bluuebunny/crossref_metadata_2025_split huggingface dataset:
The lack of conditioned place preference, but unaltered stimulatory and ataxic effects of alcohol in mGluR3-KO mice
Authors: Lainiola Mira , Hietala Lana , Linden Anni-Maija , Aitta-aho Teemu 
Published: May 2019

Background: Alcohol use associates with environmental cues that can later reinstate drinking patterns without any alcohol exposure. Alcohol-induced reward, when combined with contextual signals of various sensory modalities in the central synapses of mesolimbic reward circuitries, can lead to the formation of conditioned responses. Aims: As the activation of glutamatergic synapses is pivotal in such processes, we aimed to investigate whether the metabotropic glutamate receptor subtype 3 plays a role in alcohol-induced behaviours including place preference. Methods: The metabotropic glutamate receptor subtype 3 knockout (mGluR3-KO) mouse line was used to study alcohol-induced place preference, locomotor activating and ataxic effects, limited access alcohol drinking, and preference for sucrose and saccharin. Results: Alcohol-induced horizontal locomotor stimulation and reduced rearing behaviour remained unchanged in the mGluR3-KO mice. However, alcohol-induced place conditioning in an unbiased paradigm setup was lacking in the mGluR3-KO mice, but clearly present in wildtype mice. Locomotor activity was not different between the mGluR3-KO and wildtype mice during the acquisition and expression trials. Alcohol consumption, studied through the ‘drinking in the dark’ model, remained unchanged in the mGluR3-KO mice, although low consumption in both wildtype and knockout mice hampers interpretation. The mGluR3-KO mice also showed normal sucrose and saccharin preference. Conclusions: These studies indicate a role for metabotropic glutamate receptor subtype 3 in the conditioned contextual alcohol responses, but not in stimulatory, and ataxic alcohol effects.
Development, technical validation, and clinical application of a multigene panel for hereditary gastrointestinal cancer and polyposis
Authors: Ricci Maria Teresa , Volorio Sara , Signoroni Stefano , Mariani Paolo , Mariette Frederique , Sardella Domenico , Pensotti Valeria , Vitellaro Marco 
Published: May 2019

Introduction: Recent advances in technology and research are rapidly changing the diagnostic approach to hereditary gastrointestinal cancer (HGIC) syndromes. Although the practice of clinical genetics is currently transitioning from targeted criteria-based testing to multigene panels, important challenges remain to be addressed. The aim of this study was to develop and technically validate the performance of a multigene panel for HGIC. Methods: CGT-colon-G14 is an amplicon-based panel designed to detect single nucleotide variants and small insertions/deletions in 14 well-established or presumed high-penetrance genes involved in HGIC. The assay parameters tested were sensitivity, specificity, accuracy, and inter-run and intra-run reproducibility. Performance and clinical impact were determined using 48 samples of patients with suspected HGIC/polyposis previously tested with the targeted approach. Results: The CGT-colon-G14 panel showed 99.99% accuracy and 100% inter- and intra-run reproducibility. Moreover, panel testing detected 1 actionable pathogenic variant and 16 variants with uncertain clinical impact that were missed by the conventional approach because they were located in genes not previously analyzed. Conclusion: Introduction of the CGT-colon-G14 panel into the clinic could provide a higher diagnostic yield than a step-wise approach; however, results may not always be straightforward without the implementation of new genetic counseling models.
Outcomes in different ethnic groups of New Zealand patients with screen-detected vs. non-screen-detected breast cancer
Authors: Lawrenson Ross , Lao Chunhuan , Jacobson Gregory , Seneviratne Sanjeewa , Scott Nina , Sarfati Diana , Elwood Mark , Campbell Ian 
Published: May 2019

Objective To compare characteristics and survival of New Zealand European, Māori, and Pacific women with screen-detected vs. non-screen-detected breast cancer. Methods Women aged 45–69 diagnosed with invasive breast cancer between January 2005 and May 2013 were identified from the Waikato and Auckland Breast Cancer Registries. Patient demographics and tumour characteristics were described by detection mode and ethnicity. Kaplan–Meier method was used to estimate the five-year breast cancer-specific survival of women with stage I–III breast cancer by ethnicity and detection mode. Results Women with screen-detected cancers were older, had smaller tumours, fewer stage IV (0.8% vs. 7.6%), fewer high grade (16.8% vs. 39.0%), and fewer lymph node positive diseases (26.3% vs. 51.5%) than women with non-screen-detected cancers. There were more Luminal A (70.0% vs. 54.0%), fewer human epidermal growth factor receptor 2 positive non-Luminal (4.4% vs. 8.8%), and fewer triple negative cases (7.0% vs. 13.8%) in screen-detected than non-screen-detected cancers. If not screen detected, 22.7% of breast cancers in Pacific women were stage IV compared with 2.4% if screen detected. If not screen detected, the five-year breast cancer-specific survival was 91.1% for New Zealand European women, 84.2% for Māori women, and 80.2% for Pacific women (p-value <0.001). For screen-detected breast cancer, survival between different ethnic groups was similar. Conclusions Breast cancers detected through screening are diagnosed at an earlier stage and have a greater proportion of subtypes, with better outcome. Variations in survival for Māori and Pacific women are only found in women with non-screen-detected breast cancer.
The effects of cardiac arrest recognition by dispatcher on Smart Advanced Life Support
Authors: Lee Choung Ah , Kim Gi Woon , Kim Yu Jin , Moon Hyung Jun , Park Yong Jin , Lee Kyoung Mi , Woo Jae Hyug , Jeong Won Jung , Choi Il Kug , Choi Han Joo , Choi Hyuk Joong 
Published: May 2019

Objectives: The purpose of this study was to analyze the effect of cardiac arrest recognition by emergency medical dispatch on the pre-hospital advanced cardiac life support and to investigate the outcome of out-of-hospital cardiac arrest. Method: This study was conducted to evaluate the out-of-hospital cardiac arrest patients over 18 years of age, excluding trauma and poisoning patients, from 1 August 2015 to 31 July 2016. We investigated whether it was a cardiac-arrest recognition at dispatch. We compared the pre-hospital return of spontaneous circulation, the rate of survival admission and discharge, good neurological outcome, and also analyzed the time of securing vein, time of first epinephrine administration, and arrival time of paramedics. Results: A total of 3695 out-of-hospital cardiac arrest patients occurred during the study period, and 1468 patients were included in the study. Resuscitation rate by caller was significantly higher in the recognition group. The arrival interval between the first and second emergency service unit was shorter as 5.1 min on average, and the connection rate of paramedics and physicians before the arrival was 32.3%, which was significantly higher than that of the unrecognized group. The mean time required to first epinephrine administration was 13.1 min, which was significantly faster in the recognition group. However, there was no statistically significant difference between the two groups in patients with good neurological outcome, and rather the rate of return of spontaneous circulation and survival discharge was significantly higher in the non-recognition group. Conclusion: Although the recognition of cardiac arrest at dispatch does not directly affect survival rate and good neurological outcome, the activation of pre-hospital advanced cardiac life support and the shortening the time of epinephrine administration can increase pre-hospital return of spontaneous circulation. Therefore, effort to increase recognition by dispatcher is needed.
Clinical Outcomes and Complications of Peroneal Tendon Sheath Ultrasound-Guided Corticosteroid Injection
Authors: Fram Brianna R. , Rogero Ryan , Fuchs Daniel , Shakked Rachel J. , Raikin Steven M. , Pedowitz David I. 
Published: May 2019

Background: The treatment of symptomatic peroneal tendinopathy and tears traditionally begins with nonsteroidal anti-inflammatory drugs, activity modification, physical therapy, and immobilization, with surgery typically reserved for those failing nonoperative treatment. Ultrasound-(US)-guided peroneal tendon sheath (PTS) corticosteroid injection is an additional nonoperative modality, but limited data exist on its safety and efficacy. The purpose of this study was to assess clinical outcomes following US-guided PTS corticosteroid injection for chronic tendinopathy or tears. Methods: We retrospectively identified patients who had undergone US-guided PTS corticosteroid injection for pain due to peroneal tendinopathy, tears, or subluxation at our institution from 2012 to 2018. Underlying diagnosis was based on clinical examination, magnetic resonance imaging (MRI) results, and/or intraoperative findings, when available. Medical record data were supplemented by e-mail or telephone follow-up. Collected information included patient age, sex, body mass index (BMI), smoking status, workers’ compensation status, prior surgeries about the foot and ankle, duration of symptoms prior to injection, perceived improvement in pain following injection and its duration, number of injections, progression to surgery, and any adverse outcomes of injection. We identified 96 patients (109 injections). Thirty-seven (38.5%) had previous foot and ankle surgery, with 17 (17.7%) having surgery specifically on the peroneal tendons. Results: Twenty-four of 96 (25%) progressed to have surgery on their peroneal tendons following injection. Following injection, 38/87 (43.7%) of patients reported 0-1 weeks of pain relief, 11/87 (12.6%) 2-6 weeks, 6/87 (6.9%) 7-12 weeks, and 32/87 (36.8%) greater than 12 weeks. Preinjection duration of symptoms was associated with postinjection duration of pain relief ( P=.036). There were 2 reported complications (1.8%): 1 case of self-limited sural nerve irritation and 1 of peroneus longus tear progression. Conclusion: Our study demonstrates US-guided PTS corticosteroid injection was safe and relatively effective in patients with symptomatic peroneal tendon tears or tendinopathy, including those who had undergone prior surgery, and may be considered in a comprehensive protocol of nonoperative management. Level of Evidence: Level IV, case series.
Oxidative stress and endothelial dysfunction are associated with reduced cognition in type 2 diabetes
Authors: Groeneveld Onno N , van den Berg Esther , Johansen Odd Erik , Schnaidt Sven , Hermansson Karin , Zinman Bernard , Espeland Mark A , Biessels Geert Jan 
Published: May 2019

Objective: Type 2 diabetes is associated with cognitive dysfunction, but the mechanisms are unknown. We assessed the relationships of biomarkers of oxidation, endothelial function and inflammation with cognition in participants of the CAROLINA® trial (CARdiovascular Outcome Trial of LINAgliptin Versus Glimepiride in Type 2 Diabetes). Methods: Baseline circulating biomarkers of oxidation (8-iso-prostaglandin F2α), endothelial function (asymmetric dimethylarginine, endothelin-1) and inflammation (C-reactive protein, interleukin-6, tumour necrosis factor-α), based on linear regression, were related to cognition on five domains, as measured with an automated battery. Results: In 37 patients (mean age 66.7 ± 8.7 years, median HbA1c 6.9%/52 mmol/mol), 8-iso-prostaglandin F2α was associated with reduced mental flexibility and attention (standardised regression coefficients −0.47, −0.34), whereas asymmetric dimethylarginine was associated with reduced psychomotor speed and attention (standardised regression coefficients −0.39, −0.34). No significant associations were observed between biomarkers of inflammation and cognition. Conclusion: Elevated biomarkers of oxidation and endothelial function are associated and may play a role in reduced psychomotor speed, mental flexibility and attention in type 2 diabetes.
Evaluation of a health trainer–led service for people with knee, hip and back pain
Authors: Hurley MV , Semple A , Sibley F , Walker A 
Published: May 2019

Aims: Chronic knee, hip and back pain is extremely prevalent. Management guidelines emphasise maintaining physical activity and healthy weight to reduce pain and improve physical and mental wellbeing. Unfortunately, few people receive support to make lifestyle changes. We evaluated whether a health trainer—led ‘joint pain advice’ (JPA) service delivering person-centred lifestyle coaching was feasible, acceptable and effective for people with knee, hip and back pain. Methods: Feasibility of delivering a JPA service was assessed by documenting whether the health trainers could deliver JPA and its uptake. Nine health trainers delivered JPA. Participants were offered up to four appointments. At each appointment, health trainers gave people information about their condition, co-developed care plans, suggested self-management strategies and used behavioural change techniques (motivational interviewing, goal-setting and action planning) to increase physical activity and reduce body weight. Pain, function, physical activity and body mass index (BMI) were collected at baseline, 3 weeks, 6 weeks and 6 months. Focus groups captured people’s opinions of the service’s effectiveness, acceptability and usefulness. Results: Of the 105 people who enquired about JPA, 85 (81%) used the service, after which their physical activity and function improved, and pain, use of analgesia and BMI decreased. They felt more knowledgeable and better motivated to adopt and maintain healthier behaviours. They attributed these improvements to the JPA service, because of its better consultations and collaborative holistic approach. Only a minority attended all four appointments because they felt they received sufficient advice from the initial appointments. The health trainers gained knowledge and skills to support clients with musculoskeletal conditions. Conclusions: Using a holistic, patient-centred approach, health trainers can deliver lifestyle advice to people with chronic knee, hip or back pain safely, effectively and efficiently. The service was popular with recipients and health trainers, and helped people adopt healthier lifestyles that lead to reduced pain and other clinical improvements.
Effect of Injection Site Cooling and Warming on Insulin Glargine Pharmacokinetics and Pharmacodynamics
Authors: Bitton Gabriel , Rom Vital , Hadelsberg Uri , Raz Itamar , Cengiz Eda , Weinzimer Stuart , Tamborlane William V. 
Published: May 2019

Background: In type 1 diabetes (T1D), closed-loop systems provide excellent overnight fasting blood glucose control by adjusting the insulin infusion rate based on corresponding changes in sensor glucose levels. In patients on multiple daily insulin (MDI) injections, such control in overnight glucose levels has not been possible due to the inability to alter the absorption rate of long-acting insulin after injection. In this study, we tested the hypothesis that increases/decreases of fasting glucose levels could be achieved by cooling/warming the skin around the injection site, which would result in lower/higher Glargine absorption rates from its subcutaneous depot. Methods: Fourteen subjects with T1D (4 females; age 39.6 ± 16.7 years, HbA1c 7.8 ± 1.1%, BMI 25.4 ± 2.8 kg/m2) on MDI therapy underwent fasting pharmacokinetic and pharmacodynamic studies that started at ~8 am and lasted 240 min on 3 separate days in random order: a control day without warming or cooling of the injection site and two experimental days, one day with injection site warming and the other with cooling. Results: Cooling the skin around the glargine injection site reduced insulin concentrations by >40% ( P < .01 versus the warming study, P = .21 versus the control study), accompanied by a 55 mg/dL increase in serum glucose ( P < .01 versus the control study). Conversely, skin warming prevented the fall in serum insulin ( P = .2 versus the control study; P < .01 versus the cooling study), resulting in a 40 mg/dL reduction in serum glucose ( P < .001 versus the cooling study, P = .11 versus the control study). Conclusions: This proof of concept study has shown that cooling and warming the skin around the injection site provides a means to decrease and increase the rate of absorption and action of insulin glargine from its subcutaneous depot.
Can we reduce the number of MRSA screening site swabs in elective orthopedic patients?
Authors: Ahmad Aziz , Teoh Kar H , Lau Lilian , Cheng Natalie , Evans Aled R 
Published: May 2019

Background: Deep infection after routine elective orthopedic procedures can be catastrophic, leading to further surgery, loss of limb, disability, and risk of mortality. Ring-fencing elective orthopedic ward has been shown to significantly reduce the incidence of all postoperative infections especially with methicillin-resistant Staphylococcus aureus (MRSA). Our hospital’s current MRSA screening is a four-site MRSA swabs. Objectives: This study evaluates the possibility of reducing the number of MRSA swab sites as part of a quality improvement project. Study design and methods: Patients on the waiting list for elective orthopedic procedure in our trust who had an MRSA-positive swab from either four sites were analyzed over the time period from January 2012 to December 2014. Those without swabs from all four areas (nose, throat, axilla, and groin) were excluded. Positive swabs of different regions were recorded and compared. Results: There were 138 MRSA-positive patients, giving an incidence of 31 per 10,000 screen/year over that time period. Some patients ( n = 31, 22.5%) had a positive swab in more than one site. The positive sites were as follows: nose (69.60%, n = 96), groin (26.10%, n = 36), throat (25.30%, n = 35), and axilla (8.70%, n = 12). In our cohort, we would miss a significant proportion of positive patients if we change it to a two swab screening policy (26.8% for nose and axilla combination; 18.10% for nose and groin combination; and 15.20% for nose and throat). However, we would only miss 2.2% of cases for a nose, groin, and throat three-swab policy. There were also 11 instances, where a previously negative site become positive in the next swab. Conclusion: A three-swab combination of nasal, throat, and groin swabs improves pickup rate of MRSA significantly compared to a two-swab policy and misses only 2.2% compared to a four-swab policy. Axilla swabbing does not make a significant difference to the results. Based on this study, the policy has now been changed from a four-swab to three-swab screening in our trust. This has now been audited four times and they were all negative. This has helped to reduce cost in terms of staff time and resources. We would not recommend screening only the previous positive site for the next repeat screening swabs as there is an 8% chance of missing MRSA carrier status.
Responding to health information technology reported safety events: Insights from patient safety event reports
Authors: Adams Katharine T , Kim Tracy C , Fong Allan , Howe Jessica L , Kellogg Kathryn M , Ratwani Raj M 
Published: May 2019

Objective We analyzed the described resolutions of patient safety event reports related to health information technology to determine how healthcare systems responded to these events, recognizing that certain types of solutions such as training and education have a limited impact. Methods A large database of over 1.7 million patient safety event reports was filtered to include those identified by the reporter as being related to health information technology. The resolution text was manually reviewed and coded into one or more of four categories: No Resolution, Training/Education, Policy, Information Technology-oriented solution. Results Most events (64%) did not include a resolution. Of those that did, Training/Education was the most commonly reported single or component of a multi-pronged solution (55%), followed by Information Technology (45%). Only 59 events (6% of resolutions) described more than one method of resolution. Conclusion Health information technology-related patient safety event resolutions most often described a solution that suggested additional training or education for healthcare staff, despite the recognized limitations of training and education in resolving these events. Few events suggested multiple resolution methods. Ensuring health information technology-related events are resolved and incorporate effective solutions should be a continued focus area for healthcare systems.
Fellowship training in microvascular surgery and post-fellowship practice patterns: A cross sectional survey of microvascular surgeons from facial plastic and reconstructive surgery programs
Authors: Bennion Douglas M. , Dziegielewski Peter T. , Boyce Brian J. , Ducic Yadro , Sawhney Raja 
Published: May 2019

Background There is a lack of published literature on the training in microvascular reconstructive techniques in facial plastic and reconstructive surgery (FPRS) fellowships or of the extent these techniques are continued in practice. This cross-sectional web-based survey study was conducted to describe the volume, variety, and intended extent of practice of free tissue transfers during fellowship and the post-fellowship pattern of microsurgical practice among FPRS surgeons in various private and academic practice settings across the United States. Methods This survey was sent to recent graduates ( n = 94) of a subset of U.S. Facial Plastic and Reconstructive Surgery fellowship programs that provide significant training in microvascular surgery. Results Among survey respondents ( n = 21, 22% response rate), two-thirds completed 20–100 microvascular cases during fellowship using mainly radial forearm, fibula, anterior lateral thigh, latissimus and rectus free tissue transfers. In post-fellowship practice, those who continue practicing microvascular reconstruction (86%) complete an average of 33 cases annually. The choice of donor tissues for reconstruction mirrored their training. They are assisted primarily by residents (73%) and/or fellows (43%), while some worked with a micro-trained partner, surgical assistant, or performed solo procedures. Interestingly, among those who began in private practice (29%), only half remained with that practice, while those who joined academic practices (71%) largely remained at their initial post-fellowship location (87%). Conclusions These results provide the first formal description of the training and practice patterns of FPRS-trained microvascular surgeons. They describe a diverse fellowship training experience that often results in robust microvascular practice. The maintenance of substantial microsurgical caseloads after fellowship runs counter to the perception of high levels of burnout from free tissue transfers among microvascular surgeons. Trial Registration This study was approved as exempt by the University of Florida Institutional Review Board (#201601526).