bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adenosine Receptor Adora2b Plays a Mechanistic Role in the Protective Effect of the Volatile Anesthetic Sevoflurane during Liver Ischemia/Reperfusion
Authors: Granja Tiago F. , Köhler David , Schad Jessica , de Oliveira Franz Claudia Bernardo , Konrad Franziska , Hoch-Gutbrod Michaela , Streißenberger Ariane , Rosenberger Peter , Straub Andreas 
Published: July 2016

Abstract

Background
Liver ischemia/reperfusion (IR) injury is characterized by hepatic tissue damage and an inflammatory response. This is accompanied by the formation and vascular sequestration of platelet–neutrophil conjugates (PNCs). Signaling through Adora2b adenosine receptors can provide liver protection. Volatile anesthetics may interact with adenosine receptors. This study investigates potential antiinflammatory effects of the volatile anesthetic sevoflurane during liver IR.

Methods
Experiments were performed ex vivo with human blood and in a liver IR model with wild-type, Adora2a−/−, and Adora2b−/− mice. The effect of sevoflurane on platelet activation, PNC formation and sequestration, cytokine release, and liver damage (alanine aminotransferase release) was analyzed using flow cytometry, luminometry, and immunofluorescence. Adenosine receptor expression in liver tissue was analyzed using immunohistochemistry and real-time polymerase chain reaction.

Results

Ex vivo experiments indicate that sevoflurane inhibits platelet and leukocyte activation (n = 5). During liver IR, sevoflurane (2 Vol%) decreased PNC formation 2.4-fold in wild-type (P < 0.05) but not in Adora2b−/− mice (n ≥ 5). Sevoflurane reduced PNC sequestration 1.9-fold (P < 0.05) and alanine aminotransferase release 3.5-fold (P < 0.05) in wild-type but not in Adora2b−/− mice (n = 5). In Adora2a−/− mice, sevoflurane also inhibited PNC formation and cytokine release. Sevoflurane diminished cytokine release (n ≥ 3) and increased Adora2b transcription and expression in liver tissue of wild-types (n = 4).

Conclusions
Our experiments highlight antiinflammatory and tissue-protective properties of sevoflurane during liver IR and reveal a mechanistic role of Adora2b in sevoflurane-associated effects. The targeted use of sevoflurane not only as an anesthetic but also to prevent IR damage is a promising approach in the treatment of critically ill patients.
Alleviating Bone Cancer–induced Mechanical Hypersensitivity by Inhibiting Neuronal Activity in the Anterior Cingulate Cortex
Authors: Chiou Chiuan-Shiou , Chen Chien-Chung , Tsai Tsung-Chih , Huang Chiung-Chun , Chou Dylan , Hsu Kuei-Sen 
Published: July 2016

AbstractBackgroundThe anterior cingulate cortex (ACC) is a brain region that has been critically implicated in the processing of pain perception and modulation. While much evidence has pointed to an increased activity of the ACC under chronic pain states, less is known about whether pain can be alleviated by inhibiting ACC neuronal activity.MethodsThe authors used pharmacologic, chemogenetic, and optogenetic approaches in concert with viral tracing technique to address this issue in a mouse model of bone cancer–induced mechanical hypersensitivity by intratibia implantation of osteolytic fibrosarcoma cells.ResultsBilateral intra-ACC microinjections of γ-aminobutyric acid receptor type A receptor agonist muscimol decreased mechanical hypersensitivity in tumor-bearing mice (n =10). Using adenoviral-mediated expression of engineered Gi/o-coupled human M4 (hM4Di) receptors, we observed that activation of Gi/o-coupled human M4 receptors with clozapine-N-oxide reduced ACC neuronal activity and mechanical hypersensitivity in tumor-bearing mice (n = 11). In addition, unilateral optogenetic silencing of ACC excitatory neurons with halorhodopsin significantly decreased mechanical hypersensitivity in tumor-bearing mice (n = 4 to 9), and conversely, optogenetic activation of these neurons with channelrhodopsin-2 was sufficient to provoke mechanical hypersensitivity in sham-operated mice (n = 5 to 9). Furthermore, we found that excitatory neurons in the ACC send direct descending projections to the contralateral dorsal horn of the lumbar spinal cord via the dorsal corticospinal tract.ConclusionsThe findings of this study indicate that enhanced neuronal activity in the ACC contributes to maintain bone cancer–induced mechanical hypersensitivity and suggest that the ACC may serve as a potential therapeutic target for treating bone cancer pain.
Randomized Trial of Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults*
Authors: Janz David R. , Semler Matthew W. , Lentz Robert J. , Matthews Daniel T. , Assad Tufik R. , Norman Brett C. , Keriwala Raj D. , Ferrell Benjamin A. , Noto Michael J. , Shaver Ciara M. , Richmond Bradley W. , Zinggeler Berg Jeannette , Rice Todd W. 
Published: July 2016

Objective:
To evaluate the effect of video laryngoscopy on the rate of endotracheal intubation on first laryngoscopy attempt among critically ill adults.

Design:
A randomized, parallel-group, pragmatic trial of video compared with direct laryngoscopy for 150 adults undergoing endotracheal intubation by Pulmonary and Critical Care Medicine fellows.

Setting:
Medical ICU in a tertiary, academic medical center.

Patients:
Critically ill patients 18 years old or older.

Interventions:
Patients were randomized 1:1 to video or direct laryngoscopy for the first attempt at endotracheal intubation.

Measurements and Main Results:
Patients assigned to video (n = 74) and direct (n = 76) laryngoscopy were similar at baseline. Despite better glottic visualization with video laryngoscopy, there was no difference in the primary outcome of intubation on the first laryngoscopy attempt (video 68.9% vs direct 65.8%; p = 0.68) in unadjusted analyses or after adjustment for the operator’s previous experience with the assigned device (odds ratio for video laryngoscopy on intubation on first attempt 2.02; 95% CI, 0.82–5.02, p = 0.12). Secondary outcomes of time to intubation, lowest arterial oxygen saturation, complications, and in-hospital mortality were not different between video and direct laryngoscopy.

Conclusions:
In critically ill adults undergoing endotracheal intubation, video laryngoscopy improves glottic visualization but does not appear to increase procedural success or decrease complications.
Blood Pressure– and Coronary Perfusion Pressure–Targeted Cardiopulmonary Resuscitation Improves 24-Hour Survival From Ventricular Fibrillation Cardiac Arrest
Authors: Naim Maryam Y. , Sutton Robert M. , Friess Stuart H. , Bratinov George , Bhalala Utpal , Kilbaugh Todd J. , Lampe Joshua W. , Nadkarni Vinay M. , Becker Lance B. , Berg Robert A. 
Published: July 2016

Objectives:
Treatment algorithms for cardiac arrest are rescuer centric and vary little from patient to patient. The objective of this study was to determine if cardiopulmonary resuscitation–targeted to arterial blood pressure and coronary perfusion pressure rather than optimal guideline care would improve 24-hour survival in a porcine model of ventricular fibrillation cardiac arrest.

Data Sources:
Preclinical animal laboratory using female 3-month-old swine.

Study Selection:
A randomized interventional study.

Data Extraction:
After induction of anesthesia and 7 minutes of untreated ventricular fibrillation, 16 female 3-month-old swine were randomized to 1) blood pressure care: titration of chest compression depth to a systolic blood pressure of 100 mm Hg and vasopressor dosing to maintain coronary perfusion pressure of greater than 20 mm Hg or 2) guideline care: chest compression depth targeted to 51 mm and standard guideline vasopressor dosing. Animals received manual cardiopulmonary resuscitation for 10 minutes before the first defibrillation attempt and standardized postresuscitation care for 24 hours.

Data Synthesis:
Twenty-four–hour survival was more likely with blood pressure care versus guideline care (0/8 vs 5/8; p < 0.03), and all survivors had normal neurologic examinations. Mean coronary perfusion pressure prior to defibrillation was significantly higher with blood pressure care (28 ± 3 vs 10 ± 6 mm Hg; p < 0.01). Chest compression depth was lower with blood pressure care (48 ± 0.4 vs 44 ± 0.5 mm Hg; p < 0.05), and the number of vasopressor doses was higher with blood pressure care (median, 3 [range, 1–7] vs 2 [range, 2–2]; p < 0.01).

Conclusions:
Individualized goal-directed hemodynamic resuscitation targeting systolic blood pressure of 100 mm Hg and coronary perfusion pressure of greater than 20 mm Hg improved 24-hour survival compared with guideline care in this model of ventricular fibrillation cardiac arrest.
Bone Failure in Critical Illness
Authors: Lee Paul , Nair Priya , Eisman John A. , Center Jacqueline R. 
Published: July 2016

Objectives:
The origin of systemic inflammatory response syndrome and multiple organ dysfunction syndrome is poorly understood but remains a fundamental concern in the ICU. This paper provides a critical appraisal on whether bone failure may represent an unrecognized component of systemic inflammatory response syndrome/multiple organ dysfunction syndrome.

Data Sources, Data Selection, and Data Extraction:
Search of the PubMed database and manual review of selected articles investigating bone pathophysiology in critical illness.

Data Synthesis:
Bone hyperresorption is highly prevalent among critically ill patients. Bone breakdown releases numerous systemically active cytokines and bone-sequestered toxins, with the capacity to fuel inflammatory hypercytokinaemia and metabolic toxaemia. Anti-resorptive medication inhibits bone break down and preadmission anti-resorptive use is associated with superior survival among critically ill patients.

Conclusions:
We propose that hyperresorptive bone failure is an unrecognised component of systemic inflammatory response syndrome/multiple organ dysfunction syndrome that is causal to critical illness progression. If this hypothesis is valid, bone preservative strategies could reduce the risk of osteoporosis/fractures among ICU survivors, as well as decreasing critical illness mortality.
Acetaminophen-Induced Changes in Systemic Blood Pressure in Critically Ill Patients: Results of a Multicenter Cohort Study
Authors: Cantais Aymeric , Schnell David , Vincent François , Hammouda Zeineb , Perinel Sophie , Balichard Sarah , Abroug Fekri , Zeni Fabrice , Meziani Ferhat , Bornstain Caroline , Darmon Michael 
Published: July 2016

Objectives:
We sought to assess the incidence of acetaminophen-induced hypotension. Our secondary objectives were to describe systemic hemodynamic changes and factors associated with this complication.

Design:
Prospective observational study.

Setting:
Three ICUs.

Patients:
Adult patients requiring IV acetaminophen infusion. Arterial pressure was monitored via an arterial catheter for 3 hours. Hypotension was defined as a decrease in the mean arterial pressure of greater than or equal to 15% compared with the baseline.

Results:
Overall, 160 patients were included in this study. Eighty-three patients (51.9%) experienced acetaminophen-induced hypotension according to our definition. In patients with acetaminophen-induced hypotension, the nadir mean arterial pressure was 64 mm Hg (95% CI, 54–74). Hypotension was observed 30 minutes (95% CI, 15–71) after acetaminophen infusion. Changes in mean arterial pressure were closely correlated with decreases in the diastolic arterial pressure (r
2 = 0.92) and to a lesser extent with changes in the pulse pressure (r
2 = 0.18) and heart rate (r
2 = 0.09). Changes in the body temperature were not correlated with changes in mean arterial pressure (r
2 = 0.0002; p = 0.85). None of the patients’ baseline characteristics (shock, use of angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers, lactates, renal replacement therapy, chronic heart disease, and indication for acetaminophen infusion) or clinically relevant characteristics (baseline severity according to Logistic Organ Dysfunction score, need for vasopressors, use of antihypertensive agents, need for mechanical ventilation, or changes in the body temperature) were independently associated with acetaminophen-induced hypotension. Among patients with acetaminophen-induced hypotension, 29 (34.9%) required therapeutic intervention.

Conclusions:
Half of the patients who received IV injections of acetaminophen developed hypotension, and up to one third of the observed episodes necessitated therapeutic intervention. Adequately powered randomized studies are needed to confirm our findings, provide an accurate estimation of the consequences of acetaminophen-induced hypotension, and assess the pathophysiologic mechanisms involved.
Folliculocentric Lichen Sclerosus et Atrophicus in a 10-Year-Old Girl
Authors: El Habr Constantin , Mannava Kathleen , Koch Sara , Tull Rechelle , Goiburu-Chenu Belen , Strowd Lindsay , Sangueza Omar 
Published: July 2016

Abstract:Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory scarring disease with a predilection for the anogenital area; however, 15%–20% of LSA cases are extragenital. The folliculocentric variant is rarely reported and less well understood. The authors report a rare case of extragenital, folliculocentric LSA in a 10-year-old girl. The patient presented to the dermatology clinic for evaluation of an asymptomatic eruption of the arms and legs, with no vaginal or vulvar involvement. Physical examination revealed the presence of numerous 2–4 mm, mostly perifollicular, hypopigmented, slightly atrophic papules and plaques. Many of the lesions had a central keratotic plug. Cutaneous histopathological examination showed features of LSA. Based on clinical and histological findings, folliculocentric extragenital LSA was diagnosed.
An Update on the Level of Evidence for Plastic Surgery Research Published in Plastic and Reconstructive Surgery
Authors: Nguyen Anson , Mahabir Raman C. 
Published: July 2016

Summary:
In 2011, Plastic and Reconstructive Surgery (PRS) implemented a level-of-evidence (LOE) pyramid to bring attention to evidence-based medicine and to promote quality of research. The objective of our study was to examine the current, overall quality of plastic surgery research when compared with that of the previous 30 years. Articles from PRS published in 2013 were culled for information, including LOE based on the assigned score from the LOE pyramid. (Animal, cadaver, and basic science studies; reviews; correspondence; and continuing medical education articles were excluded.) The LOE grades were compared with those from 1983, 1993, and 2003. In 2013, 536 articles were published in PRS; of these, 247 met the inclusion criteria and were included in the analysis. The mean LOE in PRS for 2013 was 3.42. For the year 2003, the mean LOE was 4.16; 1993, 4.25; and 1983, 4.42. Analysis of variance indicated significant improvement in research quality over time (P < 0.001). In 2014, 216 of 489 published articles met the inclusion criteria. The mean LOE of PRS articles in 2014 was 3.33, demonstrating continued higher LOE. There was also a decrease in the percentage of level IV and V studies to 47.2% (from 51.4% in 2013), whereas higher quality level I and II studies had increased to 18.1% (from 17.4%). The quality of plastic surgery research has shown a continued upsurge as evidenced by overall improvement in LOE in published articles over the past 3 decades.
First Experience With the ICD 16.5 Mini-Scleral Lens for Optic and Therapeutic Purposes
Authors: Suarez Cyrielle , Madariaga Virginie , Lepage Benoît , Malecaze Marie , Fournié Pierre , Soler Vincent , Galiacy Stéphane , Mély René , Cassagne Myriam , Malecaze François 
Published: July 2016

Objectives:
To evaluate the success rate, efficacy, and safety of the ICD 16.5 mini-scleral gas permeable (GP) contact lens.

Methods:
This prospective study included referred consecutive patients with irregular corneas and severe ocular surface disease (OSD) in treatment failure. All patients were fitted with the ICD 16.5 mini-scleral GP lens. Even though we had some limited experience with scleral lenses, it was our first experience with the ICD 16.5 mini-scleral GP lens. Efficacy was assessed by comparing best-corrected visual acuity (BCVA) with the mini-scleral lens to baseline BCVA. A subjective visual functioning questionnaire (comfort score, visual quality score, handling rating, and wearing time) was administered in a face-to-face structured interview.

Results:
Thirty-nine eyes of 23 patients with a mean age of 43±16 years were included. Fitting indications were keratoconus (46%), post-penetrating keratoplasty (21%), other irregular astigmatism (15%), and severe OSD (18%). Twenty-five eyes (64%) were successfully fitted with an 18-month follow-up. The mini-scleral GP lens BCVA was 0.16 logarithm of the minimum angle of resolution (logMAR; 20/25) versus a baseline BCVA of 0.44 logMAR (20/63; P<0.001). Comfort and visual quality scores were 8.5/10 and 7.5/10, respectively. No complications were detected in 96% of the eyes (95% confidence interval, 76.1%–99.4%). One eye experienced corneal graft swelling.

Conclusions:
The present findings suggest that the ICD 16.5 mini-scleral GP lens is an effective and safe alternative for managing challenging corneas in a therapeutic impasse.
Floppy Eyelid Syndrome and Its Determinants in Iranian Adults: A Population-Based Study
Authors: Hashemi Hassan , Rastad Hadith , Emamian Mohammad Hassan , Fotouhi Akbar 
Published: July 2016

Objectives:
To estimate the prevalence of floppy eyelid syndrome (FES) and to determine the associated factors in a representative sample of Iranian adult population aged 45 to 69 years.

Methods:
The data were according to the second phase of Shahroud Eye Cohort Study performed in 2014 with 4,737 participants aged 45 to 69 years. Diagnosis of FES was made based on the clinical judgment of the ophthalmologist during ocular examinations. The percentage and confidence intervals (CIs) of the prevalence of FES were reported, and the associated factors were analyzed using simple and multiple logistic regression models.

Results:
In this study, 11.3% of the participants (6.7% of men and 14.6% of women) had FES in at least 1 eye. The prevalence of FES decreased with age. Floppy eyelid syndrome grades 1, 2, and 3 were observed in 72.8%, 21.6%, and 0.6% of the participants, respectively. Although the relationship between age and FES was not significant in men (odds ratio (OR)=0.98, 95% CI: 0.95–1.01), the odds of FES decreased significantly with an increase in age in women (OR=0.94, 95% CI: 0.92–0.96). Body mass index ≥25 (OR=1.65, 95% CI: 1.25–2.18), meibomian gland dysfunction (OR=1.47, 95% CI: 1.18–1.81), and hypertension (OR=1.84, 95% CI: 1.46–2.31) had significant associations with FES.

Conclusion:
The prevalence of FES was 11.3%, and 72.8% of the participants had grade 1 FES. Significant associations were found between FES and other eyelid disorders. Floppy eyelid syndrome was more prevalent in younger women.
Clinical and Microbiological Profile of Bacterial Microbial Keratitis in a Portuguese Tertiary Referral Center—Where Are We in 2015?
Authors: Ferreira Carla Sofia , Figueira Luis , Moreira-Gonçalves Nuno , Moreira Raúl , Torrão Luis , Falcão-Reis Fernando 
Published: July 2016

Objectives:
To study the microbial profile, antibiotic susceptibility pattern, risk factors, therapeutic trends, and clinical outcomes for microbial keratitis (MK) in a tertiary health care center.

Methods:
All cases with suspected bacterial keratitis that were followed at consultation from September 2007 to August 2015 were included. Microbial cultures were obtained and patients were managed following an internal protocol.

Results:
Two hundred thirty-five patients were included, with a mean age of 50.01±20.73 years. We obtained a 38.4% culture-positive rate, with higher proportion of gram-positives (70.8%). The commonest agents were Staphylococcus aureus (23.1%), Corynebacterium macginleyi (20.0%), and Pseudomonas aeruginosa (13.8%). Fluoroquinolone susceptibility was 97%, with no trend toward its decrease. A total of 95.7% had local risk factors, being trauma and contact lens wear the most common (28.9% each), with different age and pathogens distributions (P<0.001). Topical fluoroquinolones were first-line treatment in 99%, in association with aminoglycosides in 81.6%. Good initial response was registered in 95.9%, but 4.1% needed to step up treatment to fortified antibiotics, mainly if Pseudomonas (P=0.021). Good outcome was achieved in 81.8%, negatively affected by exposure and herpetic keratitis (P<0.001), central location (P=0.01), presence of Tyndall (P<0.001), corneal edema (P<0.001), and worse initial best-corrected visual acuity (P<0.001), but not Pseudomonas isolate (P=0.724).

Conclusions:
Gram-positives are the most frequent pathogens and shifting trends in the isolate distribution or emergence of resistant strains were not demonstrated. The susceptibility to first-line antibiotic agents remained high. We suggest a more aggressive approach to P. aeruginosa cases or MK presenting with poor outcome variables.
Clinical Outcomes of Ruptured Periorbital and Orbital Dermoid Cysts
Authors: Siah We Fong , Al-Muhaylib Ahmed A. , Rajak Saul , Ziahosseini Kimia , Selva Dinesh , Malhotra Raman , Alsuhaibani Adel H. 
Published: July 2016

Purpose:
To evaluate the clinical outcomes of ruptured dermoid cysts.

Methods:
A multicenter, retrospective study of all cases of periorbital and orbital dermoid cysts with histopathological evidence of rupture, including those with clinical rupture, was performed over a 10-year period. Demographics and clinical outcomes of ruptured dermoid cysts were recorded. Persistent inflammation was defined as the presence of edema, erythema, and discomfort for at least 28 days.

Results:
Eighty-six cases of dermoid cysts were identified. Median age was 5.5 (range, 1–63) years. Location of cyst was either periorbital (n = 60, 70%) or orbital (n = 26, 30%). There were 29 cases with clinically apparent rupture: 27 surgically ruptured (93%) and 2 spontaneous rupture (7%). Persistent inflammation was found in 1 spontaneous cyst rupture case (50%) and 1 surgically ruptured cyst (3.7%). Older age (p = 0.01) and bony attachment (p = 0.001) were significant factors for cyst rupture, while there was no influence from cyst location (p = 0.14).

Conclusions:
Persistent inflammation is uncommon after surgical rupture of dermoid cysts, but likely after spontaneous rupture. Older age and bony attachment are risk factors for cyst rupture.