bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bedside Glucose Monitoring—Is it Safe? A New, Regulatory-Compliant Risk Assessment Evaluation Protocol in Critically Ill Patient Care Settings*
Authors: DuBois Jeffrey Anton , Slingerland Robbert Jan , Fokkert Marion , Roman Alain , Tran Nam Khoa , Clarke William , Sartori David Alan , Palmieri Tina Louise , Malic Andrei , Lyon Martha Elizabeth , Lyon Andrew William 
Published: February 2017

Objectives:
New data have emerged from ambulatory and acute care settings about adverse patient events, including death, attributable to erroneous blood glucose meter measurements and leading to questions over their use in critically ill patients. The U.S. Food and Drug Administration published new, more stringent guidelines for glucose meter manufacturers to evaluate the performance of blood glucose meters in critically ill patient settings. The primary objective of this international, multicenter, multidisciplinary clinical study was to develop and apply a rigorous clinical accuracy assessment algorithm, using four distinct statistical tools, to evaluate the clinical accuracy of a blood glucose monitoring system in critically ill patients.

Design:
Observational study.

Setting:
Five international medical and surgical ICUs.

Patients:
All patients admitted to critical care settings in the centers.

Interventions:
None.

Measurements and Main Results:
Glucose measurements were performed on 1,698 critically ill patients with 257 different clinical conditions and complex treatment regimens. The clinical accuracy assessment algorithm comprised four statistical tools to assess the performance of the study blood glucose monitoring system compared with laboratory reference methods traceable to a definitive standard. Based on POCT12-A3, the Clinical Laboratory Standards Institute standard for hospitals about hospital glucose meter procedures and performance, and Parkes error grid clinical accuracy performance criteria, no clinically significant differences were observed due to patient condition or therapy, with 96.1% and 99.3% glucose results meeting the respective criteria. Stratified sensitivity and specificity analysis (10 mg/dL glucose intervals, 50–150 mg/dL) demonstrated high sensitivity (mean = 95.2%, sd = ± 0.02) and specificity (mean = 95. 8%, sd = ± 0.03). Monte Carlo simulation modeling of the study blood glucose monitoring system showed low probability of category 2 and category 3 insulin dosing error, category 2 = 2.3% (41/1,815) and category 3 = 1.8% (32/1,815), respectively. Patient trend analysis demonstrated 99.1% (223/225) concordance in characterizing hypoglycemic patients.

Conclusions:
The multicomponent, clinical accuracy assessment algorithm demonstrated that the blood glucose monitoring system was acceptable for use in critically ill patient settings when compared to the central laboratory reference method. This clinical accuracy assessment algorithm is an effective tool for comprehensively assessing the validity of whole blood glucose measurement in critically ill patient care settings.
A Quasi-Experimental, Before-After Trial Examining the Impact of an Emergency Department Mechanical Ventilator Protocol on Clinical Outcomes and Lung-Protective Ventilation in Acute Respiratory Distress Syndrome
Authors: Fuller Brian M. , Ferguson Ian T. , Mohr Nicholas M. , Drewry Anne M. , Palmer Christopher , Wessman Brian T. , Ablordeppey Enyo , Keeperman Jacob , Stephens Robert J. , Briscoe Cristopher C. , Kolomiets Angelina A. , Hotchkiss Richard S. , Kollef Marin H. 
Published: February 2017

Objectives:
To evaluate the impact of an emergency department mechanical ventilation protocol on clinical outcomes and adherence to lung-protective ventilation in patients with acute respiratory distress syndrome.

Design:
Quasi-experimental, before-after trial.

Setting:
Emergency department and ICUs of an academic center.

Patients:
Mechanically ventilated emergency department patients experiencing acute respiratory distress syndrome while in the emergency department or after admission to the ICU.

Interventions:
An emergency department ventilator protocol which targeted variables in need of quality improvement, as identified by prior work: 1) lung-protective tidal volume, 2) appropriate setting of positive end-expiratory pressure, 3) oxygen weaning, and 4) head-of-bed elevation.

Measurements and Main Results:
A total of 229 patients (186 preintervention group, 43 intervention group) were studied. In the emergency department, the intervention was associated with significant changes (p < 0.01 for all) in tidal volume, positive end-expiratory pressure, respiratory rate, oxygen administration, and head-of-bed elevation. There was a reduction in emergency department tidal volume from 8.1 mL/kg predicted body weight (7.0–9.1) to 6.4 mL/kg predicted body weight (6.1–6.7) and an increase in lung-protective ventilation from 11.1% to 61.5%, p value of less than 0.01. The intervention was associated with a reduction in mortality from 54.8% to 39.5% (odds ratio, 0.38; 95% CI, 0.17–0.83; p = 0.02) and a 3.9 day increase in ventilator-free days, p value equals to 0.01.

Conclusions:
This before-after study of mechanically ventilated patients with acute respiratory distress syndrome demonstrates that implementing a mechanical ventilator protocol in the emergency department is feasible and associated with improved clinical outcomes.
A Novel Missense Variant in the AGRN Gene; Congenital Myasthenic Syndrome Presenting With Head Drop
Authors: Karakaya Mert , Ceyhan-Birsoy Ozge , Beggs Alan H. , Topaloglu Haluk 
Published: February 2017

Abstract
Congenital myasthenic syndromes (CMS) are a heterogeneous group of diseases of the neuromuscular junction caused by compromised synaptic transmission. Clinical features include early-onset weakness of limbs and oculobulbar muscles resulting in hypotonia, bulbar paresis, ptosis, and hypoventilation. The first dropped head syndrome in children were detected in 2 patients with LMNA and SEPN1 mutations. We report a 17-month-old boy with dropped head and limb–girdle weakness, who had no ptosis or ophthalmoplegia at presentation. We performed whole exome sequencing, which revealed a homozygous missense variant in the AGRN gene c.5023G>A, p.Gly1675Ser in the LG2 domain, which is predicted to be likely disease causing by in silico tools. Agrin is known to play a critical role in the development and maintenance of the neuromuscular junction. Agrin-related CMS is one of the rarest subtypes. Of note, our patient is the first described patient with agrin-related CMS with dropped head phenotype.
A Case of Asymptomatic Inclusion Body Myositis
Authors: Bello Rey , Bertorini Tulio , Ganta Kartheek , Mays William 
Published: February 2017

Abstract

Objectives:
To present a case of asymptomatic inclusion body myositis.

Methods:
The authors report a case of a 67-year-old man who presented with idiopathic hyperCKemia. Physical examination including a complete neurological evaluation was unremarkable. Systemic causes of hyperCKemia, including medication side effects, metabolic and endocrine disorders, and connective tissue disorders, were ruled out with various indicated tests.

Results:
Two and a half years after initial consultation, the patient reported left knee pain. Magnetic resonance imaging of the left knee showed edema in the mid and distal aspect of the vastus medialis and vastus lateralis muscles. A biopsy of the left quadriceps muscles was diagnostic of inclusion body myositis. He remained asymptomatic for the ensuing 2.5 years.

Conclusions:
Asymptomatic hyperCKemia should be investigated and followed closely for definitive diagnosis and possible treatable causes.
The Effect of Plasma Rich in Growth Factors on Pattern Hair Loss: A Pilot Study
Authors: Anitua Eduardo , Pino Ander , Martinez Nahikari , Orive Gorka , Berridi Daniel 
Published: February 2017

BACKGROUND
Autologous growth factors have proved to promote tissue regeneration in various medical fields. Recent findings suggest that platelet rich plasma may also play an important role in hair follicle restoration.

OBJECTIVE
The objective of this study was to evaluate the safety and clinical efficacy of plasma rich in growth factors (PRGFs) for the treatment of androgenetic alopecia (AGA).

MATERIALS AND METHODS
Five PRGF injections were administered over 19 patients with AGA. Phototrichograms regarding follicle density/diameter and terminal/vellus hair ratio were performed at baseline and after 1 year follow-up period. Consenting participants underwent histologic scalp examination. At the end of the study, overall patient satisfaction and clinical improvement were determined.

RESULTS
After PRGF therapy, mean hair density/diameter increased and terminal/vellus hair ratio was also improved. Patients presented epidermal thickness, perifollicular neoangiogenesis, cell proliferation, and terminal/miniaturized hair ratio improvement. Plasma rich in growth factors seemed to reduce the perivascular inflammatory infiltrate, promote the remodeling of dermo-epidermal tissue, and increase bulge stem cell niches. Patients declared an overall positive satisfaction, and a high clinical improvement score was achieved when comparing premacrophotographs and postmacrophotographs.

CONCLUSION
Although randomized clinical trials are needed, this study provides preliminary data supporting the positive therapeutic effect of autologous growth factors on hair follicle regeneration.
ENDOILLUMINATION-ASSISTED MODIFIED SCLERAL BUCKLING
Authors: Assi Alexandre , Abdelmassih Youssef , El-Khoury Sylvain 
Published: February 2017

Purpose:
To assess the anatomical and functional outcomes in addition to complications for endoillumination-assisted modified scleral buckling surgery using a noncontact Oculus BIOM wide-angle viewing system in patients with primary rhegmatogenous retinal detachment.

Methods:
This is an interventional prospective noncomparative case series. Consecutive patients listed for scleral buckle surgery for primary rhegmatogenous retinal detachment were enrolled over an 18-month period and followed up for 1 year. The study cohort consisted of 25 patients (25 eyes) of which 23 patients (23 eyes) completed the 1-year follow-up. Scleral buckling surgery was done with a 23-gauge endoillumination probe, which was inserted through a pars plana sclerotomy. The primary outcome measure was anatomical success rate with one surgery assessed at the 6-month and the 1-year follow-up. Secondary outcome measures included final visual acuity, number of surgeries required, and complication rates such as entry site break, posterior vitreous detachment, endophthalmitis, and cataract.

Results:
At 1 year, anatomical success with one surgery was achieved in 20 patients (87%). One patient required two additional vitreoretinal surgeries and 2 patients required three additional surgeries. All patients had a flat retina at 1 year with silicone oil present in one eye. Mean best-corrected visual acuity improved by six ETDRS lines, from 1.03 ± 0.83 logarithm of the minimum angle of resolution (20/200) preoperatively to 0.40 ± 0.47 logarithm of the minimum angle of resolution (20/50) at 1 year. No entry site breaks were detected, and posterior vitreous detachment developed in six patients (26%). No cases of endophthalmitis or cataract progression were reported.

Conclusion:
Endoillumination-assisted modified scleral buckling surgery combined with a noncontact wide-angle viewing system can provide good anatomical and functional outcomes with many advantages and a low complication rate.
RETINAL METASTASIS FROM SQUAMOUS CELL CARCINOMA OF THE LUNG: A CASE PRESENTATION
Authors: Yalcinbayir Ozgur , Gelisken Oner , Sen Feyza , Yasar Sefa , Alizadegan Foad 
Published: February 2017

Background/Purpose:
To present a case with retinal metastasis from squamous cell carcinoma of the lung.

Methods:
Case report.

Results:
A 54-year-old man presented with blurry vision in his left eye. His medical history was significant for Stage IV squamous lung carcinoma. He was undergoing chemotherapy and had a known metastasis. He had a slightly elevated whitish lesion associated with retinal hemorrhages in the left posterior pole. Optical coherence tomography showed a full-thickness retinal mass. No involvement of the choroid could be detected. Further investigation demonstrated a de novo metastasis in the right frontal lobe of the brain.

Conclusion:
The lesion showed remarkable regression with subsequent systemic chemotherapy.
Dynamic Intraductal Meibomian Probing: A Modified Approach to the Treatment of Obstructive Meibomian Gland Dysfunction
Authors: Syed Zeba A. , Sutula Francis C. 
Published: February 2017

Purpose:
Obstructive meibomian gland dysfunction is a leading cause of ocular morbidity and its treatment remains a challenge. Meibomian gland probing was initially described in 2010. Here, the authors describe a modified technique, dynamic intraductal meibomian probing, which offers several advantages over the traditional approach including increased magnification, greater eyelid stabilization, enhanced anesthesia, and easier identification of gland orifices through the expression of meibum.

Methods:
The authors conducted a retrospective chart review of 70 eyelids with treatment-resistant obstructive meibomian gland dysfunction undergoing dynamic intraductal meibomian probing between January 2013 and April 2015.

Results:
Immediately after the procedure, 91.4% of cases experienced symptomatic improvement, and no complications were noted.

Conclusions:
Dynamic intraductal meibomian probing is an effective and safe treatment for obstructive meibomian gland dysfunction that is resistant to traditional therapies.
Long-Term Outcomes of Eye-Sparing Surgery for Adenoid Cystic Carcinoma of Lacrimal Gland
Authors: Han Jisang , Kim Yoon-Duck , Woo Kyung In , Sobti Deepak 
Published: February 2017

Purpose:
This study’s primary purpose is to assess the long-term outcomes of patients who have undergone eye-sparing surgery and adjuvant radiotherapy for adenoid cystic carcinoma of the lacrimal gland.

Methods:
In this retrospective analysis, clinical records were reviewed of all patients diagnosed with adenoid cystic carcinoma of the lacrimal gland, at a single institution, between March 1998 and November 2012. Ten patients were identified as having undergone eye-sparing surgery and adjuvant radiotherapy for adenoid cystic carcinoma of the lacrimal gland. Preoperative radiographic findings, treatment modalities, histological results, and patient outcomes were analyzed.

Results:
There were 6 male and 4 female patients. The patients’ tumors were staged according to the 8th American Joint Committee on Cancer staging system, and were as follows: 1 patient was classified as T1aN0M0; 6 patients were classified as T2aN0M0; 1 patient was classified as T2cN0M0; 2 patients were classified as T3aN0M0. All patients had a histologically confirmed diagnosis of lacrimal gland adenoid cystic carcinoma, which was confined to the orbit, and was without extension into adjacent bone marrow or other organs. All patients underwent eye-sparing tumor excision followed by postoperative radiotherapy, with a median dose of 6000 cGy (range: 5000–6600 cGy). At the last follow up, 8 patients were alive without evidence of disease. One patient was deceased at 58 months post-surgery, due to esophageal carcinoma; this was unrelated to the lacrimal gland tumor. The final patient experienced tumor recurrence in the medial orbit 53 months post-surgery, and exenteration was performed. This patient was alive, without disease recurrence, at 90 months following exenteration. The median follow-up time was 89.5 months (range: 37–217 months). Systemic metastasis did not occur in any patient.

Conclusions:
Eye-sparing surgery and adjuvant radiotherapy have demonstrated favorable local control and long-term survival outcomes in patients with orbit-confined lacrimal gland adenoid cystic carcinoma. Consequently, eye-sparing surgery with adjuvant radiotherapy can be considered as a viable treatment option for orbit-confined lacrimal gland adenoid cystic carcinoma.
Genome-wide methylation analysis of a large population sample shows neurological pathways involvement in chronic widespread musculoskeletal pain
Authors: Livshits Gregory , Malkin Ida , Freidin Maxim B. , Xia Yudong , Gao Fei , Wang Jun , Spector Timothy D. , MacGregor Alex , Bell Jordana T. , Williams Frances M.K. 
Published: February 2017

Abstract
Chronic widespread musculoskeletal pain (CWP), has a considerable heritable component, which remains to be explained. Epigenetic factors may contribute to and account for some of the heritability estimate. We analysed epigenome-wide methylation using MeDIPseq in whole blood DNA from 1708 monozygotic and dizygotic Caucasian twins having CWP prevalence of 19.9%. Longitudinally stable methylation bins (lsBINs), were established by testing repeated measurements conducted ≥3 years apart, n = 292. DNA methylation variation at lsBINs was tested for association with CWP in a discovery set of 50 monozygotic twin pairs discordant for CWP, and in an independent dataset (n = 1608 twins), and the results from the 2 samples were combined using Fisher method. Functional interpretation of the most associated signals was based on functional genomic annotations, gene ontology, and pathway analyses. Of 723,029 signals identified as lsBINs, 26,399 lsBINs demonstrated the same direction of association in both discovery and replication datasets at nominal significance (P ≤ 0.05). In the combined analysis across 1708 individuals, whereas no lsBINs showed genome-wide significance (P < 10-8), 24 signals reached p≤9E-5, and these included association signals mapping in or near to IL17A, ADIPOR2, and TNFRSF13B. Bioinformatics analyses of the associated methylation bins showed enrichment for neurological pathways in CWP. We estimate that the variance explained by epigenetic factors in CWP is 6%. This, the largest study to date of DNA methylation in CWP, points towards epigenetic modification of neurological pathways in CWP and provides proof of principle of this method in teasing apart the complex risk factors for CWP.
Pain interference and physical function demonstrate poor longitudinal association in people living with pain: a PROMIS investigation
Authors: Karayannis Nicholas V. , Sturgeon John A. , Chih-Kao Ming , Cooley Corinne , Mackey Sean C. 
Published: February 2017

Abstract
A primary goal in managing pain is to reduce pain and increase physical function (PF). This goal is also tied to continuing payment for treatment services in many practice guidelines. Pain interference (PI) is often used as a proxy for measurement and reporting of PF in these guidelines. A common assumption is that reductions in PI will translate into improvement in PF over time. This assumption needs to be tested in a clinical environment. Consequently, we used the patient-reported outcomes measurement information system (PROMIS) to describe the topology of the longitudinal relationship between PI in relation to PF. Longitudinal data of 389 people with chronic pain seeking health care demonstrated that PI partially explained the variance in PF at baseline (r = −0.50) and over 90 days of care (r = −0.65). The relationship between pain intensity and PF was not significant when PI was included as a mediator. A parallel process latent growth curve model analysis showed a weak, unidirectional relationship (β = 0.18) between average PF scores and changes in PI over the course of 90 days of care, and no relationship between average PI scores and changes in PF across time. Although PI and PF seem moderately related when measured concurrently, they do not cluster closely together across time. The differential pathways between these 2 domains suggest that therapies that target both the consequences of pain on relevant aspects of persons' lives, and capability to perform physical activities are likely required for restoration of a vital life.
Comparison of Acyclovir and Famciclovir for Ramsay Hunt Syndrome
Authors: Kim Ho Joong , Jung Junyang , Kim Sung Su , Byun Jae Yong , Park Moon Suh , Yeo Seung Geun 
Published: February 2017

Objective:
Although antiviral agents are widely used to treat Ramsay hunt syndrome (RHS), their relative effectiveness has not been assessed. This study retrospectively compared clinical outcomes in patients with RHS treated with the antiviral agents acyclovir and famciclovir.

Patients and Methods:
This study involved 227 patients diagnosed with RHS from 2003 to 2015. Patients were treated with prednisolone plus acyclovir (n = 102) or famciclovir (n = 125). Patient outcomes were measured using the House–Brackmann scale according to age, initial severity of disease, electroneurography, and underlying disease.

Results:
Based on complications (p = 0.019) and disease severity (p = 0.013), the overall complete recovery rate was significantly higher with famciclovir than with acyclovir, whereas rates of recovery in patients with severe (p = 0.111) and initially moderate (grades III–IV; p = 0.070) facial palsy were similar. Electroneurography also showed no difference in remission rate between the two groups (p = 0.692). Complete recovery rates in patients with hypertension and/or diabetes mellitus were similar in the two groups. However, the complete recovery rate of patients without hypertension and diabetes was significantly higher in patients treated with famciclovir than acyclovir (p = 0.018).

Conclusion:
Recovery rates in patients with RHS were higher following treatment with steroid plus famciclovir than with steroid plus acyclovir, especially in patients without hypertension and diabetes mellitus.
Meta-Analysis of Odds Ratios
Authors: Chang Bei-Hung , Hoaglin David C. 
Published: February 2017

Background:
Many systematic reviews of randomized clinical trials lead to meta-analyses of odds ratios (ORs). The customary methods of estimating an overall OR involve weighted averages of the individual trials’ estimates of the logarithm of the OR. That approach, however, has several shortcomings, arising from assumptions and approximations, that render the results unreliable. Although the problems have been documented in the literature for many years, the conventional methods persist in software and applications. A well-developed alternative approach avoids the approximations by working directly with the numbers of subjects and events in the arms of the individual trials.

Objective:
We aim to raise awareness of methods that avoid the conventional approximations, can be applied with widely available software, and produce more-reliable results.

Methods:
We summarize the fixed-effect and random-effects approaches to meta-analysis; describe conventional, approximate methods and alternative methods; apply the methods in a meta-analysis of 19 randomized trials of endoscopic sclerotherapy in patients with cirrhosis and esophagogastric varices; and compare the results. We demonstrate the use of SAS, Stata, and R software for the analysis.

Results:
In the example, point estimates and confidence intervals for the overall log-odds-ratio differ between the conventional and alternative methods, in ways that can affect inferences. Programming is straightforward in the 3 software packages; an appendix, Suppemental Digital Content 1 (http://links.lww.com/MLR/B335) gives the details.

Conclusions:
The modest additional programming required should not be an obstacle to adoption of the alternative methods. Because their results are unreliable, use of the conventional methods for meta-analysis of ORs should be discontinued.