bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Acute Kidney Injury on the Risk of Mortality and Health Care Utilization Among Patients Treated With Polymyxins for Severe Gram-Negative Infections
Authors: Baradaran Sarah , Black Douglas J , Keyloun Katelyn R , Hansen Ryan N , Gillard Patrick J , Devine Beth 
Published: August 2018

Abstract

Background
With the rise of antibiotic resistance, polymyxin use has re-emerged but with a concern of renal toxicity. This study aims to assess mortality, length of stay, and total hospitalization cost associated with acute kidney injury (AKI) among recipients of intravenous (IV) sodium colistimethate (CMS) or IV polymyxin B (PMB).

Methods
We conducted a retrospective database analysis using the Premier database from January 1, 2012, through September 30, 2015. Adults ≥18 years of age who were admitted for inpatient treatment with ≥3 consecutive days of CMS or PMB were included. Generalized linear models compared patients who developed AKI with those who did not. Models were adjusted for patient and clinical characteristics.

Results
A total of 4886 patients were included; 4103 patients received CMS, and 783 received PMB. In the multivariable analyses, the presence of AKI was associated with higher in-hospital mortality in both the CMS cohort (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.9–2.7; P &lt; .001) and the PMB cohort (aOR, 2.7; 95% CI, 1.8–4.2; P &lt; .001). In both cohorts, patients who developed AKI experienced longer hospital stays (9.7 days and 11.6 days in the CMS and PMB cohorts, respectively; P &lt; .001). The mean total hospitalization costs for patients who developed AKI were $47 820 higher (95% CI, $34 918–$60 722) in the CMS cohort and $35 244 higher (95% CI, $17 561–$52 928) in the PMB cohort.

Conclusions
The clinical and economic burden of AKI in the context of polymyxin use is substantial. The use of effective antibiotics with limited toxicity should remain a priority.
Side-to-Side Anastomosis Training Model Using Rat Common Carotid Arteries
Authors: Tayebi Meybodi Ali , Aklinski Joseph , Gandhi Sirin , Preul Mark C , Lawton Michael T 
Published: August 2018

Abstract

BACKGROUND
The side-to-side anastomosis is one of the difficult bypass configurations that may be used in various complex cerebral vascular and neoplastic cases. Few pure arterial models exist for practicing this bypass subtype.

OBJECTIVE
To provide an optimized side-to-side anastomosis training model using rat common carotid arteries (CCA).

METHODS
Bilateral CCAs were exposed in the neck of 10 anesthetized Sprague–Dawley rats. The arteries were juxtaposed in parallel, using temporary aneurysm clips applied proximally and distally. CCA caliber and the length of CCA juxtaposition were measured. Side-to-side anastomosis was completed and ischemia time was recorded. Unintended complications were recorded for further analysis.

RESULTS
Anastomosis was completed successfully in all animals. The CCAs were approximated in all animals without any difficulty or undue tension. In 2 rats, death occurred prior to completion of anastomosis, which was attributed to injury to the external jugular vein during vessel exposure. Mean ischemia time was 35 min with an average of 22 sutures done to complete the anastomosis. The average CCA caliber was 1.1 ± 0.2 mm and the arteries could be juxtaposed for an average length of 10.2 ± 1.5 mm.

CONCLUSION
Full exposure of the cervical segment of the CCAs enables tension-free approximation of adequate length of the vessel for a side-to-side anastomosis. Avoiding complications during exposure helps in prevention of animal death during the ischemia period.
Vitamin D/VDR signaling suppresses microRNA‐802‐induced apoptosis of keratinocytes in oral lichen planus
Authors: Zhao Bin , Xu Na , Li Ran , Yu Feiyan , Zhang Fang , Yang Fang , Ge Xuejun , Li Yan Chun , Du Jie 
Published: August 2018

ABSTRACTVitamin D is known to play a protective role in inflammatory diseases. Although the suppressive effect of vitamin D/vitamin D receptor (VDR) signaling has been shown in the context of oral lichen planus (OLP), the molecular basis of its regulatory function remains poorly understood. Herein, we reported that miR‐802 over‐expression in OLP could aggravate apoptosis of oral keratinocytes by targeting B‐cell lymphoma 2 mRNA. In addition, vitamin D/VDR signaling was able to suppress miR‐802 expression in LPS‐treated or activated CD4+ T cell‐stimulated human oral keratinocytes by blocking NF‐κB pathways, thereby inhibiting OLP apoptosis. Consistent with the results in vitro, we showed that miR‐802 expression was enhanced in oral keratinocytes from VDR‐/‐ mice, and an inverse correlation between VDR and miR‐802 was found in human biopsy specimens of OLP. Collectively, our data suggest that vitamin D/VDR signaling suppresses oral keratinocyte apoptosis by targeting miR‐802.—Zhao, B., Xu, N., Li, R., Yu, F., Zhang, F., Yang, F., Ge, X., Li, Y. C., Du, J. Vitamin D/VDR signaling suppresses microRNA‐802‐induced apoptosis of keratinocytes in oral lichen planus. FASEB J. 33, 1042–1050 (2019). www.fasebj.org
Effect of Equipotent Doses of Propofol versus Sevoflurane Anesthesia on Regulatory T Cells after Breast Cancer Surgery
Authors: Oh Chung-Sik , Lee Jaemoon , Yoon Tae-Gyoon , Seo Eun-Hye , Park Hyun-Jun , Piao Liyun , Lee Seung-Hyun , Kim Seong-Hyop 
Published: August 2018

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Clusters of differentiation 39 and 73, enzymes expressed on the surface of regulatory T cells, promote cancer recurrence and metastasis by suppressing immune cells. The authors hypothesized that propofol is less immunosuppressive than volatile anesthetics. The objective of this randomized trial was to compare the changes in cluster of differentiation 39 and 73 expression on regulatory T cells between propofol- and sevoflurane-based anesthesia during breast cancer surgery.

Methods
A total of 201 patients having breast cancer surgery were randomly assigned and analyzed (n = 99 for propofol, n = 102 for sevoflurane). Blood samples were obtained immediately before anesthesia induction and 1 and 24 h postoperatively. The frequency of cluster of differentiation 39 and 73 expression on circulating regulatory T cells (primary outcome) and the frequency of circulating type 1 and type 17 helper T cells, natural killer cells, and cytotoxic T cells were investigated. Serum cytokines and the neutrophil-to-lymphocyte ratio were also evaluated.

Results
Changes in cluster of differentiation 39 and 73 expression on regulatory T cells over time did not differ with propofol and sevoflurane groups (difference [95% confidence interval]: 0.01 [−2.04 to 2.06], P = 0.995 for cluster of differentiation 39; −0.93 [−3.12 to 1.26], P = 0.403 for cluster of differentiation 73). There were no intergroup differences in type 1, type 17 helper T cells, natural killer cells, cytotoxic T cells, cytokines, or the neutrophil-to-lymphocyte ratio.

Conclusions
Changes in immune cells were similar with propofol and sevoflurane during breast cancer surgery. The effect of anesthetics on the perioperative immune activity may be minimal during cancer surgery.
Repeat Screening for Syphilis in the Third Trimester of Pregnancy
Authors: Hersh Alyssa R. , Megli Christina J. , Caughey Aaron B. 
Published: August 2018

OBJECTIVE:
To estimate the cost-effectiveness of screening all women during the first and third trimesters compared with screening just once during pregnancy.

METHODS:
We used a theoretical cohort of 3.9 million women in the United States to model syphilis screening approaches in pregnancy, particularly comparing one-time screening with repeat third-trimester screening. Outcomes of syphilis infection included in the model were congenital syphilis, intrauterine fetal demise, neonatal death, and total quality-adjusted life-years (QALYs). Probabilities, utilities, and costs were obtained from the literature, and a cost-effectiveness threshold was set at $100,000 per QALY. A societal perspective was assumed.

RESULTS:
Our model demonstrated that repeat screening in the third trimester for syphilis in pregnancy will result in fewer maternal and neonatal adverse outcomes and higher QALYs when compared with screening once in the first trimester. Specifically, we demonstrated that repeat screening results in 41 fewer neonates with evidence of congenital syphilis, 73 fewer cases of intrauterine fetal demise, 27 fewer neonatal and infant deaths, in addition to a cost savings of $52 million and 4,000 additional QALYs.

CONCLUSION:
Using our baseline assumptions, our data support that in pregnancy, repeat screening for syphilis is superior to single screening during the first trimester and is both cost-effective and results in improvement in maternal and neonatal outcomes. When screening policies are being created for pregnant women, the cost-effectiveness of repeat screening for syphilis should be considered.
RETINAL ARTERIAL DILATION IS IMPAIRED IN EYES WITH DRUSEN AND RETICULAR PSEUDODRUSEN
Authors: Rabiolo Alessandro , Benatti Lucia , Tomasso Livia , Zucchiatti Ilaria , Gelormini Francesco , Casaluci Marco , Querques Lea , Sacconi Riccardo , Bandello Francesco , Querques Giuseppe 
Published: August 2018

Purpose:
To analyze static characteristics and dynamic functionality of retinal vessels in eyes with drusen and reticular pseudodrusen (RPD) using dynamic vessel analyzer.

Methods:
Patients with clinical diagnosis of isolated RPD or medium-large drusen and healthy controls were enrolled in the study between July 2016 and May 2018. Participants underwent complete ophthalmologic examination, including enhanced depth imaging structural optical coherence tomography, dynamic retinal vessel analysis, and static retinal vessel analysis.

Results:
Twenty-eight eyes of 23 patients with drusen (9 men, mean age 77 ± 6 years), 22 eyes of 16 patients with RPD (7 men, mean age: 76 ± 6 years), and 22 eyes of 22 control subjects (11 men, mean age of 75 ± 6 years) were enrolled. Static retinal vessel analysis did not show any significant difference between the three groups for the central retinal artery equivalent (P = 0.11), the central retinal vein equivalent (P = 0.27), and the arteriovenous ratio (P = 0.30). Dynamic vessel analysis showed significantly reduced arterial dilation in eyes with drusen (P = 0.0001) and RPD (P = 0.015) compared with control subjects. No significant difference was seen between drusen and RPD groups (P = 0.32). Dynamic vessel analysis of retinal veins showed no differences between the three groups (P = 0.10).

Conclusion:
Dynamic vessel analysis in eyes with drusen and RPD revealed an impaired retinal arterial dilation in response to flicker light stimulation, which further supports the relationship between cardiovascular risk and age-related macular degeneration.
Evaluation of IV to Enteral Benzodiazepine Conversion Calculations in a Pediatric Intensive Care Setting
Authors: Warrington Susan E. , Collier Hailey K. , Himebauch Adam S. , Wolfe Heather A. 
Published: August 2018

Objectives:
To evaluate if institutionally established calculations for transitioning continuous IV midazolam to enteral benzodiazepines maintain Withdrawal Assessment Tool—Version 1 scores equal to or less than preconversion values.

Design:
Retrospective cohort study evaluating the effectiveness and safety of benzodiazepine conversion calculations embedded within an institution-specific clinical pathway for sedation and weaning of mechanically ventilated pediatric patients.

Setting:
A 55-bed, mixed-medical, noncardiac surgical PICU in a tertiary care children’s hospital.

Patients:
All patients age 6 months to 18 years who received continuous midazolam for 5 days or longer while mechanically ventilated for 5–21 days and were then converted to either enteral diazepam or lorazepam following extubation (or return to baseline ventilator settings in tracheostomy-dependent patients) between January 1, 2015, and June 30, 2016.

Interventions:
Benzodiazepine conversion calculations were applied according to institutional clinical pathway guidance.

Measurements and Main Results:
Withdrawal Assessment Tool—Version 1 scores were compared pre and post benzodiazepine conversion. Patient demographics, benzodiazepine dose escalations, as needed benzodiazepine requirements, and severe adverse events within 48 hours of conversion were assessed. Seventy-one patient encounters were analyzed (median age, 2.5 yr; interquartile range, 1.2–5.3). The median Withdrawal Assessment Tool—Version 1 scores pre conversion and post conversion were not significantly different (1 [interquartile range, 0.75–2] and 1 [interquartile range, 0.25–2], respectively, p = 0.1). As needed benzodiazepine doses were administered in 38% of encounters post conversion, but escalation of a scheduled enteral benzodiazepine regimen was only required in 2.8% of encounters. Post conversion, one patient (1.4%) had increased seizure activity, and four patients (5.6%) required fluid boluses secondary to tachycardia or dehydration, but not hypotension.

Conclusions:
These findings suggest that standardized benzodiazepine conversions successfully achieved consistent Withdrawal Assessment Tool—Version 1 scores compared with preconversion values. Severe adverse events associated with oversedation and/or withdrawal were minimal and confounded by underlying disease states.
Pediatric Massive Transfusion
Authors: Maw Graeme , Furyk Claire 
Published: August 2018

Introduction
Balanced resuscitation of plasma, platelets, and red blood cells is now recognized as improving outcomes in traumatic bleeding in adults. The correct approach in children has yet to be determined.

Methods
We performed a systematic review of the literature into transfusion protocols in traumatic hemorrhage in children by conducting an article search of significant databases to identify relevant articles. Studies of interest included interventional trials with comparisons relating to the transfusion of blood including blood component therapy. The search identified 422 articles of interest, the abstracts of which were independently reviewed by 2 authors for inclusion in the trial. This revealed 35 articles, the full texts of which were reviewed. There were no randomized controlled trials and 4 nonrandomized trials with a further 21 articles that were deemed relevant. The data were insufficient for meta-analysis, and so a descriptive analysis was performed.

Results
There were 4 main trials. Two trials were small (approximately 100 patients) nonrandomized trials into pediatric hemorrhage managed as per a massive transfusion protocol or at physician discretion. One was a retrospective analysis of pediatric trauma patients who received red blood cell transfusion with differing platelet ratios, and one was a trauma database review of component ratios in hemorrhaging children. All 4 trials found increased ratios had no effect on mortality.

Discussion
As well as blood component therapy, adjunctive therapies used in the management of bleeding children are discussed. These include tranexamic acid, viscoelastic hemostatic assays, factor VIIa, and fibrinogen use.

Conclusions
There is little evidence for improved outcomes using component-based transfusion in a rigid 1:1:1 strategy in children. A goal-directed approach using viscoelastic hemostatic assay–guided treatment with early institution of tranexamic acid and fibrinogen replacement is considered the way forward.
An Unusual Cause for Intermittent Stridor and Dysphagia in an Infant
Authors: Ryan Sydney E. , Beyerlein Larissa , Lee Justin H. , Fenton Stephen J. , Hewes Hilary A. 
Published: August 2018

Abstract
Stridor is a common presenting symptom in young children and is produced by turbulent flow through the upper airway or trachea. In children under 12 months of age, stridor is commonly caused by laryngomalacia, tracheomalacia, croup, airway foreign body, and/or retropharyngeal abscess. In atypical presentations of stridor, soft tissue neck radiographs can be helpful to determine the underlying etiology. Occasionally, children will require bronchoscopy to determine the etiology and treatment.
Staged Raising of a Coronal Flap for Fronto-Orbital Advancement and Remodeling in Saethre–Chotzen Syndrome Complicated by Sinus Pericranii
Authors: Shaw Abigail V. , Jayamohan Jayaratnam , Sheerin Fintan , Johnson David 
Published: August 2018

Abstract
This article reports the surgical management of a 3-month-old girl with Saethre–Chotzen syndrome, who presented with bicoronal synostosis and a large midline sinus pericranii with abnormal cerebral venous drainage via scalp veins. Raised intracranial pressure was demonstrated on monitoring, indicating the need for calvarial expansion necessitating a coronal access incision. A 2-staged delayed raising of the coronal flap was performed to reduce the potential risk of cerebral venous infarction. Monitoring for clinical sequelae and a computerised tomography venogram followed each of these procedures, demonstrating successful redirection of the venous drainage of the brain posteriorly. Finally, a successful fronto-orbital advancement and remodeling procedure was performed with no complications.
Surgical Techniques and Long-term Outcomes of Living-donor Liver Transplantation With Inferior Vena Cava Replacement Using Atriocaval Synthetic Interposition Graft for Budd-Chiari Syndrome
Authors: Yoon Young-In , Lee Sung-Gyu , Moon Deok-Bog , Ahn Chul-Soo , Hwang Shin , Kim Ki-Hun , Ha Tae-Yong , Song Gi-Won , Jung Dong-Hwan , Park Gil-Chun , Kim Dong-Sik , Choo Suk-Jung 
Published: August 2018

Objective:
We aimed to describe our living-donor liver transplantation (LDLT) surgical technique and its long-term patency for patients with Budd-Chiari syndrome (BCS) and retrohepatic inferior vena cava (IVC) obstruction that extends up to the atrium.

Background:
From a technical perspective, LDLT for BCS with an IVC obstruction up to the right atrium is one of the most challenging surgical procedures. Consequently, the optimal surgical technique for patients with BCS has not yet been elucidated.

Methods:
A durable LDLT technique without piggy-back hepatectomy was designed using a large-caliber synthetic interposition vascular graft between the right atrium and the infrahepatic IVC for reconstructing the hepatic outflow tract in patients with BCS.

Results:
Between May 2006 and May 2017, 5 of 17 BCS patients who underwent LDLT required the described technique. All patients with a median follow-up of 10.5 years (range, 9.2–11.5 years) demonstrated the patent IVC grafts and no recurrence of BCS.

Conclusions:
Our refined technique does not require unnecessary and dangerous dissection of the diseased IVC, and eliminates the residual suprahepatic vena cava with the possibility of BCS recurrence by connecting the graft to the healthy atrium.
Circulating Tumor Cells Dynamics in Pancreatic Adenocarcinoma Correlate With Disease Status
Authors: Gemenetzis Georgios , Groot Vincent P. , Yu Jun , Ding Ding , Teinor Jonathan A. , Javed Ammar A. , Wood Laura D. , Burkhart Richard A. , Cameron John L. , Makary Martin A. , Weiss Matthew J. , He Jin , Wolfgang Christopher L. 
Published: August 2018

Objectives:
Previous retrospective studies demonstrated that circulating tumor cells (CTCs) subtypes correlate with overall survival in patients with pancreatic ductal adenocarcinoma (PDAC). Herein, we report results of a prospective observational study on CTCs dynamics to assess their clinical significance.

Methods:
The CLUSTER study is a prospective longitudinal study on PDAC CTCs dynamics (NCT02974764). Multiple peripheral blood samples were collected from 200 consecutively enrolled patients with presumed PDAC diagnosis. CTCs were isolated and characterized by immunofluorescence.

Results:
Two major CTCs subtypes were identified in PDAC patients: epithelial CTCs (eCTCs) and epithelial/mesenchymal CTCs (mCTCs). Patients who received neoadjuvant chemotherapy had significantly lower total CTCs (tCTCs, P = 0.007), eCTCs (P = 0.007), and mCTCs (P = 0.034), compared with untreated patients eligible for upfront resection. Surgical resection of the primary tumor resulted in significant reduction, but not disappearance, of CTCs burden across all cell subtypes (P < 0.001). In multivariable logistic regression analysis, preoperative numbers of all CTCs subpopulations were the only predictors of early recurrence within 12 months from surgery in both chemo-naive and post-neoadjuvant patients (odds ratio 5.9 to 11.0). Alterations in CTCs were also observed longitudinally, before disease recurrence. A risk assessment score based on the difference of tCTCs increase accurately identified disease recurrence within the next 2 months, with an accuracy of 75% and 84% for chemo-naive and post-neoadjuvant patients, respectively.

Conclusion:
We report novel findings regarding CTCs from a large prospective cohort of PDAC patients. CTCs dynamics reflect progression of disease and response to treatment, providing important information on clinical outcomes, not available by current tumor markers and imaging.
A Comparison of the Learning Curves of Laparoscopic Liver Surgeons in Differing Stages of the IDEAL Paradigm of Surgical Innovation
Authors: Halls Mark Christopher , Alseidi Adnan , Berardi Giammauro , Cipriani Federica , Van der Poel Marcel , Davila Diego , Ciria Ruben , Besselink Marc , D’Hondt Mathieu , Dagher Ibrahim , Alrdrighetti Luca , Troisi Roberto Ivan , Abu Hilal Mohammad 
Published: August 2018

Objective:
To compare the learning curves of the self-taught “pioneers” of laparoscopic liver surgery (LLS) with those of the trained “early adopters” in terms of short- and medium-term patient outcomes to establish if the learning curve can be reduced with specific training.

Summary of Background Data:
It is expected that a wider adoption of a laparoscopic approach to liver surgery will be seen in the next few years. Current guidelines stress the need for an incremental, stepwise progression through the learning curve in order to minimize harm to patients. Previous studies have examined the learning curve in Stage 2 of the IDEAL paradigm of surgical innovation; however, LLS is now in stage 3 with specific training being provided to surgeons.

Methods:
Using risk-adjusted cumulative sum analysis, the learning curves and short- and medium-term outcomes of 4 “pioneering” surgeons from stage 2 were compared with 4 “early adapting” surgeons from stage 3 who had received specific training for LLS.

Results:
After 46 procedures, the short- and medium-term outcomes of the “early adopters” were comparable to those achieved by the “pioneers” following 150 procedures in similar cases.

Conclusions:
With specific training, “early adapting” laparoscopic liver surgeons are able to overcome the learning curve for minor and major liver resections faster than the “pioneers” who were self-taught in LLS. The findings of this study are applicable to all surgical specialties and highlight the importance of specific training in the safe expansion of novel surgical practice.