bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is E-FAST possible and useful on the battlefield? A feasibility study during medical courses in hostile environment (MEDICHOS): preliminary results
Authors: Renard Aurélien , Martinet C , Cungi P J , Combes E , Gasperini G , Cazes N , Carfantan C , Faivre A , Travers S , Kelway C , Benner P 
Published: May 2019

IntroductionThe extent of the French forces’ territory in the Sahel band generates long medical evacuations. In case of many victims, to respect the golden hour rule, first-line sorting is essential. Through simulation situations, the aim of our study was to assess whether the use of ultrasound was useful to military doctors.MethodsIn combat-like exercise conditions, we provided trainees with a pocket-size ultrasound. Every patient for whom the trainees chose to perform ultrasound in role 1 was included. An extended focused assessment with sonography for trauma (E-FAST) was performed with six basic sonographic views. We evaluated whether these reference views were obtained or not. Once obtained by the trainees, pathological views corresponding to the scenario were shown to assess whether the trainees modified their therapeutic management strategy and their priorities.Results168 patients were treated by 15 different trainee doctors. Of these 168 patients, ultrasound (E-FAST or point-of-care ultrasound) was performed on 44 (26%) of them. In 51% (n=20/39) of the situations, the practitioners considered that the realisation of ultrasound had a significant impact in terms of therapeutic and evacuation priorities. More specifically, it changed therapeutic decisions in 67% of time (n=26/39) and evacuation priorities in 72% of time (n=28/39).ConclusionThis original work showed that ultrasound on the battlefield was possible and useful. To confirm these results, ultrasound needs to be democratised and assessed in a real operational environment.
Heritability in genetic heart disease: the role of genetic background
Authors: Jansweijer Joeri A , van Spaendonck-Zwarts Karin Y , Tanck Michael W T , van Tintelen J Peter , Christiaans Imke , van der Smagt Jasper J , Vermeer Alexa M C , Bos J Martijn , Moss Arthur J , Swan Heikki , Priori Sylvia G , Rydberg Annika , Tfelt-Hansen Jacob , Ackerman Michael J , Olivotto Iacopo , Charron Philippe , Gimeno Juan R , van den Berg Maarten P , Wilde Arthur AM , Pinto Yigal M 
Published: May 2019

BackgroundMutations in genes encoding ion channels or sarcomeric proteins are an important cause of hereditary cardiac disease. However, the severity of the resultant disease varies considerably even among those with an identical mutation. Such clinical variation is often thought to be explained largely by differences in genetic background or ‘modifier genes’. We aimed to test the prediction that identical genetic backgrounds result in largely similar clinical expression of a cardiac disease causing mutation, by studying the clinical expression of mutations causing cardiac disease in monozygotic twins.MethodsWe compared first available clinical information on 46 monozygotic twin pairs and 59 control pairs that had either a hereditary cardiomyopathy or channelopathy.ResultsDespite limited power of this study, we found significant heritability for corrected QT interval (QTc) in long QT syndrome (LQTS). We could not detect significant heritability for structural traits, but found a significant environmental effect on thickness of the interventricular septum in hypertrophic cardiomyopathy.ConclusionsOur study confirms previously found robust heritability for electrical traits like QTc in LQTS, and adds information on low or lacking heritability for structural traits in heritable cardiomyopathies. This may steer the search for genetic modifiers in heritable cardiac disease.
Why are patients not more involved in their own safety? A questionnaire-based survey in a multi-ethnic North London hospital population
Authors: Yoong Wai , Assassi Zouina , Ahmedani Iman , Abdinasir Rahma , Denning Max , Taylor Harriet , Chandrakumar Danya , Kwakye Michael , Nauta Maud 
Published: May 2019

AbstractPurposeActive patient participation in safety pathways has demonstrated benefits in reducing preventable errors, especially in relation to hand hygiene and surgical site marking. The authors sought to examine patient participation in a range of safety-related behaviours as well as factors that influence this, such as gender, education, age and language.DesignA 20-point questionnaire was employed in a London teaching hospital to explore safety-related behaviours, particularly assessing patient’s willingness to challenge healthcare professionals and engagement in taking an active role in their own care while in hospital. Data was also collected on participant demographic details including gender, age, ethnicity, English language proficiency and education status.Results85% of the 175 patients surveyed would consider bringing a list of their medications to hospital, but only 60% would bring a list of previous surgeries. Only 45% would actively engage in the WHO Safer Surgery Checklist and over three quarters (80%) would not challenge doctors and nurses regarding hand hygiene, believing that they would cause offence. Female patients who had tertiary education, were fluent in English and less than 60 years of age were statistically more likely to feel responsible for their own safety and take an active role in safety-related behaviour while in hospital (p&lt;0.05).ConclusionsMany patients are not engaged in safety-related behaviour and do not challenge healthcare professionals on safety issues. Older male patients who were not tertiary educated or fluent in English need to be empowered to take an active role in such behaviour. Further research is required to investigate how to achieve this.
Trends in steroid agent and diluent choices for epidural steroid injections: a survey of Spine Intervention Society physicians
Authors: Clements Nathan , Vydra Darrell , Cushman Daniel M. , Nagpal Ameet , Julia Jonathan , Zheng Patricia , McCormick Zachary L. 
Published: May 2019

BackgroundEpidural steroid injections (ESIs) are a frequently used treatment for refractory radicular spinal pain. ESIs, particularly transforaminal epidural steroid injections (TFESI), may provide pain relief and delay the need for surgery. Corticosteroid agent and diluent choices are known to impact the safety of ESIs. In particular, the risk of embolization with particulate corticosteroids has led to recommendations for non-particulate steroid use by the Multisociety Pain Workgroup. Additionally, there is in vitro evidence that ropivacaine can crystalize in the presence of dexamethasone, potentially creating a particulate-like injectate. Despite widespread use and known risk mitigation strategies, current practice trends related to steroid and diluent choices are unknown.ObjectiveIdentify the use of particulate versus non-particulate corticosteroids for epidural steroid injections in the cervical and lumbar spine, as well as local anesthetics commonly used as diluents during these procedures.MethodsCross-sectional survey study of 314 physician members of the Spine Interventional Society.Results41% and 9% of providers reported using particulate corticosteroids during lumbar TFESIs and cervical TFESI, respectively. Four per cent of providers reported the use of ropivacaine in cervical TFESIs. Forty-four per cent of respondents reported using anesthetic in cervical interlaminar ESIs. 21% of providers report using high volumes (> 4.5 mL) during cervical interlaminar ESIs.ConclusionCurrent trends, as assessed by this survey study, indicate substantial variability in steroid and diluent choice for ESIs. Patterns were identified that may impact patient safety including the continued use of particulate corticosteroids for TFESIs and the use of ropivacaine during TFESIs by a subset of respondents.
Effect of early versus delayed activation of thoracic epidural anesthesia on plasma pro-atrial natriuretic peptide to indicate deviations in central blood volume during esophagectomy
Authors: Strandby Rune B , Ambrus Rikard , Achiam Michael P , Goetze Jens P , Secher Niels H , Svendsen Lars B 
Published: May 2019

Background and ObjectivesA side effect to thoracic epidural anesthesia (TEA) is hypotension induced by central hypovolemia. This study addressed whether early activation (EA) versus late activation (LA) of TEA affects plasma pro-atrial natriuretic peptide (proANP) reflecting deviations in the central blood volume (CBV). We hypothesized that EA TEA would reduce plasma proANP, thus reflecting a decrease in CBV.MethodsA randomized, controlled, single-blinded trial was conducted. Patients undergoing open esophagectomy were randomized to EA (n=25, after induction of general anesthesia) or LA TEA (n=25, after re-established gastric continuity) with the epidural catheter placed at the interspaces Th7-8 or Th8-9. Plasma proANP was determined repetitively along with hemodynamic variables and administration of fluid/vasopressors as postoperative complications were noted.ResultsWith EA TEA, plasma proANP decreased following induction of anesthesia to the end of surgery (13%; 113±68 to 99±49 pmol/L; p=0.026), but that was not the case in the LA group (3%; 97±44 to 94±49 pmol/L; p=0.565) despite equal fluid balance (+1584±582 vs +1560±563 mL; p=0.888). Accordingly, the EA group required excessive treatment with vasopressors to maintain MAP >60 mm Hg during surgery (2.7±2 vs 1.6±1.4 ephedrine boluses; p=0.033 and infusion of phenylephrine for 216±86 vs 58±91 min; p<0.001). Plasma proANP and fluid balance were correlated only for EA patients (r=0.44; 95% CI 0.04 to 0.91; p=0.033).ConclusionsEA TEA reduces plasma proANP indicating that CBV becomes affected. Based on a correlation between plasma proANP and fluid balance, a 2000 mL volume surplus of lactated Ringer’s solution is required to maintain plasma proANP stable during open esophagectomy.Trial registration number2014-002036-14 (https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-002036-14).
Evidence for enhanced neural tracking of the speech envelope underlying age-related speech-in-noise difficulties
Authors: Decruy Lien , Vanthornhout Jonas , Francart Tom 
Published: May 2019

When we grow older, understanding speech in noise becomes more challenging. Research has demonstrated the role of auditory temporal and cognitive deficits in these age-related speech-in-noise difficulties. To better understand the underlying neural mechanisms, we recruited young, middle-aged, and older normal-hearing adults and investigated the interplay between speech understanding, cognition, and neural tracking of the speech envelope using electroencephalography. The stimuli consisted of natural speech masked by speech-weighted noise or a competing talker and were presented at several subject-specific speech understanding levels. In addition to running speech, we recorded auditory steady-state responses at low modulation frequencies to assess the effect of age on nonspeech sounds. The results show that healthy aging resulted in a supralinear increase in the speech reception threshold, i.e., worse speech understanding, most pronounced for the competing talker. Similarly, advancing age was associated with a supralinear increase in envelope tracking, with a pronounced enhancement for older adults. Additionally, envelope tracking was found to increase with speech understanding, most apparent for older adults. Because we found that worse cognitive scores were associated with enhanced envelope tracking, our results support the hypothesis that enhanced envelope tracking in older adults is the result of a higher activation of brain regions for processing speech, compared with younger adults. From a cognitive perspective, this could reflect the inefficient use of cognitive resources, often observed in behavioral studies. Interestingly, the opposite effect of age was found for auditory steady-state responses, suggesting a complex interplay of different neural mechanisms with advancing age. NEW & NOTEWORTHY We measured neural tracking of the speech envelope across the adult lifespan and found a supralinear increase in envelope tracking with age. Using a more ecologically valid approach than auditory steady-state responses, we found that young and older, as well as middle-aged, normal-hearing adults showed an increase in envelope tracking with increasing speech understanding and that this association is stronger for older adults.
The Sentinel Margin: Intraoperative Ex Vivo Specimen Mapping Using Relative Fluorescence Intensity
Authors: van Keulen Stan , Nishio Naoki , Birkeland Andrew , Fakurnejad Shayan , Martin Brock , Forouzanfar Tim , Cunanan Kristen , Colevas A. Dimitrios , S. van den Berg Nynke , Rosenthal Eben 
Published: May 2019

Abstract

Purpose:
Despite major advancements in surgical oncology, the positive margin rate for primary head and neck cancer resection remains around 15%–30%. In particular, the deep surface margin is the most challenging to adequately assess. Inadequate margins are directly correlated to poor survival, and as such, mitigation of these rates is critical to improve patient outcomes. We have developed an ex vivo imaging strategy that utilizes fluorescence intensity peaks (relative to background signal) of an injected anti-EGFR antibody conjugated to a fluorescent probe to locate potential close or positive margins on the deep surface of the resected tumor specimen.

Experimental Design:
Twelve patients with head and neck cancer scheduled for surgery received systemic administration of a tumor-specific contrast-agent (panitumumab-IRDye800CW). After surgical resection, the tumor specimen was imaged using a fluorescence imager. The three highest fluorescence intensity-peaks on the deep surface of the specimen were isolated and correlated to histology to determine the margin distance at these regions.

Results:
Relative fluorescence peak intensities identified the closest margin on the deep surface of the specimen within 2.5 minutes. The highest intensity peak consistently (100%) detected the closest margin to the tumor. The difference in tumor margin distance between the first and second highest fluorescence intensity peak averaged 2.1 ± 1.4 mm. The tumor-margin difference between the second and third highest peak averaged 1.6 ± 0.6 mm.

Conclusions:
Fluorescence intensity peaks can identify the region on the specimen where tumor is closest to specimen's edge on the deep surface. This technique could have broad applications in obtaining adequate margins in oncological surgery.
Education of Migrant and Nonmigrant Patients Is Associated With Initiation and Discontinuation of Preventive Medications for Acute Coronary Syndrome
Authors: Frederiksen Hanne Winther , Zwisler Ann‐Dorthe , Johnsen Søren Paaske , Öztürk Buket , Lindhardt Tove , Norredam Marie 
Published: May 2019

Background
The benefits of preventive medications after acute coronary syndrome are impeded by low medication persistence, in particular among marginalized patient groups. Patient education might increase medication persistence, but the effect is still uncertain, especially among migrant groups. We, therefore, assessed whether use of patient education was associated with medication persistence after acute coronary syndrome and whether migrant background modified the potential associations.

Methods and Results

A cohort of patients discharged with a diagnosis of acute coronary syndrome (N=33 199) was identified in national registers. We then assessed number of contacts for patient education during a period of 6 months after discharge and the initiation and discontinuation of preventive medications during a period of up to 5 years. Results were adjusted for comorbidity and sociodemographic factors. Three or more contacts for patient education was associated with a higher likelihood of initiating preventive medications, corresponding to adjusted relative risks ranging from 1.12 (95%
CI
, 1.06–1.18) for statins to 1.39 (95%
CI
, 1.28–1.51) for
ADP
inhibitors. Lower risks of subsequent discontinuation were also observed, with adjusted hazard ratios ranging from 0.86 (95%
CI
, 0.79–0.92) for statins to 0.92 (95%
CI
, 0.88–0.97) for β blockers. Stratification and test for effect modification by migrant status showed insignificant effect modification, except for initiation of
ADP
inhibitors and statins.

Conclusions
Patient education is associated with higher chance of initiating preventive medications after acute coronary syndrome and a lower long‐term risk of subsequent discontinuation independently of migrant status.
Nonvitamin K Antagonist Oral Anticoagulants Versus Warfarin in Atrial Fibrillation Patients and Risk of Dementia: A Nationwide Propensity‐Weighted Cohort Study
Authors: Søgaard Mette , Skjøth Flemming , Jensen Martin , Kjældgaard Jette Nordstrøm , Lip Gregory Y. H. , Larsen Torben Bjerregaard , Nielsen Peter Brønnum 
Published: May 2019

Background

It is unclear whether nonvitamin K antagonist oral anticoagulants (
NOAC
s) can mitigate dementia development in atrial fibrillation. We compared dementia development among users of
NOACs
or warfarin in
patients with atrial fibrillation
with no prior neurological diagnoses.

Methods and Results

We conducted a Danish nationwide cohort study including 33 617 new
oral anticoagulant
users with nonvalvular
atrial fibrillation,
of which 11 052 were aged 60 to 69 years, 13 237 were aged 70 to 79 years, and 9238 were aged 80 years and older. To exclude prevalent non
‐oral anticoagulants–
associated dementia, we considered the at‐risk population of patients alive and free of dementia at 180 days following inclusion. We compared rates of new‐onset dementia by age and treatment regimen using inverse probability of treatment weighting to account for confounding. Approximately 60% of patients were
NOAC
users and 40% were warfarin users. Mean follow‐up was 3.4 years. Dementia occurred in 41 patients aged 60 to 69 years, 276 patients aged 70 to 79 years, and 441 patients aged 80 years and older. Relative to warfarin users, dementia rates were nonsignificantly lower among
NOAC
users aged 60 to 69 years (0.11 events/100 person‐years versus 0.12 events/100 person‐years; weighted hazard ratio, 0.92 [95%
CI,
0.48–1.72]) and
NOAC
users aged 70 to 79 years (0.64 events/100 person‐years versus 0.78 events/100 person‐years;
weighted hazard ratio
, 0.86 [95%
CI,
0.68–1.09]), whereas
NOAC
s were associated with significantly higher dementia rates (2.16 events/100 person‐years versus 1.70 events/100 person‐years;
weighted hazard ratio
, 1.31 [95% CI, 1.07–1.59]) in patients 80 years and older.

Conclusions

This nationwide cohort of
patients with atrial fibrillation
revealed no clinically meaningful difference in dementia development between users of
NOACs
or warfarin apart from a higher risk in
NOAC
users 80 years and older, which may relate to residual confounding from selective prescribing and unobserved comorbidities.
HDL Phospholipids, but Not Cholesterol Distinguish Acute Coronary Syndrome From Stable Coronary Artery Disease
Authors: Meikle Peter J. , Formosa Melissa F. , Mellett Natalie A. , Jayawardana Kaushala S. , Giles Corey , Bertovic David A. , Jennings Garry L. , Childs Wayne , Reddy Medini , Carey Andrew L. , Baradi Arul , Nanayakkara Shane , Wilson Andrew M. , Duffy Stephen J. , Kingwell Bronwyn A. 
Published: May 2019

Background
Although acute coronary syndromes (ACS) are a major cause of morbidity and mortality, relationships with biologically active lipid species potentially associated with plaque disruption/erosion in the context of their lipoprotein carriers are indeterminate. The aim was to characterize lipid species within lipoprotein particles which differentiate ACS from stable coronary artery disease.

Methods and Results
Venous blood was obtained from 130 individuals with de novo presentation of an ACS (n=47) or stable coronary artery disease (n=83) before coronary catheterization. Lipidomic measurements (533 lipid species; liquid chromatography electrospray ionization/tandem mass spectrometry) were performed on whole plasma as well as 2 lipoprotein subfractions: apolipoprotein A1 (apolipoprotein A, high‐density lipoprotein) and apolipoprotein B. Compared with stable coronary artery disease, ACS plasma was lower in phospholipids including lyso species and plasmalogens, with the majority of lipid species differing in abundance located within high‐density lipoprotein (high‐density lipoprotein, 113 lipids; plasma, 73 lipids). Models including plasma lipid species alone improved discrimination between the stable and ACS groups by 0.16 (C‐statistic) compared with conventional risk factors. Models utilizing lipid species either in plasma or within lipoprotein fractions had a similar ability to discriminate groups, though the C‐statistic was highest for plasma lipid species (0.80; 95% CI, 0.75–0.86).

Conclusions
Multiple lysophospholipids, but not cholesterol, featured among the lipids which were present at low concentration within high‐density lipoprotein of those presenting with ACS. Lipidomics, when applied to either whole plasma or lipoprotein fractions, was superior to conventional risk factors in discriminating ACS from stable coronary artery disease. These associative mechanistic insights elucidate potential new preventive, prognostic, and therapeutic avenues for ACS which require investigation in prospective analyses.
Clinical Symptom Profiles After Mild–Moderate Stroke
Authors: Katzan Irene L. , Schuster Andrew , Bain Mark , Lapin Brittany 
Published: May 2019

Background
There is heterogeneity in the severity of domains affected in patients with stroke, resulting in differences in health‐related quality of life (hrQoL). Identifying different clinical profiles of stroke patients may provide a means for selecting patients for tailored interventions to improve hrQoL.

Methods and Results

This was an observational study of 496 patients with ischemic stroke or intracerebral hemorrhage seen in a cerebrovascular clinic from October 12, 2015, through June 11, 2018, who completed patient‐reported outcome measures using Patient‐Reported Outcome Measurement Information System (PROMIS) tools within 1 month of stroke. Latent profile analysis identified groups based on
PROMIS
domain scores—pain, depression, cognitive function, fatigue, social role satisfaction, and physical function—as well as clinician‐reported modified Rankin Scale (
mRS
). Five distinct profiles were identified. Group 1 (“excellent hrQoL,” n=106) had fewer symptoms in all domains than the general population. Group 2 (“disabled with mixed hrQoL,” n=17) had fewer symptoms than the general population in all domains except social role satisfaction and physical function, despite having moderate disability (median mRS score: 3). Group 3 (“mild limitations with average hrQoL,” n=189) had scores similar to the general population for all domains and minimal disability (median
mRS
score: 1). Group 4 (“mild limitations with poor hrQoL,” n=152) also had a median
mRS
score of 1 but had worse scores than group 3 on all domains. Group 5 (“disabled with poor hrQoL,” n=32) had worse symptoms than patients in the other profiles and a median
mRS
score of 3.

Conclusions
Patients with recent stroke have distinct clinical symptom profiles, even with similar levels of clinician‐reported disability. Symptom profiles provide a means of understanding patterns of outcomes in patients with stroke.
The Arrangement of the Platonic Corpus in the Newly Published Compendiosa Expositio Attributed to Apuleius of Madaura
Authors: Rheins Jason G. 
Published: May 2019

Abstract
The Middle Platonist Compendiosa Expositio gives dialogue-by-dialogue summaries of doctrines allegedly expounded in Plato’s works. According to Justin Stover, the principle of division used by the work for arranging Plato’s dialogues is the dominant philosophical influence in each case. I argue that there is no principle of division, and that the dialogues are arranged, not on the basis of influence, but according to their main speaker. One thing this allows, I suggest, is for the author of the ce to assert the dependence of the Stoics on Plato.