bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of acute upper gastrointestinal bleeding manifestations at admission on the in-hospital outcomes of liver cirrhosis: hematemesis versus melena without hematemesis
Authors: Li Yingying , Li Hongyu , Zhu Qiang , Tsochatzis Emmanuel , Wang Ran , Guo Xiaozhong , Qi Xingshun 
Published: September 2019

Objectives
Patients with acute upper gastrointestinal bleeding (AUGIB) often manifest as hematemesis and melena. Theoretically, hematemesis will carry worse outcomes of AUGIB. However, there is little real-world evidence. We aimed to compare the outcomes of hematemesis versus no hematemesis as a clinical manifestation of AUGIB at admission in cirrhotic patients.

Methods
All cirrhotic patients with AUGIB who were consecutively admitted to our hospital from January 2010 to June 2014 were considered in this retrospective study. Patients were divided into hematemesis with or without melena and melena alone without hematemesis at admission. A 1:1 propensity score matching analysis was performed. Subgroup analyses were performed based on systemic hemodynamics (stable and unstable) and Child-Pugh class (A and B+C). Sensitivity analyses were conducted in patients with moderate and severe esophageal varices confirmed on endoscopy. Primary outcomes included five-day rebleeding and in-hospital death.

Results
Overall, 793 patients were included. Patients with hematemesis at admission had significantly higher five-day rebleeding rate (17.4 versus 10.1%, P = 0.004) and in-hospital mortality (7.9 versus 2.4%, P = 0.001) than those without hematemesis. In the propensity score matching analyses, 358 patients were included with similar Child-Pugh score (P = 0.227) and MELD score (P = 0.881) between the two groups; five-day rebleeding rate (19.0 versus 10.6%, P = 0.026) and in-hospital mortality (8.4 versus 2.8%, P = 0.021) remained significantly higher in patients with hematemesis. In the subgroup and sensitivity analyses, the statistical results were also similar.

Conclusions
Hematemesis at admission indicates worse outcomes of cirrhotic patients with AUGIB, which is useful for the risk stratification of AUGIB.
Surgery for ulcerative colitis in geriatric patients is safe with similar risk to younger patients
Authors: Feuerstein Joseph D. , Curran Thomas , Alvares Daniel , Alosilla Michael , Lerner Andrew , Cataldo Thomas , Falchuk Kenneth R. , Poylin Vitaliy 
Published: September 2019

Objective
A prior study indicated that postoperative mortality and complications were higher in geriatrics with inflammatory bowel disease (IBD). We sought to assess the rates of surgical complications and mortality in patients aged ≥65 years after colectomy for ulcerative colitis (UC).

Methods
This is a single center retrospective study at a tertiary care center. We reviewed all hospital discharges with ICD-9 code 556.X between January 2002 and January 2014. Patients were included if they underwent a colectomy for UC. All records were manually reviewed for demographics, complications and mortality within 90 days postoperatively.

Results
A total of 259 patients underwent surgery for UC during the study period and 34 patients were ≥65 years old (range 65–82) at the time of their surgery. There was no difference in overall length of stay (10.5 days vs. 9.6 days; P = 0.645) or complication rates (44% vs. 47%; P = 0.854) in the ≥65 cohort compared with the under 65 cohort. Mortality was higher in the geriatric cohort but this included only two deaths within 90 days, one of which was unrelated to the surgery, compared with one death related to surgery within 90 days in the younger cohort. Readmissions occurred in 24% of both cohorts within 90 days.

Conclusion
Geriatric patients undergoing surgery for UC are not at increased risk of surgery-related morbidity or mortality compared with a younger cohort.
Graft-versus-host disease after living donor liver transplantation: an unpredictable troublesome complication for liver transplant centers
Authors: Gonultas Fatih , Akbulut Sami , Barut Bora , Kutluturk Koray , Yilmaz Sezai 
Published: September 2019

Objective
The aim of this study was to report on graft-versus-host disease (GvHD) following living donor liver transplantation (LDLT).

Methods
Between May 2002 and January 2019, a total of 2387 LT procedures were performed in our Liver Transplantation Institute. Seven patients (0.29%) were admitted to our outpatient clinic with signs and symptoms compatible with GvHD following LT. Demographic, clinical and histopathological characteristics of patients with GvHD were retrospectively evaluated.

Results
There were six male and one female patient aged from 18 months to 67 years. Acute GvHD was detected in six patients and chronic GvHD in one. Grade II GvHD was detected in six patients, and Grade IV was detected in one patient. Time from LT to GVHD ranged from 4 to 657 days (median: 59 days). Time from beginning of clinical findings to histopathological diagnosis ranged from 2 to 160 days (median: 7 days). Initial clinical manifestations were as follows: skin rash + diarrhea (n = 2), skin rash (n = 2), skin rash + flushing (n = 1), diarrhea (n = 1), and skin rash + fever (n = 1). Despite intensive treatments, five out of seven patients (71.4%) died due to sepsis (n = 4) and gastrointestinal hemorrhage (n = 1). The remaining two patients are still alive without complications.

Conclusion
GvHD is a life-threatening complication despite aggressive treatment. To achieve success in GvHD, preventive measures, early diagnosis, early initiation of treatment, antimicrobial prophylaxis, and proper supportive care should be ensured.
Predictive factors for secondary intensive care unit admission within 48 hours after hospitalization in a medical ward from the emergency room
Authors: Cancella de Abreu Marta , Rousseau Alexandra , Ehrminger Sebastien , Rufat Pierre , Hausfater Pierre 
Published: September 2019

Background
Unplanned transfer to an ICU within 48 hours of admission from the emergency department (ED) can be considered an adverse event. Screening at risk for such an event is a challenge for ED staff. Our purpose was to identify the clinical and biological variables which may be identified in the ED setting and can predict short-term unplanned secondary transfer to the intensive care setting.

Methods
This was a three-year retrospective case controlled monocentric study. The cases were patients transferred to a medical ICU within 48 hours of admission to the general wards from the ED. Each case was matched to two controls (patients not transferred to the ICU) based on age, gender, year of admission, and hospital unit. A conditional logistic regression was performed.

Results
Three hundred nineteen patients, including 107 cases and 212 controls, were studied. Community-acquired pneumonia (CAP) was the most frequent diagnosis (23% of cases) followed by sepsis (16%). We identified six predictive factors of an unplanned short-term transfer to the ICU. Former smoking status, fever between 38°C and 40°C, dyspnea as the chief complaint in the ED, a lower MEDS score, an elevated acute physiology age chronic health evaluation score, and the ordering of an arterial blood gas each correlate with secondary transfer to an intensive care setting.

Conclusion
We report a higher risk of short-term unscheduled ICU transfer in patients meeting these criteria. These patients should be closely monitored and frequently re-evaluated before being transferred to a general ward.
Prevention and Management of Supine Hypertension in Patients With Orthostatic Hypotension
Authors: Moroi Morgan K. , Ruzieh Mohammed , Ahmed Aamir , Kanjwal Shaffi , Kanjwal Khalil 
Published: September 2019

Background:
Orthostatic hypotension (OH) is a potentially debilitating condition caused by dysfunction of the autonomic nervous system, which is essential for the physiologic response to orthostatic posture. In addition to OH, autonomic dysfunction may also be associated with the development of concurrent supine hypertension (SH).

Areas of Uncertainty:
This paradoxical effect speaks to the complexity of the pathogenesis of autonomic disease and greatly complicates management of these patients. Clinicians are faced with a dilemma because aggressive treatment of orthostatic intolerance can worsen supine hypertension and attempts to control supine hypertension can worsen orthostatic intolerance.

Data Sources:
Systematic review of the published literature.

Prevention of Supine Hypertension:
Patients should aim to avoid known stressors, perform physical maneuvers (eg, slowly getting up from bed, sleeping with head of bed elevated), manage underlying related conditions (eg, diabetes mellitus), and exercise.

Management of Supine Hypertension:
With failure of conservative management, patients may advance to pharmacologic therapy. It is important to understand the underlying suspected etiology of the syndrome of supine hypertension and OH (SH-OH) to select promising pharmacologic agents. This article reviews medical treatment options to work toward achieving a better quality of life for patients afflicted with this disease. Although clonidine and beta-blockers can be used to treat hypertension without causing significant hypotension, midodrine, pyridostigmine, and droxidopa may be helpful in preventing OH.

Conclusion:
The etiology and severity of autonomic dysfunction vary widely between patients, suggesting a need for an individualized treatment approach. Achieving perfect blood pressure control is not a realistic goal. Rather, treatment should be aimed at improving the patient's quality of life and decreasing their risk of injury and organ damage.
Malaria in Pregnancy: What the Obstetric Provider in Nonendemic Areas Needs to Know
Authors: Zakama Arthurine K. , Gaw Stephanie L. 
Published: September 2019

Importance
Globally, more than 125 million women each year are at risk of malaria during pregnancy. Endemic regions carry the greatest burden; however, with globalization, providers in nonendemic regions are encountering increasing numbers of women exposed to or infected with malaria.

Objectives
The aim of this article is to provide obstetric providers in nonendemic areas with updated information on malaria infection in pregnancy focusing on pregnancy management and malaria prevention and treatment.

Evidence Acquisition
This article is based on review of the most recent peer-reviewed articles and guidelines from the Centers for Disease Control and Prevention and the World Health Organization.

Findings
Malaria infection in pregnancy causes maternal anemia, low birth weight, preterm birth, stillbirth, and miscarriages through placental malaria and severe infections. Pregnant women traveling to malaria-endemic areas should be advised against travel. If travel must occur, they should be provided with region-specific chemoprophylaxis and given methods for preventing infection. In the event that a pregnant patient has an acute malarial infection, prompt evaluation is needed to determine whether there are severe features. Medications for uncomplicated or severe malaria infection should be started as soon as the diagnosis is made.

Conclusions and Relevance
Malaria in pregnancy causes significant perinatal complications. Obstetric providers should be aware of the impact and how to prevent and treat malaria infection during pregnancy. Malaria infection should be suspected in women with concerning symptoms and recent travel to endemic areas. Providers should know the management of uncomplicated and severe malarial infection in pregnancy.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to assess the adverse pregnancy outcomes associated with malarial infection; evaluate and manage patients traveling to endemic areas during pregnancy; and formulate a treatment plan for acute malaria infection.
The Efficacy and Safety of Tipapkinogen Sovacivec Therapeutic HPV Vaccine in Cervical Intraepithelial Neoplasia Grades 2 and 3: Randomized Controlled Phase II Trial with 2.5 Years of Follow-up
Authors: Harper Diane M. , Nieminen Pekka , Donders Gilbert , Einstein Mark H. , Garcia Francisco , Huh Warner K. , Stoler Mark H. , Glavini Katerina , Attley Gemma , Limacher Jean-Marc , Bastien Berangere , Calleja Elizabeth 
Published: September 2019

(Abstracted from Gynecol Oncol 153 (2019) 521–529)
On a global scale, cervical cancer comprises approximately 80% of human papillomavirus (HPV)–associated cancers. These cancers are most often treated surgically, and despite a high surgical success and vaccine prevention rate; there exists a need for nonsurgical, nonablative techniques to treat HPV-associated cancers.
Association Between Interpregnancy Interval and Adverse Birth Outcomes in Women With a Previous Stillbirth: An International Cohort Study
Authors: Regan Annette K. , Gissler Mika , Magnus Maria C. , Haberg Siri E. , Ball Stephen , Malacova Eva , Nassar Natasha , Leonard Helen , Pereira Gavin 
Published: September 2019

(Abstracted from Lancet 2019;393:1527–1535)
Interpregnancy interval (IPI; the length of time between pregnancies) is a risk factor for adverse outcomes in infants and their mothers. The World Health Organization recommends women wait at least 2 years after a live birth and 6 months after miscarriage or abortion before conceiving again, but there is no recommendation for the best IPI after stillbirth.
Developing Pediatric Critical Care in Kenya*
Authors: Kumar Rashmi , Canarie Michael F. 
Published: September 2019

Objective:
To describe efforts to improve the care of critically ill children in a tertiary care public hospital in a resource-limited setting.

Design:
Descriptive.

Setting:
Pediatric wards at the Kenyatta National Hospital in Nairobi, Kenya.

Patients:
Critically ill children admitted to the hospital.

Interventions:
A graduated approach to improving critical care capacity in a resource-limited setting.

Measurements and Main Results:
Pediatric mortality was tracked in the adult ICU and PICU following the engagement of a pediatric intensivist and creation of a critical care team. Mortality declined from 76.2% to 37.5% in the first 2 years of the new PICU.

Conclusions:
Caring for critically ill children in resource-limited setting presents many challenges. The stepwise approach described here has led to a nearly 50% reduction in mortality among critically ill children at Kenyatta National Hospital. It is a viable strategy to begin to address the disproportionate number of critically ill and injured children in resource-limited setting.
Impact of Ondansetron Prescription on Return Emergency Department Visits Among Children with Acute Gastroenteritis
Authors: McLaren Son H. , Yim Ramy B. , Fleegler Eric W. 
Published: September 2019

Objectives
The objective of this study was to determine if providing ondansetron prescription to children with acute gastroenteritis seen in the emergency department (ED) is associated with reduced unscheduled ED revisits.

Methods
This was a retrospective comparative cohort study conducted in a tertiary urban pediatric ED. We evaluated otherwise healthy children 6 months to 18 years old who presented to the ED between 2010 and 2015 and were discharged home with acute gastroenteritis diagnosis. Illness severity was determined using dehydration score, emergency severity index, and presenting symptoms. The incidence of unscheduled 72-hour ED revisit among patients discharged home with ondansetron prescription was compared with those without a prescription.

Results
Of the 11,785 eligible patients, 35.5% (N = 4,187) of patients were discharged home with ondansetron prescription. After adjustment for emergency severity index, age, insurance source, race, time of index visit registration, intravenous fluid use, and ED–administered ondansetron, there were no differences in the rates of ED revisit (adjusted odds ratio [aOR] = 1.12 [0.92, 1.33]) or admission after ED revisit (aOR = 0.81 [0.51, 1.27]) among children with versus without ondansetron prescription. No difference was found in the proportion of alternative diagnoses among returning patients with versus without ondansetron prescription (aOR = 0.56 [0.20, 1.59]).

Conclusions
There was no association between ondansetron prescription and ED revisit among children seen in the ED with suspected acute gastroenteritis. In the appropriate setting, however, physicians may consider prescribing ondansetron for symptom control in conjunction with careful discharge instructions.
Expression of Cathepsins B, D, and G by the Embryonic Stem Cell–Like Population within Human Keloid Tissues and Keloid-Derived Primary Cell Lines
Authors: Paterson Claudia , Lee Valerie M. Y. , Brasch Helen D. , van Schaijik Bede , Marsh Reginald , Tan Swee T. , Itinteang Tinte 
Published: September 2019

Background:
The authors have previously shown that an embryonic stem cell–like population within keloid-associated lymphoid tissues in keloid lesions expresses components of the renin-angiotensin system that may be dysregulated. The authors hypothesized that cathepsins B, D, and G are present within the embryonic stem cell–like population in keloid lesions and contribute to bypass loops of the renin-angiotensin system.

Methods:
3,3′-Diaminobenzidine immunohistochemical staining for cathepsins B, D, and G was performed on formalin-fixed paraffin-embedded sections in keloid tissue samples of 11 patients. Immunofluorescence immunohistochemical staining was performed on three of these keloid tissue samples, by co-staining with CD34, tryptase, and OCT4. Western blotting, reverse transcription quantitative polymerase chain reaction, and enzyme activity assays were performed on five keloid tissue samples and four keloid-derived primary cell lines to investigate protein and mRNA expression, and functional activity, respectively.

Results:
3,3′-Diaminobenzidine immunohistochemical staining demonstrated expression of cathepsins B, D, and G in all 15 keloid tissue samples. Immunofluorescence immunohistochemical staining showed localization of cathepsins B and D to the endothelium of microvessels within the keloid-associated lymphoid tissues and localization of cathepsin G to the tryptase-positive perivascular cells. Western blotting confirmed semiquantitative levels of cathepsins B and D in keloid tissue samples and keloid-derived primary cell lines. Reverse transcription quantitative polymerase chain reaction showed quantitative transcriptional activation of cathepsins B and D in keloid tissue samples and keloid-derived primary cell lines and cathepsin G in keloid tissue samples. Enzyme activity assays demonstrated functional activity of cathepsins B and D.

Conclusion:
Cathepsins B, D, and G are expressed by the embryonic stem cell–like population within the keloid-associated lymphoid tissues of keloid lesions and may act to bypass the renin-angiotensin system, suggesting a potential therapeutic target using renin-angiotensin system modulators and cathepsin inhibitors.
Neurotized Platysma Graft: A New Technique for Functional Reanimation of the Eye Sphincter in Longstanding Facial Paralysis
Authors: Nassif Tomaz , Yung Chia Chang 
Published: September 2019

Background:
In 1984, Terzis reported on the potential use of a free platysma muscle transfer to reanimate the orbicularis oculi in longstanding paralysis of this unit. However, the vascularized platysma flap proved difficult to transfer, and this technique is not widely used today. In the present study, the authors have described the technique involving grafting of the platysma muscle to restore eyelid function and retrospectively discussed its clinical outcomes.

Methods:
This retrospective analysis included patients with longstanding facial paralysis who underwent orbicularis oculi reconstruction with neurotized platysma grafts. The authors have described the surgical technique and its retrospective clinical outcomes.

Results:
Between 1992 and 2015, 38 consecutive patients underwent this procedure; of them, 34 [16 men (47 percent) and 18 women (53 percent)] completed the follow-up. The time between the first and second surgical stages was a mean 8.6 months (range, 6 to 22 months). The surgical results were good in 18 patients (53 percent) and the recovery was satisfactory in 13 (38 percent).

Conclusions:
This study confirmed the feasibility and effectiveness of grafted muscle functional recovery and the efficiency of neuromuscular neurotization. The presented surgical technique is safe and effective for treating longstanding facial palsy of the orbicularis oculi muscle. This is the only technique that is easy and reproducible, leads to facial nerve recovery, and places a similar muscle at the original site of the paralyzed muscle for functional recovery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Spectrum of 18F-FDG Uptake in Bilateral Lung Parenchymal Diseases on PET/CT
Authors: Prabhu Meghana , Raju Shobhana , Chakraborty Dhritiman , Arora Saurabh , Kumar Rakesh 
Published: September 2019

Abstract
Bilateral lung parenchymal involvement is seen in infective as well as noninfective conditions, appearing as focal or diffuse lung disease. PET/CT with FDG helps in characterization (increased glucose utilization is seen by both inflammatory and neoplastic cells). In this article, we describe the spectrum of patterns of FDG uptake and associated CT changes involving bilateral lung parenchyma. Benign conditions described are aspiration pneumonia; pulmonary toxicity by bleomycin; infections, namely, sarcoidosis, miliary pulmonary tuberculosis, and pulmonary nocardiosis; and inflammatory conditions such as pulmonary Langerhans cell histiocytosis and pulmonary alveolar proteinosis. Neoplastic conditions described are bilateral pulmonary metastases and lymphangitic carcinomatosis.
Atypical Parkinson Syndrome Hiding a Meningioma
Authors: Bund Caroline , Ouvrard Eric , Renaud Mathilde , Tranchant Christine , Namer Izzie-Jacques 
Published: September 2019

Abstract
A 59-year-old man had developed within a few months walking disorders and rigidity of the left upper limb. 123I-FP-CIT SPECT/CT was performed in response to the suspicion of atypical parkinsonian syndrome. It showed an anomaly in presynaptic dopaminergic transmission on the right striatum and a voluminous expansive process on CT. MRI revealed an atypical meningioma. The patient had surgery for tumor removal. Later 123I-FP-CIT SPECT/CT showed normalization of presynaptic dopaminergic transmission on the right striatum.