bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative Use of Nitroglycerin to Improve Microvascular Circulation
Authors: McGahan Rose K. , Gafford Ellin F. , Whitson Bryan A. , Papadimos Thomas J. , Tripathi Ravi S. 
Published: June 2019

Background: In the setting of critical illness, life preservation may come at the expense of limb as increasing concentration of vasopressors causes peripheral ischemia. When goals of care specify comfort measures, clinicians are faced with the difficult task of mitigating already present distal malperfusion while abiding to wishes of patient and patients’ families. Physical changes post vasopressor use, such as mottling of appendages or cooling of skin, can limit meaningful physical interactions with grieving family members. Case Presentation: We describe a case series of successful utilization of intravenous nitroglycerin to improve postvasopressor digital ischemia for comfort care measures to assist patient’s families in the grieving process. Conclusion: Following decision for comfort care measures, management for patient care goes beyond the realm of pain control. Dignified dying is an active process that requires clinicians to navigate care for both patient and patients’ families. By reversing the digital ischemia associated with vasopressors, patients’ families have the opportunity to give meaningful touch in setting of which it may be needed most.
Cryopreservation of feline red blood cells in liquid nitrogen using glycerol and hydroxyethyl starch
Authors: Hon Marcelle , Thomovsky Elizabeth J , Brooks Aimee C , Johnson Paula A 
Published: June 2019

Objectives The objective of this study was to evaluate the techniques and short-term effects of cryopreservation of feline red blood cells (RBCs) in liquid nitrogen using glycerol or hydroxyethyl starch (HES) as a cryoprotectant. Methods Feline RBCs were manually mixed with either 20% glycerol or 12.5% HES and frozen for 24 h in liquid nitrogen. The samples were thawed and glycerolized samples were manually washed. Success of the freeze/thaw process was determined by recovery rate of RBCs and evaluation of morphological changes using scanning electron microscopy (SEM). A unit of canine packed RBCs was also subjected to the same methodology to evaluate the cryopreservation handling technique. Results Feline RBCs preserved with 20% glycerol had a high recovery rate (94.23 ± 1.25%) immediately after thawing. However, the majority of the cells were lost during the washing process, with a final packed cell volume of <1%. A recovery rate was unable to be assessed for samples preserved with HES owing to the high viscosity of the mixture. SEM revealed significant morphological changes after glycerol was added to the feline RBCs. Although these morphological changes were partially reversed after thawing, the majority of the RBCs were lost during the washing process. Minimal morphological changes were noted in the HES sample. Similar results were noted with the canine RBCs. Conclusions and relevance The described manual technique for cryopreservation using glycerol was not able to successfully preserve feline or canine RBCs. In the present study, it was difficult to make conclusions about the efficacy of HES. Further studies evaluating HES as a cryoprotectant are warranted.
Vitamin D receptor gene polymorphisms in ocular surface squamous cell neoplasms
Authors: Ismayilova Nergiz , Palamar Melis , Onay Huseyin , Ceylan Emine Ipek , Atik Tahir , Akalin Taner , Yagci Ayse 
Published: June 2019

Purpose: To investigate vitamin D receptor polymorphisms in ocular surface squamous cell neoplasm and to evaluate the relationship between the identified polymorphisms and susceptibility to ocular surface squamous cell neoplasm and the clinical course. Materials and Methods: A totala of 70 patients with ocular surface squamous cell neoplasm (study group) and 75 healthy age and gender-matched individuals (control group) were included in the study. Vitamin D receptor FokI and BsmI polymorphisms were examined. The relationships between histopathological diagnosis, recurrence rates, tumor stage, and identified polymorphisms were investigated. Results: Histopathologically, 43 of the cases were squamous cell carcinoma and 27 of the cases were conjunctival intraepithelial neoplasia. The frequency of FokI (FF, Ff, ff) and BsmI (BB, Bb, bb) polymorphism genotype of vitamin D receptor gene were similar in the groups. The frequency of polymorphism (heterozygous or homozygous) for BsmI (Bb and bb) was significantly higher (p = 0.046) in the study group, while no difference was found between the groups in terms of polymorphic carriers (heterozygous or homozygous) for FokI. There was no correlation between tumor stage, recurrence-polymorphism frequency, and patient age-polymorphism frequency. Conclusion: It is known that active vitamin D inhibits the growth of cancer cells by binding to vitamin D receptor with regulation of genes responsible for cell proliferation. The presence of BsmI polymorphism in vitamin D receptor, in particular bb genotype and b allele, appears to be associated with the susceptibility of ocular surface squamous cell neoplasm. BsmI gene polymorphisms of vitamin D receptor might play an effective role in the formation, progression, and in the course of ocular surface squamous cell neoplasm.
Hip resurfacing arthroplasty for end-stage arthritis caused by childhood hip disease
Authors: Su Edwin P , Morgenstern Rachelle , Khan Imraan , Gaillard Melissa D , Gross Thomas P 
Published: June 2019

Introduction: Patients with hip arthritis due to Legg-Calvé-Perthes (LCP) and slipped capital femoral epiphysis (SCFE) pose altered femoral anatomy, making hip resurfacing arthroplasty (HRA) technically complicated. We examined implant survival and clinical symptoms in patients with a history of LCP or SCPE who underwent HRA for end-stage osteoarthritis. Methods: Data was collected for patients who underwent HRA for osteoarthritis due to LCP ( n = 59) or SCFE ( n = 32). Harris Hip Scores (HHS), UCLA activity scores, and radiographs were evaluated pre and postoperatively. Wilcoxon Signed-Rank Tests and Kaplan-Meier Survivorship curves were used to analyse data. Results: Survivorship for freedom from revision or clinical failure was 93.55(95% CI, 78.47–98.18) at 5.79 years, up until the most recent follow-up of 11.23 years. There were 3 failures: 1 LCP due to instability at 2.4 years, 1 SCFE due to femoral neck fracture at 1 month, and another SCFE due to unexplained pain at 5.8 years. Five patients, 1 LCP and 4 SCFE, had retained hardware prior to surgery; 4 had their hardware removed during surgery. Postoperatively HHS and UCLA activity scores increased ( p < 0.0001, for both measures). Leg-length discrepancy improved preoperatively from 7.9 (0.0–32) mm to 0.65 (0.0–10) mm postoperatively ( p < 0.0001). Follow-up radiographs of all non-failure HRA patients revealed implants to be in good alignment with no indication of loosening. Conclusion: Although HRA in SCFE and LCP patients increases technical difficulties, findings demonstrate excellent implant survival, no intraoperative complications, and improvements in leg-length discrepancies and clinical functional outcomes.
Catastrophic femoral head trunnion dissociation: a case series with surface wear analysis
Authors: Wood Thomas J , Alzahrani Mohammad , Langohr Daniel , Teeter Matthew G , Howard James L , Schemitsch Emil H , Lanting Brent A 
Published: June 2019

Introduction: Modular designs enhance accuracy of limb length and offset during total hip arthroplasty. However, such interfaces can be the site of corrosion and implant failure. The purpose of this study was to review 5 cases of catastrophic femoral head trunnion dissociation to better understand clinical and implant related risk factors for this complication. Methods: We describe 5 cases of femoral head dissociation following significant trunnion wear. Patient and implant related factors are reviewed. Surface wear patterns were assessed using electron microscopy and wear patterns were described qualitatively. Results: Commonalties among 5 presented cases include male, age over 65 and increased BMI. All femoral heads were cobalt chromium with a head size of at least 36 mm or greater. 4 out of 5 had high offset. All stems were the same design. Surface wear analysis showed material removed initially on the inferomedial aspect of the trunnion where the femoral head contacted the stem. Conclusions: Femoral head dissociation secondary to failure of the trunnion is a rare complication. We show associations with older age, increased BMI and male patients with increased femoral head size and offset. Material is removed initially inferomedially and progresses to fracturing the superior aspect of the trunnion.
Complications related to tube thoracostomy in Southwest Finland hospital district between 2004 and 2014
Authors: Vilkki V. A. , Gunn J. M. 
Published: June 2019

Background and Aims: The purpose of this study was to describe the frequency and types of complications after tube thoracostomy among all patients treated with tube thoracostomy for both traumatic and non-traumatic indications. Material and Methods: Retrospective register-based study of patients treated with tube thoracostomy between the years 2004 and 2014 in a university hospital. Results: In total, 1808 patients who had undergone tube thoracostomy were identified, complete data on tube thoracostomy treatment was available for 1169 patients. A total of 233 (19.9%) patients had 289 complications, 284 (98.3%) were positional resulting in tube malfunction. In 84 (7.2%) patients, malposition of the tube resulted in need for non-urgent operative treatment. There were 103 in-hospital deaths, but none due to tube thoracostomy complications. Empyema as a treatment indication was more frequent in patients with complications (15.9% vs 6.8%, p < 0.001) as was diabetes (21.9% vs 13.2%, p = 0.001). The likelihood of complications was lower with CH16 tubes (odds ratio 0.22, p < 0.001) and higher in diabetics (odds ratio 1.86, p = 0.001). Conclusion: Tube thoracostomy is a common procedure and complications occur in 19.9% of patients. Serious complications caused by the chest tube placement, however, are extremely rare. Complications were most common in patients treated for empyema and diabetics. Small CH16 tubes were associated with a lower incidence of complications.
Analysis of Factors Influencing Accuracy of Volume Flow Measurement in Dialysis Access Fistulas Based on Duplex Ultrasound Simulation
Authors: Zierler R. Eugene , Leotta Daniel F. , Sansom Kurt , Aliseda Alberto , Anderson Mark D. , Sheehan Florence H. 
Published: June 2019

Objective: We developed a duplex ultrasound simulator and used it to assess accuracy of volume flow measurements in dialysis access fistula (DAF) models. Methods: The simulator consists of a mannequin, computer, and mock transducer. Each case is built from a patient’s B-mode images that are used to create a 3-dimensional surface model of the DAF. Computational fluid dynamics is used to determine blood flow velocities based on model vessel geometry. The simulator displays real-time B-mode and color-flow images, and Doppler spectral waveforms are generated according to user-defined settings. Accuracy was assessed by scanning each case and measuring volume flow in the inflow artery and outflow vein for comparison with true volume flow values. Results: Four examiners made 96 volume flow measurements on four DAF models. Measured volume flow deviated from the true value by 35 ± 36%. Mean absolute deviation from true volume flow was lower for arteries than veins (22 ± 19%, N = 48 vs. 58 ± 33%, N = 48, p < 0.0001). This finding is attributed to eccentricity of outflow veins which resulted in underestimating true cross-sectional area. Regression analysis indicated that error in measuring cross-sectional area was a predictor of error in volume flow measurement (β = 0.948, p < 0.001). Volume flow error was reduced from 35 ± 36% to 9 ± 8% ( p < 0.000001) by calculating vessel area as an ellipse. Conclusions: Duplex volume flow measurements are based on a circular vessel shape. DAF inflow arteries are circular, but outflow veins can be elliptical. Simulation-based analysis showed that error in measuring volume flow is mainly due to assumption of a circular vessel.
SMART goals setting and biometric changes in obese adults with multimorbidity: Secondary analysis of a randomized controlled trial
Authors: Takahashi Paul Y , Quigg Stephanie M , Croghan Ivana T , Schroeder Darrell R , Ebbert Jon O 
Published: June 2019

Objectives: Clinicians recommend diet and exercise for overweight/obese patients. We conducted a secondary analysis of a randomized controlled clinical trial evaluating goal setting and pedometer use versus usual care on weight, waist circumference, and blood pressure of patients with multiple chronic conditions. Methods: In this trial, we recruited and randomized patients over 18 years with multiple chronic conditions. There were two groups with an immediate intervention group who received behavioral coaching and a pedometer versus a delayed control who received the intervention after 2 months. We evaluated body weight, waist circumference, and blood pressure as outcomes. We used analysis of covariance to evaluate differences between the intervention and the control groups. Results: Of 130 patients, mean age was 63.4 years (SD, 17.3). At 2 months, intervention participants lost 0.2 kg versus a 0.1-kg gain in the control participants ( P = .44). The immediate intervention group had significantly smaller waist circumference change at 2-month follow-up compared to control at −1.6 cm (95% confidence interval = −3.1 to −0.1), which was driven by an increase in waist circumference in the delayed control group. No difference in systolic blood pressure was observed. Discussion: We observed no difference in weight or blood pressure between the groups with obesity and multiple chronic conditions.
In vitro evaluation of nanohydroxyapatite synthesized from eggshell waste in occluding dentin tubules
Authors: Onwubu Stanley Chibuzor , Mhlungu Sbusiso , Mdluli Phumlane Selby 
Published: June 2019

Objectives: Dentin hypersensitivity (DH) is a notable painful condition with a negative impact on quality of life. This paper evaluates the occluding abilities of nanohydroxyapatite synthesized from the eggshell waste (EnHAp) in the treatment of DH. Methods: EnHAp was synthesized following the wet chemical precipitation method. The purity and phase change were characterized using Fourier transform infrared (FTIR) and X-ray diffraction (XRD). Field emission scanning electron microscopy (FESEM) and high-resolution transmission electron microscopy (HRTEM) were used to observe the morphology of EnHAp. The occluding capabilities were evaluated in vitro using the bovine model. Twenty-five simulated dentin specimens were randomly assigned to five groups: Group 1, untreated; Group 2, eggshell powder alone; Group 3, calcined eggshell powder; Group 4, Colgate Sensitive treated, EnHAp; and Group 5, calcium dihydrogen phosphate ( n = 5). The specimens were then subjected to remineralization protocol. The tubule occluding capabilities were observed using FESEM. Analysis of variance was used to analyze the occluding ratio values for all treated specimens. Post hoc test with Bonferroni correction was used to identify the mean differences among the five test groups (α = .05). Results: The FTIR and XRD results confirm that synthesis of EnHAp occurred. HRTEM and FESEM revealed an irregular rod structure with a particle size of 65 nm. The occluding area ratios observed for the EnHAp specimens were significantly higher than other test groups ( p < 0.001). Conclusions: The application of EnHAp resulted in an efficient occlusion of dentin tubule. This study suggests that EnHAp is an effective therapy to treat DH.
Dokuchaevite, Cu8O2(VO4)3Cl3, a new mineral with remarkably diverse Cu2+ mixed-ligand coordination environments
Authors: Siidra Oleg I. , Nazarchuk Evgeny V. , Zaitsev Anatoly N. , Polekhovsky Yury S. , Wenzel Thomas , Spratt John 
Published: June 2019

AbstractDokuchaevite, ideally Cu8O2(VO4)3Cl3, was found in the Yadovitaya fumarole of the Second scoria cone of the North Breach of the Great Tolbachik Fissure Eruption (1975–1976), Tolbachik volcano, Kamchatka Peninsula, Russia. Dokuchaevite occurs on the crusts of various copper sulfate exhalative minerals (such as kamchatkite and euchlorine) as individual prismatic crystals. Dokuchaevite is triclinic, P$\bar{1}$, a = 6.332(3), b = 8.204(4), c = 15.562(8) Å, α = 90.498(8), β = 97.173(7), γ = 90.896(13)°, V = 801.9(7) Å3 and R1 = 0.057. The eight strongest lines of the X-ray powder diffraction pattern are (d, Å (I)(hkl): (15.4396)(18)(00$\bar{1}$), (7.2762)(27)(0$\bar{1}$1), (5.5957)(43)(012), (4.8571)(33)($\bar{1}\bar{1}$1), (3.1929) (29)(023), (2.7915)(30)(202), (2.5645)(21)(032), (2.5220)(100)(1$\bar{3}$0), (2.4906)(18)(130) and (2.3267)(71)(2$\bar{2}$2). The chemical composition determined by electron-microprobe analysis is (wt.%): CuO 60.87, ZnO 0.50, FeO 0.36, V2O5 19.85, As2O5 6.96, SO3 0.44, MoO3 1.41, SiO2 0.20, P2O5 0.22, Cl 10.66, –O = Cl2 2.41, total 99.06. The empirical formula calculated on the basis of 17 anions per formula unit is (Cu7.72Zn0.06Fe0.05)Σ7.83(V2.20As0.61Mo0.10S0.06P0.03Si0.03)Σ3.03O13.96Cl3.04.The crystal structure of dokuchaevite represents a new structure type with eight Cu sites, which demonstrate the remarkable diversity of Cu2+ mixed-ligand coordination environments. The crystal structure of dokuchaevite is based on OCu4 tetrahedra that share common corners thus forming [O2Cu6]8+ single chains. Two of the eight symmetrically independent copper atoms do not form Cu–O bonds with additional oxygen atoms, and thus are not part of the OCu4 tetrahedra, but provide the three-dimensional integrity of the [O2Cu6]8+ chains into a framework. TO4 mixed tetrahedral groups are located within the cavities of the framework. The structural formula of dokuchaevite can be represented as Cu2[Cu6O2](VO4)3Cl3.
The psychosis risk timeline: can we improve our preventive strategies? Part 2: adolescence and adulthood
Authors: Romain Karen , Eriksson Alexandra , Onyon Richard , Kumar Manoj 
Published: June 2019

SUMMARYCurrent understanding of psychosis development is relevant to patients' clinical outcomes in mental health services as a whole, given that psychotic symptoms can be a feature of many different diagnoses at different stages of life. Understanding the risk factors helps clinicians to contemplate primary, secondary and tertiary preventive strategies that it may be possible to implement. In this second article of a three-part series, the psychosis risk timeline is again considered, here focusing on risk factors more likely to be encountered during later childhood, adolescence and adulthood. These include environmental factors, substance misuse, and social and psychopathological aspects.LEARNING OBJECTIVES:After reading this article you will be able to:
•understanding the range of risk factors for development of psychotic symptoms in young people and adults•understand in particular the association between trauma/abuse and subsequent psychosis•appreciate current evidence for the nature and strength of the link between substance misuse and psychosis.DECLARATION OF INTEREST:None.
Risks and seasonal pattern for mortality among hospitalized infants in a conflict-affected area of Pakistan, 2013-2016. A retrospective chart review.
Authors: van Deursen Babette , Lenglet Annick , Ariti Cono , Hussain Barkat , Karsten Jaap , Roggeveen Harriet , Price Debbie , Fernhout Jena , Abdi Ahmed , Carrion Martin Antonio Isidro 
Published: June 2019

Background: In recent years, Médecins Sans Frontières has observed high mortality rates among hospitalized infants in Pakistan. We describe the clinical characteristics of the infants admitted between 2013 and 2016 in order to acquire a better understanding on the risk factors for mortality. Methods: We analyzed routinely collected medical data from infants (<7 months) admitted in Chaman and Dera Murad Jamali (DMJ) hospitals. The association between clinical characteristics and mortality was estimated using Poisson regression. Results: Between 2013 and 2016, 5,214 children were admitted (male/female ratio: 1.60) and 1,178 (23%) died. Days since admission was associated with a higher risk of mortality and decreased with each extra day of admission after seven days. The first 48 hours of admission was strongly associated with a higher risk of mortality. A primary diagnosis of tetanus, necrotizing enterocolitis, prematurity, sepsis and hypoxic-ischemic encephalopathy were strongly associated with higher rates of mortality. We observed an annual peak in the mortality rate in September. Conclusions: The first days of admission are critical for infant survival. Furthermore, the found male/female ratio was exceedingly higher than the national ratio of Pakistan. The observed seasonality in mortality rate by week has not been previously reported. It is fully recommended to do further in-depth research on male/female ratio differences and the reasons behind the annual peaks in mortality rate by week.
An interactive data visualisation application to investigate nosocomial transmission of infections
Authors: Smith Catherine M. , Allen David J. , Nawaz Sameena , Kozlakidis Zisis , Nastouli Eleni , Hayward Andrew , Ward Katherine N. 
Published: June 2019

Background: Healthcare-associated infections represent a major threat to patient, staff and visitor safety. Identification of episodes that are likely to have resulted from nosocomial transmission has important implications for infection control. Routinely collected data on ward admissions and sample dates, combined with pathogen genomic information could provide useful insights. We describe a novel, open-source, application for visualising these data, and demonstrate its utility for investigating nosocomial transmission using a case study of a large outbreak of norovirus infection. Methods: We developed the application using Shiny, a web application framework for R. For the norovirus case study, cases were defined as patients who had a faecal sample collected at the hospital in a winter season that tested positive for norovirus. Patient demographics and ward admission dates were extracted from hospital systems. Detected norovirus strains were genotyped and further characterised through sequencing of the hypervariable P2 domain. The most commonly detected sub-strain was visualised using the interactive application. Results: There were 156 norovirus-positive specimens collected from 107 patients. The most commonly detected sub-strain affected 30 patients in five wards. We used the interactive application to produce three visualisations: a bar chart, a timeline, and a schematic ward plan highlighting plausible transmission links. Visualisations showed credible links between cases on the elderly care ward. Conclusions: Use of the interactive application provided insights into transmission in this large nosocomial outbreak of norovirus, highlighting where infection control practices worked well or could be improved. This is a flexible tool that could be used for investigation of any infection in any hospital by interactively changing parameters. Challenges include integration with hospital systems for extracting data. Prospective use of this application could inform better infection control in real time.