bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maintenance Tocolysis With Nifedipine in Threatened Preterm Labour: 2-Year Follow-up of the Offspring in the APOSTEL II Trial
Authors: van Vliet E. , Seinen L. , Roos C. , Schuit E. , Scheepers H. , Bloemenkamp K. , Duvekot J.J. , van Eyck J. , Kok J.H. , Lotgering F.K. , van Baar A. , van Wassenaer-Leemhuis A.G. , Franssen M.T. , Porath M.M. , van der Post J. , Franx A. , Mol B. , Oudijk M.A. 
Published: May 2017

(BJOG. 2016;123(7):1107–1114)
Preterm birth is associated with an increased risk of perinatal morbidity and mortality, with the earlier the birth the greater the risk. Some of the complications resulting from preterm delivery lead to impairments with long-term consequences. Hence delivery postponement through tocolytic drug use is a management goal when women develop preterm delivery. Short-term tocolysis of 48 hours to allow administration of antenatal steroids has been found to be effective. However, several studies have shown that maintenance tocolysis beyond 48 hours does not significantly prolong pregnancy. The Assessment of Perinatal Outcome with Sustained Tocolysis in Early Labour (APOSTEL II) trial assessed maintenance tocolysis with nifedipine. This current follow-up study of APOSTEL II aimed to assess the effect of nifedipine maintenance tocolysis on neurodevelopment, as measured in 2-year-old infants whose mothers participated in the study.
Duration of Motor Block With Intrathecal Ropivacaine Versus Bupivacaine for Cesarean Section: A Meta-analysis
Authors: Malhotra R. , Johnstone C. , Halpern S. , Hunter J. , Banerjee A. 
Published: May 2017

(Int J Obstet Anesth. 2016;27:9–16)
Bupivacaine is a local anesthetic commonly used for spinal anesthesia. It provides a quick onset and sustained duration of sensory block but its prolonged duration of motor block is sometimes considered a disadvantage of the drug. Ropivacaine is another local anesthetic that has been used for spinal anesthesia. It is considered to have a shorter duration of motor block. This current meta-analysis was undertaken to examine the difference in duration of motor block as well as several secondary outcomes when ropivacaine was used compared with bupivacaine for spinal anesthesia for cesarean section.
Myoclonus-like Involuntary Movements Following Cesarean Delivery Epidural Anesthesia
Authors: Kang H.Y. , Lee S.W. , Hong E.P. , Sim Y.H. , Lee S.M. , Park S.W. , Kang J.M. 
Published: May 2017

(J Clin Anesth. 2016;34:392–394)
Arising from the central nervous system, myoclonus is a sudden, brief, involuntary shock-like muscle contraction. Research has shown that spinal myoclonus following neuraxial anesthesia is rare. This article reported on a case of myoclonus-like involuntary movement that occurred during recovery from epidural anesthesia administered for a cesarean delivery.
Bronchopulmonary sequestration
Authors: Estes Mary Ellen Zator 
Published: May 2017

Abstract:
Bronchopulmonary sequestration (BPS) is a lung mass that does not communicate with the tracheobronchial tree or the pulmonary arterial vasculature, and thus does not play a role in oxygenation. This article discusses the etiology of BPS, as well as its pathophysiology, signs and symptoms, imaging studies used to diagnose, and treatment options in both pediatric and adult patients.
Associations Between Physical Pain, Pain Management, and Frequency of Nonmedical Prescription Opioid Use Among Young Adults: A Sex-specific Analysis
Authors: Evans Tristan I. , Liebling Elliott J. , Green Traci C. , Hadland Scott E. , Clark Melissa A. , Marshall Brandon D.L. 
Published: May 2017

Objectives:
We sought to determine sex-specific associations between experiences of physical pain, pain management, and frequency of nonmedical prescription opioid (NMPO) use among young adults.

Methods:
Among participants enrolled in the Rhode Island Young Adult Prescription Drug Study, we identified associations between physical pain in the past 6 months, pain history, pain management, polysubstance use, and weekly NMPO use. In sex-specific models, independent correlates of weekly NMPO use were identified via modified stepwise Poisson regression.

Results:
Of 199 participants, the mean age was 24.6, and 65.3% were male. The racial composition was 16.6% black, 60.8% white, and 22.1% mixed or other race. A total of 119 (59.8%) participants reported weekly or greater NMPO use. The majority of male (86.2%) and female (84.1%) participants reported ever experiencing severe pain. A majority of males (72.3%) and females (81.2%) reported that they engaged in NMPO use to treat their physical pain, and one-quarter (26.9%) of males and one-third (36.2%) of females had been denied a prescription from a doctor to treat severe pain. Among males, frequent NMPO use was independently associated with white race (P < 0.001) and reporting greater physical pain (P = 0.002). Among females, older age (P = 0.002) and monthly or greater nonmedical benzodiazepine use (P = 0.001) were independently associated with weekly NMPO use.

Conclusions:
Among young men in Rhode Island, physical pain may be related to frequent NMPO use. More research is needed to identify sex-specific, pain-related factors that are linked with NMPO use to improve harm reduction and pain management interventions.
Disposition of Remifentanil in Obesity
Authors: Kim Tae Kyun , Obara Shinju , Egan Talmage D. ,   The Remifentanil Pharmacokinetics in Obesity Investigators
Published: May 2017

Abstract

Background
The influence of obesity on the pharmacokinetic (PK) behavior of remifentanil is incompletely understood. The aim of the current investigation was to develop a new population PK model for remifentanil that would adequately characterize the influence of body weight (among other covariates, e.g., age) on the disposition of remifentanil in the general adult population. We hypothesized that age and various indices of body mass would be important covariates in the new model.

Methods
Nine previously published data sets containing 4,455 blood concentration measurements from 229 subjects were merged. A new PK model was built using nonlinear mixed-effects modeling. Satisfactory model performance was assessed graphically and numerically; an internal, boot-strapping validation procedure was performed to determine the CIs of the model.

Results
Body weight, fat-free body mass, and age (but not body mass index) exhibited significant covariate effects on certain three-compartment model parameters. Visual and numerical assessments of model performance were satisfactory. The bootstrap procedure showed satisfactory CIs on all of the model parameters.

Conclusions
A new model estimated from a large, diverse data set provides the PK foundation for remifentanil dosing calculations in adult obese and elderly patients. It is suitable for use in target-controlled infusion systems and pharmacologic simulation.
Risks of Cardiovascular Adverse Events and Death in Patients with Previous Stroke Undergoing Emergency Noncardiac, Nonintracranial Surgery
Authors: Christiansen Mia N. , Andersson Charlotte , Gislason Gunnar H. , Torp-Pedersen Christian , Sanders Robert D. , Føge Jensen Per , Jørgensen Mads E. 
Published: May 2017

Abstract

Background
The outcomes of emergent noncardiac, nonintracranial surgery in patients with previous stroke remain unknown.

Methods
All emergency surgeries performed in Denmark (2005 to 2011) were analyzed according to time elapsed between previous ischemic stroke and surgery. The risks of 30-day mortality and major adverse cardiovascular events were estimated as odds ratios (ORs) and 95% CIs using adjusted logistic regression models in a priori defined groups (reference was no previous stroke). In patients undergoing surgery immediately (within 1 to 3 days) or early after stroke (within 4 to 14 days), propensity-score matching was performed.

Results
Of 146,694 nonvascular surgeries (composing 98% of all emergency surgeries), 5.3% had previous stroke (mean age, 75 yr [SD = 13]; 53% women, 50% major orthopedic surgery). Antithrombotic treatment and atrial fibrillation were more frequent and general anesthesia less frequent in patients with previous stroke (all P < 0.001). Risks of major adverse cardiovascular events and mortality were high for patients with stroke less than 3 months (20.7 and 16.4% events; OR = 4.71 [95% CI, 4.18 to 5.32] and 1.65 [95% CI, 1.45 to 1.88]), and remained increased for stroke within 3 to 9 months (10.3 and 12.3%; OR = 1.93 [95% CI, 1.55 to 2.40] and 1.20 [95% CI, 0.98 to 1.47]) and stroke more than 9 months (8.8 and 11.7%; OR = 1.62 [95% CI, 1.43 to 1.84] and 1.20 [95% CI, 1.08 to 1.34]) compared with no previous stroke (2.3 and 4.8% events). Major adverse cardiovascular events were significantly lower in 323 patients undergoing immediate surgery (21%) compared with 323 successfully propensity-matched early surgery patients (29%; P = 0.029).

Conclusions
Adverse cardiovascular outcomes and mortality were greatly increased among patients with recent stroke. However, events were higher 4 to 14 days after stroke compared with 1 to 3 days after stroke.
Progress in the pathogenesis and treatment of cardiac manifestations of neonatal lupus
Authors: Izmirly Peter , Saxena Amit , Buyon Jill P. 
Published: May 2017

Purpose of review
To provide new insights into pathogenesis, prevention and management of cardiac manifestations of neonatal lupus (cardiac neonatal lupus) and issues pertinent to all anti-SSA/Ro positive individuals of childbearing age.

Recent findings
Antibody specificity with high risk for cardiac neonatal lupus remains elusive, but high titers of Ro60, Ro52 or Ro52p200 antibodies appear to be required. Varying antibody specificities to the p200 region of Ro52 can induce first-degree block in a rodent model. In consideration of the contribution of macrophages to inflammation and fibrosis in cardiac neonatal lupus, hydroxychloroquine (HCQ) is being considered as preventive therapy. Cord blood biomarkers support the association of fetal reactive inflammatory and fibrotic components with the development and morbidity of cardiac neonatal lupus. Data from U.S. and French registries do not provide evidence that the prompt use of fluorinated steroids in cases of isolated block significantly alters fetal/neonatal morbidity or mortality.

Summary
The search for a high-risk cardiac neonatal lupus antibody profile remains, but high-titer antibodies to Ro60 and R052 are a consistent finding, and this may guide the need for fetal echocardiographic surveillance. The uniform use of fluorinated steroids to prevent progression of cardiac neonatal lupus or reduce mortality does not appear justified. HCQ, based on diminishing an inflammatory component of cardiac neonatal lupus, is under consideration as a potential preventive approach.
Socioeconomic consequences of systemic lupus erythematosus
Authors: Barber Megan R.W. , Clarke Ann E. 
Published: May 2017

Purpose of review
The present review addresses recent literature investigating the socioeconomic consequences of systemic lupus erythematosus (SLE). We highlight the latest updates on health disparities affecting the SLE population, the direct and indirect economic costs of the disease, and less quantifiable costs such as reduced health-related quality of life (HRQoL).

Recent findings
Health disparities continue to exist among socially disadvantaged populations, including African Americans, Hispanics, and patients with decreased educational attainment and in poverty. Direct and indirect costs are substantial. Recent work provides updated cost estimates for patients with SLE outside of North America, including those in developing countries. Previous research has largely focused on costs of the general SLE population and those with renal manifestations or active SLE, whereas recent research addresses special populations such as hospitalized and pregnant patients and glucocorticoid users. Patients with SLE and their caregivers experience a substantially reduced HRQoL.

Summary
SLE is a costly disease that disproportionately affects disadvantaged populations. Future economic studies should measure not only direct costs, but also incorporate indirect costs and the HRQoL of both patients with SLE and their caregivers. All these components are essential to provide a comprehensive assessment of the socioeconomic consequences of SLE and an appreciation of the potential impact of novel therapies.
Intramedullary Nailing for Pilon Nonunions
Authors: Haller Justin M. , Githens Michael , Dunbar Robert 
Published: May 2017

Summary:
Nonunions are uncommon sequelae of tibial pilon fractures, but they can present a challenging problem to the treating surgeon. Treatment strategies can range from isolated bone grafting to revision plating depending on the type of nonunion and patient factors. Here, we present our technique and clinical results for intramedullary nailing of tibial pilon nonunions.
Therapeutic Drug Monitoring for Perampanel in Japanese Epilepsy Patients: Influence of Concomitant Antiepileptic Drugs
Authors: Yamamoto Yoshiaki , Usui Naotaka , Nishida Takuji , Takahashi Yukitoshi , Imai Katsumi , Kagawa Yoshiyuki , Inoue Yushi 
Published: May 2017

Background:
Perampanel is a new antiepileptic drug (AED) that acts as a noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA) receptor antagonist and is mainly metabolized by cytochrome P450 (CYP) 3A4. This study evaluated the influence of concomitant AEDs on the serum concentration profile of perampanel.

Methods:
A total of 215 serum samples obtained from 76 patients aged 12 years or older were analyzed for routine therapeutic drug monitoring, and the concentration-to-dose ratio (CD ratio) of perampanel was compared among patients on various AED regimens.

Results:
In patients not taking concomitant enzyme-inducing AEDs, the mean CD ratio was 3963 ng·mL−1·mg−1·kg−1 (range: 1793–13,299). By contrast, the mean CD ratio was lower in patients using enzyme-inducing AEDs [1760 (range: 892–3090), 2256 (range: 700–4703), and 1120 (range: 473–1853) ng·mL−1·mg−1·kg−1 in patients taking phenytoin, phenobarbital, and carbamazepine, respectively], and carbamazepine had a significantly greater reduction in the CD ratio compared with phenytoin or phenobarbital (P < 0.001). Twenty-one patients responded with ≥50% reduction of seizure frequency from baseline, and their mean serum perampanel concentration was 450 ng/mL (range: 85–1500).

Conclusions:
There is a large interindividual variation in CD ratio of perampanel because its metabolism is highly susceptible to interactions with enzyme-inducing AEDs. Therapeutic drug monitoring could be clinically useful for determining the influence of AED CYP3A4 inducers on perampanel concentrations.
Microsurgical Hepatic Artery Reconstruction Using Ikuta A-II Double Clamp
Authors: Okochi Masayuki , Okochi Hiromi , Sakaba Takao , Momiyama Masanori , Ueda Kazuki 
Published: May 2017

Summary:
We performed hepatic artery (HA) reconstruction on 24 patients between January 2010 and October 2016. Six of 24 patients used an Ikuta type A-II vascular clamp (A-II group). The mean age was 38.0 years (range, 1–61 years). There was no blood leakage at the anastomosed site in any of the patients. No patients required an additional vascular clamp, and none developed HA thrombosis. Eighteen of 24 patients used a conventional vascular clamp. The mean age was 36.1 years (range, 1–65 years; conventional group). Sixteen of 18 patients required an additional vascular clamp due to blood leakage from the HA. There was no significant difference between the 2 groups in mean age or diameter of the recipient HA. However, there was a significant difference in the proportion of patients who required an additional vascular clamp (n < 0.001). The Ikuta type A-II clamp is an effective vascular clamp for reconstruction of the HA in living donor liver transplantation.
Cardiac Rehabilitation Outcomes by Ethnocultural Background
Authors: Findlay Briar , Oh Paul , Grace Sherry L. 
Published: May 2017

Background:
Patients of diverse ethnocultural backgrounds are underrepresented among participants and, hence, little is known about their outcomes. The objectives of this study were to compare cardiac rehabilitation (CR) utilization, cardiovascular risk factor reduction (blood pressure, lipids, anthropometrics), and functional capacity between white and ethnocultural minority patients participating in CR across Canada.

Methods:
The study was a retrospective, observational cohort study using the Canadian Cardiac Rehab Registry (CCRR). Participants from an ethnocultural minority (n ≥ 25) were propensity-matched to white participants based on sociodemographic and clinical characteristics. CR outcomes were compared.

Results:
In the CCRR, 3848 (53.8%) participants had an ethnocultural background reported. Of those, whites (n = 3630) and South Asians (n = 26), Southeast Asians (n = 45), and Arab/West Asians (n = 37) minorities had sufficient representation in the registry to be analyzed. In the matched sample, 364 (97.1%) participants completed a discharge assessment. Southeast Asian participants adhered to (96.5%, P = .02) and completed (88.2%, P = .02) CR more often than white participants (90.2% and 55.6%, respectively). Southeast Asian participants had significantly lower diastolic blood pressure (P = .002) at CR discharge than matched white participants. No other differences in outcomes or functional capacity were observed.

Conclusions:
Ethnocultural minorities make up a small proportion of CR participants in Canada. However, when they do participate, they achieve similar CR outcomes compared with white participants. CR programs should seek to ensure ethnoculturally diverse patients are referred to their programs and ensure their programs are culturally sensitive to the needs of the preponderant ethnocultural groups in their catchment areas.
EFFECTS OF INTRAVITREAL RANIBIZUMAB AND BEVACIZUMAB ON THE RETINAL VESSEL SIZE IN DIABETIC MACULAR EDEMA
Authors: Kurt Muhammed Mustafa , Çekiç Osman , Akpolat Çetin , ELÇIOGLU Mustafa 
Published: May 2017

Purpose:
The goal of this study was to assess the effects of a single injection of intravitreal ranibizumab (RAN) or bevacizumab (BEV) on the retinal vessel size in eyes with diabetic macular edema.

Materials and Methods:
In total, 32 patients were enrolled in the RAN group, and 30 patients were included in BEV group. Each of these groups was also subdivided into two others groups: a study group and a control group. The study groups were composed of the injected eyes, whereas the noninjected fellow eyes served as the control groups. The patients underwent complete ophthalmic examinations, including optical coherence tomography and fundus fluorescein angiography, and the primary outcome measures included the central retinal artery equivalent, central retinal vein equivalent, and artery-to-vein ratio.

Results:
In the RAN study group (n = 32), the preinjection mean central retinal artery equivalent (175.42 μm) decreased to 169.01 μm after 1 week, and to 167.47 μm after 1 month (P < 0.001), whereas the baseline central retinal vein equivalent (235.29 μm) decreased initially to 219.90 μm after 1 week, and to 218.36 μm after 1 month (P < 0.001). In the BEV study group (n = 30), the preinjection central retinal artery equivalent (150.21 μm) decreased to 146.25 μm after 1 week, and to 145.89 μm after 1 month (P < 0.001); whereas the baseline central retinal vein equivalent (211.87 μm) decreased initially to 204.59 μm after 1 week and was 205.24 μm after 1 month (P < 0.001). The preinjection artery-to-vein ratio values changed significantly (P = 0.001) after 1 week and after 1 month in the RAN group, but no significant alteration in the artery-to-vein ratio was observed in the BEV group (P = 0.433). In both the RAN (n = 32) and BEV (n = 30) control groups, none of the 3 parameters changed throughout the study period, when compared with the baseline.

Conclusion:
The results of this study showed that both RAN and BEV injections significantly constricted the retinal blood vessel diameters.
INFLAMMATORY CHOROIDAL NEOVASCULAR MEMBRANE
Authors: D'souza Palmeera , Ranjan Ratnesh , Babu Upendra , Kanakath Anuradha V. , Saravanan Veerappan R. 
Published: May 2017

Purpose:
To assess the long-term visual and anatomical outcomes after intravitreal anti–vascular endothelial growth factor therapy for inflammatory choroidal neovascular membrane (CNVM).

Methods:
Retrospective case series of 15 consecutive cases of newly diagnosed inflammatory CNVM who were treated with intravitreal bevacizumab or ranibizumab injections.

Results:
The study included 8 women and 7 men with mean age at presentation with CNVM of 40.53 ± 17.46 years (range, 11–70 years), and mean follow-up duration after anti–vascular endothelial growth factor therapy was 20.53 ± 14.53 months (range, 6–48 months). All eyes had classic CNVM confirmed by fluorescein angiography, most commonly located in the peripapillary area (8 eyes, 53.3%), followed by juxtafoveal (4 eyes, 26.7%), and subfoveal location (3 eyes, 20%). All CNVMs showed complete resolution with mean 2.6 ± 1.2 injections per eye. Preinjection mean best-corrected visual acuity of logarithm of minimum angle of resolution 0.79 ± 0.76 (approximate Snellen equivalent 20/123) and mean central macular thickness of 435.9 ± 190.2 μm improved significantly to mean best-corrected visual acuity of logarithm of minimum angle of resolution 0.46 ± 0.43 (approximate Snellen equivalent 20/58) and mean central macular thickness of 262.13 ± 108.70 μm (P value 0.02 and <0.0001, respectively) at the final visit. Recurrence was seen in 26.7% eyes (4/15), all of which regressed with single injection. Only complication noted was subretinal fibrosis in one eye (6.7%).

Conclusion:
For inflammatory CNVM, in addition to immunosuppression in cases with active inflammation, anti–vascular endothelial growth factor therapy seems as a very effective treatment modality resulting in significant visual improvement and foveal flattening. Incidence of major complications is rare, and the recurrence rate seems low.
POSTERIOR SCLERAL MELANOCYTOSIS: A NOVEL FUNDUS FINDING MASQUERADING AS A CHOROIDAL NEVUS
Authors: Dolz-Marco Rosa , Sebrow Dov B. , Freund K. Bailey 
Published: May 2017

Purpose:
To report a case of “posterior scleral melanocytosis,” a pigmented lesion of the posterior sclera that clinically resembles a flat choroidal nevus.

Methods:
Case report of a patient with posterior scleral melanocytosis. Multimodal imaging, including swept source optical coherence tomography, was used to demonstrate the scleral location of the pigmented lesion and to distinguish its features from a typical choroidal nevus present in the same eye.

Results:
An 86-year-old woman was seen for regular follow-up for neovascular age-related macular degeneration in her right eye and 2 pigmented lesions in her left eye, both presumed to be choroidal nevi. Anterior segment examination showed no evidence of ocular or dermal melanocytosis. Optical coherence tomography of the pigmented lesion in the left eye showed two distinct patterns. One lesion showed hyperreflectivity within the choroidal tissue associated with posterior shadowing, whereas the second lesion showed normal choroidal reflectivity with hyperreflectivity confined to the inner sclera associated with marked posterior shadowing.

Conclusion:
To the authors' knowledge, this is the first report of posterior scleral melanocytosis, a pigmented fundus lesion confined to the inner sclera. The need for high-penetrance optical coherence tomography to differentiate these lesions from a typical choroidal nevus may explain why this entity has not been previously described. The true nature of this entity will ultimately require histopathologic study.