bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transpars Microscopic Approach for the Treatment of Purely Foraminal Herniated Lumbar Disc
Authors: De Bonis Pasquale , Mongardi Lorenzo , Pompucci Angelo , Ricciardi Luca , Cavallo Michele Alessandro , Farneti Marco , Lapparelli Marcello , Capone Gennaro , Altruda Carmela , Schivalocchi Roberta , Campioni Paolo , Ghisellini Giulia , Trapella Giorgio 
Published: August 2016

Study Design.
This is a prospective two-center study.

Objective.
The aim of this study was to assess the safety and efficacy of treating patients with lumbar foraminal disc herniations via a microscopic transpars approach, with a clinical and radiological follow-up evaluation.

Summary of Background Data.
Purely foraminal lumbar disc herniations comprise about 5% of all lumbar herniated intervertebral discs. Operative management can be technically difficult, and the optimum surgical treatment remains controversial.

Methods.
From January 2012 to January 2015, 47 patients were prospectively recruited. Patients were followed-up as outpatients at 1 week after discharge, then at 1, 6, and 12 months.
A clinical multiparametric evaluation of patients including numeric rating scale (NRS), drugs intake, Macnab criteria, and working days lost was used.
Postoperative dynamic x-rays (flexion, extension) were performed in all cases 12 months after surgery.

Results.
No surgery-related complications occurred.
Among the 35 patients who were not retired at the time of the study, 29 patients returned to work and to normal daily activities within 60 days after surgery.
Pain evaluation at discharge showed a significant improvement of NRS score, from 8.93 to 1.45 at 12 months. Root palsy significantly improved in all cases already at 1-month follow-up. Drugs intake analysis showed that at 6-month follow-up, no patients used steroids, or opioids, 17 patients used non-steroidal anti-inflammatory drugs when needed, and 29 patients (61.7%) used no drugs for pain relief. No significant variations occurred at 12-month-follow-up.
At 12-month follow-up, excellent or good outcome (following Macnab criteria) was achieved in 36 (76.6%) and 8 (17%) patients, respectively.
There were no cases of spinal instability at 12-month radiological evaluation.
No recurrence occurred at follow-up.

Conclusion.
Transpars microscopic approach is effective and safe for the treatment of FLDH, but larger studies are needed.

Level of Evidence: 3
Pediatric Sepsis Biomarker Risk Model-II: Redefining the Pediatric Sepsis Biomarker Risk Model With Septic Shock Phenotype
Authors: Wong Hector R. , Cvijanovich Natalie Z. , Anas Nick , Allen Geoffrey L. , Thomas Neal J. , Bigham Michael T. , Weiss Scott L. , Fitzgerald Julie , Checchia Paul A. , Meyer Keith , Quasney Michael , Hall Mark , Gedeit Rainer , Freishtat Robert J. , Nowak Jeffrey , Raj Shekhar S. , Gertz Shira , Howard Kelli , Harmon Kelli , Lahni Patrick , Frank Erin , Hart Kimberly W. , Nguyen Trung C. , Lindsell Christopher J. 
Published: August 2016

Objective:
The Pediatric Sepsis Biomarker Risk Model (PERSEVERE), a pediatric sepsis risk model, uses biomarkers to estimate baseline mortality risk for pediatric septic shock. It is unknown how PERSEVERE performs within distinct septic shock phenotypes. We tested PERSEVERE in children with septic shock and thrombocytopenia-associated multiple organ failure (TAMOF), and in those without new onset thrombocytopenia but with multiple organ failure (MOF).

Design:
PERSEVERE-based mortality risk was generated for each study subject (n = 660). A priori, we determined that if PERSEVERE did not perform well in both the TAMOF and the MOF cohorts, we would revise PERSEVERE to incorporate admission platelet counts.

Setting:
Multiple PICUs in the United States.

Interventions:
Standard care.

Measurements and Main Results:
PERSEVERE performed well in the TAMOF cohort (areas under the receiver operating characteristic curves [AUC], 0.84 [95% CI, 0.77–0.90]), but less well in the MOF cohort (AUC, 0.71 [0.61–0.80]). PERSEVERE was revised using 424 subjects previously reported in the derivation phase. PERSEVERE-II had an AUC of 0.89 (0.85–0.93) and performed equally well across TAMOF and MOF cohorts. PERSEVERE-II performed well when tested in 236 newly enrolled subjects. Sample size calculations for a clinical trial testing the efficacy of plasma exchange for children with septic shock and TAMOF indicated PERSEVERE-II–based stratification could substantially reduce the number of patients necessary, when compared with no stratification.

Conclusions:
Testing PERSEVERE in the context of septic shock phenotypes prompted a revision incorporating platelet count. PERSEVERE-II performs well upon testing, independent of TAMOF or MOF status. PERSEVERE-II could potentially serve as a prognostic enrichment tool.
Lactated Ringer Is Associated With Reduced Mortality and Less Acute Kidney Injury in Critically Ill Patients: A Retrospective Cohort Analysis*
Authors: Zampieri Fernando G. , Ranzani Otavio T. , Azevedo Luciano Cesar Pontes , Martins Izanio D. S. , Kellum John A. , Libório Alexandre B. 
Published: August 2016

Objectives:
To assess the impact of the percentage of fluid infused as Lactated Ringer (%LR) during the first 2 days of ICU admission in hospital mortality and occurrence of acute kidney injury.

Design:
Retrospective cohort.

Setting:
Analysis of a large public database (Multiparameter Intelligent Monitoring in Intensive Care-II).

Patients:
Adult patients with at least 2 days of ICU stay, admission creatinine lower than 5 mg/dL, and that received at least 500 mL of fluid in the first 48 hours.

Interventions:
None.

Measurement and Main Results:
10,249 patients were included in mortality analysis and 8,085 were included in the acute kidney injury analysis. For acute kidney injury analysis, we excluded patients achieving acute kidney injury criteria in the first 2 days of ICU stay. Acute kidney injury was defined as stage 2/3 Kidney Disease: Improving Global Outcomes creatinine criteria and was assessed from days 3–7. The effects of %LR in both outcomes were assessed through logistic regression controlling for confounders. Principal component analysis was applied to assess the effect of volume of each fluid type on mortality. Higher %LR was associated with lower mortality and less acute kidney injury. %LR effect increased with total volume of fluid infused. For patients in the fourth quartile of fluid volume (> 7 L), the odds ratio for mortality for %LR equal to 75% versus %LR equal to 25% was 0.50 (95% CI, 0.32–0.79; p < 0.001). Principal component analysis suggested that volume of Lactated Ringer and 0.9% saline infused had opposite effects in outcome, favoring Lactated Ringer.

Conclusions:
Higher %LR was associated with reduced hospital mortality and with less acute kidney injury from days 3–7 after ICU admission. The association between %LR and mortality was influenced by the total volume of fluids infused.
Atrial Fibrillation Following Out-of-Hospital Cardiac Arrest and Targeted Temperature Management—Are We Giving It the Attention it Deserves?*
Authors: Thomsen Jakob Hartvig , Hassager Christian , Erlinge David , Nielsen Niklas , Horn Janneke , Hovdenes Jan , Bro-Jeppesen John , Wanscher Michael , Pehrson Steen , Køber Lars , Kjaergaard Jesper 
Published: August 2016

Objectives:
Atrial fibrillation has been associated with increased mortality in the general population and mixed populations of critical ill. Atrial fibrillation can also affect patients during post–cardiac arrest care. We sought to assess the prognostic implications of atrial fibrillation following out-of-hospital cardiac arrest, including relation to the level of targeted temperature management.

Design:
A post hoc analysis of a prospective randomized trial.

Setting:
Thirty-six ICUs.

Patients:
We included 897 (96%) of the 939 comatose out-of-hospital cardiac arrest survivors from the targeted temperature management trial (year, 2010–2013) with data on heart rhythm on day 2.

Interventions:
Targeted temperature management at 33°C or 36°C.

Measurements and Main Results:
Endpoints included cumulative proportion of atrial fibrillation following out-of-hospital cardiac arrest and 180-day all-cause mortality and specific death causes stratified by atrial fibrillation. Atrial fibrillation on day 2 was used as primary endpoint analyses to exclude effects of short-term atrial fibrillation related to resuscitation and initial management. The cumulative proportions of atrial fibrillation were 15% and 11% on days 1 and 2, respectively. Forty-three percent of patients with initial atrial fibrillation the first day were reported with sinus rhythm on day 2. No difference was found between the groups treated with targeted temperature management at 33°C and 36°C. Patients affected by atrial fibrillation had significantly higher 180-day mortality (atrial fibrillation: 66% vs no-atrial fibrillation: 43%; p
logrank < 0.0001 and unadjusted hazard ratio, 1.75 [1.35–2.30]; p < 0.0001). The association between atrial fibrillation and higher mortality remained significant (adjusted hazard ratio, 1.34 [1.01–1.79]; p < 0.05) adjusted for potential confounders. Atrial fibrillation was independently associated with increased risk of cardiovascular death and multiple-organ failure (adjusted hazard ratio, 2.07 [1.39–3.09]; p < 0.001), whereas no association with higher risk of death from cerebral causes was found.

Conclusions:
Atrial fibrillation was independently associated with higher mortality, primarily driven by cardiovascular causes and multiple-organ failure, and may thus identify a vulnerable subpopulation. Whether treatment to prevent atrial fibrillation is associated with an improved prognosis remains to be established.
Seasonal Variation in Diverticulitis
Authors: Adler Joel T. , Chang David C. , Chan Andrew T. , Faiz Omar , Maguire Lillias H. 
Published: August 2016

BACKGROUND:
Diverticulitis is a common and morbid disease with incompletely understood risk factors and pathophysiology. Geographic and, recently, seasonal trends in diverticulitis have been described in the United States.

OBJECTIVE:
The purpose of this study was to investigate and compare seasonal trends in urgent hospital admission for diverticulitis in geographically distinct populations in the northern and southern hemispheres.

DESIGN:
Inpatient, urgent admissions for diverticulitis were identified within the Dr Foster Intelligence Global Comparators Dataset, a global benchmarking collaborative.

SETTINGS:
Admissions to participating hospitals in the United Kingdom, Australia, and the United States were identified between 2008 and 2013.

PATIENTS:
A total of 18,672 urgent admissions for diverticulitis were identified among 5.5-million admissions.

MAIN OUTCOME MEASURES:
Four separate hypothesis testing methods were used to identify seasonal trends in diverticulitis admissions among international patient populations.

RESULTS:
Seasonal trends were present in all 3 countries. A summer peak was observed in both hemispheres using multiple statistical testing methods. Logistic regression analyses identified summer months as significantly associated with diverticulitis admission in all 3 countries.

LIMITATIONS:
This study is limited by restriction to inpatient admissions, reliance on administrative data, and participation of select hospitals within the database.

CONCLUSIONS:
These data suggest a shared seasonal risk factor among geographically distinct populations for diverticulitis.
Antioxidant Treatment Improves Cardiac Dysfunction in a Murine Model of Premature Aging
Authors: Hemmeryckx Bianca , Hohensinner Philipp , Swinnen Melissa , Heggermont Ward , Wojta Johann , Lijnen Henri Roger 
Published: August 2016

Abstract:
Bmal1-(brain and muscle ARNT-like protein-1) deficient (Bmal1−/−) mice prematurely age because of an increased reactive oxygen species (ROS) production. These mice also show a decline in cardiac function with age. We investigated whether an antioxidant treatment can ameliorate the declining cardiac function in prematurely aged Bmal1−/− mice. Male Bmal1−/− and wild-type (Bmal1+/+) mice were exposed for 15 weeks to a high fat and high cholesterol diet with or without the antioxidant 4-hydroxy-2,2,6,6-tetramethylpiperidin-1-oxyl (TEMPOL; 5 mmol/L; in drinking water during the last 10 weeks). Echocardiographic analysis revealed that TEMPOL treatment of Bmal1−/− mice normalized cardiac function, as evidenced by a decrease in left ventricular diastolic and systolic internal diameters, and by an increase in fractional shortening and ejection fraction. The antioxidant did not affect cardiac function in Bmal1+/+ mice. Although TEMPOL did not influence cardiac ROS levels in Bmal1−/− mice, it significantly protected Bmal1−/− cardiac telomeres from oxidation, as evidenced by a reduction in the telomere damage score (0.11 ± 0.012% vs. 0.16 ± 0.015%; P = 0.028). Thus, antioxidant treatment normalized cardiac function of Bmal1−/− mice, probably in part by scavenging ROS.
Evaluation of the New Siemens Tacrolimus Assay on the Dimension EXL Integrated Chemistry System Analyzer: Comparison With an Ultra-Performance Liquid Chromatography–Tandem Mass Spectrometry Method
Authors: Bargnoux Anne-Sophie , Sutra Thibault , Badiou Stéphanie , Kuster Nils , Dupuy Anne-Marie , Mourad Georges , Pageaux Georges-Philippe , Le Quintrec Moglie , Cristol Jean-Paul 
Published: August 2016

Background:
Many patients are maintained at the lower end of the tacrolimus (TAC) reference range (3–7 ng/mL), requiring the use of analytical methods displaying a very low limit of quantification for their follow-up. Therefore, the new Dimension TAC, based on affinity chrome-mediated immunoassay technology, was evaluated on the Dimension EXL Integrated Chemistry System (Siemens Healthcare Diagnostics Inc). The aims of this study were (1) to evaluate the analytical performances with special emphasis on sensibility at low levels of TAC, (2) to compare the results with an ultra-performance liquid chromatography–tandem mass spectrometry (UPLC/MS/MS) method.

Methods:
Analytical performance (imprecision, linearity, limit of detection, and limit of quantification) was evaluated. Comparison to UPLC/MS/MS was performed on 106 whole blood samples from 88 transplant recipients using regression analysis and Bland–Altman plot analysis.

Results:
Repeatability and within-laboratory coefficients of variation were <6% at mean TAC control levels of 3.7, 11.7, and 19.2 ng/mL. Linearity was confirmed between 1.0 and 22 ng/mL. Passing–Bablok regression analysis of Siemens TAC assay in comparison with UPLC/MS/MS values displayed a slope of 1.09 and an intercept of −0.42. Using Bland–Altman analysis, the mean bias was 0.27 ng/mL with 1.96 SD limits of −2.14 and 2.67 ng/mL.

Conclusions:
The new Dimension TAC immunoassay on the EXL analyzer demonstrated reliable and reproducible performances allowing routine monitoring in transplant patients, even at TAC concentrations at the lower end of the therapeutic range.
Understanding women's experience of memory over the menopausal transition: subjective and objective memory in pre-, peri-, and postmenopausal women
Authors: Unkenstein Anne E. , Bryant Christina A. , Judd Fiona K. , Ong Ben , Kinsella Glynda J. 
Published: August 2016

Abstract

Objective:
Many women complain of forgetfulness during the menopausal transition. This study aimed to examine women's subjective perception of memory and their objective memory performance across the menopausal transition.

Methods:
One hundred thirty women, aged 40 to 60 years were recruited from outpatient Menopause and Gynaecological clinics at the Royal Women's Hospital, Melbourne. Women were divided into menopausal stage groups according to the Stages of Reproductive Aging Workshop criteria based on menstrual patterns. All women completed self-report measures of depressive, anxiety, vasomotor, and sleep symptoms; attitude to menopause; and various aspects of memory, including memory contentment, frequency of forgetting, sense of control over memory, and use of memory strategies. Women also completed a comprehensive neuropsychological evaluation assessing memory and executive function.

Results:
Comprehensive neuropsychological assessment showed no difference between premenopausal (n = 36), perimenopausal (n = 54), and postmenopausal (n = 40) groups in performance on memory and executive tasks. Perimenopausal women, however, reported significantly more frequent forgetting (η2 = 0.09, P < 0.01) and less contentment with their memory (η2 = 0.08, P < 0.01) than pre- and postmenopausal women.

Conclusions:
Although no impairment was observed in neuropsychological performance, when compared with pre- and postmenopausal women, perimenopausal women were more likely to be dissatisfied with their memory. During the menopausal transition women with a more negative attitude to menopause and more intense depressive, anxiety, vasomotor, and sleep symptoms are more vulnerable to feeling less content with their memory.
PEMBROLIZUMAB ADMINISTRATION ASSOCIATED WITH POSTERIOR UVEITIS
Authors: Aaberg Michael T. , Aaberg Thomas M. 
Published: August 2016

Purpose:
To describe the development of uveitis and retinal vasculitis in association with pembrolizumab treatment for metastatic uveal melanoma.

Methods:
A case report and a brief review of the literature are presented. Information collected and reported include the patient's clinical course, physical examination findings, fluorescein angiogram images, retinal photographs, and her response to treatment.

Results:
A 54-year-old woman was diagnosed with a large choroidal malignant melanoma and had the affected eye enucleated. Pathology confirmed a mixed cell choroidal melanoma, and gene expression profiling was Class 2. Seventeen months after enucleation, the patient was diagnosed with metastatic uveal melanoma to the liver. Disease progression was observed during ipilimumab treatment. Pembrolizumab treatment was initiated, and after four infusions, she presented to clinic complaining of floaters and blurred vision. Examination revealed a nongranulomatous panuveitis characterized by perivascular retinal pigment epithelium pigmentary changes, retinal venous sheathing, 1+ anterior chamber and vitreous cellular reaction, 2+ vitreous haze, and optic disk edema. A dexamethasone sustained-release implant was administered and the uveitis regressed. A relapse in symptoms occurred but quickly subsided with a repeat injection.

Conclusion:
Pembrolizumab may induce a uveitic reaction. There is mounting evidence that patients using prembrolizumab should be educated and monitored for signs of uveitis.
25G PARS PLANA VITRECTOMY AND IRIDO-ZONULO-HYALOIDO-VITRECTOMY IN THE MANAGEMENT OF MALIGNANT GLAUCOMA IN PHAKIC EYES FOLLOWING TRABECULECTOMY
Authors: Rani Padmaja K. , Gulati Isha , Rao Harsha Laxmana , Senthil Sirisha 
Published: August 2016

Purpose:
To describe a new surgical technique in the management of malignant glaucoma in phakic eyes.

Methods:
We performed 25-gauge pars plana vitrectomy with anterior irido-zonulo-hyaloido-vitrectomy in 2 young phakic patients with malignant glaucoma after trabeculectomy. This technique allowed posteroanterior aqueous communication, relieved aqueous misdirection, helped restoring anterior chamber depth, normalized the intraocular pressure and most importantly helped to preserve the crystalline lens.

Results:
At 8 months follow-up, both patients have stable visual acuity, normal intraocular pressure, well-functioning blebs, and clear crystalline lens.

Conclusion:
One can consider 25-gauge pars plana vitrectomy with anterior irido-zonulo-hyaloido-vitrectomy as a safe and effective treatment option for the management of malignant glaucoma in phakic eyes.
Postoperative Changes in Strabismus, Ductions, Exophthalmometry, and Eyelid Retraction After Orbital Decompression for Thyroid Orbitopathy
Authors: Rootman Daniel B. , Golan Shani , Pavlovich Peter , Rootman Jack 
Published: August 2016

Introduction:
Surgical rehabilitation of thyroid orbitopathy involves reducing proptosis, treating strabismus, lengthening the eyelids, and managing aesthetic changes. Not all are necessary in each patient; however, they often are. The current investigation intends to describe postdecompression changes that may influence the staging of these procedures.

Methods:
In this retrospective cohort study, records of 169 patients who underwent orbital decompression between 1983 and 2001 were reviewed. A single orbital specialist confirmed all measurements. Time to follow up was defined as the most recent follow up after decompression and prior to any secondary procedures. No strabismus or eyelid surgery was performed at the time of decompression. Strabismus was measured with alternating prism cover test. Ductions were estimated utilizing Hirschberg’s method. Exophthalmometry was measured with Hertel. Eyelid positions were defined relative to the pupillary light reflex. Strabismus data were analyzed within eye pairs. Ductions, exophthalmometry and eyelid position were analyzed for each eye. T-test for paired data was utilized to compare means pre- and postoperatively.

Results:
The study population was on average 45 years old and 73.4% women. Average length of follow up was 1.2 years. Esotropia was significantly increased after decompression by an average of 8.1 prism diopters (p < 0.01). Exotropia and vertical deviations were not significantly altered. Ductions decreased by >5 degrees in at least one meridian for 68.1% of the population. Upper eyelid retraction remained unchanged; however, lower eyelid retraction improved by 50% from 1.4 mm to 0.7 mm (p < 0.01). Exophthalmometry improved from 23.5 mm to 19.7 mm (p < 0.01), and this result was correlated with the number of walls removed (Pearson r = −0.302, p < 0.01).

Conclusions:
On average, esotropia and ductions tend to worsen with decompression surgery. This result supports the clinical dictum to avoid strabismus surgery until after decompression. The improvement in lower eyelid retraction suggests that at least lower eyelid-lengthening surgery should be reserved for after decompression, as there may be significant spontaneous improvement, while the same may not be true for upper eyelid retraction, which does not tend to change with decompression.
Streptococcus agalactiae Toxic Shock Syndrome: New Agent, New Challenges
Authors: Meireles Mariana , Ricardo Miguel , Ribeiro Sofia , Correia João Araújo 
Published: August 2016

Abstract
Toxic shock syndrome is a rare life-threatening disease. The raising of new etiologic agent identification and antimicrobial therapy resistance poses new questions. We report a rare case of Streptococcus agalactiae toxic shock–like syndrome and a literature review focusing on the presentation, current therapeutic challenges, and future approaches.
Early Cerebritis Resulting in a First-Time Seizure in an Otherwise Healthy Young Man
Authors: Jenks Jeffrey D. , Benson Constance A. 
Published: August 2016

Abstract
We report the case of an otherwise healthy 28-year-old man who presented with a first-time seizure. Computed tomography and magnetic resonance imaging revealed a circumscribed left frontal lobe heterogeneous mass most consistent with a neoplasm. He underwent left supraorbital craniotomy with mass resection of the lesion, with histopathology of the brain tissue revealing heightened cellularity with perivascular neutrophilic predominance and neutrophils percolating through the brain parenchyma and surrounding cortical neurons, most consistent with a diagnosis of early cerebritis. He completed 6 weeks of empiric antimicrobial therapy with resolution of his seizures. Early cerebritis, which was elegantly demonstrated on histopathology in this case, is an uncommon diagnosis as patients typically present later with progressive disease and signs and symptoms reflective of an underlying brain abscess.