bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cytotoxicity of Ciprofloxacin and Steroids in Mouse Tympanic Membrane Fibroblasts
Authors: Redula Sonny , Antonelli Patrick J. , Dirain Carolyn O. 
Published: January 2018

ObjectiveCiprofloxacin, commonly given as eardrops, has been shown to adversely affect tympanic membrane fibroblasts. Dexamethasone potentiates this effect. A newly available eardrop contains ciprofloxacin and fluocinolone, a more potent steroid. We evaluated the cytotoxic effects of this preparation on mouse tympanic membrane fibroblasts.Study DesignProspective, in vitro.SettingAcademic laboratory.Subjects and MethodsIn experiment 1, fibroblasts were exposed to 1:10 dilutions of commercially available 0.3% ofloxacin, 0.3% ciprofloxacin, 0.3% ciprofloxacin + 0.1% dexamethasone, 0.3% ciprofloxacin + 0.025% fluocinolone, or dilute hydrochloric acid (control), twice within 24 hours. In experiment 2, cells were also treated with the dilutions of the pure form of dexamethasone 0.1% or fluocinolone 0.025%, alone and in combination with ofloxacin or ciprofloxacin. Cells were exposed to the solutions for 2 hours each time and were placed back in growth media after the treatments. Cells were observed with phase‐contrast microscope until the cytotoxicity assay was performed.ResultsSurvival of fibroblasts treated with ofloxacin was not different from the control. Fibroblasts treated with ciprofloxacin, ciprofloxacin + dexamethasone, or ciprofloxacin + fluocinolone had much lower survival (all P <. 0001). Cells treated with ciprofloxacin + fluocinolone had lower survival than ciprofloxacin (P <. 0001) and ciprofloxacin + dexamethasone (P =. 0001). Steroids alone also decreased fibroblast survival compared to control (P <. 0001). The combination of dexamethasone or fluocinolone with ciprofloxacin, but not ofloxacin, further decreased fibroblast survival (P <. 0001). Phase‐contrast images mirrored the cytotoxicity findings.ConclusionTympanic membrane fibroblast cytotoxicity of ciprofloxacin is potentiated by corticosteroids. This effect may be deleterious when treating a healing perforation but beneficial when treating granulation tissue on the tympanic membrane.
Compositional Assessment of Human Tracheal Cartilage by Infrared Spectroscopy
Authors: Linkov Gary , Hanifi Arash , Yousefi Farzad , Tint Derrick , Bolla Sudheer , Marchetti Nathanial , Soliman Ahmed M. S. , Pleshko Nancy 
Published: January 2018

ObjectivesTo assess the potential of infrared fiber‐optic spectroscopy to evaluate the compositional properties of human tracheal cartilage.Study DesignLaboratory‐based study.MethodsTwenty human cadaveric distal tracheas were harvested (age range 20‐78 years; 6 females, 14 males) for compositional analysis. Histologic staining, Fourier transform infrared imaging spectroscopy data on collagen and proteoglycan (PG) content, and near‐infrared (NIR) fiber‐optic probe spectroscopic data that reflect protein and water content were evaluated. NIR fiber‐optic probe data were also obtained from the proximal trachea in 4 human cadavers (age range 51‐65 years; 2 females, 2 males) in situ for comparison to distal trachea spectral data.ResultsIn the distal trachea cohort, the spectroscopic‐determined ratio of PG/amide I, indicative of the relative amount of PG, was significantly higher in the tissues from the younger group compared to the older group (0.37 ± 0.08 vs 0.32 ± 0.05, P =. 05). A principal component analysis of the NIR spectral data enabled separation of spectra based on tracheal location, likely due to differences in both protein and water content. The NIR‐determined water content based on the 5200‐cm−1 peak was significantly higher in the distal trachea compared to the proximal trachea (P <. 001).ConclusionsEstablishment of normative compositional values and further elucidating differences between the segments of trachea will enable more directed research toward appropriate compositional end points in regenerative medicine for tracheal repair.
Sequelae of Tympanostomy Tubes in a Multihospital Health System
Authors: Padia Reema , Hall Daniel , Sjogren Phayvanh , Narayanan Prem , Meier Jeremy D. 
Published: January 2018

ObjectivesReview the incidence of long‐term sequelae after placement of tympanostomy tubes.Study DesignCase series with chart review.SettingMultihospital network.SubjectsPatients 0 to 3 years old undergoing tympanostomy tube (TT) placement.MethodsA case series of 14,058 children between 2004 and 2010 was reviewed. The patients were followed for 5 years to determine number of repeated tube placements, need for surgical removal of tubes, and presence of perforation requiring repair.ResultsThe study cohort included 14,058 children who underwent TT placement. The mean age at time of procedure was 1.4 years. A total of 14.4% of patients required a second set of tubes within the 5 years of follow‐up studied, and 4.6% required 3 or more sets. Three percent required removal of a tube, and this occurred at an average time of 34.2 ± 17.6 months postplacement. In total, 5.1% had a resulting perforation after either tube extrusion or tube removal requiring myringoplasty.ConclusionsThe rate of multiple tube placements and myringoplasty and tympanoplasty to correct resulting perforations has yet to be studied in a single large population. This information allows for more detailed preoperative counseling to patients and families. Better characterization of these populations with accurate rates of sequelae can help to tailor treatment and preoperative counseling in the future.
Does CPAP Affect Patient‐Reported Voice Outcomes?
Authors: Hartke Vance , Gillespie Amanda , Smith Libby J. , Soose Ryan J. 
Published: January 2018

Upper aerodigestive tract symptoms are common in patients with obstructive sleep apnea (OSA). It remains unclear whether continuous positive airway pressure (CPAP) improves or worsens these otolaryngology symptoms. As therapy‐related side effects limit CPAP adherence, this study aimed to determine if CPAP negatively affects voice, sinonasal, and reflux symptoms of the upper airway. Case series with planned data collection was performed at an academic otolaryngology sleep center. Newly diagnosed patients with OSA were evaluated before and 6 months after initiating CPAP therapy. Data collected included CPAP data download, Reflux Symptom Index (RSI), Epworth Sleepiness Scale (ESS), Voice Handicap Index 10 (VHI‐10), Sino‐Nasal Questionnaire (SNQ), and oral dryness visual analog scale (VAS). For the 11 CPAP‐adherent participants, the RSI significantly improved with CPAP (mean RSI, 22.0‐9.5; P =. 002); however, the VAS, VHI‐10, and SNQ did not change after 6 months of CPAP therapy. In a small sample size, patient‐reported voice outcomes (VHI‐10) and other upper aerodigestive tract symptoms did not worsen with CPAP; rather, CPAP therapy was associated with a reduction in reflux symptoms.
Concentrations of Blood Components in Commercial Platelet-Rich Plasma Separation Systems: A Review of the Literature
Authors: Oudelaar Bart W. , Peerbooms Joost C. , Huis in ‘t Veld Rianne , Vochteloo Anne J.H. 
Published: January 2018

Background: Platelet-rich plasma (PRP) has proven to be a very safe therapeutic option in the treatment of tendon, muscle, bone, and cartilage injuries. Currently, several commercial separation systems are available for the preparation of PRP. The concentrations of blood components in PRP among these separation systems vary substantially. Purpose: To systematically review and evaluate the differences between the concentrations of blood components in PRP produced by various PRP separation systems. Study Design: Systematic review. Methods: MEDLINE/PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE were searched for studies that compared the concentrations of blood components and growth factors in PRP between various separation systems and studies that reported on the concentrations of blood components and growth factors of single separation systems. The primary outcomes were platelet count, leukocyte count, and concentration of growth factors (eg, platelet-derived growth factor–AB [PDGF-AB], transforming growth factor–β1 [TGF-β1], and vascular endothelial growth factor [VEGF]). Furthermore, the preparation protocols and prices of the systems were compared. Results: There were 1079 studies found, of which 19 studies were selected for inclusion in this review. The concentrations of platelets and leukocytes in PRP differed largely between, and to a lesser extent within, the studied PRP separation systems. Additionally, large differences both between and within the studied PRP separation systems were found for all the growth factors. Furthermore, preparation protocols and prices varied widely between systems. Conclusion: There is a large heterogeneity between PRP separation systems regarding concentrations of platelets, leukocytes, and growth factors in PRP. The choice for the most appropriate type of PRP should be based on the specific clinical field of application. As the ideal concentrations of blood components and growth factors for the specific fields of application are yet to be determined for most of the fields, future research should focus on which type of PRP is most suitable for the specific field.
Novel Mortality Markers for Critically Ill Patients
Authors: Yoldas Hamit , Karagoz Ibrahim , Ogun Muhammed Nur , Velioglu Yusuf , Yildiz Isa , Bilgi Murat , Demirhan Abdullah 
Published: January 2018

Aim: Inflammatory markers, such as the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), derived from a complete blood count have recently attracted attention as potential markers of morbidity and mortality in various diseases. The aim of the present study was to assess the usefulness of the NLR and PLR as markers of hospital stay and mortality of patients in intensive care units (ICUs). Methods: Patients treated in the ICU of our institution between October 2016 and August 2017 were enrolled in the study. After obtaining approval from the institutional committee, patient data were sourced from the institution’s computerized database and retrospectively analyzed. The patients were assigned to 2 groups according to the outcomes: survivors and deceased. Results: The NLR of survivors and deceased patients was 2.06 (1.18-21.68) and 10.42 (2.85-48.2), respectively. The NLR was significantly elevated in deceased patients as compared with that of survivors ( P < .001). Similarly, the median PLR of patients in the deceased group (268.9 [150-3000]) was significantly higher than that of patients in the survivor group (55.7 [11.8-152.5]). The difference in the PLR between groups was significant ( P < .001). Conclusion: Both the NLR and PLR, as well as C-reactive protein, predicted mortality in this critically ill population. The PLR and NLR are easy-to-measure, inexpensive markers. Physicians should be aware of elevations in PLR and NLR in patient care in ICUs.
Monitoring of Metabolic Adverse Effects Associated With Atypical Antipsychotics Use in an Outpatient Psychiatric Clinic
Authors: Pereira Luis , Budovich Aliaksandr , Claudio-Saez Maria 
Published: January 2018

Background: Atypical antipsychotics are associated with metabolic complications that contribute to a higher risk of cardiovascular disease. Current evidence reveal suboptimal adherence to the complex and variable official recommendations on metabolic monitoring in the corresponding patient population. A study evaluating metabolic monitoring at guideline-recommended intervals may help identify areas for intervention. Objective: Describe the frequency of monitoring metabolic adverse effects in patients receiving atypical antipsychotics in an outpatient psychiatric clinic with respect to the specific guideline-recommended intervals. Methods: A retrospective chart review was conducted in the outpatient psychiatric clinic. The primary outcome measure was the percentage of patients monitored for metabolic parameters at the current guideline-recommended intervals. The secondary end points were the percentage of patients with documented primary care physician, untreated metabolic comorbidities, and treated metabolic comorbidities by disease state. Results: The most assessed parameters were family history (98%), blood pressure (81%), and body mass index/body weight (83%) at the baseline interval. The least assessed parameters were lipids (14%) at the 12-week interval and waist circumference (0%) at any interval. Conclusion: Interventions are needed to encourage higher compliance with current recommendations. The complexity of the recommendations is the most likely reason for the suboptimal compliance.
Improved Measurement of Vascular Access Pressure
Authors: Kleinekofort W. 
Published: January 2018

Vascular access stenosis and thrombosis is one of the key problems for hemodialysis patients. Prospective monitoring of static venous dialysis pressures can be applied to detect outflow stenoses in a vascular access. However, the location of stenoses within the access may influence the diagnostic value of venous pressure measurements. Whereas a decrease in access flow occurs with all types of stenosis, strictures within the arterial anastomosis or between arterial and venous dialysis needle cannot be detected with venous pressure measurements alone. A new approach is discussed, which bases on the improved measurement of static venous and arterial extracorporeal pressures. Extracorporeal pressure at zero blood flow depends on both the position of the heart relative to the extracorporeal blood circuit and the vertical offset between access site and fluid level in the bloodline. After hydrostatic correction of each pressure signal the normalized arterial and venous intra-access pressure ratio AP/MAP can be calculated. A venous stenosis leads to an increase in both arterial and venous pressure ratio. In case of access stenosis between arterial and venous needle the ratio of venous pressure to mean arterial pressure is normal, and only the arterial pressure ratio is elevated. In summary, a combination of arterial and venous pressure measurement is more sensitive and allows differentiation between mid-access and venous stenosis. Hydrostatic correction of the dialysis pressure signal is inevitable. To minimize the rate of access thrombosis, venous and arterial intra-access pressure should be considered when evaluating dialysis pressures as part of any access monitoring program.
Valved Central Venous Catheter Connected to Subcutaneous Port: A Multicenter Phase IV Study Based on a Cohort of 50 Oncology Patients
Authors: Biffi R. , Pittiruti M. , Gillet J.P. , Fobe D. , Hermanne J.P. , Pescio M. , Gourlia A. , Collet K. , Battelli C. , Cenciarelli S. 
Published: January 2018

Purpose Since technical aspects and clinical features of central venous valved catheters are far from being completely understood, a multinational group of investigators has decided to assess a new distally-valved catheter connected to a port, in the clinical setting of oncology patients undergoing chemotherapy, in an attempt to verify its safety and viability, while also investigating its practical features. Methods Our project was structured as a phase IV multicenter study. Hospitalized adults (ages 18–80 years) who had solid tumors and were candidate for intravenous chemotherapy met the criteria to enter the study. One single type of port was used (made of titanium, plastic and silicone) connected to a silicone, distally valved catheter (as manufactured by B. Braun Aesculap). A case report form was provided for each treated case; all relevant data regarding implantation and follow-up were entered into the form, mailed to a coordinating center (G. Chevillon, B. Braun Medical, France) and stored in a software database for statistical analysis. Results 50 patients (from 6 participating centers) were included in this study. No major complications occurred at insertion. The most frequent clinical problem during follow-up was inability to draw blood samples (9% during the first chemotherapy cycle; 8% after the second cycle); blood obtained from the device was defined “unsuitable for hematology test” in 9% of the cases at first chemotherapy cycle and in 23% of the cases after the second cycle. No catheter obstruction occurred. Conclusion The distally valved catheter port tested in this study was reliable, safe and practical for long-term treatment of an oncology patients’ population undergoing chemotherapy. As most other reports and clinical trials dealing with other types of distally valved catheters pointed out, inability to draw viable blood samples (so called withdrawal occlusion) is a major concern in their clinical use. Mechanisms underlying this technical problem are still unclear.
Thrombotic Events of Arteriovenous Fistulae in Hemodialysis Patients Related to the C677T Thermolabile Variant of Methylenetetrahydrofolate Reductase
Authors: Trimarchi H. , Genoud V. , Schropp J. , CastañÓN M. , Freixas E. , Forrester M. , Pereyra H. , Kordich L. 
Published: January 2018

Background Hyperhomocysteinemia is a risk factor for thrombosis, a frequent complication of vascular access (VA) in hemodialysis (HD). The enzyme methylenetetrahydrofolate reductase (MTHFR) is necessary for the remethylation of homocysteine (Hcy) to methionine. It has been postulated that patients homozygous and, to a lesser extent, heterozygous for the C677T thermolabile variant of this enzyme present a reduced catalytic activity, with secondary increases in plasmatic Hcy levels (normal: 10 ± 5 μmol/L) and an elevated risk of vascular thromboses. Methods Sixty-two patients on chronic HD were divided into two groups: group A (n = 23, 37.1%) was normal for the enzyme (CC); group B (n = 39, 62.9%) was heterozygous (CT). Both groups were not different according to age, sex, time on HD, hematocrits (Hct), baseline levels of Hcy, folic acid and vitamin B12. After the 1st HD session patients were started on folic acid 10 mg/day and 500 μg/week of intravenous (i.v.) methylcobalamin. Results Two years later, thrombotic events were not different between the two groups. Group A = 5 (21.7%) vs. group B = 12 (30.7%), Hcy levels were significantly different between final and baseline measurements (group A 21.5 ± 5.2 vs. 16.6 ± 3.9 μmol/L, p = 0.02; group B 22.1 ± 8.9 vs. 16.1 ± 3.9 μmol/L, p = 0.008), folic acid (group A 22.1 vs. 346.9 ng/ml, range (r) = 166–527, p<0.001; group B 19.2 vs. 218.5 ng/ml, r = 138–298, p<0.001) and vitamin B12 (group A 1489 vs. 3192.3 pg/ml, r = 1494–4890, p = 0.01; group B 1086 vs. 1513.8 pg/ml, r = 1092–1934, p = 0.02). Conclusions HD patients heterozygous for the C677T variant of the enzyme MTHFR can present a similar risk of thrombotic events in arteriovenous fistulae (AVF) compared to patients normal for the enzyme at a 1-yr follow-up. These results could be explained by an adequate control of Hcy levels after folic acid and methylcobalamin replacement therapy.
Accuracy of Implanted Port Placement with the use of the Electromagnetic CathTrack® catheter locator system
Authors: Popp M.B. , Dobrilovic N. , Matern W. , Korelitz J. , Morin R. , Foundas S. , Fegelman E. , Juergens C. , Schaefer S. , Brophy P.F. 
Published: January 2018

Purpose To test whether an electromagnetic guidance system such as CathTrack® would allow long-term central venous access devices to be reliably placed at a decreased cost and without radiation exposure to patients and staff. The following study was undertaken to verify accuracy of the CathTrack® system for catheter placement and to develop guidelines for its use. Methods Twenty-nine consecutive patients were prospectively enrolled in the study and taken to the operating room for implantation of a permanent central venous access port. By protocol, the CathTrack® system was used to guide initial catheter positioning using the center of the third intercostal space along the right sternal border as the desired external target. Fluoroscopy was then used to visualize tip position and relocate the catheter tip to the exact position desired by the surgeon. Results Catheter placement using the CathTrack® system was successfully accomplished in 27 out of 29 patients. In two instances CathTrack® was abandoned and fluoroscopy utilized because of difficulty in threading the initial guidewire into the superior vena cava. Conclusion The CathTrack® electromagnetic locator system can be used to reliably position catheters for the establishment of long-term central venous access. Decreased cost and elimination of radiation exposure are distinct advantages of this system over fluoroscopy.
Infection assessment of totally implanted long-term venous access devices
Authors: Brouns F. , Schuermans A. , Verhaegen J. , De Wever I. , Stas M. 
Published: January 2018

Aim Comparison of catheter tip versus port content culture techniques to assess infection in totally implanted vascular access devices (TIVAD). Materials and methods Comparison of pocket swab, catheter-tip and port content cultures after removing the silicon puncture septum in a prospectively collected consecutive series of 102 TIVAD removed for clinical suspicion of infection, between May 2000 and March 2003. Results 102 totally implanted port-catheters in 98 patients, age ranging from 1 to 90 years (median 53 years), were removed 7 to 2616 days after insertion (median 210 days). Infection of the pocket surrounding the port was found in 21 cases, all proven by a positive culture of the pocket swab. Out of the remaining 81 cases without pocket infection, 32 had only a positive catheter tip culture, whereas 56 had a positive port content culture (p = 0.0002). Always the same microorganism was isolated in the 32 patients with positive catheter tip and port content cultures. The main organisms identified within TIVAD were Coagulase Negative Staphylococcus (CNS) (41 cases) and Candida sp (15 cases). Eight out of the 21 pocket infections were caused by Staphylococcus aureus. Conclusion In the presence of local signs of infection, taking cultures of the pocket surrounding the port is sufficient for diagnostic purposes. When infection is localized within the device only, port content cultures taken after removal of the silicon septum are more often positive than cultures of the catheter tip, and constitute therefore a more reliable tool for the assessment of TIVAD infection.
Prediction of natalizumab anti-drug antibodies persistency
Authors: Deisenhammer Florian , Jank Marlies , Lauren Anna , Sjödin Anders , Ryner Malin , Fogdell-Hahn Anna , Sievers Claudia , Lindberg Raija , Jensen Poul Erik , Sellebjerg Finn , Christodoulou Louis , Birchler Mary , Pallardy Marc , Auer Michael , Liblau Roland ,   ABIRISK consortium
Published: January 2018

Background: Anti-drug antibodies (ADA) against natalizumab develop early during treatment. ADA persistency is defined by two consecutive positive results as performed by the current qualitative ELISA assay (positive/negative). Very little is known about the magnitude of the natalizumab ADA response and persistency. Design/methods: We developed a highly sensitive natalizumab ADA titration assay on the Meso Scale Discovery (MSD) platform and a pharmacokinetic (PK) assay. We included 43 patients with a positive ELISA-ADA result within 6 months of treatment initiation (baseline) of whom a follow-up serum sample was available 12–30 months after treatment start. MSD-ADA titres and drug levels were measured. Results: Median MSD-ADA titre at baseline was 4881 and 303 at follow-up. A titre of >400 at baseline had a 94% sensitivity and 89% specificity to predict ADA persistency. Reversion to ADA negativity occurred in 10 patients with mean drug levels of 10.8 μg/mL. The median trough drug level in ADA-positive samples was 0 µg/mL. PK levels and ADA titres correlated strongly negatively ( r = −0.67). Conclusion: High baseline natalizumab ADA titres accurately predict persistency. Despite continuous treatment, the majority of patients with persistent ADA had no detectable drug levels indicating loss of efficacy in line with phase 3 study results.