bluuebunny/crossref_metadata_2025_split huggingface dataset:
NLRP3 Inflammasome Activation Contributes to Mechanical Stretch–Induced Endothelial-Mesenchymal Transition and Pulmonary Fibrosis
Authors: Lv Zhou , Wang Yan , Liu Yu-Jian , Mao Yan-Fei , Dong Wen-Wen , Ding Zhong-Nuo , Meng Guang-Xun , Jiang Lai , Zhu Xiao-Yan 
Published: October 2017

Objectives:
Mechanical ventilation can induce lung fibrosis. This study aimed to investigate whether ventilator-induced lung fibrosis was associated with endothelial-mesenchymal transition and to uncover the underlying mechanisms.

Design:
Randomized, controlled animal study and cell culture study.

Setting:
University research laboratory.

Subjects:
Adult male Institute of Cancer Research, NACHT, LRR, and PYD domains-containing protein 3 (NLRP3) knockout and wild-type mice. Primary cultured mouse lung vascular endothelial cells.

Interventions:
Institute of Cancer Research, NLRP3 knockout and wild-type mice were subjected to mechanical ventilation (20 mL/kg) for 2 hours. Mouse lung vascular endothelial cells were subjected to cyclic stretch for 24 hours.

Measurements and Main Results:
Mice subjected to mechanical ventilation exhibited increases in collagen deposition, hydroxyproline and type I collagen contents, and transforming growth factor-β1 in lung tissues. Ventilation-induced lung fibrosis was associated with increased expression of mesenchymal markers (α smooth muscle actin and vimentin), as well as decreased expression of endothelial markers (vascular endothelial–cadherin and CD31). Double immunofluorescence staining showed the colocalization of CD31/α smooth muscle actin, CD31/vimentin, and CD31/fibroblast-specific protein-1 in lung tissues, indicating endothelial-mesenchymal transition formation. Mechanical ventilation also induced NLRP3 inflammasome activation in lung tissues. In vitro direct mechanical stretch of primary mouse lung vascular endothelial cells resulted in similar NLRP3 activation and endothelial-mesenchymal transition formation, which were prevented by NLRP3 knockdown. Furthermore, mechanical stretch–induced endothelial-mesenchymal transition and pulmonary fibrosis were ameliorated in NLRP3-deficient mice as compared to wild-type littermates.

Conclusions:
Mechanical stretch may promote endothelial-mesenchymal transition and pulmonary fibrosis through a NLRP3-dependent pathway. The inhibition of endothelial-mesenchymal transition by NLRP3 inactivation may be a viable therapeutic strategy against pulmonary fibrosis associated with mechanical ventilation.
COMPARISON OF SHORT-TERM EFFICACY BETWEEN ORAL SPIRONOLACTONE TREATMENT AND PHOTODYNAMIC THERAPY FOR THE TREATMENT OF NONRESOLVING CENTRAL SEROUS CHORIORETINOPATHY
Authors: Lee Ji Hwan , Lee Sung Chul , Kim Hyesun , Lee Christopher Seungkyu 
Published: October 2017

Purpose:
To compare the short-term therapeutic efficacy of oral spironolactone treatment with that of half-dose photodynamic therapy (PDT) in patients with nonresolving central serous chorioretinopathy.

Methods:
This retrospective, interventional, comparative study included 41 patients with nonresolving central serous chorioretinopathy who exhibited subretinal fluid accumulation for more than 3 months. Of the 41 patients, 18 (18 eyes) received oral spironolactone treatment and 23 (23 eyes) received half-dose PDT. Treatment outcomes, including the central macular thickness, subretinal fluid height, subfoveal choroidal thickness, and best-corrected visual acuity, were measured at baseline and 1 and 3 months after treatment.

Results:
There were no differences in baseline characteristics between the two groups. The central macular thickness and the subretinal fluid height significantly decreased at 1 and 3 months after treatment. The central macular thickness at 1 month was lesser in the PDT group than in the spironolactone group. The subfoveal choroidal thickness decreased at 1 and 3 months only in the PDT group, whereas best-corrected visual acuity showed a significant improvement at 3 months in both groups.

Conclusion:
Our results suggest that the short-term efficacy of oral spironolactone treatment for the management of nonresolving central serous chorioretinopathy is comparable with that of half-dose PDT, with an excellent safety profile.
Excisional Bleb Revision for Management of Failed Ahmed Glaucoma Valve
Authors: Eslami Yadollah , Fakhraie Ghasem , Moghimi Sasan , Zarei Reza , Mohammadi Masoud , Nabavi Amin , Yaseri Mehdi , Izadi Ali 
Published: October 2017

Purpose:
To evaluate the outcome of excisonal bleb revision in patients with failed Ahmed glaucoma valve (AGV).

Patients and Methods:
In total, 29 patients with uncontrolled intraocular pressure (IOP) despite of maximal tolerated medical therapy at least 6 months after AGV implantation were enrolled in this prospective interventional case series. Excision of fibrotic tissue around the reservoir with application of mitomycin C 0.02% was performed. IOP, number of glaucoma medications were evaluated at baseline and 1 week and 1, 3, 6, and 12 months postoperatively. Complete and qualified success was defined as IOP≤21 mm Hg with or without glaucoma medications, respectively. Intraoperative and postopervative complications were also recorded.

Results:
Mean IOP was reduced from 30±4.2 mm Hg at baseline to 19.2±3.1 mm Hg at 12-month follow-up visit (P<0.001). Average number of glaucoma medications was decrease from 3.2±0.5 at baseline to 1.9±0.7 at 12-month follow-up (P<0.001). Qualified and complete success rates at 12-month follow-up were 65.5% and 6.9%, respectively. Younger age and higher number of previous glaucoma surgeries were significantly associated with the failure of excisonal bleb revision.

Conclusion:
Excisional bleb revision could be considered as a relatively effective alternative option for management of inadequate IOP control after AGV implantation.
Efficacy of 2 Trabecular Micro-Bypass Stents During Phacoemulsification for Mild to Advanced Primary Open-angle Glaucoma Controlled With Topical Hypotensive Medications
Authors: Buffet Jenna , Brasnu Emmanuelle , Baudouin Christophe , Labbé Antoine 
Published: October 2017

Purpose:
The purpose of the current study was to evaluate the efficacy and adverse event profile of 2 trabecular micro-bypass stents implanted during standard phacoemulsification cataract surgery in patients with mild to advanced open-angle glaucoma whose intraocular pressure (IOP) was well controlled by topical medications.

Patients and Methods:
This study was a retrospective analysis of patients with mild to advanced chronic open-angle glaucoma who underwent phacoemulsification and implantation of 2 stents. For all patients, preoperative and postoperative characteristics were evaluated, including number of medications and IOP. Postoperative visits were scheduled at 7 days and at months 1, 6, 12, and 24 after surgery. At each visit, IOP and the number of medications were noted.

Results:
In total, 63 eyes of 41 patients were included in the study. The vast majority of eyes (85.7%) were diagnosed with primary open-angle glaucoma. Preoperative mean IOP at baseline was 16.8±3.0 mm Hg (range, 10 to 24 mm Hg) with a mean of 2.3±0.9 medications. The mean IOP reduction represented a 13% decrease at 1 month (P<0.001), 13% at 6 months (P<0.001), 12% at 1 year (P<0.001), and 10% at 2 years (P<0.001), concomitant with a 23% reduction in the mean number of medications (P<0.001), 35% (P<0.001), 40% (P<0.001), and 40% (P<0.001), respectively, at each scheduled follow-up visit. At 24 months postoperatively, 19 of 23 (83%) patients experienced an IOP decrease compared with the preoperative visit. No severe device-related adverse events were observed.

Conclusions:
Patients with mild to advanced glaucoma can benefit from micro-bypass implantation even if their IOP is well controlled with topical hypotensive medications. Expectations for these reductions should be moderate.
Microphthalmia, Dermal Aplasia, and Sclerocornea Syndrome: Endoscopic Cyclophotocoagulation in the Management of Congenital Glaucoma
Authors: Thompson Atalie C. , Thompson Matthew O. , Lim Maria E. , Freedman Sharon F. , Enyedi Laura B. 
Published: October 2017

Purpose:
To report on the use of endoscopic cyclophotocoagulation (ECP) to treat congenital glaucoma in a triple X female with microphthalmia, dermal aplasia, and sclerocornea (MIDAS) syndrome.

Observations:
The patient demonstrated linear streaks on the face and neck consistent with dermal aplasia. The corneas were scleralized with ectatic areas of corneal thinning, and the eyes were microphthalmic. Ultrasound biomicroscopy demonstrated congenital aphakia and iris stumps. The patient had elevated intraocular pressure (IOP) that responded to topical glaucoma therapy in the right but not the left eye. Intraoperative endoscopy of the posterior segment revealed multiple hypopigmented chorioretinal lacunae surrounding a pale, cupped optic nerve. ECP of the ciliary processes in the left eye led to marked improvement in IOP.

Conclusions and Importance:
Patients with MIDAS syndrome can develop congenital glaucoma secondary to angle dysgenesis. This is the first case report to demonstrate the safe and effective use of ECP to treat elevated IOP in a patient with MIDAS.
Postoperative Spinal Implant Infections in Children
Authors: Lamberet Aurore , Violas Philippe , Buffet-Bataillon Sylvie , Hamel Antoine , Launay Elise , Lamberet Romain , Arvieux Cédric , Tattevin Pierre 
Published: October 2017

Background:
Postoperative infection is a major complication of spinal surgery with implants. We aimed to identify risk factors for, and characteristics of, postoperative spinal infections in children.

Methods:
We performed a retrospective observational study of all children who underwent posterior spinal fusion with instrumentation in 2 referral hospitals in 2008–2013. Spinal infections were defined as local and/or general signs of infection that required surgical treatment in the early postoperative phase (ie, within 30 days). Data were collected on a standardized questionnaire from medical charts.

Results:
Of the 450 children who underwent spinal surgery, 26 (5.8%) were diagnosed with early postoperative spinal implant infection, with a median age of 14 years (interquartile range, 13–17) and a median delay of 13 days postsurgery (interquartile range, 7–18). Postoperative infection was more common in children with neurologic scoliosis as compared with idiopathic scoliosis (12.2% [15/123] versus 2.4% [5/211]; P < 0.01). Neurologic scoliosis was an independent predictor of spinal implant infections (hazard ratio, 3.87 [1.72–8.69]; P < 0.001). Main pathogens were Staphylococcus aureus (n = 14) and Enterobacteriaceae (n = 8). All children underwent early surgery (wound exploration, debridement and lavage) and antibiotics for a median duration of 19 weeks [interquartile range, 12–26]. Two children (7.7%) required a second surgery. Spinal implants could be retained in all, and no relapse occurred with a follow-up of ≥24 months after antibiotic discontinuation.

Conclusions:
Postoperative spinal implant infection is not rare in pediatric patients, especially with neurologic scoliosis. Most children may be cured with implant retention if managed with early surgery followed by a 3-month course of appropriate antibacterial agents.
Pertussis Outbreak in a Primary School in China
Authors: Liu Xiaoguai , Wang Zengguo , Zhang Juansheng , Li Fang , Luan Yang , Li Hao , Li Yarong , He Qiushui 
Published: October 2017

Background:
A pertussis outbreak was studied in a primary school in Xi’an, China, in March 2016. The school consisted of 536 pupils 6–12 years of age who were divided into 12 classes of 6 grades (2 classes for each grade). The identified index case was an 11-year-old girl at class 2 of grade 5.

Methods:
Interview was conducted and nasopharyngeal swabs were taken from all pupils (N = 94) in the 2 classes of grade 5. Nasopharyngeal swabs were tested by both culture and polymerase chain reaction (PCR).

Results:
Four culture- and 17 PCR-positive cases were identified in 94 pupils. Infection rate was significantly higher in class 2 compared with that in class 1 [37.0% (17/46) vs. 14.6% (7/48), χ2 = 4.26, P < 0.05]. All Bordetella pertussis isolates were macrolide-resistant, harbored prn1/ptxP1/fim3-1 as previously reported and belonged to multilocus variable tandem repeat analysis type MLVA 195. Of the 17 DNAs positive for diagnostic PCR, 12 were also positive for 23S ribosomal RNA PCR. All the 12 DNAs had the A2047G mutation of 23S rRNA gene of B. pertussis.

Conclusions:
This study described a pertussis outbreak caused by macrolide-resistant B. pertussis in a primary school and indicated that close contact of index case causes the bacterial transmission.
A Phase II/III Trial of Lopinavir/Ritonavir Dosed According to the WHO Pediatric Weight Band Dosing Guidelines
Authors: Pinto Jorge A. , Capparelli Edmund V. , Warshaw Meredith , Zimmer Bonnie , Cressey Tim R. , Spector Stephen A. , Qin Min , Smith Betsy , Siberry George K. , Mirochnick Mark 
Published: October 2017

Background:
The World Health Organization (WHO) recommends weight band dosing of antiretrovirals for children. Data are limited describing drug exposure/safety of lopinavir/ritonavir using WHO weight band dosing.

Methods:
International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) P1083 was a phase II/III trial assessing the pharmacokinetics (PK) and short-term safety, tolerance and efficacy of lopinavir/ritonavir in human immunodeficiency virus–infected children 3–25 kg dosed according to WHO weight bands, with liquid solution or meltrex extrusion tablets. The main PK target was an area under the curve (AUC0–24) of 80–320 μg·h/mL.

Results:
Of 97 enrolled participants, median age 2.5 years, 89 (91.8%) completed the protocol. Median LPV dose was 303 mg/m2. The geometric mean (90% confidence limits) LPV PK AUC0–24 was 196 (177–217) μg·h/mL and C
min was 2.47 (1.52–4.02) μg/mL. AUC0–24 was within the target range for 79% of participants. The median (Q1, Q3) difference between individual observed PK parameters and those expected if Food and Drug Administration dosing guidelines were followed was 30.7 (7.9, 54.3) for AUC0–24 and 0.56 (0, 1.27) for C
min. Ten (10%) participants had grade 3 or 4 events deemed related to study treatment, mostly asymptomatic laboratory abnormalities. Three participants died of unrelated study treatment causes. At week 24, 57 of 79 (72%) participants reached viral suppression and the median increase in CD4% (n = 83) was 6.0 (P < 0.0001).

Conclusions:
WHO weight band dosing guidelines in children achieved adequate LPV plasma exposure but was higher than that expected with Food and Drug Administration dosing guidelines. Despite the higher LPV exposure, the treatment was well tolerated and the 24-week efficacy data were favorable.
Emergency Department Burden of Nausea and Vomiting Associated With Cannabis Use Disorder
Authors: Bollom Andrea , Austrie Jasmine , Hirsch William , Nee Judy , Friedlander Daniel , Iturrino Johanna , Ballou Sarah , Lembo Anthony 
Published: October 2017

Background and Aims:
Chronic cannabis use is associated with nausea and vomiting that may lead to emergency department (ED) visits, multiple diagnostic tests, and procedures. The aim of this study was to analyze recent trends in ED visits for vomiting associated with cannabis use disorder between 2006 and 2013.

Methods:
Data were obtained from the National Emergency Department Sample records in which vomiting (ICD-9-CM codes 787.01, 787.03, and 536.2) was a primary diagnosis in combination with cannabis abuse or dependence (304.3, 304.30, 304.31, 304.32, 304.33, 305.2, 305.20, 305.21, 305.22, and 305.23) and were seen in the ED between 2006 and 2013. The National Emergency Department Sample collects data from more than 25 million visits in over 950 EDs and is weighted to provide national estimates.

Results:
The rate of ED visits for vomiting with cannabis use disorder from 2006 compared with 2013 increased from 2.3 to 13.3 per 100,000 ED visits, while the mean inflation-adjusted costs increased 68.5% from $2758.43 to $4647.62, respectively. Men between the ages of 20 and 29 were the most common group to present to the ED for vomiting with cannabis use disorder. The Midwest and West had the higher rates of ED visits for vomiting with cannabis use disorder compared with the Northeast and South.

Conclusions:
ED visits for vomiting associated with cannabis use disorder is common and is associated with significant medical costs. Further research on the role of cannabis use in nausea and vomiting is warranted.
EUS-guided Choledochoduodenostomy Versus Hepaticogastrostomy
Authors: Uemura Ricardo S. , Khan Muhammad Ali , Otoch José P. , Kahaleh Michel , Montero Edna F. , Artifon Everson L.A. 
Published: October 2017

Background and Aims:
Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative in cases of endoscopic retrograde cholangiopancreatography (ERCP) failure. Two types of EUS-BD methods for achieving biliary drainage when ERCP fails are choledochoduodenostomy (CDS) or hepaticogastrostomy (HGS). However, there is no consensus if one approach is better than the other. Therefore, we conducted a systematic review and meta-analysis to evaluate these 2 main EUS-BD methods.

Methods:
We searched MEDLINE, Embase, Scopus, Cochrane database, LILACS from inception through April 8, 2017, using the following search terms in various combinations: biliary drainage, biliary stent, transluminal biliary drainage, choledochoduodenostomy, hepaticogastrostomy, endoscopic ultrasound-guided biliary drainage. We selected studies comparing CDS and HGS in patients with malignant biliary obstruction with ERCP failure. Pooled odds ratio (OR) were calculated for technical success, clinical success, and adverse events and difference of means calculated for duration of procedure and survival after procedure.

Results:
A total of 10 studies with 434 patients were included in the meta-analysis: 208 underwent biliary drainage via HGS and the remaining 226 via CDS. The technical success for CDS and HGS was 94.1% and 93.7%, respectively, pooled OR=0.96 [95% confidence interval (CI)=0.39-2.33, I
2=0%]. Clinical success was 88.5% in CDS and 84.5% in HGS, pooled OR=0.76 (95% CI=0.42-1.35, I
2=17%). There was no difference for adverse events OR=0.97 (95% CI=0.60-1.56), I
2=37%. CDS was about 2 minutes faster with a pooled difference in means of was −2.69 (95% CI=−4.44 to −0.95).

Conclusion:
EUS-CDS and EUS-HGS have equal efficacy and safety, and are both associated with a very high technical and clinical success. The choice of approach may be selected based on patient anatomy.
Adaptation and Validation of the Combined Comorbidity Score for ICD-10-CM
Authors: Sun Jenny W. , Rogers James R. , Her Qoua , Welch Emily C. , Panozzo Catherine A. , Toh Sengwee , Gagne Joshua J. 
Published: October 2017

Background:
The combined comorbidity score, which merges the Charlson and Elixhauser comorbidity indices, uses the ninth revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM). In October 2015, the United States adopted the 10th revision (ICD-10-CM).

Objective:
The objective of this study is to examine different coding algorithms for the ICD-10-CM combined comorbidity score and compare their performance to the original ICD-9-CM score.

Methods:
Four ICD-10-CM coding algorithms were defined: 2 using General Equivalence Mappings (GEMs), one based on ICD-10-CA (Canadian modification) codes for Charlson and Elixhauser measures, and one including codes from all 3 algorithms. We used claims data from the Clinfomatics Data Mart to identify 2 cohorts. The ICD-10-CM cohort comprised patients who had a hospitalization between January 1, 2016 and March 1, 2016. The ICD-9-CM cohort comprised patients who had a hospitalization between January 1, 2015 and March 1, 2015. We used logistic regression models to predict 30-day hospital readmission for the original score in the ICD-9-CM cohort and for each ICD-10-CM algorithm in the ICD-10-CM cohort.

Results:
Distributions of each version of the score were similar. The algorithm based on ICD-10-CA codes [c-statistic, 0.646; 95% confidence interval (CI), 0.640–0.653] had the most similar discrimination for readmission to the ICD-9-CM version (c, 0.646; 95% CI, 0.639–0.653), but combining all identified ICD-10-CM codes had the highest c-statistic (c, 0.651; 95% CI, 0.644–0.657).

Conclusions:
We propose an ICD-10-CM version of the combined comorbidity score that includes codes identified by ICD-10-CA and GEMs. Compared with the original score, it has similar performance in predicting readmission in a population of United States commercially insured individuals.
Influence of Nonindex Hospital Readmission on Length of Stay and Mortality
Authors: Burke Robert E. , Jones Christine D. , Hosokawa Patrick , Glorioso Thomas J. , Coleman Eric A. , Ginde Adit A. 
Published: October 2017

Importance:
Hospitals and health care systems face increasing accountability for postdischarge outcomes of patients, but it is unclear how frequently hospital readmissions in particular occur at a different hospital than the index hospitalization and whether this is associated with worse outcomes.

Objective:
Describe the prevalence of nonindex 30-day readmissions in a nationally representative sample of all payers and associations with outcomes.

Design:
Secondary retrospective analysis of the 2013 Nationwide Readmissions Database.

Setting:
Nonfederal hospitals from 21 states representing half of hospitalizations in the United States annually.

Participants:
Our overall sample included all adults discharged alive from an inpatient stay with 30 days of follow-up; we also created 3 additional cohorts: patients with Medicare as the payer (Medicare cohort), patients discharged to home health or skilled nursing facilities after discharge (postacute care cohort), and Medicare patients with any of the current Hospital Readmission Reduction Program’s penalized conditions (readmission penalty cohort).

Exposure:
Readmission within 30 days to “index” hospital (where index stay occurred) or “nonindex” hospital.

Main Outcome(s) and Measure(s):
In-hospital mortality and length of stay during the readmission.

Results:
The weighted overall sample included 22,884,505 hospital discharges from 2004 unique hospitals. The overall 30-day readmission rate was 11.9%, of these, 22.5% occurred at a nonindex hospital. Readmissions to nonindex facilities were associated with increased odds of in-hospital mortality (odds ratio, 1.21; 95% confidence interval, 1.17–1.25) and longer hospital length of stay (hazard ratio for hospital discharge, 0.87; 95% confidence interval, 0.86–0.88) in the overall sample and in the 3 cohorts.

Conclusions and Relevance:
Nonindex readmissions are common and associated with worse outcomes; the common findings across cohorts highlight the importance for hospitals and care systems participating in value-based payment models. Hospitals and care systems should invest in improved methods for real-time identification and intervention for these patients.