bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measuring the Operative Treatment Effect in End-Stage Ankle Arthritis: Are We Asking the Right Questions? A COFAS Multicenter Study
Authors: Wing Kevin J. , Chapinal Nuria , Coe Marcus P. , Daniels Timothy R. , Glazebrook Mark , Dryden Peter , Younger Alastair , Penner Murray J. , Sutherland Jason M. 
Published: July 2017

Background: Foot and ankle surgeons are increasingly relying on patient-reported outcome measures (PROMs) such as the Ankle Osteoarthritis Scale (AOS) to evaluate treatment options. The objectives of this retrospective cohort study were 2-fold: (1) to examine the AOS instrument using psychometric analysis and (2) to revise the questions on the AOS to improve the effect of questions on the score and remove redundancies. Methods: Pre- and postoperative patient scores were obtained from AOS questionnaires in the COFAS Prospective Ankle Reconstruction Database, a cohort of patients operatively treated for end-stage ankle arthritis. A split-sample approach was used to evaluate the AOS and to propose a revised instrument. Results: A total of 380 patients who had been treated with total ankle replacement or ankle arthrodesis were prospectively followed to the 2-year postoperative time point. Correlation analysis demonstrated that a number of questions on the AOS were highly correlated with other similar questions, frequently incomplete, or showed little variation between respondents. Eight of the original AOS questions were retained in the newly proposed Ankle Arthritis Score (AAS) [3 from the AOS Pain subscale and 5 from the AOS Disability subscale]. Principal components analysis (PCA) showed that these questions equally clustered into 2 domains in AAS: Basic Activity and Advanced Activity. Conclusions: The AAS is shorter and has improved psychometric properties as compared to the AOS. Further investigation is required to better characterize the clinical utility of this proposed new patient-reported outcome score. Level of Evidence: Level III, retrospective cohort study.
Comparison of serological assessments in the diagnosis of liver fibrosis in bile duct ligation mice
Authors: Xie Chengxia , Ma Bo , Wang Ning , Wan Lin 
Published: July 2017

Liver fibrosis assessment is essential to make a prognosis and to determine the appropriate anti-fibrosis treatment. Non-invasive serum markers are widely studied in patients to assess liver fibrosis due to the limitations of liver biopsy. When using animal models to study the mechanism and intervention of hepatic fibrosis, serum markers might be useful for the continuous assessment of liver fibrosis in individual animals, which could avoid the influence of biological differences between individuals. However, it is unclear whether serum markers can assess hepatic fibrosis in the animal model. In the present study, we evaluated and compared the ability of four serum markers to assess liver fibrosis in bile duct ligation mice. According to the stages of liver fibrosis assessed by pathological changes, mice in this study were divided into five groups (F0, F1, F2, F3, and F4). Subsequently, four serum markers, aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis index based on the 4 factors (FIB-4), and Forns Index, were calculated for each group. Furthermore, the correlations between serum markers and pathological stages and the ability of serological markers to evaluate liver fibrosis were analyzed. AAR, APRI, FIB-4, and Forns Index could significantly distinguish F0-2 from F3-4 mice. APRI, FIB-4, and Forns Index could detect F0-3 from F4 mice. Among these four markers, FIB-4 was the best able to distinguish ≥F2 and ≥F3, with area under the curve values of 0.882 and 0.92, respectively. Forns Index was best for diagnosing F4 with area under the curve value of 0.879. These results demonstrated that serum markers could be used for assessing liver fibrosis in bile duct ligation mice, and therefore, these markers might lead to more accurate diagnostic and therapeutic studies through continuous monitoring in individual animals. Impact statement The assessment of liver fibrosis is essential for making a prognosis and determining the appropriate anti-fibrosis treatment. In studies focusing on the mechanism and treatment of liver fibrosis using animal models, it would be more accurate to continuously evaluate liver fibrosis in a single animal to avoid individual biological differences. Unfortunately, it is difficult to perform continuous assessment through liver biopsy in the most commonly used rodent models. It is unclear whether serum markers, which have been used in hepatic fibrosis patients, could be used in animal models. Our results demonstrate that serum markers could be used for assessing liver fibrosis in bile duct ligation mice. This study might contribute to more accurate diagnostic and therapeutic studies through continuous monitoring in individual animals.
The sharing of radiological images by professional mixed martial arts fighters on social media
Authors: Rahmani George , Joyce Cormac W , McCarthy Peter 
Published: July 2017

Background Mixed martial arts is a sport that has recently enjoyed a significant increase in popularity. This rise in popularity has catapulted many of these “cage fighters” into stardom and many regularly use social media to reach out to their fans. An interesting result of this interaction on social media is that athletes are sharing images of their radiological examinations when they sustain an injury. Purpose To review instances where mixed martial arts fighters shared images of their radiological examinations on social media and in what context they were shared. Material and Methods An Internet search was performed using the Google search engine. Search terms included “MMA,” “mixed martial arts,” “injury,” “scan,” “X-ray,” “fracture,” and “break.” Articles which discussed injuries to MMA fighters were examined and those in which the fighter themselves shared a radiological image of their injury on social media were identified. Results During our search, we identified 20 MMA fighters that had shared radiological images of their injuries on social media. There were 15 different types of injury, with a fracture of the mid-shaft of the ulna being the most common. The most popular social media platform was Twitter. The most common imaging modality X-ray (71%). The majority of injuries were sustained during competition (81%) and 35% of these fights resulted in a win for the fighter. Conclusion Professional mixed martial artists are sharing radiological images of their injuries on social media. This may be in an attempt to connect with fans and raise their profile among other fighters.
Retrospective Assessment of Possible Hypersensitivity Reactions to Abacavir
Authors: Segarra-Newnham Marisel , Volpp Bryan D 
Published: July 2017

Objective: To document the frequency of abacavir hypersensitivity reactions in HIV-positive patients followed in a Veterans Affairs outpatient clinic. Methods: Abacavir's manufacturer lists the incidence of hypersensitivity as 5%. We conducted a retrospective review of all patients in our clinic who received abacavir from January 1999 to December 1999 to document the rate of discontinuation of the drug due to possible hypersensitivity reactions. The duration of abacavir therapy, concomitant antiretrovirals, most recent CD4+ count, most recent viral load, number of antiretroviral regimens previously tried, and the number and types of new antiretrovirals started concomitant with abacavir were collected. Results: Of 24 patients analyzed, nine (38%) discontinued abacavir, with six (25%) having a potential hypersensitivity reaction. Four reactions were classified as probable and two as possible according to the Naranjo scale. Only one patient was hospitalized for the reaction. Patients who discontinued abacavir due to a hypersensitivity reaction had similar CD4+ counts, viral loads, and had received a similar number of antiretroviral regimens compared with patients who continued the drug. However, 67% of patients who discontinued abacavir due to a hypersensitivity reaction had at least one previously documented adverse event that led to the discontinuation of another antiretroviral, compared with 7% of the patients who continued the drug (p = 0.02). Conclusions: The frequency of possible hypersensitivity reactions to abacavir in patients seen in our HIV clinic is higher than the manufacturer's reported rate of 5%. These patients may be more prone to adverse reactions based on previous medication history and adverse events.
Histamine2-Receptor Antagonists Do Not Prevent Allergic Reactions
Authors: Root Thomas S. , Quan David J. 
Published: July 2017

Objective: To determine whether histamine2 (H2)-receptor antagonists are effective in the treatment of allergic reactions such as rhinitis and urticaria. Methods: A MEDLINE search of current literature revealed 13 journal articles for review. Literature evaluation was conducted. Conclusions: H2-antagonists alone did not seem to prevent allergic reactions. While further studies are needed to clearly define the mechanism of the beneficial effects seen with combined H1.- and H2-antagonist therapy, there are no convincing data to suggest that H2-antagonists used alone have any therapeutic value in the prevention of allergic rhinitis or urticaria.
Attitudes toward Pharmacy Technician Use: A Six-State Survey of Community Pharmacists
Authors: Lance Judy C. , Jang Raymond 
Published: July 2017

Objective: To determine the attitudes of community pharmacists in six states toward technician employment in their community practice and to relate the effects of these attitudes to pharmacist behavior. Design: Four-part mail questionnaire survey. Sections A and B dealt with pharmacist attitudes toward technicians. Section C was 22 activities common to pharmacy dispensing that pharmacists currently allow technicians to perform. Section D was respondent demographics. Respondents: Licensed, practicing, full-time (>32 h/wk) community pharmacists in six states (Illinois, Iowa, Maine, New York, Texas, Washington). Methods: Attitude scores were assessed (ANOVA analysis) by pharmacist age, daily prescription volume, practice site, current technician employment, and state laws. The collective attitude scores (A plus B) were compared with activity scores for correlation between attitude and activities. Results: Overall, responding pharmacists were favorable toward technician use. ANOVA disclosed significant differences for pharmacist age, prescription volume, practice site, and employment of technicians. The top four activities pharmacists allowed technicians to perform were: (1) type labels, (2) select drugs from stock, (3) count needed amount of drugs, and (4) receive refill drug orders. The four least-allowed technician activities were: (1) compound intravenous solutions, (2) verify other technicians' work, (3) provide patients with drug information, and (4) verify completed drug orders. Spearman's r, showed consistency (0.335) between attitudes and activities allowed. Conclusions: Pharmacists approve of technician use, are comfortable with a clinically oriented counseling role, do not feel threatened by increased technician use, are willing to accept the additional professional liability technician use brings, and favor a formally structured technician training program.
Digoxin Immune Fab Administration following an Unexplained Increase in Serum Digoxin Concentration
Authors: Aruna Augustine S. , Jue Sandra G. 
Published: July 2017

Objective: To report a case of digoxin immune Fab (DIF) administration following an unexplained increase in serum digoxin concentration in an asymptomatic patient with chronic renal failure. Case Summary: A 70-year-old man presented to the hospital with congestive heart failure, atrial fibrillation, chronic renal failure, and suspected digoxin toxicity. By day 3, he developed a more stable cardiac rhythm with nodal beats. His last known digoxin dose was 12 hours prior to admission. No explanation for an elevated serum digoxin concentration 48 hours after admission could be found. Despite absence of other signs of digoxin toxicity, DIF 80 mg iv was administered, and was immediately followed by 40 mg. Discussion: This case illustrates that elevated digoxin concentrations may be observed in patients with renal failure. These may not be true high concentrations because of the following potential factors: (1) the presence of digoxin-like factors, (2) increased biotransformation of digoxin, and (3) accumulation of metabolites that interfere with the assay. Digoxin metabolites are known to cross-react with the antibodies in commonly used digoxin immunoassays, and may be inappropriately interpreted to signal digoxin toxicity. Both the accuracy and reliability of digoxin immunoassay techniques have been questioned or challenged over the years. It is difficult to determine whether a reported toxic serum digoxin concentration represents the true concentration or cross-reactivity between digoxin metabolites and antibodies used in most digoxin immunoassays. Data Sources: Data collection sources included retrospective review of patient medical records, personal contact with one of the physicians involved in rendering patient care for interpretation of the electrocardiogram changes, clinical symptoms and rationale for DIF administration, and contact with the immunoassay technologist, who indicated that the fluorescence polarization immunoassay technique was used for analysis of digoxin concentrations. The medical literature then was reviewed. Conclusions: DIF should be reserved for use in symptomatic patients. Elevated digoxin concentrations must be evaluated for various factors that can cause falsely elevated values. Clinical signs and symptoms are critical in making the decision to use Fab. Antidotal measures should be based on correlation of patient symptoms with serum digoxin concentrations.
Phenobarbital Pharmacokinetics in Infants Using Saliva as a Biologic Fluid
Authors: Gutierrez Stella , Vázquez Marta , Amodio Amanda , Giachetto Gustavo , Moller Diana , Queirolo Mariela , Taboas Silvia , Ferrari Ana M. , Fagiolino Pietro L. 
Published: July 2017

Objective: To determine the pharmacokinetic parameters of phenobarbital in infants, using saliva as a biologic fluid, and to correlate the parameters obtained from saliva data with those obtained from plasma data. Design: A prospective, randomized study. Setting: Hospitalized patients at the Medical Center Pereira Rossell, a pediatric hospital in Montevideo, Uruguay. Patients: Sixteen infants with seizure disorders were included in the study. None of them was treated with other medications. Interventions: A direct intravenous loading dose of phenobarbital 10 mg/kg was administered, followed by a maintenance dosage of 5 mg/kg/d (once- or twice-daily dosing) given 12 hours after the loading dose. Main Outcome Measures: Saliva and plasma samples were obtained 6 and 12 hours after the loading dose and 3 days after the initiation of the maintenance dose (trough sample): the samples were analyzed by HPLC and the elimination half-life (t1/2), the volume of distribution (Vd), and the percentage of unbound drug in plasma (UDP) were calculated. Results: The t1/2 obtained from plasma and saliva data was 30 hours; the Vd was 0.73 L/kg from plasma data and 2.4 L/kg from saliva data; and the UDP was 75 percent. Trough concentrations showed no significant difference between treatments. Conclusions: Saliva is a useful biologic fluid to determine phenobarbital pharmacokinetic parameters, mainly in pediatric patients. Moreover, a single daily dose of phenobarbital is sufficient to obtain therapeutic concentrations.
Enalapril-Induced, Near-Fatal Angioedema
Authors: Rao Satya , MacHuga David T 
Published: July 2017

Objective: To report a near-fatal angioedema associated with the use of enalapril, a long-acting angiotensin-converting enzyme inhibitor. Data Sources: Medical record of the patient, case reports identified by MEDLINE. Case Summary: A 52-year-old man was admitted to our institution for closed reduction and debridement of an injury sustained to the left index finger. The patient's blood pressure was increased (180/102 mm Hg), and he was placed on nifedipine 60 mg and enalapril 5 mg/d. Other medications included ranitidine 150 mg bid and cefotaxime 2 g q8h. Eighteen hours after the first dose of enalapril the patient developed swelling of the face and lips and had difficulty breathing. The patient was seen initially by the house physician, who ruled out a penicillin/cephalosporin allergy. The assessment of an allergic reaction to enalapril was made and the drug was discontinued. Diphenhydramine 50 mg im, epinephrine 0.5 mL sc, and methylprednisone 125 mg iv were given immediately, and the patient was transferred to the intensive care unit (ICU). Methylprednisone 100 mg q6h was initiated along with diphenhydramine 50 mg im q6h prn. Over the next 48 hours the swelling decreased and the patient was removed from the ICU. The dosage of methylprednisone was decreased to 40 mg q6h and the patient was discharged the following day. Conclusions: The pathogenesis of angiotensin-converting enzyme (ACE) inhibitor-induced angioedema is not fully understood. This unique idiosyncratic adverse drug reaction may occur even though the medication has been tolerated for months or years. The symptoms may regress quickly while the patient is still taking the medication, resulting in no diagnosis, or the symptoms may progress rapidly despite aggressive medical intervention. The rapidly expanding market of these agents along with the expected availability of generic captopril in 1995 may increase overall prescriptions written for ACE inhibitors in the US, potentially increasing the number of cases of angioedema. This patient was diagnosed quickly and resulted in a positive outcome. Physicians and other healthcare providers should be aware of the symptoms of ACE inhibitor-induced angioedema and make their patients aware as well.
Role of Nonsteroidal Antiinflammatory Drugs in the Differential Diagnosis of Neoplastic Fevers versus Fevers of Infectious Etiology
Authors: Rabon Parrish G , Murray Kim M 
Published: July 2017

Objective: To determine the role of nonsteroidal antiinflammatory drugs (NSAIDs) in the differential diagnosis of neoplastic fevers versus fevers of infectious etiology and to recommend a therapeutic regimen as well as a suggested treatment duration of NSAID therapy to aid in this diagnosis. Data Sources: The English-language literature was searched using MEDLINE, Index Medicus, and bibliographic reviews of relevant textbooks and review articles. Conclusions: NSAIDs have induced dramatic antipyretic effects when administered to patients with cancer whose fevers are particularly disabling and often a major contributor to patient morbidity and mortality. When a fever persists after infection has been ruled out, an NSAID test may be of diagnostic value for a neoplastic fever. Naproxen, indomethacin, and diclofenac all have been studied and demonstrated efficacy. A reduction or cessation of a neoplastic fever can be expected within 24 hours after initiation of NSAID therapy. However, NSAID therapy should be continued for three days before cessation of therapy or a change to another NSAID is considered.
Efficacy of Intranasal Apomorphine in Parkinson's Disease
Authors: Duarte Jacinto , Ruiz Maria Dolores , Mataix Angel L , Sempere Angel P , García Francisco M , Coria Francisco , Jose Maria Angeles San , Clavería Luis Erick 
Published: July 2017

Objective: To suggest that intranasal delivery may offer an effective alternative to subcutaneous injection of apomorphine. Methods: Four patients (3 men, 1 woman) with idiopathic Parkinson's disease, with disabling “on-off” fluctuations in motor performance, despite optimal adjustment in the levodopa regimen and use of dopamine agonists, were included in this study. Their mean age was 61.5 years (range 58–65) and the mean duration of the disease was 13.5 years (range 5–18). The mean duration of levodopa treatment was 12.2 years (range 5–16). Disabling fluctuations had been present in these patients for more than 1 year. The Hoehn and Yahr stage was III-IV during the off periods. All four patients had dyskinesia when receiving the peak dose. Levodopa and dopamine agonist medications were unchanged for 1 month before the study. All four patients had already received intermittent subcutaneous apomorphine injections for a mean of 12.25 months (range 7–16). Apomorphine solution 10 mg/mL was administered with the use of a metered-dose nebulizer that delivered 1 mg of solution with each puff. Results: All patients showed a clear clinical response, with a mean reduction in daily off period of 94.5% with respect to the basal off period. No loss of therapeutic effect or increase in dyskinesia was observed compared with subcutaneous apomorphine. The speed, quality, and duration of response were comparable with that found with injection of apomorphine. One patient showed a slight vestibulitis, but it did not interfere with the efficacy of apomorphine. Conclusions: Intranasal apomorphine is a comfortable and easy alternative to subcutaneous apomorphine in the treatment of off phases in patients with Parkinson's disease and severe refractory motor fluctuations.
Phenytoin in the Treatment of Epidermolysis Bullosa
Authors: Moshfeghi Mersedeh , Contractor Ghazala M 
Published: July 2017

Objective: To review the efficacy of phenytoin in the treatment of epidermolysis bullosa (EB). Data Sources: English-language clinical study reports, abstracts, case reports, and review articles pertaining to the use of phenytoin in the treatment of EB (MEDLINE search, January 1973-August 1996). Data Extraction: Clinical study and case reports evaluating the effect of phenytoin in the treatment of EB were reviewed, and the methodology, results, and conclusions of the studies were evaluated. Because of the limited number of randomized, controlled study reports, all available case reports were reviewed, and information we considered pertinent was synthesized. Data Synthesis: Results of studies of EB suggest that the blister fluid and fibroblasts in patients with this disease produce an increased amount of collagenase, which is thought to induce blistering. Phenytoin inhibits collagenase synthesis and/or secretion and, therefore, is used to treat patients with EB. Data regarding the use of phenytoin in patients with EB, especially those with recessive dystrophic EB, revealed that phenytoin may reduce the number of blisters in these patients. Dosage recommendations and monitoring parameters are also discussed. Conclusions: More randomized, controlled trials are needed to determine the true efficacy of phenytoin in the treatment of EB. Although the only available report of a randomized, controlled trial reported a lack of phenytoin efficacy in patients with EB, it does not rule out the possibility of success in selected patients.