bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of the Effect of Cervical Radiculopathy on Peripheral Nerves of the Upper Extremity With High-Resolution Ultrasonography
Authors: Metin Ökmen Burcu , Ökmen Korgün , Altan Lale 
Published: December 2017

Study Design.
Prospective, cross-sectional observational study.

Objective.
We aimed to investigate the effects of chronic cervical radiculopathy (CR) on the cross-sectional area (CSA) values of the cervical nerve roots (CNRs), median, ulnar, and radial nerves with high-resolution ultrasonography.

Summary of Background Data.
Symptomatic nerve roots are wider than asymptomatic nerve roots due to the presence of edema. Peripheral nerves have also been shown to develop edema, fibrosis, and changes distal to the affected nerve as a result of mechanical compression. In addition according to “double-crush syndrome” hypothesis, the peripheral nerves are more sensitive to pressure, and a proximal nerve lesion makes the distal segment of the nerve more susceptible to anatomic deterioration by causing interruption in the axoplasmic conduction due to compression.

Methods.
Forty patients with chronic CR were included to the study. Both affected CNRs and the contralateral nerve roots (control group) were evaluated with high-resolution ultrasonography. Ulnar and median nerve CSA measurements were performed at four measurement points and radial nerve measurements at a single measurement point.

Results.
CSA measurements were statistically significantly higher at the CNR of the affected side compared to the unaffected side. There was no statistically significant difference when affected and unaffected sides were compared in terms of measurements performed from median, ulnar, and radial nerves at all measurement points.

Conclusion.
The results of the present study indicate that the changes in the CNR caused by CR do not have any effect on the peripheral nerves. We did not find any affection in peripheral nerve CSA that might have been suggestive of double-crush syndrome in CR.

Level of Evidence: 2
Renal Tubular Cell Mitochondrial Dysfunction Occurs Despite Preserved Renal Oxygen Delivery in Experimental Septic Acute Kidney Injury
Authors: Arulkumaran Nishkantha , Pollen Sean , Greco Elisabetta , Courtneidge Holly , Hall Andrew M. , Duchen Michael R. , Tam Frederick W. K. , Unwin Robert J. , Singer Mervyn 
Published: December 2017

Objective:
To explain the paradigm of significant renal functional impairment despite preserved hemodynamics and histology in sepsis-induced acute kidney injury.

Design:
Prospective observational animal study.

Setting:
University research laboratory.

Subjects:
Male Wistar rats.

Intervention:
Using a fluid-resuscitated sublethal rat model of fecal peritonitis, changes in renal function were characterized in relation to global and renal hemodynamics, and histology at 6 and 24 hours (n = 6–10). Sham-operated animals were used as comparison (n = 8). Tubular cell mitochondrial function was assessed using multiphoton confocal imaging of live kidney slices incubated in septic serum.

Measurements and Main Results:
By 24 hours, serum creatinine was significantly elevated with a concurrent decrease in renal lactate clearance in septic animals compared with sham-operated and 6-hour septic animals. Renal uncoupling protein-2 was elevated in septic animals at 24 hours although tubular cell injury was minimal and mitochondrial ultrastructure in renal proximal tubular cells preserved. There was no significant change in global or renal hemodynamics and oxygen delivery/consumption between sham-operated and septic animals at both 6- and 24-hour timepoints. In the live kidney slice model, mitochondrial dysfunction was seen in proximal tubular epithelial cells incubated with septic serum with increased production of reactive oxygen species, and decreases in nicotinamide adenine dinucleotide and mitochondrial membrane potential. These effects were prevented by coincubation with the reactive oxygen species scavenger, 4-hydroxy-2,2,6,6-tetramethyl-piperidin-1-oxyl.

Conclusions:
Renal dysfunction in sepsis occurs independently of hemodynamic instability or structural damage. Mitochondrial dysfunction mediated by circulating mediators that induce local oxidative stress may represent an important pathophysiologic mechanism.
Effect of a National Standard for Deteriorating Patients on Intensive Care Admissions Due to Cardiac Arrest in Australia
Authors: Jones Daryl , Bhasale Alice , Bailey Michael , Pilcher David , Anstey Matthew H. 
Published: December 2017

Objectives:
To assess whether a national standard for improving care of deteriorating patients affected ICU admissions following cardiac arrests from hospital wards.

Design:
Retrospective study assessing changes from baseline (January 1, 2008, to June 30, 2010), rollout (July 1, 2010, to December 31, 2012), and after (January 1, 2013, to 31 December 31, 2014) national standard introduction. Conventional inferential statistics, interrupted time series analysis, and adjusted hierarchical multiple logistic regression analysis.

Setting:
More than 110 ICU-equipped Australian hospitals.

Patients or Subjects:
Adult patients (≥ 18 yr old) admitted to participating ICUs.

Interventions:
Introducing a national framework to improve care of deteriorating patients including color-coded observation charts, mandatory rapid response system, enhanced governance, and staff education for managing deteriorating patients.

Measurements and Main Results:
Cardiac arrest–related ICU admissions from the ward decreased from 5.6% (baseline) to 4.9% (rollout) and 4.1% (intervention period). Interrupted time series analysis revealed a decline in the rate of cardiac arrest–related ICU admissions in the rollout period, compared with the baseline period (p = 0.0009) with a subsequent decrease in the rate in the intervention period (p = 0.01). Cardiac arrest–related ICU admissions were less likely in the intervention period compared with the baseline period (odds ratio, 0.85; 95% CI, 0.78–0.93; p = 0.001), as was in-hospital mortality from cardiac arrests (odds ratio, 0.79; 95% CI, 0.65–0.96; p = 0.02).

Conclusions:
Introducing a national standard to improve the care of deteriorating patients was associated with reduced cardiac arrest–related ICU admissions and subsequent in-hospital mortality of such patients.
Determinants of Health-Related Quality of Life After ICU: Importance of Patient Demographics, Previous Comorbidity, and Severity of Illness
Authors: Griffith David M. , Salisbury Lisa G. , Lee Robert J. , Lone Nazir , Merriweather Judith L. , Walsh Timothy S. 
Published: December 2017

Objectives:
ICU survivors frequently report reduced health-related quality of life, but the relative importance of preillness versus acute illness factors in survivor populations is not well understood. We aimed to explore health-related quality of life trajectories over 12 months following ICU discharge, patterns of improvement, or deterioration over this period, and the relative importance of demographics (age, gender, social deprivation), preexisting health (Functional Comorbidity Index), and acute illness severity (Acute Physiology and Chronic Health Evaluation II score, ventilation days) as determinants of health-related quality of life and relevant patient-reported symptoms during the year following ICU discharge.

Design:
Nested cohort study within a previously published randomized controlled trial.

Setting:
Two ICUs in Edinburgh, Scotland.

Patients:
Adult ICU survivors (n = 240) who required more than 48 hours of mechanical ventilation.

Interventions:
None.

Measurements and Main Results:
We prospectively collected data for age, gender, social deprivation (Scottish index of multiple deprivation), preexisting comorbidity (Functional Comorbidity Index), Acute Physiology and Chronic Health Evaluation II score, and days of mechanical ventilation. Health-related quality of life (Medical Outcomes Study Short Form version 2 Physical Component Score and Mental Component Score) and patient-reported symptoms (appetite, fatigue, pain, joint stiffness, and breathlessness) were measured at 3, 6, and 12 months. Mean Physical Component Score and Mental Component Score were reduced at all time points with minimal change between 3 and 12 months. In multivariable analysis, increasing pre-ICU comorbidity count was strongly associated with lower health-related quality of life (Physical Component Score β = –1.56 [–2.44 to –0.68]; p = 0.001; Mental Component Score β = –1.45 [–2.37 to –0.53]; p = 0.002) and more severe self-reported symptoms. In contrast, Acute Physiology and Chronic Health Evaluation II score and mechanical ventilation days were not associated with health-related quality of life. Older age (β = 0.33 [0.19–0.47]; p < 0.001) and lower social deprivation (β = 1.38 [0.03–2.74]; p = 0.045) were associated with better Mental Component Score health-related quality of life.

Conclusions:
Preexisting comorbidity counts, but not severity of ICU illness, are strongly associated with health-related quality of life and physical symptoms in the year following critical illness.
Systematic Review and Meta-Analysis of Procalcitonin-Guidance Versus Usual Care for Antimicrobial Management in Critically Ill Patients: Focus on Subgroups Based on Antibiotic Initiation, Cessation, or Mixed Strategies*
Authors: Lam Simon W. , Bauer Seth R. , Fowler Robert , Duggal Abhijit 
Published: December 2017

Objective:
Numerous studies have evaluated the use of procalcitonin guidance during different phases of antibiotics management (initiation, cessation, or a combination of both) in patients admitted to ICUs. Several meta-analyses have attempted to generate an overall effect of procalcitonin-guidance on patient outcomes. However, combining studies from different phases of antibiotics management may not be appropriate due to the risk of clinical heterogeneity. The purpose of this systematic review and meta-analysis was to evaluate the effect of procalcitonin-guided strategies in different phases of antibiotics use.

Data Sources:
We searched MEDLINE and EMBASE from inception until November 1, 2017.

Study Selection:
We included randomized controlled trials that evaluated procalcitonin guidance compared with usual care for management of antibiotics in critically ill adult patients.

Data Extraction:
We extracted study details, patient characteristics, procalcitonin algorithm, and outcomes.

Data Synthesis:
We included 15 studies, from 1,624 abstracts identified based on our search strategy (three initiation, nine cessation, and three mixed). The pooled risk ratio for short-term mortality for the initiation, cessation, and mixed procalcitonin strategies were 1.00 (95% CI, 0.86–1.15,;p = 0.91), 0.87 (95% CI, 0.77–0.98; p = 0.02), and 1.01 (95% CI, 0.80–1.29; p = 0.93), respectively. Procalcitonin for cessation and mixed strategies was associated with decrease antibiotics duration (–1.26 d [p < 0.001] and –3.10 d [p =0.04], respectively). No differences were observed in other outcome measures.

Conclusion:
When evaluating all studies of procalcitonin-guided antibiotics management in critically ill patients, no difference in short-term mortality was observed. However, when only examining procalcitonin-guided cessation of antibiotics, lower mortality was detected. Future studies should focus specifically on procalcitonin for the cessation of antibiotics in critically ill patients.
Medical Versus Surgical ICU Obese Patient Outcome: A Propensity-Matched Analysis to Resolve Clinical Trial Controversies
Authors: De Jong Audrey , Verzilli Daniel , Sebbane Mustapha , Monnin Marion , Belafia Fouad , Cisse Moussa , Conseil Matthieu , Carr Julie , Jung Boris , Chanques Gérald , Molinari Nicolas , Jaber Samir 
Published: December 2017

Objectives:
To determine the short- and long-term mortality of obese ICU patients following medical as opposed to surgical admission and the relation between obesity and mortality.

Design:
Retrospective analysis of prospectively collected data, using a propensity score–matched analysis of patients with medical or surgical admission.

Setting:
One French mixed medical-surgical ICU.

Patients:
Critically ill obese patients (body mass index ≥ 30 kg/m2) and nonobese patients admitted during a 14-year period.

Interventions:
None.

Measurements and Main Results:
Seven-hundred ninety-one obese patients and 4,644 nonobese patients were included, 338 (43%) and 2,367 (51%) medical and 453 (57%) and 2,277 (49%) surgical obese and nonobese patients, respectively. Mortality was significantly higher in medical than in surgical obese patients in ICU (25% vs 12%; p < 0.001) and up to 365 days (36% vs 18%; p < 0.001) post ICU admission. One-to-one propensity score matching generated 260 pairs with well-balanced baseline characteristics. After matching on propensity score, mortality was still significantly higher in medical patients both in the ICU (21% vs 13%; p = 0.03) and up to 365 days (30% vs 20%; p = 0.01) post ICU admission. Obesity was not significantly associated with mortality both in univariate analysis (140 obese patients [15%] in the dead group vs 651 [14%] in the alive group; p = 0.72) and multivariate analysis (odds ratio, 1.09 [95% CI, 0.86–1.38]; p = 0.49) after adjustment for Simplified Acute Physiology Score II, age, category of admission, history of cardiac disease, and history of respiratory disease.

Conclusions:
After careful matching, the data suggest that ICU mortality in obese population was higher in the medical group than in the surgical group and remains significantly higher 365 days post ICU admission.
Chloride and Other Electrolyte Concentrations in Commonly Available 5% Albumin Products
Authors: Lai Alison T. , Zeller Michelle P. , Millen Tina , Kavsak Peter , Szczeklik Wojciech , Elahie Allahna , Alhazzani Waleed , D’Aragon Frederick , Jaeschke Roman , Lamontagne Francois , Karachi Timothy , Cook Deborah , Meade Maureen , Rochwerg Bram 
Published: December 2017

Objective:
Use of hyperchloremic IV fluids for resuscitation in sepsis may be associated with increased mortality and use of renal replacement therapy. After crystalloids, 5% human albumin represents the second most common resuscitation fluid in the ICU. Its chloride concentration is rarely considered in the clinical setting. This study quantifies previously undocumented chloride concentrations of three 5% albumin solutions using biochemical analysis.

Design:
We performed blinded analysis of the electrolyte concentration of albumin samples obtained directly from the national blood supplier (Canadian Blood Services). Two-tailed independent t tests were performed for all possible comparative analyses. Analysis of variance testing was performed for relevant three-way comparisons. Significance threshold was set at p less than 0.05.

Setting:
All samples were analyzed in the core laboratory at an academic hospital associated with McMaster University in Hamilton, Ontario, Canada.

Subjects:
We analyzed 65 albumin samples from three available brands obtained through Canadian Blood Services. They include Plasbumin (n = 21), Alburex (n = 24), Octalbin (n = 20).

Intervention:
Laboratory technologists blinded to product identification measured the concentration of electrolytes, extended electrolytes, lactate, and albumin of each sample using the Abbott ARCHITECT c8000 chemistry analyzer.

Measurements and Main Results:
The mean chloride concentration of Plasbumin, Alburex, and Octalbin, respectively, were 109.4 mmol/L (sd, 1.3), 123.6 mmol/L (sd, 1.3), and 136.8 mmol/L (sd, 0.4). The mean sodium concentration of Plasbumin, Alburex, and Octalbin, respectively, were 139.6 mmol/L (sd, 1.6), 137.3 mmol/L (sd, 2.2), and 149.4 mmol/L (sd, 0.5). The chloride and sodium concentration differed significantly for all two-way comparisons (p < 0.0001) and multiple comparison testing (p < 0.0001).

Conclusion:
This study is the first to identify and document a statistically significant variability in the chloride concentration of available 5% albumin products. This study has also informed a pilot randomized controlled trial examining the effect of administering high chloride versus low chloride fluids in critically ill patients with sepsis.
Temporal Trends in Healthcare Costs and Outcome Following ICU Admission After Traumatic Brain Injury
Authors: Raj Rahul , Bendel Stepani , Reinikainen Matti , Hoppu Sanna , Luoto Teemu , Ala-Kokko Tero , Tetri Sami , Laitio Ruut , Koivisto Timo , Rinne Jaakko , Kivisaari Riku , Siironen Jari , Higgins Alisa , Skrifvars Markus B. 
Published: December 2017

Objective:
To assess temporal trends in 1-year healthcare costs and outcome of intensive care for traumatic brain injury in Finland.

Design:
Retrospective observational cohort study.

Setting:
Multicenter study including four tertiary ICUs.

Patients:
Three thousand fifty-one adult patients (≥ 18 yr) with significant traumatic brain injury treated in a tertiary ICU during 2003–2013.

Intervention:
None.

Measurements and Main Results
: Total 1-year healthcare costs included the index hospitalization costs, rehabilitation unit costs, and social security reimbursements. All costs are reported as 2013 U.S. dollars ($). Outcomes were 1-year mortality and permanent disability. Multivariate regression models, adjusting for case-mix, were used to assess temporal trends in costs and outcome in predefined Glasgow Coma Scale (3–8, 9–12, and 13–15) and age (18–40, 41–64, and ≥ 65 yr) subgroups. Overall 1-year survival was 76% (n = 2,304), and of 1-year survivors, 37% (n = 850) were permanently disabled. Mean unadjusted 1-year healthcare cost was $39,809 (95% CI, $38,144–$41,473) per patient. Adjusted healthcare costs decreased only in the Glasgow Coma Scale 13–15 and 65 years and older subgroups, due to lower rehabilitation costs. Adjusted 1-year mortality did not change in any subgroup (p < 0.05 for all subgroups). Adjusted risk of permanent disability decreased significantly in all subgroups (p < 0.05).

Conclusion:
During the last decade, healthcare costs of ICU-admitted traumatic brain injury patients have remained largely the same in Finland. No change in mortality was noted, but the risk for permanent disability decreased significantly. Thus, our results suggest that cost-effectiveness of traumatic brain injury care has improved during the past decade in Finland.
Prevalence of Anxiety and Depression Symptomatology in Adolescents Faced With the Hospitalization of a Loved One in the ICU*
Authors: Fergé Jean-Louis , Le Terrier Christophe , Banydeen Rishika , Kentish-Barnes Nancy , Derancourt Christian , Jehel Louis , Moroy Anne , Valentino Ruddy , Mehdaoui Hossein 
Published: December 2017

Objective:
ICU experience is linked to anxiety and depression symptomatology in family members of patients. Minors may be forbidden from visiting. To bring practices in line with evidence, we determined the prevalence of anxiety and depression symptomatology in adolescents visiting a relative in the ICU.

Design:
One-year prospective observational monocenter study.

Setting:
Medical-surgical ICU, University Hospital of Martinique.

Patients:
Forty-one patients intubated for more than 2 days; 53 adolescents (12–17 yr) first- to third-degree relatives in regular contact (minimum once a month) with patient before hospitalization.

Interventions:
Adolescents with unrestricted ICU access completed a satisfaction survey, anxiety history questionnaire, and psychometric evaluation (Hospital Anxiety and Depression Scale) before the patient’s 15th day of hospitalization and extubation.

Measurements and Main Results:
Forty adolescents (75.5%) visited their relative. Possible and probable anxiety and depression symptomatology prevalence was 35.9% and 18.9%, respectively, with no significant difference according to ICU visiting status. Most (80%) reported a lack of information, 40% insufficient consideration, and 27.5% misunderstood the reason for hospitalization. Two (5%) regretted visiting. Probable anxiety and depression symptomatology was associated with first-degree relationship (odds ratio, 9.1 [95% CI, 1.1–78.9]; p = 0.045), past exposure to a traumatic event (odds ratio, 8.7 [1.1–69.0]; p = 0.040) and past sense of threat (odds ratio, 10.4 [1.1–94.5]; p = 0.038).

Conclusions:
Anxiety and depression symptomatology is common in adolescent family members of ICU patients. An open visiting policy for adolescents is recommended, with visit planning, information meetings, and individual support from ICU staff.
Direct Immunofluorescence as a Helpful Tool for the Differential Diagnosis of Oral Lichen Planus and Oral Lichenoid Lesions
Authors: Yamanaka Yasmin , Yamashita Maurício , Innocentini Lara M. A. , Macedo Leandro D. , Chahud Fernando , Ribeiro-Silva Alfredo , Roselino Ana Maria , Rocha Maria José A. , Motta Ana Carolina 
Published: December 2017

Abstract:
A great number of lichenoid lesions have overlapping clinicopathological features, so the use of adjunct tests to establish definitive diagnosis is recommended for correct management and prognosis of the lesions. In this context, direct immunofluorescence (DIF) can be a useful tool. Thus, this study aimed to characterize the clinical, histopathological, and DIF pattern in patients with oral lichen planus (OLP) and patients with oral lichenoid lesions (OLLs). Patients with OLP and patients with OLL were characterized and compared with patients with mucous membrane pemphigoid, pemphigus vulgaris, and fibrous hyperplasia through a cross-sectional study. Patients with OLP (n = 30) and patients with OLL (n = 26) were mostly white women in the fifth decade of age, with reticular lesions mainly on the buccal mucosa. All patients with OLP and half of the patients with OLL showed liquefaction degeneration at the basal cell layer and a band-like lymphocytic infiltrate in the subepithelial tissue. Twenty-two patients with OLP (73.3%), 10 with OLL (38.4%), 25 with mucous membrane pemphigoid (96.1%), and all with pemphigus vulgaris (100%) had positive DIF. There was no positive DIF in patients with fibrous hyperplasia. The most frequent DIF pattern in patients with OLP and patients with OLL was linear fibrinogen at the basement membrane zone, and a logistic regression model for positive DIF found statistically significant difference in OLP versus OLL (odds ratio, 3.73; confidence interval, 1.23–11.38). Although clinical and histopathological features are sufficient for diagnosing most of the patients with OLP and OLL, DIF is a key tool in differentiating some lichenoid lesions and could improve the diagnosis of OLP and OLL, especially in lesions showing typical clinical and histological features of OLP.
Psoriasiform Graft-Versus-Host Disease: Report and Brief Review of the Literature
Authors: Vernali Steven , Vertes George Eva , Gonzalez Santiago Tania , Motaparthi Kiran 
Published: December 2017

Abstract:
Graft-versus-host disease (GVHD) is the primary cause of morbidity and non–relapse-related mortality after hematopoietic stem cell transplantation. GVHD is classically divided into acute and chronic forms; acute cutaneous GVHD presents as a morbilliform eruption, whereas chronic cutaneous GVHD presents with lichen planus–like or sclerodermoid morphology. Psoriasiform GVHD is a rarely described subtype that is challenging to distinguish clinically from psoriasis. In addition to classic psoriasiform histologic findings, demonstration of an often subtle vacuolar interface dermatitis and lymphocyte satellitosis are helpful for discrimination. Herein, the authors describe psoriasiform GVHD and review the clinicopathologic findings of this unusual variant. With the appropriate clinical findings, psoriasiform GVHD should be considered in the histologic differential diagnosis of a mixed tissue reaction pattern with both psoriasiform and interface changes.