bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Clinical Study of Delirium
Authors: Curran Desmond 
Published: July 2019

The study is based upon 103 cases, which have been observed at either the Phipps Psychiatric Clinic or the Maudsley Hospital; twenty-seven different ætiological agents are represented. The following questions are raised:— (1) Whether there is evidence that different ætiological agents produce specific or even characteristic delirious states. (2) In what ways are the ætiological agents directly related to the states they produce. (3) What other factors help to determine the clinical picture. (4) What are the characteristics which these states appear to possess in common. (5) What light may this shed upon the rôles of exogenous as opposed to endogenous factors in the production of mental disease. The symptomatology, as recorded, is briefly sketched and some cases to illustrate particular points are given. It is advanced, on the observations made—with a clear realization that different and more detailed study might come to quite other conclusions—that:— (1) Nothing was found to suggest that any ætiological agent bore a truly specific relationship to the delirious state it produced. (2) The delirious states produced appeared to be directly related to the ætiological agent, and could be considered characteristic of them, in so far as the ætiological agent tended to affect the intensity and duration and “stability” of the functional disturbance in a fairly uniform manner. (3) The final clinical picture was also strikingly dependent upon the previous personality of the subject, and upon environmental stimuli sustained during the period of illness. (4) The nature of the functional disturbance which all these cases had in common had two aspects: ( a) a decrease in the ability to discriminate and differentiate, “confusion,” a deficiency in just those qualities for whose proper exhibition the integrity of the cerebral cortex is generally considered to be necessary, and ( b) an increased activity of a type bearing close resemblance to the dreaming state. (5) Finally, it is argued that it is highly improbable that in psychoses which do not show “confusion,” exogenous factors are likely to play more than a subsidiary, though in certain instances none the less an exceedingly important, rôle. Thus a study of exogenous reaction types might help to a better perspective in such debated issues as the importance of “focal sepsis” and the speculative toxæmias in the production of mental disease.
Jung's Contribution to Clinical Psychiatry
Authors: Mackenzie Murdo 
Published: July 2019

This attempt to correlate Jung's work with practical psychiatry is concerned mainly with his conception of clinical types. Jung went far away from the provinces of clinical medicine and psychiatry for his evidence, and the possible cause for this is discussed. He expands his view of introversion and extraversion, and so the suggestion is made that for practical purposes his early limitation of these terms should be maintained. The difficulties encountered in type description by comparison and contrast are emphasized. The value of his conception of basic functions is discussed and criticized. A review is made of the personalities he describes, and a simplification of his resulting classification suggested for practical purposes. The notion is put forward that Jung describes one type in psychological adaptation much better than any others, and it is hinted that his psycho-pathological description of this type in nerve disorder constitutes his main contribution to clinical psychiatry. A review of the treatable nerve disorders suggests that this disorder has received more adequate description from Jung than any other, and reveals a unique method of investigation and therapy. This does not apply to his other descriptions. Possibly some of the vagueness attributed to Jung is because he did not give this disorder an adequate diagnosis, and an explanation for this is offered. The correlation between the simplified classification and the classification of treatable nerve disorders is close, and it is suggested that this constitutes Jung's contribution to clinical psychiatry in general. The application of Jung's principles is of daily help to the practising psychiatrist.
Experimental Concussion
Authors: Denny-Brown D. E. , Russell W. Ritchie 
Published: July 2019

The various hypotheses of the mechanism of coma resulting from cerebral trauma are discussed. Experimental evidence shows that there are two kinds of transient abolition of cerebral function by trauma—acceleration concussion, and compression concussion. The former is a passing paralysis which occurs in all brain-stem mechanisms examined and is brought about at and beyond a threshold value of change in velocity. A lesser degree of change causes momentary depression of function, a greater degree prolongs the phase of paralysis before recovery occurs. Movement of the head is necessary for the usual kind of concussion to occur, as also for contre-coup injury. Compression concussion has much more selective incidence on the respiratory centre, and appears to require an extreme crushing injury or penetration of the skull by a relatively large object. Acceleration concussion is that accompanying closed head injury and is not accompanied by any significant change in C.S.F. pressure. The cerebral blood flow is verv greatly increased in this variety owing to stimulation of the vagoglossopharyngeal nerves at the foramen magnum. With more severe blows subpial or intramedullary lesions may occur in this situation, indicating that distortion at the foramen magnum occurs. No evidence of vascular spasm or paralysis is found. An immediate brief rise of blood-pressure is due to stimulation of the vasomotor centre. Vagal effects may not appear until the traumatic paralysis of all centres begins to pass off. A delayed fall in blood-pressure lasting many minutes may follow severe vagal effects, and appears comparable to acute surgical shock as produced by intense stimulation of any other visceral nerve. Death occurs from failure of blood-pressure, an intensification of shock with shallow respiration and intense constriction of viscera. It is concluded that sudden failure of what has been called the veno-pressor system is important in death shortly following experimental concussion. No macroscopical lesions are found, and histological examination shows no change with ordinary tissue stains. The unconsciousness of coma is believed to be related to direct traumatic paralysis of the cortical neurones and if their sensitivity to physical violence is similar to that of anæsthetics, prolonged impairment of function from this cause alone is possible. Clinical observations were related in support of these conclusions.
Isolated Oculomotor Palsy Caused by Intracranial Aneurysm
Authors: Jefferson Geoffrey 
Published: July 2019

The present paper is concerned with the 55 aneurysms out of a total of 158 that caused isolated paralysis of the oculomotor nerve. The majority arose from the internal carotid artery after it had pierced the dura (supraclinoid). Rarely the aneurysm sprang from the basilar artery. In two-thirds of the cases there had been a subarachnoid hæmorrhage from leakage. Not more than 10% of patients had arteriosclerosis. Calcification of the sac is not a sign that the aneurysm has thrombosed. The only certain way of demonstrating the position and size of an intracranial aneurysm is by arteriography, which is a safe procedure.The correct treatment is by carotid ligature. In about 8% of normals the circle of Willis is incomplete, therefore percutaneous compression must first be tried. The only fatalities from ligature were in persons in the acute stage of subarachnoid hæmorrhage, not from meningeal bleeding alone. In this type of case a clip applied to the neck of the sac is probably a better method. In the more usual cases where the hæmorrhage has been spontaneously arrested common carotid ligature in the neck is probably a little safer than intracranial clipping.
Diagnostic performance of neutrophil CD64 index in patients with sepsis in the intensive care unit
Authors: Ye Zhenglong , Zou Hui , Liu Shangxiang , Mei Chengqing , Chang Xiaoliang , Hu Zhiqing , Yang Huanhuan , Wu Yong 
Published: July 2019

Objective This study was performed to evaluate the diagnostic value of the neutrophil CD64 index in patients with sepsis in the intensive care unit (ICU). Methods Patients with sepsis who were treated at the ICU of the authors’ institution from December 2016 to June 2018 were retrospectively reviewed. The controls comprised age- and sex-matched patients who underwent coronary bypass and had no evidence of infection. The neutrophil CD64 index, C-reactive protein (CRP) level, and procalcitonin level were compared between the two groups. The diagnostic performance of these measures, including the sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve, was examined. Results In total, 35 patients with sepsis and 27 control patients were included in the data analysis. The sensitivity of the neutrophil CD64 index, CRP level, and procalcitonin level was 83%, 74%, and 77%, respectively. The specificity was 88%, 86%, and 81%, respectively. The area under the ROC curve was 0.923 [95% confidence interval (CI), 0.856–0.989], 0.904 (95% CI, 0.832–0.976), and 0.863 (95% CI, 0.776–0.950), respectively. Conclusion The neutrophil CD64 index is a valuable biomarker for diagnosing sepsis in patients in the ICU.
Analysis of Return to Sport and Weight Training After Repair of the Pectoralis Major Tendon
Authors: Liu Joseph N. , Gowd Anirudh K. , Garcia Grant H. , Manderle Brandon J. , Beletsky Alexander , Nicholson Gregory P. , Forsythe Brian , Romeo Anthony A. , Verma Nikhil N. 
Published: July 2019

Background:The use of routine patient-reported outcomes after repair of the pectoralis major tendon (PMT) is often prone to the ceiling effect owing to the high functional demand of those who sustain this injury.Hypothesis:A significant number of patients are expected to fail to achieve return to preoperative activity after PMT repair despite achieving significant improvements in functional score.Study Design:Case series; Level of evidence, 4.Methods:A prospectively maintained institutional database was reviewed for all patients undergoing PMT repair from 2010 to 2016. Patients were surveyed with regard to pre- and postoperative participation in sports, level of intensity, maximum weight repetitions in exercises utilizing the PMT, and American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores.Results:Forty-four patients (73.3%) were available for final follow-up. All patients were male. Mean ± SD follow-up was 51.1 ± 24.1 months. Mean age was 39.6 ± 8.8 years (range, 24-61 years), and mean body mass index was 28.6 ± 3.5 kg/m2. The dominant side was affected in 20 of 44 cases. Acute repairs were performed in 30 cases and chronic in 14. There were statistically significant improvements in both ASES and SANE scores ( P < .001). Return to sport at any level was achieved by 43 of 44 (97.7%) patients, while 22 of 44 patients (50.0%) reported returning to sport at the same or better intensity as preinjury status. On average, there was a 23.3% ± 45.6% decrease in 1–repetition maximum (1RM) barbell bench press, 14.7% ± 62.3% decrease in 5–repetition maximum barbell bench press, 24.3% ± 21.8% decrease in 1RM dumbbell bench press, 35.7% ± 32.1% decrease in 1RM dumbbell fly, and 15.6% ± 39.8% decrease in consecutive push-ups able to be performed. Seventeen patients (38.6%) reported a degree of apprehension that affected their ability to lift weights. When all preoperative variables were accounted for, history of surgery to the contralateral shoulder (odds ratio, 0.600; 95% CI, 0.389-0.925) was associated with a decreased likelihood of returning to sport at the same or better level of intensity, while injury sustained during sport had a greater likelihood (odds ratio, 2.231; 95% CI, 1.234-4.031).Conclusion:Patients undergoing PMT repair should expect significant functional improvements and a low complication rate. Yet, only 50% are able to return to preoperative intensity of sport, and they will also have significant reductions in their ability to weight lift.
Concussion in American Versus European Professional Soccer: A Decade-Long Comparative Analysis of Incidence, Return to Play, Performance, and Longevity
Authors: Ramkumar Prem N. , Navarro Sergio M. , Haeberle Heather S. , Luu Bryan C. , Jang Albert , Frangiamore Salvatore J. , Farrow Lutul D. , Schickendantz Mark S. , Williams Riley J. 
Published: July 2019

Background: The incidence and effect of sports-related concussions (SRCs) within the global sport of professional soccer is poorly described. Purpose: To comparatively examine the effects of SRC on athletes in Major League Soccer (MLS) and the English Premier League (EPL) in terms of incidence, return to play (RTP), performance, and career longevity. Study Design: Cohort study; Level of evidence, 3. Methods: Contracts, transactions, injury reports, and performance statistics from 2008 to 2017 were obtained and cross-referenced across 6 publicly available websites detailing MLS and EPL data, including official league publications. For each league, players who sustained a concussion were compared with the 2008-2017 uninjured player pool. RTP and games missed were analyzed and compared. Career length was analyzed with Kaplan-Meier survival curves. Player performance changes were evaluated before and after concussion. Results: Of the 1784 eligible MLS and 2001 eligible EPL players evaluated over the 10-year period, the incidence of publicly reported concussions per 1000 athlete-exposures was 20.22 and 18.68, respectively ( P = .53). The incidence of reported concussions steadily increased in both leagues. MLS players missed a mean 7.3 games after concussion (37.0 days missed); EPL players missed a mean 0.6 games after concussion (10.9 days missed) ( P < .0001, P < .0001). Statistical performance in terms of games started, assists, shots on goal, and total shots after concussion was significantly reduced at all nongoalie positions for players in the EPL; however, MLS nongoalie positions with concussion had no significant decreases in these categories. Goalies in both leagues had no significant change in performance or games started. The probability of playing a full season after concussion was not significantly decreased when compared with the uninjured pool in both leagues. Conclusion: This study established the SRC incidence among elite soccer players in 2 international professional leagues and identified major RTP and performance differences between EPL and MLS players. While career longevity was unaffected, the approach to managing concussion as in MLS may better promote player safety and preserve on-field performance.
Tidal peritoneal dialysis versus ultrafiltration in type 1 cardiorenal syndrome: A prospective randomized study
Authors: Al-Hwiesh Abdullah K , Abdul-Rahman Ibrahiem Saeed , Al-Audah Nadia , Al-Hwiesh Amani , Al-Harbi Mousa , Taha Abdulrahman , Al-Shahri Abdulla , Ghazal Sami , Amir Rawan , Al-Audah Nehad , Mansour Hany , El-Mansouri Mohammad , El-Salamony Tamer S , Nasr El-Din Mohammed A , Noor Abdulsalam , Al-Elq Zainab , Alzahir Zainab H , Alzawad Noor A 
Published: July 2019

Background: Ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure. Little is known about the efficacy and safety of peritoneal dialysis in patients with acute decompensated heart failure complicated by acute cardiorenal syndrome. Methods: We randomly assigned a total of 88 patients with type 1 acute cardiorenal syndrome to a strategy of ultrafiltration therapy (44 patients) or tidal peritoneal dialysis (44 patients). The primary endpoint was the change from baseline in the serum creatinine level and left ventricular function represented as ejection fraction, as assessed 72 and 120 h after random assignment. Patients were followed for 90 days after discharge from the hospital. Results: Ultrafiltration therapy was inferior to tidal peritoneal dialysis therapy with respect to the primary endpoint of the change in the serum creatinine levels at 72 and 120 h ( p = 0.041) and ejection fraction at 72 and 120 h after enrollment ( p = 0.044 and p = 0.032), owing to both an increase in the creatinine level in the ultrafiltration therapy group and a decrease in its level in the tidal peritoneal dialysis group. At 120 h, the mean change in the creatinine level was 1.4 ± 0.5 mg/dL in the ultrafiltration therapy group, as compared with 2.4 ± 1.3 mg/dL in the tidal peritoneal dialysis group ( p = 0.023). At 72 and 120 h, there was a significant difference in weight loss between patients in the ultrafiltration therapy group and those in the tidal peritoneal dialysis group ( p = 0.025). Net fluid loss was also greater in tidal peritoneal dialysis patients ( p = 0.018). Adverse events were more observed in the ultrafiltration therapy group ( p = 0.007). At 90 days post-discharge, tidal peritoneal dialysis patients had fewer rehospitalization for heart failure (14.3% vs 32.5%, p = 0.022). Conclusion: Tidal peritoneal dialysis is a safe and effective means for removing toxins and large quantities of excess fluid from patients with intractable heart failure. In patients with cardiorenal syndrome type 1, the use of tidal peritoneal dialysis was superior to ultrafiltration therapy for the preservation of renal function, improvement of cardiac function, and net fluid loss. Ultrafiltration therapy was associated with a higher rate of adverse events.
What Is the Optimal Protocol for Performing Debridement, Antibiotics and Implant Retention (DAIR) in an Infected Total Ankle Arthroplasty (TAA) (Type and Volume of Irrigation Solution, and so on)?
Authors: Uçkay Ilker , Pedowitz David , Assal Mathieu , Stull Justin D. 
Published: July 2019

Recommendation: Debridement, antibiotics, and implant retention (DAIR) in acute total ankle arthroplasty (TAA) infections may be an acceptable treatment option. If performed, DAIR should be done meticulously, ensuring that all necrotic or infected tissues are removed and modular parts of the prosthesis, if any, exchanged. The infected joint should also be irrigated with antiseptic solutions. Level of Evidence: Consensus. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)
Thrombocytosis as a prognostic factor in polymyalgia rheumatica: characteristics determined from cluster analysis
Authors: Hayashi Keigo , Ohashi Keiji , Watanabe Haruki , Sada Ken-Ei , Shidahara Kenta , Asano Yosuke , Asano Sumie Hiramatsu , Yamamura Yuriko , Miyawaki Yoshia , Morishita Michiko , Matsumoto Yoshinori , Kawabata Tomoko , Wada Jun 
Published: July 2019

Background: This study aimed to identify the clinical subgroups of polymyalgia rheumatica (PMR) using cluster analysis and compare the outcomes among the identified subgroups. Methods: We enrolled patients with PMR who were diagnosed at Okayama University Hospital, Japan between 2006 and 2017, met the 2012 European League Against Rheumatism/American College of Rheumatology provisional classification criteria for PMR, and were treated with glucocorticoids. Hierarchical cluster analysis using variables selected by principal component analysis was performed to identify the clusters. Subsequently, the outcomes among the identified clusters were compared in the study. The primary outcome was treatment response at 1 month after commencement of treatment. The secondary outcome was refractory clinical course, which was defined as the requirement of additional treatments or relapse during a 2-year observational period. Results: A total of 61 consecutive patients with PMR were enrolled in the study. Their mean age was 71 years, and 67% were female. Hierarchical cluster analysis revealed three distinct subgroups: cluster 1 ( n = 14) was characterized by patients with thrombocytosis (all patients showed a platelet count of >45 × 10⁴/µl), cluster 2 ( n = 38), by patients without peripheral arthritis, and cluster 3 ( n = 9), by patients with peripheral arthritis. The patients in cluster 1 achieved treatment response less frequently than those in cluster 2 (14% versus 47%, p = 0.030). Refractory cases were more frequent in cluster 1 than in cluster 2; however, no significant difference was noted (71% versus 42%, p = 0.06). Conclusions: Thrombocytosis could predict the clinical course in patients with PMR.
Regional lung function in nonsmokers and asymptomatic current and former smokers
Authors: Vogt Barbara , Deuß Kathinka , Hennig Victoria , Zhao Zhanqi , Lautenschläger Ingmar , Weiler Norbert , Frerichs Inéz 
Published: July 2019

Electrical impedance tomography (EIT) is able to detect rapid lung volume changes during breathing. The aim of our observational study was to characterise the heterogeneity of regional ventilation distribution in lung-healthy adults by EIT and to detect the possible impact of tobacco consumption.A total of 219 nonsmokers, asymptomatic ex-smokers and current smokers were examined during forced full expiration using EIT. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC were determined in 836 EIT image pixels for the analysis of spatial and temporal ventilation distribution. Coefficients of variation (CVs) of these pixel values were calculated. Histograms and medians of FEV1/FVCEITand times required to exhale 50%, 75%, 90% of FVCEIT(t50, t75and t90) were generated.CV of FEV1/FVCEITdistinguished among all groups (mean±sd: nonsmokers 0.43±0.05, ex-smokers 0.52±0.09, smokers 0.62±0.16). Histograms of FEV1/FVCEITdifferentiated between nonsmokers and the other groups (p<0.0001). Medians of t50, t75and t90showed the lowest values in nonsmokers. Median t90separated all groups (median (interquartile range): nonsmokers 0.82 (0.67–1.15), ex-smokers 1.41 (1.03–2.21), smokers 1.91 (1.33–3.53)).EIT detects regional ventilation heterogeneity during forced expiration in healthy nonsmokers and its increase in asymptomatic former and current smokers. Therefore, EIT-derived reference values should only be collected from nonsmoking lung-healthy adults.