bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fibrodysplasia Ossificans Progressiva – FOP
Authors: Morhart R. , Semler O. , Seefried L. 
Published: January 2019

ZusammenfassungBei der Fibrodysplasia ossificans progressiva (FOP) besteht aufgrund einer aktivierenden Mutation im Gen für den Activin A Rezeptor Typ 1 (ACVR1 / ALK2), eine Prädisposition zu heterotoper Knochenbildung in Weichgeweben, insbesondere der Muskulatur. Die Prävalenz der Erkrankung wird in einer Größenordnung von 1 pro 1–2 Mio. angegeben. Klinisch kommt es intrauterin zu Fehlbildungen, z. B. zu einem bds. Hallux valgus, der bei der überwiegenden Mehrheit der Patienten bereits bei Geburt besteht. Postnatal kommt es meist in den ersten Lebensjahren beginnend im Schulter-/ Nackenbereich episodenartig bereits nach kleineren Verletzungen zu schmerzhaften Weichteilreaktionen, sogenannten flareups die nachfolgend im Sinne einer enchondralen Ossifikation verknöchern. Die Akkumulation dieser irreversiblen Verknöcherungen im Weichgewebe bedingt eine zunehmende Einschränkung der Beweglichkeit bis hin zur kompletten Einsteifung des Körpers. Letztlich kommt es durch die fortschreitende Rigidität des Thorax zu einer respiratorischen Insuffizienz und kardialer Dekompensation.Therapeutisch steht im Vordergrund die Vermeidung von Traumata als Auslöser für die Entstehung extraossären Knochengewebes, insbesondere auch der Verzicht auf unnötige iatrogene Schädigungen durch Operationen, Biopsien und intramuskuläre Injektionen. Supportiv sind eine adäquate Hilfsmittelversorgung, psychologische Unterstützung und eine analgetische Versorgung erforderlich. Im Falle eines Traumas werden kurzfristig hochdosiert Glucocorticoide empfohlen, um das Risiko und Ausmaß der flare-ups und nachfolgender Verknöcherungen zu reduzieren. Ergänzend können NSAR hilfreich sein. Derzeit werden unterschiedliche neue Therapieansätze entwickelt. Am weitesten fortgeschritten ist dabei der Retinolsäure Rezeptor Gamma (RARg) Agonist Palovarotene, der durch Interferenz mit der ALK2 vermittelten Signalkaskade einen zentralen Punkt im Pathomechanismus der Erkrankung adressiert.
Meniscus Injuries in the Military Athlete
Authors: Zhou Liang , Haley Chad , Donohue Michael 
Published: January 2019

AbstractMeniscal injuries in the young, active patient are often challenging injuries for the orthopaedic surgeon whose goal is to provide pain-free return to play/military duty and preserve maximal meniscal integrity. In the U.S. military, the incidence rate of meniscal tears is almost 10 times higher than that of the civilian population; although, the rates of reoperation following meniscal repair are fairly similar. The decision to pursue meniscal debridement versus repair is multifactorial depending on tear characteristics, concomitant injury, patient characteristics, and goals. Meniscal allograft transplantation remains reserved as a salvage procedure but with limited goals for potential to return to complete unrestricted military duties. The purpose of this article is to review treatment principles for the military athlete with meniscal pathology.
Perioperative Endocarditis Management in a Patient with Homozygous Sickle Cell Disease
Authors: Gozdzik Malgorzata , Mariotti Sergio , Genoni Michele , Zientara Alicja 
Published: January 2019

Background Homozygous sickle cell disease (SCD) compounded with bacterial endocarditis makes open-heart surgery a multidisciplinary challenge.
Case description A 45-year-old African male patient with homozygous SCD presented with right heart decompensation, tricuspid regurgitation, and endocarditis of the aortic valve. Blood coulters were positive for coagulase-negative staphylococci. An emergent double valve replacement was successfully performed involving a multidisciplinary team.
Conclusion Homozygous SCD is associated with an increased risk of preoperative vaso-occlusive complications. Surgery with cardiopulmonary bypass can be performed, if hypothermia, hypoxia, acidosis, or low-flows are being avoided. Due to the lack of data, the adequate approach is still intuitive and requires standardization.
Ruptured Deep Femoral Artery Aneurysm Confused with an Incarcerated Inguinal Hernia: a Case of an Elderly Patient
Authors: Hamasaki Takafumi , Ota Rikako , Matsuoka Yuki , Kodama Wataru , Fukino Syunsuke , Nishimura Kengo 
Published: January 2019

Deep femoral artery (DFA) aneurysms are rare. DFA is protected by the adductor canal, which may delay the diagnosis. Then, its early diagnosis may be difficult and it is possible to be misdiagnosis with incarcerated inguinal hernia, which occurs more often in elderly people. We report a very rare case of a treatment of an advanced elderly patient with an isolated ruptured DFA aneurysm that was preoperatively confused with an incarcerated inguinal hernia.A 97-year-old man was admitted to a neighboring hospital due to a painful mass of the right groin after transient consciousness loss and the patient was diagnosed with right incarcerated inguinal hernia by a nonenhanced computed tomography (CT). Although he was observed for 3 days, he suddenly lost consciousness again with a decrease in blood pressure. Thus, he was referred to our hospital due to the painful pulsatile inguinal mass after resuscitation from shock. As we diagnosed a ruptured DFA aneurysm by an enhanced CT, we emergently performed an excision of the aneurysm with revascularization of the right DFA. The postoperative course was uneventful without ischemic change of the lower leg.
Technology Access, Technical Assistance, and Disparities in Inpatient Portal Use
Authors: Grossman Lisa , Masterson Creber Ruth , Ancker Jessica , Ryan Beatriz , Polubriaginof Fernanda , Qian Min , Alarcon Irma , Restaino Susan , Bakken Suzanne , Hripcsak George , Vawdrey David 
Published: January 2019

Background Disadvantaged populations, including minorities and the elderly, use patient portals less often than relatively more advantaged populations. Limited access to and experience with technology contribute to these disparities. Free access to devices, the Internet, and technical assistance may eliminate disparities in portal use.
Objective To examine predictors of frequent versus infrequent portal use among hospitalized patients who received free access to an iPad, the Internet, and technical assistance.
Materials and Methods This subgroup analysis includes 146 intervention-arm participants from a pragmatic randomized controlled trial of an inpatient portal. The participants received free access to an iPad and inpatient portal while hospitalized on medical and surgical cardiac units, together with hands-on help using them. We used logistic regression to identify characteristics predictive of frequent use.
Results More technology experience (adjusted odds ratio [OR] = 5.39, p = 0.049), less severe illness (adjusted OR = 2.07, p = 0.077), and private insurance (adjusted OR = 2.25, p = 0.043) predicted frequent use, with a predictive performance (area under the curve) of 65.6%. No significant differences in age, gender, race, ethnicity, level of education, employment status, or patient activation existed between the frequent and infrequent users in bivariate analyses. Significantly more frequent users noticed medical errors during their hospital stay.
Discussion and Conclusion Portal use was not associated with several sociodemographic characteristics previously found to limit use in the inpatient setting. However, limited technology experience and high illness severity were still barriers to frequent use. Future work should explore additional strategies, such as enrolling health care proxies and improving usability, to reduce potential disparities in portal use.
The New York State Safe Motherhood Initiative: Early Impact of Obstetric Hemorrhage Bundle Implementation
Authors: Goffman Dena , Ananth Cande V. , Fleischer Adiel , D'Alton Mary , Lavery Jessica A. , Smiley Richard , Zielinski Kristin , Chazotte Cynthia ,   for the Safe Motherhood Initiative Obstetric Hemorrhage Work Group
Published: January 2019

Objective To determine the effects of the Safe Motherhood Initiative's (SMI) obstetric hemorrhage bundle in New York State (NYS).
Study Design In 2013, the SMI convened interprofessional workgroups on hemorrhage, venous thromboembolism, and hypertension tasked with developing evidence-based care bundles. Participating hospitals submitted data measured before, during, and after implementation of the hemorrhage bundle: maternal mortality, intensive care unit (ICU) admission, cardiovascular collapse, hysterectomy, and transfusion of ≥4 units of red blood cells (RBCs). Data were analyzed for trends stratified by implementation status.
Results Of the 123 maternity hospitals in NYS, 117 participated, of which 113 submitted data. Of 250,719 births, transfusion of ≥4 units RBCs (1.8 per 1,000) and ICU admissions (1.1 per 1,000) were the most common morbidities. Four hemorrhage-related maternal deaths (1.6 per 100,000) and 10 cases of cardiovascular collapse requiring cardiopulmonary resuscitation (4.0 per 100,000) occurred. Hemorrhage morbidity did not change over the five quarters studied. Risks were similar across hospital level of care and implementation status.
Conclusion Statewide implementation of bundles is feasible with resources critical to success. The low hemorrhage-related maternal death rate makes changes in mortality risk difficult to detect over short time intervals. Long-term and timely data collection with individual expert case review will be required.
Esophageal Blood Flow May Not Be Directly Influenced by Anastomotic Tension: An Exploratory Laser Doppler Study in Swine
Authors: Oetzmann von Sochaczewski Christina , Heimann Axel , Linder Andreas , Kempski Oliver , Muensterer Oliver J. 
Published: January 2019

Background Anastomotic tension has been linked to leakage and stenosis in esophageal surgery in both adults and children. We aimed to determine the effects of esophageal topography, operative technique, and anastomotic tension on esophageal blood flow.
Materials and Methods We divided and reanastomosed the esophagi at the carinal level with increasing levels of anastomotic tension in piglets (n = 10) and sham controls (n = 4). We examined esophageal blood flow pre- and postoperatively using laser Doppler flowmetry at the anastomosis and two predetermined proximal and distal points. Blood flow in relation to distance from the anastomosis was examined by multivariate linear regression.
Results Thoracotomy alone did not influence perfusion at the carinal level in shams (Δ = 3.13 laser Doppler units, 95% confidence interval: −3.4 to 9.7, p = 0.2686). We constructed a (F[5,134] = 6.34, p < 0.0001) multinomial regression model based on distance to the anastomotic site and pre-/postoperative measurements (adjusted R
2 = 0.1624). Tissue blood flow was higher distant to the carina, but lower postoperatively and not influenced by the tension resulting from the extent of resection (F[1, 8] = 1.134, p = 0.318).
Conclusion Esophageal blood flow is higher at greater distances to the carinal level and hampered by esophageal division and reanastomosis. The extent of resection has less influence than previously assumed. Therefore, leakage and stenosis after esophageal anastomosis may not solely be caused by insufficient anastomotic blood flow.
Characteristics and Outcomes in Patients with Venous Thromboembolism Taking Concomitant Anti-Platelet Agents and Anticoagulants in the AMPLIFY Trial
Authors: Cohen Alexander , Agnelli Giancarlo , Buller Harry , Gallus Alexander , Raskob Gary , Sanders Paul , Thompson John , Weitz Jeffrey 
Published: January 2019

AbstractThe double-blind, randomized, AMPLIFY trial compared 6 months' treatment with apixaban (10 mg twice daily for 7 days and 5 mg twice daily thereafter) versus conventional treatment (subcutaneous enoxaparin [1 mg/kg twice daily for ≥ 5 days] overlapped and followed by warfarin [international normalized ratio = 2.0–3.0]) in patients with acute venous thromboembolism (VTE). This post hoc analysis of AMPLIFY compared outcomes among those taking or not taking concomitant anti-platelet therapy. The primary efficacy outcome was recurrent VTE or VTE-related death; the principal safety outcome was major bleeding. Of 5,365 (apixaban, n = 2,676; enoxaparin/warfarin, n = 2,689) randomized patients, 813 (apixaban, n = 402 [15%]; enoxaparin/warfarin, n = 411 [15%]) took concomitant anti-platelet therapy, of which 92% consisted of low-dose aspirin. Rates of VTE or VTE-related death were similar whether or not anti-platelet agents were taken (apixaban: 3.6 and 2.0%; enoxaparin/warfarin: 3.0 and 2.6%; anti-platelet use: relative risk [RR], 1.23; 95% confidence interval [CI], 0.58–2.62; no anti-platelet use: RR, 0.77; 95% CI, 0.52–1.13); interaction p-value = 0.299. Major bleeding rates were threefold higher in those taking versus those not taking anti-platelet agents (apixaban: 1.2 and 0.4%; enoxaparin/warfarin: 4.1 and 1.4%; anti-platelet use: RR, 0.30; 95% CI, 0.11–0.81; no anti-platelet use: RR, 0.31; 95% CI, 0.15–0.63); interaction p-value = 0.924. Concomitant anti-platelet therapy produced a proportionally similar increase in major bleeding in patients randomized to apixaban or conventional therapy, but there were fewer major bleeds with apixaban. Therefore, the overall safety of apixaban over conventional therapy was maintained in patients receiving anti-platelet therapy. Clinicaltrials.gov: NCT00643201.
Novel Murine Model of Immune Thrombocytopaenia through Immunized CD41 Knockout Mice
Authors: Li Xin , Wang Shu-wen , Feng Qi , Hou Yu , Lu Nan , Ma Chun-hong , Gao Cheng-jiang , Hou Ming , Peng Jun 
Published: January 2019

AbstractImmune thrombocytopaenia (ITP) is the most common autoimmune bleeding disorder, where platelets are destroyed by auto-antibodies and/or cell-mediated mechanisms. To understand the pathogenesis of ITP and explore novel therapeutics, three types of animal models have been used: passive ITP, secondary ITP and platelet-induced ITP. However, the first two are not ideal for chronic ITP pathophysiology where both T cell and B cell play important roles in platelet destruction. The most efficient model to mimic chronic ITP is developed by Chow et al through transferring splenocytes from platelet-immune CD61-knockout (KO) mice into mice with severe combined immunodeficiency (SCID). However, placental defects are evident in 25% of CD61-KO females and post-natal haemorrhage does occur, reducing the survival rate of embryos and pups. Compared with CD61-KO mice, CD41-KO ones do not present such problems. In our study, we employ CD41-KO mice as another source of immunized spleen cells. We evaluated our model with existing standards. Transferred SCID mice presented typical features of ITP, such as reduced platelet counts in the peripheral blood, increased anti-platelet antibody levels in the serum and reduced mature megakaryocytes in the bone marrow. What is more, lymphocyte-depletion experiments showed the role of CD8+ T cells in mature megakaryocyte decrease and thrombocytopaenia. And we confirmed the antibody-mediated platelet destruction by phagocytosis in the spleen. Our study develops another efficient murine ITP model through immunized CD41-KO mice.
Bleeding After Free Flap-Based Breast Reconstruction: A NSQIP Analysis
Authors: Orr Jonah Parker , Shammas Ronnie Labib , Thomas Analise B. , Truong Tracy , Cho Eugenia H. , Kuchibhatla Maragatha , Hollenbeck Scott Thomas 
Published: January 2019

Background Despite limited oncologic benefit for women without an increased risk for breast cancer, the rates of contralateral prophylactic mastectomy (CPM) have increased. Patients undergoing CPM are more likely to undergo bilateral and immediate breast reconstruction. This study assessed the relationship between the timing and laterality of free flap-based breast reconstruction and the risk of postoperative bleeding complications.
Methods Women undergoing postmastectomy free-flap based breast reconstruction from 2010 to 2015 were identified using the National Surgical Quality Improvement Program (NSQIP) dataset. Patients were categorized according to reconstructive laterality and timing. Modified Poisson regression was used to assess the risk of postoperative bleeding and complications across reconstructive procedures.
Results Of the 4,133 patients undergoing free flap-based breast reconstruction, 12% (n = 494) experienced postoperative bleeding complications. Bilateral immediate reconstruction was associated with the highest incidence of bleeding (16.6%, n = 188), followed by bilateral delayed (12.8%, n = 58), unilateral immediate (10%, n = 142), and unilateral delayed reconstruction (9.4%, n = 106). Among patients undergoing immediate reconstruction, bilateral, rather than unilateral, reconstruction was associated with a significantly elevated risk of bleeding complications (RR [rate ratio]  = 1.58; 95% CI [confidence interval] =1.19, 2.10; p = 0.0002). Furthermore, immediate bilateral reconstruction was associated with a significantly higher rate of return to the operating room (RR =1.39; 95% CI =1.06, 1.82; adjusted p = 0.009) when compared with a unilateral procedure.
Conclusion Patients undergoing immediate bilateral free flap-based breast reconstruction may be at an increased risk for experiencing acute postoperative bleeding complications and a return to the operating room. Patients undergoing CPM and considering immediate reconstruction should be counseled regarding the increased morbidity of a bilateral reconstructive procedure.
Inklusion chronisch kranker Kinder und Jugendlicher in den Schulsport
Authors: Merker J. , Henner N. , Hartmann M. 
Published: January 2019

ZusammenfassungChronische Erkrankungen verursachen im Kindesalter bisweilen erhebliche Auswirkungen auf die Funktionalität und körperliche Aktivität. Die Inklusion in den Schulsport ist von hoher Bedeutung und in den meisten Fällen möglich. Ein vollständiges Sportverbot sollte daher die Ausnahme bleiben. Wichtig sind vielmehr die Beratung des Patienten und der Eltern durch den Arzt hinsichtlich der sportlichen Aktivität trotz chronischer Erkrankung sowie die Empfehlung für den Sportlehrer in Form einer Sportbescheinigung mit einer möglichst genauen Beschreibung der Einschränkungen und der Fähigkeiten. Wenn möglich, sollten dabei zu vermeidende und zu fördernde sportliche Funktionen beschrieben werden. Hierbei muss der Datenschutz Berücksichtigung finden. Eine Zusammenarbeit von Sportlehrer, Patient, Eltern und Arzt ermöglicht die optimale Abstimmung auf die individuellen Voraussetzungen des Patienten. Der Sportlehrer kann dazu auf pädagogische und didaktische Modelle, wie beispielsweise das Zusammenspiel von Informationsanforderungen und Druckbedingungen für koordinative Anforderungen, zurückgreifen. Grundsätzlich sind alternative Notengebungen möglich und sollten genutzt werden. Unter Berücksichtigung dieser Punkte kann die Inklusion des chronisch kranken Schülers in den Sportunterricht erfolgreich gelingen.
Sport und chronische Entzündung
Authors: Milatz F. , Wolfarth B. 
Published: January 2019

ZusammenfassungGesellschaftliche Veränderungen und eine zunehmend medienorientierte Welt haben sich in den letzten Dekaden negativ auf das Bewegungsverhalten Heranwachsender ausgewirkt. Die Folgen eines unterdrückten „natürlichen Bewegungsdrangs” äußern sich in einer Verschlechterung der motorischen Leistungsfähigkeit, einer Zunahme von Haltungsschäden sowie psychomotorischen Störungen. Kinder mit chronischen Erkrankungen haben dasselbe Bedürfnis wie gesunde Kinder, körperlich aktiv zu sein. Eine ungerechtfertigte Einschränkung von Bewegung, Spiel und Sport ist bei chronisch kranken Heranwachsenden kontraindiziert. Die Möglichkeit, diese ausüben zu können, dient auch als Gradmesser für ihre Lebensqualität und Gesundheit. Im Rahmen kindlich rheumatischer Erkrankungen, wie der juvenilen idiopathischen Arthritis (JIA), gilt ein bewegungsreicher Alltag als feste therapeutische Säule. Der aktuelle wissenschaftliche Datenbestand unterstreicht die Bedeutung regelmäßiger Sportaktivität zur Verbesserung der gesundheitsbezogenen Lebensqualität sowie Reduktion der Krankheitslast.
Endokrinologische Korrelate der Borderline-Persönlichkeitsstörung
Authors: Kröner J. , Schaitz C. , Maier A. , Connemann B. , Sosic-Vasic Z. 
Published: January 2019

ZusammenfassungDie Borderline-Persönlichkeitsstörung (BPS) ist eine schwerwiegende und im psychiatrischen sowie psychotherapeutischen Kontext die am häufigsten vorkommende Persönlichkeitsstörung. Sie zeichnet sich durch ein Muster von Instabilität im zwischenmenschlichen Kontakt und im Selbstbild sowie eine gesteigerte Impulsivität aus. Annahmen besagen, dass Personen mit einer BPS sehr stark auf emotionale Stimuli reagieren und Schwierigkeiten haben, ihre physiologischen Reaktionen zu kontrollieren. Die Übersichtsarbeit durchleutete die Datenbank PubMed systematisch auf Artikel zum Thema „Kortisol“ oder „Hpa“ und „psychosozialer Stress“ oder „interpersoneller Stress“ und „Borderline“. Hierbei konnten von 135 Artikeln 8 identifiziert werden, die den Suchkriterien entsprachen. Nach Evaluation der Studien können die Hypothesen bezüglich interpersoneller Stressoren teilweise bestätigt werden. Hierbei erlebten Personen mit BPS im Vergleich zu gesunden Kontrollprobanden eine erhöhte physiologische Stressreaktion, gemessen am Kortisol im Speichel, auf einen interpersonellen Konflikt. In Studien zu sozial-evaluativen Stressoren reagierten BPS-Probanden jedoch im Gegensatz zu diesen Ergebnissen auf Stress mit einer Hyporeagibilität des physiologischen und endokrinologischen Stresssystems. In Bezug auf ein Fazit bleiben die Befunde uneindeutig, was den geringen Stichprobengrößen, teilweise fehlenden Mediatorsowie Moderatorvariablen, unterschiedlichen Einschlusskriterien und Messzeitpunkten, aber auch der einseitigen Geschlechterverteilung geschuldet sein könnte.
Psychiatrische Türöffnung
Authors: Mühleck M. , Meyer D. , Elmiger A. , Leyhe T. , Reiter-Theil S. 
Published: January 2019

ZusammenfassungZur Unterstützung der Türöffnung einer ehemals geschlossenen psychiatrischen Station wurde begleitend eine Serie von Ethikkonsultationen durchgeführt. Aus der Ethikserie wurden Ansätze zur Verbesserung und Vereinfachung der Prozesse auch für andere Institutionen mit bevorstehender Türöffnung herausgearbeitet. Ziel ist, dem Auftreten ethischer Probleme während und nach einem Türöffnungsprozess vorzubeugen.
Neutrophil isolation from feline blood using discontinuous Percoll dilutions
Authors: Cakmak Ayse , Yildiz Kader , Sursal Neslihan 
Published: January 2019

Summary
Objective: Some studies have performed in vitro neutrophil isolation from feline blood. The major limiting factor for these studies is the small volume of blood that can be collected without development of potentially life-threatening complications. In the present study we attempted neutrophil isolation from feline venous blood samples using discontinuous Percoll gradients. Material and methods: Blood was collected from the cephalic vein of clinically healthy adult cats. The blood samples were layered on Percoll dilutions (72 %, 63 %, 54 % and 45 %). After centrifugation, the feline polymorphonuclear leukocytes (PMN) accumulated as a band between 72–63 % Percoll dilutions. The total cell count was calculated using light microscopy counts. The percentage of the neutrophils was determined microscopically after staining with Diff-Quik stain. Neutrophil viability was evaluated with a 0.01 % Trypan blue assay. The activation was determined based on intact cell morphology in the isolated neutrophils. Results: The mean PMN number was 22 x 105 per ml (minimum – maximum: 20–26 x 105/ml). Neutrophil homogeneity was > 95 % in the cell suspensions. The viability of isolated neutrophils was > 98 %. The technique did not result in neutrophil activation. Conclusion and clinical relevance: Discontinuous Percoll gradients (72 %, 63 %, 54 % and 45 %) can be used to isolate neutrophils from blood samples of cats. The technique was simple to perform and neutrophil activation was minimal.