bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender stratified adjustment of the DAS28-CRP improves inter-score agreement with the DAS28-ESR in rheumatoid arthritis
Authors: Hamann Philip D H , Shaddick Gavin , Hyrich Kimme , Green Amelia , McHugh Neil , Pauling John D ,   BSRBR-RA Contributors Group
Published: November 2018

Abstract

Objectives
To evaluate determinants of discordance between DAS28-ESR and DAS28-CRP and resulting impact on disease activity stratification in RA.

Methods
Paired DAS28-ESR and DAS28-CRP readings (n = 31 074) were obtained from the British Society for Rheumatology Biologics Register for RA. Factors influencing discordance between DAS28-ESR and DAS28-CRP were evaluated alongside the resulting effect on disease activity stratification. The impact of gender adjustment to the DAS28-CRP was evaluated.

Results
DAS28-CRP scores were ∼0.3 lower than DAS28-ESR overall, with greatest differences for women (−0.35) and patients over 50 years old (−0.34). Mean male DAS28-CRP scores were 0.15 less than corresponding DAS28-ESR scores. Discordance between DAS28-ESR and DAS28-CRP significantly impacted disease activity stratification at low disease activity and remission thresholds (32.0% and 66.6% concordance, respectively). Adjusting DAS28-CRP scores by gender significantly (P < 0.001) improved agreement with the DAS28-ESR.

Conclusion
Discordance between DAS28-ESR and DAS28-CRP is greatest for women and patients over 50 years of age, and influences disease activity stratification. The proposed gender-adjusted DAS28-CRP improves inter-score agreement with DAS28-ESR, supporting more reliable disease activity stratification in treat-to-target approaches for RA.
Combined Antihypertensive Therapies That Increase Expression of Cardioprotective Biomarkers Associated With the Renin–Angiotensin and Kallikrein–Kinin Systems
Authors: Lezama-Martinez Diego , Flores-Monroy Jazmin , Fonseca-Coronado Salvador , Hernandez-Campos Maria Elena , Valencia-Hernandez Ignacio , Martinez-Aguilar Luisa 
Published: November 2018

Abstract:
Antihypertensive pharmacological treatments focus on the use of angiotensin-converting enzyme (ACE) inhibitors, AT1 receptor antagonists, and beta-blockers as single and combined treatments. The effect of single treatments on the mRNA expression of some components of the renin–angiotensin system has been studied, but not the effect of combined treatments. This study determined the expression of the AT1, AT2, B1, and B2 receptors and of the enzymes ACE and ACE2 in hypertensive rats treated with captopril–propranolol or losartan–propranolol. Methods: The mRNA expression of the receptors and enzymes was determined by reverse transcription-quantitative polymerase chain reaction in the aorta of spontaneously hypertensive rats under different treatments. Results: Rats under combined treatments showed a decrease in the expression of AT1 and ACE, and an increase in the expression of the B1 receptor (captopril + propranolol group: 0.43 ± 0.046, 2.243 ± 0.269, 3.356 ± 0.418; Group: losartan + propranolol: 0.727 ± 0.071, 0.852 ± 0.102, 1.277 ± 0.131 compared to the spontaneously hypertensive group: 1 ± 0.212, 1 ± 0.192, 1 ± 0.214). This decrease in the expression of ACE and AT1 suggests a reduction in the expression of Ang II that could be related to a lower response to this vasoconstrictor. An increase in the expression of B1 would improve vasodilation, which would be a beneficial effect of combined therapies for hypertension.
Late Phases of Cardioprotection During Remote Ischemic Preconditioning and Adenosine Preconditioning Involve Activation of Neurogenic Pathway
Authors: Singh Harinder , Kumar Manish , Singh Nirmal , Jaggi Amteshwar Singh 
Published: November 2018

Background:
The role of the neurogenic pathway in early phases of cardioprotection during remote ischemic preconditioning (RIPC) and adenosine preconditioning is reported.

Aim:
This study was designed to explore the involvement of the neurogenic pathway in late phases of cardioprotection during RIPC and adenosine preconditioning.

Material and Methods:
Fifty-four Wistar rats were used and divided into 9 experimental groups. RIPC was induced by tying the blood pressure cuff around the hind limb and subjecting to 4 cycles of inflation and deflation of 5 minutes each. In early RIPC, the heart was isolated immediately after the last episode of RIPC, whereas in late RIPC, the heart was isolated 24 hours after the last cycle of RIPC. In a similar way, adenosine preconditioning was instituted in early and late phases by either isolating the heart 40 minutes or 24 hours after adenosine (4 mg/kg, intraperitoneally [i.p.]) administration. Isolated hearts were subjected to ischemia–reperfusion (I/R) injury on the Langendorff's system.

Results:
Both early and late phases of RIPC and adenosine preconditioning significantly abrogated I/R-induced myocardial injury in terms of decrease in the release of lactate dehydrogenase, creatine kinase, and decrease in infarct size. Pretreatment with hexamethonium, a ganglion blocker (20 mg/kg, i.p.), significantly abolished the cardioprotective effects of both early and late phases of RIPC and adenosine preconditioning.

Conclusion:
Apart from the involvement of the neurogenic pathway in the early phases, there is a critical role of the neurogenic pathway in the late phase of cardioprotection during RIPC and adenosine preconditioning.
Single Stage Repair of #30 Facial Cleft with Bone Morphogenic Protein
Authors: Sheckter Clifford C. , Mittermiller Paul , Hung Kay , Maan Zeshaan , Rochlin Danielle , Menard Robert M. 
Published: November 2018

Summary:
Tessier #30 clefts (median mandibular clefts) represent a spectrum of deformities ranging from a minor cleft in the lower lip to complete clefts of the mandible involving the tongue, lower lip, hyoid bone, thyroid cartilages, and manubrium. Various techniques have been used to address these problems; the most common procedure involving 2 stages: an initial correction of the soft tissue followed by closure of the mandibular cleft at a later date using bone grafting. This approach was subsequently reduced to a single operation, but still required harvesting of autologous bone graft. Here, we describe a modified single-stage operation using human recombinant bone morphogenic protein, avoiding bone graft harvest and allowing for simultaneous treatment of bone and soft tissue.
Tablet Computer as a Distraction Tool During Facial Laceration Repair
Authors: Bryl Amy W. , Bonsu Bema , Johnson Ariana L. , Pommert Kathleen B. J. , Hollenbach Kathryn A. , Kanegaye John T. 
Published: November 2018

Objectives
Child life interventions reduce the anxiety of medical procedures but are not always available in emergency departments. In this study, we determined the effect of parent-directed tablet computer use without child life direction on patient anxiety and on parent and suturing clinician experience during pediatric facial laceration repair.

Methods
In a children's hospital emergency department, we enrolled children 2 to 12 years of age undergoing unsedated facial laceration repairs and randomized them to parent-directed tablet computer distraction or standard supportive care. We measured anxiety using the Observational Scale of Behavioral Distress—Revised (OSBD-R) for 5 procedure phases from videotaped laceration repairs. We compared OSBD-R scores for 5 phases and weighted averages between the tablet and standard care groups. Parents and suturing clinicians completed surveys about their experiences after the procedures.

Results
From April 2014 to July 2015, 77 patients (39 tablet, 38 standard) underwent repairs. Age, use of restraint, procedure duration, and number of sutures were similar between the 2 groups. The groups did not differ in procedure phase or weighted-average OSBD-R scores. Parents in the tablet group reported less personal anxiety compared with parents in the standard group (P = 0.01). In a post hoc subgroup analysis, subjects in the unrestrained tablet group had lower OSBD-R scores during the anesthetic injection phase than did subjects in the unrestrained standard group (P = 0.04). If restrained, subjects in the tablet group had higher OSBD-R scores during the anesthetic injection phase than did subjects in the standard group (P = 0.048).

Conclusions
Unrestrained children may benefit from parent-directed tablet computer distraction. Parents who operate the device are less anxious during their children's procedures.
A Comprehensive Pediatric Acute Sexual Assault Protocol
Authors: Kaplan Dana M. , Moore Jessica L. , Hirway Priyadarshini , Barron Christine E. , Goldberg Amy P. 
Published: November 2018

Objective
Close medical follow-up after pediatric acute sexual assault is recommended and may mitigate adverse consequences and decrease long-term comorbidities. The objectives are to (1) examine adherence to a comprehensive outpatient medical follow-up protocol after evaluation in the emergency department in a pediatric population and (2) identify characteristics associated with patient adherence to inform the utilization of a medical follow-up protocol after pediatric acute sexual assault.

Methods
A retrospective medical record review was conducted of patients younger than 18 years presenting to the emergency department from January 1, 2010, to December 31, 2013, with a discharge diagnosis suggestive of sexual assault/abuse. We examined differences in demographics, assault characteristics, and medical/legal needs of patients who were evaluated in follow-up versus patients who were not.

Results
Of 182 patients, 60.4% completed follow-up appointments with the child protection center. Younger patients had follow-up rates higher than older patients (70.2% vs 50%; odds ratio [OR], 0.42). For patients where child protective services or law enforcement were called, follow-up rates were 74.2% and 64.7%, respectively (OR, 2.5; OR, 3.1). All patients with anogenital injuries on initial examination were seen in follow-up. The majority of patients who followed-up were accompanied by a caregiver/relative (95%).

Conclusions
(1) Caregivers should be integrated into the evaluation to facilitate compliance with follow-up; (2) child abuse specialists may be consulted to facilitate specific interventions and recommendations; (3) professionals should work as a multidisciplinary team; and (4) the patient's psychological status should be evaluated, and mental health interventions recommended.
Consensus Statement on Urgent Care Centers and Retail Clinics in Acute Care of Children
Authors: Saidinejad Mohsen , Paul Audrey , Gausche-Hill Marianne , Woolridge Dale , Heins Alan , Scott William Russell , Friesen Phillip , Rayburn David , Conners Gregory , Petrack Emory , Horeczko Timothy , Stoner Michael , Edgerton Elizabeth , Joseph Madeline 
Published: November 2018

Abstract
This article provides recommendations for pediatric readiness, scope of services, competencies, staffing, emergency preparedness, and transfer of care coordination for urgent care centers (UCCs) and retail clinics that provide pediatric care. It also provides general recommendations for the use of telemedicine in these establishments. With continuing increases in wait times and overcrowding in the nation's emergency departments and the mounting challenges in obtaining timely access to primary care providers, a new trend is gaining momentum for the treatment of minor illness and injuries in the form of UCCs and retail clinics. As pediatric visits to these establishments increase, considerations should be made for the type of injury or illnesses that can be safely treated, the required level training and credentials of personnel needed, the proper equipment and resources to specifically care for children, and procedures for safe transfer to a higher level of care, when needed. When used appropriately, UCCs and retail clinics can be valuable and convenient patient care resources.
Acute Flaccid Paralysis in an 11-Year-Old
Authors: Schwartz Lisa , Bishop Rebecca , Le Jacqueline , Hu Eugene , Kim Tommy 
Published: November 2018

Abstract
Rhabdomyolysis is a syndrome caused by injury to skeletal muscle and subsequent release of intracellular components into the systemic circulation. We report a case of rhabdomyolysis causing acute paralysis from underlying and unrecognized hypothyroidism in an 11-year-old girl. To date, publications of rhabdomyolysis secondary to hypothyroidism have been limited, especially in the pediatric population. Early intervention with intravenous fluids and levothyroxine led to resolution of our patient's symptoms and is overall important in preventing the serious sequela of rhabdomyolysis including renal failure, cardiac dysrhythmias, compartment syndrome, and disseminated intravascular coagulation.
Extended Patient Alone Time in Emergency Department Leads to Increased Risk of 30-Day Hospitalization
Authors: VanDeusen Adam J. , Pasupathy Kalyan S. , Huschka Todd R. , Heaton Heather A. , Hellmich Thomas R. , Sir Mustafa Y. 
Published: November 2018

Objectives
This study was conducted to describe patients at risk for prolonged time alone in the emergency department (ED) and to determine the relationship between clinical outcomes, specifically 30-day hospitalization, and patient alone time (PAT) in the ED.

Methods
An observational cohort design was used to evaluate PAT and patient characteristics in the ED. The study was conducted in a tertiary academic ED that has both adult and pediatric ED facilities and of patients placed in an acute care room for treatment between May 1 and July 31, 2016, excluding behavioral health patients. Simple linear regression and t tests were used to evaluate the relationship between patient characteristics and PAT. Logistic regression was used to evaluate the relationship between 30-day hospitalization and PAT.

Results
Pediatric patients had the shortest total PAT compared with all older age groups (86.4 minutes versus 131 minutes, P < 0.001). Relationships were seen between PAT and patient characteristics, including age, geographic region, and the severity and complexity of the health condition. Controlling for Charlson comorbidity index and other potentially confounding variables, a logistic regression model showed that patients are more likely to be hospitalized within 30 days after their ED visit, with an odds ratio (95% confidence interval) of 1.056 (1.017–1.097) for each additional hour of PAT.

Conclusions
Patient alone time is not equal among all patient groups. Study results indicate that PAT is significantly associated with 30-day hospitalization. This conclusion indicates that PAT may affect patient outcomes and warrants further investigation.
The Ambulatory Version of the Safety Attitude Questionnaire: Psychometric Validation and Measurement Properties in Nigerian Clinical Setting
Authors: Ogaji Daprim Samuel , Emudiaga-Ohwerhi Mabel , Adesina Adedotun Daniel 
Published: November 2018

Background
Understanding the safety culture of health care providers can help administrators improve patient safety. However, it is difficult to measure complex constructs such as safety culture without valid and reliable tools. This study determined the measurement properties of the ambulatory version of the safety attitude questionnaire (SAQ-AV) in the Nigerian clinical setting.

Methods
A multiphase, iterative research involving clinical staff in primary and tertiary level of care in South-south Nigeria. The phases included face and content validity by subject experts, pretesting with clinical staff and a field validation involving 812 clinical staff. The acceptability, reliability (internal consistency), and validity (face, content, and construct) of the SAQ-AV were determined. All quantitative analysis was conducted using the SPSS Version 22 statistical package with statistical significance set at a P value of less than 0.05.

Results
A response rate of 53.7% was obtained during the field validation study. The item nonresponse rates were less than 10%, whereas extremes of the response scale were frequently endorsed. The internal consistency of the scale was good (Cronbach’s α of 0.91 for entire scale and ranged from 0.62 to 0.76 among the different domains of the tool). Patient safety culture scores from primary and tertiary health care facilities assessed were significantly different.

Conclusions
The SAQ-AV is an acceptable, reliable, and valid tool for use in assessing patient safety culture in ambulatory settings in Nigeria. There is a need to determine its dimensionality and factor structure in future research.
Chyle Leak Following Autologous Breast Reconstruction
Authors: Long Samuel R. , Butterworth James A. 
Published: November 2018

Background
While complications of deep inferior epigastric artery perforator flaps are known and well documented, a thorough literature review revealed no other reports of a patient developing a chyle leak following the use of the internal mammary vessels for recipient vessels in autologous breast reconstruction.

Case
A 55-year-old woman underwent free autologous breast reconstruction. She developed a chyle leak during the postoperative period. This was verified through a computed tomography scan and fluid analysis demonstrating a high triglyceride count and the presence of chylomicrons. The leak resolved with conservative measures including compression and a low-fat, high-protein diet.

Discussion
The presence of chyle leak following dissection of the internal mammary vessels is a unique complication of autologous breast reconstruction. There have been reports of lymph leaks following mastectomy, but these are mostly reported in the axilla. A history of radiation to the contralateral breast and aberrant anatomy may have contributed to the complication. Treatment of chyle leaks ranges from conservative management to the use of total parenteral nutrition and somatostatin analogs to surgical intervention.

Conclusion
While altering practice patterns based on a single case is not usually suggested, this complication does intimate that dealing with lymphatic vessels and lymph nodes in the chest should be done deliberately to prevent lymphatic leaks.
Determinants of Free Fasciocutaneous Flap Outcomes in Partial Hypopharyngeal Defects
Authors: Chen Ching-En , Wu Shang-Liang , Liao Wen-Chieh , Perng Cherng-Kang , Ma Hsu , Lin Chih-Hsun 
Published: November 2018

Background
Most of the patients with hypopharyngeal cancer are still diagnosed with advanced stage, and total or partial pharyngectomy with free flap reconstruction is the mainstay of treatment. The aim of this study was to find out the possible risk factors related to surgical complications after free fasciocutaneous flap reconstruction for partial pharyngeal defect and its sequelae in the follow-up.

Patients and Methods
We retrospectively reviewed the charts of patients with advanced hypopharyngeal cancer who received free fasciocutaneous flaps for partial pharyngeal defects reconstruction. From 2005 to 2015, 79 free fasciocutaneous flaps (59 free fasciocutaneous flaps and 20 anterolateral thigh flaps) were performed in our department. The risk factors for free flap outcome and complications were evaluated with multivariant linear regression model.

Results
The mean age of patients was 60.8 years with male predominance. The mean follow-up duration was 39.6 months. Most of the cases (97.5%) were in stage III or IV. Patients with comorbidities showed significant correlation to flap failure (95% confidence interval [CI] = 0.038 to 0.264, P = 0.10). Anastomosis style (end-to-side vs end-to-end) was the only operation-related factors significantly related to flap failure rate (18.8% vs 3.2%, 95% CI = 0.031 to 0.32, P = 0.18). Flap size was significantly associated with fistula formation (95% CI = −0.005 to 0.000, P = 0.38).

Conclusions
In our experience, patients with comorbidities and end-to-side anastomosis illustrate significantly higher flap failure rate in free fasciocutaneous flap reconstruction of partial hypopharyngeal defect. Reconstruction with smaller flap size had higher possibility of fistula formation.
Oxygenated UW Solution Decreases ATP Decay and Improves Survival After Transplantation of DCD Liver Grafts
Authors: Martins Paulo N. , Berendsen Timothy A. , Yeh Heidi , Bruinsma Bote G. , Izamis Maria-Louisa , Op den Dries Sanna , Gillooly Andrew R. , Porte Robert , Yarmush Martin L. , Uygun Korkut , Markmann James F. 
Published: November 2018

Background
Donation after circulatory death (DCD) liver grafts are known to be predisposed to primary nonfunction and ischemic cholangiopathy. Many DCD grafts are discarded because of older donor age or long warm ischemia times. Thus, it is critical to improve the quality of DCD liver grafts. Here, we have tested whether an enriched oxygen carrier added to the preservation solution can prolong graft survival and reduce biliary damage.

Methods
We assessed the adenosine triphosphate (ATP) content decay of mouse liver grafts after cold ischemia, warm ischemia, and combined warm+cold ischemia. In addition, we used a rat model of liver transplantation to compare survival of DCD grafts preserved in high-oxygen solution (preoxygenated perfluorocarbon [PFC] + University of Wisconsin [UW] solution) versus lower oxygen solution (preoxygenated UW solution).

Results
Adenosine triphosphate levels under UW preservation fall to less than 10% after 30 minutes of warm ischemia. Preoxygenated UW solution with PFC reached a significantly higher PaO2. After 45 minutes of warm ischemia in oxygenated UW + PFC solution, grafts showed 63% higher levels of ATP (P = 0.011). In addition, this was associated with better preservation of morphology when compared to grafts stored in standard UW solution. Animals that received DCD grafts preserved in higher oxygenation solution showed improved survival: 4 out of 6 animals survived long-term whereas all control group animals died within 24 hours.

Conclusions
The additional oxygen provided by PFC during static cold preservation of DCD livers can better sustain ATP levels, and thereby reduce the severity of ischemic tissue damage. PFC-based preservation solution extends the tolerance to warm ischemia, and may reduce the rate of ischemic cholangiopathy.
Spectral Content of Electroencephalographic Burst-Suppression Patterns May Reflect Neuronal Recovery in Comatose Post-Cardiac Arrest Patients
Authors: Sekar Krithiga , Schiff Nicholas D. , Labar Douglas , Forgacs Peter B. 
Published: November 2018

Purpose:
To assess the potential biologic significance of variations in burst-suppression patterns (BSPs) after cardiac arrest in relation to recovery of consciousness. In the context of recent theoretical models of BSP, bursting frequency may be representative of underlying network dynamics; discontinuous activation of membrane potential during impaired cellular energetics may promote neuronal rescue.

Methods:
We reviewed a database of 73 comatose post-cardiac arrest patients who underwent therapeutic hypothermia to assess for the presence of BSP and clinical outcomes. In a subsample of patients with BSP (n = 14), spectral content of burst and suppression periods were quantified using multitaper method.

Results:
Burst-suppression pattern was seen in 45/73 (61%) patients. Comparable numbers of patients with (31.1%) and without (35.7%) BSP regained consciousness by the time of hospital discharge. In addition, in two unique cases, BSP initially resolved and then spontaneously reemerged after completion of therapeutic hypothermia and cessation of sedative medications. Both patients recovered consciousness. Spectral analysis of bursts in all patients regaining consciousness (n = 6) showed a prominent theta frequency (5–7 Hz) feature, but not in age-matched patients with induced BSP who did not recover consciousness (n = 8).

Conclusions:
The prognostic implications of BSP after hypoxic brain injury may vary based on the intrinsic properties of the underlying brain state itself. The presence of theta activity within bursts may index potential viability of neuronal networks underlying recovery of consciousness; emergence of spontaneous BSP in some cases may indicate an innate neuroprotective mechanism. This study highlights the need for better characterization of various BSP patterns after cardiac arrest.