bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre‐hospital emergency anaesthesia in awake hypotensive trauma patients: beneficial or detrimental?
Authors: Crewdson K. , Rehn M. , Brohi K. , Lockey D. J. 
Published: January 2018

BackgroundThe benefits of pre‐hospital emergency anaesthesia (PHEA) are controversial. Patients who are hypovolaemic prior to induction of anaesthesia are at risk of severe cardiovascular instability post‐induction.This study compared mortality for hypovolaemic trauma patients (without major neurological injury) undergoing PHEA with a patient cohort with similar physiology transported to hospital without PHEA.MethodsA retrospective database review was performed to identify patients who were hypotensive on scene [systolic blood pressure (SBP) < 90 mmHg], and GCS 13–15. Patient records were reviewed independently by two pre‐hospital clinicians to identify the likelihood of hypovolaemia. Primary outcome measure was mortality defined as death before hospital discharge.ResultsTwo hundred and thirty‐six patients were included; 101 patients underwent PHEA. Fifteen PHEA patients died (14.9%) compared with six non‐PHEA patients (4.4%), P = 0.01; unadjusted OR for death was 3.73 (1.30–12.21; P = 0.01). This association remained after adjustment for age, injury mechanism, heart rate and hypovolaemia (adjusted odds ratio 3.07 (1.03–9.14) P = 0.04).Fifty‐eight PHEA patients (57.4%) were hypovolaemic prior to induction of anaesthesia, 14 died (24%). Of 43 PHEA patients (42.6%) not meeting hypovolaemia criteria, one died (2%); unadjusted OR for mortality was 13.12 (1.84–578.21). After adjustment for age, injury mechanism and initial heart rate, the odds ratio for mortality remained significant at 9.99 (1.69–58.98); P = 0.01.ConclusionOur results suggest an association between PHEA and in‐hospital mortality in awake hypotensive trauma patients, which is strengthened when hypotension is due to hypovolaemia. If patients are hypovolaemic and awake on scene it might, where possible, be appropriate to delay induction of anaesthesia until hospital arrival.
Good quality of life before cardiac arrest predicts good quality of life after resuscitation
Authors: Hellevuo H. , Sainio M. , Huhtala H. , Olkkola K. T. , Tenhunen J. , Hoppu S. 
Published: January 2018

BackgroundThe survival rate of cardiac arrest patients is increasing. Our aim was to compare the quality of life before and after cardiac arrest and analyse the factors associated with outcome.MethodsAll adult cardiac arrest patients admitted to the Tampere University Hospital intensive care unit between 2009 and 2011 were included in a retrospective follow‐up study if surviving to discharge and were asked to return a questionnaire after 6 months. Data on patient demographics and pre‐arrest quality of life were retrieved from medical records. Data are given as means (SD) or medians [Q1, Q3]. We used logistic regression to identify factors associated with better quality of life after cardiac arrest.ResultsSix months after cardiac arrest, 36% (79/222) were alive and 70% (55/79) of those patients completed the follow‐up EuroQoL (EQ‐5D) quality of life questionnaire. Median values for the EQ‐5D before and after cardiac arrest were 0.89 [0.63, 1] and 0.89 [0.62, 1], respectively (P = 0.75). Only the EQ‐5D prior to cardiac arrest was associated with better quality of life afterwards (OR 1.2; 95% CI 1.0–1.3; P = 0.02).ConclusionsQuality of life remained good after cardiac arrest especially in those patients who had good quality of life before cardiac arrest.
Validation of a behavioral economic purchase task for assessing drug abuse liability
Authors: MacKillop James , Goldenson Nicholas I. , Kirkpatrick Matthew G. , Leventhal Adam M. 
Published: January 2018

AbstractBehavioral economic purchase tasks quantify drug demand (i.e. reinforcing value of a drug) and have been used extensively to assess the value of various drugs among current users. However, purchase tasks have been rarely used with unfamiliar drugs to address a compound's abuse liability, and the current study sought to validate the paradigm in this capacity. Using a double‐blind placebo‐controlled within‐subjects drug challenge design, the study evaluated differential drug demand on an experimental drug purchase task for a 20 mg dose of oral D‐amphetamine (versus placebo), a prototypic psychostimulant, in 98 stimulant‐naïve participants. Compared with placebo, amphetamine significantly increased intensity, breakpoint and Omax, and significantly decreased elasticity. Mechanistic analyses revealed that Omax and breakpoint mediated the relationship between subjective drug effects and ‘willingness to take again’, a putative indicator of liability via motivation for future drug‐seeking behavior. These findings validate the purchase task paradigm for quantifying the reinforcing value and, in turn, abuse liability of unfamiliar compounds, providing a foundation for a variety of future applications.
Cocaine conditioned place preference: unexpected suppression of preference due to testing combined with strong conditioning
Authors: Marion‐Poll Lucile , Besnard Antoine , Longueville Sophie , Valjent Emmanuel , Engmann Olivia , Caboche Jocelyne , Hervé Denis , Girault Jean‐Antoine 
Published: January 2018

AbstractConditioned place preference (CPP) is widely used for evaluating the rewarding effects of drugs. Like other memories, CPP is proposed to undergo reconsolidation during which it is unstable and sensitive to pharmacological inhibition. Previous studies have shown that cocaine CPP can be apparently erased by extracellular signal‐regulated kinase (ERK) pathway inhibition during cocaine reconditioning (re‐exposure to the drug‐paired environment in the presence of the drug). Here, we show that blockade of D1 receptors during reconditioning prevented ERK activation and induced a loss of CPP. However, we also unexpectedly observed a CPP disappearance in mice that underwent testing and reconditioning with cocaine alone, specifically in strong conditioning conditions. The loss was due to the intermediate test. CPP was not recovered with reconditioning or priming in the short term, but it spontaneously reappeared after a month. When we challenged the D1 antagonist‐mediated erasure, we observed that both a high dose of cocaine and a first CPP test were required for this effect. Our results also suggest a balance between D1‐dependent ERK pathway activation and an A2a‐dependent mechanism in D2 striatal neurons in controlling CPP expression. Our data reveal that, paradoxically, a simple CPP test can induce a complete (but transient) loss of place preference following strong but not weak cocaine conditioning. This study emphasizes the complex nature of CPP memory and the importance of multiple parameters that must be taken into consideration when investigating reconsolidation.
Trends in alcohol‐related mortality in East and West Germany, 1980–2014: age, period and cohort variations
Authors: Piontek Daniela , Kraus Ludwig 
Published: January 2018

AbstractBackground and aimsSeveral indicators suggest that the extent and trends of alcohol‐related mortality differ between East and West Germany. Regional drinking patterns and differences in health‐care systems are assumed to affect the risk of dying from an alcohol‐induced disease. The study addresses two questions: (1) what are the unbiased and independent age, period and cohort effects on alcohol‐related mortality trends in Germany; and (2) do these trends differ between East and West Germany?MethodsData on alcohol‐related mortality for East and West Germany came from the national causes of death register for the years 1980–2014. Analyses included all deaths fully attributable to alcohol based on the International Classification of Diseases (ICD‐9 and ICD‐10). Gender‐stratified age–period–cohort analyses were conducted using the intrinsic estimator model.ResultsAge effects showed a concave pattern with a peak at ages 55–64 years in both regions. Incidence rate ratios (IRR) in East Germany were highest in the years 1990–1994 (men and women: IRR = 1.52) and declined thereafter. In West Germany, IRR were lowest in 1980–1984 (men: IRR = 0.81, women: IRR = 0.75) and stabilized at approximately 1.10 since 1995–1999. Cohort effects showed continuously lower IRR for those born after 1955–1959 in the East and those born after 1945–1949 in the West. Patterns for males and females were comparable.ConclusionsThe results suggest that alcohol‐related mortality showed different trends in East and West Germany, which can be explained partly by different drinking patterns before and changes in the health‐care system after the reunification.
IL‐37 inhibits IL‐4/IL‐13‐induced CCL11 production and lung eosinophilia in murine allergic asthma
Authors: Lv J. , Xiong Y. , Li W. , Cui X. , Cheng X. , Leng Q. , He R. 
Published: January 2018

AbstractBackgroundIL‐37 is emerging as an anti‐inflammatory cytokine, particularly in innate inflammation. However, the role of IL‐37 in Th2‐mediated allergic lung inflammation remains uncertain. We sought to determine the role and the underlying mechanisms of IL‐37 in the development of house dust mites (HDM)‐induced murine asthma model.MethodsWe examined the effect of IL‐37 administration during the sensitization or challenge phase on Th2‐mediated allergic asthma induced by inhaled HDM. Cellular source of CCL11 and distribution of IL‐37 receptors, IL‐18Rα and IL‐1R8, were determined in HDM‐exposed lungs. Finally, we examined the effect of IL‐37 on CCL11 production and STAT6 activation in different primary lung structural cell types upon IL‐4/IL‐13 stimulation.ResultsIL‐37 had no effect on HDM sensitization, but when administrated during the challenge phase, significantly attenuated pulmonary eosinophilia, CCL11 production, and airway hyper‐reactivity (AHR). Interestingly, IL‐37 treatment had no significant effects on lung infiltrating T cells and Th2 cytokine production. Intranasal co‐administration of CCL11 reversed the inhibiting effect of IL‐37 on HDM‐induced pulmonary eosinophilia and AHR. Furthermore, we demonstrated that CCL11 was primarily expressed by fibroblasts and airway smooth muscle cells (AMSC), while IL‐37 receptors by tracheobronchial epithelial cells (TEC). In vitro study showed that IL‐37 inhibited IL‐4/IL‐13‐induced STAT6 activation and CCL11 production by fibroblasts and AMSC, which was dependent on its direct action on TEC. Moreover, cell contact was required for the inhibitory effect of IL‐37‐treated TEC.ConclusionsIL‐37 attenuates HDM‐induced asthma, possibly by inhibiting IL‐4/IL‐13‐induced CCL11 production by fibroblasts and AMSC via its direct act on TEC.
Diagnostic accuracy, risk assessment, and cost‐effectiveness of component‐resolved diagnostics for food allergy: A systematic review
Authors: Flores Kim J. , McCleary N. , Nwaru B. I. , Stoddart A. , Sheikh A. 
Published: January 2018

AbstractBackgroundComponent‐resolved diagnostics (CRD) are promising tools for diagnosing food allergy, offering the potential to determine specific phenotypes and to develop patient‐tailored risk profiles. Nevertheless, the diagnostic accuracy of these tests varies across studies; thus, their clinical utility remains unclear. Therefore, we synthesized the evidence from studies investigating the diagnostic accuracy, risk assessment ability, and cost‐effectiveness of CRD for food allergy.MethodsWe systematically searched 10 electronic databases and four clinical trial registries for studies published from January 2000 to February 2017. The quality of included studies was assessed using QUADAS‐2. Due to heterogeneity, we narratively synthesized the evidence.ResultsEleven studies met inclusion criteria, altogether recruiting 1098 participants. The food allergies investigated were cow's milk, hen's egg, peanut, hazelnut, and shrimp. The components with the highest diagnostic accuracy for each allergen, along with their sensitivity‐specificity pairs, were as follows: Bos d 4 for cow's milk (62.0% and 87.5%), Gal d 1 for hen's egg (84.2% and 89.8% for heated egg, and 60.6% and 97.1% for raw egg), Ara h 6 for peanut (94.9% and 95.1%), Cor a 14 for hazelnut (100% and 93.8%), and Lit v 1 for shrimp (82.8% and 56.3%) allergy.ConclusionSelected components of cow's milk, hen's egg, peanut, hazelnut, and shrimp allergen showed high specificity, but lower sensitivity. However, few studies exist for each component, and studies vary widely regarding the cutoff values used, making it challenging to synthesize findings across studies. Further research is needed to determine clinically appropriate cutoff values, risk assessment abilities, and cost‐effectiveness of CRD approaches.
Systemic IL‐2/anti‐IL‐2Ab complex combined with sublingual immunotherapy suppresses experimental food allergy in mice through induction of mucosal regulatory T cells
Authors: Smaldini P. L. , Trejo F. , Cohen J. L. , Piaggio E. , Docena G. H. 
Published: January 2018

AbstractBackgroundTherapeutic tolerance restoration has been proven to modify food allergy in patients and animal models and although sublingual immunotherapy (SLIT) has showed promise, combined therapy may be necessary to achieve a strong and long‐term tolerance.AimsIn this work, we combined SLIT with systemic administration of IL‐2 associated with an anti‐IL‐2 monoclonal antibody (IL‐2/anti‐IL‐2Ab complex or IL‐2C) to reverse the IgE‐mediated experimental allergy.Materials and MethodsBalb/c mice were sensitized with cholera toxin and milk proteins and orally challenged with allergen to elicit hypersensitivity reactions. Then, allergic mice were treated with a sublingual administration of very low amounts of milk proteins combined with intraperitoneal injection of low doses of IL‐2C. The animals were next re‐exposed to allergens and mucosal as well as systemic immunological parameters were assessed in vivo and in vitro.ResultsThe treatment reduced serum specific IgE, IL‐5 secretion by spleen cells and increased IL‐10 and TGF‐β in the lamina propria of buccal and duodenal mucosa. We found an augmented frequency of IL‐10‐secreting CD4+CD25+Foxp3+ regulatory T cells (Treg) in the submaxilar lymph nodes and buccal lamina propria. Tregs were sorted, characterized and adoptively transferred to naïve mice, which were subsequently sensitized. No allergy was experienced in these mice and we encouragingly discovered a faster and more efficient tolerance induction with the combined therapy compared with SLIT.ConclusionThe combination of two therapeutic strategies rendered Treg‐mediated tolerance more efficient compared to individual treatments and reversed the established IgE‐mediated food allergy. This approach highlights the ability of IL‐2C to expand Tregs, and it may represent a promising disease‐modifying therapy for managing food allergy.
Usefulness of asthma predictive index in ascertaining asthma status of children using medical records: An explorative study
Authors: Wi C.‐I. , Krusemark E. A. , Voge G. , Sohn S. , Liu H. , Ryu E. , Park M. A. , Castro‐Rodriguez J. A. , Juhn Y. J. 
Published: January 2018

AbstractBackgroundFrequent wheezing in original asthma predictive index (API) was defined by parental report of recurrent wheezing within 1 year during the first 3 years of life. The nature of frequent wheezing in children, particularly aged over 3 years, has not been studied. We aimed to assess the frequency and interval of wheezing to define frequent wheezing in ascertaining asthma for children using medical records.MethodsAmong children who participated in a previous study (n = 427), all wheezing episodes documented in medical records were collected for children who had ≥2 wheezing episodes PLUS met one major criterion or two minor criteria of API. We compared the distribution of known risk factors for asthma between subjects having two consecutive wheezing episodes with shorter interval (≤1 year) compared to those with longer interval (1 to 3 years).ResultsA total of 62 children met API at median age of 2.3 years. During follow‐up period (median age: 11.3 years), a total of 198 wheezing episodes were observed. 81% of wheezing intervals were within 3 years from the earlier wheezing episode, including 60% within 1 year. Children who met API based on 1‐year interval (n = 40) vs 1‐ to 3‐year interval (n = 13) appeared to be similar in regard to the known risk factors for asthma.ConclusionsOur exploratory study finding suggests that children who had frequent wheezing episodes with longer interval (<3 years) need to be considered to be determined as asthma cases when API is applied to retrospective medical records. Prospective studies with a larger sample size need to replicate this finding.
A before‐and‐after observational study of a protocol for use of the C‐MAC videolaryngoscope with a Frova introducer in pre‐hospital rapid sequence intubation
Authors: Ångerman S. , Kirves H. , Nurmi J. 
Published: January 2018

SummaryResults using videolaryngoscopy in pre‐hospital rapid sequence intubation are mixed. A bougie is not commonly used with videolaryngoscopy. We hypothesised that using videolaryngoscopy and a bougie as core elements of a standardised protocol that includes a drugs and a laryngoscopy algorithm would result in a high first‐pass tracheal intubation success rate. We employed videolaryngoscopy (C‐MAC) combined with a bougie (Frova intubating introducer) in an anaesthetist‐staffed helicopter emergency medical service. Data for adult tracheal intubation were collected prospectively as part of the airway registry of our unit for 22 months after implementation of the protocol (n = 543) and compared with controls (n = 238) treated in the previous year before the implementation. The mean first‐pass success rate (95%CI) was 98.2% (96.6–99.0%) in the study group and 85.7% (80.7–89.6%) in the control group, p < 0.0001. Combining C‐MAC videolaryngoscopy and bougie with a standardised rapid sequence induction protocol leads to a high first attempt intubation success rate when performed by an anaesthetist‐led helicopter emergency medical service team.
Solid pseudopapillary tumour of the pancreas: clinicopathological analysis
Authors: McCluney Simon , Wijesuriya Nilukshi , Sheshappanavar Vinayata , Chin‐Aleong Joanne , Feakins Roger , Hutchins Robert , Abraham Ajit , Bhattacharya Satyajit , Valente Roberto , Kocher Hemant 
Published: January 2018

BackgroundWe report on our experience of the surgical management and outcomes of 11 patients with solid pseudopapillary tumour of the pancreas (SPT). We sought to correlate the immunohistochemical staining of these tumours with that previously reported in the literature.MethodsA retrospective analysis of the clinical presentation, radiological findings, surgical treatment, histopathological characteristics and outcomes for patients surgically managed with SPT at The Royal London Hospital. A literature search was performed to analyse the immunohistochemical stains commonly used to diagnose SPT.ResultsBetween August 2006 and April 2016, 10 females and one male patient underwent surgery for SPT. The localization of the tumour was in the pancreatic head in two patients, one in the neck, three in the body and five in the tail. All 11 patients had localised disease. Six patients suffered post‐surgical complications. Histopathology shows immunoreactivity for: β‐catenin, vimentin, CD‐10, CD‐56, α1‐antitrypsin and negative staining for synaptophysin and chromogranin. At a median of 24 months of follow‐up, the disease‐free survival rate was 100% and no recurrence was noted. A literature review generated 38 suitable articles with 116 individual cases of SPT, with high expression of vimentin and neuron specific enolase throughout, and low rates of chromogranin and synatophysin positivity.ConclusionSPT is rare and affects mostly young women. An accurate diagnosis is important as the relative indolent behaviour can be managed with surgical resection even when large in size, bringing excellent long‐term outcomes.
Which outcome measures should be used in stress urinary incontinence trials?
Authors: Lim Renly , Liong Men Long , Leong Wing Seng , Yuen Kah Hay 
Published: January 2018

ObjectiveTo review measures used in recent randomised controlled trials (RCTs) evaluating stress urinary incontinence (SUI) treatments and to propose the most relevant outcome measure that should be included in future trials.Materials and methodsWe identified RCTs for SUI interventions published between January 2015 and July 2017. We listed the objective and subjective outcome measures used in eligible trials in the literature search. Using data from our RCT conducted from 2013 to 2016 evaluating pulsed magnetic stimulation for SUI, we analysed the correlation between all measures.ResultsA total of 45 RCTs were included; 28 (62%) involved surgical interventions. The most frequently used objective and subjective measures were the cough stress test and International Consultation on Incontinence Questionnaire‐Urinary Incontinence Short Form (ICIQ‐UI SF), respectively. In all, 24 different validated questionnaires were administered in the 42 studies that used subjective outcome measure. Analyses of measures used in our trial showed that all measures were significantly correlated with each other except for pelvic floor muscle function. The ICIQ‐UI SF showed the highest correlation coefficients (0.587–0.733) with all outcome measures.ConclusionThe outcome measures used in recent trials were inconsistent. The ICIQ‐UI SF had the highest correlation with all measures in our trial; however, further studies evaluating correlation of measures in other patient cohorts are needed to corroborate our present results. We propose the use of ICIQ‐UI SF, as the most relevant outcome measure, in future trials evaluating efficacy of SUI interventions.
Low‐dose‐rate brachytherapy for prostate cancer: outcomes at >10 years of follow‐up
Authors: Lazarev Stanislav , Thompson Marcher R. , Stone Nelson N. , Stock Richard G. 
Published: January 2018

ObjectiveTo examine biochemical control, survival, and late morbidity with definitive low‐dose‐rate brachytherapy (LDR‐BT) for patients with prostate cancer surviving for >10 years after treatment.Patients and MethodsWe identified 757 men with localised prostate cancer who underwent definitive LDR‐BT in the period 1990–2006 and were followed for >10 years at our institution. Biochemical failure‐free survival (BFFS), distant metastases‐free survival (DMFS), prostate cancer‐specific survival (PCSS), and overall survival (OS) were selected as study endpoints. Survival was examined using the log‐rank test, Kaplan–Meier method, and Cox regression modelling. Urinary, quality of life (QoL), and potency scores at baseline and last follow‐up were recorded.ResultsThe median follow‐up was 12.5 years (range, 10.1–21.8 years). At the time of analysis, 88.6% of patients were alive, 1.5% died from prostate cancer and 13.9% developed biochemical failure, with 82% of failures occurring in the first decade of follow‐up. Overall, 2.3% developed distant metastases. On multivariate analyses, stage T3a–T3b, prostate‐specific antigen level of >20 ng/mL, intermediate‐ and high‐risk disease predicted worse BFFS; whereas age >70 years at diagnosis and stage T3a–T3b predicted worse OS. A total biologically effective dose of ≥150 Gy and androgen‐deprivation therapy were associated with improved BFFS, but not OS. The overall 17‐year rates for BFFS, DMFS, PCSS, and OS were 79, 97, 97, and 72%, respectively. Respective 17‐year BFFS rates for low‐, intermediate‐ and high‐risk patients were 86, 80, and 65% (P < 0.001), whereas OS rates for the same groups were 82, 73, and 60%, respectively (P = 0.09). Amongst those patients who were potent at baseline, 25% remained potent at the last follow‐up. Urinary function and QoL were mainly unaffected.ConclusionsLDR‐BT yields excellent survival rates, with a 17‐year PCSS rate of 97%. In all, 18% of patients with biochemical relapse failed at >10 years after implantation, which justifies their continued follow‐up.