bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meropenem, Cefepime, and Piperacillin Protein Binding in Patient Samples
Authors: Al-Shaer Mohammad H. , Alghamdi Wael A. , Graham Emily , Peloquin Charles A. 
Published: July 2019

Background:
The mortality rate of patients with a drug-resistant bacterial infection is high, as are the associated treatment costs. To overcome these issues, optimization of the available therapeutic options is required. Beta-lactams are time-dependent antibiotics and their efficacy is determined by the amount of time the free concentration remains above the minimum inhibitory concentration. Therefore, the aim of this study was to assess the extent and variability of protein binding for meropenem, cefepime, and piperacillin.

Methods:
Plasma samples for the analysis of meropenem, cefepime, and piperacillin were collected from patients admitted to a tertiary care hospital as part of the standard care. The bound and unbound drug fractions in the samples were separated by ultrafiltration. Validated liquid chromatography-tandem mass spectrometry assays were used to quantify the total and free plasma concentrations, and the protein binding was determined.

Results:
Samples from 95 patients were analyzed. The median (range) age of patients was 56 years (17–87) and the median (range) body mass index was 25.7 kg/m2 (14.7–74.2). Approximately 59% of the patients were men. The median (range) unbound fraction (fu) was 62.5% (41.6–99.1) for meropenem, 61.4% (51.6–99.2) for cefepime, and 48.3% (39.4–71.3) for piperacillin. In the bivariate analysis, as the total meropenem concentration increased, the fu increased (r = 0.37, P = 0.045). A decrease in piperacillin fu was observed as the albumin concentration increased (r = −0.56, P = 0.005).

Conclusions:
The average fu values were lower than those reported in the literature. There was also a large variability in fu; hence, it should be considered when managing patients administered with these drugs through direct measurements of free drug concentrations.
Prospective Investigation of the Performance of 2 Gamma-Hydroxybutyric Acid Tests: DrugCheck GHB Single Test and Viva-E GHB Immunoassay
Authors: Smits Thomas A. , Gresnigt Femke M. J. , van Groen Bianca D. , Franssen Eric J. F. , Attema-de Jonge Milly E. 
Published: July 2019

Background:
Gamma-hydroxybutyric acid (GHB) is a recreational drug with central nervous system depressing effects that is often abused. A urine GHB point-of-care test can be of great diagnostic value. The objective of this prospective study was to determine the performance of the new DrugCheck GHB Single Test and the Viva-E GHB immunoassay for urine samples in emergency department patients.

Methods:
Patients presented to the emergency department of the OLVG hospital in Amsterdam with a Glasgow Coma Scale score <15 and potential drug of abuse intoxication were included in the study. Between June 2016 and October 2017, 375 patients were included. Using the DrugCheck GHB Single Test (Express Diagnostics Int'l, Blue Earth, MN) and the Viva-E GHB immunoassay (Siemens Healthineers, The Hague, the Netherlands), patients' urine samples were tested for GHB (cutoff for a positive result, 10 or 50 mcg/mL GHB). To ensure quality, the results obtained were compared with those generated using a validated gas chromatography method. The tests were considered reliable if specificity and sensitivity were both >90%. Possible cross-reactivity with ethanol was investigated by analyzing ethanol concentrations in patients' samples.

Results:
Seventy percentage of the included patients was men, and the median age was 34 years old. The DrugCheck GHB Single Test's specificity and sensitivity were 90.0% and 72.9%, respectively, and using 50 mcg/mL as a cutoff value, its specificity and sensitivity improved to 96.7% and 75.0%, respectively. Serum and urine ethanol levels in the false-positive group were significantly higher compared with those in the true-negative group. The specificity and sensitivity of the Viva-E GHB immunoassay (cutoff value of 50 mcg/mL and excluding samples with ethanol levels ≥2.0 g/L) were 99.4% and 93.5%, respectively.

Conclusions:
The DrugCheck GHB Single Test's specificity was sufficient, whereas its sensitivity was poor, making it unsuitable for use at point-of-care. Contrarily, using 50 mcg/mL as the cutoff value and excluding samples with ethanol levels ≥2.0 g/L, the Viva-E GHB immunoassay showed acceptable results to detect clinically relevant GHB intoxications.
Speech Perception Growth Patterns in Prelingual Deaf Children With Bilateral Sequential Cochlear Implantation
Authors: Kim Yehree , Lee Jee Yeon , Lim Won Seob , Kwak Min Young , Seo Ji Won , Park Jun Woo , Lee Je Yeon , Kang Byung Chul , Kang Woo Seok , Ahn Joong Ho , Chung Jong Woo , Park Hong Ju 
Published: July 2019

Objective:
To evaluate speech perception following the first (CI-1) and second (CI-2) cochlear implantation (CI) in children with sequential bilateral CI.

Study Design:
Retrospective.

Patients:
Seventy children with follow-up for 60 months post CI-1 and 36 months post CI-2.

Main Outcome Measures:
Word recognition score (WRS) was the main outcome. WRSs were compared by age at CI operation (group A ≤ 3.5 yr, B 3.6–8.6, for CI-1; group I ≤ 3.5 yr, II 3.6–7.0, III 7.1–13, IV > 13, for CI-2).

Results:
For CI-1, the WRS of group A exceeded 80% at 24 months post procedure, earlier than group B (54 mo). Group A also had a shorter period of CI-1 use up to the WRS plateau than group B. CI-2 showed an initial burst of WRS growth much earlier than CI-1. This initial burst was most robust within 3 months in group II, but modest in group IV. The periods of CI-2 use (11–17 mo) up to the WRS plateau were much shorter than CI-1 (40–64 mo). Group I did not show the best WRS at 1 month post CI but later exceeded the other groups.

Conclusion:
Children received an immediate benefit by a burst of WRS growth from CI-2 earlier than CI-1, even within 3 months, suggesting that CI-1 gets the auditory cortex ready to foster speech processing from CI-2. The CI-2 performance depends on age at CI-2 implantation and on CI-1 performance. Our current findings will be relevant for clinicians who are counselling parents on CI-2 surgery.
Long-term Outcomes of Bone Conduction Hearing Implants in Patients With Bilateral Microtia-atresia
Authors: Fan Xinmiao , Yang Tengyu , Niu Xiaomin , Wang Yibei , Fan Yue , Chen Xiaowei 
Published: July 2019

Objectives:
To evaluate the long-term outcomes of three different types of bone conduction hearing implants (BCHI)—BAHA, Ponto, and Bonebridge—in Mandarin-speaking patients with bilateral microtia-atresia.

Methods:
This cohort study enrolled 59 patients affected by bilateral microtia-atresia, with an upper bone conduction threshold limit of 30 dB HL at frequencies of 0.5 to 4 kHz. All subjects underwent unilateral BCHI surgery, including 26 (18 males, 8 females, of mean age 8.7 ± 1.9 yr) implanted with BAHA devices; 10 (7 males, 3 females, of mean age 11.7 ± 2.8 yr) implanted with Ponto devices; and 23 (14 males, 9 females, of mean age 9.0 ± 1.8 yr) implanted with Bonebridge devices. The main outcome measures included long-term audiological benefits, patient satisfaction, and complications. Each subject acted as his or her own control.

Results:
Two years after BCHI surgery, the mean hearing thresholds in the BAHA, Ponto, and Bonebridge groups had improved to 22.6 ± 1.6 dB HL, 21.6 ± 1.2 dB HL, and 22.5 ± 1.5 dB HL, respectively. The mean percentages of subjects in these three groups recognizing speech at 65 dB SPL under quiet conditions were 97.7 ± 4.2%, 96.3 ± 1.1%, and 94.4 ± 9.4%, respectively, whereas the mean percentages recognizing speech under noise conditions (signal:noise ratio +5) were 87.0 ± 1.8%, 89.3 ± 9.3%, and 85.3 ± 4.7%, respectively. Questionnaires revealed patients’ benefits and satisfaction with this surgery. Three (11.5%) of 26 patients in the BAHA group and 1 (10%) of 10 in the Ponto group experienced skin irritation, but all recovered after local treatment. Five (19.2%) patients in the BAHA group and two (20%) in the Ponto experienced abutment extrusion about 6 months postoperatively, with all achieving good results after revision surgery to replace the abutment. One (3.8%) patient in the BAHA group experienced local chronic inflammation and underwent surgery to replace the BAHA with a Bonebridge implant. One (4.3%) patient in the Bonebridge group developed a local infection 3 months postoperatively and underwent implant removal.

Conclusions:
All three BCHIs were well tolerated after long-term follow-up, and all improved audiometric thresholds and the intelligibility of speech in the presence of both quiet and noise. These implants should be considered valid and safe options for the functional rehabilitation of patients with bilateral microtia-atresia.
Heart-Focused Anxiety Among Latinxs in Primary Care
Authors: Manning Kara , Rogers Andrew H. , Bakhshaie Jafar , Viana Andres G. , Lemaire Chad , Garza Monica , Ochoa-Perez Melissa , Zvolensky Michael J. 
Published: July 2019

Abstract
There is a public health need to better characterize the individual-based differences that may be involved in the expression and maintenance of psychological and related health problems among Latinx individuals. One individual difference factor that may be relevant to the nexus of psychological and physical concerns is heart-focused anxiety. The current study sought to evaluate the potential explanatory relevance of heart-focused anxiety as an important individual difference factor for anxiety, depression, pain experience, and functional impairment. Participants included 158 Latinx adults (M
age = 39.26, SD = 13.19; 85.4% female) from a primary health clinic. Results indicated that heart-focused anxiety was significantly related to anxious arousal, pain intensity, pain disability, and functional impairment. However, no significant effects were evident for depressive symptoms. These data indicate that heart-focused anxiety may be an underrecognized cognitive factor relevant to better understanding anxiety and pain among Latinx adults in primary care.
Case Report: Transient Dorsal Midbrain Syndrome as the Initial Presentation of Multiple Sclerosis
Authors: Malloy Kelly A. , Draper Erin M. , Maglione Ashley Kay 
Published: July 2019

SIGNIFICANCE
Prompt neuroimaging is important to identify multiple sclerosis lesions in the appropriate clinical setting. However, despite a normal brain MRI finding, a diagnosis of multiple sclerosis still must be considered in cases of dorsal midbrain syndrome, even if it is transient.

PURPOSE
The purpose of this case report is to present a patient with a transient presentation of dorsal midbrain syndrome, resolving within 1 week of initial symptoms, which was ultimately attributed to multiple sclerosis in the setting of a normal enhanced brain MRI study.

CASE REPORT
A 33-year-old man with new-onset visual complaints was found to have upgaze paresis, eyelid retraction, and pupillary light-near dissociation suggestive of dorsal midbrain syndrome. Within days, enhanced brain MRI was completed and showed a normal finding, and the clinical features of dorsal midbrain syndrome had resolved. Subsequent spine imaging and lumbar puncture lead to an ultimate diagnosis of multiple sclerosis.

CONCLUSIONS
There have been a few reported cases of dorsal midbrain syndrome as the presenting feature of multiple sclerosis. This case is unique because it reports a transient presentation of dorsal midbrain syndrome, documented to have resolved only days after initial presentation, which was ultimately attributed to multiple sclerosis.
Black Mamba Death
Authors: Blumenthal Ryan , Scholtz Pieter Evelyn Pienaar , Shuttleworth Jenna-lee 
Published: July 2019

Abstract
We present the case of a male adult who was admitted to an emergency department after having sustained envenomation from a black mamba (Dendroaspis polylepis). According to the available history, a single fang hooked his right index finger, post venom extraction. After administering antivenom in the accident and emergency department, further vials were transfused in the intensive care unit. An urticarial rash was noted, which was thought to be related to the antivenom. The victim remained in a coma for 3 days, after which he was declared dead. A medicolegal postmortem examination was performed 4 days after death because of logistical reasons. The complexities of differentiating acute envenomation from black mamba versus early acute reactions to polyvalent antivenom administration are highlighted in this case study.
Pediatric Pain Assessment in the Emergency Department
Authors: Lawson Simone L. , Hogg Melanie M. , Moore Charity G. , Anderson William E. , Osipoff Paul S. , Runyon Michael S. , Reynolds Stacy L. 
Published: July 2019

Objective
This study aimed to assess the agreement between patients presenting to the pediatric emergency department (ED) with acute pain and their caregivers when using the Wong-Baker FACES (WBF) and Faces Pain Scale–Revised (FPS-R).

Methods
This was a prospective, observational study examining patients 3 to 7.5 years old presenting to a pediatric ED with acute pain. Participants completed the WBF and FPS-R twice during their ED evaluation. Caregivers rated their child's pain using both the WBF and FPS-R at the same time points. Intraclass correlations (ICCs) were calculated between caregiver and child reports at each time point, and Bland-Altman plots were created.

Results
Forty-six subjects were enrolled over 5 months. Mean age was 5.5 ± 1.2 years. Average initial child pain scores were 6.6 ± 2.8 (WBF) and 6.1 ± 3.3 (FPS-R), and repeat scores were 3.3 ± 3.4 (WBF) and 3.1 ± 3.3 (FPS-R). Average initial caregiver pain scores were 6.3 ± 2.4 (WBF) and 6.2 ± 2.3 (FPS-R), and repeat scores were 3.4 ± 2.0 (WBF) and 3.4 ± 2.1 (FPS-R). On initial assessment, ICCs between children and caregivers using the FPS-R and WBF were 0.33 and 0.22, respectively. On repeat assessment, the ICCs were 0.31 for FPS-R and 0.26 for WBF. Bland-Altman plots showed poor agreement but no systematic bias.

Conclusion
There was poor agreement between caregivers and children when using the WBF and FPS-R for assessment of acute pain in the ED. Caregiver report should not be used as a substitute for self-report of pain if possible.
Developing and Testing the Diagnostic Accuracy of a Brief Nursing Dysphagia Screen
Authors: Groppo-Lawless Sarah , Davies Claire C. , Lengerich Alex 
Published: July 2019

Abstract

Purpose
The aim of the study was to develop and test the Groppo-Lawless nurse-initiated screen designed to identify patients diagnosed with pneumonia who are at risk for dysphagia.

Design
This is a two-phase methodological study.

Methods
Phase 1 involved three steps. First, risk factors (n = 27) for dysphagia were identified from the literature. Next, frequency of these risk factors was calculated from a chart review of patients diagnosed with pneumonia (N = 301). Finally, frequency of risk factors among those patients who failed the 3-oz water trial (n = 56) were calculated, and a five-item instrument, the Groppo-Lawless Dysphagia Screen, was constructed. In Phase 2, nurses’ results using the screen were compared to blinded results of speech-language pathologists.

Findings
Sensitivity (81.1%), specificity (96.4%), and diagnostic odds ratio (22.43) were calculated.

Conclusions/Clinical Relevance
Given the strong psychometric properties of this screen, its use by nurses may increase the number of appropriate speech-language pathologist referrals among patients diagnosed with pneumonia.
Total Neoadjuvant Therapy in Rectal Cancer
Authors: Petrelli Fausto , Trevisan Francesca , Cabiddu Mary , Sgroi Giovanni , Bruschieri Lorenza , Rausa Emanuele , Ghidini Michele , Turati Luca 
Published: July 2019

Background:The addition of induction chemotherapy to concomitant neoadjuvant chemoradiation in locally advanced rectal cancer could increase pathological downstaging and act on occult micrometastatic disease, leading ultimately to a better outcome. A systematic review was carried out of the existing literature on the treatment outcomes of total neoadjuvant therapy (TNT) on locally advanced rectal cancer. TNT was defined as chemotherapy using cycles of induction and/or consolidation in conjunction with standard chemoradiotherapy prior to surgery.Methods:A systematic search of PubMed, Embase, and the Cochrane Library was performed according to the PRISMA statement up until January 2019. The primary endpoints were complete pathologic response (pCR), disease-free survival, and overall survival rates.Results:A total of 28 studies (3 retrospective and 25 prospective for a total of 3579 patients) were included in the final analysis (n = 2688 treated with TNT and n = 891 with neoadjuvant chemoradiotherapy therapy). The pooled pCR rate was 22.4% (95% CI 19.4%–25.7%) in all patients treated with TNT (n = 27 studies with data available). In n = 10 comparative studies with data available, TNT was found to increase the odds of pCR by 39% (1.40, 95% CI 1.08–1.81,P= 0.01).Conclusions:The addition of induction or consolidation chemotherapy to standard neoadjuvant chemoradiotherapy results in a higher pCR rate. Given that the comparative analysis was derived from few randomized publications, large confirmatory trials should be carried out before a strong recommendation is made in favor of TNT.
Patients Remain at High Risk of Gallstones Development Late (10 y) After Sleeve Gastrectomy?
Authors: Csendes Attila , Csendes Paula , Orellana Omar , Cuneo Nicole , Figueroa Manuel , Martinez Gustavo 
Published: July 2019

Background:
Sleeve gastrectomy (SG) is an established bariatric procedure which produces substantial and rapid weight loss and hence can lead to an increase in gallstones development.

Objectives:
To demonstrate the early and late appearance of gallstones after SG.

Materials and Methods:
A prospective protocol was established in consecutive patients submitted to SG. Clinical and ultrasound evaluations were performed early (1 to 2 y) and late after surgery (over 6 y).

Results:
From 109 patients included, 13 (13.1%) had a previous and 10 (10.1%) had simultaneous cholecystectomy at the time of SG. Therefore, 86 patients were submitted to surveillance. Seven patients were unreachable, leaving 79 patients for late follow-up. Forty-five patients (57%) had alithiasic gallbladder late after surgery, whereas 34 patients (43%) showed appearance of gallstone. From them, 53% developed gallstones late after surgery (mean, 7.5 y). Among the group with early development of stones, 69% were symptomatic and in the latter group only 17%.

Conclusions:
Study with 92% of follow-up late after SG demonstrated a 43% development of gallstones: half earlier and half late after surgery. We emphasize the need for late control to detect the real appearance of gallstones after SG.
Quality of Life and Urinary Incontinence Symptoms in Women Undergoing Bariatric Surgery: A Combined Case-Cohort Study
Authors: Durigon Keller Kalina , La Rosa Valentina Lucia , Cerentini Taís Marques , Machado de Souza Cislaine , Langlois Costa Filipe , Viana da Rosa Patricia , da Silva Klahr Patrícia , de Almeida Pereira Elvio , Telles da Rosa Luis Henrique 
Published: July 2019

Objective
Obese women with large abdominal volume may present with elevated intra-abdominal and intravesical pressure due to their high body mass index (BMI), which leads to an imbalance in the mechanism responsible for urinary continence. Thus, these women have a 2-fold chance of developing urinary incontinence (UI) than nonobese women. Because increased BMI represents a risk factor for UI development, we hypothesize that its reduction could alleviate or decrease the symptoms of this condition in obese women. Therefore, the aim of this study was to describe the impact of weight loss on the severity of UI symptoms and quality of life (QoL) in women undergoing bariatric surgery.

Methods
This was a combined case-cohort study lasting 1 year, with 26 obese women aged 18 to 59 years who underwent bariatric surgery and presented preoperative UI. The participants’ BMI was calculated, their UI was assessed through the International Consultation on Incontinence Questionnaire–Short Form, and QoL by the King’s Health Questionnaire. Reassessments were performed at 3, 6, 9, and 12 postoperative months.

Results
We found no significant association between BMI reduction and prevalence and severity of UI. However, the 8-point reduction in BMI was sufficient to decrease the severity of UI. Quality of life improved significantly in 7 of the 9 domains evaluated.

Conclusions
According to the results of our study, we can conclude that the reduction in the prevalence and severity of UI together with weight loss induced by bariatric surgery was more evident in the first 3 months postoperatively, impacting positively the QoL of these women.
One-year mortality in geriatric trauma patients: Improving upon the geriatric trauma outcomes score utilizing the social security death index
Authors: Ross Samuel W. , Adeyemi Folarin M. , Zhou Michael , Minhajuddin Abu T. , Porembka Matthew R. , Cripps Michael W. , Phelan Herbert A. 
Published: July 2019

BACKGROUND
Geriatric Trauma Outcomes Score (GTOS) predicts in-patient mortality in geriatric trauma patients and has been validated in a prospective multicenter trial and expanded to predict adverse discharge (GTOS II). We hypothesized that these formulations actually underestimate the downstream sequelae of injury and sought to predict longer-term mortality in geriatric trauma patients.

METHODS
The Parkland Memorial Hospital Trauma registry was queried for patients 65 years or older from 2001 to 2013. Patients were then matched to the Social Security Death Index. The primary outcome was 1-year mortality. The original GTOS formula (variables of age, Injury Severity Score [ISS], 24-hour transfusion) was tested to predict 1-year mortality using receiver operator curves. Significant variables on univariate analysis were used to build an optimal multivariate model to predict 1-year mortality (GTOS III).

RESULTS
There were 3,262 patients who met inclusion. Inpatient mortality was 10.0% (324) and increased each year: 15.8%, 1 year; 17.8%, 2 years; and 22.6%, 5 years. The original GTOS equation had an area under the curve of 0.742 for 1-year mortality. Univariate analysis showed that patients with 1-year mortality had on average increased age (75.7 years vs. 79.5 years), ISS (11.1 vs. 19.1), lower GCS score (14.3 vs. 10.5), more likely to require transfusion within 24 hours (11.5% vs. 31.3%), and adverse discharge (19.5% vs. 78.2%; p < 0.0001 for all). Multivariate logistic regression was used to create the optimal equation to predict 1-year mortality: (GTOSIII = age + [0.806 × ISS] + 5.55 [if transfusion in first 24 hours] + 21.69 [if low GCS] + 34.36 [if adverse discharge]); area under the curve of 0.878.

CONCLUSION
Traumatic injury in geriatric patients is associated with high mortality rates at 1 year to 5 years. GTOS III has robust test characteristics to predict death at 1 year and can be used to guide patient centered goals discussions with objective data.

LEVEL OF EVIDENCE
Prognostic, level III.