bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study*
Authors: Roberts Brian W. , Kilgannon J. Hope , Hunter Benton R. , Puskarich Michael A. , Shea Lisa , Donnino Michael , Jones Christopher , Fuller Brian M. , Kline Jeffrey A. , Jones Alan E. , Shapiro Nathan I. , Abella Benjamin S. , Trzeciak Stephen 
Published: October 2018

Objectives:
Laboratory studies suggest elevated blood pressure after resuscitation from cardiac arrest may be protective; however, clinical data are limited. We sought to test the hypothesis that elevated postresuscitation mean arterial blood pressure is associated with neurologic outcome.

Design:
Preplanned analysis of a prospective cohort study.

Setting:
Six academic hospitals in the United States.

Patients:
Adult, nontraumatic cardiac arrest patients treated with targeted temperature management after return of spontaneous circulation.

Interventions:
Mean arterial blood pressure was measured noninvasively after return of spontaneous circulation and every hour during the initial 6 hours after return of spontaneous circulation.

Measures and Main Results:
We calculated the mean arterial blood pressure and a priori dichotomized subjects into two groups: mean arterial blood pressure 70–90 and greater than 90 mm Hg. The primary outcome was good neurologic function, defined as a modified Rankin Scale less than or equal to 3. The modified Rankin Scale was prospectively determined at hospital discharge. Of the 269 patients included, 159 (59%) had a mean arterial blood pressure greater than 90 mm Hg. Good neurologic function at hospital discharge occurred in 30% of patients in the entire cohort and was significantly higher in patients with a mean arterial blood pressure greater than 90 mm Hg (42%) as compared with mean arterial blood pressure 70–90 mm Hg (15%) (absolute risk difference, 27%; 95% CI, 17–37%). In a multivariable Poisson regression model adjusting for potential confounders, mean arterial blood pressure greater than 90 mm Hg was associated with good neurologic function (adjusted relative risk, 2.46; 95% CI; 2.09–2.88). Over ascending ranges of mean arterial blood pressure, there was a dose-response increase in probability of good neurologic outcome, with mean arterial blood pressure greater than 110 mm Hg having the strongest association (adjusted relative risk, 2.97; 95% CI, 1.86–4.76).

Conclusions:
Elevated blood pressure during the initial 6 hours after resuscitation from cardiac arrest was independently associated with good neurologic function at hospital discharge. Further investigation is warranted to determine if targeting an elevated mean arterial blood pressure would improve neurologic outcome after cardiac arrest.
OCULAR HYPERTENSION AFTER INTRAVITREAL INJECTION OF 2-MG TRIAMCINOLONE
Authors: Storey Philip P. , Obeid Anthony , Pancholy Maitri , Goodman Jake , Borkar Durga , Su Daniel , Regillo Carl 
Published: October 2018

Purpose:
To report the incidence and course of ocular hypertension after intravitreal injection of 2-mg triamcinolone acetonide (IVT).

Methods:
In a retrospective, consecutive series, all patients receiving 2-mg IVT at a single institution between March 1, 2012, and March 1, 2017, with a minimum of 3-month follow-up were reviewed. Ocular hypertension was defined as an intraocular pressure (IOP) measurement over 24 mmHg at any follow-up visit after IVT. Patients receiving topical, periocular, or intravitreal corticosteroid other than 2-mg IVT were excluded.

Results:
A total of 106 eyes in 100 patients receiving at least one injection of 2-mg IVT were included. Eyes received an average of 2.9 injections (range 1–17), and average patient follow-up was 15.1 months (range 3.0–52.5 months). A total of 14 eyes (13.2%) in 14 patients developed ocular hypertension after a median of 1.5 injections (range 1–9) with an average peak IOP of 29 mmHg (range 25–38 mmHg). Overall, a total of 11 eyes (10.4%) had an IOP elevation ≥10 mmHg above baseline at any point after first IVT. In all cases of ocular hypertension, IOP was successfully managed with observation or topical IOP-lowering medication alone; no patients required surgical intervention.

Conclusion:
Ocular hypertension developed in 13.2% of eyes receiving intravitreal injection of 2-mg triamcinolone acetonide. Incidence of ocular hypertension after 2-mg IVT compares favorably with other intravitreally administered corticosteroids.
IDIOPATHIC FULL-THICKNESS MACULAR HOLE IN AN 8-YEAR-OLD BOY
Authors: Manayath George J. , Jain Arvind , Ranjan Ratnesh , Naik Adarsh S. , Narendran Vekatapathy 
Published: October 2018

Purpose:
To report a case of idiopathic full-thickness macular hole in a young boy, which was managed surgically with good visual and anatomical outcomes.

Method:
Single case report.

Results:
An 8-year-old boy presented for defective vision in the left eye noticed for the past 2 weeks with best-corrected visual acuity of 6/24. A large full-thickness macular hole was diagnosed clinically and was confirmed on optical coherence tomography. There was no clinical or tomographic findings suggestive of trauma or retinal degeneration. After observation for 8 weeks, the patient underwent macular hole surgery in the left eye including internal limiting membrane peeling and C3F8 gas tamponade. Intraoperatively abnormally tight vitreoretinal adherence was noted during the induction of posterior vitreous detachment. Optical coherence tomography at 1 month after surgery showed decrease in the size of macular hole suggestive of incomplete closure. Repeat optical coherence tomography at 3 months showed closed macular hole with mild foveal thinning and ellipsoid zone discontinuity with best-corrected visual acuity improving to 6/18. The tomographic features and best-corrected visual acuity remained stable at 6-month follow-up.

Conclusion:
We hereby report the first case, to the best of our knowledge, of a truly idiopathic full-thickness macular hole in an 8-year-old boy. Surgical treatment offers the best outcomes in these cases and should be considered at the earliest without waiting for spontaneous closure unlike in the case of traumatic full-thickness macular hole.
Detection of Lipid Mediators of Inflammation in the Human Tear Film
Authors: Panthi Shyam , Chen Jianzhong , Wilson Landon , Nichols Jason J. 
Published: October 2018

Purpose:
Lipid mediators of inflammation are a group of signaling molecules produced by various cells under physiological conditions and modulate the inflammatory process during various pathologic conditions. Although eicosanoids and F2-isoprostanes are recognized lipid mediators of inflammation, there is no consensus yet on the extraction and mass spectrometry (MS) method for their analysis in individual human tear samples. Thus, the aim of this study was to develop an optimal method for extraction of lipid mediators of inflammation in the tear film and evaluate MS techniques for their analysis.

Methods:
Basal tears were collected from each eye of 19 subjects using glass microcapillaries. Lipid extraction was performed using either varying concentrations of acidified methanol, a modified Folch method, or solid-phase extraction. Initially, an untargeted analysis of the extracts was performed using SCIEX TripleTOF 5600 mass spectrometer to identify any lipid mediators of inflammation (eicosanoids) and later a targeted analysis was performed using the SCIEX 6500 Qtrap to identify and quantify prostaglandins and isoprostanes. Mass spectra and chromatograms were analyzed using Peakview, XCMS, and Multiquant software.

Results:
Prostaglandins and isoprostanes were observed and quantified using the Qtrap mass spectrometer under multiple reaction monitoring (MRM) mode after solid-phase extraction. Extraction with acidified methanol along with the Folch method produced cleaner spectra during MS with the Triple time of flight (TOF) mass spectrometer. Lipid mediators of inflammation were not observed in any of the tear samples using the Triple TOF mass spectrometer.

Conclusions:
Solid-phase extraction may be the method of choice for extraction of prostaglandins and isoprostanes in low volumes of tears. The SCIEX Qtrap 6500 in MRM mode may be suitable to identify and quantify similar lipid mediators of inflammation.
Methylenedioxymethamphetamine (MDMA) in Psychiatry
Authors: Schenk Susan , Newcombe David 
Published: October 2018

Abstract

Background
For a number of mental health disorders, including posttraumatic stress disorders (PTSD), there are not many available treatment options. Recently, there has been renewed interest in the potential of methylenedioxymethamphetamine (MDMA) to restore function for patients with these disorders. The primary hypothesis is that MDMA, via prosocial effects, increases the ability of patients to address the underlying psychopathology of the disorder. However, the use of MDMA poses potential problems of neurotoxicity, in addition to its own potential for misuse.

Methods
In this article, the proposed potential of MDMA as an adjunct to psychotherapy for PTSD is evaluated. The rationale for the use of MDMA and the positive results of studies that have administered MDMA in the treatment of PTSD are provided (pros). A description of potential adverse effects of treatment is also presented (cons). An overview of MDMA pharmacology and pharmacokinetics and a description of potential adverse effects of treatments are also presented. Methylenedioxymethamphetamine-produced oxytocin release and decreased expression of fear conditioning as well as one of the MDMA enantiomers (the n R− entaniomer) are suggested as potential mechanisms for the beneficial effects of MDMA in PTSD (suggestions).

Results
There is some evidence that MDMA facilitates recovery of PTSD. However, the significant adverse effects of MDMA raise concern for its adoption as a pharmacotherapy. Alternative potential treatments with less adverse effects and that are based on the ubiquitous pharmacology of MDMA are presented.

Conclusions
We suggest that additional research investigating the basis for the putative beneficial effects of MDMA might reveal an effective treatment with fewer adverse effects. Suggestions of alternative treatments based on the behavioral pharmacology and toxicology of MDMA and its enantiomers are presented.
Who is a high-risk surgical patient?
Authors: Bose Somnath , Talmor Daniel 
Published: October 2018

Purpose of review
Timely identification of high-risk surgical candidates facilitate surgical decision-making and allows appropriate tailoring of perioperative management strategies. This review aims to summarize the recent advances in perioperative risk stratification.

Recent findings
Use of indices which include various combinations of preoperative and postoperative variables remain the most commonly used risk-stratification strategy. Incorporation of biomarkers (troponin and natriuretic peptides), comprehensive objective assessment of functional capacity, and frailty into the current framework enhance perioperative risk estimation. Intraoperative hemodynamic parameters can provide further signals towards identifying patients at risk of adverse postoperative outcomes. Implementation of machine-learning algorithms is showing promising results in real-time forecasting of perioperative outcomes.

Summary
Perioperative risk estimation is multidimensional including validated indices, biomarkers, functional capacity estimation, and intraoperative hemodynamics. Identification and implementation of targeted strategies which mitigate predicted risk remains a greater challenge.
Left main coronary artery atresia with concomitant mitral regurgitation in an adult
Authors: Tian Meice , Wang Xianqiang , Gao Huawei , Wang Liqing , Hu Shengshou 
Published: October 2018

Abstract

Introduction:
Left main coronary artery (LMCA) atresia is a quite rare congenital malformation, which may present with various symptoms. Past literatures were sporadic without recent summary of world-wide cases. We hereby report an adult case of LMCA atresia with concomitant mitral regurgitation and also summarize all cases found in published literatures.

Case presentation:
A 48-year old female presented with sudden dyspnea. Preliminary impression was acute heart failure caused by mitral regurgitation. Preoperative coronary angiography demonstrated that there was no left coronary ostium and multiple collateral vessels arising from right coronary artery. The diagnosis of left main coronary atresia was made and the patient received successful valvuloplasty and coronary artery bypass grafting with left internal mammary artery anastomosed to the left anterior descending (LAD) artery. She recovered well and 3-month follow-up showed the graft was patent.

Conclusion:
This case highlights the importance of angiography for diagnosis of LMCA and performance of CABG once diagnosed.
The prognostic value of decreased NDRG1 expression in patients with digestive system cancers
Authors: Chen Kang , Liu Xiao-Hong , Wang Fu-Rong , Liu Hai-Peng , Huang Ze-Ping , Chen Xiao 
Published: October 2018

Abstract

Background:
Digestive system cancers are recognized as associated with high morbidity and mortality. It is generally accepted that N-myc downstream-regulated gene 1 (NDRG1) is aberrantly overexpressed or downregulated in digestive system cancers, and its prognostic value remains controversial. Accordingly, we herein conducted a meta-analysis to explore whether NDRG1 expression is correlated with overall survival (OS) and clinicopathological characteristics of patients with digestive system cancers.

Methods:
We systematically searched PubMed, EMBASE, and Web of Science for eligible studies up to June 6, 2017. In all, 19 publications with 21 studies, were included.

Results:
The pooled results showed that low NDRG1 expression was significantly associated with worse OS in colorectal cancer (pooled HR = 1.67, 95% CI: 1.22–2.28, P < .001) and pancreatic cancer (pooled HR = 1.87, 95% CI: 1–3.5, P < .0001). Moreover, the relationships between low NDRG1 expression and higher OS ratio of patients with liver cancer (pooled HR = 0.44, 95% CI: 0.32–0.62, P = .009) and gallbladder cancer (pooled HR = 0.56, 95% CI: 0.23–1.38, P = .01) were observed. Nevertheless, no significant association was observed between low NDRG1 expression and OS in gastric cancer (pooled HR = 0.81, 95% CI: 0.45–1.43, P = .46) or esophageal cancer (pooled HR = 0.76, 95% CI: 0.26–2.24, P = .62).

Conclusion:
The prognostic significance of NDRG1 expression varies according to cancer type in patients with DSCs. Considering that several limitations existed in this meta-analysis, more studies are required to further assess the prognostic value of NDRG1 expression in patients with DSCs and relevant mechanisms.
Oral health condition and occurrence of depression in the elderly
Authors: Skośkiewicz-Malinowska Katarzyna , Malicka Barbara , Ziętek Marek , Kaczmarek Urszula 
Published: October 2018

Abstract
Depression is a common disorder among the elderly; however, it is not a standard element of the ageing process. Depression can affect oral health as a result of neglecting oral hygiene procedures, cariogenic nutrition, avoidance of necessary dental care which leads to an increased risk of dental caries and periodontal disease.
Assessment of the relationship of oral health parameters with depression.
500 subjects aged ≥65 (mean 74.4 ± 7.4) were involved in the study. Dental condition (decay-missing-filled index [DMFT], number of missing teeth [MT], removable denture wearing, teeth mobility), periodontal condition (bleeding on probing [BoP], pocket depth [PD], loss of attachment), oral dryness (the Challacombe Scale) and depression according to the Patient Health Questionnaire-9 (PHQ-9) scale were assessed.
Depression on a minimal level was detected in 60.2% of the subjects, mild—in 22.2%, moderate—in 6.0% and moderately—in 2.6%. The mean of the PHQ-9 scale was 3.56 ± 4.07. Regression analysis showed a positive relationship of the PHQ-9 value with DMFT, the number of MT, oral dryness and with age. No correlation was observed between other examined oral health indicators, such as periodontal condition (BoP, PD, clinical attachment level), periodontitis, removable denture wearing a PHQ-9.
The results of our study have shown that among people aged 65 and over, the severity of depression increases with a higher number of MT, the number of decayed teeth, as well as prevalence of oral dryness.
Percutaneous versus open pedicle screw instrumentation in treatment of thoracic and lumbar spine fractures
Authors: Tian Feng , Tu Lai-Yong , Gu Wen-Fei , Zhang En-Feng , Wang Zhen-Bin , Chu Ge , Ka Haer , Zhao Jiang 
Published: October 2018

AbstractBackground:To assess the safety and efficacy of percutaneous short-segment pedicle instrumentation compared with conventionally open short-segment pedicle instrumentation and provide recommendations for using these procedures to treat thoracolumbar fractures.Methods:The Medline database, Cochrane database of Systematic Reviews, Cochrane Clinical Trial Register, and Embase were searched for articles published. The randomized controlled trials (RCTs) and non-RCTs that compared percutaneous short-segment pedicle instrumentation to open short-segment pedicle instrumentation and provided data on safety and clinical effects were included. Demographic characteristics, clinical outcomes, radiological outcomes, and adverse events were manually extracted from all of the selected studies. Methodological quality of included studies using Methodological Index for Non-Randomized Studies scale and Cochrane collaboration's tool for assessing the risk of bias by 2 reviewers independently.Results:Nine studies encompassing 433 patients met the inclusion criteria. Subgroup meta-analyses were performed according to the study design. The pooled results showed there were significant differences between the 2 techniques in short- and long-term visual analog scale, intraoperative blood loss, operative time, postoperative draining loss, hospital stay, and incision size, although there were no significant differences in postoperative radiological outcomes, Oswestry Disability Index, hospitalization cost, intraoperative fluoroscopy time, and adverse events.Conclusion:Percutaneous short-segment pedicle instrumentation in cases with achieve satisfactory results, could replace in many cases extensive open surgery and not increased related complications. However, further high-quality RCTs are needed to assess the long-term outcome of patients between 2 techniques.
Diffuse optical spectroscopy for monitoring the responses of patients with breast cancer to neoadjuvant chemotherapy
Authors: Liu Yong Hong , Xue Ling Bo , Yang Yan Fang , Zhao Tian Jiao , Bai Yang , Zhang Bu Yong , Li Jie 
Published: October 2018

Abstract

Background:
This study aimed to investigate the potential of diffuse optical spectroscopy (DOT) for monitoring the responses of patients with breast cancer to neoadjuvant chemotherapy (NAC).

Methods:
We searched PubMed, EMBASE, Cochrane Database of Systematic Reviews, and Web of Science for relevant studies. Data were extracted for pooled analysis, heterogeneity testing, threshold effect testing, sensitivity analysis, publication bias analysis, and subgroup analysis.

Results:
The pooled meta-analysis of the 10 eligible studies that included 422 patients indicated the high performance of DOT for monitoring total patient responses to NAC (OR = 14.78, 95% CI: 8.23–26.54, P < .001), with low significant heterogeneity (I
2 = 7.2%, P = .375). DOT possessed an area under the curve of 0.84 (95% CI: 0.81–0.87) to distinguish total patient responses to NAC. Subgroup analysis showed that the pooled sensitivity of DOT for monitoring pathologic complete response to NAC was 87%, and the pooled specificity was 70%. Meanwhile, the pooled sensitivity of DOT for monitoring pathologic complete and partial responses to NAC was 82%, and the pooled specificity was 82%. Although Begg's funnel plot (P = .049) indicated the presence of publication bias among the included studies, trim-and-fill method verified the stability of the pooled outcomes.

Conclusion:
Our meta-analysis of available published data indicated that DOT can be potentially used to predict and monitor patient responses to NAC. A larger study population is needed to fully assess the use of DOT for guiding therapies and predicting responses of individual subjects to NAC.
Granulomatous lymphadenitis mimicking metastatic lymphadenopathy in the neck after lymphatic embolization of chyle leakage
Authors: Ryu Kyeong Hwa , Baek Hye Jin , Cho Soo Buem , An Hyo Jung , Kim Jin Pyeong 
Published: October 2018

Abstract

Rationale:
Lymphatic embolization is a minimally invasive treatment option for managing chyle leakage after nodal dissection in the neck. After the procedure, the embolic material may cause foreign body granulomatous lymphadenitis and can be a diagnostic challenge for radiologists because of sonographic similarity to metastatic lymph node. Herein, we describe a clinical case of granulomatous lymphadenitis due to embolic material mimicking nodal metastasis detected on ultrasonography (US) with cytologic findings in a patient with thyroid cancer who underwent lymphatic embolization to treat chyle leakage after total thyroidectomy and neck dissection. We also review the relevant literature regarding this disease with technical background of the procedure and suggest the importance of clinical suspicion in diagnosing the granulomatous lymphadenitis in patients with a history of lymphatic embolization.

Patient concerns:
A 40-year-old man who underwent total thyroidectomy and bilateral modified radical neck dissection due to papillary thyroid carcinoma had suspicious cervical lymph node on US after lymphatic embolization of chyle leakage.

Diagnoses:
The suspicious cervical lymph node proved to be foreign body granulomatous lymphadenitis due to embolic material by US-guided fine-needle aspiration.

Interventions:
The patient did not undergone additional surgery because the pathologic cervical lymph node was confirmed to be foreign body granulomatous lymphadenitis.

Outcomes:
The patient is being followed up regularly at the outpatient department.

Lessons:
Clinical awareness of the technical background of lymphatic embolization and possible sonographic features of granulomatous lymphadenitis is important for an accurate diagnosis and the appropriate management in patients who underwent lymphatic embolization.