bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alkali addition and roughage inclusion effect on performance and carcass characteristics of feedlot steers fed diets containing 60% dried distillers grains with solubles
Authors: Lancaster Nicholas A , Muegge Chris R , Reis de Carvalho Jose R , Cistolo Lopes Rodrigo , Narumiya Rafael S , Pinese Fabio , Baird A Nickie , Schoonmaker Jon P 
Published: July 2019

AbstractThree experiments were conducted to determine the effectiveness of calcium hydroxide (Ca(OH)2) addition and roughage inclusion on digestibility, performance, and carcass characteristics of steers fed 60% dried distillers grains with solubles (DGS). Statistical analyses for studies were conducted using the MIXED procedures of SAS. In experiment 1, 48 steers (353.5 ± 7.55 kg) were allotted to individual pens and fed 1 of 3 diets (dry matter [DM] basis) containing 60% dried DGS, 20% corn silage, and 4% supplement with: 1) 14.5% corn and no Ca(OH)2; 2) 14% corn and 2% Ca(OH)2; and 3) 14.5% additional corn silage and no Ca(OH)2. Steers fed Ca(OH)2 consumed the least (P = 0.03) and steers fed added corn silage consumed the most and had the least gain:feed (P = 0.02). Gain and carcass quality were not affected by treatment (P ≥ 0.48). In experiment 2, 112 steers (375.3 ± 19.25 kg) were allotted to pens (four pens per treatment; seven steers per pen) arranged as a 2 × 2 factorial (roughage × Ca(OH)2) and fed one of four diets (DM basis) containing 60% dried DGS, 17% corn silage, and 4% supplement with: 1) 17.5% corn silage and no Ca(OH)2; 2) 17% corn silage and 2% Ca(OH)2; 3) 17.25% corn stover and no Ca(OH)2; and 4) 17% corn stover and 2% Ca(OH)2. Added stover decreased average daily gain (ADG) compared to added corn silage (P = 0.04). Ca(OH)2 increased ADG when steers were fed stover, but not when steers were fed only corn silage (P = 0.05; interaction). In experiment 3, six ruminally cannulated steers (initial body weight = 352 ± 14.8 kg) were randomly allotted to a 6 × 6 Latin square design to determine the effects of roughage inclusion (corn, corn silage, stover) and Ca(OH)2 addition (0% or 2%) on ruminal characteristics. Feeding stover decreased total volatile fatty acid(s) (VFA) concentration and DM digestibility compared to corn silage or corn (P &lt; 0.01), whereas Ca(OH)2 resulted in greater total VFA concentrations and DM digestibility (P ≤ 0.02). Stover increased rate of DM degradation (Kd) and rate of particle outflow from the rumen (P ≤ 0.04) but decreased extent of DM digestion and mean retention time (P ≤ 0.02) compared to corn or silage. Ca(OH)2 increased Kd (P &lt; 0.01) and tended to increase (P = 0.06) liquid passage rate. In conclusion, added roughage did not improve performance of cattle fed 60% dried DGS. Ca(OH)2 may decrease intake and maintain performance of cattle fed 60% dried DGS with corn silage as the roughage source and increases ADG when corn stover replaces a portion of the corn silage.
Gender differences in anaphylaxis
Authors: Salvati Lorenzo , Vitiello Gianfranco , Parronchi Paola 
Published: July 2019

Purpose of review
Is sexual dimorphism also true in anaphylaxis as described in other allergic diseases? Possible gender differences in the epidemiology, triggers, severity, outcomes of anaphylaxis as well as in the pathogenesis of the disease are discussed.

Recent findings
Hormonal status and the X-chromosome-coded factors deeply involved in the regulation of T-cell and B-cell responses may influence the gender difference noticed in allergic diseases, such as asthma and rhinitis. Little is known if sex is also relevant for anaphylaxis, although the description of catamenial anaphylaxis is intriguing. However, epidemiologic bias, lack of reliable animal models for the human disease, differences into diagnostic codes and not harmonized clinical grading unfortunately represent hurdles to obtain meaningful information on this topic.

Summary
The female sex predisposes to a dysregulation of the immune response as suggested by the increased prevalence of autoimmunity and atopy. In anaphylaxis, pathomechanisms are not fully disclosed, triggers are numerous and IgE-dependent mast cell degranulation only represents a part of the story. Improvement into the definition of the disease including a more careful coding system and better investigations about triggers seem the only way to allow a more precise assessment of the possible different risk for women to develop anaphylaxis.
Tryptase values in anaphylaxis and insect allergy
Authors: Bonadonna Patrizia , Scaffidi Luigi , Boni Elisa 
Published: July 2019

Purpose of reviewTo recognize the relevance of serum tryptase measurement as a useful tool for the diagnosis of allergic diseases and mast cell disorders.Recent findingsRecent data on the role of mast cells and tryptase in allergic and other diseases provide new understanding into the mechanisms and causes of anaphylaxis.SummaryMeasurement of transiently elevated tryptase levels shortly after a severe reaction can help elucidate mechanism behind the reaction in identifying mast cell activation. Hymenoptera venom allergy represents an important cause of morbidity and mortality worldwide. Venom allergy is a typical IgE-mediated reaction because of sensitization to one or more allergens of the venom, and accounts for 1.5–34% of all cases of anaphylaxis. There is a preferential association between insect venom allergy and mastocytosis. The diagnosis of a clonal mast cell disease leads to therapeutic consequences concerning the treatment of venom allergy. In conclusion, baseline tryptase levels support the clinical diagnosis of anaphylaxis and mast cell disorders, determine venom immunotherapy treatment and are relevant in deciding on lifelong treatment.
Direct Drop-Down Anterior Approach to Subaxial Cervical Spine
Authors: Dagar Ashish , Kumar Vishal , Dhatt Sarvdeep S. 
Published: July 2019

Background:
Subaxial cervical spine comprises C3-C7 levels. Southwick and Robinson’s is most commonly used surgical approach for subaxial cervical spine. We are describing a new technique of approaching cervical vertebrae using same planes as in classical approach by Southwick and Robinson.

Material and Methods:
A total of 35 cases with cervical spine pathologies requiring anterior cervical approach were included in the study. Patients requiring posterior based surgeries, >2-disk level anterior exposure and with history of any previous anterior based cervical spine surgery were excluded from the study.

Surgical Technique:
The patients were positioned supine on operating table. A 3 cm transverse skin incision is given starting from midline and extending laterally at desired vertebral level. Langenbeck’s retractor of appropriate size is used by surgical assistant to apply gentle constant lateral traction on trachea. The esophagus being invaginated by same pretracheal layer of deep cervical fascia, moves along with trachea. Soft tissue is bluntly dissected with peanut sponge. Steps are repeated till vertebra is reached.

Result:
Of the 35 cases included in the study, maximum cases (19) were traumatic cervical spine fractures. The average surgical time, intraoperative blood loss in negative suction drains, postoperative hospital stays in this group of cohort was similar to the cohort in which typical traditional approach was used.

Discussion:
Perceived advantages include—smaller skin incision, less chances to damage carotid sheath and its contents, safe, easy and less time-consuming technique, cosmetically better due to smaller incision size along Langer’s lines.
Implementation of a Bundled Consent Process in the ICU: A Single-Center Experience*
Authors: Anandaiah Asha M. , Stevens Jennifer P. , Sullivan Amy M. 
Published: July 2019

Objectives:
A bundled consent process, where patients or surrogates provide consent for all commonly performed procedures on a single form at the time of ICU admission, has been advocated as a method for improving both rates of documented consent and patient/family satisfaction, but there has been little published literature about the use of bundled consent. We sought to determine how residents in an academic medical center with a required bundled consent process actually obtain consent and how they perceive the overall value, efficacy, and effects on families of this approach.

Design:
Single-center survey study.

Setting:
Medical ICUs in an urban academic medical center.

Subjects:
Internal medicine residents.

Interventions:
We administered an online survey about bundled consent use to all residents. Quantitative and qualitative data were analyzed.

Measurements and Main Results:
One-hundred two of 164 internal medicine residents (62%) completed the survey. A majority of residents (55%) reported grouping procedures and discussing general risks and benefits; 11% reported conducting a complete informed consent discussion for each procedure. Respondents were divided in their perception of the value of bundled consent, but most (78%) felt it scared or stressed families. A minority (26%) felt confident that they obtained valid informed consent for critical care procedures with the use of bundled consent. An additional theme that emerged from qualitative data was concern regarding the validity of anticipatory consent.

Conclusions:
Resident physicians experienced with the use of bundled consent in the ICU held variable perceptions of its value but raised concerns about the effect on families and the validity of consent obtained with this strategy. Further studies are necessary to further explore what constitutes best practice for informed consent in critical care.
How to assimilate the tsunami of immune checkpoints inhibitors data into clinical practice?
Authors: Castelo-Branco Luís , Aspeslagh Sandrine , Kotecki Nuria , Awada Ahmad 
Published: July 2019

Purpose of review
Immune checkpoint inhibitors (ICIs) are rapidly changing practice across different tumor settings. With this article, we reflect on how to assimilate the tsunami of ICIs data into clinical practice.

Recent findings
A tremendous increase on approvals, number of publications, and clinical trials ongoing with ICIs on many different tumor types.

Summary
ICIs are innovative treatments that are showing a significant benefit on different tumors. More approvals and an explosive increase of knowledge around the usage of ICI are to be expected in the near future, bringing new challenges on how to integrate this fast-growing evidence with ICI into clinical practice. To be updated, oncologists could follow approved guidelines from relevant societies and complement it with an appropriate search from publication databases. There are also some available courses, conferences and online material that are useful to improve knowledge in this so rapidly changing environment. In the future, we believe the integration of artificial intelligence and learning machines will play an important role to facilitate best clinical practices in different fields of medicine but particularly for oncology.
Effect of OTX-101, a Novel Nanomicellar Formulation of Cyclosporine A, on Corneal Staining in Patients With Keratoconjunctivitis Sicca: A Pooled Analysis of Phase 2b/3 and Phase 3 Studies
Authors: Malhotra Ranjan , Devries Douglas K. , Luchs Jodi , Kabat Alan , Schechter Barry A. , Shen Lee Bridgitte , Shettle Lee , Smyth-Medina Robert , Ogundele Abayomi , Darby Charles , Bacharach Jason , Karpecki Paul 
Published: July 2019

Background:
Keratoconjunctivitis sicca affects 5% to 33% of the population and is often accompanied by symptoms such as burning and dryness. This pooled analysis evaluated total and central corneal fluorescein staining (CFS) in patients receiving OTX-101 0.09% or vehicle in phase 2b/3 and 3 studies and whether improvements in corneal staining correlated with improved visual acuity.

Methods:
In these randomized, vehicle-controlled studies, patients received 1 drop of OTX-101 or vehicle in both eyes twice daily. Corneal staining was performed at baseline and days 28, 56, and 84. CFS was evaluated in each zone (0-to-4 scale); total corneal staining (0-to-20 scale per eye) was averaged over both eyes. Pooled safety assessments included adverse event monitoring.

Results:
Mean baseline CFS total scores (SD) were 4.2 (2.5) and 4.3 (2.6) for the OTX-101 (n = 523) and vehicle (n = 525) groups, respectively. For total corneal staining, least squares mean changes from baseline (standard error) were −0.9 (0.08) versus −0.5 (0.08) for OTX-101 and vehicle, respectively (P = 0.0008), on day 28 and −1.4 (0.09) versus −0.9 (0.09) on day 84 (P = 0.0002). There was a significantly high correlation (P = 0.0117) between reduced central corneal staining and improved visual acuity on day 84. Treatment-related adverse events were mostly mild, with instillation site pain reported by 21.8% and 4.0% of patients receiving OTX-101 and vehicle, respectively.

Conclusions:
Treatment with OTX-101 led to greater improvements versus vehicle in corneal surface staining as early as 4 weeks, and further improvements were seen up to 12 weeks. OTX-101 was well tolerated in patients with keratoconjunctivitis sicca.
Synergy Testing of Antiamoebic Agents for Acanthamoeba: Antagonistic Effect of Voriconazole
Authors: Talbott Maya , Cevallos Vicky , Chen Michael C. , Chin Stephanie A. , Lalitha Prajna , Seitzman Gerami D. , Lietman Thomas M. , Keenan Jeremy D. 
Published: July 2019

Purpose:
To determine whether combinations of commonly used antiamoebic agents display synergy in their ability to kill Acanthamoeba cysts in vitro.

Methods:
Synergy testing was performed with a microdilution checkerboard assay on 10 clinical Acanthamoeba keratitis isolates collected at the Proctor Foundation from 2008 to 2012. Each isolate was exposed to pairwise combinations of chlorhexidine, propamidine, and voriconazole. The minimum cysticidal concentration (MCC) for each drug pair was estimated for each isolate, and the summed fractional cysticidal concentration (ΣFCC) was calculated for each drug combination in the checkerboard, with synergy defined as a lack of growth at a ΣFCC ≤ 0.5 and antagonism as growth at a ΣFCC > 4.

Results:
Chlorhexidine and propamidine were cysticidal, with median MCCs of 12.5 (range 1.5–50) and 11.7 (range 0.2–250), respectively. Voriconazole was not cysticidal, with a median MCC of >10,000 μg/mL. The combination of chlorhexidine and propamidine did not markedly change the cysticidal activity compared with either drug alone. By contrast, voriconazole antagonized the cysticidal activity of both chlorhexidine and propamidine, with Acanthamoeba growth observed at antagonistic ΣFCCs in 27 of 49 (55.1%, 95% confidence interval 35.7%–78.6%) checkerboard combinations of voriconazole and chlorhexidine and in 58 of 147 (39.5%, 95% confidence interval 14.3%–50.3%) combinations of voriconazole and propamidine.

Conclusions:
In an in vitro assay, voriconazole reduced the cysticidal activity of 2 commonly used antiamoebic drugs. Although the in vivo drug interactions could be different, these observations may be useful in cases of nonhealing Acanthamoeba keratitis being treated with combination therapies that include voriconazole.
Corneal Subbasal Nerve Analysis Using In Vivo Confocal Microscopy in Patients With Dry Eye: Analysis and Clinical Correlations
Authors: Liu Yan , Chou Yilin , Dong Xuran , Liu Ziyuan , Jiang Xiaodan , Hao Ran , Li Xuemin 
Published: July 2019

Purpose:
This study aimed to observe corneal subbasal nerves and Langerhans cells (LCs) using in vivo confocal microscopy (IVCM) in patients with dry eye, a tool for the evaluation of disease stage and severity and for treatment monitoring at the microstructural level.

Methods:
A total of 107 eyes from 62 patients were included. The Ocular Surface Disease Index (OSDI) questionnaire and other examinations were used to assess dry eye symptoms and signs. IVCM was performed to observe subbasal corneal nerves and LCs. Corneal nerves were graded using both objective and subjective methods. The correlations between dry eye symptoms and corneal nerve parameters, corneal nerve grading, and LC number were analyzed.

Results:
Corneal nerve length was negatively correlated with sensitivity to light [correlation coefficient (CC)= −0.24, P < 0.05]; nerve width was positively correlated with the OSDI score, painful eyes, and blurred vision (CC = 0.41, 0.23, and 0.46, respectively, all P < 0.05); and nerve tortuosity was positively correlated with sensitivity to light (CC = 0.23, P < 0.05). Moreover, both total objective and subjective grading scores were positively correlated with OSDI scores (CC = 0.48 and 0.27, respectively, both P < 0.05). LC number was found not to be significantly correlated with dry eye symptoms (P > 0.05).

Conclusions:
IVCM is a useful tool to evaluate corneal subbasal nerve changes in patients with dry eye. Detailed nerve grading could help to understand and evaluate the pathophysiologic conditions of the disease and could be used for further treatment follow-up in the future.
Limbal and Conjunctival Epithelial Thickness in Ocular Graft-Versus-Host Disease
Authors: Kheirkhah Ahmad , Coco Giulia , Satitpitakul Vannarut , Pham Tommy T. , Dana Reza 
Published: July 2019

Purpose:
To compare the thickness of the limbal epithelium (LE) and the bulbar conjunctival epithelium (BCE) between patients with dry eye disease (DED) with and without ocular graft-versus-host disease (GVHD).

Methods:
This cross-sectional study enrolled 40 patients with moderate to severe DED including 20 with and 20 without chronic ocular GVHD. All patients had a comprehensive clinical ophthalmic assessment. Moreover, the thickness of the LE and BCE in both nasal and temporal regions of both eyes was measured using spectral domain optical coherence tomography.

Results:
The average LE thickness in all patients with dry eye (GVHD and non-GVHD) was 65.8 ± 11.9 μm temporally and 69.7 ± 11.1 μm nasally (P = 0.02). The average BCE thickness was 55.8 ± 11.4 μm temporally and 60.1 ± 11.0 μm nasally (P = 0.03). There were no statistically significant differences between GVHD and non-GVHD groups in LE thickness (69.6 ± 11.7 vs. 66.1 ± 6.2 μm, respectively, P = 0.31) or BCE thickness (58.9 ± 9.6 vs. 57.3 ± 9.8 μm, respectively, P = 0.82). There was a significant correlation between LE thickness and BCE thickness (P = 0.01, Rs = 0.41). A statistically significant negative correlation was also observed between LE thickness and age (P = 0.002, Rs = −0.35). There were no significant correlations between the thickness of the LE or BCE and other clinical parameters.

Conclusions:
No difference exists in the thickness of the ocular surface epithelia between dry eyes with and without ocular GVHD, which would suggest that these epithelial changes may be independent of the underlying etiology and possibly only reflect the disease severity. Furthermore, there are regional variations in the thickness of the ocular surface epithelia in patients with DED.
Carvedilol Combined With Ivabradine Improves Left Ventricular Diastolic Dysfunction, Clinical Progression, and Survival in Cirrhosis
Authors: Premkumar Madhumita , Rangegowda Devaraja , Vyas Tanmay , Khumuckham Jelen S. , Shasthry Saggere M. , Thomas Sherin S. , Goyal Ritu , Kumar Guresh , Sarin Shiv K. 
Published: July 2019

Background:
Left ventricular diastolic dysfunction (LVDD) refers to impaired cardiac diastolic relaxation and may be improved by targeted heart rate reduction (THR). The authors evaluated whether a combination of carvedilol and ivabradine, an If channel blocker that reduces heart rate without affecting blood pressure, could improve LVDD and outcomes in cirrhosis.

Patients and Methods:
THR was defined as heart rate reduction to 55 to 65 beats per minute. Of 260 patients with cirrhosis, 189 (72%) with LVDD were randomized to THR [group (Gr.)A; n=94; carvedilol±ivabradine)] or standard care (Gr.B; n=95; no β-blockers) and followed for 12 months.

Results:
In Gr.A, THR was achieved at 4 weeks in 88 (93%) patients (responders, R): 48 (61.5%) with carvedilol alone and 40 (86.9%) of 46 patients with additional ivabradine. In Gr.A, LVDD reversed in 16 (20.5%) and improved from grade 2 to 1 in 34 (35.4%)], whereas in Gr.B, it progressed from grade 1 to 2 in 10 (10.5%) patients. At 12 months, 21 (11.1%) patients died, 6 (14%) in Gr.A and 15 (18%) in Gr.B (P=0.240), but no mortality was seen in those who had persistent THR at 1 year (n=78; P=0.000). In multivariate analysis, model for end-stage liver disease [hazard ratio (HR), 1.52; 95% confidence interval (CI), 1.22-2.75; P=0.034] and E-wave transmitral/early diastolic mitral annular velocity (HR, 1.28; 95% CI, 1.23-2.42; P=0.048) predicted 1-year mortality. Nonresponders had an increased mortality risk (HR, 1.3; 95% CI, 1.2-1.8; P=0.046) independent of age, gender, and baseline model for end-stage liver disease. Levels of norepinephrine, N terminal brain natriuretic peptide, plasma renin activity, and aldosterone were reduced (P<0.01) in responders. More patients in Gr.B developed acute kidney injury (odds ratio, 4.2; 95% CI, 2.8-10.5; P=0.027) and encephalopathy (odds ratio, 6.6; 95% CI, 1.9-9.7; P=0.040).

Conclusions:
Ivabradine combined with carvedilol improves LVDD, achieves THR more often and reduces risk of encephalopathy, acute kidney injury with improved survival in patients with cirrhosis.
A Role for Alveolar Exhaled Nitric Oxide Measurement in the Diagnosis of Hepatopulmonary Syndrome
Authors: Lam Shin Cheung Jeffrey , Naimi Madina , Sykes Jenna , Gupta Samir 
Published: July 2019

Goals:
The authors sought to characterize predominantly alveolar exhaled nitric oxide (eNO) in hepatopulmonary syndrome (HPS) compared with non-HPS, changes after liver transplantation, and diagnostic properties.

Background:
HPS is defined by liver disease, intrapulmonary vascular dilatations (IPVDs), and hypoxemia. Rat models and small human studies suggest that NO overproduction may cause IPVDs.

Study:
A retrospective review of the Canadian HPS Database (2007 to 2017) and prospective eNO measurement (main outcome) in healthy controls (measurement expiratory flow, 200 mL/s). HPS was defined as: (1) liver disease; (2) contrast echocardiography consistent with IPVDs; and (3) partial pressure of arterial oxygen <70 mm Hg with alveolar-arterial gradient >20 mm Hg; subclinical HPS as criteria (1) and (2) only; and no HPS as criterion (1) only. Current smokers and subjects with asthma or pulmonary hypertension were excluded. A linear mixed effects model was used to compare eNO between groups and before and after transplantation.

Results:
eNO was 10.4±0.7 ppb in HPS (n=26); 8.3±0.6 ppb in subclinical HPS (n=38); 7.1±1.0 ppb in no HPS (n=15); and 5.6±0.7 ppb in controls (n=30) (P<0.001). eNO decreased from 10.9±0.8 ppb preliver to 6.3±0.8 ppb postliver transplant (n=6 HPS, 6 subclinical HPS) (P<0.001). eNO <6 ppb was 84.4% (73.1% to 92.2%) sensitive and ≥12 ppb was 78.1% (69.4% to 85.3%) specific for HPS (vs. subclinical HPS).

Conclusions:
HPS subjects have higher alveolar eNO than non-HPS subjects, levels normalize with liver transplantation. Applying eNO cutoff values may aid in HPS diagnosis.