bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mild Hypothermia Is Ineffective to Protect Against Myocardial Injury Induced by Chemical Anoxia or Forced Calcium Overload
Authors: Kawada Toru , Yamazaki Toji , Akiyama Tsuyoshi , Hayama Yohsuke , Sugimachi Masaru 
Published: December 2018

Abstract:
Although hypothermia suppresses myocardial ischemia/reperfusion injury, whether it also protects the myocardium against cellular stresses such as chemical anoxia and calcium overload remains unknown. We examined the effect of mild hypothermia (33°C) on myocardial injury during ischemia/reperfusion, local administration of sodium cyanide (chemical anoxia), or local administration of maitotoxin (forced Ca2+ overload) using cardiac microdialysis applied to the feline left ventricle. Baseline myoglobin levels (in ng/mL) were 237 ± 57 and 150 ± 46 under normothermia and hypothermia, respectively (mean ± SE, n = 6 probes each). Coronary artery occlusion increased the myoglobin level to 2600 ± 424 under normothermia, which was suppressed to 1160 ± 149 under hypothermia (P < 0.05). Reperfusion further increased the myoglobin level to 6790 ± 1550 under normothermia, which was also suppressed to 2060 ± 343 under hypothermia (P < 0.05). By contrast, hypothermia did not affect the cyanide-induced myoglobin release (930 ± 130 vs. 912 ± 62, n = 6 probes each) or the maitotoxin-induced myoglobin release (2070 ± 511 vs. 2110 ± 567, n = 6 probes each). In conclusion, mild hypothermia does not make the myocardium resistant to cellular stresses such as chemical anoxia and forced Ca2+ overload.
SEROUS MACULAR DETACHMENT ASSOCIATED WITH WALDENSTROM MACROGLOBULINEMIA MANAGED WITH IBRUTINIB: A CASE REPORT AND NEW INSIGHTS INTO PATHOGENESIS
Authors: Leskov Ilya , Knezevic Alexander , Gill Manjot K. 
Published: December 2018

Purpose:
To report a case of serous macular detachment in a patient with Waldenstrom macroglobulinemia treated with ibrutinib.

Methods:
The patient underwent a complete ophthalmic examination and imaging at presentation and at follow-up visits up to 13 months.

Results:
At presentation, there were serous macular detachments bilaterally with no dye leakage on fluorescein angiography or vasculature abnormalities on optical coherence tomography angiography. After treatment with ibrutinib, there was near resolution of the patient's retinopathy with an improvement in vision at 13 months' follow-up.

Conclusion:
Serous macular detachments in Waldenstrom macroglobulinemia–associated retinopathy may be due to the disruption of the retinal pigment epithelium pump mechanism by hyperglobulinemia. The favorable course of this patient, treated with the novel tyrosine kinase inhibitor ibrutinib, suggests this may be the preferred treatment for Waldenstrom macroglobulinemia patients with associated retinopathy.
QTc Prolongation Associated With Psychiatric Medications
Authors: Shao Wanda , Ayub Shehzad , Drutel Robert , Heise William C. , Gerkin Richard 
Published: December 2018

Abstract

Objective
The aim of our study was to assess the impact of psychiatric medications and concomitant risk factors on the prevalence of QTc prolongation and torsades de pointes (TdP) in hospitalized subjects. We examined the association between individual risk scores and QTc prolongation and proposed an evidence-based protocol for electrocardiogram monitoring on psychotropic medications.

Method
Electrocardiograms (ECGs) of subjects hospitalized over a 1-year period were analyzed for QTc prolongation, associated risk factors, and use of medications. Analysis was performed using logistic regression to identify independent predictors of QTc prolongation, and the Pearson χ2 test was used for risk score assessment.

Results
A total of 1249 ECGs of 517 subjects were included in this study. Eighty-seven subjects had QTcB intervals greater than 470 milliseconds for females and greater than 450 milliseconds for males. Twelve (2.3%) subjects had QTcB of 500 milliseconds or greater, or greater than 60 milliseconds of change from baseline. Of these subjects, only 1 case of QTc interval change was related to routine use of psychiatric medications. There were no incidents of TdP. Age, diabetes, hypokalemia, overdose, diphenhydramine, and haloperidol were significant independent predictors of QTc prolongation. Risk scores were significantly correlated with QTc prolongation (P = 0.001).

Conclusion
Our retrospective review study found that the occurrence of TdP and QTc prolongation was low in this subject population. QT abnormalities were associated with known risk factors, and risk scores correlated well with QTc prolongation. Providers can use the protocol proposed in this study, which incorporates risk scores and the CredibleMeds classification system to determine the need for ECG monitoring and to guide treatment.
Rupture of the Patellar Tendon After Platelet-Rich Plasma Treatment: A Case Report
Authors: Redler Andrea , Proietti Lorenzo , Mazza Daniele , Koverech Guido , Vadala Antonio , De Carli Angelo , Ferretti Andrea 
Published: December 2018

Introduction:
Rupture of the patellar tendon is becoming more and more frequent, even in sports activities overloading the extensor mechanism of the knee. Platelet-rich plasma (PRP) treatment has been recently introduced in treatment for several knee- and sport-related injuries including muscle strain cartilage defect and tendinopathies. The aim of this case report is to present a case of rupture of the patellar tendon occurred after injections of PRP.

Case Report:
A case of a 40-year-old male soccer player sustaining a patellar tendon rupture after a series of 4 PRP injections. At surgery, a complete rupture in the middle of the patellar tendon was found, with severe degenerative changes of the tendon tissue. This case questions the actual efficacy and safety of PRP in severe degenerative tendinopathies.
New stimulant formulations for pediatric attention-deficit/hyperactivity disorder: a case-based approach for the primary care provider
Authors: Partain Paige I. , White Jacob , Hammerness Paul 
Published: December 2018

Purpose of review
To provide an up-to-date clinical review of U.S. Food and Drug Administration (FDA)-approved stimulant medications for attention-deficit/hyperactivity disorder (ADHD), including a framework for individualized treatment by primary care pediatric providers.

Recent findings
Stimulant medications are first-line agents for pediatric ADHD. Since 2012, 11 novel stimulant medications have been approved by the FDA for the treatment of ADHD. Because of an expanded formulary of available methylphenidate-based and amphetamine-based stimulants, primary care providers may be unfamiliar with some novel medications outside a select formulary.

Summary
The current broad formulary of methylphenidate-based and amphetamine-based stimulants provides primary care clinicians with a greater opportunity for personalized medicine within the patient-centered medical home. Through a systematic review of prior relevant medication trials, a consideration of daily symptom burden and thoughtful pragmatics, primary care providers can offer a more precise, customized stimulant treatment.
Tibial spine avulsion fractures: treatment update
Authors: Tuca Maria , Bernal Nazira , Luderowski Eva , Green Daniel W. 
Published: December 2018

Purpose of review
The purpose of this review is to summarize and clarify the current framework for treating tibial spine avulsion fractures (TSAFs). We will discuss how these fractures are classified both on plain radiographs and MRI as well as report the incidence of concomitant soft tissue injury, an important consideration that guides treatment. We will also compare guidelines for nonsurgical versus surgical treatment and summarize frequently used surgical techniques. Finally, we will review outcomes following treatment, including common complications.

Recent findings
Although TSAFs only constitute 2–5% of all pediatric knee injuries, the incidence is increasing. A recently developed MRI-based system for evaluating TSAFs is another tool that aids in the treatment of these injuries.

Summary
TSAFs can be classified using plain radiographs as well as MRI. Type I fractures are usually treated with immobilization whereas type II fractures typically undergo an initial attempt at closed reduction followed by arthroscopic or open reduction and fixation if needed. Type III fractures are indicated directly for arthroscopic surgery and both suture and screw fixation produce good clinical outcomes. All-epiphyseal or transphyseal approaches can minimize the risk of physeal injury in skeletally immature patients. Common complications following TSAF injury and treatment are residual laxity, knee stiffness, and nonunion or malunion.
Mortality Risk in Homebound Older Adults Predicted From Routinely Collected Nursing Data
Authors: Sullivan Suzanne S. , Hewner Sharon , Chandola Varun , Westra Bonnie L. 
Published: December 2018

Background
Newer analytic approaches for developing predictive models provide a method of creating decision support to translate findings into practice.

Objectives
The aim of this study was to develop and validate a clinically interpretable predictive model for 12-month mortality risk among community-dwelling older adults. This is done by using routinely collected nursing assessment data to aide homecare nurses in identifying older adults who are at risk for decline, providing an opportunity to develop care plans that support patient and family goals for care.

Methods
A retrospective secondary analysis of Medicare and Medicaid data of 635,590 Outcome and Assessment Information Set (OASIS-C) start-of-care assessments from January 1, 2012, to December 31, 2012, was linked to the Master Beneficiary Summary File (2012–2013) for date of death. The decision tree was benchmarked against gold standards for predictive modeling, logistic regression, and artificial neural network (ANN). The models underwent k-fold cross-validation and were compared using area under the curve (AUC) and other data science metrics, including Matthews correlation coefficient (MCC).

Results
Decision tree variables associated with 12-month mortality risk included OASIS items: age, (M1034) overall status, (M1800–M1890) activities of daily living total score, cancer, frailty, (M1410) oxygen, and (M2020) oral medication management. The final models had good discrimination: decision tree, AUC = .71, 95% confidence interval (CI) [.705, .712], sensitivity = .73, specificity = .58, MCC = .31; ANN, AUC = .74, 95% CI [.74, .74], sensitivity = .68, specificity = .68, MCC = .35; and logistic regression, AUC = .74, 95% CI [.735, .742], sensitivity = .64, specificity = .70, MCC = .35.

Discussion
The AUC and 95% CI for the decision tree are slightly less accurate than logistic regression and ANN; however, the decision tree was more accurate in detecting mortality. The OASIS data set was useful to predict 12-month mortality risk. The decision tree is an interpretable predictive model developed from routinely collected nursing data that may be incorporated into a decision support tool to identify older adults at risk for death.
Determinants of Dual-Task Training Effect Size in Parkinson Disease: Who Will Benefit Most?
Authors: Strouwen Carolien , Molenaar Esther A. L. M. , Münks Liesbeth , Broeder Sanne , Ginis Pieter , Bloem Bastiaan R. , Nieuwboer Alice , Heremans Elke 
Published: December 2018

Background and Purpose:
Dual-task interventions show positive effects in people with Parkinson disease (PD), but it remains unclear which factors determine the size of these benefits. As a secondary analysis of the DUALITY trial, the aim of this study was to assess the determinants of the effect size after 2 types of dual-task practice.

Methods:
We randomly allocated 121 participants with PD to receive either integrated or consecutive dual-task training. Dual-task walking performance was assessed during (i) a backward digit span task (digit), (ii) an auditory Stroop task (Stroop), and (iii) a functional mobile phone task. Baseline descriptive, motor, and cognitive variables were correlated with the change in dual-task gait velocity after the intervention. Factors correlated with the change in dual-task gait velocity postintervention (P < 0.20) were entered into a stepwise forward multiple linear regression model.

Results:
Lower dual-task gait velocity and higher cognitive capacity (Scales for Outcomes in Parkinson's Disease-Cognition [ScopaCog]) at baseline were related to larger improvements in dual-task gait velocity after both integrated and consecutive dual-task training for all 3 tasks (β[gait] = −0.45, β[ScopaCog] = 0.34, R
2 = 0.23, P < 0.001, for digit; β[gait] = −0.52, β[ScopaCog] = 0.29, R
2 = 0.26, P < 0.001, for Stroop; and β[gait] = −0.40, β[ScopaCog] = 0.30, R
2 = 0.18, P < 0.001, for mobile phone task).

Discussion and Conclusions:
Participants with PD who showed a slow dual-task gait velocity and good cognitive functioning at baseline benefited most from the dual-task training, irrespective of the type of training and type of dual-task outcome.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A242).
Auditory Cueing for Gait Impairment in Persons With Parkinson Disease: A Pilot Study of Changes in Response With Disease Progression
Authors: Lirani-Silva Ellen , Lord Sue , Moat Dionne , Rochester Lynn , Morris Rosie 
Published: December 2018

Background and Purpose:
Gait impairments in persons with Parkinson disease (PD) are difficult to manage. Auditory cueing has been shown to be an effective therapy. However, the optimal time to introduce cues with respect to disease stage has not yet been established. This longitudinal study examines the effect of auditory cues on gait characteristics in people with early PD at 2 time points, 3 years apart.

Methods:
We assessed 25 people with PD from the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation-Parkinson's disease (ICICLE-PD) study. Participants walked with and without an auditory cue set at individual cadence. Characteristics of step velocity, step length, step time, step length variability, and step time variability were collected using an instrumented walkway. In a subset of 9 participants with PD, all assessments were repeated 3 years later. Twenty-nine healthy older adults were assessed at 1 time point to provide comparison data.

Results:
At baseline, independent of group, step velocity, step length, and step time improved with auditory cue; however, there was an increase in step time variability, indicating a worsening of gait with the cue. Three years later, in the smaller subset the response to cue was improved, demonstrated by increased step velocity and length but step time variability was no longer increased.

Discussion and Conclusions:
This pilot study indicates that people with early PD have small benefits from auditory cues and the benefit increases as disease progresses. Early in disease the benefit of cue may come at the cost of increased variability. Therefore, the time to introduce an auditory cue in PD rehabilitation may be important to optimize therapeutic effect.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A243).
Symmetrical Apophyses on the Posterior Margins of the Thyroid Cartilage
Authors: Porzionato Andrea , Macchi Veronica , Mazzarolo Cristina , Morra Aldo , Sanudo Jose , De Caro Raffaele 
Published: December 2018

AbstractDifferential diagnosis between normal/variant anatomy and pathological/traumatic findings represents one of the main matters of investigation of the so-called forensic clinical anatomy. In the literature, many anatomical variations of the laryngeal thyroid cartilage have been reported, with potential implications in forensic pathology. They include triticeal cartilages, foramen thyroideum, asymmetry, segmentation or agenesis of the superior thyroid horns, bone connections with the hyoid bone, absence of cricothyroid facets, hypertrophy of the inferior thyroid tubercle, and asymmetries in the thyroid notch, isthmus, or length of the inferior horn. In this report, we describe a laryngeal anatomical variation never described before, consisting of 2 apophyses symmetrically arising from the posterior margins of the thyroid laminae. Postmortem computed tomography performed on the laryngeal visceral block excluded previous traumatic injuries or natural pathologies of the laryngeal cartilages, confirming the congenital origin of the finding. An “omega epiglottis” and 3 laryngeal cysts in the piriform sinuses also coexisted, suggesting the possibility of underlying common developmental mechanisms.
Criteria for Clinically Relevant Bleeding in Critically Ill Children: An International Survey*
Authors: Karam Oliver , Nellis Marianne E. , Zantek Nicole D. , Lacroix Jacques , Faustino E. Vincent S. 
Published: December 2018

Objectives:
Bleeding, a feared complication of critical illness, is frequent in critically ill children. However, the concept of clinically relevant bleeding is ill-defined in this population. There are many established diagnostic criteria for bleeding, but only one estimates bleeding in critically ill adults, and none exist for critically ill children. Our objective was to identify the factors that influence pediatric intensivists’ perception of clinically relevant bleeding.

Design:
Self-administered, web-based survey with 9-point Likert scales, to qualify the clinical significance of 103 bleeding characteristics in critically ill children.

Setting:
Online survey.

Subjects:
Pediatric critical care physicians and nurse practitioners.

Interventions:
None.

Measurements and Main Results:
The response rate was 40%, with 225 respondents from 16 countries. Characteristics most frequently identified as clinically relevant were bleeding in critical locations (e.g., pericardium, pleural space, CNS, and lungs); requiring interventions; leading to physiologic repercussions, including organ failure; and of prolonged duration. Quantifiable bleeding greater than 5 mL/kg/hr for more than 1 hour was frequently considered clinically relevant. Respondents identified the following characteristics as clinically irrelevant: dressings required to be changed no less frequently than every 6 hours, streaks of blood in gastric tubes, streaks of blood in endotracheal tubes or blood in endotracheal tubes only during suctioning, lightly blood-tinged urine, quantifiable bleeding less than 1 mL/kg/hr, and noncoalescing petechiae. Perception of the clinical relevance of bleeding was not associated with the respondent’s geographical location of clinical practice or years of experience.

Conclusions:
This international survey provides a better understanding of the factors that influence the pediatric intensivists’ assessment of the clinical relevance of bleeding in critically ill children. It provides the foundation for the development of a validated, diagnostic definition of clinically relevant bleeding in this population.
Matching into Integrated Plastic Surgery: The Value of Research Fellowships
Authors: Mehta Karan , Sinno Sammy , Thanik Vishal , Weichman Katie , Janis Jeffrey E. , Patel Ashit 
Published: December 2018

Background:
Integrated plastic surgery residency applicants sometimes complete research fellowships before residency. The average productivity and the impact of these fellowships on subsequent application to residency are unknown. The purpose of this study was to provide objective data to better understand the utility and productivity of a research fellowship.

Methods:
A national survey was conducted in which integrated plastic surgery residency applicants from 2013 to 2016 were surveyed regarding their experiences with research fellowships. American Council of Academic Plastic Surgeons members were also surveyed to elicit their perspectives on the value of these fellowships.

Results:
Six hundred twenty-one integrated plastic surgery applicants from 2013 to 2016 were included in the study. Twenty-five percent of applicants participated in a research fellowship. Applicants who completed research fellowships were more likely to match into plastic surgery compared to those who did not (97 percent versus 81 percent, respectively; p < 0.05). Fellows were highly satisfied with their fellowship experience and produced an average of five publications and presentations per fellowship year. Sixty-three percent of research fellowships were performed to strengthen applications to categorical integrated plastic surgery residency. American Council of Academic Plastic Surgeons members considered three or four publications/presentations productive. Most do not recommend research fellowships to all medical students.

Conclusions:
Research fellowships can effectively prepare for categorical plastic surgery by improving publication and presentation experience. This is the first study to show that applicants who completed research fellowships were highly satisfied with their experience, accomplished higher than expected levels of productivity, and statistically significantly matched into an integrated plastic surgery residency more often than applicants without research fellowships.
Analysis of Keloid Response to 5-Fluorouracil Treatment and Long-Term Prevention of Keloid Recurrence
Authors: LaRanger Ryan , Karimpour-Fard Anis , Costa Christopher , Mathes David , Wright Woodring E. , Chong Tae 
Published: December 2018

Summary:
Keloids are benign fibroproliferative skin tumors that can cause disfigurement and disability. Although they frequently recur after excision or medical management and can affect 6 to 16 percent of African Americans, there is no gold standard therapy. Keloids are challenging to study because there are no animal or in vitro models of this disorder. This makes it very difficult to validate data from treated tissue samples or cells and develop targeted therapies for this disease. In this study, the authors demonstrate that intralesional 5-fluorouracil injection after keloid excision prevents recurrence for 2 years, with no reported adverse events. The authors analyze the expression of treated and untreated biopsy specimens of the same keloids in their native context to capture insights that may be missed by in vitro cell culture models and correct for intrakeloid variability. Random forest analysis of the microarray data dramatically increased the statistical power of the authors’ results, permitting hypothesis-free creation of a gene expression profile of 5-fluorouracil–treated keloids. Through this analysis, the authors found a set of genes, including YAP1 and CCL-2, whose expression changes predict 5-fluorouracil therapy status and include genes that have not previously been associated with keloid biology and are of unknown function. The authors further describe keloid heterogeneity for the first time using multidimensional analysis of their microarray results. The methods and tools the authors developed in this research may overcome some of the challenges in studying keloids and developing effective treatments for this disease.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.