bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient outcomes after total hip arthroplasty in extreme elderly patients older than 80 years
Authors: Austin Daniel C , Torchia Michael T , Moschetti Wayne E , Jevsevar David S , Keeney Benjamin J 
Published: April 2019

Background: While extreme elderly patients (age 80 and above) benefit from joint replacement, there is controversy about whether their physical function improves as much as younger individuals following total hip arthroplasty. Methods: We completed a retrospective cohort study comparing extreme elderly total hip arthroplasty (THA) patients to younger patients. We obtained data from a large institutional repository of 2327 consecutive THAs performed from April 2011 through July 2016 at an American academic medical centre. We performed multivariate regression analyses to determine associations between age group and clinically significant improvement in the Patient-Reported Outcome Measurement Information System (PROMIS)-10 physical component summary (PCS) score. Secondary outcomes included the magnitude of PCS change, length of stay (LOS), and facility discharge. Results: There were 187 THAs (8.0%) in patients age ⩾ 80 years compared to 2140 THA procedures in patients < age 80. Extreme elderly patients had similar adjusted odds of achieving clinically significant PCS improvement after THA ( p = 0.528) and there were no statistical differences in adjusted postoperative PCS score improvements between the cohorts. Extreme elderly patients were associated with a 0.68 day longer adjusted LOS ( p < 0.001) and demonstrated higher adjusted odds of facility discharge following THA (OR 8.96, p < 0.001). Conclusions: Compared to younger patients, extreme elderly individuals had similar adjusted postoperative functional outcomes following THA but utilised substantially more resources in the form of increased time in the hospital and higher rates of facility discharges.
Pulmonary Versus Extrapulmonary Tuberculosis Associated Factors: A Case-Case Study
Authors: Arnedo-Pena Alberto , Romeu-Garcia Maria Angeles , Meseguer-Ferrer Noemi , Vivas-Fornas Iraya , Vizcaino-Batllés Ana , Safont-Adsuara Lourdes , Bellido-Blasco Juan Bautista , Moreno-Muñoz Rosario 
Published: April 2019

Background: Tuberculosis (TB) incidence remains low in health departments of Castellon and La Plana-Vila-real, but TB elimination is challenging. The objective of this study was to estimate associated factors of pulmonary tuberculosis (PTB) compared with extrapulmonary tuberculosis (ETB) and investigate epidemiological characteristics of these pathologies to orient control and prevention actions. Materials and Methods: A prospective case-case study was implemented by comparing PTB and ETB incidences during 2013-2016 from notification reports, epidemiological surveillance, and microbiological results of hospitals’ laboratories Hospital General Castellon and La Plana-Vila-Real in the province of Castellon of Valencia region in Spain. In this design, cases were patients with PTB and controls were patients with ETB. Directed acyclic graph approach was used for selection of potential risk and confounding factors. Adjusted odds ratios (AORs) were estimated by logistic regression models. Results: The study included 136 patients with PTB and 57 patients with ETB, with microbiological confirmation of 93.4% and 52.6%, and the annual median of incidence rates were 7.5 and 3.1 per 100 000 inhabitants, respectively. In general, patients with PTB were younger with higher male proportion than patients with ETB. Risk factors of PTB were smoking tobacco (AOR = 3.98; 95% confidence interval [CI] = 1.66-9.56), social problems (social marginalization, homeless, residence in shelters for the poor, or stay in prison) (AOR = 3.39; 95% CI = 1.05-10.94), and contact with patients with TB (AOR = 2.51; 95% CI = 1.06-5.95). No-smoking tobacco and no-drug abuse interaction decrease PTB risk (AOR = 0.27; 95% CI = 0.12-0.64). From these results, specific measures of health promotion and prevention can be addressed. Conclusions: The estimated associated factors of PTB may be prevented, and it was demonstrated that the case-case design is useful in the study of TB.
Effects of Pubertal Status and Inflammation on the Use of Ferritin to Define Iron Deficiency in Children With Overweight or Obesity
Authors: Muzzio Maria Luz , Lozano Chiappe Ezequiel S , Kabakian Laura , Ferraro Florencia , Landó Ines , Alonso Elizabeth , Fernández Jorgelina , Peredo Soledad , Brovarone Lucrecia , Pia Santucci Maria , Meroño Tomás 
Published: April 2019

Background and aims: A worldwide increase in childhood overweight (OW) and obesity (OB) has been reported. OB is an inflammatory state which affects iron metabolism and the sensibility of the tests to detect iron deficiency (ID). Our aim was to evaluate the adequacy of current ferritin cut-offs to define ID in children with OW/OB. Methods: This cross-sectional study included 152 children (54% girls) aged (median [Q1-Q3]) 11 (8-13) years with OW/OB. Complete blood count and iron metabolism were evaluated. Low ferritin, transferrin saturation (TSat), and anemia were defined by age- and sex-specific cut-offs recommended by National Guidelines. Iron intake was assessed in a subgroup (n = 80) by a 24-hour dietary recall. Analyses were made according to pubertal development and ferritin tertiles. Results: The overall prevalence of low ferritin, TSat, and anemia was 2.6%, 23.8%, and 5.2%, respectively. Among pre-pubertal children (n = 87), the frequency of low TSat rose across ferritin tertiles ( P < .05), whereas it decreased among pubertal children (n = 65; P < .005). Cases of anemia among pre-pubertal children were found in the highest ferritin tertile, whereas 4/6 anemia cases in pubertal children were found in the lowest ferritin tertile (<39 µg/L). Pubertal children within the lowest ferritin tertile + low TSat (n = 11) showed lower hemoglobin (–9%; P < .005) and hematocrit (–8%, P < .01) than those in the same tertile + normal TSat (n = 16). The overall prevalence of children with ferritin < 39 µg/L + low TSat was 9.2%. Conclusions: Higher ferritin cut-off values are required to define ID in children with OW/OB. Such cut-off remains to be validated in larger, multi-ethnic cohorts of children with OW/OB.
Depressive symptoms in adolescents with chronic fatigue syndrome (CFS): Are rates higher than in controls and do depressive symptoms affect outcome?
Authors: Loades Maria Elizabeth , Rimes Katharine A. , Ali Sheila , Chalder Trudie 
Published: April 2019

Introduction:Previous research has indicated that co-morbid depression is common in adolescents with chronic fatigue syndrome (CFS).Objectives:We sought to compare the characteristics of depressive symptoms in adolescents with CFS to those of healthy controls (HCs) and illness controls (adolescents with asthma).Design:Case-control study nested within a prospective clinical cohort.Methods:A total of 121 adolescents with CFS who attended an initial assessment at two specialist CFS units completed the Children’s Depression Inventory (CDI). Their responses were compared to 80 HCs and 27 adolescents with asthma (illness controls). The clinical cohort of adolescents with CFS completed questionnaires at assessment, and those who were seen subsequently for treatment at the CFS unit (68%) completed the measures again at their first treatment session.Results:CFS participants scored significantly higher on all the depression subscales than participants with asthma and HCs. Depression score explained 11% of the variance in subsequent fatigue, but only 1.9% of the variance in physical functioning. Depression score also explained most (68%) of the variance in subsequent depression.Conclusion:Depressive symptoms are more prominent in adolescents with CFS than in HCs or illness controls. These symptoms also appear to remain over time during a naturalistic follow-up where no treatment was provided. This highlights the need for further research into depression in CFS, including stratifying treatment outcomes by depression status to determine what is effective at addressing these symptoms.
A randomized 500-subject open-label phase 3 clinical trial of minimally invasive surgery plus alteplase in intracerebral hemorrhage evacuation (MISTIE III)
Authors: Ziai Wendy C , McBee Nichol , Lane Karen , Lees Kennedy R , Dawson Jesse , Vespa Paul , Thompson Richard E , Mendelow A David , Kase Carlos S , Carhuapoma J Ricardo , Thompson Carol B , Mayo Steven W , Reilly Pat , Janis Scott , Anderson Craig S , Harrigan Mark R , Camarata Paul J , Caron Jean-Louis , Zuccarello Mario , Awad Issam A , Hanley Daniel F ,   On Behalf of the MISTIE III Investigators
Published: April 2019

Rationale and hypothesis Surgical removal of spontaneous intracerebral hemorrhage may reduce secondary destruction of brain tissue. However, large surgical trials of craniotomy have not demonstrated definitive improvement in clinical outcomes. Minimally invasive surgery may limit surgical tissue injury, and recent evidence supports testing these approaches in large clinical trials. Methods and design MISTIE III is an investigator-initiated multicenter, randomized, open-label phase 3 study investigating whether minimally invasive clot evacuation with thrombolysis improves functional outcomes at 365 days compared to conservative management. Patients with supratentorial intracerebral hemorrhage clot volume ≥ 30 mL, confirmed by imaging within 24 h ofknown symptom onset,and intact brainstem reflexes were screened with a stability computed tomography scan at least 6 h after diagnostic scan. Patients who met clinical and imaging criteria (no ongoing coagulopathy; no suspicion of aneurysm, arteriovenous malformation, or any other vascular anomaly; and stable hematoma size on consecutive scans) were randomized to either minimally invasive surgery plus thrombolysis or medical therapy. The sample size of 500 was based on findings of a phase 2 study. Study outcomes The primary outcome measure is dichotomized modified Rankin Scale 0–3 vs. 4–6 at 365 days adjusting for severity variables. Clinical secondary outcomes include dichotomized extended Glasgow Outcome Scale and all-cause mortality at 365 days; rate and extent of parenchymal blood clot removal; patient disposition at 365 days; efficacy at 180 days; type and intensity of ICU management; and quality of life measures. Safety was assessed at 30 days and throughout the study.
Clinical outcomes of chemical pleurodesis using a minocycline
Authors: Hsu Li-Han , Feng An-Chen , Soong Thomas C. , Ko Jen-Sheng , Chu Nei-Min , Lin Yung-Feng , Kao Shu-Huei 
Published: April 2019

Background: Pleurodesis is often used to prevent the re-accumulation of a malignant pleural effusion (MPE). Intrapleural urokinase (IPUK) therapy facilitates lung re-expansion for patients with loculated MPE or a trapped lung that allows subsequent pleurodesis. MPE management has been traditionally regarded as a symptomatic treatment. We tried to evaluate their impact on patient survival. Methods: There were 314 consecutive patients with symptomatic MPE that underwent minocycline pleurodesis with ( n = 109) and without ( n = 205) the antecedent IPUK therapy between September 2005 and August 2015, who were recruited for the pleurodesis outcome and survival analysis. Results: The rate of successful pleurodesis was similar between the simple pleurodesis group and the IPUK therapy group followed by the pleurodesis group (69.0% versus 70.5%; p = 0.804). The patients who succeeded pleurodesis had a longer survival rate than those who failed in either the simple pleurodesis group (median, 414 versus 100 days; p < 0.001) or the IPUK therapy followed by pleurodesis group (259 versus 102 days; p < 0.001). The survival differences remained when the lung and breast cancer patients were studied separately. Conclusion: Successful pleurodesis translated into a better survival rate that promotes performing pleurodesis on lung re-expansion. The apparent shorter survival of the patients with loculated MPE or trapped lung, and those that did not respond to the IPUK therapy, lowered the probability of the survival benefit through the simple physical barrier by the fibrin formation to prevent the tumor spreading. The successfully induced inflammatory response by minocycline is supposed to prohibit the tumor invasion and metastasis. Further studies are warranted to clarify the mechanism and provide opportunities to develop novel therapeutic strategies.
Real-World Hypoglycemia Avoidance With a Predictive Low Glucose Alert Does Not Depend on Frequent Screen Views
Authors: Puhr Sarah , Derdzinski Mark , Parker Andrew Scott , Welsh John B. , Price David A. 
Published: April 2019

Background: Frequent real-time continuous glucose monitoring (rtCGM) data viewing has been associated with reduced mean glucose and frequent scanning of an intermittently scanned continuous glucose monitoring (isCGM) system has been associated with reduced hypoglycemia for patients with diabetes. However, requiring patients to frequently interact with their glucose monitoring devices to detect actual or impending hypoglycemia is burdensome. We hypothesized that a predictive low glucose alert, which forecasts glucose ≤55 mg/dL within 20 minutes and is included in a new rtCGM system, could mitigate hypoglycemia without requiring frequent device interaction. Methods: We analyzed estimated glucose values (EGVs) from an anonymized convenience sample of 15,000 patients who used Dexcom G6 (Dexcom, Inc, San Diego, CA, USA) and its mobile app for at least 30 days with or without the “Urgent Low Soon” alert (ULS) enabled. Screen view frequency was determined as the frequency with which the trend screen was accessed on the app. Multiple screen views within any 5-minute interval were counted as one. Hypoglycemia exposure for patients in the top and bottom quartiles of screen view frequency (>8.25 and <3.30 per day, respectively) was calculated as the percentage of EGVs below various thresholds. Results: Over 93% of users enabled the ULS alert; its use was associated with significantly reduced hypoglycemia <55 and <70 mg/dL, independent of screen view frequency. Conclusion: Use of the G6 ULS alert may disencumber rtCGM users by promoting significant reductions in hypoglycemia without requiring frequent device interactions.
Arthroscopic Treatment of Patellar and Trochlear Cartilage Lesions with Matrix Encapsulated Chondrocyte Implantation versus Microfracture: Quantitative Assessment with MRI T2-Mapping and MOCART at 4-Year Follow-up
Authors: Olivos Meza Anell , Cortés González Socorro , Ferniza Garza Jairo José , Pérez Jiménez Francisco Javier , Enrique Villalobos Córdova , Ibarra Clemente 
Published: April 2019

Methods Seventeen patients aged 18 to 55 years with symptomatic full-thickness cartilage lesions on either patella or trochlea were treated with matrix autologous chondrocyte implantation (MACI) or microfracture (MF). Both procedures combined with unloading/realigning techniques. Clinical assessment and T2-mapping were evaluated at 48-months. Results Clinically results from pre-op to 48-months improved significantly in MACI and MF for Lysholm ( p = 0.001, p = 0.001), IKDC-S ( p = 0.001, p = 0.002), KOOS-P ( p = 0.000, p = 0.002), KOOS-DLA ( p = 0.002, p = 0.003), KOOS-Sports/Rec ( p = 0.000, p = 0.004), KOOS-QoL ( p = 0.000, p = 0.003), KOOS-symptoms ( p = 0.001, p = 0.020), and Kujala ( p = 0.000, p = 0.01), respectively. Tegner was significant between baseline and 48 months only for MACI ( p < 0.008) compared with MF ( p = 0.25). No significant difference was observed between groups for any score at 3, 12, 24, and 48-months ( p > 0.05). T2-mapping values improved significantly over time in MACI compared with MF at 24 months (39.35 vs. 50.44, p = 0.007) and 48 months (36.54 vs. 48.37, p = 0.005). When comparing control values to MACI at 12-m ( p = 0.714), 24-m ( p = 0.175), and 48-m ( p = 0.097), no significant difference was found. MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score comparison gave no statistical difference between groups. Conclusions Clinically both techniques improved significantly over time. However, quantitative assessment showed that only newly formed tissue with MACI technique improves significantly since 12-months and maintains stable values compared with native cartilage until 48-month follow-up. MF results were never comparable to those native values. Level of evidence II.
Lithium treatment, nephrogenic diabetes insipidus and the risk of hypernatraemia: a retrospective cohort study
Authors: Ott Michael , Forssén Björn , Werneke Ursula 
Published: April 2019

Background: Hypernatraemia is a serious condition that can potentially become life threatening. It is known that lithium is associated with polyuria and nephrogenic diabetes insipidus, risk factors for hypernatraemia. In this study, we tested the hypothesis that lithium treatment was a risk factor for hypernatraemia. Methods: We performed a retrospective cohort study in the Swedish region of Norrbotten into the effects and potential adverse effects of lithium treatment and other mood stabilizers (LiSIE). For this particular study, we included all patients who had experienced at least one episode with a sodium concentration ⩾150 mmol/L between 1997 and 2013. Medical records were reviewed regarding past or current lithium exposure, diabetes insipidus and other potential risk factors for hypernatraemia. Results: Of 2463 patients included, 185 (7.5%) had experienced 204 episodes of hypernatraemia within the 17-year review period. In patients 65 years or older, infections dominated as the cause with 51%. In patients younger than 65 years, intoxications, particularly with alcohol, dominated as the cause with 35%. In the whole sample, dehydration accounted for 12% of episodes, 25% of which in the context of suspected or confirmed nephrogenic diabetes insipidus. Of all episodes, 25% resulted in death, with infection being the most common cause of death in 62% of cases. Conclusions: In our sample, infections and harmful use of substances including alcohol were the most common causes of hypernatraemia. Both current and past use of lithium also led to episodes of hypernatraemia, when associated with nephrogenic diabetes insipidus. Clinicians should remain vigilant, have a low threshold for checking sodium concentrations and consider even risk factors for hypernatraemia beyond lithium.
Optimal treatment of HIV-associated neurocognitive disorders: myths and reality. A critical review
Authors: Bougea Anastasia , Spantideas Nikolaos , Galanis Petros , Gkekas George , Thomaides Thomas 
Published: April 2019

Background: The aim of this study was to review the clinical data on the effectiveness of the pharmacotherapy of HIV-associated neurocognitive disorders (HANDs). Methods: A literature search of PubMed was performed (from January 1996 to October 2018) using the terms: ‘HIV-associated neurocognitive disorders’, ‘HIV-associated dementia’, ‘mild neurocognitive disorder (MND)’, ‘asymptomatic neurocognitive impairment (ANI)’, ‘adjuvant therapies’, ‘antiretroviral treatment (cART)’, ‘neurotoxicity’, ‘cART intensification’, ‘fluid markers’, ‘cerebrospinal fluid’, ‘protease inhibitors’, ‘nonnucleoside reverse transcriptase inhibitor’, ‘nucleoside reverse transcriptase inhibitors’, and ‘integrase strand transfer inhibitors’. Additional references were identified from a review of literature citations. All English language clinical studies of adjunctive therapies and neuronal markers were selected in order to evaluate a closer relationship between the early involvement and the onset of cognitive decline. We identified 407 relevant studies, of which 248 were excluded based on abstract analysis. Finally, we analyzed 35 articles, organizing the results by cART, adjuvant and neuronal markers (total of 7716 participants). Results: It is important to inform clinicians about the importance of accurate phenotyping of HIV patients, incorporating an array of markers relevant to HAND pathophysiology, in order to assess the individual’s risk and potential response to future personalized antiretroviral treatment Conclusion: So far, no clinical trials of HAND therapies are effective beyond optimal suppression of HIV replication in the central nervous system. Combination of validated neuronal markers should be used to distinguish between milder HAND subtypes and improve efficiency of clinical trials, after strict control of confounders.
Healthcare professionals’ perceptions on the use of opioid analgesics for the treatment of cancer-related pain in Cyprus: A mixed-method study
Authors: Charalambous Andreas , Zorpas Marios , Cloconi Constantina , Kading Yolanda 
Published: April 2019

Objectives: Pain is considered the most common and debilitating symptom reported by patients affected by cancer, and opioids are at the front line for its effective management. However, the appropriate use of opioids can be limited by healthcare professionals’ perceptions on opioids. Therefore, the aim of this study was to explore their perceptions on the use of opioids medication. Methods: This was a study of sequential mixed-method design conducted in Cyprus. As part of the quantitative phase of the study, the Barriers to Opioid Analgesic Availability Test questionnaire was completed by 73 physicians randomly selected. In the qualitative phase, 28 healthcare professionals working in primary and secondary healthcare centers participated in two focus groups. They were asked to express their perceptions on the use of opioid analgesics for the treatment of cancer-related pain. Data were analyzed according to Colaizzis’ seven-stage phenomenological analysis. Results: The quantitative analysis showed that 69.85% of physicians acknowledge opiophobia as a main barrier to appropriate pain relief but also explicitly for cancer pain which is not adequately managed (45.19%). In terms of opioids availability, physicians stated that moderate to severe problems in opioids availability were mainly caused by their reluctance to prescribe opioids (49.3%) followed by the laws/regulations in place (41.08%). The qualitative analysis yielded the following six main themes: inadequate training of healthcare professionals in the use of opioid analgesics, inadequate patient/caregivers’ awareness of opioid analgesics, opiophobia in healthcare professionals, opiophobia of patients/caregivers, poor management of opioid analgesics by healthcare professionals and patients/caregivers, and ineffective pain relief with opioids. Conclusions: The lack of appropriate education is a significant barrier to opioids use in Cyprus. This is compounded by the attitudes and phobias of both healthcare professionals and the general public. In addition, there are barriers to opioid availability and unsatisfactory cancer pain relief.