bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment with triple combination of atorvastatin, perindopril, and amlodipine in patients with stable coronary artery disease: A subgroup analysis from the PAPA-CAD study
Authors: Dézsi Csaba András 
Published: March 2018

Background In patients with stable coronary artery disease, aspirin, a statin, and an angiotensin-converting enzyme inhibitor are recommended as first-line agents for secondary prevention. Subgroup analyses of the previously published Hungarian Perindopril plus Amlodipine in PAtients with Coronary Artery Disease (PAPA-CAD) non-interventional trial demonstrated that the addition of the metabolically beneficial, fixed combination of perindopril + amlodipine to atorvastatin further improves the patient’s lipid profile. Methods The PAPA-CAD study, a 6-month open-label, prospective, multicenter, observational/non-interventional survey evaluated data accumulated from patients with hypertensive patients with stable coronary artery disease. The herein-reported subgroup analysis was conducted using the findings from those 1130 patients, who were taking atorvastatin in addition to the fixed combination of perindopril + amlodipine at the time of all four study visits (i.e., at baseline and 1, 3, and 6 months later). Results In the subgroup of patients taking atorvastatin as an add-on agent, 82.5% reached the target blood pressure of 140/90 mmHg compared with 78.8% of those not taking a statin. The addition of atorvastatin to the fixed combination of perindopril + amlodipine resulted in further significant improvements of key metabolic parameters. Conclusion This subgroup analysis confirmed that favorable synergism exists among perindopril, amlodipine, and atorvastatin.
Sudden unexpected death in epilepsy in a 14-year-old girl: case report and literature review
Authors: Zhang Xinyue , Sun Lichao , Cui Li , Lin Weihong 
Published: March 2018

Background Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in people with epilepsy. The pathogenesis of SUDEP is still unclear. The majority of SUDEP cases occur in intractable epilepsy, especially in the aftermath of a generalized tonic-clonic seizure. We report an atypical SUDEP case with infrequent seizures in frontal lobe epilepsy. Case Report A 14-year-old girl presented with a 13-year history of paroxysmal convulsions. She experienced three episodes within 6–10 months after birth. At 14 years old, she experienced an aggravated seizure, manifesting as unconsciousness, hyperventilation, and urinary incontinence. Electroencephalography showed spike-slow waves and slow waves with mixed asynchronized spike waves originating from the frontal lobe during the sleep stage. Transient outbreaks of spike-slow complex waves (1–2 s) were also noted in all leads. The diagnosis of frontal lobe epilepsy (generalized tonic-clonic seizures secondary to focal impaired awareness seizures and myoclonus) was made. Oral sodium valproate was prescribed. However, she suddenly died on her way to school 2 months later. Conclusion The causes of SUDEP are complicated, and frontal lobe epilepsy may be a potential risk factor. Early diagnosis and appropriate treatment of epileptic seizures, as well as close observation, should be emphasized.
Surgical management of proximal fibular tumors: risk factors for recurrence and complications
Authors: Guo Changzhi , Zhang Xiaoran , Gao Feng , Wang Lingxiang , Sun Tao 
Published: March 2018

Objectives The aim of this study was to identify patient- and treatment-specific independent risk factors for the recurrence of proximal fibular tumors and complications of their surgical management. Methods Patients who underwent surgical treatment of proximal fibular tumors at our institution from 2004 to 2015 were retrospectively reviewed. All patients had a pathologically confirmed diagnosis and were followed up for at least 12 months for recurrence and complications. All patients were evaluated with respect to seven patient-, disease-, and treatment-specific variables. Results In the univariate analysis, peroneal nerve palsy at presentation and malignancy were associated with an increased risk of recurrence, iatrogenic peroneal nerve injury, and wound healing problems. The multivariate analysis showed that peroneal nerve palsy at presentation was an independent risk factor for recurrence and iatrogenic peroneal nerve injury and that malignancy was an independent risk factor for wound healing problems. Conclusions Peroneal nerve palsy and malignant potential are independent risk factors for complications of surgical treatment of proximal fibular tumors. The recognition of these factors may contribute to proper management and help to prevent recurrence and postoperative complications.
Integrated approach to pain management for a patient with multiple bone metastases of uterine cervical cancer
Authors: Qin De-An , Song Jie-Fu , Song Li-Ping , Feng Gui-Sheng 
Published: March 2018

Background Pain management for multiple bone metastases is complex and often requires multidisciplinary treatment. We herein describe patient-centered multidisciplinary pain management for metastatic cancer. Case presentation: A 61-year-old woman with multiple bone metastases of uterine cervical cancer developed intractable low back pain. After external beam radiotherapy failed, we performed lumbar spinal intralesional curettage, pedicle screw fixation, and nerve decompression. However, the neuralgia persisted. We then percutaneously injected epirubicin into the intervertebral foramina under computed tomography guidance for L5 dorsal root ganglion destruction. Osteoplasty was performed under C-arm X-ray guidance; however, the sacrum was mistaken for the ilium, and treatment was ineffective. We administered zoledronic acid and strontium-89. The last resort was outpatient implantation of an epidural bupivacaine-morphine infusion system. A visual analog scale (VAS) was used for pain evaluation. Lumbar spinal intralesional curettage and fixation, epirubicin-induced ganglion destruction, and administration of zoledronic acid and strontium-89 decreased her VAS pain score from 7–8 to 3–4. Radiotherapy and nerve decompression and release were ineffective, as was osteoplasty because of the location error. The epidural infusion system decreased the VAS score from 7–8 to 2–3 and was highly efficient. Conclusions Multidisciplinary integrated treatment for metastatic cancer can be effective.
Open Versus Arthroscopic Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review and Meta-analysis
Authors: Hurley Eoghan T. , Lim Fat Daren , Farrington Shane K. , Mullett Hannan 
Published: March 2018

Background: Anterior shoulder instability with significant glenoid bone loss is a challenging condition. The open Latarjet procedure is the established standard treatment method in this setting, but there is an increasing use of the arthroscopic technique. Purpose: To systematically review the current evidence in the literature to ascertain if the open or arthroscopic Latarjet procedure resulted in improved patient outcomes. Study Design: Systematic review and meta-analysis. Methods: A literature search of MEDLINE, EMBASE, and the Cochrane Library was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Cohort studies comparing the open and arthroscopic Latarjet procedures for anterior shoulder instability were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager (version 5.3). A P value of <.05 was considered statistically significant. Results: Six clinical trials with 896 patients were included. The open and arthroscopic Latarjet procedures resulted in a similar number of total recurrent instability (2.0% vs 2.4%; P = .75), revision procedures (2.4% vs 5.4%; P = .06), and total complications (13.8% vs 11.9%; P = .50), but the open procedure had a lower rate of persistent apprehension (10.2% vs 35.7%; P < .05). In addition, after the learning curve, the operative time was similar between the 2 procedures. Conclusion: Both the open and arthroscopic Latarjet procedures result in significant improvements in patient function and outcome scores, with low rates of recurrent instability and similar complication rates. While technically challenging, the arthroscopic procedure has been shown to be a safe and viable alternative. However, there is a significant learning curve associated with the arthroscopic Latarjet procedure. The significant learning curve associated with this procedure suggests the arthroscopic procedure may be advisable to perform only in high-volume centers with experienced arthroscopists.
Completely Integrated Wearable TAH-drive Unit
Authors: Heimes H.P. , Klasen F. 
Published: March 2018

A pneumatic, wearable, batter-powered TAH-drive unit is presented. This drive-unit is characterized by a very good overall efficiency, achieved by design optimization on one hand and controlled economized membrane displacement on the other. The implemented control system facilitates an adoption to circulatory needs. The integrated micro-computer controls the whole pumping cycle and calculates the effective blood-side stroke volume by a beat to beat analysis of drive-side parameters. It could be demonstrated in animal tests (calves) under varying loads that the available driving power is sufficient to maintain an adequate circulatory supply for calves up to 135 kg. Further, it could be demonstrated that a sufficient right/left balance was obtained over the whole animal test duration.
Treatment of Progressive Systemic Sclerosis with Plasma Exchange. Seven Cases
Authors: Guillevin L. , Leon A. , Levy Y. , Bletry O. , Gayraud M. , Andreu G. , Godeau P. 
Published: March 2018

Seven patients, 4 women and 3 men afflicted with severe progressive systemic sclerosis (PSS) were treated with Plasma Exchange after failure of different other treatment. All patients presented Raynaud phenomenon and arthritis, 6 patients presented extensive skin lesions, 5 of them digestive manifestations, 3 pulmonary fibrosis. In one case PSS was associated with polymyositis, one patient presented bilateral recurrent cornea ulcerations, (Sjögren Syndrom) and one patient numerous skin ulcerations. In 5 patients adjuvant corticosteroid therapy was given during the course of PE. In 3 patients PE must be stopped after one or two sessions because of insufficient venous access. Among the 4 other patients 8 to 20 PE were performed: the patient with cornea ulcerations became blind during the treatment, skin ulcerations and severe Raynaud phenomenon did not improved in two other patients. Benefit of PE was noted in only one patient with regressive myositis, and improvement of articular and cutaneous symptoms. Therefore, PE are not useful in most patients afflicted with PSS, they are difficult to realize in numerous patients and did not improve clinical symptoms in most cases.
Controlling Anticoagulation in Extracorporeal Blood Circuits (hemoperfusion)
Authors: Mor L. , Sideman S. , Mihich M. , Tzipiniuk A. , Lupovich S. , Brandes J.M. 
Published: March 2018

The study demonstrates that different individuals (monkeys) need different heparin doses so as to avoid either clotting or bleeding when an extracorporeal blood system is involved. The linear correlation between PT and WBPTT values enables to utilize the latter for monitoring the heparin level in the blood. One procedure is based on the application of the Gotch and Keen intravenous heparinization model in its steady state limit by utilizing the pre-treatment evaluation of k/S, the ratio of the elimination rate constant to the individual's sensitivity to heparin. A second procedure involves the direct heparinization of the extracorporeal system. The heparin infusion rate is monitored through the arterial WBPTT values after relating the individual's PT or WBPTT values to the in vitro heparin concentration in the blood. In vitro and in vivo study of the effect of hemoperfusion through a column containing anion exchange particles on the amount and rate of heparin administration indicates that only the in vivo results are meaningful. The sharp response of WBPTT to relatively small changes of citrate concentration in the blood precludes individual monitoring by WBPTT. Work on the advantage of utilizing heparin together with citrate is required.
Cervical Spinal Cord Injury Shows Markedly Lower than Predicted Mortality (>72 Hours After Multiple Trauma) From Sepsis and Multiple Organ Failure
Authors: Kamp Oliver , Jansen Oliver , Lefering Rolf , Meindl Renate , Waydhas Christian , Schildhauer Thomas A. , Hamsen Ume ,   the TraumaRegister DGU
Published: March 2018

Background: Sepsis and multiple organ failure (MOF) remain one of the main causes of death after multiple trauma. Trauma- and infection-associated immune reactions play an important role in the pathomechanism of MOF, but the exact pathways remain unknown. Spinal cord injury (SCI) may lead to an altered immune response, and some studies suggest a prognostic advantage for such patients having sepsis or multiple trauma. Yet these findings need to be evaluated in larger cohorts of trauma patients. Methods: Retrospective, multicenter study, using the data of the TraumaRegister DGU. Patients with and without SCI surviving the initial first 72 hours after trauma were matched according to injury pattern and age. Comparative analysis considered morbidity (sepsis, MOF) and hospital mortality. Results: The study population included 800 matched pairs. As intended by the matching process, patients with cervical SCI had an otherwise comparable injury pattern but a higher severity of trauma (mean Injury Severity Score: 36 vs 29, mean number of diagnosis: 5.6 vs 4.4). They had a higher rate of sepsis (15.9% vs 10.9%, P = .005) and MOF (35.9% vs 24.1%, P < .001) while mortality revealed no significant difference (9.5% vs 9.9%, P = .866). Conclusions: Cervical SCI leads to an increased rate of sepsis and MOF but appears to be favorable with respect to outcome of sepsis and MOF following multiple trauma. Further research should focus on the pathomechanisms and the possible arising therapeutic options.
The Impact of AUC-Based Monitoring on Pharmacist-Directed Vancomycin Dose Adjustments in Complicated Methicillin-Resistant Staphylococcus aureus Infection
Authors: Stoessel Andrew M. , Hale Cory M. , Seabury Robert W. , Miller Christopher D. , Steele Jeffrey M. 
Published: March 2018

Objective: This study aimed to assess the impact of area under the curve (AUC)-based vancomycin monitoring on pharmacist-initiated dose adjustments after transitioning from a trough-only to an AUC-based monitoring method at our institution. Methods: A retrospective cohort study of patients treated with vancomycin for complicated methicillin-resistant Staphylococcus aureus (MRSA) infection between November 2013 and December 2016 was conducted. The frequency of pharmacist-initiated dose adjustments was assessed for patients monitored via trough-only and AUC-based approaches for trough ranges: 10 to 14.9 mg/L and 15 to 20 mg/L. Results: Fifty patients were included: 36 in the trough-based monitoring and 14 in the AUC-based-monitoring group. The vancomycin dose was increased in 71.4% of patients when troughs were 10 to 14.9 mg/L when a trough-only approach was used and in only 25% of patients when using AUC estimation ( P = .048). In the AUC group, the dose was increased only when AUC/minimum inhibitory concentration (MIC) <400; unchanged regimens had an estimated AUC/MIC ≥400. The AUC-based monitoring did not significantly increase the frequency of dose reductions when trough concentrations were 15 to 20 mg/L (AUC: 33.3% vs trough: 4.6%; P = .107). Conclusions: The AUC-based monitoring resulted in fewer patients with dose adjustments when trough levels were 10 to 14.9 mg/L. The AUC-based monitoring has the potential to reduce unnecessary vancomycin exposure and warrants further investigation.
Game for Low-Formal Education Farmers to Learn How to Improve Soil Quality
Authors: Pruksakorn Sutheera , Kiratiprayoon Somboon , Uttaranakorn Somkit , Sukreeyapongse Orathai , Dumrongrojwatthana Pongchai 
Published: March 2018

Background. Many Thai farmers who live in national parks farmlands lack a formal education. They usually lack of knowledge on soil quality improvement and proper use of fertilizer. They illegally trespass in forest areas because of soil deterioration in their own limited expanses of farmland. Consequently, most of them are arrested, creating individual and family problems. Aim. This “soil analysis and appropriate fertilizer use game” (SAAFU game) was designed for farmers having low-formal education to realize the soil analysis before planting and improve the appropriate chemical fertilizer usage. Method.This quasi-experiential research used pre- and post-tests to evaluate the game session processes and learning of the players. The important steps were: 1) analysis of soil in the land box; 2) making decisions to buy fertilizer; 3) calculating, harvesting and selling products. Debriefing was also used to discuss and exchange their knowledge and experiences. Follow up process was also performed. Results. The pre- and post-test score showed the better understanding of appropriate fertilizer use of the players. Soon after the gaming sessions, players went to their fields and collected 31 soil samples for soil nutrient analysis. Players also disseminated knowledge to their relatives and neighbors. As a result, non-players of Dongbak(22), Wangmon(9) and Chaimongkol(2) collected soil samples for soil nutrient analysis. Moreover, they grouping together to buy quicklime and fertilizers to get cheaper price. Conclusion. This simple game can be used effectively with farmers having low-formal education. After the game and simulation, most of them realized how important of soil nutrients and soil analysis before planting and were able to teach their relatives and neighbours about soil collecting. This indicated the successful of this game.
Management of hepatitis B reactivation in lymphoma patients on rituximab with past hepatitis B exposure: An observational study
Authors: Yeo Denise , Hossain Ihtimam , Lim Soon Thye , Farid Mohamad , Tao Miriam , Quek Richard , Tang Tiffany , Chan Alexandre 
Published: March 2018

Background Currently, a standardized approach to prevent and manage hepatitis B reactivation in lymphoma patients with past hepatitis exposure receiving rituximab in Singapore is lacking. This study is designed to report the current management approach and outcomes associated with hepatitis B reactivation. Objectives The primary objective was to report 6-, 12-, 24-month cumulative hepatitis B reactivation-related outcomes. Secondary objectives were to report monitoring frequencies of hepatitis B DNA and liver function tests performed in lymphoma patients with resolved hepatitis B receiving rituximab, and anti-viral prophylaxis use. Methodology This was a single centre, retrospective observational study. Patients with resolved hepatitis B initiated on rituximab from January 2011 to December 2015 were identified and reviewed over a two-year period starting from the date of rituximab initiation. Relevant parameters were obtained from electronic medical records. Hepatitis B reactivation was defined by hepatitis B DNA levels 20 IU/ml (1.30 log/ml) and above. Data were analysed using descriptive statistics. Results Seventy-five patients were retrospectively reviewed over a two-year period. Hepatitis B reactivation was defined as hepatitis B DNA levels ≥20 IU/ml (1.30 log/ml). The 24-month cumulative hepatitis B reactivation rate was 4.0%. The median (interquartile range) number of hepatitis B DNA tests performed during treatment, initial six-month follow-up, and subsequent follow-up were 1.0 (0.0–2.6), 1.0 (0.0–2.0), and 1.0 (0.0–3.1), respectively. Conclusion Large variations in hepatitis B reactivation monitoring and management strategies were observed. Further studies are required to develop and determine a standardised protocol that could contribute to safer and more cost-effective care for lymphoma patients with resolved hepatitis B on rituximab.
Steroid-induced ocular hypertension in the pediatric age group
Authors: Al Hanaineh Abeer T , Hassanein Dina H , Abdelbaky Sameh H , El Zawahry Omar M 
Published: March 2018

Purpose: Comparing the effects of topical Rimexolone versus Dexamethasone and Rimexolone versus Fluorometholone on the intraocular pressure in children <13 years. Methods: A total of 40 patients (80 eyes) undergoing bilateral recession strabismus surgery were divided into two groups. Group A included 20 children (40 eyes); for each, one eye was randomized to receive 1% Rimexolone and the fellow eye received 0.1% Dexamethasone. Group B included 20 children (40 eyes); for each, one eye was randomized to receive 1% Rimexolone and the fellow eye received 0.1% Fluorometholone. Patients received eye drops for two consecutive weeks. Preoperative and postoperative intraocular pressure values for weeks 1, 2, 3, 4, and 6 were measured. The ocular-hypertensive response of all patients was categorized as either high, intermediate or low (Armaly–Becker Classification). Results: After a 2-week treatment for both groups, peak and maximal intraocular pressure changes were reached. Changes were significantly higher in the Dexamethasone-treated eyes than in the Rimexolone- and Fluorometholone-treated eyes, which had a comparable change. (Week 2 intraocular pressure Group A: 14.15 ± 3.23 mmHg vs 17.95 ± 4.27 mmHg; Group B: 15.1 ± 2.27 mmHg vs 15.2 ± 2.73 mmHg). In both groups, the increase was statistically significant compared to the baseline intraocular pressure (preoperative intraocular pressure Group A: 13.2 ± 3.53 mmHg vs 13.1 ± 3.43 mmHg; Group B: 12.55 ± 2.98 mmHg vs 12.15 ± 3.31 mmHg). Intraocular pressure returned to near preoperative values over the following four consecutive weeks (Week 6 intraocular pressure Group A: 12.25 ± 2.67 mmHg vs 12.55 ± 2.95 mmHg; Group B: 12.15 ± 2.8 mmHg vs 12.00 ± 2.75 mmHg). None of the patients were high responders. Conclusion: Dexamethasone caused a higher elevation in intraocular pressure than Rimexolone and Fluorometholone in children. The ocular-hypertensive response was transient after the 2-week course.