bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined angiotensin receptor and neprilysin inhibition therapy for heart failure
Authors: Lu Becky N. , Davis Lindsay E. 
Published: June 2018

ABSTRACT
The FDA has approved sacubitril/valsartan, an angiotensin-receptor-neprilysin inhibitor, for the treatment of chronic symptomatic heart failure (stage C) in patients with a left ventricular ejection fraction of 35% or less. This article discusses results from a major clinical trial, PARADIGM-HF, and the role of this new drug in heart failure treatment.
Effectiveness of NPs and PAs in managing diabetes and cardiovascular disease
Authors: Faza Nadeen N. , Akeroyd Julia M. , Ramsey David J. , Shah Tina , Nasir Khurram , Deswal Anita , Ballantyne Christie M. , Petersen Laura A. , Virani Salim S. 
Published: June 2018

ABSTRACT

Background:
The effectiveness of cardiovascular disease (CVD) and diabetes care delivered by NPs and physician assistants (PAs), and resource use by these providers has not been studied.

Methods:
We performed regression analyses of patients with diabetes or CVD with a primary care visit in 130 Veterans Affairs (VA) facilities to assess the association between provider type and effectiveness or resource use.

Results:
The diabetes cohort consisted of 156,034 patients assigned to NPs and 54,590 assigned to PAs. Glycemic and BP control, statin use, number of primary or specialty care visits, lipid panels, and A1C results were comparable between groups. The CVD cohort consisted of 185,694 patients assigned to NPs and 66,217 assigned to PAs. BP control; use of beta-blockers, statins, or antiplatelets; primary or specialty care visits; lipid panels; and number of stress tests ordered were comparable between groups.

Conclusion:
Effectiveness of care and resource use among patients in both groups were comparable.
Presenting Symptoms Independently Predict Mortality in Septic Shock: Importance of a Previously Unmeasured Confounder*
Authors: Filbin Michael R. , Lynch James , Gillingham Trent D. , Thorsen Jill E. , Pasakarnis Corey L. , Nepal Saurav , Matsushima Minoru , Rhee Chanu , Heldt Thomas , Reisner Andrew T. 
Published: June 2018

Objectives:
Presenting symptoms in patients with sepsis may influence rapidity of diagnosis, time-to-antibiotics, and outcome. We tested the hypothesis that vague presenting symptoms are associated with delayed antibiotics and increased mortality. We further characterized individual presenting symptoms and their association with mortality.

Design:
Retrospective cohort study.

Setting:
Emergency department of large, urban, academic U.S. hospital.

Patients:
All adult patients with septic shock treated in the emergency department between April 2014 and March 2016.

Interventions:
None.

Measurements and Main Results:
Of 654 septic shock cases, 245 (37%) presented with vague symptoms. Time-to-antibiotics from first hypotension or elevated lactate was significantly longer for those with vague symptoms versus those with explicit symptoms of infection (1.6 vs 0.8 hr; p < 0.01), and in-hospital mortality was also substantially higher (34% vs 16%; p < 0.01). Patients with vague symptoms were older and sicker as evidenced by triage hypotension, Sequential Organ Failure Assessment score, initial serum lactate, and need for intubation. In multivariate analysis, vague symptoms were independently associated with mortality (adjusted odds ratio, 2.12; 95% CI, 1.32–3.40; p < 0.01), whereas time-to-antibiotics was not associated with mortality (adjusted odds ratio, 1.01; 95% CI, 0.94–1.08; p = 0.78). Of individual symptoms, only the absence of fever, chills, or rigors (odds ratio, 2.70; 95% CI, 1.63–4.47; p < 0.01) and presence of shortness of breath (odds ratio, 1.97; 95% CI, 1.23–3.15; p < 0.01) were independently associated with mortality.

Conclusions:
More than one third of patients with septic shock presented to the emergency department with vague symptoms that were not specific to infection. These patients had delayed antibiotic administration and higher risk of mortality even after controlling for demographics, illness acuity, and time-to-antibiotics in multivariate analysis. These findings suggest that the nature of presenting symptoms is an important component of sepsis clinical phenotyping and may be an important confounder in sepsis epidemiologic studies.
Acute Respiratory Failure in Pediatric Hematopoietic Cell Transplantation: A Multicenter Study*
Authors: Rowan Courtney M. , McArthur Jennifer , Hsing Deyin D. , Gertz Shira J. , Smith Lincoln S. , Loomis Ashley , Fitzgerald Julie C. , Nitu Mara E. , Moser Elizabeth A. S. , Duncan Christine N. , Mahadeo Kris M. , Moffet Jerelyn , Hall Mark W. , Pinos Emily L. , Tamburro Robert F. , Cheifetz Ira M. 
Published: June 2018

Objectives:
Acute respiratory failure is common in pediatric hematopoietic cell transplant recipients and has a high mortality. However, respiratory prognostic markers have not been adequately evaluated for this population. Our objectives are to assess respiratory support strategies and indices of oxygenation and ventilation in pediatric allogeneic hematopoietic cell transplant patients receiving invasive mechanical ventilation and investigate how these strategies are associated with mortality.

Design:
Retrospective, multicenter investigation.

Setting:
Twelve U.S. pediatric centers.

Patients:
Pediatric allogeneic hematopoietic cell transplant recipients with respiratory failure.

Interventions:
None.

Measurements and Main Results:
Two-hundred twenty-two subjects were identified. PICU mortality was 60.4%. Nonsurvivors had higher peak oxygenation index (38.3 [21.3–57.6] vs 15.0 [7.0–30.7]; p < 0.0001) and oxygen saturation index (24.7 [13.8–38.7] vs 10.3 [4.6–21.6]; p < 0.0001), greater days with Fio
2 greater than or equal to 0.6 (2.4 [1.0–8.5] vs 0.8 [0.3–1.6]; p < 0.0001), and more days with oxygenation index greater than 18 (1.4 [0–6.0] vs 0 [0–0.3]; p < 0.0001) and oxygen saturation index greater than 11 (2.0 [0.5–8.8] vs 0 [0–1.0]; p < 0.0001). Nonsurvivors had higher maximum peak inspiratory pressures (36.0 cm H2O [32.0–41.0 cm H2O] vs 30.0 cm H2O [27.0–35.0 cm H2O]; p < 0.0001) and more days with peak inspiratory pressure greater than 31 cm H2O (1.0 d [0–4.0 d] vs 0 d [0–1.0 d]; p < 0.0001). Tidal volume per kilogram was not different between survivors and nonsurvivors.

Conclusions:
In this cohort of pediatric hematopoietic cell transplant recipients with respiratory failure in the PICU, impaired oxygenation and use of elevated ventilator pressures were common and associated with increased mortality.
Pharmacokinetics and Pharmacodynamics of Once-Daily Tacrolimus Compared With Twice-Daily Tacrolimus in the Early Stage After Living Donor Liver Transplantation
Authors: Iwasaki Mami , Yano Ikuko , Fukatsu Sachio , Hashi Sachiyo , Yamamoto Yuki , Sugimoto Mitsuhiro , Fukudo Masahide , Masuda Satohiro , Nakagawa Shunsaku , Yonezawa Atsushi , Kaido Toshimi , Uemoto Shinji , Matsubara Kazuo 
Published: June 2018

Background:
This study investigates the pharmacokinetics and pharmacodynamics of tacrolimus using the once-daily (OD) formulation in the early stage after living donor liver transplantation (LDLT) in comparison with those using the twice-daily (TD) formulation.

Methods:
Nine patients undergoing primary LDLT and treated with the OD tacrolimus formulation were included. The trough blood concentration (C0) of tacrolimus was monitored every day for 3 weeks after LDLT. A time course study of the blood tacrolimus concentrations and calcineurin (CN) phosphatase activity in peripheral blood mononuclear cells was performed 3 weeks after LDLT. Pharmacokinetic and pharmacodynamic parameters were compared with previously reported data using the TD formulation.

Results:
The interindividual variability in the daily dose of tacrolimus was significantly larger in the OD formulation than in the TD formulation (P < 0.001). In the time course study, the tacrolimus blood concentrations at 4, 8, and 12 hours after administration and the area under the concentration–time curve from 0 to 24 hours (AUC0–24) in the OD group were significantly higher than in the TD group, although the C0 was equivalent. In addition, the C0 was not significantly correlated with the AUC0–24 in the OD formulation. The apparent clearance and the pharmacodynamic parameters examined were not significantly different between the OD and TD groups.

Conclusions:
The C0 monitoring of the OD formulation may not be optimal in patients at the early stage after LDLT because the C0 was not correlated with the AUC0–24. If clinicians target the same C0 using the OD and TD formulations, the exposure of tacrolimus can be higher in the OD formulation, and excessive immunosuppression should be noted. Particular attention should be paid to the patients in the early stage after LDLT in the use of the OD oral formulation of tacrolimus.
Descemet Stripping Automated Endothelial Keratoplasty With a Retention Suture: Description of a Technique for Patients at High Risk of Graft Detachment
Authors: Newman Lara R. , Rosenwasser George O. D. 
Published: June 2018

Purpose:
To evaluate the utility, safety, and efficacy of a parallel or cloverleaf retention suture in Descemet stripping automated endothelial keratoplasty that does not penetrate donor tissue and can be removed at the slit lamp for patients at high risk of graft detachment.

Methods:
Data were prospectively collected over 9 years from patients who received a retention suture. Indications for use of a retention suture included difficulty with postoperative positioning, abnormal intraocular anatomy including glaucoma tube shunts, trabeculectomies, anterior chamber intraocular lens implants, previous vitrectomy, aniridia, and aphakia, or history of previous graft detachment.

Results:
Of 128 surgeries, 12 (9.4%) required additional intervention for graft reattachment (rebubble). Overall, 120 grafts (93.8%) remained clear and attached either after surgery with a retention suture or after rebubble procedures. Mean endothelial cell density at 1 year was 1840 cells/mm2, and mean endothelial cell density loss was 37.3%.

Conclusions:
A cloverleaf or parallel retention suture in conjunction with Descemet stripping automated endothelial keratoplasty seems to reduce the risk of detachment in high-risk patients, while maintaining adequate cell density and graft clarity at 1 year.
Reversible Cystoid Macular Edema Following Uneventful Microinvasive Kahook Dual Blade Goniotomy in a Pseudophakic Patient: A Case Report
Authors: Arnljots Thorsteinn S. , Economou Mario A. 
Published: June 2018

Purpose:
The purpose of this study is to present a case of cystoid macular edema (CME) as a potential complication following uncomplicated stand-alone Kahook Dual Blade (KDB) goniotomy in a patient with pseudoexfoliative glaucoma.

Methods:
A 71-year-old woman who developed CME following KDB goniotomy subsequently treated with topical nonsteroidal anti-inflammatory (NSAID) therapy.

Results:
The CME successfully regressed following a standard course of topical NSAID therapy.

Conclusions:
This case report describes the first case of CME following uneventful stand-alone KDB goniotomy and highlights the importance of postoperative topical NSAID therapy with regard to both prophylaxis and treatment.
Longitudinal Changes in Bleb Height, Vascularity, and Conjunctival Microcysts After Trabeculectomy
Authors: Kumaran Arjunan , Husain Rahat , Htoon Hla M. , Aung Tin 
Published: June 2018

Objective:
The objective of this article was to study longitudinal changes in bleb morphology (presence of microcysts and bleb height and vascularity) in subjects enrolled in the Singapore 5-Fluorouracil (5-FU) trabeculectomy study.

Study Design:
Retrospective subgroup analysis of a randomized controlled trial.

Materials and Methods:
Following trabeculectomy with either 5-FU or placebo, subjects were reviewed at day 1, weeks 1, 2, and 3, and months 3, 6, 9, 12, 16, 20, 24, 28, 32, and 36 and intraocular pressure (IOP), presence of microcysts and bleb height and vascularity graded and recorded. Statistical analyses were used to investigate baseline factors (demographics, eye drops use, IOP, treatment type, and comorbidities) that might account for long-term bleb changes and assess the influence of bleb morphology on mean, maximum, minimum, and variation in IOP following trabeculectomy.

Results:
One hundred fifty-nine (61.2%) subjects completed follow-up and 71 subjects (44.7%) received 5-FU. Proportion of subjects with microcysts increased posttrabeculectomy till weeks 3 and 6 in 5-FU and placebo-treated eyes, respectively, before decreasing. Presence of microcysts at day 1 and week 2 was associated with lower mean (P=0.027 to 0.033), maximum (P=0.040), and minimum IOP (P=0.010). Mean bleb height decreased over 36 months and at months 20 and 36 was associated with maximum (P=0.031) and minimum IOP (P=0.032), respectively. Mean bleb vascularity decreased till month 9 and remained fairly constant after.

Conclusions:
Microcysts seen early posttrabeculectomy is associated with lower IOP. Blebs reduce in height as they remodel and the relationship between bleb vascularity and IOP is complex.
Histopathologic Examination of Trabecular Meshwork Changes After Trabecular Bypass Stent Implantation
Authors: Capitena Young Cara E. , Ammar David A. , Seibold Leonard K. , Pantcheva Mina B. , SooHoo Jeffrey R. , Kahook Malik Y. 
Published: June 2018

Purpose:
The purpose of this article was to evaluate how human trabecular meshwork (TM) is influenced by the chronic presence of trabecular bypass implants.

Methods:
Human TM samples were obtained intraoperatively from 3 patients who had previously undergone implantation of a trabecular micro-bypass stent. Trabecular strips were obtained with a goniotomy blade from areas directly adjacent to the stent after stent removal. Tissue samples were preserved, processed, cut, and stained according to standardized laboratory protocol. Harvested samples were compared with human cadaveric TM from an eye without ocular disease as well as TM obtained from a glaucomatous eye without prior stent placement.

Results:
In all samples, a significant increase in the amount of fibrous material compared with cellular material was noted when compared with controls. In a single strip, a basement membrane-like structure was noted, which correlated with a semiopaque membrane noted intraoperatively overlying the stent and adjacent TM. Further, TM cells were absent from areas adjacent to the stent implantation site with related collapse of collagen beams.

Conclusions:
These findings indicate that inflammatory and fibrotic changes are present surrounding the device with clear differences noted when compared with both healthy and glaucomatous controls. These changes suggest a possible etiology for device failure over time. Further studies are necessary to tease out differences in TM tissue reaction to various implant materials as well as to make comparisons to procedures that excise TM.
Epidemiology of Nephrostomy Tube–Related Urinary Tract Infections Among US Veterans
Authors: Maramara Bennadette , Lobo Zeena , Psevdos George 
Published: June 2018

Objective
The aim of this study was to review the incidence of asymptomatic bacteriuria (AB) and pyelonephritis after placement of percutaneous nephrostomy tube (NT) in our patients.

Methods
We retrospectively reviewed patients who underwent NT placement from January 1, 2005, to December 31, 2015, at Northport Veterans Affairs Medical Center. We identified patients with NT-associated AB and NT-related pyelonephritis within 60 days following NT placement. We analyzed demographic data, medical history, and microbiological data.

Results
Seventy-one patients underwent NT placement. Indications for NT placement included intrinsic obstruction (34%) and extrinsic obstruction (66%). Prostate and urinary bladder cancers were the most common causes of extrinsic obstruction. Twenty percent (14/71) had pyelonephritis, and 24% (17/71) had AB. All patients were men, and median age was 73 years. In the pyelonephritis group, Pseudomonas aeruginosa (36%) and Enterococcus faecalis (35%) were most commonly isolated. Three cases of extended-spectrum β-lactamase–producing Enterobacteriaceae and 2 multiple drug–resistant gram-negative organisms were identified. In the AB group, P. aeruginosa (23%), Enterococcus species (23%), and coagulase-negative staphylococci (23%) were most common. Only 1 case of extended-spectrum β-lactamase organism was identified. Comparing the 2 groups, there was no difference in age (P = 0358), diabetes mellitus (P = 0.441), chronic kidney disease (P = 0.6705), and prior urinary tract infection (P = 1.000). Presence of ureteral stent was seen more in AB (P = 0.057).

Conclusions
Nephrostomy tube placement was associated with pyelonephritis and AB in 44% of cases overall. Pseudomonas and Enterococcus species were the most common pathogens. Isolation of resistant organisms was mostly observed in the pyelonephritis group.
Outpatient High-dose Methotrexate for Osteosarcoma: It’s Safe and Feasible, If You Want It
Authors: Hendershot Eleanor , Volpe Jocelyn , Taylor Tracey , Nicksy Darcy , Mills Denise , Ramachandran Nivetha , Shaikh Furqan , Riss Vera , Grant Ronald , Gupta Abha A. 
Published: June 2018

Background:
High-dose methotrexate (HD MTX) is usually administered as an inpatient to those with osteosarcoma. We prospectively tested the safety and feasibility of administering HD MTX in the ambulatory setting.

Materials and Methods:
In this single arm prospective observational study, eligible patients had previously completed 2 courses of HD MTX as an inpatient. On study, patients received MTX in hospital, discharged home and returned for daily assessment. Criteria to determine safety and feasibility included: (1) parent compliance with home instructions, (2) pump functioning/failure, and/or (3) admission for toxicity/noncompliance. Outpatient therapy was deemed feasible if <25% courses resulted in study event. Patient satisfaction was assessed.

Results:
Six patients (median age, 13.5 y) with extremity osteosarcoma completed 35 courses of MTX. There were no study events—no hospitalizations or pump failures and all parents were compliant. The Data and Safety Committee concluded that with zero events in 35 courses, it was unlikely for outpatient MTX to be infeasible; study was thus terminated early. Participants reported value to stay out of hospital, permitted life to feel “more normal”; however, burden of daily commute to hospital was cited.

Conclusions:
The delivery of HD MTX is safe and feasible in patients with osteosarcoma.
Incidence and Clinical Features of Panic Related Posttraumatic Stress
Authors: Shasha Tomer , Dolgin Michael J. , Tzur Bitan Dana , Somer Eli 
Published: June 2018

Abstract
The current study assessed the incidence and associated features of posttraumatic stress after the experience of panic. One hundred seventy-eight participants meeting diagnostic criteria for panic attacks (PAs) were assessed using standardized measures of posttraumatic symptoms and posttraumatic stress disorder (PTSD) in specific reference to their experience of panic. Sixty-three (35.4%) participants scored above the cutoff for PTSD in reference to the worst PA they had experienced. Adjusted means for the four PTSD symptom clusters indicate that panic-related posttraumatic symptoms are, on average, experienced “moderately” to “quite a bit.” Panic-related posttraumatic symptoms and PTSD were best predicted by specific features of the panic experience itself, including subjective levels of distress, fear of losing control, chest pain, agoraphobia, and number of PAs experienced. These findings are discussed in terms of the diagnostic, prognostic, and treatment implications for a subset of individuals presenting with panic who may also have panic-related PTSD.
Before, During, and After Self Injury
Authors: Stacy Stephanie E. , Bandel Shelby L. , Lear Mary K. , Pepper Carolyn M. 
Published: June 2018

AbstractLittle is currently known about the repetitive behaviors that take place before, during, and after nonsuicidal self-injury (NSSI). These practice patterns surrounding repetitive self-injury may be part of a habituation process in NSSI. Congruent with the opponent process theory (OPT), the mechanisms through which NSSI is reinforced may include preparation, engagement, and follow-up practice patterns to achieve the desired effect. This may result in increased habituation leading to a change in method and resulting NSSI severity. College students with a history of NSSI (N= 80) completed questionnaires, including an instrument to assess practice patterns around NSSI. High levels of NSSI practice patterns were positively related to various NSSI characteristics and clinical correlates, suggesting higher levels of NSSI severity. Further, NSSI versatility partially explained the relationship between NSSI practice patterns and habituation. Consistent with OPT, practice patterns associated with repetitive NSSI may lead an individual to change methods, fostering habituation to self-injury.
Treatment Within an Adult Mental Health Day Program
Authors: Taube-Schiff Marlene , Mehak Adrienne , Ferreira Natalie , Kalim Anastasia , Ungar Thomas , Mills Jennifer S. 
Published: June 2018

Abstract
Day hospital programs provide stabilization, medication optimization, and therapeutic intervention for individuals experiencing acute psychiatric illnesses. The current study investigated treatment impact within an adult day hospital setting in a large Canadian general acute care hospital. A total of 196 patients were sampled in a naturalistic design. Participants filled out measures at admission and discharge, including the Patient Health Questionnaire–9, the Generalized Anxiety Disorder–7, the World Health Organization Disability Assessment Schedule 2.0, the Behavior and Symptom Identification Scale–24, the Quality of Life Enjoyment and Satisfaction Questionnaire–Short Form, and the Emotion Regulation Questionnaire (ERQ). Paired sample t-tests revealed significant improvements from admission to discharge on all but one measure, the ERQ Suppression scale. Overall, patients improved during treatment in terms of psychopathology and disability, and perceived quality of life. When the emotion regulation strategy of reappraisal was increasingly used over the duration of the treatment, improvements were observed in symptomatology, quality of life, and enhanced functionality. This article highlights the impact of therapeutic interventions received within a Canadian day hospital program.
Cannabis Use, Psychotic Like Experiences and Aberrant Salience in a Sample of Belgian Students
Authors: Bernardini Francesco , Gobbicchi Chiara , Attademo Luigi , Puchalski Severin , Trezzi Riccardo , Moretti Patrizia , Tortorella Alfonso , Loas Gwenolé 
Published: June 2018

Abstract
The main goal of our study was to investigate the association between psychotic-like experiences, aberrant salience, and cannabis use in a nonclinical sample of Belgian students. The participants were asked to complete a self-report questionnaire on cannabis use. The Community Assessment of Psychic Experiences and the Aberrant Salience Inventory were used to assess psychotic-like experiences and aberrant salience. The final sample was of 257 students. Cannabis users showed significantly higher Aberrant Salience Inventory score and, concerning the Community Assessment of Psychic Experiences, higher total, positive, and negative dimension scores. Years of cannabis use and frequency of use showed a positive correlation with Aberrant Salience Inventory score. Our results support the evidence that cannabis use is associated with an increased rate of psychotic experiences in individuals without a clinical form of psychosis. Future studies are required to better investigate the meaning of the association between cannabis use, psychotic-like experiences, and aberrant salience.