bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Analgesic Efficacy of Intra‐Articular Acetaminophen in an Experimental Model of Carrageenan‐Induced Arthritis
Authors: Arun Oguzhan , Canbay Ozgur , Celebi Nalan , Sahin Altan , Konan Ali , Atilla Pergin , Aypar Ulku 
Published: March 2016

BACKGROUND: Acetaminophen is one of the most common drugs used for the treatment of pain and fever.OBJECTIVES: To examine the effects of intra‐articular (IA) acetaminophen on carrageenan‐induced arthritic pain‐related behaviour and spinal c‐Fos expression in rats.METHODS: The present study was performed using 20 Sprague Dawley rats. Forty microlitres of IA 0.9% NaCl was injected in the control group, and 40 μL of IA carrageenan was injected in the carrageenan group. One hour after carrageenan injection, 400 μg of IA acetaminophen was injected in the IA acetaminophen group, and 400 μg of intraperitoneal (IP) acet‐aminophen was injected in the IP acetaminophen group. One day before injection, and 4 h and 8 h after injection, diameters of both knee joints, motility of the rat, paw loading and joint mobility were assessed. After the rats were euthanized, L3 and L4 spinal segments were excised for c‐Fos assessment.RESULTS: IA acetaminophen decreased both the severity and distribution of c‐Fos expression. IP acetaminophen decreased only the distribution of c‐Fos expression. IA acetaminophen decreased knee diameter at 8 h. IA and IP acetaminophen increased rat motility and paw loading scores. Joint mobility scores of IP acetaminophen were similar to saline at 8 h.CONCLUSIONS: Results of the present study indicate an analgesic and/or possible anti‐inflammatory effect of IA acetaminophen and provide further evidence on the efficacy of systemic acetaminophen injection in reducing arthritic pain.
In a ‘Real-World’, Clinic-Based Community Setting, Sorafenib Dose of 400 mg/day is as Effective as Standard Dose of 800 mg/day in Patients with Advanced Hepatocellular Carcimona, with Better Tolerance and Similar Survival
Authors: Shingina Alexandra , Hashim Al Moutaz , Haque Mazhar , Suen Michael , Yoshida Eric M , Gill Sharlene , Donnellan Fergal , Weiss Alan A 
Published: March 2016

BACKGROUND: Sorafenib, an oral multityrosine kinase inhibitor, has been approved for treatment of unresectable hepatocellular carcinoma (HCC). British Columbia (BC) was the first province in Canada to provide drug coverage for sorafenib.OBJECTIVE: To review the BC experience with sorafenib to assess its effectiveness and tolerance in a ‘real-world’ clinical setting.METHODS: A retrospective clinic chart review identified 99 patients referred to the BC Cancer Agency from 2008 to 2010 with a diagnosis of HCC who qualified for treatment with sorafenib.RESULTS: Therapy with sorafenib was initiated and continued at a reduced dosage of 400 mg/day in 66 of 99 patients, with 22 patients requiring further dose reduction. Full- and reduced-dose group patients had similar baseline characteristics, except for a higher proportion of female patients (P=0.02) and individuals with alcoholic liver disease (P=0.04) in the full-dose group. The incidence of any grade of adverse effects was higher in the full-dose group (94% versus 77% in the reduced-dose group; P=0.04). Dose reduction rates were significantly higher in the full-dose group, occurring in 66% versus 24% of reduced-dose group patients (P=0.001). The overall survival rates were similar between the two groups: 7.8 months versus 7.1 months in full- versus reduced-dose groups (P=0.14), as were radiological progression rates and alpha-fetoprotein levels.CONCLUSIONS: In a review of 99 patients in a ‘real-world’ community setting, a sorafenib dose of 400 mg/day was better tolerated and had similar efficacy compared with a sorafenib dose of 800 mg/day with respect to survival and outcomes.
Immunoglobulin G4-Related Pancreatic and Biliary Diseases
Authors: Al-Dhahab Hisham , McNabb-Baltar Julia , Al-Busafi Said , Barkun Alan N 
Published: March 2016

BACKGROUND: Autoimmune pancreatitis and autoimmune cholangitis are new clinical entities that are now recognized as the pancreaticobiliary manifestations of immunoglobulin (Ig) G4-related disease.OBJECTIVE: To summarize important clinical aspects of IgG4-related pancreatic and biliary diseases, and to review the role of IgG4 in the diagnosis of autoimmune pancreatitis (AIP) and autoimmune cholangitis (AIC).METHODS: A narrative review was performed using the PubMed database and the following keywords: “IgG4”, “IgG4 related disease”, “autoimmune pancreatitis”, “sclerosing cholangitis” and “autoimmune cholangitis”. A total of 955 articles were retrieved; of these, 381 contained relevant data regarding the IgG4 molecule, pathogenesis of IgG-related diseases, and diagnosis, management and long-term follow-up for patients with AIP and AIC. Of these 381 articles, 66 of the most pertinent were selected.RESULTS: The selected studies demonstrated the increasing clinical importance of both AIP and AIC, which can mimic pancreatic cancer and cholangiocarcinoma, respectively. IgG4 titration in tissue or blood cannot be used alone to diagnose all IgG4-related diseases; however, it is often a useful adjunct to clinical, radiological and histological features. AIP and AIC respond to steroids; however, relapse is common and long-term maintenance treatment often required.CONCLUSIONS: A review of the diagnosis and management of both AIC and AIP is timely and pertinent to clinical practice because the amount of information regarding these conditions has increased substantially in the past few years, resulting in significant impact on the clinical management of affected patients.
Diagnostic Value of Stool Dna Testing for Multiple Markers Of Colorectal Cancer and Advanced Adenoma: A Meta-Analysis
Authors: Yang Hua , Xia Bing-Qing , Jiang Bo , Wang Guozhen , Yang Yi-Peng , Chen Hao , Li Bing-Sheng , Xu An-Gao , Huang Yun-Bo , Wang Xin-Ying 
Published: March 2016

BACKGROUND AND OBJECTIVES: The diagnostic value of stool DNA (sDNA) testing for colorectal neoplasms remains controversial. To compensate for the lack of large-scale unbiased population studies, a meta-analysis was performed to evaluate the diagnostic value of sDNA testing for multiple markers of colorectal cancer (CRC) and advanced adenoma.METHODS: The PubMed, Science Direct, Biosis Review, Cochrane Library and Embase databases were systematically searched in January 2012 without time restriction. Meta-analysis was performed using a random-effects model using sensitivity, specificity, diagnostic OR (DOR), summary ROC curves, area under the curve (AUC), and 95% CIs as effect measures. Heterogeneity was measured using the χ2test and Q statistic; subgroup analysis was also conducted.RESULTS: A total of 20 studies comprising 5876 individuals were eligible. There was no heterogeneity for CRC, but adenoma and advanced adenoma harboured considerable heterogeneity influenced by risk classification and various detection markers. Stratification analysis according to risk classification showed that multiple markers had a high DOR for the high-risk subgroups of both CRC (sensitivity 0.759 [95% CI 0.711 to 0.804]; specificity 0.883 [95% CI 0.846 to 0.913]; AUC 0.906) and advanced adenoma (sensitivity 0.683 [95% CI 0.584 to 0.771]; specificity 0.918 [95% CI 0.866 to 0.954]; AUC 0.946) but not for the average-risk subgroups of either. In the methylation subgroup, sDNA testing had significantly higher DOR for CRC (sensitivity 0.753 [95% CI 0.685 to 0.812]; specificity 0.913 [95% CI 0.860 to 0.950]; AUC 0.918) and advanced adenoma (sensitivity 0.623 [95% CI 0.527 to 0.712]; specificity 0.926 [95% CI 0.882 to 0.958]; AUC 0.910) compared with the mutation subgroup. There was no significant heterogeneity among studies for subgroup analysis.CONCLUSION: sDNA testing for multiple markers had strong diagnostic significance for CRC and advanced adenoma in high-risk subjects. Methylation makers had more diagnostic value than mutation markers.
Asthma Education Program for First Nations Children: An exemplar of the Knowledge‐to‐Action Framework
Authors: Douglas Maureen L , McGhan Shawna L , Tougas Danielle , Fenton Nancy , Sarin Christopher , Latycheva Oxana , Befus A Dean 
Published: March 2016

BACKGROUND: The prevalence of asthma in Aboriginal children is 6% to 14%. Gaps in knowledge regarding asthma and its management exist in First Nations (FN) communities, and culturally relevant education and resources are required. Studies have recommended that the children’s asthma education program, the ‘Roaring Adventures of Puff’, be modified through partnership with FN communities to be culturally appropriate.OBJECTIVE: To adapt this knowledge tool and design an effective implementation process for FN knowledge users (children with asthma and care providers), guided by the Canadian Institutes of Health Research knowledge translation framework.METHODS: The problem was identified, knowledge was identified/reviewed/selected (literature review); knowledge was adapted to the local context (FN working and advisory groups); barriers to knowledge use were assessed (by knowledge users); and interventions were selected, tailored and implemented (modified curricula and the creation of a new activity book and web‐based resources, and regional coordinators, asthma educator mentors and community teams were recruited).RESULTS: Major outcomes were the adapted tools and blueprints for tailoring implementation. Additional outcomes were preliminary observations and outputs from the iterative processes, including information about local context and barriers. Specific additions were roles for community members supported by asthma educators (applying FN teaching models and addressing health care demands); relevant triggers (addressing knowledge gaps); and FN images and stories, themes of circle, sacred teachings, nature and family/elders (culture and addressing low reading levels).CONCLUSION: The framework model provides a logical, valuable tool for adapting a knowledge tool and implementation process to new knowledge users. Future research should measure uptake, effect on health outcomes of FN asthma sufferers and sustainability.
The Appropriateness of Surveillance Colonoscopy Intervals after Polypectomy
Authors: Schreuders Eline , Nicolaas Jerome Sint , de Jonge Vincent , van Kooten Harmke , Soo Isaac , Sadowski Daniel , Wong Clarence , van Leerdam Monique E , Kuipers Ernst J , van Zanten Sander JO Veldhuyzen 
Published: March 2016

BACKGROUND: Adherence to surveillance colonoscopy guidelines is important to prevent colorectal cancer (CRC) and unnecessary workload.OBJECTIVE: To evaluate how well Canadian gastroenterologists adhere to colonoscopy surveillance guidelines after adenoma removal or treatment for CRC.METHODS: Patients with a history of adenomas or CRC who had surveillance performed between October 2008 and October 2010 were retrospectively included. Time intervals between index colonoscopy and surveillance were compared with the 2008 guideline recommendations of the American Gastroenterological Association and regarded as appropriate when the surveillance interval was within six months of the recommended time interval.RESULTS: A total of 265 patients were included (52% men; mean age 58 years). Among patients with a normal index colonoscopy (n=110), 42% received surveillance on time, 38% too early (median difference = 1.2 years too early) and 20% too late (median difference = 1.0 year too late). Among patients with nonadvanced adenomas at index (n=96), 25% underwent surveillance on time, 61% too early (median difference = 1.85) and 14% too late (median difference = 1.1). Among patients with advanced neoplasia at index (n=59), 29% underwent surveillance on time, 34% too early (median difference = 1.86) and 37% later than recommended (median difference = 1.61). No significant difference in adenoma detection rates was observed when too early surveillance versus appropriate surveillance (34% versus 33%; P=0.92) and too late surveillance versus appropriate surveillance (21% versus 33%; P=0.11) were compared.CONCLUSION: Only a minority of surveillance colonoscopies were performed according to guideline recommendations. Deviation from the guidelines did not improve the adenoma detection rate. Interventions aimed at improving adherence to surveillance guidelines are needed.
Postoperative Delirium in the Intensive Care Unit Predicts Worse Outcomes in Liver Transplant Recipients
Authors: Lescot Thomas , Karvellas Constantine J , Chaudhury Prosanto , Tchervenkov Jean , Paraskevas Steven , Barkun Jeffrey , Metrakos Peter , Goldberg Peter , Magder Sheldon 
Published: March 2016

BACKGROUND: Delirium is common in intensive care unit patients and is associated with worse outcome.OBJECTIVE: To identify early risk factors for delirium in patients admitted to the intensive care unit following orthotopic liver transplantation (OLT).METHODS: An observational study of patients admitted to the intensive care unit from January 2000 to May 2010 for elective or semi-elective OLT was conducted. The primary end point was delirium in the intensive care unit. Pre- and post-transplantation and intraoperative factors potentially associated with this outcome were examined.RESULTS: Of the 281 patients included in the study, 28 (10.03%) developed delirium in the intensive care unit at a median of two days (interquartile range one to seven days) after OLT. According to multivariate analysis, independent risk factors for delirium were intraoperative transfusion of packed red blood cells (OR 1.15 [95% CI 1.01 to 1.18]), renal replacement therapy during the pretransplantation period (OR 13.12 [95% CI 2.82 to 72.12]) and Acute Physiologic and Health Evaluation (APACHE) II score (OR per unit increase 1.10 [95% CI 1.03 to 1.29]). Using Cox proportional hazards models adjusted for baseline covariates, delirium was associated with an almost twofold risk of remaining in hospital, a fourfold increased risk of dying in hospital and an almost threefold increased rate of death by one year.CONCLUSION: Intraoperative transfusion of packed red blood cells, pretransplantation renal replacement therapy and APACHE II score are predictors for the development of delirium in intensive care unit patients post-OLT and are associated with increased hospital lengths of stay and mortality.
Detection of Adult Celiac Disease Using Duodenal Screening Biopsies Over a 30-Year Period
Authors: Freeman Hugh James 
Published: March 2016

BACKGROUND: Serological studies suggest that celiac disease may be present in approximately 0.5% to 1% of the North American population. Screening data based on small intestinal biopsy performed during routine endoscopic evaluations are not available.METHODS: Patients referred between January 1982 and December 2011 for evaluation of gastrointestinal symptoms and requiring elective investigative upper endoscopic evaluation underwent duodenal biopsies to determine whether changes of adult celiac disease were present.RESULTS: A total of 9665 patients, including 4008 (41.5%) males and 5657 (68.5%) females, underwent elective endoscopies and duodenal biopsies. Of these, 234 (2.4%) exhibited changes of celiac disease including 73 males (1.8%) and 161 females (2.8%). During the first 20 years, the number of biopsy-positive patients in five-year intervals progressively decreased and, subsequently, during the next 10 years, the number progressively increased.CONCLUSIONS: Celiac disease is far more common in specialist practice than has been suggested in the evaluation of healthy populations using serological screening studies. Endoscopic duodenal biopsy is an important method of identifying underlying celiac disease and should be routinely considered in all patients undergoing an elective endoscopic evaluation. Noninherited factors, possibly environmental, may play a role in the appearance of biopsy-defined celiac disease and alter detection over time.
The Epidemiology of Hepatitis C in a Canadian Indigenous Population
Authors: Uhanova Julia , Tate Robert B , Tataryn Douglas J , Minuk Gerald Y 
Published: March 2016

BACKGROUND An estimated 1% to 1.9% of North Americans are infected with the hepatitis C virus (HCV). Although Indigenous peoples are considered to bear the highest burden, there are only limited data regarding the demographic features and epidemiology of hepatitis C in this population.OBJECTIVES: To document the demographic characteristics, rates of newly diagnosed hepatitis C cases and prevalence of HCV infection in a Canadian First Nations population, and to compare the findings with an infected non-First Nations population.METHODS: A research database spanning 1991 to 2002 was developed, linking records from multiple clinical and administrative sources. Over a 12-year period, 671 First Nations and 4347 non-First Nations HCV-positive Canadians were identified in the province of Manitoba. Demographics, residence and time trends were compared between infected First Nations and non-First Nations persons.RESULTS: HCV-infected First Nations individuals were younger (mean [± SD] age 33.0±0.4 years versus 39.7±0.2 years; P<0.0001), more often female (60% versus 40%; P<0.0001) and more often resided in urban centres (73% versus 27%; P<0.001). The rate of newly diagnosed HCV cases was 2.5-fold (91.1 per 100,000 versus 36.6 per 100,000; P<0.000) and prevalence 2.4-fold (801.7 per 100,000 versus 334.8 per 100,000; P<0.000) higher among the First Nations relative to non-First Nations populations.CONCLUSIONS: The results of the present large population-based study indicate that the First Nations population with hepatitis C is characteristically different from infected non-First Nations persons. The results also describe higher rates of newly diagnosed cases and prevalence of HCV infection in the First Nations population. These findings should serve as an important baseline for future primary prevention and therapeutic intervention strategies in this high-risk population.
Evolution of the COPD Assessment Test Score during Chronic Obstructive Pulmonary Disease Exacerbations: Determinants and Prognostic Value
Authors: Feliz-Rodriguez Darwin , Zudaire Santiago , Carpio Carlos , Martínez Elizabet , Gómez-Mendieta Antonia , Santiago Ana , Alvarez-Sala Rodolfo , García-Río Francisco 
Published: March 2016

BACKGROUND: An adequate evaluation of exacerbations is a primary objective in managing patients with chronic obstructive pulmonary disease (COPD).OBJECTIVES: To define the profile of health status recovery during severe exacerbations of COPD using the COPD Assessment Test (CAT) questionnaire and to evaluate its prognostic value.METHODS: Forty‐five patients with previous COPD diagnoses who were hospitalized due to severe exacerbation(s) were included in the study. These patients were treated by their respective physicians following current recommendations; health status was assessed daily using the CAT questionnaire. The CAT score, spirometry and recurrent hospitalizations were recorded one and three months after hospital discharge.RESULTS: Global initiative for chronic Obstructive Lung Disease (GOLD) stage was an independent determinant for increased CAT score during the first days of exacerbation with respect to postexacerbation values. From hospitalization day 5, the CAT score was similar to that obtained in the stable phase. Body mass index, GOLD stage and education level were related to health status recovery pattern. CAT score increase and the area under the curve of CAT recovery were inversely related to the forced expiratory volume in 1 s achieved three months after discharge (r= −0.606; P<0.001 and r= −0.532; P<0.001, respectively). Patients with recurrent hospitalizations showed higher CAT score increases and slower recovery.CONCLUSIONS: The CAT detects early health status improvement during severe COPD exacerbations. Its initial worsening and recovery pattern are related to lung function and recurrent hospitalizations.
Percutaneous Liver Biopsy Practice Patterns Among Canadian Hepatologists
Authors: Aljawad Mohammed , Yoshida Eric M , Uhanova Julia , Marotta Paul , Chandok Natasha 
Published: March 2016

BACKGROUND: Percutaneous liver biopsy (PLB) is the standard procedure to obtain histological samples essential for the management of various liver diseases. While safe, many hepatologists no longer perform their own PLBs; the reasons for this practice shift are unknown.OBJECTIVE: To describe the attitudes, practice patterns and barriers to PLB among hepatologists in Canada.METHODS: A survey was distributed to all hepatologists in Canada.RESULTS: Thirty-two of 40 (80%) hepatologists completed the survey; the majority of respondents were male (72%) and had been in practice for >5 years in an academic setting. Fifty-six per cent of hepatologists referred all PLBs to radiology, and only 19% of hepatologists reported performing their own PLBs most or all of the time. There were no sex differences nor were there differences based on years in practice. Fifty per cent of respondents who performed PLB routinely used ultrasound, and PLBs are performed in equal frequency in an ambulatory procedure area (50%) versus the endoscopy suite (36%). For almost one-half of hepatologists (47%), their performance of PLBs decreased in the past five years. The majority of respondents at an academic centre (75%) reported access to FibroScan (Echosens, France), and most estimated a resultant 25% to 50% reduction in the need for PLBs. Lack of resources, patient preference and suboptimal reimbursement were the most common reasons cited for not performing PLBs.CONCLUSION: Most hepatologists in Canada do not perform PLBs to the extent that they did in the past, but refer to radiology. The reasons for this shift in practice include lack of resources, improved perception of safety and patient preference. Where available, FibroScan resulted in a perceived 25% to 50% reduction in required liver biopsies.