bluuebunny/crossref_metadata_2025_split huggingface dataset:
Testing Elevated Protease Activity: Prospective Analysis of 160 Wounds
Authors: Lockmann Anike , Schill Tillmann , Hartmann Franziska , Grönemeyer Lisa-Lena , Holzkamp Ricarda , Schön Michael P. , Thoms Kai-Martin 
Published: January 2018

ABSTRACT

OBJECTIVE:
Given that local elevated protease activity (EPA) has been implicated in impaired wound healing, a prospective single-center study was conducted to assess protease activity in various wound types.

METHODS:
Protease activity was determined using an easy-to-use test system (Woundchek Protease Status Test Kit; Systagenix, Gatwick, United Kingdom) in 160 wounds in 143 patients. The assay detects the combined activity of inflammatory proteases, mainly matrix metalloproteinases 8 and 9 and human neutrophil elastase.

RESULTS:
Local EPA was detected in 29 of 153 validly tested wounds (18.95%). No difference was detected between acute and chronic wounds, regardless of associated or causative conditions, with the sole exception of surgical wounds. Surgical wounds showed EPA significantly less frequently than nonsurgical wounds. Among nonsurgical wounds, EPA was detected more frequently in acute compared with chronic wounds. Wounds with signs of unimpeded healing (granulation or epithelialization) showed EPA less often than wounds covered with necrotic tissue or a fibrin layer. However, 14% of wounds with epithelialization or granulation exhibited EPA potentially impeding wound healing. Wounds treated with moisture-retentive wound dressings showed EPA significantly less frequently compared with wounds bandaged with dressings with less moisture-retentive properties. Remarkably, none of the wounds treated with collagen/oxidized regenerated cellulose/silver, which is a protease-modulating dressing, showed EPA.

CONCLUSIONS:
To the study authors’ knowledge, this is the largest study assessing EPA in various wound types. The convenient applicability of the test system provides a basis for future studies assessing the pathophysiologic relevance of EPA. In some unsuspicious wounds, early detection of EPA might precede impaired healing and prompt protease-modulating treatment before failure to heal becomes apparent.
Avstick: An Intravenous Catheter Insertion Simulator for Use with Standardized Patients
Authors: Devenny Andrew , Lord Danielle , Matthews Joshua , Tuhacek Julia , Vitlip Jennifer , Zhang Mingxu , Bucha Amy C. , Wang Liyun , Buckley Jenni M. , Cowperthwait Amy 
Published: January 2018

Abstract
An overwhelming majority of hospitalized patients undergo intravenous (IV) catheter insertion in order to receive hydration and necessary medication. Current IV insertion training techniques include manikins that are unable to react or give feedback to the trainee. The Avstick® is a realistic training device that can be worn by an actor, allowing a nurse trainee to perform an IV catheter insertion on a live patient without causing the person harm. The purpose of this study is to demonstrate the effectiveness of the Avstick in nursing education to increase nurse-patient communication and trainee self-efficacy.
Virtual Surgical Planning: The Pearls and Pitfalls
Authors: Efanov Johnny I. , Roy Andrée-Anne , Huang Ke N. , Borsuk Daniel E. 
Published: January 2018

Objective:
Over the past few years, virtual surgical planning (VSP) has evolved into a useful tool for the craniofacial surgeon. Virtual planning and computer-aided design and manufacturing (CAD/CAM) may assist in orthognathic, cranio-orbital, traumatic, and microsurgery of the craniofacial skeleton. Despite its increasing popularity, little emphasis has been placed on the learning curve.

Methods:
A retrospective analysis of consecutive virtual surgeries was done from July 2012 to October 2016 at the University of Montreal Teaching Hospitals. Orthognathic surgeries and free vascularized bone flap surgeries were included in the analysis.

Results:
Fifty-four virtual surgeries were done in the time period analyzed. Forty-six orthognathic surgeries and 8 free bone transfers were done. An analysis of errors was done. Eighty-five percentage of the orthognathic virtual plans were adhered to completely, 4% of the plans were abandoned, and 11% were partially adhered to. Seventy-five percentage of the virtual surgeries for free tissue transfers were adhered to, whereas 25% were partially adhered to. The reasons for abandoning the plans were (1) poor communication between surgeon and engineer, (2) poor appreciation for condyle placement on preoperative scans, (3) soft-tissue impedance to bony movement, (4) rapid tumor progression, (5) poor preoperative assessment of anatomy.

Conclusion:
Virtual surgical planning is a useful tool for craniofacial surgery but has inherent issues that the surgeon must be aware of. With time and experience, these surgical plans can be used as powerful adjuvants to good clinical judgement.
Novel Bronchoscopic Management of Airway Bleeding With Absorbable Gelatin and Thrombin Slurry
Authors: Peralta A. Rolando , Chawla Mohit , Lee Robert P. 
Published: January 2018

Background:
Airway bleeding, either spontaneous or as a result of bronchoscopy, is associated with significant morbidity and mortality. Multiple bronchoscopic techniques are available to achieve complete hemostasis or as a bridge to definitive therapies.

Methods:
We report our experience on the feasibility of endobronchial instillation of an absorbable gelatin and thrombin slurry (GTS) for the treatment of spontaneous hemoptysis and procedure-related bleeding.

Results:
We identified 13 cases in which GTS was used for endobronchial hemostasis when standard bronchoscopic measures like cold saline, epinephrine, and in some cases balloon occlusion were not successful. GTS was delivered through the working channel of the bronchoscope in 10 cases and through the distal port of a bronchial blocker in the remaining 3 cases. Median age was 69 years (range, 52 to 79 y). Eight cases corresponded to spontaneous hemoptysis and 5 cases to diagnostic or therapeutic procedures. Bleeding was considered severe in 9 (70%) cases. All but 1 case were associated with malignancy. Hemostasis was achieved in 10 (77%) cases by using standard measures in addition to GTS. No patient adverse events at 30 days or damage to the equipment were identified.

Conclusions:
Bronchoscopic instillation of an absorbable GTS is feasible and may be used in cases of spontaneous or procedure-related bleeding in addition to conventional measures. It can be delivered through the working channel of the bronchoscope or through the distal port available in some bronchial blockers. Controlled studies are necessary to determine the safety and efficacy of this novel technique.
Use of Point-of-Care Ultrasound to Guide Pediatric Gastrostomy Tube Replacement in the Emergency Department
Authors: Myatt Toby C. , Medak Anthony J. , Lam Samuel H.F. 
Published: January 2018

Abstract
The presentation of a pediatric patient to the emergency department for a malfunctioning or dislodged gastrostomy tube (G-tube) is not uncommon. As such, these tubes are often replaced at the bedside. Improper placement can result in a number of complications, including perforation, fistula tract formation, peritonitis, and sepsis. The current criterion standard method to confirm proper G-tube placement is contrast-enhanced radiography. However, point-of-care ultrasound may be an alternative method to guide and confirm pediatric G-tube replacement in the emergency department. We report a series of cases on this novel point-of-care ultrasound application.
Video Recordings to Analyze Preventable Management Errors in Pediatric Resuscitation Bay
Authors: Borns Julia , Ersch Jörg , Dobrovoljac Milana , Staubli Georg , Brotschi Barbara 
Published: January 2018

Objective
In treating patients of different ages and diseases in the pediatric resuscitation bay, management errors are common. This study aimed to analyze the adherence to advanced trauma life support and pediatric advanced life support guidelines and identify management errors in the pediatric resuscitation bay by using video recordings.

Methods
Video recording of all patients admitted to the pediatric resuscitation bay at University Children's Hospital Zurich during a 13-month period was performed. Treatment adherence to advanced trauma life support guidelines and pediatric advanced life support guidelines and errors per patient were identified.

Results
During the study period, 128 patients were recorded (65.6% with surgical, 34.4% with medical diseases). The most common causes for admission were traumatic brain injury (21.1%), multiple trauma (20.3%), and seizures (14.8%). There was a statistically significant correlation between accurate handover from emergency medical service to hospital physicians and adherence to airway, breathing, circulation, and disability sequence (correlation coefficient [CC], 0.205; P = 0.021), existence of a defined team leader and adherence to airway, breathing, circulation, and disability sequence (CC, 0.856; P < 0.001), and accurate hand over and existence of a defined team leader (CC, 0.186; P = 0.037). Unexpected errors were revealed. Cervical spine examination/stabilization was omitted in 40% of admitted surgical patients, even in 20% of patients with an injury of spine/limbs.

Conclusions
Video recording is a useful tool to evaluate patient management in the pediatric resuscitation bay. Analyzing errors of missing the adherence to the guidelines helps to pay attention and focus on specific items to improve patient care.
Trends in Severe Pediatric Emergency Conditions in a National Cohort, 2008 to 2014
Authors: Michelson Kenneth A. , Hudgins Joel D. , Burke Laura G. , Lyons Todd W. , Monuteaux Michael C. , Bachur Richard G. , Finkelstein Jonathan A. 
Published: January 2018

Objective
The objective of this study was to determine the incidence and recent trends in serious pediatric emergency conditions.

Methods
We conducted a cross-sectional study of the Nationwide Emergency Department Sample from 2008 through 2014, and included patients with age below 18 years with a serious condition, defined as each diagnosis group in the diagnosis grouping system with a severity classification system score of 5. We calculated national incidences for each serious condition using annualized weighted condition counts divided by annual United States census child population counts. We determined the highest-incidence serious conditions over the study period and calculated percentage changes between 2008 and 2014 for each serious condition using a Poisson model.

Results
The 2008 incidence of serious conditions across the national child population was 1721 visits per million person-years (95% confidence interval, 1485–1957). This incidence increased to 2020 visits per million person-years (95% confidence interval, 1661–2379) in 2014. The most common serious conditions were serious respiratory diseases, septicemia, and serious neurologic diseases. Anaphylaxis was the condition with the largest change, increasing by 147%, from 101 to 249 visits per million person-years.

Conclusions
The most common serious condition in children presenting to United States emergency departments is serious respiratory disease. Anaphylaxis is the fastest increasing serious condition. Additional research attention to these diagnoses is warranted.
Pediatric Pelvic Fractures and Differences Compared With the Adult Population
Authors: de la Calva Carolina , Jover Nadia , Alonso Jaime , Salom Marta 
Published: January 2018

Introduction
Although pelvic fractures in children are rare, because of anatomical differences between an adult's skeleton and a child's skeleton, these lesions in the pediatric population have specific characteristics that need to be borne in mind when dealing with them.

Materials and Methods
A retrospective chart review was performed on the pelvic fractures in skeletally immature patients treated in our hospital in the last 20 years.

Results
Eighty-one pelvic fractures in children were treated between 1993 and 2013. The mean age was 9.98 years, with 61.7%(50/81) boys and 38.2% (31/81) girls. A traffic accident was the main injury mechanism (74%, 60/81), and height fall was in second place (16%, 13/81). Following Tile pelvic fracture classification, type A2 was the most frequent (58.04%, 47/81); and following Torode and Zieg classification, type IIIA (45.68%, 37/81).
Associated injuries were present in 77.8% (63/81) of the patients; fractures of other bones and head trauma were the most frequent. An acetabular fracture was present in 13.5% (11/81) of the patients.
Nonsurgical treatment was chosen for all the pelvic fractures except in 4 patients, which required surgical management for their pelvic injuries. Blood transfusion was required in 32% (26/81) of the patients, and arterial embolization was not needed in any case. Furthermore, 11.1% (9/81) required a stay in the pediatric care unit, and the death rate was 8.64% (7/81).
The mean length of hospital stay was 12.4 days.

Conclusions
Because of the specific characteristics of pelvic fractures in children, fracture patterns are less severe than those of adults, but the injury mechanisms are high-energy traumas. The rate of associated injuries is very high, and a multidisciplinary management in pediatric trauma centers is needed to treat these patients.
Synergistic Impact of Training Followed by On-Site Support on HIV Clinical Practice: A Mixed-Design Study in Uganda With Pre/Post and Cluster-Randomized Trial Components
Authors: Burnett Sarah M. , Mubiru Norbert , Imani Peace , Mbonye Martin K. , Fisher Leigh , Colebunders Robert , Manabe Yukari C. , Weaver Marcia R. 
Published: January 2018

Background:
Task shifting can expand antiretroviral therapy access, but little is known about effective approaches to improve clinical practice among midlevel practitioners (MLPs) such as clinical officers, nurses, and midwives. The Integrated Infectious Diseases Capacity Building Evaluation compared training alone with training combined with on-site support (OSS).

Methods:
Two MLPs each from 36 health facilities attended the 5-week Integrated Management of Infectious Disease training. After training, 18 facilities randomly assigned to arm A received OSS for 9 months, whereas 18 arm B facilities did not. Clinical faculty assessed MLP HIV clinical practice on 6 tasks: history taking, physical examination, laboratory investigations, diagnosis, treatment, and patient education. We analyzed the effect of training alone and training combined with OSS as the pre/post change within each arm. We analyzed the incremental effect of OSS with a difference-in-difference analysis that compared changes between arms.

Results:
Training alone and training combined with OSS significantly improved clinical practice in patient history taking (13% and 24% increase, respectively), physical examination (54% and 71%), laboratory investigations (32% and 20%), and diagnosis (31% and 51%). Combined training and OSS also improved patient education significantly (72% increase). Effect sizes for training combined with OSS were larger than for training alone except for laboratory investigations, and the effects were robust in sensitivity analyses. The incremental effect of OSS on diagnosis was significant [adjusted relative risk = 1.23; 95% confidence interval = 1.00 to 1.50].

Conclusions:
Combined training and OSS improved MLP HIV clinical practice over training alone and can contribute to continued expansion of access to antiretroviral therapy.
A New Robot-assisted Billroth-I Reconstruction: Details of the Technique and Early Results
Authors: Ceccarelli Graziano , Marano Luigi , Codacci-Pisanelli Massimo , Andolfi Enrico , Biancafarina Alessia , Fabozzi Massimiliano , Caruso Stefano , Patriti Alberto 
Published: January 2018

Background:
Laparoscopic surgery for gastric tumor is considered a demanding procedure because of lymph node dissection and reconstruction. Billroth-I (B-I) reconstruction after laparoscopic distal gastrectomy is commonly performed extracorporeally because of the complexity of an intracorporeal procedure. Robotic surgery overcomes some limitations of laparoscopy, allowing to reproduce the basic maneuvers of open surgery. We describe a new technique to perform robotic B-I anastomosis.

Methods:
Between January 2012 and February 2015, 5 patients underwent distal gastrectomy with intracorporeal B-I-stapled anastomosis. Patient demographics, tumor characteristics, histopathologic features, and perioperative data were analyzed.

Results:
Median operative time was 170 minutes (145 to 180 min). There were no conversions. Contrast swallow was routinely performed on the third postoperative day. Median postoperative hospitalization was 7 days (range: 6 to 8). No major complications or mortality were observed.

Conclusions:
Robotic distal gastrectomy with intracorporeal B-I anastomosis is a safe and promising technique in selected cases of gastric tumors.
Coevolution of male and female mate choice can destabilize reproductive isolation
Authors: Aubier Thomas G. , Kokko Hanna , Joron Mathieu 
Published: January 2018

AbstractSexual interactions play an important role in the evolution of reproductive isolation, with important consequences for speciation. Theoretical studies have focused on the evolution of mate preferences in each sex separately. However, mounting empirical evidence suggests that premating isolation often involves mutual mate choice. Here, using a population genetic model, we investigate how female and male mate choice coevolve under a phenotype matching rule and how this affects reproductive isolation. We show that the evolution of female preferences increases the mating success of males with reciprocal preferences, favouring mutual mate choice. However, the evolution of male preferences weakens indirect selection on female preferences and, with weak genetic drift, the coevolution of female and male mate choice leads to periodic episodes of random mating with increased hybridization (deterministic ‘preference cycling’ triggered by stochasticity). Thus, counterintuitively, the process of establishing premating isolation proves rather fragile if both male and female mate choice contribute to assortative mating.
The Delirium and Population Health Informatics Cohort study protocol: ascertaining the determinants and outcomes from delirium in a whole population
Authors: Davis Daniel , Richardson Sarah , Hornby Joanne , Bowden Helen , Hoffmann Katrin , Weston-Clarke Maryse , Green Fenella , Chaturvedi Nishi , Hughes Alun , Kuh Diana , Sampson Elizabeth , Mizoguchi Ruth , Cheah Khai Lee , Romain Melanie , Sinha Abhi , Jenkin Rodric , Brayne Carol , MacLullich Alasdair 
Published: January 2018

AbstractBackgroundDelirium affects 25% of older inpatients and is associated with long-term cognitive impairment and future dementia. However, no population studies have systematically ascertained cognitive function before, cognitive deficits during, and cognitive impairment after delirium. Therefore, there is a need to address the following question: does delirium, and its features (including severity, duration, and presumed aetiologies), predict long-term cognitive impairment, independent of cognitive impairment at baseline?MethodsThe Delirium and Population Health Informatics Cohort (DELPHIC) study is an observational population-based cohort study based in the London Borough of Camden. It is recruiting 2000 individuals aged ≥70 years and prospectively following them for two years, including daily ascertainment of all inpatient episodes for delirium. Daily inpatient assessments include the Memorial Delirium Assessment Scale, the Observational Scale for Level of Arousal, and the Hierarchical Assessment of Balance and Mobility. Data on delirium aetiology is also collected. The primary outcome is the change in the modified Telephone Interview for Cognitive Status at two years.DiscussionDELPHIC is the first population sample to assess older persons before, during and after hospitalisation. The cumulative incidence of delirium in the general population aged ≥70 will be described. DELPHIC offers the opportunity to quantify the impact of delirium on cognitive and functional outcomes. Overall, DELPHIC will provide a real-time public health observatory whereby information from primary, secondary, intermediate and social care can be integrated to understand how acute illness is linked to health and social care outcomes.
Timing of Cyclic Estradiol Treatment Differentially Affects Cognition in Aged Female Rhesus Monkeys
Authors: Baxter Mark G. , Santistevan Anthony C. , Bliss-Moreau Eliza , Morrison John H. 
Published: January 2018

AbstractSome evidence suggests that there may be a limited "window of opportunity" for beneficial effects of hormone therapy on physiology after menopause in women. We tested, in aged, surgically menopausal (ovariectomized) rhesus monkeys, whether the timing of cyclic estradiol (E2) treatment impacted its effect on cognitive function. Monkeys were assigned to one of four treatment conditions after ovariectomy: either vehicle or E2 treatment for the duration of the protocol, vehicle for the first 2 years of the protocol followed by E2 for the remainder (delayed treatment), or E2 for the first year of the protocol followed by vehicle for the remainder (withdrawn treatment). Delayed treatment addressed the hypothesis that E2 treatment initiated more than 2 years after ovariectomy would have a reduced effect on cognitive function. Withdrawn treatment mirrors current clinical advice to women to use hormone therapy in the initial post-menopausal period then discontinue it. Two periods of cognitive testing assessed treatment effects on cognition over time. E2 treatment predominantly affected a prefrontal cortex-dependent test of spatiotemporal working memory (delayed response). Monkeys with delayed E2 treatment improved in delayed response performance over time, whereas vehicle-treated monkeys declined. Monkeys with withdrawn E2 treatment maintained their performance across assessments, as did monkeys treated with E2 across the entire protocol. These findings suggest that a "window of opportunity" for hormone treatment after cessation of ovarian function, if present in nonhuman primates, lasts longer than 2 years. It also supports the notion that beneficial effects of hormone therapy may persist after discontinuation of treatment.
Astrocyte networks and intercellular calcium propagation
Authors: Lallouette Jules , De Pittà Maurizio , Berry Hugues 
Published: January 2018

AbstractAstrocytes organize in complex networks through connections by gap junction channels that are regulated by extra‐ and intracellular signals. Calcium signals generated in individual cells, can propagate across these networks in the form of intercellular calcium waves, mediated by diffusion of second messengers molecules such as inositol 1,4,5-trisphosphate. The mechanisms underpinning the large variety of spatiotemporal patterns of propagation of astrocytic calcium waves however remain a matter of investigation. In the last decade, awareness has grown on the morphological diversity of astrocytes as well as their connections in networks, which seem dependent on the brain area, developmental stage, and the ultrastructure of the associated neuropile. It is speculated that this diversity underpins an equal functional variety but the current experimental techniques are limited in supporting this hypothesis because they do not allow to resolve the exact connectivity of astrocyte networks in the brain. With this aim we present a general framework to model intercellular calcium wave propagation in astrocyte networks and use it to specifically investigate how different network topologies could influence shape, frequency and propagation of these waves.