bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peripheral Nerve Block as a Supplement to Light or Deep General Anesthesia in Elderly Patients Receiving Total Hip Arthroplasty
Authors: Mei Bin , Zha Hanning , Lu Xiaolong , Cheng Xinqi , Chen Shishou , Liu Xuesheng , Li Yuanhai , Gu Erwei 
Published: April 2017

Background:
Peripheral nerve block combined with general anesthesia is a preferable anesthesia method for elderly patients receiving hip arthroplasty. The depth of sedation may influence patient recovery. Therefore, we investigated the influence of peripheral nerve blockade and different intraoperative sedation levels on the short-term recovery of elderly patients receiving total hip arthroplasty.

Methods:
Patients aged 65 years and older undergoing total hip arthroplasty were randomized into 3 groups: a general anesthesia without lumbosacral plexus block group, and 2 general anesthesia plus lumbosacral plexus block groups, each with a different level of sedation (light or deep). The extubation time and intraoperative consumption of propofol, sufentanil, and vasoactive agent were recorded. Postoperative delirium and early postoperative cognitive dysfunction were assessed using the Confusion Assessment Method and Mini-Mental State Examination, respectively. Postoperative analgesia was assessed by the consumption of patient-controlled analgesics and visual analog scale scores. Discharge time and complications over a 30-day period were also recorded.

Results:
Lumbosacral plexus block reduced opioid intake. With lumbosacral plexus block, intraoperative deep sedation was associated with greater intake of propofol and vasoactive agent. In contrast, patients with lumbosacral plexus block and intraoperative light sedation had lower incidences of postoperative delirium and postoperative cognitive decline, and earlier discharge readiness times. The 3 groups showed no difference in complications within 30 days of surgery.

Conclusions:
Lumbosacral plexus block reduced the need for opioids and offered satisfactory postoperative analgesia. It led to better postoperative outcomes in combination with intraoperative light sedation (high bispectral index).
Geographic Variance of Cost Associated With Hysterectomy
Authors: Sheyn David , Mahajan Sangeeta , Billow Megan , Fleary Alexandra , Hayashi Emi , El-Nashar Sherif A. 
Published: April 2017

OBJECTIVE:
To estimate whether the cost of hysterectomy varies by geographic region.

METHODS:
This was a cross-sectional, population-based study using the 2013 Healthcare Cost and Utilization Project National Inpatient Sample of women older than 18 years undergoing inpatient hysterectomy for benign conditions. Hospital charges obtained from the National Inpatient Sample database were converted to actual costs using cost-to-charge ratios provided by the Healthcare Cost and Utilization Project. Multivariate regression was used to assess the effects that demographic factors, concomitant procedures, diagnoses, and geographic region have on hysterectomy cost above the median.

RESULTS:
Women who underwent hysterectomy for benign conditions were identified (N=38,414). The median cost of hysterectomy was $13,981 (interquartile range $9,075–29,770). The mid-Atlantic region had the lowest median cost of $9,661 (interquartile range $6,243–15,335) and the Pacific region had the highest median cost, $22,534 (interquartile range $15,380–33,797). Compared with the mid-Atlantic region, the Pacific (adjusted odds ratio [OR] 10.43, 95% confidence interval [CI] 9.44–11.45), South Atlantic (adjusted OR 5.39, 95% CI 4.95–5.86), and South Central (adjusted OR 2.40, 95% CI 2.21–2.62) regions were associated with the highest probability of costs above the median. All concomitant procedures were associated with an increased cost with the exception of bilateral salpingectomy (adjusted OR 1.03, 95% CI 0.95–1.12). Compared with vaginal hysterectomy, laparoscopic and robotic modes of hysterectomy were associated with higher probabilities of increased costs (adjusted OR 2.86, 95% CI 2.61–3.15 and adjusted OR 5.66, 95% CI 5.11–6.26, respectively). Abdominal hysterectomy was not associated with a statistically significant increase in cost compared with vaginal hysterectomy (adjusted OR 1.01, 95% CI 0.91–1.09).

CONCLUSION:
The cost of hysterectomy varies significantly with geographic region after adjusting for confounders.
Long-Acting Reversible Contraceptive Placement Among Active-Duty U.S. Army Servicewomen
Authors: Erickson Anne K. , Nelson D. Alan , Shaw Jonathan G. , Loftus Pooja D. , Kurina Lianne M. , Shaw Kate A. 
Published: April 2017

OBJECTIVE:
To quantify uptake of long-acting reversible contraceptives (LARC)—intrauterine devices (IUDs) and hormonal implants—among U.S. Army active-duty female soldiers and identify characteristics associated with uptake.

METHODS:
This retrospective cohort study used the Stanford Military Data Repository, which includes all digitally recorded health encounters for active-duty U.S. Army soldiers from 2011 to 2014. We analyzed data from women aged 18–44 years to assess rates of LARC initiation using medical billing codes. We then evaluated predictors of LARC initiation using multivariable regression.

RESULTS:
Among 114,661 servicewomen, 14.5% received a LARC method; among those, 60% received an IUD. Intrauterine device insertions decreased over the study period (38.7–35.9 insertions per 1,000 women per year, β=0.14, 95% confidence interval [CI] –0.23 to –0.05, P<.05), whereas LARC uptake increased, driven by an increase in implant insertions (20.3–35.4/1,000 women per year, β=0.41, CI 0.33–0.48, P<.001). Younger age was a positive predictor of LARC uptake: 32.4% of IUD users and 62.6% of implant users were in the youngest age category (18–22 years) compared with 9.6% and 2.0% in the oldest (36–44 years). The likelihood of uptake among the youngest women (compared with oldest) was most marked for implants (adjusted relative risk 7.12, CI 5.92–8.55; P<.001). A total of 26.2% of IUD users had one child compared with 13.2% among non-LARC users (adjusted relative risk 1.94, CI 1.85–2.04, P<.001). The majority (52.2%) of those initiating IUDs were married, which was predictive of uptake over never-married women (adjusted relative risk 1.52, CI 1.44–1.59, P<.001).

CONCLUSION:
Among servicewomen, we observed low but rising rates of LARC insertion, driven by increasing implant use. Unmarried and childless soldiers were less likely to initiate LARC. These findings are consistent with potential underutilization and a need for education about LARC safety and reversibility in a population facing unique consequences for unintended pregnancies.
Maternal, Fetal, and Neonatal Imatinib Levels With Treatment of Chronic Myeloid Leukemia in Pregnancy
Authors: Burwick Richard M. , Kuo Kelly , Brewer Diana , Druker Brian J. 
Published: April 2017

BACKGROUND:
Pregnant women with chronic myeloid leukemia (CML) can be treated effectively with the tyrosine-kinase inhibitor imatinib, but data regarding fetal and neonatal exposure and safety are limited.

CASE:
We present a patient with newly diagnosed CML in early pregnancy. Leukapheresis and interferon-α were initiated in the second trimester with limited benefit. Imatinib was subsequently started at 28 weeks of gestation with complete hematologic response within 4 weeks. No significant maternal or neonatal adverse effects were noted, but imatinib and its primary active metabolite concentrated in maternal breast milk and neonatal urine.

CONCLUSION:
Imatinib is effective for CML in pregnancy, but caution is warranted in light of potentially unrecognized fetal and neonatal effects.
Trimetazidine Protects Cardiomyocytes Against Hypoxia/Reoxygenation Injury by Promoting AMP-activated Protein Kinase–dependent Autophagic Flux
Authors: Zhong Yongkang , Zhong Peiyao , He Shangfei , Zhang Ya , Tang Lu , Ling Yuanna , Fu Shanshan , Tang Ying , Yang Pingzhen , Luo Tao , Chen Baihe , Chen Aihua , Wang Xianbao 
Published: April 2017

Abstract:
Trimetazidine (TMZ), a metabolic agent, may protect against myocardial ischemia/reperfusion injury. Because of the critical role of autophagy in cardioprotection, we aimed to evaluate whether autophagy was involved in TMZ-induced protection during hypoxia/reoxygenation (H/R). Neonatal rat cardiomyocytes were subjected to H/R injury, and they were divided into 7 groups: control, control+TMZ, control+chloroquine (Cq)/compound C (com C), H/R, H/R+TMZ, H/R+Cq/com C, and H/R+TMZ+Cq/com C. Autophagic flux was primarily assessed by Western blot and tandem fluorescent mRFP-GFP-LC3. Assays for MTS, terminal deoxynucleotidyl transferase–mediated dUTP nick end labeling, and lactate dehydrogenase release were performed to assess cell injury. Our results showed that TMZ pretreatment had a cardioprotective effect against H/R injury. The H/R+TMZ group had an increased ratio of LC3-II to LC3-I and increased autophagic flux (degradation of p62 and increases in autophagosomes and autolysosomes). TMZ also reduced apoptosis and enhanced cell survival while inducing autophagy. Correspondingly, autophagy inhibition with Cq blocked this protective effect. Furthermore, TMZ-induced enhancement of autophagy could be related to increased AMP-activated protein kinase (AMPK) phosphorylation and decreased Mammalian target of rapamycin (mTOR) phosphorylation, which was abolished by an AMPK-specific inhibitor (com C). Our data provide evidence that TMZ pretreatment protects against H/R injury by promoting autophagic flux through the AMPK signaling pathway.
Valganciclovir Dosing for Cytomegalovirus Prophylaxis in Pediatric Solid-organ Transplant Recipients
Authors: Peled Orit , Berkovitch Matitiahu , Rom Eran , Bilavsky Efraim , Bernfeld Yael , Dorfman Lev , Pappo Adi , Ziv-Baran Tomer , Brandriss Nurit , Bar-Haim Adina , Amir Jacob , Ashkenazi-Hoffnung Liat 
Published: April 2017

Background:
Valganciclovir is extensively used for prophylaxis and treatment of cytomegalovirus (CMV) infection in solid-organ transplant recipients. However, pharmacokinetic data in children are scarce, and the pediatric dosing regimen is uncertain. This study sought to prospectively evaluate the pharmacokinetic profile, the clinical efficacy and safety of oral valganciclovir in pediatric transplant recipients and compare different dosing regimens.

Methods:
The cohort included solid-organ transplant recipients treated with valganciclovir for CMV prophylaxis in 2014–2015 at a tertiary pediatric medical center. All received a weight-based once-daily oral dose of 17 mg/kg. Ganciclovir concentrations were measured and the area under the curve (AUC0–24) was calculated.

Results:
Thirteen children of median age 7.3 years (interquartile range, 2.2–11.6) were included. Median ganciclovir AUC0–24 was 21.0 mcg·h/mL (interquartile range, 17.1–39.8); 10 patients (77%) attained AUC0–24 <40 mcg·h/mL. Exposure to ganciclovir was about 2-fold lower in young children (<9 years old; P = 0.01) and children with low body surface area (BSA; <0.7 m2; P = 0.006) than in their counterparts. Significantly lower doses were recommended with our weight-based protocol than with the manufacturer-recommended BSA- and glomerular filtration rate-based protocol (P = 0.002), reaching a 3-fold difference in infants. No evidence of CMV viremia or disease was observed while prophylaxis was given.

Conclusions:
The weight-based regimen of 17 mg/kg/dose oral valganciclovir results in relatively low ganciclovir exposure, especially in young children with low BSA, yet showed satisfactory clinical efficacy for CMV prophylaxis. The manufacturer’s dosing recommendation appears to result in supratherapeutic ganciclovir concentrations. Further studies are needed to establish target AUCs and valganciclovir dosing for CMV prophylaxis in pediatric transplant recipients.
High Prevalence of Abacavir-associated L74V/I Mutations in Kenyan Children Failing Antiretroviral Therapy
Authors: Dziuban Eric J. , DeVos Joshua , Ngeno Bernadette , Ngugi Evelyn , Zhang Guoqing , Sabatier Jennifer , Wagar Nick , Diallo Karidia , Nganga Lucy , Katana Abraham , Yang Chunfu , Rivadeneira Emilia D. , Mukui Irene , Odhiambo Francesca , Redfield Robert , Raizes Elliot 
Published: April 2017

Abstract:
A survey of 461 HIV-infected Kenyan children receiving antiretroviral therapy found 143 (31%) failing virologically. Drug resistance mutations were found in 121; 37 had L74V/I mutations, with 95% receiving abacavir (ABC)-containing regimens. L74V/I was associated with current ABC usage (P = 0.0001). L74V/I may be more prevalent than previously realized in children failing ABC-containing regimens, even when time on treatment has been short. Ongoing rigorous pediatric drug resistance surveillance is needed.
Cerebrovascular, Cardiovascular, and Mortality Events in New Users of Selective Serotonin Reuptake Inhibitors and Serotonin Norepinephrine Reuptake Inhibitors
Authors: Leong Christine , Alessi-Severini Silvia , Enns Murray W. , Nie Yao , Sareen Jitender , Bolton James , Prior Heather J. , Chateau Dan 
Published: April 2017

Abstract

Background
Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are widely prescribed for mood and anxiety disorders. However, it is not clear whether SNRIs are more strongly associated with cardiovascular and cerebrovascular events than SSRIs.

Methods
This was a propensity score–matched, population-based, cohort study of Manitobans who started an SSRI or SNRI between April 1, 1998, and March 31, 2014. The primary outcome was a composite of acute myocardial infarction (AMI), stroke, or cardiovascular-related hospitalization within 1 year of drug initiation. Each component of the primary outcome and death were analyzed separately in secondary analyses.

Results
A total of 225,504 and 54,635 patients initiated treatment on an SSRI and SNRI, respectively. After propensity score matching, a higher risk was observed for the primary outcome among SNRI users (weighted hazards ratio [HR], 1.13; 95% confidence interval [CI], 1.06–1.21). Secondary analyses showed that the risk of nonfatal stroke was higher among SNRI users (weighted HR, 1.20; 95% CI, 1.08–1.33). The risk of death was higher among SNRI users without mood and/or anxiety disorders (weighted HR, 1.17; 95% CI; 1.03–1.32). No differences were observed in the risk of AMI or fatal stroke between SSRI and SNRI use.

Conclusions
New SNRI use was associated with a higher risk of nonfatal stroke relative to SSRI use. Further investigation is warranted regarding the higher risk of death observed in our subgroup analysis among incident SNRI users without mood and/or anxiety disorders.
A Phase 3, Multicenter, Open-Label, 12-Month Extension Safety and Tolerability Trial of Lisdexamfetamine Dimesylate in Adults With Binge Eating Disorder
Authors: Gasior Maria , Hudson James , Quintero Javier , Ferreira-Cornwell M. Celeste , Radewonuk Jana , McElroy Susan L. 
Published: April 2017

Abstract

Background
A 12-month, open-label extension study assessed the long-term safety and tolerability of lisdexamfetamine dimesylate (LDX) in adults with binge eating disorder (BED).

Methods
Adults (aged 18–55 y) with BED who completed 1 of 3 antecedent studies were enrolled in a 52-week, open-label extension study (dose optimization, 4 weeks [initial titration dose, 30-mg LDX; target doses, 50- or 70-mg LDX]; dose maintenance, 48 weeks). Safety evaluations included the occurrence of treatment-emergent adverse events (TEAEs), vital sign and weight assessments, and Columbia-Suicide Severity Rating Scale responses.

Results
Of the 604 enrolled participants, 599 (521 women and 78 men) comprised the safety analysis set, and 369 completed the study. Mean (SD) LDX exposure was 284.3 (118.84) days; cumulative LDX exposure duration was 12 months or longer in 344 participants (57.4%). A total of 506 participants (84.5%) reported TEAEs (TEAEs leading to treatment discontinuation, 54 [9.0%]; severe TEAEs, 42 [7.0%]; serious TEAEs, 17 [2.8%]). Treatment-emergent adverse events reported in greater than or equal to 10% of participants were dry mouth (27.2%), headache (13.2%), insomnia (12.4%), and upper respiratory tract infection (11.4%). Mean (SD) changes from antecedent study baseline in systolic and diastolic blood pressure, pulse, and weight at week 52/early termination (n = 597) were 2.19 (11.043) and 1.77 (7.848) mm Hg, 6.58 (10.572) beats per minute, and −7.04 (7.534) kg, respectively. On the Columbia-Suicide Severity Rating Scale, there were 2 positive responses for any active suicidal ideations; there were no positive responses for suicidal behavior or completed suicides.

Conclusions
In this 12-month, open-label, extension study, the long-term safety and tolerability of LDX in adults with BED were generally consistent with its established profile for attention-deficit/hyperactivity disorder.
Influence of Floating-Mass Transducer Coupling Efficiency for Active Middle-Ear Implants on Speech Recognition
Authors: Müller Alexander , Mir-Salim Parwis , Zellhuber Nina , Helbig Ralf , Bloching Marc , Schmidt Tobias , Koscielny Sven , Dziemba Oliver C. , Plontke Stefan K. , Rahne Torsten 
Published: April 2017

Objective:
The efficiency of vibroplasty (coupler-floating mass transducer [FMT] assembly) can be monitored by direct stimulation of the inner ear through the active middle-ear implant system and comparison of the vibroplasty in vivo threshold and the postoperative bone-conduction pure-tone threshold. The aim of this study was to compare the vibroplasty in vivo threshold with the postoperative speech recognition in patients with a high preoperative maximum word recognition score.

Study Design:
Retrospective cohort study of German-speaking patients implanted with a vibrating ossicular prosthesis (VORP) 502 or VORP 503 and high preoperative maximum word recognition score between the years of 2011 and 2015.

Setting:
Multicenter study of four German centers.

Patients:
Twenty-three active middle-ear implant users.

Intervention:
Rehabilitative.

Main Outcome Measures:
Bone-conduction pure-tone and vibroplasty thresholds, postoperative aided word recognition score (WRS) at 65 dB SPL (sound pressure level) and preoperative maximum WRS with Freiburg monosyllabic words.

Results:
The mean postoperative aided WRS at 65 dB SPL was 82%. An increasing difference between vibroplasty thresholds and bone-conduction thresholds was associated with a higher discrepancy between the unaided maximum WRS and the postoperative aided WRS. Only if this difference was less than 20 dB, an articulation index of 0.5 (WRS = 75%) or more was achieved.

Conclusions:
Audiological outcome after vibroplasty depends on the coupling efficiency reflected by the vibroplasty threshold.
Generating autologous hematopoietic cells from human-induced pluripotent stem cells through ectopic expression of transcription factors
Authors: Hwang Yongsung , Broxmeyer Hal E. , Lee Man Ryul 
Published: April 2017

Purpose of review
Hematopoietic cell transplantation (HCT) is a successful treatment modality for patients with malignant and nonmalignant disorders, usually when no other treatment option is available. The cells supporting long-term reconstitution after HCT are the hematopoietic stem cells (HSCs), which can be limited in numbers. Moreover, finding an appropriate human leukocyte antigen-matched donor can be problematic. If HSCs can be stably produced in large numbers from autologous or allogeneic cell sources, it would benefit HCT. Induced pluripotent stem cells (iPSCs) established from patients’ own somatic cells can be differentiated into hematopoietic cells in vitro. This review will highlight recent methods for regulating human (h) iPSC production of HSCs and more mature blood cells.

Recent findings
Advancements in transcription factor-mediated regulation of the developmental stages of in-vivo hematopoietic lineage commitment have begun to provide an understanding of the molecular mechanism of hematopoiesis. Such studies involve not only directed differentiation in which transcription factors, specifically expressed in hematopoietic lineage-specific cells, are overexpressed in iPSCs, but also direct conversion in which transcription factors are introduced into patient-derived somatic cells which are dedifferentiated to hematopoietic cells. As iPSCs derived from patients suffering from genetically mutated diseases would express the same mutated genetic information, CRISPR-Cas9 gene editing has been utilized to differentiate genetically corrected iPSCs into normal hematopoietic cells.

Summary
IPSCs provide a model for molecular understanding of disease, and also may function as a cell population for therapy. Efficient differentiation of patient-specific iPSCs into HSCs and progenitor cells is a potential means to overcome limitations of such cells for HCT, as well as for providing in-vitro drug screening templates as tissue-on-a-chip models.
Complications of Heart Rhythm Management Devices After Cardiac Rehabilitation Program
Authors: Rakhshan Mahnaz , Ansari Leyla , Molazem Zahra , Zare Najaf 
Published: April 2017

Objective:
The aim of this study was to examine physical and heart rhythm management device malfunction complications after participating in a cardiac rehabilitation program intervention compared with usual care.

Method:
This study was a clinical trial of 100 patients. After randomization, intervention group patients received 8 cardiac rehabilitation program sessions for 8 weeks and follow-up phone calls. Each session consisted of exercise training, education, and psychological interventions. Data were collected at 3 points in both groups—baseline and 8 and 12 weeks after the first day of the intervention—using a researcher-designed case report form. Data were analyzed using descriptive and nonparametric tests.

Results:
Of the participants, 59% were men, and the sample was aged 40 to 60 years. At the 8- to 12-week follow-up, there were less physical complications among the cardiac rehabilitation group (P < .001) and no between-group differences in complications related to device malfunction. By heart rhythm device type, cardiac rehabilitation had the greatest efficacy in reducing physical complications in patients with cardioverter/defibrillators.

Conclusions:
Cardiac rehabilitation reduced physical complications in patients with cardiac rhythm management devices, especially in patients with cardioverter/defibrillators. Cardiac clinical nurse specialists should recommend rehabilitation programs as part of postimplantation rhythm device treatment to decrease the risk of physical complications.
Ten Years of Simulation in Healthcare
Authors: Nestel Debra 
Published: April 2017

Summary Statement
In this commentary, I review 38 articles published as editorials in Simulation in Healthcare from inception to April 2016. Of the 27 authors, there was a predominance of medical doctors (63%), male authors (67%), and work originating in the United States (86%). The founding Editor-in-Chief Dr David Gaba contributed to half of the editorials. Using inductive thematic analysis, the following five themes were identified: “embedding” simulation, simulation responding to clinical practice, educational considerations for simulation, research practices, and communicating leadership and scholarship about the community. After thematic analysis, the theoretical notion of communities of practice was used to make further meaning of the themes. This theorizing process reveals that editorial content aligns with the features of an evolving community of practice. The editorials seem to have responded to and shaped contemporary simulation practices. The editorial is a powerful forum in which to frame issues relevant to the healthcare simulation community. As the founding Editor-in-Chief, Gaba has made an extraordinary contribution to the Society for Simulation in Healthcare, in these editorials and the broader healthcare simulation community. Under the leadership of the Editor-in-Chief, Dr Mark Scerbo, I am confident that the editorial voice will continue in the true spirit of scholarship.