bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cyclosporine before Coronary Artery Bypass Grafting Does Not Prevent Postoperative Decreases in Renal Function
Authors: Ederoth Per , Dardashti Alain , Grins Edgars , Brondén Björn , Metzsch Carsten , Erdling André , Nozohoor Shahab , Mokhtari Arash , Hansson Magnus J. , Elmér Eskil , Algotsson Lars , Jovinge Stefan , Bjursten Henrik 
Published: January 2018

Abstract

Background
Acute kidney injury is a common complication after cardiac surgery, leading to increased morbidity and mortality. One suggested cause for acute kidney injury is extracorporeal circulation–induced ischemia–reperfusion injury. In animal studies, cyclosporine has been shown to reduce ischemia–reperfusion injury in the kidneys. We hypothesized that administering cyclosporine before extracorporeal circulation could protect the kidneys in patients undergoing cardiac surgery.

Methods
The Cyclosporine to Protect Renal Function in Cardiac Surgery (CiPRICS) study was an investigator-initiated, double-blind, randomized, placebo-controlled, single-center study. The primary objective was to assess if cyclosporine could reduce acute kidney injury in patients undergoing coronary artery bypass grafting surgery with extracorporeal circulation. In the study, 154 patients with an estimated glomerular filtration rate of 15 to 90 ml · min–1 · 1.73 m–2 were enrolled. Study patients were randomized to receive 2.5 mg/kg cyclosporine or placebo intravenously before surgery. The primary endpoint was relative plasma cystatin C changes from the preoperative day to postoperative day 3. Secondary endpoints included biomarkers of kidney, heart, and brain injury.

Results
All enrolled patients were analyzed. The cyclosporine group (136.4 ± 35.6%) showed a more pronounced increase from baseline plasma cystatin C to day 3 compared to placebo (115.9 ± 30.8%), difference, 20.6% (95% CI, 10.2 to 31.2%, P < 0.001). The same pattern was observed for the other renal markers. The cyclosporine group had more patients in Risk Injury Failure Loss End-stage (RIFLE) groups R (risk), I (injury), or F (failure; 31% vs. 8%, P < 0.001). There were no differences in safety parameter distribution between groups.

Conclusions
Administration of cyclosporine did not protect coronary artery bypass grafting patients from acute kidney injury. Instead, cyclosporine caused a decrease in renal function compared to placebo that resolved after 1 month.
Development and External Validation of an Automated Computer-Aided Risk Score for Predicting Sepsis in Emergency Medical Admissions Using the Patient’s First Electronically Recorded Vital Signs and Blood Test Results*
Authors: Faisal Muhammad , Scally Andy , Richardson Donald , Beatson Kevin , Howes Robin , Speed Kevin , Mohammed Mohammed A. 
Published: January 2018

Objectives:
To develop a logistic regression model to predict the risk of sepsis following emergency medical admission using the patient’s first, routinely collected, electronically recorded vital signs and blood test results and to validate this novel computer-aided risk of sepsis model, using data from another hospital.

Design:
Cross-sectional model development and external validation study reporting the C-statistic based on a validated optimized algorithm to identify sepsis and severe sepsis (including septic shock) from administrative hospital databases using International Classification of Diseases, 10th Edition, codes.

Setting:
Two acute hospitals (York Hospital - development data; Northern Lincolnshire and Goole Hospital - external validation data).

Patients:
Adult emergency medical admissions discharged over a 24-month period with vital signs and blood test results recorded at admission.

Interventions:
None.

Main Results:
The prevalence of sepsis and severe sepsis was lower in York Hospital (18.5% = 4,861/2,6247; 5.3% = 1,387/2,6247) than Northern Lincolnshire and Goole Hospital (25.1% = 7,773/30,996; 9.2% = 2,864/30,996). The mortality for sepsis (York Hospital: 14.5% = 704/4,861; Northern Lincolnshire and Goole Hospital: 11.6% = 899/7,773) was lower than the mortality for severe sepsis (York Hospital: 29.0% = 402/1,387; Northern Lincolnshire and Goole Hospital: 21.4% = 612/2,864). The C-statistic for computer-aided risk of sepsis in York Hospital (all sepsis 0.78; sepsis: 0.73; severe sepsis: 0.80) was similar in an external hospital setting (Northern Lincolnshire and Goole Hospital: all sepsis 0.79; sepsis: 0.70; severe sepsis: 0.81). A cutoff value of 0.2 gives reasonable performance.

Conclusions:
We have developed a novel, externally validated computer-aided risk of sepsis, with reasonably good performance for estimating the risk of sepsis for emergency medical admissions using the patient’s first, electronically recorded, vital signs and blood tests results. Since computer-aided risk of sepsis places no additional data collection burden on clinicians and is automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.
Oral Hypertonic Saline Is Effective in Reversing Acute Mild-to-Moderate Symptomatic Exercise-Associated Hyponatremia
Authors: Bridges Eileen , Altherwi Tawfeeq , Correa José A. , Hew-Butler Tamara 
Published: January 2018

Objectives:
To determine whether oral administration of 3% hypertonic saline (HTS) is as efficacious as intravenous (IV) 3% saline in reversing symptoms of mild-to-moderate symptomatic exercise-associated hyponatremia (EAH) in athletes during and after a long-distance triathlon.

Design:
Noninferiority, open-label, parallel-group, randomized control trial to IV or oral HTS. We used permuted block randomization with sealed envelopes, containing the word either “oral” or “IV.”

Setting:
Annual long-distance triathlon (3.8-km swim, 180-km bike, and 42-km run) at Mont-Tremblant, Quebec, Canada.

Participants:
Twenty race finishers with mild to moderately symptomatic EAH.

Independent Variables:
Age, sex, race finish time, and 9 clinical symptoms.

Main Outcome Measures:
Time from treatment to discharge.

Methods:
We successfully randomized 20 participants to receive either an oral (n = 11) or IV (n = 9) bolus of HTS. We performed venipuncture to measure serum sodium (Na) at presentation to the medical clinic and at time of symptom resolution after the intervention.

Results:
The average time from treatment to discharge was 75.8 minutes (SD 29.7) for the IV treatment group and 50.3 minutes (SD 26.8) for the oral treatment group (t test, P = 0.02). Serum Na before and after treatment was not significantly different in both groups. There was no difference on presentation between groups in age, sex, or race finish time, both groups presented with an average of 6 symptoms.

Conclusions:
Oral HTS is effective in reversing symptoms of mild-to-moderate hyponatremia in EAH.
Intraocular Pressure Response to Maximal Exercise Test during Recovery
Authors: Najmanova Eliska , Pluhacek Frantisek , Botek Michal 
Published: January 2018

SIGNIFICANCEThe main aim of this study was to determine the intraocular pressure (IOP) response to maximal incremental running test during 30 minutes of recovery. Exhaustive exercise induced a highly individually variable IOP response, which was related to its initial value and the initial heart rate.PURPOSEThe purpose of the study was to analyzed the IOP response to a maximal incremental running test in healthy women during a 30-minute recovery period. Secondarily, the study attempted to determine if the IOP was dependent on its baseline, maximal oxygen uptake, initial heart rate, and autonomic nervous system regulation.METHODSTwenty-four healthy women between the ages of 19 and 30 years were recruited for the study. Initial IOP (baseline), heart rate, and autonomic nervous system regulation were measured after 30 minutes of rest. Each subject then underwent an incremental running test on a treadmill to reach the maximal physical activity and to determine physical fitness based on maximal oxygen uptake. Intraocular pressure and autonomic nervous system activity were measured immediately after completion of the physical activity during a 30-minute recovery period in the supine position.RESULTSThe IOP variability increased markedly after the exercise up to 1.7-fold of the resting state. The IOP before and after exercise did not differ significantly; however, the lower baseline revealed a significant increase in comparison with the higher baseline. The time course of the IOP changes was significantly influenced by the initial heart rate. All other effects, interactions, and correlations were insignificant.CONCLUSIONSThe IOP response after maximal exercise was highly dependent on the individual. The IOP seems to be slightly increasing with a significant dependence on its resting baseline and initial heart rate.
Differentiating Occult Branch Retinal Artery Occlusion from Primary Open-angle Glaucoma
Authors: Sullivan-Mee Michael , Amin Pathik , Pensyl Denise , Katiyar Suchitra 
Published: January 2018

SIGNIFICANCE
Clinical findings in occult branch retinal artery occlusion (BRAO) can mimic those of primary open-angle glaucoma (POAG). Because management of these conditions substantially differs, accurate diagnosis is crucial. Our comparative analysis indicates that specific macular thickness variables reliably differentiate these conditions and that macular scanning may enhance routine glaucoma evaluation.

PURPOSE
The aim of this study was to identify clinical factors that reliably and efficiently identify occult BRAO masquerading as POAG.

METHODS
All subjects had comprehensive eye examinations including measurements of retinal nerve fiber layer and macular thickness (MT) using spectral-domain optical coherence tomography (SD-OCT). All subjects were asymptomatic for previous acute vision loss episodes, had optic nerve appearances suggestive of glaucoma, and exhibited SD-OCT retinal nerve fiber layer thinning with corresponding visual field loss. Macular thickness scans were divided into 64 individual thickness blocks with thin MT blocks defined by the lower 99% confidence interval from a group of normal eyes. We defined BRAO by the presence of regional inner retinal thinning with lack of inner-layer stratification on macular SD-OCT b-scan images that spatially corresponded with arteriolar distribution and visual field loss location. Primary open-angle glaucoma eyes were selected to match the BRAO eyes by age and disease severity. Pairwise and receiver operating characteristic curve analyses were used to compare occult BRAO and POAG eyes.

RESULTS
Compared with POAG (n = 52), occult BRAO eyes (n = 11) demonstrated lower cup-disc ratio, greater intereye and intraeye (superior vs. inferior) MT asymmetry, and higher frequency of thin MT blocks (<200 μm). Area under the receiver operating characteristic curve (AUC) for differentiating these conditions was highest for intraeye MT asymmetry (AUC = 0.990 [95% confidence interval, 0.925 to 1.000]) and number of thin MT blocks (AUC = 0.993 [95% confidence interval, 0.929 to 1.000]).

CONCLUSIONS
Macular thickness parameters provided accurate and efficient diagnostic capability in this study. Considering the clinical implications of inaccurate diagnosis, macular scanning may be important in baseline glaucoma evaluation.
Assessing the True Intraocular Pressure in the Non-human Primate
Authors: McAllister Faith , Harwerth Ronald , Patel Nimesh 
Published: January 2018

SIGNIFICANCEFor glaucoma patients, high intraocular pressure (IOP) is a risk factor for progressive neuropathy. Similarly, animal models used to study the disease are based on an experimental elevation of IOP. Thus, accurate IOP measurements are important in characterizing experimental models and resulting effects.PURPOSEThe purpose of the present study was to investigate IOP measurements in a non-human primate model of experimental glaucoma by comparing clinical tonometry (Tono-Pen and TonoVet) to the true IOP from intracameral manometry.METHODSA total of 17 rhesus macaque eyes from 12 animals were used for this study. Eleven eyes had no previous experimental intervention, whereas six eyes were at varying stages of laser-induced experimental glaucoma. IOPs were adjusted by inserting a needle in the anterior chamber that was attached to a pressure transducer and syringe pump system. The anterior chamber IOP was adjusted to values between 10 and 50 mmHg and corresponding measures with Tono-Pen and TonoVet were taken.RESULTSThe IOPs by TonoVet and Tono-Pen were linearly related over the range of pressures tested (slope = 0.68 normal/healthy and 0.72 experimental glaucoma). For the most, TonoVet measures overestimated IOP at all anterior chamber pressure settings (mean difference of 3.17 mmHg, 95% CI 12.53 to −4.74 normal and 3.90 mmHg, 95% CI 12.90 to −6.53 experimental glaucoma). In contrast, Tono-Pen measures overestimated IOP at lower IOPs and underestimated at higher IOP (slope = −0.26 normal and −0.21 experimental glaucoma).CONCLUSIONSThe TonoVet and Tono-Pen tonometers that are often used to assess IOP in both clinical and experimental settings generally reflect the status of IOP, but the results from this study suggest that the instruments need calibration with true anterior chamber pressure for accurate measures in experimental models of glaucoma.
The Role of Minimally Invasive Glaucoma Surgery Devices in the Management of Glaucoma
Authors: Fingeret Murray , Dickerson Jaime E. 
Published: January 2018

SIGNIFICANCE
Noncompliance is a problem affecting glaucoma patients. Approaches to improve adherence include the use of drug-delivery systems and safer forms of surgery. Minimally invasive glaucoma surgery (MIGS) has reduced complications, particularly in combination with cataract surgery, and with its good intraocular pressure (IOP) reduction may reduce or eliminate glaucoma medications.
Glaucoma is a progressive disease and a leading cause of irreversible blindness. Elevated IOP is the most important risk factor, but effective medical management is dependent on patient adherence. This review summarizes the adherence problem in glaucoma and the efforts, including MIGS, to provide effective IOP control that is not dependent on patient compliance.
The current understanding of patient adherence to pharmacological treatment of glaucoma is discussed including the challenges facing glaucoma patients. Historical approaches to providing IOP control in a sustained and reliable way are presented culminating in a review of the burgeoning use of MIGS devices.
It is estimated that, in the United States, 27% of prescriptions written, across all medications, are not filled or are filled but not taken. For ocular hypotensive medications, even when filled, a large percentage (which varies widely by study) are not instilled as prescribed. To address this problem, methods for sustained drug delivery have been and continue to be developed, as well as surgical and laser approaches. Most recently, MIGS devices have gained popularity because of the ease of implantation during cataract surgery, favorable safety profile, and the possibility for effective and long-lasting IOP lowering, as well as the reduction or elimination of need for IOP-lowering medication.
Poor adherence to treatment is relatively common among glaucoma patients and is associated with progression of disease. Recommending MIGS implantation during cataract surgery may offer optometrists a valuable treatment option in managing glaucoma patients, particularly where good adherence is in doubt.
Venous Superdrainage in DIEP Flap Breast Reconstruction: The Impact of Superficial Inferior Epigastric Vein Dissection on Abdominal Seroma Formation
Authors: Nedomansky Jakob , Nickl Stefanie , Radtke Christine , Haslik Werner , Schroegendorfer Klaus F. 
Published: January 2018

Background:
Abdominal seroma formation after deep inferior epigastric perforator (DIEP) flap breast reconstruction is a common donor-site complication. Additional dissection of one or both of the superficial inferior epigastric veins (SIEVs) in DIEP flap breast reconstruction allows an additional anastomosis for venous superdrainage if venous congestion occurs. However, generally, SIEV dissection involves greater invasiveness into the inguinal region, which can traumatize lymphatic tissue and lead to lymph accumulation. The aim of this study was to evaluate the impact of SIEV dissection on the incidence of postoperative abdominal seroma.

Methods:
A series of 100 consecutive cases performed by the Department of Plastic and Reconstructive Surgery at the Medical University of Vienna from 2001 to 2016 was analyzed. Patients were divided into three groups: unilateral, bilateral, and no SIEV dissection. Abdominal seroma rates, length of hospital stay, abdominal drainage duration, and drainage fluid volumes were compared retrospectively.

Results:
Seromas were observed in 11.5 percent of patients without SIEV dissection, 17.2 percent of patients with unilateral SIEV dissection (p = 0.45 versus no SIEV), and 40 percent of patients with bilateral SIEV dissection (p = 0.02 versus no SIEV). The SIEV was anastomosed to salvage a congested DIEP flap twice. All seromas that developed could be treated with, on average, two fine-needle aspirations without any complications.

Conclusions:
Bilateral, but not unilateral, SIEV dissection increased abdominal seroma rates significantly. Venous congestion was observed rarely, but when it did occur, it endangered flap viability. Because an additional anastomosis of the SIEV can salvage a flap, unilateral SIEV dissection should be considered when raising a DIEP flap.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Paradoxical Frontalis Activation: An Underrecognized Consequence of Facial Palsy
Authors: Cooper Lilli , Izard Charles , Harries Victoria , Neville Catriona , Venables Vanessa , Malhotra Raman , Nduka Charles 
Published: January 2018

Background:
Aberrant reinnervation and synkinesis are common and debilitating after facial palsy. Paradoxical frontalis activation can antagonize eye closure and increase the risk of corneal damage. If recognized, judicious botulinum toxin injection to the affected side may reduce this risk.

Methods:
One hundred consecutive patients with synkinesis were identified from a prospective database. Routine facial view photographs were converted to a standardized scale using iris diameter. The vertical distance from the midpoint of the midcanthal line to the inferior border of the eyebrow was measured bilaterally. A value of p < 0.05 was considered significant.

Results:
Eighty-two patients were included, with a median age of 44 years (interquartile range, 33 to 59 years); 59 of the patients were women. The commonest cause was idiopathic (n = 55). The median time since onset of palsy was 13 months (interquartile range, 6.5 to 27 months). There was less midpoint of the midcanthal line to the inferior border of the eyebrow excursion on the synkinetic side of the face (p < 0.001). Twenty-two patients (27 percent) displayed paradoxical frontalis movement on the affected side of their face, with increased midpoint of the midcanthal line to the inferior border of the eyebrow distance (eyebrow raise) when attempting eye closure compared with eyebrow raise (n = 19), and tight eye closure compared with gentle eye closure (n = 3).

Conclusions:
This study highlights the phenomenon of paradoxical frontalis activation during eye closure. This is often underrecognized and may contribute to lagophthalmos. The authors found it to be present in 27 percent of patients with moderate or severe synkinesis. Further dynamic studies are required to understand the relationship among frontalis activity, eye closure, and the effects of its inhibition.
Gluteal Augmentation and Enhancement of the Female Silhouette: Analysis and Technique
Authors: Mendieta Constantino , Stuzin James M. 
Published: January 2018

Summary:
Dr. Constantino Mendieta demonstrates and details his personal technique for gluteal augmentation. The video demonstration is divided into three parts: Part I, Aesthetic Analysis and Preoperative Marking; Part II, Creating the Female Silhouette with Circumferential Lipoplasty; and Part III, Autogenous Gluteal Augmentation. Artistic concepts for gluteal augmentation and contouring the female silhouette and technical considerations for patient safety are emphasized. This Master Series Video article is the first in a planned series of video vignettes.
Hepatocellular Carcinoma: Retrospective Evaluation of the Correlation Between Gadobenate Dimeglumine–Enhanced Magnetic Resonance Imaging and Pathologic Grade
Authors: Huang Xiuzhu , Xiao Zebin , Zhang Yuyang , Lin Na , Xiong Meilian , Huang Xinyao , Chen Qi , Cao Dairong 
Published: January 2018

Objective
The aim of this study was to evaluate the usefulness of gadobenate dimeglumine–enhanced magnetic resonance imaging in characterizing the grade of hepatocellular carcinoma (HCC) using the signal intensity (SI) of the erector spinae as internal reference.

Materials and Methods
Clinical data of 40 patients (a total of 44 lesions) confirmed by pathology for HCC were retrospectively reviewed. Gadobenate dimeglumine–enhanced magnetic resonance imaging was performed in all patients, and SI of lesions (SIles), liver parenchyma around the lesions (SIhep), erector spinae (SImus) and standard deviation of SI of the surrounding noise (SDnoi) on nonenhanced T2WI, nonenhanced T1WI, and contrast-enhanced T1WI (in both arterial and hepatobiliary phase [AP and HBP]) were measured, respectively. Contrast-to-noise ratio (CNR) were separately defined as CNR1 ([SIles − SIhep]/SDnoi) and CNR2 ([SIles − SImus]/SDnoi). Statistical analyses were performed using one-way analysis of variance, least significant difference test, logistic regression analysis, Spearman rank correlation, and receiver operating characteristic curves analysis.

Results
Forty-four HCCs, including 3 well-differentiated HCCs, 26 moderately differentiated HCCs, and 15 poorly differentiated (PD) HCCs, were confirmed. On logistic regression analysis, only CNR2 in the HBP was predictor of PD HCCs (P = 0.015, odds ratio = 1.040). The size of lesions, CNR1 in the AP, CNR2 in the AP, and CNR2 in the HBP, showed significant correlations with the degree of differentiation (correlation coefficients = −0.371, 0.435, 0.503, and 0.512, respectively; P = 0.013, 0.003, 0.001, and 0.000, respectively). Contrast-to-noise ratio 2 in the HBP with the cutoff of less than 4.56 could distinguish moderately differentiated HCCs from PD HCC with the sensitivity and specificity of 84.6% and 60.0%, respectively.

Conclusions
Relatively low arterial enhancement and low CNR2 value in the HBP are predictive for poor histological grade of HCCs.