bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Different Head-of-Bed Elevations and Body Positions on Intracranial Pressure and Cerebral Perfusion Pressure in Neurosurgical Patients
Authors: Altun Uğraş Gülay , Yüksel Serpil , Temiz Zeynep , Eroğlu Selin , Şirin Keziban , Turan Yüksel 
Published: July 2018

ABSTRACT

Purpose: The aim of this study was to evaluate the effects of different head of bed (HOB) elevations and body positions on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and to identify safe positions for neurosurgical patients with different Glasgow Coma Scale (GCS) scores. Methods: This study with a quasi-experimental, prospective repeated measures is designed with control over the intervention consisted of 30 patients hospitalized in the neurocritical care units (NCU). Patients’ HOB was elevated (degree of 15,30,45) and the patients were at supine, left lateral and right lateral positions. ICP and CPP were recorded for each patient. Results: It was found that ICP increased and CPP decreased at supine, left and right lateral positions with different HOB elevations, which, however, did not reach statistical significance. When patients with a GCS score of 3–8 were at degree of 15 right and left lateral positions and 45 right lateral position; and when patients with a GCS score of 13–15 were positioned at degree of 15 left lateral, ICP and CPP changed significantly. Conclusion: The results of this study showed that different positions the patients’ HOB (degree of 15,30,45) led to slight insignificant changes in ICP and CPP; and these values were maintained within the ranges established by recent guidelines.
Effectiveness of a Tailored Lifestyle Management Program for Middle-Aged Women With Coronary Artery Disease: A Preliminary Study
Authors: TSAI Ching-Ching , LI Ai-Hsien , TU Chung-Ming , HWANG Kai-Lin , JENG Chii 
Published: July 2018

ABSTRACT

Background:
Coronary artery disease (CAD) is a leading cause of death in women. Many of the risk factors for CAD relate to lifestyle and thus may be influenced by lifestyle modification. However, middle-aged women often find it difficult to adjust their lifestyle behaviors. Thus, providing individualized treatment is crucial to reducing the risk and incidence of CAD in this population.

Purpose:
The aim of this study was to explore the effectiveness of a tailored lifestyle management program (TLMP) for middle-aged women with CAD.

Methods:
An experimental design was employed. Thirty-five middle-aged women with CAD (with stenosis [> 50%] of at least one main artery as determined by cardiac catheterization examination results) were recruited. The 35 women were randomlyassigned to the experimental group (n = 17) or the control group (n = 18). Both groups received regular health education during their hospitalization. After discharge, the experimental group received the 12-week, home-based TLMP. A generalized estimating equation was used to examine the effects of the TLMP on metabolic and biomarker indicators for CAD.

Results:
The average age of participants was 56.1 ± 5.6 years. No significant demographic differences were identified between the two groups. Compared with the control group, the experimental group had a significantly higher high-density lipoprotein level (B = 7.83, p < .001), a lower level of total cholesterol (B = −49.21, p = .04), and a lower waist circumference (B = −6.42, p < .001).

Conclusions/Implications for Practice:
This study suggests that using tailored interventions is an effective approach to improving high-density lipoprotein, total cholesterol, and waist circumference in middle-aged women with CAD. This result is expected to have important implications for women’s healthcare, particularly in terms of preventing the incidence of CAD.
Megakaryocyte modification of platelets in thrombocytopenia
Authors: Roweth Harvey G. , Parvin Somayje , Machlus Kellie R. 
Published: July 2018

Purpose of review
Platelets are small, anucleate cells that circulate within the blood and play essential roles in preserving vascular integrity. However, abnormalities in either platelet production or destruction can result in thrombocytopenia, clinically defined by a platelet count lower than 150 000/μL of whole blood. Thrombocytopenia is frequently associated with impaired hemostatic responses to vascular injury and can be life-threatening because of bleeding complications. Megakaryocytes are the precursor cells responsible for platelet production, a process commonly referred to as thrombopoiesis. This review specifically discusses how perturbation of molecular mechanisms governing megakaryocyte differentiation and development manifest in various forms of thrombocytopenia.

Recent findings
This review highlights the identification of novel transcriptional regulators of megakaryocyte maturation and platelet production. We also provide an update into the essential role of cytoskeletal regulation in thrombopoiesis, and how both megakaryopoiesis and platelet production are altered by anticancer therapeutics. Lastly, we focus on recent investigative approaches to treat thrombocytopenia and discuss future prospects in the field of megakaryocyte research.

Summary
In patients where thrombocytopenia is not due to heightened platelet destruction or clearance, defects in megakaryocyte development should be considered.
Piecemeal Deglutition and the Implications for Pressure Impedance Dysphagia Assessment in Pediatrics
Authors: Ferris Lara , King Sebastian , McCall Lisa , Rommel Nathalie , Scholten Ingrid , Teague Warwick , Doeltgen Sebastian , Omari Taher 
Published: July 2018

ABSTRACTObjectives:High‐resolution impedance manometry (HRIM) enables biomechanical swallow assessment. Piecemeal deglutition (PD) defines swallowing of a single bolus in 2 or more portions. We investigated PD sequences on HRIM recordings to ascertain appropriate swallow selection for analysis and to determine the impact of PD on swallow function measures.Methods:Pharyngo‐esophageal motility and bolus flow were assessed in 27 children (19 M, mean age 15 months) with repaired esophageal atresia and trachea‐esophageal fistula, but who were asymptomatic of oropharyngeal dysphagia. A consistent volume of between 2 and 5 mL saline boluses was given to each patient. Retrospectively, PD sequences were defined based on the number of swallows required to clear the bolus from the oral cavity: pattern A = 1–2 swallows; pattern B = 3 swallows; and pattern C = 4+ swallows. The largest bolus volume swallowed was noted as the dominant swallow in each pattern. Pressure Flow Analysis defined contractility, distension and flow timing metrics. Data were averaged for each PD pattern, and compared with dominant swallows from each pattern.Results:PD pattern B (43.7%) was the most prevalent across the cohort. PD patterns were similarly distributed across age groups (G1: <1 years, G2: 1–4 years). Differences in upper esophageal sphincter distension and pharyngeal flow timing measures were, however, seen in relation to both age and PD pattern, whereby a larger pharynx in older children elicited greater distension for a longer latency, and for larger volumes.Conclusions:PD reduces bolus volume, and biomechanical swallow measures are impacted. PD is a necessary consideration for accurate HRIM analysis of swallow function. Selection of dominant swallows from a PD sequence provides a swallow profile which best represents a child's swallow function, and should always be reported and interpreted in context of the PD sequence observed.
Erythromycin and Reflux Events in Premature Neonates
Authors: Ballengee Cortney R. , Davalian Faranek , Conaway Mark R. , Sauer Cary G. , Kaufman David A. 
Published: July 2018

ABSTRACTObjective:Gastroesophageal reflux disease (GERD) in premature neonates may manifest as apnea, bradycardia, growth failure, aspiration, or feeding intolerance. Erythromycin ethylsuccinate (EES), is often used as a pro‐kinetic in the management of GERD, despite lack of evidence or safety from randomized controlled trials. We sought to study the efficacy of enteral EES at a dose of 50 mg · kg−1 · day−1 in decreasing the frequency of gastroesophageal reflux events as determined by pH‐multichannel intraluminal impedance (pH‐MII) monitoring.Methods:In a randomized, double‐blind, placebo‐controlled trial, eligible premature neonates with clinical signs of GERD underwent 24‐hour pH‐MII monitoring. If >5 reflux events were identified on pH‐MII, then subjects were randomized to receive either EES or placebo. Repeat 24‐hour pH‐MII was performed on day 7 of study treatment and compared to initial pH‐MII.Results:Forty‐three premature neonates were enrolled. Of those, 31 neonates were randomized, 15 to EES and 16 to placebo with a median (IQR) pretreatment total reflux events per 24 hours of 23 (16–40) and 29 (12–40), respectively. Day 7 total events per 24 hours decreased by 4 events in the EES group to 19 (15–33) and by 10 events in the placebo group to 19 (11–26) (P = 0.09). There were no differences in pretreatment and day 7 acidic and nonacidic reflux, proximal reflux, total or percent reflux time, median or longest bolus clearance time, or nurse‐reported apnea events between groups.Conclusions:Enteral EES did not decrease reflux events on 24‐hour pH‐MII at the dose studied. Therefore, it may be ineffective in the treatment of GERD in premature neonates.
An Academic-Practice Partnership
Authors: Roach Ashley , Hooke Sherrill 
Published: July 2018

Background
Through the Veterans Affairs Nursing Academic Partnership (VANAP), baccalaureate nursing students and faculty participated in practice innovations in a Veterans Affairs Health Care System. Nationally, VANAP has attempted to bridge gaps between theory and practice and across care settings.

Approach
In a population health course, nursing students were placed in both inpatient and outpatient settings. Through activities such as postconferences and population-based projects, students joined forces with Veterans Affairs staff on issues that affected veterans' health care.

Outcomes
Two student groups worked on amputation prevention from opposite ends of the spectrum. Their projects, with the continuation of these by faculty and staff, resulted in 47% decrease in vascular-related hospital readmissions.

Conclusions
Student placements in settings across the care continuum improved communication between the settings. The enhanced partnership between the 2 organizations addressed a relevant, meaningful patient care issue.
Quetiapine protects the blood-brain barrier in traumatic brain injury
Authors: Robinson Bobby Darnell , Isbell Claire Larson , Anasooya Shaji Chinchusha , Kurek Stanley , Regner Justin L. , Tharakan Binu 
Published: July 2018

BACKGROUNDThe integrity of the blood-brain barrier (BBB) is paramount in limiting vasogenic edema following traumatic brain injury (TBI). The purpose of this study was to ascertain if quetiapine, an atypical antipsychotic commonly used in trauma/critical care for delirium, protects the BBB and attenuates hyperpermeability in TBI.METHODSThe effect of quetiapine on hyperpermeability was examined through molecular modeling, cellular models in vitro and small animal models in vivo. Molecular docking was performed with AutoDock Vina to matrix metalloproteinase-9. Rat brain microvascular endothelial cells (BMECs) were pretreated with quetiapine (20 μM; 1 hour) followed by an inflammatory activator (20 μg/mL chitosan; 2 hours) and compared to controls. Immunofluorescence localization for tight junction proteins zonula occludens-1 and adherens junction protein β-catenin was performed. Human BMECs were grown as a monolayer and pretreated with quetiapine (20 μM; 1 hour) followed by chitosan (20 μg/mL; 2 hours), and transendothelial electrical resistance was measured. C57BL/6 mice (n = 5/group) underwent mild to moderate TBI (controlled cortical impactor) or sham craniotomy. The treatment group was given 10 mg/kg quetiapine intravenously 10 minutes after TBI. The difference in fluorescence intensity between intravascular and interstitium (ΔI) represented BBB hyperpermeability. A matrix metalloproteinase-9 activity assay was performed in brain tissue from animals in the experimental groups ex vivo.RESULTSIn silico studies showed quetiapine thermodynamically favorable binding to MMP-9. Junctional localization of zonula occludens-1 and β-catenin showed retained integrity in quetiapine-treated cells as compared with the chitosan group in rat BMECs. Quetiapine attenuated monolayer permeability compared with chitosan group (p< 0.05) in human BMECs. In the animal studies, there was a significant decrease in BBB hyperpermeability and MMP-9 activity when compared between the TBI and TBI plus quetiapine groups (p< 0.05).CONCLUSIONQuetiapine treatment may have novel anti-inflammatory properties to provide protection to the BBB by preserving tight junction integrity.LEVEL OF EVIDENCElevel IV.
Hypobaria during long-range flight resulted in significantly increased histopathological evidence of lung and brain damage in a swine model
Authors: Scultetus Anke H. , Jefferson Michelle A. , Haque Ashraful , Ho Lam Thuy Vi Tran , Hazzard Brittany , Saha Biswajit K. , Chun Steve J. , Auker Charles R. , Moon-Massat Paula F. , McCarron Richard M. , Malone Debra L. 
Published: July 2018

BACKGROUND
Aeromedical evacuation to definitive care is standard in current military conflicts. However, there is minimal knowledge on the effects of hypobaria (HYPO) on either the flight crew or patients. The effects of HYPO were investigated using healthy swine.

METHODS
Anesthetized Yorkshire swine underwent a simulated 4 h “transport” to an altitude of 2,441 m (8,000 feet.; HYPO, N = 6) or at normobaric conditions (NORMO, N = 6). Physiologic and biochemical data were collected. Organ damage was assessed for hemorrhage, inflammation, edema, necrosis, and for lungs only, microatelectasis.

RESULTS
All parameters were similar prior to and after “transport” with no significant effects of HYPO on hemodynamic, neurologic, or oxygen transport parameters, nor on blood gas, chemistry, or complete blood count data. However, the overall Lung Injury Score was significantly worse in the HYPO than the NORMO group (10.78 ± 1.22 vs. 2.31 ± 0.71, respectively) with more edema/fibrin/hemorrhage in the subpleural, interlobular and alveolar space, more congestion in alveolar septa, and evidence of microatelectasis (vs. no microatelectasis in the NORMO group). There was also increased severity of pulmonary neutrophilic (1.69 ± 0.20 vs. 0.19 ± 0.13) and histiocytic inflammation (1.83 ± 0.23 vs. 0.47 ± 0.17) for HYPO versus NORMO, respectively. On the other hand, there was increased renal inflammation in NORMO compared with HYPO (1.00 ± 0.13 vs. 0.33 ± 0.17, respectively). There were no histopathological differences in brain (whole or individual regions), liver, pancreas, or adrenals.

CONCLUSION
Hypobaria, itself, may have an adverse effect on the respiratory system, even in healthy individuals, and this may be superimposed on combat casualties where there may be preexisting lung injury. The additional effects of anesthesia and controlled ventilation on these results are unknown, and further studies are indicated using awake models to better characterize the mechanisms for this pathology and the factors that influence its severity.
Use of diaphragm pacing in the management of acute cervical spinal cord injury
Authors: Kerwin Andrew J. , Yorkgitis Brian K. , Ebler David J. , Madbak Firas G. , Hsu Albert T. , Crandall Marie L. 
Published: July 2018

BACKGROUND
Cervical spinal cord injury (CSCI) is devastating. Respiratory failure, ventilator-associated pneumonia (VAP), sepsis, and death frequently occur. Case reports of diaphragm pacing system (DPS) have suggested earlier liberation from mechanical ventilation in acute CSCI patients. We hypothesized DPS implantation would decrease VAP and facilitate liberation from ventilation.

METHODS
We performed a retrospective review of patients with acute CSCI managed at a single Level 1 trauma center between January 2005 and May 2017. Routine demographics were collected. Patients underwent propensity matching based on age, injury severity score, ventilator days, hospital length of stay, and need for tracheostomy. Outcome measures included hospital length of stay, intensive care unit length of stay, ventilator days (vent days), incidence of VAP, and mortality. Bivariate and multivariate logistic and linear regression statistics were performed using STATA Version 10.

RESULTS
Between July 2011 and May 2017, all patients with acute CSCI were evaluated for DPS implantation. Forty patients who had laparoscopic DPS implantation (DPS) were matched to 61 who did not (NO DPS). Median time to liberation after DPS implantation was 7 days. Hospital length of stay and mortality were significantly lower on bivariate analysis in DPS patients. Diaphragm pacing system placement was not found to be associated with statistically significant differences in these outcomes on risk-adjusted multivariate models that included admission year.

CONCLUSIONS
Diaphragm pacing system implantation in patients with acute CSCI can be one part of a comprehensive critical care program to improve outcomes. However, the association of DPS with the marked improved mortality seen on bivariate analysis may be due solely to improvements in critical care throughout the study period. Further studies to define the benefits of DPS implantation are needed.

LEVEL OF EVIDENCE
Therapeutic, level IV.
Inability to predict subprophylactic anti–factor Xa levels in trauma patients receiving early low-molecular-weight heparin
Authors: Imran Jonathan B. , Madni Tarik D. , Clark Audra T. , Rizk Paul , Huang Emily , Minshall Christian T. , Taveras Luis R. , Cunningham Holly B. , Eastman Alexander L. , Koshy Jojo P. , Kacir Cory D. , Cripps Michael W. 
Published: July 2018

BACKGROUND
Standard low-molecular-weight heparin dosing may be suboptimal for venous thromboembolism prophylaxis. We aimed to identify independent predictors of subprophylactic Xa (subXa) levels in trauma patients treated under a novel early chemoprophylaxis algorithm.

METHODS
A retrospective analysis of trauma patients from July 2016 to June 2017 who received enoxaparin 40 mg twice daily and had peak Xa levels drawn was performed. Patients were divided into cohorts based on having a subXa (<0.2 IU/mL) or prophylactic (≥0.2 IU/mL) Xa level.

RESULTS
In all, 124 patients were included, of which 38 (31%) had subXa levels, and 17 (14%) had Xa levels greater than 0.4 IU/mL. Of the subXa cohort, 35 (92%) had their dosage increased, and the repeat Xa testing that was done in 32 revealed that only 75% reached prophylactic levels. The median time to the initiation of chemoprophylaxis was 21.9 hours (interquartile range [IQR], 11.45–35.07 hours). Patients who were defined as having lower risk of having a complication as a result of bleeding had a shorter time to starting prophylaxis than those at higher risk (18.39 hours [IQR 5.76–26.51 hours] vs. 29.5 hours [IQR 16.23–63.07 hours], p < 0.01).
There was no difference in demographics, weight, body mass index, creatinine, creatinine clearance, injury severity score, type of injury, weight-based dose, time to chemoprophylaxis, or bleeding complications between the cohorts. No independent predictors of subXa level were identified on multivariable logistic regression.

CONCLUSIONS
A significant number of trauma patients fail to achieve prophylactic Xa levels. Intrinsic factors may prevent adequate prophylaxis even with earlier administration and higher dosing of low-molecular-weight heparin.

LEVEL OF EVIDENCE
Therapeutic, level IV
Perhaps it's not the platelet: Ristocetin uncovers the potential role of von Willebrand factor in impaired platelet aggregation following traumatic brain injury
Authors: Kornblith Lucy Z. , Robles Anamaria J. , Conroy Amanda S. , Hendrickson Carolyn M. , Calfee Carolyn S. , Fields Alexander T. , Callcut Rachael A. , Cohen Mitchell J. 
Published: July 2018

BACKGROUND
Injury to the blood-brain barrier exposes endothelium rich in von Willebrand factor (vWF), which may play a role in altered platelet aggregation following traumatic brain injury (TBI). Ristocetin is an antimicrobial substance that induces vWF-mediated aggregation of platelets. We examined these mechanisms in injured patients by measuring the aggregation response of platelets to stimulating agonists (including ristocetin) via whole-blood multiple-electrode platelet aggregometry. We hypothesized that patients with TBI have an altered platelet aggregation response to ristocetin stimulation compared with patients without TBI.

METHODS
Blood was collected from 233 trauma patients without thrombocytopenia. Platelet aggregation was assessed using multiple-electrode platelet aggregometry (Multiplate). Platelet aggregation response to stimulating agonists collagen, thrombin receptor-activating peptide 6, adenosine diphosphate, arachidonic acid, and ristocetin was measured. Factor activity was measured.

RESULTS
Of the 233 patients, 23% had TBI. There were no differences in platelet aggregation responses to any agonists between TBI and non-TBI patients except ristocetin. Platelet aggregation response to ristocetin stimulation was significantly lower in TBI patients (p = 0.03). Patients with TBI also had higher factor VIII activity (215% vs. 156%, p = 0.01). In multivariate analysis, there was a significant independent association of impaired platelet aggregation response to ristocetin stimulation with TBI (odds ratio, 3.05; p = 0.04).

CONCLUSIONS
Given the importance of platelets in hemostasis, understanding the mechanisms of impaired platelet aggregation following injury is critical. The impaired platelet aggregation response to ristocetin stimulation and corresponding increase in factor VIII activity in TBI patients may be secondary to a TBI-induced effect on vWF quantity (due to injury-driven consumption of vWF) or vWF function with resultant increase in circulating factor VIII activity (due to impaired carrying capacity of vWF). Given there are multiple known therapies for vWF deficits including desmopressin, purified and recombinant vWF, and estrogens, these lines of investigation are particularly compelling in patients with TBI and hemorrhage.

LEVEL OF EVIDENCE
Prognostic study, level II.
Metabolic Concepts in Idiopathic Intracranial Hypertension and Their Potential for Therapeutic Intervention
Authors: Hornby Catherine , Mollan Susan P. , Botfield Hannah , O'Reilly Michael W. , Sinclair Alexandra J. 
Published: July 2018

Background:
Traditional risk factors associated with idiopathic intracranial hypertension (IIH) include obesity, weight gain, and female sex. The incidence of IIH is increasing and yet the underlying trigger and the fueling pathological mechanisms are still poorly understood.

Evidence Acquisition:
Review of ophthalmology, neurology, general surgery, obesity, endocrinology, nutrition, and neurosurgery literature was made.

Results:
The facts that implicate sex and obesity in IIH and headache are examined. The role of fat distribution in IIH is questioned, and the concept of adipose tissue functioning as an endocrine organ driving IIH is discussed. The impact of androgen metabolism in IIH is reviewed as is the emerging role of glucagon-like-peptide-1 analogues in modulating intracranial pressure. This introduces the concept of developing targeted disease-modifying therapeutic strategies for IIH.

Conclusions:
This review will discuss the possible role of the adipose/gut/brain metabolism axis in IIH and speculate how this may impact the pathogenesis of IIH and therapeutic opportunities.