bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardioprotection by Humoral Factors Released After Remote Ischemic Preconditioning Depends on Anesthetic Regimen
Authors: Bunte Sebastian , Behmenburg Friederike , Eckelskemper Franziska , Mohr Felix , Stroethoff Martin , Raupach Annika , Heinen André , Hollmann Markus W. , Huhn Ragnar 
Published: January 2019

Objectives:
Remote ischemic preconditioning (RIPC) is a practicable and noninvasive method to protect the heart against ischemia reperfusion injury. Unfortunately results from clinical studies are not convincing. Propofol is suggested to be an inhibiting factor of cardioprotection by RIPC, but the underlying mechanism is still unknown. We investigated whether after RIPC the release of humoral factors and/or the direct cardioprotective effect at the myocardium is inhibited by propofol.

Design:
Randomized, prospective, blinded laboratory investigation.

Setting:
Experimental laboratory.

Patients/Subjects:
Male Wistar rats.

Interventions:
Repetitive hind limb ischemia in rats—blood plasma transfers to isolated rat heart.

Measurements and Main Results:
In male Wistar rats (six groups, each n = 6/group), RIPC was induced by four cycles of 5 minutes bilateral hind limb ischemia alternately with 5 minutes of reperfusion. Blood samples were taken with (RIPC) and without RIPC (Con). Rats received continuous anesthesia with pentobarbital (Pento, 40 mg/kg body weight/hr) or propofol (Prop, 12 mg/kg body weight/hr), respectively. Cardioprotective properties of the blood plasma was investigated in the rat heart in vitro (six groups, each n = 6/group) perfused with Krebs-Henseleit buffer alone or with propofol (10 µM). Plasma was administered over 10 minutes before myocardial ischemia. All hearts underwent 33 minutes of global ischemia followed by 1 hour of reperfusion. At the end of the experiments, infarct size was determined by triphenyl-tetrazolium-chloride staining. RIPC plasma from pentobarbital anesthetized rats (Pento-RIPC) reduced infarct size from 64% (62–71%) (Pento-Con) to 34% (30–39%) (p < 0.0001). Infarct size with control plasma from propofol anesthetized rats was 59% (58–64%) (Prop-Con). RIPC plasma could not induce cardioprotection (Prop-RIPC: 63% [56–70%] ns vs Prop-Con). In contrast, RIPC plasma from pentobarbital anesthetized rats induced a significant infarct size reduction under propofol perfusion (Pento-RIPC: 34% [30–42%] vs Pento-Con: 54% [53–63%]; p < 0.0001).

Conclusions:
Loss of cardioprotection by RIPC during propofol anesthesia depends on inhibition of release of humoral factors.
Evaluation of Medication Errors at the Transition of Care From an ICU to Non-ICU Location
Authors: Tully Andrea P. , Hammond Drayton A. , Li Chenghui , Jarrell Andrew S. , Kruer Rachel M. 
Published: January 2019

Objectives:
To determine the point prevalence of medication errors at the time of transition of care from an ICU to non-ICU location and assess error types and risk factors for medication errors during transition of care.

Design:
This was a multicenter, retrospective, 7-day point prevalence study.

Setting:
Fifty-eight ICUs within 34 institutions in the United States and two in the Netherlands.

Patients:
Nine-hundred eighty-five patients transferred from an ICU to non-ICU location.

Interventions:
None.

Measurements and Main Results:
Of 985 patients transferred, 450 (45.7%) had a medication error occur during transition of care. Among patients with a medication error, an average of 1.88 errors per patient (sd, 1.30; range, 1–9) occurred. The most common types of errors were continuation of medication with ICU-only indication (28.4%), untreated condition (19.4%), and pharmacotherapy without indication (11.9%). Seventy-five percent of errors reached the patient but did not cause harm. The occurrence of errors varied by type and size of institution and ICU. Renal replacement therapy during ICU stay and number of medications ordered following transfer were identified as factors associated with occurrence of error (odds ratio, 2.93; 95% CI, 1.42–6.05; odds ratio 1.08, 95% CI, 1.02–1.14, respectively). Orders for anti-infective (odds ratio, 1.66; 95% CI, 1.19–2.32), hematologic agents (1.75; 95% CI, 1.17–2.62), and IV fluids, electrolytes, or diuretics (odds ratio, 1.73; 95% CI, 1.21–2.48) at transition of care were associated with an increased odds of error. Factors associated with decreased odds of error included daily patient care rounds in the ICU (odds ratio, 0.15; 95% CI, 0.07–0.34) and orders discontinued and rewritten at the time of transfer from the ICU (odds ratio, 0.36; 95% CI, 0.17–0.73).

Conclusions:
Nearly half of patients experienced medication errors at the time of transition of care from an ICU to non-ICU location. Most errors reached the patient but did not cause harm. This study identified risk factors upon which risk mitigation strategies should be focused.
Lipidomics Detection of Brain Cardiolipins in Plasma Is Associated With Outcome After Cardiac Arrest
Authors: Anthonymuthu Tamil S. , Kenny Elizabeth M. , Lamade Andrew M. , Gidwani Hitesh , Krehel Nicholas M. , Misse Amalea , Gao Xiaotian , Amoscato Andrew A. , Straub Adam C. , Kagan Valerian E. , Dezfulian Cameron , Bayır Hülya 
Published: January 2019

Objectives:
Brain mitochondrial dysfunction limits neurologic recovery after cardiac arrest. Brain polyunsaturated cardiolipins, mitochondria-unique and functionally essential phospholipids, have unprecedented diversification. Since brain cardiolipins are not present in plasma normally, we hypothesized their appearance would correlate with brain injury severity early after cardiac arrest and return of spontaneous circulation.

Design:
Observational case-control study.

Setting:
Two medical centers within one city.

Participants (Subjects):
We enrolled 41 adult cardiac arrest patients in whom blood could be obtained within 6 hours of resuscitation. Two subjects were excluded following outlier analysis. Ten healthy subjects were controls. Sprague-Dawley rats were used in asphyxial cardiac arrest studies.

Interventions:
None.

Measurements and Main Results:
We developed a high-resolution liquid chromatography/mass spectrometry method and determined cardiolipins speciation in human brain, heart, and plasma within 6 hours of (return of spontaneous circulation) from 39 patients with cardiac arrest, 5 with myocardial infarction, and 10 healthy controls. Cerebral score was derived from brain-specific cardiolipins identified in plasma of patients with varying neurologic injury and outcome. Using a rat model of cardiac arrest, cardiolipins were quantified in plasma, brain, and heart. Human brain exhibited a highly diverse cardiolipinome compared with heart that allowed the identification of brain-specific cardiolipins. Nine of 26 brain-specific cardiolipins were detected in plasma and correlated with brain injury. The cerebral score correlated with early neurologic injury and predicted discharge neurologic/functional outcome. Cardiolipin (70:5) emerged as a potential point-of-care marker predicting injury severity and outcome. In rat cardiac arrest, a significant reduction in hippocampal cardiolipins corresponded to their release from the brain into systemic circulation. Cerebral score was significantly increased in 10 minutes versus 5 minutes no-flow cardiac arrest and naïve controls.

Conclusions:
Brain-specific cardiolipins accumulate in plasma early after return of spontaneous circulation and proportional to neurologic injury representing a promising novel biomarker.
How and Whom to Monitor for Seizures in an ICU: A Systematic Review and Meta-Analysis
Authors: Limotai Chusak , Ingsathit Atiporn , Thadanipon Kunlawat , McEvoy Mark , Attia John , Thakkinstian Ammarin 
Published: January 2019

Objectives:To pool prevalence of nonconvulsive seizure, nonconvulsive status epilepticus, and epileptiform activity detected by different electroencephalography types in critically ills and to compare detection rates among them.Data Sources:MEDLINE (via PubMed) and SCOPUS (via Scopus)Study Selection:Any type of study was eligible if studies were done in adult critically ill, applied any type of electroencephalography, and reported seizure rates. Case reports and case series were excluded.Data Extraction:Data were extracted independently by two investigators. Separated pooling of prevalence of nonconvulsive seizure/nonconvulsive status epilepticus/epileptiform activity and odds ratio of detecting outcomes among different types of electroencephalography was performed using random-effect models. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and also adhered to the Meta-analyses Of Observational Studies in Epidemiology guidelines. Quality of evidence was assessed with the Newcastle-Ottawa Quality Assessment Scale for observational studies and Cochrane methods for randomized controlled trial studies.Data Synthesis:A total of 78 (16,707 patients) and eight studies (4,894 patients) were eligible for pooling prevalence and odds ratios. For patients with mixed cause of admission, the pooled prevalence of nonconvulsive seizure, nonconvulsive status epilepticus, either nonconvulsive seizure or nonconvulsive status epilepticus detected by routine electroencephalography was 3.1%, 6.2%, and 6.3%, respectively. The corresponding prevalence detected by continuous electroencephalography monitoring was 17.9%, 9.1%, and 15.6%, respectively. In addition, the corresponding prevalence was high in post convulsive status epilepticus (33.5%, 20.2%, and 32.9%), CNS infection (23.9%, 18.1%, and 23.9%), and post cardiac arrest (20.0%, 17.3%, and 22.6%). The pooled conditional log odds ratios of nonconvulsive seizure/nonconvulsive status epilepticus detected by continuous electroencephalography versus routine electroencephalography from studies with paired data 2.57 (95% CI, 1.11–5.96) and pooled odds ratios from studies with independent data was 1.57 (95% CI, 1.00–2.47).Conclusions:Prevalence of seizures detected by continuous electroencephalography was significantly higher than with routine electroencephalography. Prevalence was particularly high in post convulsive status epilepticus, CNS infection, and post cardiac arrest.
Validation and Critical Evaluation of the Effective Arterial Elastance in Critically Ill Patients
Authors: Jozwiak Mathieu , Millasseau Sandrine , Richard Christian , Monnet Xavier , Mercado Pablo , Dépret François , Alphonsine Jean-Emmanuel , Teboul Jean-Louis , Chemla Denis 
Published: January 2019

Objectives:
First, to validate bedside estimates of effective arterial elastance = end-systolic pressure/stroke volume in critically ill patients. Second, to document the added value of effective arterial elastance, which is increasingly used as an index of left ventricular afterload.

Design:
Prospective study.

Setting:
Medical ICU.

Patients:
Fifty hemodynamically stable and spontaneously breathing patients equipped with a femoral (n = 21) or radial (n = 29) catheter were entered in a “comparison” study. Thirty ventilated patients with invasive hemodynamic monitoring (PiCCO-2; Pulsion Medical Systems, Feldkirchen, Germany), in whom fluid administration was planned were entered in a “ dynamic” study.

Interventions:
In the “dynamic” study, data were obtained before/after a 500 mL saline administration.

Measurements and Main Results:
According to the “cardiocentric” view, end-systolic pressure was considered the classic index of left ventricular afterload. End-systolic pressure was calculated as 0.9 × systolic arterial pressure at the carotid, femoral, and radial artery level. In the “comparison” study, carotid tonometry allowed the calculation of the reference effective arterial elastance value (1.73 ± 0.62 mm Hg/mL). The femoral estimate of effective arterial elastance was more accurate and precise than the radial estimate. In the “dynamic” study, fluid administration increased stroke volume and end-systolic pressure, whereas effective arterial elastance (femoral estimate) and systemic vascular resistance did not change. Effective arterial elastance was related to systemic vascular resistance at baseline (r = 0.89) and fluid-induced changes in effective arterial elastance and systemic vascular resistance were correlated (r = 0.88). In the 15 fluid responders (cardiac index increases ≥ 15%), fluid administration increased end-systolic pressure and decreased effective arterial elastance and systemic vascular resistance (each p < 0.05). In the 15 fluid nonresponders, end-systolic pressure increased (p < 0.05), whereas effective arterial elastance and systemic vascular resistance remained unchanged.

Conclusions:
In critically ill patients, effective arterial elastance may be reliably estimated at bedside (0.9 × systolic femoral pressure/stroke volume). We support the use of this validated estimate of effective arterial elastance when coupled with an index of left ventricular contractility for studying the ventricular-arterial coupling. Conversely, effective arterial elastance should not be used in isolation as an index of left ventricular afterload.
Effect of Neutropenic Diet on Infection Rates in Cancer Patients With Neutropenia
Authors: Ball Somedeb , Brown Timothy J. , Das Avash , Khera Rohan , Khanna Sahil , Gupta Arjun 
Published: January 2019

Introduction:
Neutropenic diets are commonly prescribed to cancer patients with neutropenia with the intention of reducing rates of infection. These diets are restrictive and are associated with lower patient satisfaction and possibly malnutrition. Further, it is unclear if these restrictive diets are effective in reducing infection. We performed a meta-analysis on the rates of infection reported in trials comparing the neutropenic diet to unrestricted diets in cancer patients with neutropenia.

Methods and Materials:
A comprehensive database search for all published randomized controlled trials comparing infection rates in cancer patients receiving a neutropenic diet versus an unrestricted diet was performed for all publications in English language from database’s inception until September 12, 2017. The search strategy, study selection, and subsequent analysis adhered to PRISMA guidelines. Random effects modeling was used to obtain pooled relative risks. The primary outcome measure was the rate of infection.

Results:
Five randomized controlled trials with a total of 388 patients were included in the final analysis. Patients mostly had acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or sarcoma. Infection was noted in 53.7% patients in the neutropenic diet group, as compared with 50% in the unrestricted diet group. No significant difference in infection rate was observed between the neutropenic diet versus unrestricted diet groups, pooled risk ratio (RR) 1.13 (95% CI, 0.98-1.30; P=0.10).

Conclusions:
This meta-analysis of randomized controlled trials suggests that the use of neutropenic diet was not associated with decreased risk of infection in neutropenic cancer patients. The continued use of neutropenic diets should be questioned.
Impact of Primary Care Access on Mortality of Lung Cancer Patients in an Underserved Community
Authors: Su Christopher T. , Chau Vincent , Halmos Balazs , Shah Chirag D. , Gucalp Rasim A. , Packer Stuart H. , Wilson Kevin , Rapkin Bruce D. , Perez-Soler Roman , Cheng Haiying 
Published: January 2019

Background:
Lack of access to primary care physicians (PCPs) may be an important contributor to mortality differences attributed to race/ethnicity. This study examined the effects of primary care access on mortality of lung cancer patients in an underserved community.

Methods:
Medical records of all newly diagnosed patients with primary lung cancer from 2012 to 2016 at a National Cancer Institute (NCI)-designated center in Bronx, New York were reviewed. Demographic data, PCP status, and residence in primary care shortage areas (PCSAs) were collected. Survival data from time of first imaging to death or the end of follow-up on January 1, 2018 were recorded. Survival analysis was performed using Kaplan-Meier and Cox hazards modeling.

Results:
Among 1062 patients, 874 (82%) were PCSA residents, 314 (30%) were Hispanic, and 445 (42%) were African American. PCSA residents were likely Hispanics (P<0.001), African Americans (P<0.001), of lower income (P<0.001), and had advanced disease at diagnosis (P=0.01). Patients without established PCPs had more comorbidities (P=0.04), more advanced disease (P<0.001), and less in-network cancer treatment (P<0.001). PCSA residence (P=0.03, hazard ratio [HR]=1.27) and no established PCP (P<0.001, HR=1.50) were associated with increased mortality. In multivariable modeling, lack of established PCP remained a predictor of increased mortality (P=0.02, HR=1.25).

Discussion:
Among newly diagnosed lung cancer patients, lack of established PCP is associated with increased mortality. Hispanics and African Americans increasingly resided in PCSAs, suggesting race/ethnicity mortality differences may be mediated by primary care shortage. Patients without PCPs had worse health outcomes. Effective health policy efforts to reduce mortality in lung cancer patients must include approaches to improve primary care access.
Factors Associated With Patient-Initiated Communication After Mohs Micrographic Surgery
Authors: Chitgopeker Pooja , Sidey Kirk , Aronson Adam , Hammel Josh , Noe Megan H. , Auh Sogyong , Lehrer Michael , Hopp Shelby , Johnson-Jahangir Hillary , VanBeek Marta , Ferguson Nkanyezi 
Published: January 2019

BACKGROUND
Despite extensive counseling, patients commonly call with postoperative concerns after Mohs micrographic surgery (MMS).

OBJECTIVE
We sought to determine the incidence, reasons, and patient and surgical characteristics that lead to patient-initiated communication after MMS.

MATERIALS AND METHODS
A retrospective chart review of 1,531 patients who underwent MMS during the observational period was conducted. Demographics and perioperative characteristics of patients who initiated communication were compared with a random sample of matched controls.

RESULTS
Of the 1,531 patients who underwent MMS, 263 patients (17.2%) initiated 412 communication encounters within 90 days of surgery. Top reasons for patient-initiated communication included wound concerns, bleeding, and postoperative pain. Female patients and those with a larger surgical defect size (cm2) were more likely to call postoperatively. Patients who underwent second intention healing, grafts, and interpolation flaps were more likely to initiate communication compared to patients repaired with a linear closure.

CONCLUSION
This study identifies the incidence, reasons, and patient and surgical factors predictive of patient-initiated communication after MMS, which may allow for targeted improvements in postoperative counseling, ameliorating patient anxiety, augmenting patient satisfaction, and improved efficiency for the health care team.
Changes in the Layers of the Temple During Pinch Manipulation: Implications for Thread Lifting
Authors: Oh Seung Min , Kim Bong Cheol , Jung Wonsug 
Published: January 2019

BACKGROUND
During minimally invasive aesthetic procedures, the skin is often pinched to facilitate filler injection or thread insertion into the desired layer. However, little is known about changes in the facial layers during pinch manipulation.

OBJECTIVE
To determine which layer of the temple is lifted during pinching and whether the artery and the nerve are affected by pinching.

MATERIALS AND METHODS
At 11 sites on 3 fresh Korean cadavers, the skin of the temple was pinched gently or deeply, and the skin pulled up was cut at the bottom. The exposed areas were grossly and histologically examined.

RESULTS
With gentle pinching, the subcutaneous fat and superficial temporal fascia (STF) layer were separated, and the fat was removed with the skin. The superficial temporal artery and temporal branches of the facial nerve were intact. With deep pinching, the STF was separated from the deep temporal fascia and lifted with the skin.

CONCLUSION
When thread lifting is performed, deep pinching is helpful for anchoring thread to the temporal fascia, whereas gentle pinching helps to insert thread into the safe subcutaneous fat layer, where no significant blood vessels or nerves are present.
Assessment of Provider Utilization Through Skin Biopsy Rates
Authors: Hamid Ramiz N. , McGregor Sean P. , Siegel Daniel M. , Feldman Steven R. 
Published: January 2019

BACKGROUND
There have been recent claims of overdiagnosis and unnecessary treatment in dermatology. One potential manifestation of overutilization would be providers who perform numerous biopsies per patient.

OBJECTIVE
To identify the frequency of skin biopsy rate outliers.

MATERIALS AND METHODS
Data on biopsy rates at the individual provider level were obtained from Medicare Provider Utilization and Payment Data Public Use Files. The total number of biopsies for each provider was obtained by summing the number of claimed biopsy services for each unique National Provider Identifier. The visit count for each provider was obtained by summing all evaluation and management services claimed. Provider biopsy rates were calculated by dividing the total number of biopsies associated with each National Provider Identifier by the corresponding visit count.

RESULTS
The mean provider biopsy rate was 0.31 services per visit, or approximately 1 biopsy every 3 visits. Defining outliers as providers who averaged 3 or more biopsies per visit, there were 38 outliers out of 18,260 providers. Physicians had a lower mean biopsy rate than nonphysician clinicians (p = 1.70E–28).

CONCLUSION
Contrary to claims, the authors' results do not indicate widespread overutilization of skin biopsy services.
Stratification of Poor Outcomes for Cutaneous Squamous Cell Carcinoma in Immunosuppressed Patients Using the American Joint Committee on Cancer Eighth Edition and Brigham and Women's Hospital Staging Systems
Authors: Blechman Adam B. , Carucci John A. , Stevenson Mary L. 
Published: January 2019

BACKGROUND
Staging systems for cutaneous squamous cell carcinoma (CSCC) include Brigham and Women's Hospital (BWH) and American Joint Committee on Cancer staging system, eighth edition (AJCC-8).

OBJECTIVE
To evaluate and compare AJCC-8 and BWH staging systems for CSCC in immunosuppressed patients.

MATERIALS AND METHODS
A retrospective cohort study of immunosuppressed patients diagnosed with primary CSCC from 2012 to 2016. The main end point was any poor outcome (PO), which included local recurrence, nodal metastasis, and disease-specific death.

RESULTS
Fifty-eight immunosuppressed patients had 263 CSCCs. Fifty percent of tumors were AJCC-8 T1, 44.7% T2, and 4.8% T3. Fifty percent of tumors were BWH T1, 48.5% T2a, 1.3% T2b, and 0.4% T3. Risk of PO for AJCC-8 was 1.7%, 8.8%, and 36.4% for T1, T2, and T3, respectively (p < .01). Risk of PO for BWH was 1.8%, 9.9%, 33.3%, and 100.0% for T1, T2a, T2b, and T3, respectively (p < .01). Thirty-six percent of AJCC-8 T3/T4 tumors had POs compared with 5.1% in low T1/T2 stages (p = .002). Fifty percent of BWH T2b/T3 tumors had POs compared with 5.3% in low T1/T2a stages (p = .01).

CONCLUSION
AJCC-8 and BWH staging systems stratify CSCC with similar distinctiveness, homogeneity, and monotonicity for immunosuppressed patients.