bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel method of Uniblocker placement: extraluminal technique supported by trachea length measurement
Authors: Liu Zhuo , Zhao Li , He Wensheng , Zhu Yan , Bao Lina , Jia Qianqian , Yang Xiaochun , Liang Shujuan 
Published: April 2019

Abstract

Background:
The use of bronchial blockers has been increased for one-lung ventilation; however, the placement of bronchial blockers is time consuming. The objective of this study was to compare the novel extraluminal technique of Uniblocker placement supported by trachea length measurement on computerized tomography images with conventional intraluminal Uniblocker placement method.

Methods:
Seventy adult patients undergoing left side thoracic surgery were included in the study. All the patients were randomly assigned to one of two groups: conventional intraluminal intubation group (CV-IN group, n = 35) or extraluminal CT guided group (CT-EX group, n = 35). The primary endpoints were the optimal positions of Uniblocker and the injuries of bronchi and carina. The secondary outcomes included the time of Uniblocker placement, the adequacy of lung collapse, the incidences of Uniblocker displacement, sore throat, and hoarseness postoperative.

Results:
In the CV-IN group, 19 of 35 Uniblockers went to the left main-stem bronchus on the initial blind insertion and 15 of 35 Uniblockers were considered as in optimal depth, whereas in the CT-EX group, 32 of 35 Uniblockers went to the left main-stem bronchus on the initial blind insertion and 31 of 35 Uniblockers were considered as in optimal depth (P < .01). The incidence of bronchi and carina injuries was obviously lower in the CT-EX group (occurred in 1 of 35 cases) than that in the CV-IN group (occurred in 8 of 35 cases) (P < .05). The time of Uniblocker placement took 145.4 s in the CV-IN group and 85.4 s in the CT-EX group (P < .01). The malpositions of Uniblocker, the degree of pulmonary collapse and the adverse events postoperative such as sore throat and hoarseness were not significantly different between the two groups (P > .05).

Conclusion:
The novel extraluminal technique of Uniblocker placement supported by trachea length measurement on computerized tomography images was proved to be more rapid, more accurate and less complications than conventional intraluminal Uniblocker placement method.
Effectiveness of extracorporeal shock wave monotherapy for avascular necrosis of femoral head
Authors: Tang Hua-Yu , Zhao Yu , Li Yu-Zhi , Wang Tian-Shu 
Published: April 2019

Abstract

Background:
Previous clinical studies have reported that extracorporeal shock wave (EPSW) monotherapy can effectively treat avascular necrosis of femoral head (ANFH). However, no systematic review has been conducted to assess its effectiveness and safety for patients with ANFH. Therefore, this study will systematically assess the effectiveness and safety of EPSW monotherapy for patients with ANFH.

Methods:
In this study, the following electronic databases will be searched from their inceptions to the present: Cochrane Library, EMBASE, PUBMED, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database. This study will include randomized controlled trials for assessing the effectiveness and safety of EPSW monotherapy for patients with ANFH. Two independent authors will perform study selection, data extraction, and methodology assessment. RevMan 5.3 software will be used for statistical analysis.

Results:
This systematic review will provide latest summary evidence of EPSW monotherapy for patients with ANFH through assessing the outcome measurements. The primary outcome is pain intensity, which can be measured by visual analog scale or relevant measurement tools. The secondary outcomes are functional status of attacked femoral head, as assessed by Western Ontario and McMaster Universities Osteoarthritis Index, or other relevant scales; quality of life, as evaluated by The 36-Item Short Form Health Survey, or related instruments; and adverse events.

Conclusion:
The results of this study may provide the latest evidence for assessing the effectiveness and safety of EPSW for the treatment of ANFH.

Dissemination and ethics:
This study does not require ethical approval, because no individual data will be involved in this systematic review. The findings of this study will be published through a peer-reviewed journal.

Systematic review registration:
PROSPERO CRD42019124665.
Validity of routine reimaging of blunt renal trauma managed conservatively
Authors: Tomasz Ząbkowski , Piotr Piasecki , Ryszard Skiba , Marek Saracyn 
Published: April 2019

Abstract
The purpose of this study was to determine the need of repeat follow-up computed tomography imaging in patients with renal trauma.
All patients who were admitted in the trauma center of the Military Institute of Medicine with a diagnosis of kidney injury from January 2008 to December 2017 were identified. A retrospective review of all patients’ medical records and radiologic imaging was conducted.
Data on the following factors were collected – patients’ demographics, mechanism of trauma, American Association for the Surgery of Trauma renal injury scale, injury severity score, laboratory examinations, multiorgan injuries, transfusion of fresh frozen plasma and packed red blood cells, time of surgical procedure in multiorgan injuries, length of hospital stay, and acute kidney injury.
This group consisted of 37 patients with left renal injuries, 32 with right renal injuries, and 5 with bilateral renal injuries. Renal trauma due to blunt injury secondary to a motor vehicle accident was noted in 45 patients, falling from a height in 14 patients, injury from battery in 4 patients, sports-related activities in 1 patient, and other factors in 10 patients.
Of the 63 patients treated conservatively due to multiorgan trauma or isolated trauma, values of morphology, serum creatinine and blood urea nitrogen, and ultrasonography in all patients did not reveal any pathological changes within earlier kidney damage.
The conservative treatment of grade I-IV renal injury in the American Association for the Surgery of Trauma scale provided good outcome and only involved noninvasive ultrasonography.
This study confirms that routine follow-up computed tomography imaging can be safely omitted in renal injuries graded I-IV providing that the patient remains in good clinical state.
Crossing low-level donor-specific antibodies in heart transplantation
Authors: Olymbios Michael , Kobashigawa Jon A. 
Published: April 2019

Purpose of review
Donor-specific antibodies (DSA) detected by solid-phase single-antigen bead (SAB) immunoassays have been associated with antibody-mediated rejection (AMR), cardiac allograft vasculopathy (CAV) and decreased survival after heart transplantation. The clinical relevance of low-level DSA is equivocal. This review examines the techniques used to define low-level DSA, the limitations of these techniques and recent clinical experience crossing low-level DSA.

Recent findings
Solid-phase multiplex bead immunoassays were introduced to solid-organ transplantation over 15 years ago. These technologies have a much greater sensitivity and specificity than older cell-based immunoassays. It was hoped that this increased resolution would lead to better outcomes by avoiding donors with antigens that transplant candidates produced antibodies against. Although some transplant patients with DSA show increased risk of AMR and decreased survival, a subset of patients with DSA at the time of transplant have outcomes comparable with patients with no DSA. Recent studies have demonstrated that DSA delineated according to titration studies and C1q assays better define low-level DSA that are well tolerated to cross. Early experience with crossing low-level DSA shows promise in kidney and heart transplantation.

Summary
Preliminary findings from heart and kidney transplant patients show acceptable outcomes after crossing low-level DSA. The policy of crossing low-level DSA increases the donor pool for sensitized heart transplant candidates.
Does the Canadian allocation system for highly sensitized patients work?
Authors: Aleksova Natasha , Ross Heather J. 
Published: April 2019

Purpose of review
The number of sensitized heart transplant candidates is rising. Highly sensitized patients are disadvantaged because they encounter longer waiting times to heart transplant. Strategies to reduce their waiting times include waitlist prioritization and desensitization therapies. The purpose of this review is to describe the listing category for highly sensitized patients in the Canadian allocation system, examine the advantages and limitations of this strategy and provide an approach to the management of the highly sensitized patient awaiting heart transplant.

Recent findings
Analysis of data from the United Network of Organ Sharing shows that the incidence of death or removal from the waitlist in patients listed for heart transplant increases as the calculated panel reactive antibody (cPRA) increases and is independent of medical urgency. In the Canadian allocation system, patients with cPRA more than 80% have a similar incidence of death on the waitlist as less sensitized patients, suggesting they survive to be transplanted. Furthermore, prioritizing and transplanting highly sensitized patients has been associated with acceptable post-transplant outcomes.

Summary
The Canadian allocation system prioritizes highly sensitized patients to increase equity and access to transplantation while maintaining good post-transplant outcomes. Not all highly sensitized patients can wait for an organ, even if prioritized. A pragmatic individualized approach would consider the medical stability of the patient, the likelihood of transplant with a negative crossmatch and then determine whether waitlist prioritization or desensitization is the more appropriate strategy.
Intraoperative Peritoneal Washing Cytology on Survival in Pancreatic Ductal Adenocarcinoma With Resectable, Locally Advanced, and Metastatic Disease
Authors: Yin Zi , Ma Tingting , Chen Sheng 
Published: April 2019

Objectives
The prognostic implications of intraoperative peritoneal washing cytology (IPWC) in patients with pancreatic ductal adenocarcinoma (PDAC) remains incompletely understood.

Methods
A meta-analysis was conducted to investigate the impact of IPWC status on the clinicopathologic features and survival outcomes in potentially resectable, locally advanced, and metastatic PDAC. Hazard ratio (HR) and 95% confidence interval (CI) were used as the pooled estimates.

Results
A total of 12 studies qualified for inclusion with 3751 PDAC patients. In resectable PDAC, the postoperative 5-year overall survival was significantly better in negative IPWC than in positive IPWC patients, with a pooled HR of 2.47 (95% CI, 1.90–3.21; P < 0.001; I
2 = 69%) in a random-effects model. Likely, combined outcome showed a significantly longer survival benefit in the negative IPWC group (HR, 2.80; 95% CI, 1.94–4.04; P < 0.001) in terms of recurrence-free survival. The presence of positive IPWC did not significantly alter survival outcomes in those PDAC patients with locally advanced or metastatic disease.

Conclusions
This systematic review and meta-analysis demonstrated that a positive IPWC status in patients with clinically resectable PDAC predicts a poor prognosis. Patients with positive IPWC should be regarded as a specific subgroup, with intensive adjuvant chemotherapy that seems to be warranted for further evaluation.
Impact of Antimicrobial Prophylaxis for Severe Acute Pancreatitis on the Development of Invasive Candidiasis
Authors: Horibe Masayasu , Sanui Masamitsu , Sasaki Mitsuhito , Honda Hitoshi , Ogura Yuki , Namiki Shin , Sawano Hirotaka , Goto Takashi , Ikeura Tsukasa , Takeda Tsuyoshi , Oda Takuya , Yasuda Hideto , Miyazaki Dai , Hirose Kaoru , Kitamura Katsuya , Chiba Nobutaka , Ozaki Tetsu , Yamashita Takahiro , Koinuma Toshitaka , Oshima Taku , Yamamoto Tomonori , Hirota Morihisa , Yamamoto Satoshi , Oe Kyoji , Ito Tetsuya , Masuda Yukiko , Saito Nobuyuki , Iwasaki Eisuke , Kanai Takanori , Mayumi Toshihiko 
Published: April 2019

Objective
Antimicrobial prophylaxis is not generally recommended for patients with severe acute pancreatitis (SAP) owing to the limited clinical benefits. Nonetheless, it is frequently administered in actual practice given the patients' critical condition and the lack of solid evidence showing adverse effects of antimicrobial prophylaxis. We evaluated herein an association between antimicrobial prophylaxis and invasive pancreatic candidiasis as an adverse effect in patients with SAP.

Methods
This is a retrospective cohort study of all consecutive patients with SAP who were admitted to the study institutions (n = 44) between January 1, 2009, and December 31, 2013. We performed multivariable logistic regression analysis adjusting for the extent of pancreatic necrosis and surgical interventions for invasive pancreatic candidiasis.

Results
Of the 1097 patients with SAP, 850 (77.5%) received antimicrobial prophylaxis, and 21 (1.9%) had invasive pancreatic candidiasis. In multivariable logistic regression analysis, antimicrobial prophylaxis was significantly associated with the development of invasive pancreatic candidiasis (adjusted odds ratio, 4.23; 95% confidence interval, 1.14–27.6) (P = 0.029).

Conclusions
The results suggest that antimicrobial prophylaxis may contribute to the development of invasive pancreatic candidiasis, and therefore, the routine use of antimicrobial prophylaxis for SAP may be discouraged.
Trends and Outcomes of Hospitalizations Related to Acute Pancreatitis
Authors: Gapp Jonathan , Hall Alexander G. , Walters Ryan W. , Jahann Darius , Kassim Thamer , Reddymasu Savio 
Published: April 2019

Objectives
The aim of this study was to determine the recent trends of the rates of hospitalization, mortality of hospitalized patients, and associated health care utilization in patients with acute pancreatitis (AP).

Methods
We identified adult patients with primary discharge diagnosis of AP from the National Inpatient Sample database. Patients with chronic pancreatitis and/or pancreatic cancer were excluded. Primary outcomes included age-adjusted incidence of AP and in-hospital mortality based on US standard population derived from the 2000 census data. Secondary outcomes were length of stay, inflation-adjusted hospital costs in 2014 US dollars, and procedural rates. Subgroup analysis included disease etiologies, age, race, sex, hospital region, hospital size, and institution type.

Results
From 2001 to 2014, the rate of primary discharge diagnosis for AP increased from 65.38 to 81.88 per 100,000 US adults per year. In-hospital case fatality decreased from 1.68% to 0.69%. Mortality rate is higher in patients with AP who are older than 65 years (3.4%). Length of stay decreased, with a median of 3.8 days; cost per hospitalization decreased since 2007 from $7602 to $6766 in 2014.

Conclusions
The rate of hospitalization related to AP in the United States continues to increase. Mortality, length of stay, and cost per hospitalization decrease. The increase in volume of hospitalization might contribute to an overall increase in health care resource utilization.
Ocoxin Oral Solution Exerts an Antitumoral Effect in Pancreatic Cancer and Reduces the Stromal-Mediated Chemoresistance
Authors: Hernandez-Unzueta Iera , Benedicto Aitor , Romayor Irene , Herrero Alba , Sanz Eduardo , Arteta Beatriz , Olaso Elvira , Márquez Joana 
Published: April 2019

Objectives
Pancreatic carcinoma is one of the most aggressive cancers overcoming chemoresistance. Thus, novel compounds to complement the current antitumor agents are in need. Ocoxin oral solution (OOS) has proven antioxidant, anti-inflammatory, and antistromagenic properties. The aim of this study was to analyze the effect of OOS in an experimental pancreatic cancer model and its implication in stroma-related chemoresistance to paclitaxel and gemcitabine.

Methods
Murine pancreatic carcinoma 266-6 cells were treated with OOS to analyze cell cycle and to perform a mRNA comparative microarray study. Then the viability was assessed in combination with paclitaxel and/or gemcitabine. Chemoresistance induced by the medium taken from fibroblast cultures was also investigated on 6 human pancreatic carcinoma cell lines. Furthermore, an experimental model of pancreatic cancer was carried out to study the effect of OOS in vivo.

Results
Ocoxin oral solution enhances the cytotoxic effect of paclitaxel and gemcitabine, while it ameliorates the chemoresistance induced by fibroblast-derived soluble factors in human pancreatic cancer cells. The OOS also promotes the regulation of the expression of genes that are altered in pancreatic carcinoma and slows down 266-6 cell pancreatic tumor development in vivo.

Conclusions
Ocoxin oral solution could be a potential complement to the chemotherapeutic drugs for pancreatic adenocarcinoma.
Establishing the Clinical Nurse Specialist Identity by Transforming Structures, Processes, and Outcomes
Authors: Sanchez Kimberly , Winnie Kathrine , de Haas-Rowland Natalie 
Published: April 2019

Purpose:
The purpose of this project was to delineate the clinical nurse specialist (CNS) from other nursing roles within this academic medical center with the goal of (1) aligning role responsibilities with core competencies, (2) categorizing role-specific activities using a productivity spreadsheet, and (3) disseminating role-sensitive outcomes.

Description of Project:
The Donabedian model was used to evaluate the recently added CNS position and ensure the position aligned with professionally established role responsibilities and practice expectations. Using CNS competencies and standards of practice, the job description was restructured. A process for tracking productivity was developed, and outcomes reporting method was selected.

Outcome:
Changes to the job description resulted in 88% of the job description being reflective of CNS competencies and standards of practice. With this new process, collective role-specific work increased from 36% to 95%. Outcomes were identified from 4 frequently performed role-specific activities.

Conclusion:
The CNS role was successfully established and differentiated from other nursing roles by redesigning the job description, documenting role-specific activities, and capturing role-sensitive outcomes. Success was captured and disseminated using a year-end report, resulting in a positive response from hospital leadership and a recognized need for current and additional CNSs.
Management of Endometriomas
Authors: Rehmer Jenna M. , Flyckt Rebecca L. , Goodman Linnea R. , Falcone Tommaso 
Published: April 2019

Importance
Endometriomas are a unique and complex representation of the classic phenotypes of endometriosis. Associated symptoms, high recurrence rate, and multimodal approach represent ongoing challenges in the management of this chronic disease.

Objective
To review current literature regarding medical and surgical management of endometriomas.

Evidence Acquisition
An extensive literature search including PubMed and Cochrane Library was performed. Review was performed using the following key words: “endometrioma,” “cystectomy,” “chronic pain,” “infertility,” “IVF,” “menopause,” “recurrence.” All pertinent articles were assessed. The references of those articles were then reviewed, and additional publications were evaluated. Eligibility of the studies was first assessed on titles and abstracts. Full articles were then reviewed for all selected studies, and decision for final inclusion was made at that time.

Conclusions and Relevance
Cystectomy of ovarian endometriomas has been the first-line treatment for management for many years because it provides improved pain relief, reduces recurrence rates, and was thought to be favorable in in vitro fertilization. However, a growing body of evidence is demonstrating benefit, or at least no harm, in expectant management for asymptomatic patients with small, stable endometriomas. Medical management is often very effective and appropriate first line. When surgical intervention is appropriate, careful ovarian cyst excision with goal of ovarian tissue preservation and treatment of additional endometriosis by a trained surgeon can provide the patient the best long-term outcome and preservation of ovarian tissue and function.

Target Audience
Physicians from family medicine, obstetrics and gynecology, and reproductive endocrinology and infertility.

Learning Objectives
Following completion of this CME activity, physicians should be better able to accurately diagnose endometriomas; select appropriate medical management; determine when surgical intervention is warranted; and identify the importance of ovarian tissue–conserving surgical techniques.
Neurokinin 3 Receptor Antagonism Rapidly Improves Vasomotor Symptoms With Sustained Duration of Action
Authors: Prague Julia K. , Roberts Rachel E. , Comninos Alexander N. , Clarke Sophie , Jayasena Channa N. , Mohideen Pharis , Lin Vivian H. , Stern Theresa P. , Panay Nicholas , Hunter Myra S. , Webber Lorraine C. , Dhillo Waljit S. 
Published: April 2019

(Abstracted from Menopause 2018;25(8):862–869)
Approximately 70% of postmenopausal women experience vasomotor symptoms, and 10% describe these symptoms as intolerable. Conventional treatment of hot flashes (HFs) includes hormone therapy and other alternative treatments; however, these treatments have mixed responses, variable availability, and can be contraindicated in some women such as those with a history of breast cancer.
Awareness of Fetal Movements and Care Package to Reduce Fetal Mortality (AFFIRM): A Stepped Wedge, Cluster-Randomised Trial
Authors: Norman Jane E. , Heazell Alexander E. P. , Rodriguez Aryelly , Weir Christopher J. , Stock Sarah J. E. , Calderwood Catherine J. , Burley Sarah Cunningham , Frøen J. Frederik , Geary Michael , Breathnach Fionnuala , Hunter Alyson , McAuliffe Fionnuala M. , Higgins Mary F. , Murdoch Edile , Ross-Davie Mary , Scott Janet , Whyte Sonia 
Published: April 2019

(Abstracted from Lancet 2018;392:1629–1638)
Two to 6 million pregnancies were estimated to have ended in stillbirth in 2015. The aim of the AFFIRM study was to test the hypothesis that introduction of a reduced fetal movement care package for pregnant women and clinicians that increased women's awareness of the need for prompt reporting of RFM and that standardized management, including timely delivery, would alter the incidence of stillbirth.
Association of Race/Ethnicity With Very Preterm Neonatal Morbidities
Authors: Janevic Teresa , Zeitlin Jennifer , Auger Nathalie , Egorova Natalia N. , Hebert Paul , Balbierz Amy , Howell Elizabeth A. 
Published: April 2019

(Abstracted from JAMA Pediatr 2018;172(11):1061–1069)
Racial/ethnic disparity in neonatal mortality associated with the increased risk of very preterm birth among black infants is well documented. However, racial/ethnic disparities in severe neonatal morbidities among very preterm infants are less studied, despite the association of these morbidities with long-term health disparities.