bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Double-Blind, Placebo-Controlled, Pilot Study of Riluzole Monotherapy for Acute Bipolar Depression
Authors: Park Lawrence T. , Lener Marc S. , Hopkins Matthew , Iadorola Nicolas , Machado-Vieira Rodrigo , Ballard Elizabeth , Nugent Allison , Zarate Carlos A. 
Published: March 2017

Abstract

Background
Glutamatergic system abnormalities are implicated in the pathophysiology and treatment of both major depressive disorder and bipolar depression (BDep). Subsequent to studies demonstrating the rapid and robust antidepressant effects of ketamine, an N-methyl-d-aspartate receptor antagonist, other glutamatergic modulators are now being studied in clinical trials of mood disorders. A previous open-label study found that riluzole, administered in combination with the mood stabilizer lithium, had antidepressant effects.

Methods
We conducted a randomized, double-blind, placebo-controlled trial of riluzole monotherapy for the treatment of BDep. Nineteen subjects aged 18 to 70 years with bipolar disorder currently experiencing a depressive episode were tapered off of excluded medications and randomized to receive riluzole (50–200 mg/d) or placebo for 8 weeks. Rating scale scores (Montgomery-Åsberg Depression Rating Scale, Hamilton Rating Scale for Depression, Hamilton Rating Scale for Anxiety, and Young Mania Rating Scale) were obtained weekly.

Results
No significant differences in depressive symptoms were observed between subjects treated with riluzole and those receiving placebo (P = 0.12). Anxiety scores were significantly lower in the placebo group (P = 0.046). An interim analysis was conducted that resulted in stopping the study because of futility; no subjects had achieved treatment response.

Conclusions
Although we found no change in severity of depressive symptoms in BDep patients receiving riluzole compared with placebo, this trial was limited by the relatively high number of subject withdrawals and the small sample size. Thus, while riluzole monotherapy did not demonstrate efficacy for BDep, further studies examining riluzole as adjunctive therapy for this disorder may be warranted.
Clinical Trials Identifier NCT00054704.
Is severe hypercalcemia immediately life-threatening?
Authors: Guimard Camille , Batard Eric , Lavainne Frédéric , Trewick David 
Published: March 2017

Objective
Severe hypercalcemia is often considered an emergency because of a potential risk of cardiac arrest or coma. However, there is little evidence to support this. The aim of our study was to assess whether severe hypercalcemia (Ca>4 mmol/l or 16 mg/dl) was associated with immediately life-threatening cardiac arrhythmias or neurological complications in patients admitted to the Emergency Department (ED).

Methods
A retrospective observational study was carried out over a 5-year period (2008–2012). Eligible patients were admitted to the Adult Emergency Department of Nantes University Hospital and had a calcium concentration in excess of 4 mmol/l. There were no exclusion criteria. The primary outcome was the number of life-threatening cardiac arrhythmias and/or neurological complications during the stay in the ED. The secondary outcomes were correlation between calcium concentrations/ECG QTc intervals and mortality.

Results
A total of 126 204 adult patients had calcium concentrations measured. Thirty one (0.025%) patients had severe hypercalcemia as defined in our study. The median calcium concentration was 4.3 mmol/l (Q1, 4.2; Q3, 4.7) and the median albumin-adjusted calcium concentration was 4.3 mmol/l (Q1, 4.1; Q3, 4.7). No patient presented with a life-threatening cardiac event during stay in the ED. The median ED stay was 7 h 32 min. One patient presented with a coma of multifactorial origin. There was no correlation between calcemia and QTc intervals (P=0.60). Mortality at 1 year was 55% (17 patients).

Conclusion
We found no cases of immediately life-threatening cardiac arrhythmias or neurological complications associated with hypercalcemia above 4 mmol/l over a 5-year period in a large tertiary ED.
Cost-effectiveness of Antihypertensive Medication
Authors: Tajeu Gabriel S. , Mennemeyer Stephen , Menachemi Nir , Weech-Maldonado Robert , Kilgore Meredith 
Published: March 2017

Background:
Antihypertensive medication decreases risk of cardiovascular disease (CVD) events in adults with hypertension. Although black adults have higher prevalence of hypertension and worse CVD outcomes compared with whites, limited attention has been given to the cost-effectiveness of antihypertensive medication for blacks.

Objective:
To compare the cost-effectiveness of antihypertensive medication treatment versus no-treatment in white and black adults.

Research Design:
We constructed a State Transition Model to assess the costs and quality-adjusted life-years (QALYs) associated with either antihypertensive medication treatment or no-treatment using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study and published literature. CVD events and health states considered in the model included stroke, coronary heart disease, heart failure, chronic kidney disease, and end-stage renal disease.

Subjects:
White and black adults with hypertension in the United States, 45 years of age and above.

Measures:
Yearly risk of CVD was determined using REGARDS data and published literature. Antihypertensive medication costs were determined using Medicare claims. Event and health state costs were estimated from published literature. All costs were adjusted to 2012 US dollars. Effectiveness was assessed using QALYs.

Results:
Antihypertensive medication treatment was cost-saving and increased QALYs compared with no-treatment for white men ($7387; 1.14 QALYs), white women ($7796; 0.89 QALYs), black men ($8400; 1.66 QALYs), and black women ($10,249; 1.79 QALYs).

Conclusions:
Antihypertensive medication treatment is cost-saving and increases QALYs for all groups considered in the model, particularly among black adults.
Influenza in children
Authors: Kondrich Janienne , Rosenthal Michele 
Published: March 2017

Purpose of review
We review the current information and evidence available on the global burden of disease in the pediatric population, clinical presentation and complications, testing, treatment, and immunization.

Recent findings
In addition to multiple other risk factors for influenza complications, children with neurologic and neuromuscular disorders are significantly higher risk for serious complications. In practice, there is no lower age limit for children with influenza who can be treated with oseltamivir. The quadrivalent live attenuated influenza vaccine was not recommended for use during the 2016–2017 season due to poor effectiveness.

Summary
Influenza infection causes a significant burden of disease each year in the pediatric population worldwide. Both healthy and chronically ill children can fall prey to complications either due to the virus itself or secondary bacterial infection. Children within high-risk groups should be tested and treated with neuraminidase inhibitors. Immunization against influenza is well tolerated and effective.
Six-Month Follow-up of a Regional Evidence-based Practice Fellowship Program
Authors: Kim Son Chae , Stichler Jaynelle F. , Ecoff Laurie , Gallo Ana-Maria , Davidson Judy E. 
Published: March 2017

OBJECTIVE
This study examined a 6-month follow-up of a regional evidence-based practice (EBP) fellowship program and the predictors of EBP adoption at hospital units.

BACKGROUND
The immediate beneficial effects of a regional EBP program are known, but the medium-term effects are not certain.

METHODS
A matched pretest/posttest study was conducted using a mailed questionnaire 6 months after the completion of a 9-month regional EBP fellowship program among 3 annual cohorts of participants.

RESULTS
Statistically significant improvements in the mean scores of EBP beliefs, EBP implementation, and group cohesion were found (P < .05). Of the 47 participants who completed their EBP projects, more than three-quarters reported EBP adoption at their own hospital units, and EBP beliefs were a positive predictor of EBP adoption (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P = .017).

CONCLUSIONS
The outcome improvements continued 6 months after the fellowship program, and strong EBP beliefs predicted EBP adoption in the participants’ units.
Mobile Phone and Internet Use Mostly for Sex-Seeking and Associations With Sexually Transmitted Infections and Sample Characteristics Among Black/African American and Hispanic/Latino Men Who Have Sex With Men in 3 US Cities
Authors: Allen Jacob E. , Mansergh Gordon , Mimiaga Matthew J. , Holman Jeremy , Herbst Jeffrey H. 
Published: March 2017

Background
Men who have sex with men (MSM) have a relatively high prevalence of sexually transmitted infections (STIs). This study examines the association of self-reported STIs and use of mobile phones and/or computer-based Internet to meet sexual partners among black and Hispanic/Latino MSM in the United States.

Methods
Black and Hispanic/Latino MSM (N = 853) were recruited from 3 US cities (Chicago, IL; Kansas City, MO; and Fort Lauderdale, FL) via online and community outreach. Men completed a computer-assisted, self-interview assessment on demographics, use of mobile phones and computer-based Internet for sex-seeking, sexual risk behavior, and self-reported bacterial STIs in the past year. Multivariable logistic regression was used to model independent associations of STIs and use of these technologies to meet sexual partners.

Results
Twenty-three percent of the sample reported having an STI in the past year; 29% reported using a mobile phone and 28% a computer-based Internet mostly for sex-seeking; and 22% reported using both. Number of male sexual partners (past year) was associated with any STI (adjusted odds ratio, 1.03; 95% confidence interval, 1.01–1.06). Adjusting for human immunodeficiency virus status, number of male sexual partners (past year), and demographic variables, men who reported use of both mobile phones and computer-based Internet for sex-seeking had increased odds of reporting an STI (adjusted odds ratio, 2.59; 95% confidence interval, 1.75–3.83), as well as with separate reports of chlamydia, gonorrhea, and syphilis (P’s < 0.05).

Conclusions
Enhanced community education regarding STI prevention, testing, and treatment options are necessary among this subpopulation of MSM who may benefit from messaging via Internet and mobile phone application sites.
Studying the Retinal Source of Photophobia by Facial Electroretinography
Authors: Tyler Christopher W. , Likova Lora T. 
Published: March 2017

ABSTRACT

Purpose
Photophobia is a debilitating clinical condition that disrupts the ability to use vision for everyday tasks in bright lighting conditions. The goal of the study is to develop a methodology to study the neural basis of photophobia and the contribution of the melanopic pathway to its etiology with differential chromatic responses by means of standard electroencephalographic recording equipment.

Methods
We introduce and validate the approach of recording wavelength-specific electroretinographic (ERG) responses from the face electrodes of the high-density whole-head electroencephalography recording system under light-adapted conditions.

Results
ERGs recorded in this way to whole-field chromatic stimuli exhibit striking differences between the photophobic and non-photophobic groups. The control responses were consistent with photopic intensity in peak time, and in the ordering of peak times as a function of wavelength condition, indicating a predominantly cone source of the signals. The photophobic responses, on the other hand, were substantially slowed relative to controls, with the peak times conforming to a different order as a function of wavelength condition than controls, implying that the cone response has been suppressed and that the responses derived from a different photoreceptor system consistent with mediation by melanopic retinal ganglion cells.

Conclusions
The results will be important for determining the neural pathways involved in photophobia and potential approaches to its treatment on the basis of this etiology.
Medial Row Perforators Are Associated with Higher Rates of Fat Necrosis in Bilateral DIEP Flap Breast Reconstruction
Authors: Kamali Parisa , Lee Michelle , Becherer Babette E. , Wu Winona , Curiel Daniel , Tran Bao Ngoc N. , Tobias Adam M. , Lin Samuel J. , Lee Bernard T. 
Published: March 2017

Background:
The purpose of this study was to evaluate perfusion-related complications in bilateral deep inferior epigastric perforator (DIEP) flap breast reconstruction based on perforator selection.

Methods:
A retrospective review of a prospectively maintained database was performed on all patients undergoing bilateral DIEP flap reconstruction at a single institution between 2004 and 2014. The hemiflaps were separated into three cohorts based on perforator location: lateral row only, medial row only, and medial plus lateral rows. Postoperative flap-related complications were compared and analyzed.

Results:
There were 728 total hemiflaps: 263 (36.1 percent) based on the lateral row, 225 (30.9 percent) based on the medial row, and 240 (33.0 percent) based on both the medial and lateral rows. The groups were well matched by perforator number and flap weight. Fat necrosis occurrence was significantly higher in flaps based solely on the medial row versus lateral row perforators (24.5 percent versus 8.2 percent; p < 0.001). There was no statistically significant difference in fat necrosis between flaps based only on the lateral row versus flaps based on both the medial and lateral rows (8.2 percent versus 11.6 percent; p = 0.203). Generally, within the same row, increasing the number of perforators decreased the incidence of fat necrosis.

Conclusions:
Perforator selection is critical for minimizing perfusion-related flap complications. In bilateral DIEP flaps, lateral row–based perforators result in significantly less fat necrosis than medial row–based perforators. The authors’ data suggest that the addition of a lateral row perforator to a dominant medial row perforator may decrease the risk of fat necrosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Validation of the Clinician-Graded Electronic Facial Paralysis Assessment
Authors: Chong Lauren S. H. , Eviston Timothy J. , Low Tsu-Hui (Hubert) , Hasmat Shaheen , Coulson Susan E. , Clark Jonathan R. 
Published: March 2017

Background:
Facial paralysis remains a debilitating condition despite advances in medical, surgical, and adjunctive interventions. Established grading systems used to assess facial paralysis and interventional outcomes have well-described limitations. The Electronic Facial Paralysis Assessment, a clinician-graded zone-based facial function scale, has recently emerged as a grading tool that may provide greater sensitivity when assessing incomplete paralysis and postsurgical improvement. The authors perform the first comprehensive validation of this tool.

Methods:
Video recordings of 83 facial paralysis patients were assessed. Grading was performed in two sittings by three individuals with varying degrees of experience in assessing facial paralysis. Interobserver reliability; intraobserver reliability; administration time; and agreement with the Facial Disability Index, House-Brackmann, Sunnybrook, and Sydney facial grading systems were assessed.

Results:
The Electronic Facial Paralysis Assessment demonstrated high intra observer and interobserver reliability (intraclass correlation coefficient, 0.84 to 0.91 and 0.81 to 0.83, respectively). It correlated well with the House-Brackmann, Sunnybrook, and Sydney facial grading systems (Spearman rho, 0.73, 0.77 and 0.77, respectively). In subdomain analysis, it correlated well with the Sunnybrook and Sydney systems in dynamic movement (Spearman rho, 0.90 and 0.89, respectively) and synkinesis (Spearman rho, range 0.74 and 0.72, respectively). It had poor agreement with the Facial Disability Index (Spearman rho, 0.25). The mean time to complete the tool was 116 ± 61 seconds.

Conclusions:
The Electronic Facial Paralysis Assessment is a valid facial assessment tool with high reliability and correlation with the established facial paralysis grading systems. It also provides an efficient and detailed analysis of paralysis according to each facial zone.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, II.
Lung Cancers Associated With Cystic Airspaces: Natural History, Pathologic Correlation, and Mutational Analysis
Authors: Fintelmann Florian J. , Brinkmann Jesaja K. , Jeck William R. , Troschel Fabian M. , Digumarthy Subba R. , Mino-Kenudson Mari , Shepard Jo-Anne O. 
Published: March 2017

Purpose:
The aim of the study was to investigate the natural history of non–small cell lung cancers (NSCLCs) associated with cystic airspaces, including histopathology and molecular analysis.

Materials and Methods:
A total of 34,801 computed tomographic (CT) scans of 2954 patients diagnosed with NSCLC between 2010 and 2015 were evaluated for association with a cystic airspace. Characteristics on serial CT, 18F-fludeoxyglucose positron emission tomography, and pathologic analysis were recorded.

Results:
Cystic airspaces were associated with 1% of NSCLC cases (12 men and 18 women; median age, 66 y [range, 44 to 87 y]). Of the total number of patients, 97% had a smoking history. Twenty-four adenocarcinomas, 4 squamous cell carcinomas, and 2 poorly differentiated carcinomas were distributed throughout all lobes and were predominantly peripheral. Some cystic airspaces appeared in previously normal lungs, whereas others were preceded by subcentimeter nodules. Twenty of 30 cases demonstrated increased soft tissue due to wall thickening, increased loculations, enlargement and/or increased attenuation of a mural nodule, or replacement by a mass. 18F-fludeoxyglucose uptake was present if solid components measured >8 mm. Twenty of 30 patients demonstrated >1 cystic lesion or ground-glass nodule, lymphadenopathy, or evidence of prior lung resection. Pathologic analysis revealed that cystic airspaces correspond to a check-valve mechanism, adenocarcinoma superimposed on emphysema, cystification, and adenocarcinoma parasitizing a preexisting bulla. Fourteen of 26 tumors and 64% of adenocarcinomas tested positive for an alteration of KRAS with or without other alterations.

Conclusions:
Cystic airspaces preceded by nodules can evolve into NSCLCs. Wall thickening and/or mural nodularity may develop. Location in the periphery of the upper lobes, emphysema, additional cystic lesions or ground-glass nodules, lymphadenopathy, and prior lung cancer should further increase suspicion. Cystic airspaces on CT can be due to a check-valve mechanism obstructing the small airways, lepidic growth of adenocarcinoma in an area of emphysema, cystification of tumor due to degeneration, or adenocarcinoma growing along the wall of a preexisting bulla. KRAS mutations are the predominant genetic alterations.
Restrictive Transfusion Practices After Esophagectomy Are Associated With Improved Outcome
Authors: Towe Christopher W. , Gulack Brian C. , Kim Sunghee , Ho Vanessa P. , Perry Yaron , Donahue James M. , Linden Philip A. 
Published: March 2017

Objective:
Blood transfusion has been associated with poor outcomes in many disciplines, yet transfusion practices and related outcomes in esophagectomy are unknown. We analyzed the Society of Thoracic Surgeons General Thoracic Database to determine patient factors associated with transfusion after esophagectomy, risk-adjusted variation in transfusion practice among institutions, and the association of transfusion practice with mortality.

Methods:
We performed a retrospective review of patients undergoing esophagectomy for cancer from October 2008 to December 31, 2014. Patient comorbidities and procedure variables were used to construct a risk model for transfusion. Using this model, each institution was assigned an observed to expected (O:E) transfusion rate. We examined institutional factors associated with variation in O:E transfusion rate. Finally, O:E transfusion rate was compared to risk-adjusted mortality to determine if there was an association of transfusion practice and survival.

Results:
Seven thousand one hundred thirty-seven patients underwent esophagectomy at 182 institutions during the study period. The median unadjusted transfusion rate was 23.1%. The risk model for transfusion demonstrated patients who received transfusions were more likely to be older, female, and have low preoperative hemoglobin and other comorbidities, such as CAD, COPD, and low creatinine clearance. Patients who received a minimally invasive procedure were less likely to have received a transfusion.
After adjusting for the characteristics above, 13 centers (7.1%) were classified as having lower than average O:E transfusion rate and 16 centers (8.7%) were classified as higher than average O:E transfusion rate.
Institutions with lower than expected transfusion rates also had lower risk-adjusted perioperative mortality than institutions with higher than expected transfusion rates (median [IQR] = 0.90 [0.77–0.94] vs. 0.99 [0.94–1.06], P = 0.028).

Conclusion:
Age, female sex, CAD, COPD, renal insufficiency, and open technique are associated with transfusion after esophagectomy, while tumor stage and preoperative chemoradiation are not. There is wide variation in transfusion practice. Centers with lower than expected transfusion rate also had lower than expected perioperative mortality. At an institutional level, lower transfusion rates are associated with improved outcomes.
Patterns, Timing, and Predictors of Recurrence Following Pancreatectomy for Pancreatic Ductal Adenocarcinoma
Authors: Groot Vincent P. , Rezaee Neda , Wu Wenchuan , Cameron John L. , Fishman Elliot K. , Hruban Ralph H. , Weiss Matthew J. , Zheng Lei , Wolfgang Christopher L. , He Jin 
Published: March 2017

Objective:
To describe accurately the pattern, timing, and predictors of disease recurrence after a potentially curative resection for pancreatic ductal adenocarcinoma (PDAC).

Summary Background Data:
After surgery for PDAC, most patients will develop disease recurrence. Understanding the patterns and timing of disease failure can help guide improvements in therapy.

Methods:
Patients who underwent pancreatectomy for PDAC at the Johns Hopkins Hospital between 2000 and 2010 were included. Exclusion criteria were incomplete follow-up records, follow-up <24 months, and neoadjuvant therapy. The first recurrence site was recorded and recurrence-free survival (RFS) was estimated using Kaplan–Meier curves. Predictive factors for specific recurrence patterns were assessed by univariate and multivariate analyses using Cox-proportional hazard regression models.

Results:
From the identified cohort of 1103 patients, 692 patients had comprehensive and detailed follow-up data available. At a median follow-up of 25.3 months, 531 (76.7%) of the 692 had recurred after a median RFS of 11.7 months. Most patients recurred at isolated distant sites (n = 307, 57.8%), while isolated local recurrence was seen in 126 patients (23.7%). Liver-only recurrence (n = 134, 25.2%) tended to occur early (median 6.9 mo), while lung-only recurrence (n = 78, 14.7%) occurred later (median 18.6 mo). A positive lymph node ratio >0.2 was a strong predictor for all distant disease recurrence. Patients receiving adjuvant chemotherapy or chemoradiotherapy had fewer recurrences and a longer RFS of 18.0 and 17.2 months, respectively.

Conclusions:
Specific recurrence locations have different predictive factors and possess distinct RFS curves, supporting the hypothesis that unique biological differences exist among tumors leading to distinct patterns of recurrence.