bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of glucocorticoids in patients with COPD exacerbations in China: a retrospective observational study
Authors: Zhang Jing , Zheng Jinping , Huang Kewu , Chen Yahong , Yang Jingping , Yao Wanzhen 
Published: April 2018

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common in patients with underlying moderate to severe COPD and are associated with increased health and economic burden. International and Chinese guidelines recommend using glucocorticoids for the management of AECOPD because glucocorticoid therapy has been shown to benefit clinical outcomes. However, only scant data are available for current status of glucocorticoid therapy in hospitalized AECOPD patients in China. The aim of the study was to identify current use of glucocorticoids for the treatment of AECOPD in China. Methods: This retrospective, multicenter, noninterventional study evaluated the treatment pattern of AECOPD in patients hospitalized from January 2014 to September 2014 at 43 sites (41 tertiary hospitals and two secondary hospitals) in China. The endpoints of the study were the percentage of patients receiving glucocorticoids by different routes of administration, doses and duration, mortality, and the mean length of hospitalization. Results: A total of 4569 patients (90.17%) received glucocorticoids for AECOPD treatment. A combination of nebulized and systemic route was most frequently used (40.51%), followed by using nebulized route alone (38.00%), systemic route alone (15.45%), and inhaled route other than nebulization (6.04%). Furthermore, the most commonly prescribed glucocorticoids of the nebulized, intravenous, inhaled (other than nebulized) and oral route was budesonide (69.4%), methylprednisolone sodium succinate (45.31%), fluticasone propionate (19.54%), and prednisone acetate (11.90%), respectively. The in-hospital mortality rate was 1.24% and the mean length of hospitalization was 12.22 ± 6.20 days (± SD). Conclusions: Our study was the first study of the treatment pattern of glucocorticoids in the management of hospitalized AECOPD patients in China. Data indicates that there is a gap in the implementation of international guidelines for the treatment of AECOPD in China. Further studies are warranted to clarify the appropriate glucocorticoids strategy for the management of AECOPD to determine the optimal route of administration, dose and duration, and resulting clinical outcomes.
Factors associated with emotional distress in patients with myocardial infarction: Results from the SWEDEHEART registry
Authors: Norlund Fredrika , Lissåker Claudia , Wallert John , Held Claes , Olsson Erik MG 
Published: April 2018

Background Emotional distress, symptoms of depression and anxiety, is common among patients after a myocardial infarction (MI), and is associated with an increased risk of cardiovascular morbidity. Real world population data on factors associated with emotional distress in MI patients are scarce. The aim was to determine factors associated with incident emotional distress two and 12 months post MI respectively, and with persistent emotional distress, versus remittent, in patients <75 years old. Design This was a registry-based observational study. Methods Data from the national SWEDEHEART registry on 27,267 consecutive patients with a first-time MI, followed up at two and 12 months post MI ( n = 22,911), were included in the analyses. Emotional distress was assessed with the EuroQol-5D questionnaire. Several candidate sociodemographic and clinical factors were analysed for their association with emotional distress in multivariate models. Results Symptoms of emotional distress were prevalent in 38% and 33% at two and 12 months post MI respectively. At both time-points, previous depression and/or anxiety, readmission for new cardiovascular event, female gender, younger age, born outside the neighbouring Nordic countries, smoking and being neither employed nor retired showed the strongest associations with emotional distress. Other factors related to medical history, the MI and its care or were only modestly associated with emotional distress. Persistent emotional distress was associated with younger age, female gender, smoking and being born outside of the Nordic countries. Conclusion Previous depression/anxiety, female gender, younger age, smoking, born outside of the Nordic countries, neither employed nor retired and readmission due to cardiovascular events were strongly associated with emotional distress post MI. These factors may be of relevance in tailoring rehabilitation programmes.
Cardiopulmonary Bypass Reduces Early Thrombosis of Systemic-to-Pulmonary Artery Shunts
Authors: Patregnani Jason T. , Sochet Anthony A. , Zurakowski David , Klugman Darren , Diab Yaser , Berger John T. , Sinha Pranava 
Published: April 2018

Background: Shunt thrombosis is a significant cause of morbidity and mortality after systemic-to-pulmonary artery shunt (SPS) placement. Concurrent procedures with placement of SPS may require cardiopulmonary bypass (CPB). Cardiopulmonary bypass is known to cause bleeding and platelet dysfunction in infants, which may protect from early shunt thrombosis. We hypothesized that infants undergoing SPS placement on CPB have a lower incidence of early shunt thrombosis. Methods: Retrospective cohort study of infants undergoing SPS placement from January 2008 to December 2014 was performed. Patients with and without early shunt thrombosis and on or off CPB were compared using the Mann-Whitney U test or Fisher exact test. Multivariable regression analysis was performed to identify independent predictors of early shunt thrombosis and to assess effect of CPB independent of other factors. Results: Seventy-five infants underwent SPS placement during the study period (on CPB, n = 25; off CPB, n = 50). Operative mortality was 11% (8/75). Nine (12%) patients developed early shunt thrombosis, all of whom had shunt placement off CPB. Independent risk factors for early shunt thrombosis were identified to be SPS placement off CPB ( P = .011), prematurity ( P = .034), and competitive antegrade pulmonary blood flow ( P = .038). Conclusion: Prematurity, competitive antegrade pulmonary blood flow, and shunt placement off CPB lead to higher risk of early shunt thrombosis. We speculate that the protection offered by use of CPB may be accounted for by the associated complex coagulopathy and platelet dysfunction associated with CPB.
Optimal Use of Z-Scores to Preserve the Pulmonary Valve Annulus During Repair of Tetralogy of Fallot
Authors: Awori Mark Nelson , Mehta Nikita P. , Mitema Frederick O. , Kebba Naomi 
Published: April 2018

Objective: The size of the pulmonary annulus measured as a z-score is often used to determine when to insert a transannular patch (TAP). Multiple “cutoffs” are quoted in the literature; this could lead to inappropriate insertion. We aimed to determine whether the use of z-scores derived from different populations may have contributed to the varied “cutoffs” quoted. Methods: PubMed was searched using the terms: “tetralogy,” “Fallot,” “transannular,” “patch,” “mortality,” and “death.” Studies published between January 1, 2005, and October 5, 2017, were included; studies without participants under the age of 18 years and studies that did not describe the operative procedure were excluded. Results: Of 52 papers retrieved, 19 were included representing 2,500 repaired patients; 1,371 (54.8%) had a TAP. Five (26.3%) papers representing 638 patients (25.5%) quoted a z-score “cutoff” and what data set was used; “cutoffs” ranged from −2 to −4 and were derived from 2 different data sets. Three studies quoted a data set that has been shown in previous work to be problematic; the only quoted “cutoffs” of −4 were from two of these studies. Conclusions: Surprisingly few (26.3%) studies mention what pulmonary annulus size “cutoff” was used to decide when to insert a TAP. Z-scores derived from different populations were used by different studies and it is possible that this may have contributed to the varied “cutoffs’ quoted. Recommendations to perform valve-sparing surgery in pulmonary annuli as small as −4 may not be warranted. Future papers should record “cutoffs” employing recommended z-score data set.
Implant Prophylaxis: The Next Best Practice Toward Asepsis in Spine Surgery
Authors: Agarwal Aakash , Schultz Christian , Goel Vijay K. , Agarwal Anand , Anand Neel , Garfin Steve R. , Wang Jeffrey C. 
Published: April 2018

Study Design: A literature review. Objectives: An evaluation of the contaminants prevalent on implants used for surgery and the aseptic methods being employed against them. Methods: PubMed was searched for articles published between 2000 and 2017 for studies evaluating the contaminants present on spine implants, and associated pre- and intraoperative implant processing and handling methodology suggested to avoid them. Systematic reviews, observational studies, bench-top studies, and expert opinions were included. Results: Eleven studies were identified whose major focus was the asepsis of implants to reduce the incidence of surgical site infection incidences during surgery. These studies measured the colony forming units of bacteria on sterilized implants and/or gloves from the surgeon, scrub nurse, and assistants, as well as reductions of surgical site infection rates in spine surgery due to changes in implant handling techniques. Additionally, the search included assessments of endotoxins and carbohydrates present on reprocessed implants. The suggested changes to surgical practice based on these studies included handling implants with only fresh gloves, keeping implants covered until the immediate time of use, reducing operating room traffic, avoiding reprocessing of implants (ie, providing terminally sterilized implants), and avoiding touching the implants altogether. Conclusions: Both reprocessing (preoperative) and handling (intraoperative) of implants seem to lead to contamination of sterilized implants. Using a terminally sterilized device may mitigate reprocessing (preoperative implant prophylaxis), whereas the use of fresh gloves for handling each implant and/or a permanent shielding technique (intraoperative implant prophylaxis) could potentially avoid recontamination at the theatre.
Degenerative Lumbar Spine Disease: Estimating Global Incidence and Worldwide Volume
Authors: Ravindra Vijay M. , Senglaub Steven S. , Rattani Abbas , Dewan Michael C. , Härtl Roger , Bisson Erica , Park Kee B. , Shrime Mark G. 
Published: April 2018

Study Design: Meta-analysis-based calculation. Objectives: Lumbar degenerative spine disease (DSD) is a common cause of disability, yet a reliable measure of its global burden does not exist. We sought to quantify the incidence of lumbar DSD to determine the overall worldwide burden of symptomatic lumbar DSD across World Health Organization regions and World Bank income groups. Methods: We used a meta-analysis to create a single proportion of cases of DSD in patients with low back pain (LBP). Using this information in conjunction with LBP incidence rates, we calculated the global incidence of individuals who have DSD and LBP (ie, their DSD has neurosurgical relevance) based on the Global Burden of Disease 2015 database. Results: We found that 266 million individuals (3.63%) worldwide have DSD and LBP each year; the highest and lowest estimated incidences were found in Europe (5.7%) and Africa (2.4%), respectively. Based on population sizes, low- and middle-income countries have 4 times as many cases as high-income countries. Thirty-nine million individuals (0.53%) worldwide were found to have spondylolisthesis, 403 million (5.5%) individuals worldwide with symptomatic disc degeneration, and 103 million (1.41%) individuals worldwide with spinal stenosis annually. Conclusions: A total of 266 million individuals (3.63%) worldwide were found to have DSD and LBP annually. Significantly, data quality is higher in high-income countries, making overall quantification in low- and middle-income countries less complete. A global effort to address degenerative conditions of the lumbar spine in regions with high demand is important to reduce disability.
Dog Bites in Children: A Descriptive Analysis
Authors: McGuire Connor , Morzycki Alex , Simpson Andrew , Williams Jason , Bezuhly Michael 
Published: April 2018

Objective: To describe characteristics of dog bites and their treatment in a pediatric population including infection, medical specialties involved, rates of admission, and need for surgery. Method: Patients presenting with a dog bite to the emergency department of a tertiary care pediatric hospital between January 1, 2015, and June 30, 2017, were included. Details related to demographics, complications, consultations, and treatment were extracted from the patients’ records. Descriptive statistics were performed and binary logistic regression was used to assess potential predictors of infection. Results: One hundred fifty-eight dog bite patients were identified. Most patients were male (53.8%) and less than 5 years of age (50%). Bites occurred most frequently in June (13.3%) and July (16.5%). The face was most commonly involved (42.9%), followed by the hands (12.6%) and the scalp (26.6%). Pit bulls (11.4%), Labrador retrievers (7.0%), and German shepherds (4.4%) were the most common offending breeds. Most bites were superficial (91.1%). Half were treated conservatively with dressings and petrolatum-based ointment, with 41.1% requiring simple primary closure. Ten (6.3%) cases necessitated primary repair in the main operating room under general anesthesia. More than half of patients were treated with prophylactic systemic antibiotics (55.1%). Plastic surgery was the most common service involved (24.7%). Seven (4.4%) patients developed an infection and there were no mortalities or long-term complications. Rates of infection did not differ between patients who did or did not receive prophylactic systemic antibiotics ( P = .88). Regression analysis revealed no significant predictors of infection. Conclusions: Most dog bites are superficial and involve the head and hands. Infection rate is low, with no significant difference in infection rates between patients treated with or without prophylactic antibiotics.
Are We Over Treating Hand Fractures? Current Practice of Single Metacarpal Fractures
Authors: Retrouvey Helene , Morzycki Alexander , Wang Annie M. Q. ,   The Canadian Plastic Surgery Research Collaborative, Binhammer Paul 
Published: April 2018

Purpose: We conducted a national survey of Canadian plastic surgeons to assess if inconsistencies in management strategies exist for single metacarpal fractures. Methods: A cross-sectional study of Canadian plastic surgeons who perform hand surgeries was conducted. A 15-question survey was distributed to all members of the Canadian Society of Plastic Surgeons. Participants’ demographics, practice settings, and current treatment strategies for patients presenting with single metacarpal fractures were evaluated. Results: A total of 113 Canadian plastic surgeons met inclusion criteria. The majority of respondents were male (76%), with 50% in practice for more than 15 years. Canadian surgeons used a wide variety of surgical techniques for the management of single metacarpal fractures, with close reduction (94%), Kirshner wires (94%), and splinting and immobilization (89%) being the most common. The majority of plastic surgeons stated that rotational deformity (81%) was the most important indication for surgery. Surgeons demonstrated a trend toward immobilization after splinting (48%), instead of early mobilization after splinting (21%). When results were stratified by years in practice, no differences in surgical and non-surgical management were found, although surgeons in practice for less than 15 years were more likely to suggest hand therapy. Conclusion: These findings demonstrate inconsistencies in management of single metacarpal fractures among Canadian plastic surgeons. Surprisingly, surgeons in the survey tended to favor immobilization, as oppose to the literature that favors mobilization. The study highlights the lack of clear guidelines dictating treatment, possibly leading to these inconsistencies.
Clinical and laboratory profile of juvenile-onset systemic sclerosis in a Brazilian cohort
Authors: Sampaio-Barros Percival D , Bortoluzzo Adriana B , Del Rio Ana Paula T , Luppino-Assad Ana Paula , Andrade Danieli CO , Marques-Neto João Francisco 
Published: April 2018

Objective: To characterize the clinical and laboratory profile of juvenile-onset compared to adult-onset systemic sclerosis in a large Brazilian cohort. Methods: Retrospective analysis of a cohort of 1016 systemic sclerosis patients followed at the Scleroderma Outpatient Clinic from two referral university centers in Brazil. Patients were classified as systemic sclerosis according to the 1980 American College of Rhaumatology (ACR) criteria. Juvenile-onset systemic sclerosis was defined if age at onset was <16 years. Results: Thirty-one (3.1%) patients were classified as juvenile-onset systemic sclerosis. These patients were predominantly females (90.3%), Caucasians (71.0%), and presented diffuse systemic sclerosis (51.6%), with mean age at onset of 12.71 years. Compared to the adult-onset patients, juvenile onset was associated with diffuse systemic sclerosis (p < 0.001), calcinosis (p < 0.001), myositis (p = 0.050), and lower frequency of interstitial lung disease (p = 0.050), pulmonary hypertension (p = 0.035), and esophageal (p = 0.005) involvement. Conclusion: Juvenile-onset systemic sclerosis characterized a distinct clinical pattern in this large series of systemic sclerosis patients, since it was predominantly associated with diffuse systemic sclerosis without significant organ involvement.
Interface between general adult and old age psychiatry
Authors: Khrypunov Oleksandr , Aziz Raheel , Al-Kaissy Ban , Jethwa Ketan , Joseph Verghese 
Published: April 2018

SUMMARYOlder people with mental health problems are entitled to the same level and quality of care as younger people. Several factors continue to influence policy and delivery of older adults' mental health services in the UK. Following the introduction of the Equality Act 2010, there has been a drive to create an ‘ageless’ National Health Service. This has opened up the debate about whether such a service is best equipped to meet the specific needs of older adults. In this contribution we consider the concepts of ‘old age’ and ‘frailty’ and their clinical and service provision implications in psychiatry. The management of late-life depression and early-onset dementia, advance care planning and palliation in dementia are also considered.LEARNING OBJECTIVES•Appreciate how old age psychiatric services and the concept of ‘old age’ have evolved over time•Gain an understanding of issues at the interface between old age and general adult psychiatry and those specific to old age psychiatry•Gain an overview of procedures involved in transferring care between general adult and old age psychiatric services and the need for a separate old age psychiatry subspecialtyDECLARATION OF INTERESTNone.
Liaison psychiatry: heart and lung transplantation
Authors: Sheehan John D. 
Published: April 2018

SUMMARYOwing to the continuing shortage of organs, the demand for transplantation outstrips supply. Liaison psychiatrists, as part of a multidisciplinary team, have a key role in the assessment of transplant candidates and participate in the decision-making process regarding ‘listing’ the patient for transplantation. Psychiatric and psychosocial factors affect prognosis post-transplantation and there are absolute and relative contraindications to transplantation. The skills of the liaison psychiatrist are employed throughout the patient's illness journey, in the pre-, peri- and post-transplantation periods.LEARNING OBJECTIVES•Learn the salient factors in a pre-transplantation psychosocial assessment•Know the contraindications to transplantation•Appreciate the factors associated with a poor outcome post-transplantationDECLARATION OF INTERESTNone.
Klimaschutz lokal
Authors: Rudolph Sven , Kawakatsu Takeshi 
Published: April 2018

Während Japan im internationalen Klimaschutz derzeit auf der Bremse steht, geht Tokyo einen innovativen Weg. Seit dem Jahr 2010 läuft dort das erste städtische CO2-Emissionshandelssystem. Die ersten Erfahrungen zeigen Stärken und Schwächen.
Impact of the Solar Irradiation Angle on the Work of Modules with Spherical Cells - Simulation
Authors: Rodziewicz Tadeusz , Nakata Josuke , Taira Kenichi , Zaremba Aleksander , Wacławek Maria 
Published: April 2018

Abstract
The main purpose of all PV modules is to convert solar energy into electricity, but in the era of building integrated photovoltaics, there are additional opportunities to use them. The use of them as a composite of architectural structures in the form of facade cladding, roofing, stained glass windows or noise barriers on highways, in addition to generating electricity embellish also the aesthetic value of the facilities. However, these atypical their use, cause that the modules should have quite different properties then in the traditional application, which is related to their unusual way of positioning. Particularly for structures such as the modules made of spherical cells with the two active planes of operation. The article presents a comparison of the results of simulation of module with two active surfaces containing spherical solar cells in an open space in relation to a typical flat photovoltaic module. A comparison of its work with different orientation and inclination. Article shows the basic difference in its properties occurring at some settings in relation to a typical module and makes predictions about its future use.
Reservoir’s Impact on the Water Chemistry of the Teesta River Mountain Course (Darjeeling Himalaya)
Authors: Wiejaczka Łukasz , Prokop Paweł , Kozłowski Rafał , Sarkar Subir 
Published: April 2018

Abstract
The article presents the role of the newly built reservoir in the formation of the hydrochemistry of water of the Teesta River (a tributary of the Brahmaputra) in its Himalayan course. Field research were performed in the post-monsoon season of the period 2013-2015. Sampling and measuring points were located in five points over 43 km of the Teesta River in the Darjeeling Himalaya. Analysis of water along of river longitudinal profile above and below the reservoir suggest that the reservoir caused decrease most of the basic ions concentrations (Cl−, K+, Na+, Mg2+, NO3
− and PO4
3−). An inverse trend was observed only with respect to Ca2+, SO4
2− and NH4
+. The dam does not influent on the F− concentration. The reservoir causes minor enrichment most of the heavy metals such Cu, Ni, Zn, Cr, Cd and Sr. The lower enrichment of Teesta water below the dam indicates the water self-purification processes for metals by the Teesta Reservoir. The changes of physicochemical properties and concentrations of ions caused by the reservoir are usually normalised by environmental factors before the Teesta River outlet from the Himalayas (within 15 km of the river).