bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect-site concentration of remifentanil for smooth inhalational induction with desflurane
Authors: Yoo Ji Young , Lee Sook Young , Jeong Hae Won , Park Hyung Bae , Chae Yun Jeong 
Published: July 2016

Objective To determine the effect-site concentration (Ce) of remifentanil target-controlled infusion required for a smooth inhalational induction without airway irritation using desflurane in a stepwise incremental manner for 50% of patients (EC50) and 95% of patients (EC95). Methods Patients with an American Society of Anesthesiologists physical status I and II, aged 19–60 years undergoing elective surgery were enrolled in this study. When target Ce of remifentanil was reached, desflurane was inhaled at 4 vol% initially and then it was increased to 8 and 12 vol% at intervals of 30 s. Smooth induction was regarded as an absence of airway irritation signs and excitatory movements. The EC50 and EC95 values for remifentanil were determined using a modified Dixon’s up-and-down method as well as an isotonic regression method with a bootstrapping approach. Results The EC50 and EC95 of remifentanil for smooth induction during inhalation of desflurane were 3.40 ng/ml (95% confidence interval [CI] 2.42, 4.38 ng/ml) and 4.31 ng/ml (95% CI 2.15, 5.98 ng/ml), respectively. Conclusion Prior administration of remifentanil could provide smooth inhalational induction with desflurane in a stepwise increment.
Are Short-term Outcomes of Hip Arthroscopy in Patients 55 Years and Older Inferior to Those in Younger Patients?
Authors: Bryan Andrew J. , Krych Aaron J. , Pareek Ayoosh , Reardon Patrick J. , Berardelli Rebecca , Levy Bruce A. 
Published: July 2016

Background: Hip arthroscopy for young patients with femoroacetabular impingement (FAI) has been successful, but the efficacy of hip arthroscopy in older patients is not clearly defined. Purpose: To evaluate the clinical outcomes of patients 55 years and older who are undergoing hip arthroscopy and to compare outcomes with those of patients younger than 55 years. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 201 (63 male, 138 female) patients undergoing primary hip arthroscopy for FAI without radiographic arthritis (Tönnis grade <3) were isolated from a prospective database and stratified by age to <55-year and ≥55-year groups. Patients were evaluated preoperatively and 1 and 2 years postoperatively using the modified Harris Hip Score (mHHS) and Hip Outcome Score (HOS: functional scores, as well as Activities of Daily Living [ADL] and Sport subscales). A Wilcoxon signed rank sum test was used to evaluate the differences in outcome scores between the cohorts at each interval. Results: The <55-year group included 174 patients (mean age, 37 ± 12 years), and the ≥55-year group included 27 patients (mean age, 61 ± 5 years). The minimum follow-up time was 2 years in each group. Preoperative Tönnis grades and mHHS scores (59 vs 59; P = .75) were similar between groups. The ≥55-year cohort underwent labral debridement more frequently (78% vs 36%; P =.02) and were more likely to have full-thickness cartilage defects (22% vs 4%; P = .04). Despite this, the mHHS in both groups improved significantly from baseline, without significant differences at 1 year (86 [≥55 years] vs 81 [<55 years]; P = .53) or 2 years (73.88 [≥55 years] vs 79.54 [<55 years]; P = .06). However, at a minimum 2-year follow-up, patients <55 years had significant improvements over patients ≥55 years in the HOS subscales for ADL score (85.6 vs 75.2; P = .03), ADL rating (80.1 vs 70.0; P = .004), Sport score (70.2 vs 55.6; P = .04), and Sport rating (70.2 vs 58.0; P = .04). Conclusion: Although younger patients had superior HOS outcomes reported at 2 years compared with older patients after hip arthroscopy for FAI, both groups had significant improvement compared with their baseline. These data suggest that carefully selected patients 55 years and older without radiographic arthritis may benefit from hip arthroscopy.
The Prevalence of Major Depressive Episodes Is Higher in Urban Regions of Canada
Authors: Wiens Kathryn , Williams Jeanne V. A. , Lavorato Dina H. , Bulloch Andrew G. M. , Patten Scott B. 
Published: July 2016

Objective: Major depressive disorder is an important contributor to disease burden. Anticipation of service needs is important, yet basic information is lacking. For example, there is no consensus as to whether major depressive episodes (MDE) are more or less prevalent in urban or rural areas. The objective of this study was to determine whether a difference exists in Canada. Method: A series of 11 Canadian national cross-sectional studies were examined from 2000 to 2014, providing much greater precision than prior analyses. Survey-specific MDE prevalence estimates were synthesized into a pooled odds ratio comparing urban to rural areas using meta-analytic methods. Results: Differences in the survey-specific estimates were not in excess of what would be expected due to sampling variability. This suggests that inconsistency in the prior literature is due to inadequate power and precision, an issue addressed by the meta-analytic pooling. The pooled odds ratio for Canada is 1.18 (95% confidence interval, 1.12 to 1.25), indicating that urban regions have higher MDE prevalence than rural regions. However, the difference is very small and of uncertain significance for policy and planning. Conclusions: Prevalence of MDE is approximately 18% higher in urban compared to rural regions of Canada. The difference is insufficient to impute differing need for services, but the result resolves an inconsistency in the existing literature and may play a role in future needs assessment.
Managing melancholic depression: a personal perspective
Authors: Parker Gordon 
Published: July 2016

Objectives: The objective of this article is to offer a personal perspective on managing melancholia by interpreting both the limited salient evidence base and offering clinical observations. Conclusions: It is suggested that medication needs to be prioritised, that not all antidepressants are equally potent for those with melancholia and that as response to a single antidepressant alone (especially a narrow-spectrum one) is low, management commonly requires broader-spectrum antidepressant drugs and augmentation strategies.
Integration of a Clinical Pharmacist into an Interdisciplinary Palliative Care Outpatient Clinic
Authors: DiScala Sandra Lee , Onofrio Sarah , Miller Maura , Nazario Mitchell , Silverman Michael 
Published: July 2016

Objectives: The primary objective of this quality improvement (QI) project was to determine if the Interdisciplinary Palliative Care Outpatient Clinic (IPCOC) at the West Palm Beach Veterans Affairs Medical Center offered improved symptom assessment and palliative care treatment outcomes. Secondary objectives were to identify, classify, and resolve medication problems and calculate the number of pharmacist recommendations accepted by prescribing providers. Methods: An IPCOC was created by selecting disciplines for a core group including a nurse practitioner, clinical pharmacist, social worker, chaplain, and physician. Consult referrals were recruited by providing educational sessions. The patient assessments were completed using the Edmonton Symptom Assessment System: (revised version; ESAS-R). The clinical pharmacist classified and resolved drug-related problems. The pharmacy resident telephoned veterans for completion of the “Patient Assessment: Overall Satisfaction with Outpatient Palliative Care Clinic.” Results: Seventeen consults were received, 6 patients were excluded, and 11 were seen in clinic. One (9%) of 11 patients met the outcomes measure of system assessment documentation in the past year. At completion, 11 (100%) of 11 patients met the outcomes data measure. The Patient Satisfaction Assessment revealed veterans strongly agree to recommend the IPCOC. The clinical pharmacist identified 20 drug-related problems, made 16 recommendations, had a 93.7% implementation rate, and facilitated implementation of medication changes. Conclusion: This QI project demonstrates that an IPCOC improved symptom assessment and palliative care outcomes in addition to resolution of medication prescribing issues in veterans with advanced cancer by integration of a clinical pharmacist into the core team.
Discourse particles in Chinese–Japanese code switching: Constrained by the Matrix Language Frame?
Authors: Meng Hai-Rong , Nakamoto Takeshi 
Published: July 2016

Aims and objectives/purpose/research questions: The purpose of this paper is to clarify the grammatical constraints on discourse particles in Chinese–Japanese intra-sentential code switching in light of the general framework of the Matrix Language Frame (MLF) model augmented by the 4-M model. Design/methodology/approach: This study retrieves data collected for three years from three Chinese–Japanese bilingual children aged between 2;1 and 5;0. Data and analysis: The database consists of nearly 300 hours of spontaneous conversations that are audio-recorded from the families of the three bilingual children, as well as diary entries. It shows that a large number of code switching utterances involve discourse particles. Findings/conclusions: Qualitative analyses of the data indicate that discourse particles are generally constrained by the MLF, yet they do not fit into any category of the 4-M model. Morphologically bound, discourse particles represent the information structure of a sentence (as in the Japanese topic marker - wa) or encode constraints on the inferential processes (as in the Japanese complementizer - kara) rather than truth-conditional information. They manifest some idiosyncrasy at the interface of syntax and pragmatics, and set up the MLF at a discourse level. Thus, the MLF model is extended from a merely syntactic level to the syntax–discourse interface. Originality: The present work has contributed empirical evidence from a hitherto undocumented language pair of Chinese and Japanese, and made theoretical explorations on the linguistic constraints of discourse particles. Significance/implications: On one hand, it is work that provides support for the robust nature of universality of the MLF constraints on code switching. On the other hand, discourse particles exhibit typological features that need further theoretical exploration in order to make a more comprehensive account for the grammatical constraints on Chinese–Japanese code switching.
Evaluation of the role of left atrial strain using two-dimensional speckle tracking echocardiography in patients with diabetes mellitus and heart failure with preserved left ventricular ejection fraction
Authors: Georgievska-Ismail Ljubica , Zafirovska Planinka , Hristovski Zarko 
Published: July 2016

Objective: To evaluate additional role of left atrial two-dimensional speckle tracking echocardiography in patients with diabetes mellitus type 2, 218 patients with heart failure with preserved left ventricular ejection fraction divided according to the presence of diabetes mellitus (108 with and 110 without) were enrolled in the study. Methods: Traditional parameters using two-dimensional echocardiography and Doppler imaging were measured as expressions of left ventricular diastolic function as well as peak atrial longitudinal strain and peak atrial contraction strain were measured using two-dimensional speckle tracking echocardiography. Results: Global average peak atrial longitudinal strain and peak atrial contraction strain were significantly lower in patients with diabetes mellitus ( p = 0.002 and p = 0.001, respectively) and its reduced values were significantly associated with higher prevalence of diabetes mellitus ( p = 0.002 and p = 0.001, respectively), its greater severity ( p = 0.002 and p = 0.016, respectively) and longer duration only for global average peak atrial longitudinal strain ( p = 0.030). Multiple linear regression analysis demonstrated that the presence of diabetes mellitus appeared as independent predictor of reduced global peak atrial longitudinal strain [ B = −2.173; 95% confidence interval: −3.870 to (−0.477); p = 0.012] as well of reduced global peak atrial contraction strain [ B = −1.30; 95% confidence interval: −2.234 to (−0.366); p = 0.007]. Conclusion: Two-dimensional speckle tracking echocardiography appeared as a useful additional tool for detection of left atrial dysfunction in patients with heart failure who have preserved left ventricular ejection fraction and diabetes mellitus who are especially prone to develop cardiovascular complications.
Can we reduce the incidence of complex regional pain syndrome type I in distal radius fractures? The Liverpool experience
Authors: Gillespie Sharon , Cowell Fiona , Cheung Graham , Brown Daniel 
Published: July 2016

Introduction Complex regional pain syndrome is a multifaceted condition, which is relatively common after distal radius fracture. Method A series of audits and service evaluations were conducted from 2004 to 2013 to investigate the incidence of complex regional pain syndrome type I and any correlation to tight, restrictive, over-flexed casts. Simple subsequent clinical and patient management changes were implemented and impact re-evaluated. Results These audits have contributed to organisational learning and a subsequent reduction in the incidence of complex regional pain syndrome type I in non-operatively managed distal radius fracture from 25%, in keeping with expected incidence in the relevant literature, to a rare event (<1%). Conclusion The authors suggest that careful attention to the prevention of complex regional pain syndrome through staff and patient awareness, vigilance for warning signs and minor modifications to the traditional management of distal radius fractures can significantly reduce the incidence of complex regional pain syndrome type I after distal radius fracture.
Renal transitional cell carcinoma with bilateral ocular metastasis in a cat
Authors: Grader Irit , Southard Teresa L , Neaderland Marjorie H 
Published: July 2016

Case summary A 4-year-old, spayed female, domestic shorthair cat was presented for evaluation due to a 4 day history of inappetence and lethargy. Physical examination revealed mild dehydration and blindness of the left eye. Abnormal imaging findings included a well-margined soft tissue mass with irregular central cavity located in the dorsal aspect of the caudal lung lobe. Cytological examination of the mass revealed chronic inflammation with hemorrhage. Tests for parasitic and fungal diseases were negative. Ophthalmic examination 17 days after the cat was initially presented revealed severe diffuse pathology of both retinas. Left renomegaly was noted 22 days after the initial presentation, and cytological examination of samples obtained from the right vitreous, left kidney and the pulmonary mass yielded atypical epithelial cells exhibiting malignant changes. Post-mortem examination following euthanasia revealed renal transitional cell carcinoma with metastasis to both eyes, lungs and skeletal muscle. Immunohistochemical evaluation of the neoplastic cells in the eye revealed moderate cytoplasmic reactivity for CK7. CK20 immunohistochemistry was negative. Relevance and novel information To the best of our knowledge, this is the first report of renal transitional cell carcinoma with ocular metastasis in a cat. In addition, this report describes immunohistochemistry results of transitional cell carcinoma in a cat using CK7 and CK20.
Different Stabilization Techniques for Type 62B3 Acetabular Fractures in Combination With Primary Total Hip Arthroplasty in Elderly Patients
Authors: Uvarovas Valentinas , Šatkauskas Igoris , Urbonavičius Robertas , Bučinskas Vytautas , Griškevičius Julius , Vengrauskas Vytautas , Petryla Giedrius , Masionis Povilas , Andrijauskas Audrius , Porvaneckas Narūnas 
Published: July 2016

Introduction: The total hip arthroplasty (THA) as part of acute fracture management is used for acetabular fractures in elderly patients. Our objective was to assess the stability of osteosynthesis performed using 2 different techniques in combination with THA in an experimental model. Materials and Methods: We conducted 20 experiments using the left-side hemipelves composite bone models. There were 2 testing groups: 1- and 2-stage osteosynthesis. The acetabular fractures of the anterior column and posterior hemitransverse were simulated. The same THA technique was used in both groups. The stability of osteosynthesis was explored and compared between the groups by measuring the fracture displacement of anterior and posterior columns under the standardized test load (1187 N) protocol. Load distance diagrams were generated. Results: The 0.680-mm gap (0.518; 1.548) of the posterior column in the 1-stage group (n = 10) was higher than the 0.370-mm gap (0.255; 0.428) in the 2-stage group (n = 10; P = .002). There was no significant difference between the gap of the anterior column in the 1- and 2-stage groups (0.135 [0.078; 0.290] mm vs 0.160 [0.120; 0.210] mm; P = .579). Conclusion: The 2-stage osteosynthesis of the anterior and posterior columns in combination with THA provides better stability of posterior column when compared to 1-stage method in composite bone models.
Patients With Multiple Myeloma Have More Complications After Surgical Treatment of Hip Fracture
Authors: Park Kwan Jun , Menendez Mariano E. , Mears Simon C. , Barnes C. Lowry 
Published: July 2016

Objectives: Bone lesions from multiple myeloma may lead to pathological fracture of the proximal femur, requiring either fixation or arthroplasty. Little is known about the impact of multiple myeloma on hip fracture care. We investigated whether the patients with multiple myeloma undergoing surgical treatment of hip fractures would be at increased risk for adverse outcomes versus patients who sustain a hip fracture without multiple myeloma. Methods: Using discharge records from the Nationwide Inpatient Sample (2002-2011), we identified 2 440 513 patients older than 50 years of age with surgically treated hip fractures. Of which, 4011 (0.2%) were found to have multiple myeloma. We compared perioperative outcomes between the patients with multiple myeloma and the nonmultiple myeloma patients using multivariable logistic regression modeling. Results: Patients with multiple myeloma were more likely to have several postoperative complications, such as in-hospital pneumonia (odds ratio [OR]: 1.31, 95% confidence interval [CI]: 1.14-1.51), sepsis (OR: 1.72, 95% CI: 1.32-2.25), surgical site infection (OR: 1.66, 95% CI: 1.38-2.00), and acute renal failure (OR: 1.28, 95% CI: 1.14-1.43). We found that myeloma was not associated with increased inpatient mortality, myocardial infarction, respiratory failure, thromboembolic events, or pulmonary embolism. Conclusion: Patients with multiple myeloma are at increased risk for immediate postoperative complications following surgical treatment of hip fractures including in-hospital pneumonia, surgical site infection, and acute renal failure but not hospital mortality, when compared to hip fracture patients without multiple myeloma. Perioperative management of hip fractures in patients with myeloma may be optimized by increased awareness of these risks in this subset of patients.
Continuous laryngoscopy quantitates laryngeal behaviour in exercise and recovery
Authors: Olin J. Tod , Clary Matthew S. , Fan Elizabeth M. , Johnston Kristina L. , State Claire M. , Strand Matthew , Christopher Kent L. 
Published: July 2016

Exercise-induced laryngeal obstruction (E-ILO) causes exertional dyspnoea. There is no standardised methodology which characterises laryngeal obstruction in relation to exercise or links laryngeal obstruction and dyspnoea severity. Continuous laryngoscopy during exercise (CLE) may improve diagnostic sensitivity by enabling laryngeal visualisation at peak work capacity in patients with rapidly resolving obstruction. The time course of laryngeal obstruction across exercise and recovery has not been quantitated until this report.Adolescents and young adults referred for CLE were laryngoscopically monitored across rest, maximal cycle ergometry exercise, and recovery. Three reviewers, blinded to time sequencing, rated inspiratory glottic and supraglottic obstruction during 10 windows of 15-s corresponding to rest, 25%, 50%, 75%, 90% and 100% of individual symptom-limited peak work capacity (expressed in Watts), and four consecutive recovery windows.85 patients were screened and 71 included. Over 96% of time windows were interpretable. Laryngeal obstruction severity reached observed maximal levels at peak work capacity, and rapidly resolved. A spectrum of observed maximal obstruction was measured.CLE provides interpretable data demonstrating laryngeal obstruction in patients with suspected E-ILO that is more severe at peak work capacity than during rest, submaximal exercise, or recovery. Observed maximal obstruction was infrequently severe and rapidly resolved.
Role of interleukin-1 receptor 1/MyD88 signalling in the development and progression of pulmonary hypertension
Authors: Parpaleix Aurélien , Amsellem Valérie , Houssaini Amal , Abid Shariq , Breau Marielle , Marcos Elisabeth , Sawaki Daigo , Delcroix Marion , Quarck Rozenn , Maillard Aurélie , Couillin Isabelle , Ryffel Bernhard , Adnot Serge 
Published: July 2016

Pulmonary artery smooth muscle cell (PA-SMC) proliferation and inflammation are key components of pulmonary arterial hypertension (PAH). Interleukin (IL)-1β binds to IL-1 receptor (R)1, thereby recruiting the molecular adaptor myeloid differentiation primary response protein 88 (MyD88) (involved in IL-1R1 and Toll-like receptor signal transduction) and inducing IL-1, IL-6 and tumour necrosis factor-α synthesis through nuclear factor-κB activation.We investigated the IL-1R1/MyD88 pathway in the pathogenesis of pulmonary hypertension.Marked IL-1R1 and MyD88 expression with predominant PA-SMC immunostaining was found in lungs from patients with idiopathic PAH, mice with hypoxia-induced pulmonary hypertension and SM22-5-HTT+mice. Elevations in lung IL-1β, IL-1R1, MyD88 and IL-6 preceded pulmonary hypertension in hypoxic mice. IL-1R1−/−, MyD88−/−and control mice given the IL-1R1 antagonist anakinra were protected similarly against hypoxic pulmonary hypertension and perivascular macrophage recruitment. Anakinra reversed pulmonary hypertension partially in SM22-5-HTT+mice and markedly in monocrotaline-treated rats. IL-1β-mediated stimulation of mouse PA-SMC growth was abolished by anakinra and absent in IL-1R1−/−and MyD88−/−mice. Gene deletion confined to the myeloid lineage (M.lys-Cre MyD88fl/flmice) decreased pulmonary hypertension severityversuscontrols, suggesting IL-1β-mediated effects on PA-SMCs and macrophages. The growth-promoting effect of media conditioned by M1 or M2 macrophages from M.lys-Cre MyD88fl/flmice was attenuated.Pulmonary vessel remodelling and inflammation during pulmonary hypertension require IL-1R1/MyD88 signalling. Targeting the IL-1β/IL-1R1 pathway may hold promise for treating human PAH.