential impact on both pathogen survival and disease epidemiology.