bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Pilot Crossover Trial of Sleep Medications for Sleep-disturbed Methadone Maintenance Patients
Authors: Stein Michael D. , Kurth Megan E. , Anderson Bradley J. , Blevins Claire E. 
Published: March 2019

Objectives:
Problems with sleep are a common and detrimental occurrence among individuals who receive methadone maintenance for opioid use disorder (OUD).

Methods:
We enrolled ten methadone-maintained persons with insomnia (60% female, mean age 40) in a double-blind trial using actigraphy to confirm daily sleep reports. After a no-medication week to establish baseline sleep patterns, each participant received 1 week each of mirtazapine (30 mg), zolpidem (sustained-release 12.5 mg), mirtazapine (30 mg IR) plus zolpidem (10 mg), and placebo, with a washout week between each medication week. Study medication order was randomized so that the order of each 1-week medication treatment was different for each participant, but all participants received all 4 regimens.

Results:
We found that mirtazapine alone improved total sleep (mean 23 minutes), sleep latency (mean 23 minutes), and sleep efficiency (mean 3%), surpassing the other regiments.

Conclusions:
This pilot work suggests that mirtazapine is worthy of further testing as a sleep aid for persons with OUD receiving methadone maintenance.
Gradually Increasing Tidal Volume May Mitigate Experimental Lung Injury in Rats
Authors: Felix Nathane S. , Samary Cynthia S. , Cruz Fernanda F. , Rocha Nazareth N. , Fernandes Marcos V. S. , Machado Joana A. , Bose-Madureira Rebecca L. , Capelozzi Vera L. , Pelosi Paolo , Silva Pedro L. , Marini John J. , Rocco Patricia R. M. 
Published: March 2019

Abstract

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Background
This study hypothesized that, in experimental mild acute respiratory distress syndrome, lung damage caused by high tidal volume (VT) could be attenuated if VT increased slowly enough to progressively reduce mechanical heterogeneity and to allow the epithelial and endothelial cells, as well as the extracellular matrix of the lung to adapt. For this purpose, different strategies of approaching maximal VT were tested.

Methods
Sixty-four Wistar rats received Escherichia coli lipopolysaccharide intratracheally. After 24 h, animals were randomly assigned to receive mechanical ventilation with VT = 6 ml/kg for 2 h (control); VT = 6 ml/kg during hour 1 followed by an abrupt increase to VT = 22 ml/kg during hour 2 (no adaptation time); VT = 6 ml/kg during the first 30 min followed by a gradual VT increase up to 22 ml/kg for 30 min, then constant VT = 22 ml/kg during hour 2 (shorter adaptation time); and a more gradual VT increase, from 6 to 22 ml/kg during hour 1 followed by VT = 22 ml/kg during hour 2 (longer adaptation time). All animals were ventilated with positive end-expiratory pressure of 3 cm H2O. Nonventilated animals were used for molecular biology analysis.

Results
At 2 h, diffuse alveolar damage score and heterogeneity index were greater in the longer adaptation time group than in the control and shorter adaptation time animals. Gene expression of interleukin-6 favored the shorter (median [interquartile range], 12.4 [9.1–17.8]) adaptation time compared with longer (76.7 [20.8 to 95.4]; P = 0.02) and no adaptation (65.5 [18.1 to 129.4]) time (P = 0.02) strategies. Amphiregulin, metalloproteinase-9, club cell secretory protein-16, and syndecan showed similar behavior.

Conclusions
In experimental mild acute respiratory distress syndrome, lung damage in the shorter adaptation time group compared with the no adaptation time group was attenuated in a time-dependent fashion by preemptive adaptation of the alveolar epithelial cells and extracellular matrix. Extending the adaptation period increased cumulative power and did not prevent lung damage, because it may have exposed animals to injurious strain earlier and for a longer time, thereby negating any adaptive benefit.
Relationship between Perioperative Hypotension and Perioperative Cardiovascular Events in Patients with Coronary Artery Disease Undergoing Major Noncardiac Surgery
Authors: Roshanov Pavel S. , Sheth Tej , Duceppe Emmanuelle , Tandon Vikas , Bessissow Amal , Chan Matthew T. V. , Butler Craig , Chow Benjamin J. W. , Khan James S. , Devereaux P. J. 
Published: March 2019

Abstract

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Background
Perioperative hypotension is associated with cardiovascular events in patients having noncardiac surgery. It is unknown if the severity of preexisting coronary artery disease determines susceptibility to the cardiovascular risks of perioperative hypotension.

Methods
In this retrospective exploratory analysis of a substudy of an international prospective blinded cohort study, 955 patients 45 yr of age or older with history or risk factors for coronary artery disease underwent coronary computed tomographic angiography before elective inpatient noncardiac surgery. The authors evaluated the potential interaction between angiographic findings and perioperative hypotension (defined as systolic blood pressure less than 90 mmHg for a total of 10 min or more during surgery or for any duration after surgery and for which intervention was initiated) on the composite outcome of time to myocardial infarction or cardiovascular death up to 30 days after surgery. Angiography assessors were blinded to study outcomes; patients, treating clinicians, and outcome assessors were blinded to angiography findings.

Results
Cardiovascular events (myocardial infarction or cardiovascular death within 30 days after surgery) occurred in 7.7% of patients (74/955), including in 2.7% (8/293) without obstructive coronary disease or hypotension compared to 6.7% (21/314) with obstructive coronary disease but no hypotension (hazard ratio, 2.51; 95% CI, 1.11 to 5.66; P = 0.027), 8.8% (14/159) in patients with hypotension but without obstructive coronary disease (hazard ratio, 3.85; 95% CI, 1.62 to 9.19; P = 0.002), and 16.4% (31/189) with obstructive coronary disease and hypotension (hazard ratio, 7.34; 95% CI, 3.37 to 15.96; P < 0.001). Hypotension was independently associated with cardiovascular events (hazard ratio, 3.17; 95% CI, 1.99 to 5.06; P < 0.001). This association remained in patients without obstructive disease and did not differ significantly across degrees of coronary disease (P value for interaction, 0.599).

Conclusions
In patients having noncardiac surgery, perioperative hypotension was associated with cardiovascular events regardless of the degree of coronary artery disease on preoperative coronary computed tomographic angiography.
Nasopharyngeal Tube Effects on Breathing during Sedation for Dental Procedures
Authors: Kohzuka Yuuya , Isono Shiroh , Ohara Sayaka , Kawabata Kazune , Kitamura Anri , Suzuki Takashi , Almeida Fernanda R. , Sato Yasunori , Iijima Takehiko 
Published: March 2019

Abstract

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Background
Intravenous sedation is effective in patients undergoing dental procedures, but fatal hypoxemic events have been documented. It was hypothesized that abnormal breathing events occur frequently and are underdetected by pulse oximetry during sedation for dental procedures (primary hypothesis) and that insertion of a small-diameter nasopharyngeal tube reduces the frequency of the abnormal breathing events (secondary hypothesis).

Methods
In this nonblinded randomized control study, frequency of abnormal breathing episodes per hour (abnormal breathing index) of the patients under sedation for dental procedures was determined and used as a primary outcome to test the hypotheses. Abnormal breathing indexes were measured by a portable sleep monitor. Of the 46 participants, 43 were randomly allocated to the control group (n = 23, no nasopharyngeal tube) and the nasopharyngeal tube group (n = 20).

Results
In the control group, nondesaturated abnormal breathing index was higher than the desaturated abnormal breathing index (35.2 [20.6, 48.0] vs. 7.2 [4.1, 18.5] h−1, difference: 25.1 [95% CI, 13.8 to 36.4], P < 0.001). The obstructive abnormal breathing index was greater than central abnormal breathing index (P < 0.001), and half of abnormal breathing indexes were followed by irregular breathing. Despite the obstructive nature of abnormal breathing, the nasopharyngeal tube did not significantly reduce the abnormal breathing index (48.0 [33.8, 64.4] h−1
vs. 50.5 [36.4, 63.9] h−1, difference: −2.0 [95% CI, −15.2 to 11.2], P = 0.846), not supporting the secondary hypothesis.

Conclusions
Patients under sedation for dental procedure frequently encounter obstructive apnea/hypopnea events. The majority of the obstructive apnea/hypopnea events were not detectable by pulse oximetry. The effectiveness of a small-diameter nasopharyngeal tube to mitigate the events is limited.
Opioid Sensitivity in Children with and without Obstructive Sleep Apnea
Authors: Montana Michael C. , Juriga Lindsay , Sharma Anshuman , Kharasch Evan D. 
Published: March 2019

Abstract

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Background
Opioids are a mainstay of perioperative analgesia. Opioid use in children with obstructive sleep apnea is challenging because of assumptions for increased opioid sensitivity and assumed risk for opioid-induced respiratory depression compared to children without obstructive sleep apnea. These assumptions have not been rigorously tested. This investigation tested the hypothesis that children with obstructive sleep apnea have an increased pharmacodynamic sensitivity to the miotic and respiratory depressant effects of the prototypic μ-opioid agonist remifentanil.

Methods
Children (8 to 14 yr) with or without obstructive sleep apnea were administered a 15-min, fixed-rate remifentanil infusion (0.05, 0.1, or 0.15 μg · kg-1 · min-1). Each dose group had five patients with and five without obstructive sleep apnea. Plasma remifentanil concentrations were measured by tandem liquid chromatography mass spectrometry. Remifentanil effects were measured via miosis, respiratory rate, and end-expired carbon dioxide. Remifentanil pharmacodynamics (miosis vs. plasma concentration) were compared in children with or without obstructive sleep apnea.

Results
Remifentanil administration resulted in miosis in both non-obstructive sleep apnea and obstructive sleep apnea patients. No differences in the relationship between remifentanil concentration and miosis were seen between the two groups at any of the doses administered. The administered dose of remifentanil did not affect respiratory rate or end-expired carbon dioxide in either group.

Conclusions
No differences in the remifentanil concentration–miosis relation were seen in children with or without obstructive sleep apnea. The dose and duration of remifentanil administered did not alter ventilatory parameters in either group.
Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery
Authors: Klinger Rebecca Y. , Cooter Mary , Bisanar Tiffany , Terrando Niccolò , Berger Miles , Podgoreanu Mihai V. , Stafford-Smith Mark , Newman Mark F. , Mathew Joseph P. ,   for the Neurologic Outcomes Research Group of the Duke Heart Center
Published: March 2019

Abstract

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Background
Cognitive decline after cardiac surgery occurs frequently and persists in a significant proportion of patients. Preclinical studies and human trials suggest that intravenous lidocaine may confer protection in the setting of neurologic injury. It was hypothesized that lidocaine administration would reduce cognitive decline after cardiac surgery compared to placebo.

Methods
After institutional review board approval, 478 patients undergoing cardiac surgery were enrolled into this multicenter, prospective, randomized, double-blinded, placebo-controlled, parallel group trial. Subjects were randomized to lidocaine 1 mg/kg bolus after the induction of anesthesia followed by a continuous infusion (48 μg · kg−1 · min−1 for the first hour, 24 μg · kg−1 · min−1 for the second hour, and 10 μg · kg−1 · min−1 for the next 46 h) or saline with identical volume and rate changes to preserve blinding. Cognitive function was assessed preoperatively and at 6 weeks and 1 yr postoperatively using a standard neurocognitive test battery. The primary outcome was change in cognitive function between baseline and 6 weeks postoperatively, adjusting for age, years of education, baseline cognition, race, and procedure type.

Results
Among the 420 allocated subjects who returned for 6-week follow-up (lidocaine: N = 211; placebo: N = 209), there was no difference in the continuous cognitive score change (adjusted mean difference [95% CI], 0.02 (−0.05, 0.08); P = 0.626). Cognitive deficit (greater than 1 SD decline in at least one cognitive domain) at 6 weeks occurred in 41% (87 of 211) in the lidocaine group versus 40% (83 of 209) in the placebo group (adjusted odds ratio [95% CI], 0.94 [0.63, 1.41]; P = 0.766). There were no differences in any quality of life outcomes between treatment groups. At the 1-yr follow-up, there continued to be no difference in cognitive score change, cognitive deficit, or quality of life.

Conclusions
Intravenous lidocaine administered during and after cardiac surgery did not reduce postoperative cognitive decline at 6 weeks.
Auditory Localization and Spatial Release From Masking in Children With Suspected Auditory Processing Disorder
Authors: Boothalingam Sriram , Purcell David W. , Allan Chris , Allen Prudence , Macpherson Ewan 
Published: March 2019

Objectives:
We sought to investigate whether children referred to our audiology clinic with a complaint of listening difficulty, that is, suspected of auditory processing disorder (APD), have difficulties localizing sounds in noise and whether they have reduced benefit from spatial release from masking.

Design:
Forty-seven typically hearing children in the age range of 7 to 17 years took part in the study. Twenty-one typically developing (TD) children served as controls, and the other 26 children, referred to our audiology clinic with listening problems, were the study group: suspected APD (sAPD). The ability to localize a speech target (the word “baseball”) was measured in quiet, broadband noise, and speech-babble in a hemi-anechoic chamber. Participants stood at the center of a loudspeaker array that delivered the target in a diffused noise-field created by presenting independent noise from four loudspeakers spaced 90° apart starting at 45°. In the noise conditions, the signal-to-noise ratio was varied between −12 and 0 dB in 6-dB steps by keeping the noise level constant at 66 dB SPL and varying the target level. Localization ability was indexed by two metrics, one assessing variability in lateral plane [lateral scatter (Lscat)] and the other accuracy in the front/back dimension [front/back percent correct (FBpc)]. Spatial release from masking (SRM) was measured using a modified version of the Hearing in Noise Test (HINT). In this HINT paradigm, speech targets were always presented from the loudspeaker at 0°, and a single noise source was presented either at 0°, 90°, or 270° at 65 dB A. The SRM was calculated as the difference between the 50% correct HINT speech reception threshold obtained when both speech and noise were collocated at 0° and when the noise was presented at either 90° or 270°.

Results:
As expected, in both groups, localization in noise improved as a function of signal-to-noise ratio. Broadband noise caused significantly larger disruption in FBpc than in Lscat when compared with speech babble. There were, however, no group effects or group interactions, suggesting that the children in the sAPD group did not differ significantly from TD children in either localization metric (Lscat and FBpc). While a significant SRM was observed in both groups, there were no group effects or group interactions. Collectively, the data suggest that children in the sAPD group did not differ significantly from the TD group for either binaural measure investigated in the study.

Conclusions:
As is evident from a few poor performers, some children with listening difficulties may have difficulty in localizing sounds and may not benefit from spatial separation of speech and noise. However, the heterogeneity in APD and the variability in our data do not support the notion that localization is a global APD problem. Future studies that employ a case study design might provide more insights.
Spectral-temporally modulated ripple test Lite for computeRless Measurement (SLRM): A Nonlinguistic Test for Audiology Clinics
Authors: Landsberger David M. , Stupak Natalia , Aronoff Justin M. 
Published: March 2019

Objectives:
Many clinics are faced with the difficulty of evaluating performance in patients who speak a language for which there are no validated tests. It would be desirable to have a nonlinguistic method of evaluating these patients. Spectral ripple tests are nonlinguistic and highly correlated with speech identification performance. However, they are generally not amenable to clinical environments as they typically require the use of computers which are often not found in clinic sound booths. In this study, we evaluate the Spectral-temporally Modulated Ripple Test (SMRT) Lite for computeRless Measurement (SLRM), which is a new variant of the adaptive SMRT that can be implemented via a CD player.

Design:
SMRT and SLRM were measured for 10 normal hearing and 10 cochlear implant participants.

Results:
Performance on the two tests was highly correlated (r = 0.97).

Conclusions:
The results suggest that SLRM can be used interchangeably with SMRT but can be implemented without a computer.
Associations Between Telomere Length and Hearing Status in Mid-Childhood and Midlife: Population-Based Cross-Sectional study
Authors: Wang Jing , Nguyen Minh Thien , Sung Valerie , Grobler Anneke , Burgner David , Saffery Richard , Wake Melissa 
Published: March 2019

Objectives:
The purpose of this study is to determine if telomere length (a biomarker of aging) is associated with hearing acuity in mid-childhood and midlife.

Design:
The study was based on the population-based cross-sectional study within the Longitudinal Study of Australian Children with telomere length and audiometry data. We calculated high Fletcher Index (hFI, mean threshold of 1, 2, and 4 kHz), defining hearing loss as threshold >15 dB HL (better ear). Linear and logistic regression analyses quantified associations of telomere length with continuous hearing threshold and binary hearing loss outcomes, respectively.

Results:
One thousand one hundred ninety-five children (mean age 11.4 years, SD 0.5) and 1334 parents (mean age 43.9 years, SD 5.1) were included in analyses. Mean (SD) telomere length (T/S ratio) was 1.09 (0.55) for children and 0.81 (0.38) for adults; hFI (dB HL) was 8.0 (5.6) for children and 13.1 (7.0) for adults, with 8.4% and 25.9%, respectively, showing hearing loss.Telomere length was not associated with hearing threshold or hearing loss in children (hFI: OR, 0.99; 95% confidence interval, 0.55 to 1.78) or adults (hFI: OR, 1.35; 95% confidence interval, 0.81 to 2.25).

Conclusions:
Telomere length was not associated with hearing acuity in children or their midlife parents.
Mechanisms of Localization and Speech Perception with Colocated and Spatially Separated Noise and Speech Maskers Under Single-Sided Deafness with a Cochlear Implant
Authors: Dirks Coral , Nelson Peggy B. , Sladen Douglas P. , Oxenham Andrew J. 
Published: March 2019

Objectives:
This study tested listeners with a cochlear implant (CI) in one ear and acoustic hearing in the other ear, to assess their ability to localize sound and to understand speech in collocated or spatially separated noise or speech maskers.

Design:
Eight CI listeners with contralateral acoustic hearing ranging from normal hearing to moderate sensorineural hearing loss were tested. Localization accuracy was measured in five of the listeners using stimuli that emphasized the separate contributions of interaural level differences (ILDs) and interaural time differences (ITD) in the temporal envelope and/or fine structure. Sentence recognition was tested in all eight CI listeners, using collocated and spatially separated speech-shaped Gaussian noise and two-talker babble. Performance was compared with that of age-matched normal-hearing listeners via loudspeakers or via headphones with vocoder simulations of CI processing.

Results:
Localization improved with the CI but only when high-frequency ILDs were available. Listeners experienced no additional benefit via ITDs in the stimulus envelope or fine structure using real or vocoder-simulated CIs. Speech recognition in two-talker babble improved with a CI in seven of the eight listeners when the target was located at the front and the babble was presented on the side of the acoustic-hearing ear, but otherwise showed little or no benefit of a CI.

Conclusion:
Sound localization can be improved with a CI in cases of significant residual hearing in the contralateral ear, but only for sounds with high-frequency content, and only based on ILDs. In speech understanding, the CI contributed most when it was in the ear with the better signal to noise ratio with a speech masker.
Spiritual Care at the Bedside
Authors: Taylor Elizabeth Johnston , Gober-Park Carla , Schoonover-Shoffner Kathy , Mamier Iris , Somaiya Chintan K. , Bahjri Khaled 
Published: March 2019

ABSTRACT:
Little is known about how nurses' personal spirituality and religious (S/R) beliefs impact their spiritual care of patients. An online survey was used to collect data from 445 nurses, assessing facets of religiosity, their opinions about introducing S/R during patient care, demographic, and work-related variables. Findings indicated that even in a sample of Christian nurses who scored high on religiousness measures, spiritual care is infrequent. Nurses' opinions about whether it was appropriate to initiate S/R conversation, self-disclosure, and prayer were associated with aspects of nurse religiosity. Nurses working in a faith-based organization were more likely to believe they could initiate S/R conversation and offer prayer.
Histological Analysis of the Effect of ATX-101 (Deoxycholic Acid Injection) on Subcutaneous Fat: Results From a Phase 1 Open-Label Study
Authors: Walker Patricia S. , Lee Daniel R. , Toth Bryant A. , Bowen Beta 
Published: March 2019

BACKGROUND
ATX-101 is approved for submental fat reduction.

OBJECTIVE
To characterize the histological effect of ATX-101 injection into subcutaneous fat.

METHODS
This Phase 1 open-label study enrolled 14 adults to receive injections of ATX-101 into abdominal fat at varying concentrations (0.5%, 1.0%, 2.0%, or 4.0%), volumes (0.2 or 0.4 mL), spacing (0.7, 1.0, or 1.5 cm), and time points before scheduled abdominoplasty (1, 3, 7, or 28 days). During abdominoplasty, tissue was excised and preserved for histology.

RESULTS
All injection paradigms resulted in histological changes confined to the subcutaneous layer, which were more prominent at higher concentrations and independent of volume and spacing. Key features at Day 1 after injection were adipocytolysis, blood vessel injury, neutrophilic inflammation, and lysis of locally present neutrophils. At Day 3, inflammation was reduced versus Day 1, and hemorrhage and lipid lake formation (at higher concentrations) were observed. Day 7 samples exhibited prominent adipocytolysis, mild inflammation, lipid-laden macrophages in the septae, and repair of vascular injury. At Day 28, inflammation was largely resolved and prominent features were septal thickening, neovascularization, and atrophy of fat lobules.

CONCLUSION
Subcutaneous injection of ATX-101 induces adipocytolysis and local inflammation with septal thickening and resolution of inflammation by 28 days after injection.