bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can a Cohesive Silicone Bandage Outperform an Adhesive Silicone Gel Sheet in the Treatment of Scars? A Randomized Comparative Trial
Authors: Moortgat Peter , Meirte Jill , Maertens Koen , Lafaire Cynthia , De Cuyper Lieve , Anthonissen Mieke 
Published: December 2018

Background:
The use of topical silicone to treat scars is widespread, and various studies have demonstrated its efficacy to treat scars. A new form of silicone application is a cohesive elastic bandage. The aim of this study was to compare the effects of this bandage versus an adhesive silicone gel sheet on scar elasticity after burn injury.

Methods:
A total of 60 patients were enrolled in a randomized, prospective, single-blind, single-center, comparative, parallel-group study. The participants were assigned randomly to one of two treatment arms: one for treatment with a cohesive silicone bandage, and the other with a silicone gel sheet. The color was measured objectively using a Chromameter, and the Cutometer was used to assess vertical elasticity. For subjective assessment of the scars, the authors used the Patient and Observer Scar Assessment Scale.

Results:
The results reveal that there were no significant differences between the two interventions for most subjective assessments and color measurements. However, the group that received treatment with the cohesive silicone bandage did seem to perform statistically significantly better than the silicone gel sheet group for vertical elasticity and the global score of the Patient and Observer Scar Assessment Scale (observer scale). This was probably because of the unique microstructure of the bandage that ensured a standardized pressure together with uninterrupted contact with the skin.

Conclusions:
An elastic cohesive silicone bandage seems to outperform silicone gel sheets for vertical elasticity when treating hypertrophic burn scars. The authors recommend including timing of application and duration of application in future studies.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
The Association of the Nurse Work Environment and Patient Safety in Pediatric Acute Care
Authors: Lake Eileen T. , Roberts Kathryn E. , Agosto Paula D. , Ely Elizabeth , Bettencourt Amanda P. , Schierholz Elizabeth S. , Frankenberger Warren D. , Catania Gianluca , Aiken Linda H. 
Published: December 2018

Objectives
Eighteen years ago, the Institute of Medicine estimated that medical errors in hospital were a major cause of mortality. Since that time, reducing patient harm and improving the culture of patient safety have been national health care priorities. The study objectives were to describe the current state of patient safety in pediatric acute care settings and to assess whether modifiable features of organizations are associated with better safety culture.

Methods
An observational cross-sectional study used 2015–2016 survey data on 177 hospitals in four U.S. states, including pediatric care in general hospitals and freestanding children’s hospitals. Pediatric registered nurses providing direct patient care assessed hospital safety and the clinical work environment. Safety was measured by items from the Agency for Healthcare Research and Quality’s Culture of Patient Safety survey. Hospital clinical work environment was measured by the National Quality Forum-endorsed Practice Environment Scale.

Results
A total of 1875 pediatric nurses provided an assessment of safety in their hospitals. Sixty percent of pediatric nurses gave their hospitals less than an excellent grade on patient safety; significant variation across hospitals was observed. In the average hospital, 46% of nurses report that mistakes are held against them and 28% do not feel safe questioning authority regarding unsafe practices. Hospitals with better clinical work environments received better patient safety grades.

Conclusions
The culture of patient safety varies across U.S. hospital pediatric settings. In better clinical work environments, nurses report more positive safety culture and higher safety grades.
The Role of Macrophage Migration Inhibitory Factor in Remote Ischemic Conditioning Induced Hepatoprotection in a Rodent Model of Liver Transplantation
Authors: Emontzpohl Christoph , Stoppe Christian , Theißen Alexander , Beckers Christian , Neumann Ulf P. , Lurje Georg , Ju Cynthia , Bernhagen Jürgen , Tolba René H. , Czigany Zoltan 
Published: December 2018

ABSTRACT

Background:
Macrophage migration inhibitory factor (MIF) is an important stress-regulating mediator of acute ischemia/reperfusion (I/R) injury and ischemic conditioning. The present study aimed to investigate whether MIF is involved in the effects of remote ischemic conditioning (RIC) in a rat model of orthotopic liver transplantation (OLT).

Methods:
OLTs were performed in male Lewis rats (245 g–340 g). Recipients were allocated in a randomized fashion into three experimental groups: remote preconditioning-RIPC, remote post-conditioning-RIPOST, control. RIC was applied as 4×5-5 min I/R via clamping of the infrarenal aorta. Animals were followed for 1, 3, 24, 168 h post-reperfusion (n = 6 recipient/group/time point). Graft micro- and macrocirculation and hepatocellular damage were assessed. Messenger ribonucleic acid (mRNA) expression, serum, and tissue protein levels of MIF, as well as additional markers of I/R injury, were measured.

Results:
RIC resulted in a prominent downregulation of MIF mRNA, serum, and tissue protein. Compared with control, hepatocellular damage was significantly mitigated after RIPC or RIPOST (serum ALT; RIPC, RIPOST vs. Control, P = 0.008, P = 0.030, respectively). Graft circulation was better preserved in the RIC groups. Furthermore, there was a significant positive correlation between serum MIF and transaminase levels (r = 0.330; P = 0.02). RIC showed a significant effect on iNOS and STAT5 mRNA expressions. Supporting findings were obtained from the measurements of tissue CXCL12 mRNA expression and pAkt/Akt, pErk/Erk.

Conclusion:
In this sophisticated experimental model of OLT, RIC-induced hepatoprotective effects were associated with a downregulation of MIF at mRNA and protein levels, suggesting the role of MIF as a mediator in RIC-induced protection following OLT.
Protein Compositions Changes of Circulating Microparticles in Patients With Valvular Heart Disease Subjected to Cardiac Surgery Contribute to Systemic Inflammatory Response and Disorder of Coagulation
Authors: Jian Yu-Peng , Yuan Hao-Xiang , Hu Kun-Hua , Chen Chao , Li Yu-Quan , Li Yan , Yang Tian-Xin , Ou Zhi-Jun , Ou Jing-Song 
Published: December 2018

ABSTRACT
We recently demonstrated that circulating microparticles (MPs) from patients with valvular heart diseases (VHD) subjected to cardiac surgery impaired endothelial function and vasodilation. However, it is unknown whether or not the protein composition of these circulating MPs actually changes in response to the disease and the surgery. Circulating MPs were isolated from age-matched control subjects (n = 50) and patients (n = 50) with VHD before and 72 h after cardiac surgery. Proteomics study was performed by liquid chromatography and mass spectrometry combined with isobaric tags for relative and absolute quantification technique. The differential proteins were identified by ProteinPilot, some of which were validated by Western blotting. Bio-informatic analysis of differential proteins was carried out. A total of 849 proteins were identified and 453 proteins were found in all three groups. Meanwhile, 165, 39, and 80 proteins were unique in the control, pre-operation, and postoperation groups respectively. The unique proteins were different in localization, molecular function, and biological process. The pro-inflammatory proteins were increased in VHD patients and more so postoperatively. Proteins related to coagulation were dramatically changed before and after surgery. The protein composition of circulating MPs was changed in patients with VHD undergoing cardiac surgery, which may lead to activation of the systemic inflammatory response and disorders of coagulation.
Methane-Rich Saline Protects Against Sepsis-Induced Liver Damage by Regulating the PPAR-γ/NF-κB Signaling Pathway
Authors: Li Zeyu , Jia Yifan , Feng Yang , Cui Ruixia , Wang Zi , Qu Kai , Liu Chang , Zhang Jingyao 
Published: December 2018

ABSTRACT
Sepsis, a life-threatening organ dysfunction due to a dysregulated response to infection, is a common complication of major surgery. Previous studies have shown that methane possesses protective properties. This study aims to investigate the protective effect of methane-rich saline (MRS) on sepsis-induced liver injury. In an in vivo experiment, C57BL/6 mice received cecal ligation and puncture to create a septic model followed by MRS treatment (10 mL/kg, ip treatment) 30 min and 12 h after the operation. We found that methane effectively decreased the serum aspartate aminotransferase, alanine aminotransferase and liver index, as well as the liver pathological damage, and reduced the localized infiltration of inflammatory cells. Methane suppressed the expression of the toll-like receptor 4/nuclear factor-kappa B (NF-κB) signaling pathway and stimulated the expression of peroxisome proliferator-activated receptor-γ (PPAR-γ) during sepsis, which inhibited the activation of NF-κB and decreased the level of inflammatory cytokines, such as tumor necrosis factor-α, interleukin-6, and interleukin-1β. Moreover, we found that MRS treatment relieved reactive oxygen species (ROS) damage by upregulating heme oxygenase-1, superoxide dismutase and glutathione, and downregulating malondialdehyde, which was consistent with the results of dihydroethidium fluorescent staining. MRS treatment also regulated apoptosis-related proteins, such as Bax, Bcl-2, and caspase-3. In the in vitro experiment, HepG2 cells received inflammatory stimulation induced by LPS followed by methane-rich medium (MRM) treatment. We found that MRM alleviated the inflammatory damage, ROS damage and regulated the expression of PPAR-γ/NF-κB. Our data indicated that methane treatment prevented liver damage in sepsis via anti-inflammatory, anti-oxidative, and anti-apoptotic properties that involved the PPAR-γ/ NF-κB signaling pathway.
Function is Dissociated From Activation-Related Immunophenotype on Phagocytes From Patients With SIRS/Sepsis Syndrome
Authors: Flores-Mejía Luis A. , Cabrera-Rivera Graciela L. , Ferat-Osorio Eduardo , Mancilla-Herrera Ismael , Torres-Rosas Rafael , Boscó-Garate Ilka B. , López-Macías Constantino , Isibasi Armando , Cérbulo-Vazquez Arturo , Arriaga-Pizano Lourdes A. 
Published: December 2018

ABSTRACT
Sepsis is a life-threatening condition associated with failure of at least one organ in the presence of infection. Along with SIRS, the acute systemic inflammatory syndrome without documented infection, sepsis represents a main health problem in intensive care units around the world. Hypercytokinemia and overexpression of activation-markers on leukocytes are frequently reported in SIRS/sepsis. Leukocyte functions including antibody mediated-phagocytosis, pathogen recognition, and migration appear to be disabled in SIRS/septic patients. Our aim was to evaluate the so-called activation immunophenotype and functions related to infection contention in phagocytes from patients with sepsis. We analyzed blood samples from 44 patients with SIRS/sepsis and 14 healthy volunteers. CD16, CD69, CD64, CCR7, and TREM-1 levels were determined on the surface of neutrophils and monocytes. Phagosome maturation and p38, STAT3, and STAT5 phosphorylation were evaluated in these phagocytes. As expected, sepsis and SIRS patients had increased serological levels of pro- and anti-inflammatory cytokines. E coli internalization was not increased in monocytes from patients with SIRS/sepsis, despite increased numbers of circulating neutrophils and monocytes (P < 0.05) and overexpression of CD64 and CD69 in neutrophils (P < 0.05), TREM-1 (P < 0.01), CD69 (P < 0.001), and CCR7 (P < 0.05). Moreover, phagosome maturation was decreased in phagocytes from patients with SIRS/sepsis syndrome (P < 0.00001). Furthermore, p38 and STAT-3 phosphorylation elicited by LPS or IL-10 (respectively) was diminished in neutrophils and monocytes from patients (P < 0.05). Our results indicate that “activation markers” may not reflect higher functionality, so a more profound analysis should be made before assuming that the activated immunophenotype means increased phagocyte responses.
Can Haptic Simulators Distinguish Expert Performance? A Case Study in Central Venous Catheterization in Surgical Education
Authors: Chen Hong-En , Yovanoff Mary A. , Pepley David F. , Sonntag Cheyenne C. , Mirkin Katelin A. , Han David C. , Moore Jason Z. , Miller Scarlett R. 
Published: December 2018

Introduction
High-tech simulators are gaining popularity in surgical training programs because of their potential for improving clinical outcomes. However, most simulators are static in nature and only represent a single anatomical patient configuration. The Dynamic Haptic Robotic Training (DHRT) system was developed to simulate these diverse patient anatomies during Central Venous Catheterization (CVC) training. This article explores the use of the DHRT system to evaluate objective metrics for CVC insertion by comparing the performance of experts and novices.

Methods
Eleven expert surgeons and 13 first-year surgical residents (novices) performed multiple needle insertion trials on the DHRT system. Differences between expert and novice performance on the following five metrics were assessed using a multivariate analysis of variance: path length, standard deviation of deviations (SDoD), average velocity, distance to the center of the vessel, and time to complete (TtC) the needle insertion. A regression analysis was performed to identify if expertise could be predicted using these metrics. Then, a curve fit was conducted to identify whether learning curves were present for experts or novices on any of these five metrics.

Results
Time to complete the insertion and SDoD of the needle tip from an ideal path were significantly different between experts and novices. Learning curves were not present for experts but indicated a significant decrease in path length and TtC for novices.

Conclusions
The DHRT system was able to identify significant differences in TtC and SDoD between experts and novices during CVC needle insertion procedures. In addition, novices were shown to improve their skills through DHRT training.
Self-Reported Emotions in Simulation-Based Learning
Authors: Rogers Timothy , Andler Carly , O'Brien Bridget , van Schaik Sandrijn 
Published: December 2018

Introduction
Experiential learning through active participation is thought to be a key benefit of simulation-based education. Recent research has challenged this assumption, suggesting that active participants learn just as well as observers. Studies report that active participants experience stress and anxiety during simulation, which may hamper learning by active participants. We undertook the current study to examine whether active participation results in different emotional arousal than observing during simulation. We hypothesized that participants in active roles experience higher levels of negative emotions than those observing and looked for evidence that this may impact learning.

Methods
Pediatric residents participate in simulations, rotating through active and observer roles, as part of their standard curriculum. We assessed both positive and negative emotional arousal with the Positive and Negative Affect Scale immediately after each simulation and assessed learning through multiple-choice questions. We used repeated measures analysis of variance to examine potential interactions between Positive and Negative Affect Scale scores and role in simulation. To explore differences in learning, we examined whether knowledge retention differed between the groups.

Results
Residents had higher levels of both positive and negative emotional arousal in active roles compared with observing roles. We could not detect a difference in learning between the roles.

Conclusions
The increase in both positive and negative emotions among active participants compared with observers may have important implications for simulation design and participant learning. Future studies should be powered to detect differences in learning and examine the impact of contributing factors such as learner level and context.
Severe traumatic brain injury is associated with a unique coagulopathy phenotype
Authors: Samuels Jason M. , Moore Ernest E. , Silliman Christopher C. , Banerjee Anirban , Cohen Mitchell J. , Ghasabyan Arsen , Chandler James , Coleman Julia R. , Sauaia Angela 
Published: December 2018

BACKGROUND
Traumatic brain injury (TBI) patients present on a spectrum from hypocoagulability to hypercoagulability, depending on the injury complexity, severity, and time since injury. Prior studies have found a unique coagulopathy associated with TBI using conventional coagulation assays such as INR; however, few studies have assessed the association of TBI and coagulopathy using viscoelastic assays that comprehensively evaluate the coagulation in whole blood. This study aims to reevaluate the TBI-specific trauma-induced coagulopathy using arrival thrombelastography. Because brain tissue is high in key procoagulant molecules, we hypothesize that isolated TBI is associated with procoagulant and hypofibrinolytic profiles compared with injuries of the torso, extremities, and polytrauma, including TBI.

METHODS
Data are from the prospective Trauma Activation Protocol study. Activated clotting time (ACT), angle, maximum amplitude (MA), 30-minute percent lysis after MA (LY30), and functional fibrinogen levels (FFLEV) were recorded. Patients were categorized into isolated severe TBI (I-TBI), severe TBI with torso and extremity injuries (TBI + TORSO/EXTREMITIES), and isolated torso and extremity injuries (I-TORSO/EXTREMITIES). Poisson regression was used to adjust for multiple confounders.

RESULTS
Overall, 572 patients (48 I-TBI, 45 TBI + TORSO/EXTREMITIES, 479 I-TORSO/EXTREMITIES) were included in this analysis. The groups differed in INR, ACT, angle, MA, and FFLEV but not in 30-minute percent lysis. When compared with I-Torso/Extremities, after adjustment for confounders, severe I-TBI was independently associated with ACT less than 128 seconds (relative risk [RR], 1.5; 95% confidence interval [CI], 1.1–2.2), angle less than 65 degrees (RR, 2.2; 95% CI, 1.4–3.6), FFLEV less than 356 (RR, 1.7; 95% CI, 1.2–2.4) but not MA less than 55 mm, hyperfibrinolysis, fibrinolysis shutdown, or partial thromboplastin time (PTT) greater than 30.

CONCLUSION
Severe I-TBI was independently associated with a distinct coagulopathy with delayed clot formation but did not appear to be associated with fibrinolysis abnormalities. Low fibrinogen and longer ACT values associated with I-TBI suggest that early coagulation factor replacement may be indicated in I-TBI patients over empiric antifibrinolytic therapy. Mechanisms triggering coagulopathy in TBI are unique and warrant further investigation.

LEVEL OF EVIDENCE
Retrospective cohort study, prognostic, level III.
The EGS grading scale for skin and soft-tissue infections is predictive of poor outcomes: a multicenter validation study
Authors: Savage Stephanie A. , Li Shi Wen , Utter Garth H. , Cox Jessica A. , Wydo Salina M. , Cahill Kevin , Sarani Babak , Holzmacher Jeremy , Duane Therese M. , Gandhi Rajesh R. , Zielinski Martin D. , Ray-Zack Mohamed , Tierney Joshua , Chapin Trinette , Murphy Patrick B. , Vogt Kelly N. , Schroeppel Thomas J. , Callaghan Emma , Kobayashi Leslie , Coimbra Raul , Schuster Kevin M. , Gillaspie Devin , Timsina Lava , Louis Alvancin , Crandall Marie 
Published: December 2018

INTRODUCTION
Over the last 5 years, the American Association for the Surgery of Trauma has developed grading scales for emergency general surgery (EGS) diseases. In a previous validation study using diverticulitis, the grading scales were predictive of complications and length of stay. As EGS encompasses diverse diseases, the purpose of this study was to validate the grading scale concept against a different disease process with a higher associated mortality. We hypothesized that the grading scale would be predictive of complications, length of stay, and mortality in skin and soft-tissue infections (STIs).

METHODS
This multi-institutional trial encompassed 12 centers. Data collected included demographic variables, disease characteristics, and outcomes such as mortality, overall complications, and hospital and ICU length of stay. The EGS scale for STI was used to grade each infection and two surgeons graded each case to evaluate inter-rater reliability.

RESULTS
1170 patients were included in this study. Inter-rater reliability was moderate (kappa coefficient 0.472–0.642, with 64–76% agreement). Higher grades (IV and V) corresponded to significantly higher Laboratory Risk Indicator for Necrotizing Fasciitis scores when compared with lower EGS grades. Patients with grade IV and V STI had significantly increased odds of all complications, as well as ICU and overall length of stay. These associations remained significant in logistic regression controlling for age, gender, comorbidities, mental status, and hospital-level volume. Grade V disease was significantly associated with mortality as well.

CONCLUSION
This validation effort demonstrates that grade IV and V STI are significantly predictive of complications, hospital length of stay, and mortality. Though predictive ability does not improve linearly with STI grade, this is consistent with the clinical disease process in which lower grades represent cellulitis and abscess and higher grades are invasive infections. This second validation study confirms the EGS grading scale as predictive, and easily used, in disparate disease processes.

LEVEL OF EVIDENCE
Prognostic/Epidemiologic retrospective multicenter trial, level III.
Indocyanine green dye angiography as an adjunct to assess indeterminate burn wounds: A prospective, multicentered, triple-blinded study
Authors: Wongkietkachorn Apinut , Surakunprapha Palakorn , Winaikosol Kengkart , Waraasawapati Sakda , Chaiwiriyakul Surachat , Eua-angkanakul Kant , Wongkietkachorn Nuttapone , Punyavong Pattama , Jenwitheesuk Kamonwan , Chowchuen Bowornsilp 
Published: December 2018

BACKGROUND
Clinical assessment of indeterminate burn wounds has been reported to yield poor accuracy, even when performed by burn experts. Indocyanine green (ICG) dye angiography has been found to be highly accurate in assessing burn depth, but there is still limited evidence of its use in indeterminate burn wounds. This study aims to compare the accuracy of ICG angiography to that of clinical assessment in assessing indeterminate burn wounds.

METHODS
This is a prospective, multicentered, triple-blinded, experimental study. Participants were stable patients, admitted to the hospital with burn wounds of indeterminate depth. The burn wounds were clinically assessed by an attending plastic surgeon. ICG angiography was performed and evaluated by another surgeon. Tissue biopsies were obtained and sent for histological study to be assessed as the gold standard.

RESULTS
In the 30 burn sites that were assessed, the accuracy of ICG angiography was 100.0%, compared with 50.0% for clinical assessment (p < 0.001). Clinical assessment yielded a sensitivity of 33.3% and specificity of 66.7%, while ICG angiography yielded both a sensitivity and specificity of 100.0%. Therefore, the number needed to treat for using ICG angiography in indeterminate burn wounds was two.

CONCLUSION
Indocyanine green angiography yields a significantly higher accuracy than clinical assessment in indeterminate burn wounds. This intervention can, thus, be a useful tool to aid clinical judgment.

TRIAL REGISTRATION
Thai Clinical Trials Registry, number TCTR20170821001.

LEVEL OF EVIDENCE
Diagnostic test, level I.