bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of pneumodilation in achalasia after failed Heller myotomy
Authors: Saleh C. M. G. , Ponds F. A. M. , Schijven M. P. , Smout A. J. P. M. , Bredenoord A. J. 
Published: July 2016

AbstractBackgroundHeller myotomy is an effective treatment for the majority of achalasia patients. However, a small proportion of patients suffer from persistent or recurrent symptoms after surgery and they are usually subsequently treated with pneumodilation (PD). Data on the efficacy of PD as secondary treatment for achalasia are scarce. Therefore, this study aimed to investigate the efficacy of PD as treatment for achalasia patients suffering from persistent or recurrent symptoms after Heller myotomy.MethodsPatients with recurrent or persistent symptoms (Eckardt score >3) after Heller myotomy were selected. Patients were treated with PD, using a graded distension protocol with balloon sizes ranging from 30 to 40 mm. After each dilation symptoms were assessed to evaluate whether a subsequent dilation with a larger balloon size was required. Patients with recurrent or persistent symptoms (Eckardt score >3) after treatment with a 40‐mm balloon were identified as failures.Key ResultsTwenty‐four patients were included in total; 15 patients with achalasia type I, seven with achalasia type II and two with achalasia type III. Median relapse time was 2.5 years after Heller myotomy (IQR: 9 years and 3 months). Three patients were not suitable for PD; one patient was morbidly obese and not fit for any form of sedation and two had a siphon‐shaped esophagus leaving 21 patients to treat. Eight patients were successfully treated with a single 30‐mm balloon dilation (median follow‐up time: 6.5 years; IQR: 7.5 years). Four patients required dilations with 30‐ and 35‐mm balloons (median follow‐up time: 11 years; IQR: 3 years). Nine patients failed on the 35‐mm balloon dilation and underwent a subsequent dilation with a 40‐mm balloon, and all failed on this balloon as well. Thus, PD was successful in 12 of the 21 treatable patients, resulting in a success rate of 57% for treatable patients or 50% for all patients. Baseline Eckardt scores were also higher in those that failed (median: 8; IQR: 2) than those that were treated successfully (median: 5.5; IQR: 2) treated (p = 0.009). Furthermore, baseline barium column height at 5 min was higher in patients with failed (median: 6 cm; IQR: 6 cm) treatment than in patients with successful (median: 2.6 cm; IQR: 4.7 cm) treatment (p = 0.016). Baseline lower esophageal sphincter pressure was not different between patients who were treated successfully (median: 11 mmHg; IQR: 5 mmHg) and those that failed on PD (median: 17.5 mmHg; IQR: 10.8 mmHg) treatment (p > 0.05). Baseline symptom pattern was also not a predictor of successful treatment. No adverse events were recorded during or after PD.Conclusions & InferencesPneumodilation for recurrent symptoms after previous Heller myotomy is safe and has a modest success rate of 57%, using 30‐ and 35‐mm balloons. Patients with recurrent symptoms after PD with 35‐mm balloon are likely to also fail after subsequent dilation with a 40‐mm balloon.
Perioperative management of pediatric en‐bloc combined heart–liver transplants: a case series review
Authors: Navaratnam Manchula , Ng Ann , Williams Glyn D. , Maeda Katsuhide , Mendoza Julianne M. , Concepcion Waldo , Hollander Seth A. , Ramamoorthy Chandra 
Published: July 2016

SummaryBackgroundCombined heart and liver transplantation (CHLT) in the pediatric population involves a complex group of patients, many of whom have palliated congenital heart disease (CHD) involving single ventricle physiology.ObjectiveThe purpose of this study was to describe the perioperative management of pediatric patients undergoing CHLT at a single institution and to identify management strategies that may be used to optimize perioperative care.MethodsWe did a retrospective database review of all patients receiving CHLT at a children's hospital between 2006 and 2014. Information collected included preoperative characteristics, intraoperative management, blood transfusions, and postoperative morbidity and mortality.ResultsFive pediatric CHLTs were performed over an 8‐year period. All patients had a history of complex CHD with multiple sternotomies, three of whom had failing Fontan physiology. Patient age ranged from 7 to 23 years and weight from 29.5 to 68.5 kg. All CHLTs were performed using an en‐bloc technique where both the donor heart and liver were implanted together on cardiopulmonary bypass (CPB). The median operating room time was 14.25 h, median CPB time was 3.58 h, and median donor ischemia time was 4.13 h. Patients separated from CPB on dopamine, epinephrine, and milrinone infusions and two required inhaled nitric oxide. All patients received a massive intraoperative blood transfusion post CPB with amounts ranging from one to three times the patient's estimated blood volume. The patient who required the most transfusions was in decompensated heart and liver failure preoperatively. Four of the five patients received an antifibrinolytic agent as well as a procoagulant (prothrombin complex concentrate or recombinant activated Factor VII) to assist with hemostasis. There were no 30‐day thromboembolic events detected. Postoperatively the median length of mechanical ventilation, ICU stay and stay to hospital discharge was 4, 8, and 37 days, respectively. All patients are alive and free from allograft rejection at this time.ConclusionCombined heart and liver transplantation in the pediatric population involves a complex group of patients with unique perioperative challenges. Successful management starts with thorough preoperative planning and communication and involves strategies to deal with massive intraoperative hemorrhage and coagulopathy in addition to protecting and supporting the transplanted heart and liver and meticulous surgical technique. An integrated multidisciplinary team approach is the cornerstone for successful outcomes.
Korean Version of the painDETECT Questionnaire: A Study for Cultural Adaptation and Validation
Authors: Sung Jun Kyung , Choi Jeong‐Hyun , Jeong Jinyoung , Kim Won‐Joong , Lee Da Jeong , Lee Sang Chul , Kim Yong‐Chul , Moon Jee Youn 
Published: July 2016

AbstractObjectiveThe purpose of this study was to adapt the painDETECT Questionnaire (PD‐Q) into a Korean version (KPD‐Q) and validate it.MethodsA single‐center prospective observational study was performed. During the first phase of the study, linguistic adaptation was carried out to develop the KPD‐Q. During the second phase of the study, feasibility, internal consistency, discriminant validity, and concurrent validity were assessed for psychometric validation of the KPD‐Q.ResultsA total of 232 patients participated. Among them, 82 patients (35%) were classified in the neuropathic pain (NeP) group, 80 (34%) in the nociceptive pain group, and 70 (30%) in the mixed pain group. Regarding the reliability of the KPD‐Q, internal consistency for the whole scale was 0.804, as evaluated by Cronbach's alpha. Pearson's correlation between the Leeds Assessment of Neuropathic Symptoms and Signs scale and the KPD‐Q scores was positive and statistically significant (r = 0.74, P < 0.001). Similar to the result obtained by the original developers, a value of ≥ 19 points suggested a clear diagnosis of the presence of an NeP component with 95.4% sensitivity, 73.8% specificity, and 0.737 Youden index. We used ≤ 13 (as opposed to ≤ 12, as suggested previously) as an alternative cutoff value, which showed a sensitivity of 95.4%, specificity of 73.8%, and the Youden index of 0.691.ConclusionThe KPD‐Q showed good psychometric and discriminant features for assessing the neuropathic component in chronic pain patients. We hope that this newly validated KPD‐Q will be recognized in Korea as a credible tool for detection of NeP and thus may be used in further international clinical research.
The effects of respiratory sinus arrhythmia on anger reactivity and persistence in major depression
Authors: Ellis Alissa J. , Shumake Jason , Beevers Christopher G. 
Published: July 2016

AbstractThe experience of anger during a depressive episode has recently been identified as a poor prognostic indicator of illness course. Given the clinical implications of anger in major depressive disorder (MDD), understanding the mechanisms involved in anger reactivity and persistence is critical for improved intervention. Biological processes involved in emotion regulation during stress, such as respiratory sinus arrhythmia (RSA), may play a role in maintaining negative moods. Clinically depressed (MDD; n = 49) and nondepressed (non‐MDD; n = 50) individuals were challenged with a stressful computer task shown to increase anger, while RSA (high frequency range 0.15–0.4 Hz) was collected. RSA predicted future anger, but was unrelated to current anger. That is, across participants, low baseline RSA predicted anger reactivity during the task, and in depressed individuals, those with low RSA during the task had a greater likelihood of anger persistence during a recovery period. These results suggest that low RSA may be a psychophysiological process involved in anger regulation in depression. Low RSA may contribute to sustained illness course by diminishing the repair of angry moods.
Dissecting the U, M, S and C genomes of wild relatives of bread wheat (Aegilops spp.) into chromosomes and exploring their synteny with wheat
Authors: Molnár István , Vrána Jan , Burešová Veronika , Cápal Petr , Farkas András , Darkó Éva , Cseh András , Kubaláková Marie , Molnár‐Láng Márta , Doležel Jaroslav 
Published: July 2016

SummaryGoat grasses (Aegilops spp.) contributed to the evolution of bread wheat and are important sources of genes and alleles for modern wheat improvement. However, their use in alien introgression breeding is hindered by poor knowledge of their genome structure and a lack of molecular tools. The analysis of large and complex genomes may be simplified by dissecting them into single chromosomes via flow cytometric sorting. In some species this is not possible due to similarities in relative DNA content among chromosomes within a karyotype. This work describes the distribution of GAA and ACG microsatellite repeats on chromosomes of the U, M, S and C genomes of Aegilops, and the use of microsatellite probes to label the chromosomes in suspension by fluorescence in situ hybridization (FISHIS). Bivariate flow cytometric analysis of chromosome DAPI fluorescence and fluorescence of FITC‐labelled microsatellites made it possible to discriminate all chromosomes and sort them with negligible contamination by other chromosomes. DNA of purified chromosomes was used as a template for polymerase chain reation (PCR) using Conserved Orthologous Set (COS) markers with known positions on wheat A, B and D genomes. Wheat–Aegilops macrosyntenic comparisons using COS markers revealed significant rearrangements in the U and C genomes, while the M and S genomes exhibited structure similar to wheat. Purified chromosome fractions provided an attractive resource to investigate the structure and evolution of the Aegilops genomes, and the COS markers assigned to Aegilops chromosomes will facilitate alien gene introgression into wheat.
Relationship between transfusion volume and outcomes in children undergoing noncardiac surgery
Authors: Goobie Susan M. , DiNardo James A. , Faraoni David 
Published: July 2016

BACKGROUNDThe objective of this study was to assess the relationship between the volume of red blood cells (RBCs) transfused and outcomes in children undergoing noncardiac surgery.STUDY DESIGN AND METHODSChildren undergoing noncardiac surgery recorded in the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) pediatric databases were included. Outcomes included 30‐day mortality and the incidence of major postoperative complications. Children who received RBC transfusions were further classified into four subgroups based on the volume transfused. We used multivariable logistic regression analysis and propensity‐matched analysis to match each child who received a transfusion with a nontransfused control and to compare the incidences of 30‐day mortality and adverse postoperative outcomes.RESULTSAfter propensity‐matched analysis, there were 4496 children in the group that received transfusion volumes from 1 to 19 mL/kg, 1557 in the group that received volumes from 20 to 39 mL/kg, 506 in the group that received from 40 to 59 mL/kg, and 412 in the group that received ≥60 mL/kg. Children who received RBC transfusion volumes from 40 to 59 mL/kg and ≥60 mL/kg had an increased risk for 30‐day mortality of 7.3% versus 1.4% (p < 0.001) and 11.2% versus 2.9% (p = 0.005), respectively, compared with their matched controls. No statistical difference was reported for children who were exposed to transfusion volumes from 20 to 39 mL/kg (3.3% vs 1.3%; p = 0.021), or from 1 to 19 mL/kg (1.4% vs. 1.2%; p = 0.691). Although no effect was observed on the incidence of postoperative renal failure or wound complications, RBC transfusions were associated with an increased incidence of postoperative infection when the volume transfused exceeded 20 mL/kg.CONCLUSIONSRBC transfusion is associated with an increased incidence of 30‐day mortality and postoperative infections in children undergoing noncardiac surgery, and there is a correlation between the volume of red blood cells transfused and the incidences of adverse outcomes. Potential associations related to the reason to transfuse, the cause of the bleeding, or the actual blood products themselves need to be studied in further prospective trials.
Canine acute leukaemia: 50 cases (1989–2014)
Authors: Bennett A. L. , Williams L. E. , Ferguson M. W. , Hauck M. L. , Suter S. E. , Lanier C. B. , Hess P. R. 
Published: July 2016

AbstractAcute leukaemia (AL) is a bone marrow malignancy of hematopoietic progenitors that historically is poorly responsive to treatment. With the widespread adoption of dose‐intense chemotherapy, more human patients attain long‐term survivals, but whether comparable progress has been made in canineALis unknown. To investigate this question, medical records from three academic veterinary hospitals were reviewed. Fifty dogs met the criteria forAL, having excess circulating or marrow blasts, a major cytopenia(s), and no substantial lymphadenopathy. Thirty‐six dogs received cytotoxic chemotherapy; 23 achieved a complete or partial response for a median of 56 days (range, 9–218). With failure or relapse, 14 dogs were rescued. Median survival with treatment was poor at 55 days (range, 1–300). Untreated (n = 6) and palliatively‐treated (n = 8) dogs lived a median of 7.5 days. Most dogs developed chemoresistance within weeks of initiating treatment, and consequently, survival times forALremain disappointingly short.
Activation of autonomic thermoeffectors preceding the decision to behaviourally thermoregulate in resting humans
Authors: Schlader Zachary J. , Coleman Gregory L. , Sackett James R. , Sarker Suman , Chapman Christopher L. , Johnson Blair D. 
Published: July 2016

New Findings
What is the central question of this study?
Do increases in metabolic heat production and sweat rate precede the initiation of thermoregulatory behaviour in resting humans exposed to cool and warm environments?
What is the main finding and its importance?
Thermoregulatory behaviour at rest in cool and warm environments is preceded by changes in vasomotor tone in glabrous and non‐glabrous skin, but not by acute increases in metabolic heat production or sweat rate. These findings suggest that sweating and shivering are not obligatory for thermal behaviour to be initiated in humans.
We tested the hypothesis that acute increases in metabolic heat production and sweating precede the initiation of thermoregulatory behaviour in resting humans exposed to cool and warm environments. Twelve healthy young subjects passively moved between 17 and 40°C rooms when they felt ‘too cool’ (C→W) or ‘too warm’ (W→C). Skin and internal (intestinal) temperatures, metabolic heat production, local sweat rate (forearm and chest) and cutaneous vascular conductance (CVC; forearm and fingertip) were measured continually. Compared with pretest baseline (31.8 ± 0.3°C), skin temperature was higher at C→W (32.0 ± 0.7°C; P = 0.01) and W→C (34.5 ± 0.5°C; P < 0.01). Internal temperature did not differ (P = 0.12) between baseline (37.2 ± 0.3°C), C→W (37.2 ± 0.3°C) and W→C (37.0 ± 0.3°C). Metabolic heat production was not different from baseline (40 ± 9 W m−2) at C→W (39 ± 7 W m−2; P = 0.50). Forearm (0.06 ± 0.01 mg cm−2 min−1) and chest (0.04 ± 0.02 mg cm−2 min−1) sweat rate at W→C did not differ from baseline (forearm, 0.05 ± 0.02 mg cm−2 min−1 and chest, 0.04 ± 0.02 mg cm−2 min−1; P ≥ 0.23). Forearm CVC was not different from baseline (0.30 ± 0.21 perfusion units (PU) mmHg−1) at C→W (0.24 ± 0.11 PU mmHg−1; P = 0.17), but was higher at W→C (0.65 ± 0.33 PU mmHg−1; P < 0.01). Fingertip CVC was different from baseline (2.6 ± 2.0 PU mmHg−1) at C→W (0.70 ± 0.42 PU mmHg−1; P < 0.01) and W→C (4.49 ± 1.66 PU mmHg−1; P < 0.01). Thermoregulatory behaviour at rest in cool and warm environments is preceded by changes in vasomotor tone in glabrous and non‐glabrous skin, but not by acute increases in metabolic heat production or sweat rate.
Increasing the Energy Expenditure of Seated Activities in Older Adults with a Portable Elliptical Device
Authors: Lerma Nicholas L. , Swartz Ann M. , Rowley Taylor W. , Maeda Hotaka , Strath Scott J. 
Published: July 2016

Background:The ill-health effects of sedentary behavior are becoming well-documented, yet older adults spend 70–80% of waking hours sedentary.Purpose:To determine if a portable elliptical device increases energy expenditure (EE) while performing popular seated activities.Methods:Twenty older adults (68.1 ± 1.4 years) participated to compare the measured EE between seated rest and three randomized seated pedaling activities: computer use, reading, TV viewing. Each pedaling activity included 5-min of self-selected paced/no resistance (SSP) and externally paced/added resistance pedaling (Paced).Results:A significant increase in EE existed during SSP (+1.44 ± 0.12 kcal/min) and Paced (+2.19 ± 0.09 kcal/min) pedaling relative to Seated Rest (p < .001). EE during the Paced activities was significantly greater than all SSP activities (p <.01).Conclusion:Extrapolating these results, pedaling at a SSP for an hour while performing seated activities is equivalent to the net EE of walking 1.6 miles. Future home-based effectiveness and feasibility should be explored.
Impact of Infectious Diseases Consultation on Clinical Outcomes of Patients with Staphylococcus aureus Bacteremia in a Community Health System
Authors: Turner R. Brigg , Valcarlos Elena , Won Regina , Chang Eric , Schwartz Jacqueline 
Published: July 2016

ABSTRACT

Staphylococcus aureus
bacteremia (SAB) causes high rates of morbidity and death. Several studies in academic health settings have demonstrated that consultations from infectious diseases specialists improve the quality of care and clinical outcomes for SAB. Few data that describe the impact in resource-limited settings such as community hospitals are available. This retrospective cohort study evaluated the adherence to quality-of-care indicators and the clinical outcomes for SAB in a five-hospital community health system (range of 95 to 272 available beds per hospital), for patients with versus without infectious diseases consultation (IDC). IDC was provided if requested by the attending physician. The primary outcome was the incidence of treatment failure, defined as 30-day in-hospital death or 90-day SAB recurrence. Other outcomes included adherence to quality-of-care indicators. A total of 473 adult patients with SAB were included, with 369 (78%) receiving IDC. We identified substantial differences in baseline characteristics between the IDC group and the no-IDC group, including greater incidences of complicated bacteremia and intravenous drug users in the IDC group, with similar rates of severe illness (measured by Pitt bacteremia scores). Adherence to quality-of-care indicators was greater for patients with IDC (
P
< 0.001). After adjustment for other predicting variables, IDC was associated with a lower rate of treatment failure (adjusted odds ratio, 0.42 [95% confidence interval, 0.20 to 0.86];
P
= 0.018). IDC provided better quality of care and better clinical outcomes for patients with SAB who were treated at small, resource-limited, community hospitals.
Nonprescription Antimicrobial Use in a Primary Care Population in the United States
Authors: Zoorob Roger , Grigoryan Larissa , Nash Susan , Trautner Barbara W. 
Published: July 2016

ABSTRACT
Community antimicrobial resistance rates are high in communities with frequent use of nonprescription antibiotics. Studies addressing nonprescription antibiotic use in the United States have been restricted to Latin American immigrants. We estimated the prevalence of nonprescription antibiotic use in the previous 12 months as well as intended use (intention to use antibiotics without a prescription) and storage of antibiotics and examined patient characteristics associated with nonprescription use in a random sample of adults. We selected private and public primary care clinics that serve ethnically and socioeconomically diverse patients. Within the clinics, we used race/ethnicity-stratified systematic random sampling to choose a random sample of primary care patients. We used a self-administered standardized questionnaire on antibiotic use. Multivariate regression analysis was used to identify independent predictors of nonprescription use. The response rate was 94%. Of 400 respondents, 20 (5%) reported nonprescription use of systemic antibiotics in the last 12 months, 102 (25.4%) reported intended use, and 57 (14.2%) stored antibiotics at home. These rates were similar across race/ethnicity groups. Sources of antibiotics used without prescriptions or stored for future use were stores or pharmacies in the United States, “leftover” antibiotics from previous prescriptions, antibiotics obtained abroad, or antibiotics obtained from a relative or friend. Respiratory symptoms were common reasons for the use of nonprescription antibiotics. In multivariate analyses, public clinic patients, those with less education, and younger patients were more likely to endorse intended use. The problem of nonprescription use is not confined to Latino communities. Community antimicrobial stewardship must include a focus on nonprescription antibiotics.