bluuebunny/crossref_metadata_2025_split huggingface dataset:
A common pronociceptive pain modulation profile typifying subgroups of chronic pelvic pain syndromes is interrelated with enhanced clinical pain
Authors: Grinberg Keren , Granot Michal , Lowenstein Lior , Abramov Liora , Weissman-Fogel Irit 
Published: February 2017

Abstract
Provoked vestibulodynia (PVD) and painful bladder syndrome (PBS), subgroups of chronic pelvic pain syndromes (CPPS), are considered to share common biophysiological peripheral mechanisms. In addition, indications of a pronociceptive pain profile coexisting with psychological vulnerability suggest common dysfunctional pain processing and pain modulation in these 2 subgroups of CPPS. We therefore aimed at comparing the pain profile and psychological traits of patients with PVD and PBS to see whether the pain profile contributes to intersubject variability of clinical pain symptoms. Patients with PVD (n = 18) and PBS (n = 21) were compared with healthy controls (n = 20) in their responses to (1) pain psychophysical tests applied to both referred (suprapubis) and remote (hand) body areas and (2) pain-related psychological factors (pain catastrophizing, depression, anxiety, and somatization). We found a similar pronociceptive pain profile in the 2 subgroups of CPPS—enhanced facilitation (ie, hyperalgesia in the referred body area [P < 0.001]) and inefficient inhibition (ie, reduced conditioned pain modulation [P < 0.001] that were associated with both enhanced pain ratings evoked during trigger point examination [P < 0.037]) and higher Brief Pain Inventory ratings (P = 0.002). The latter was also correlated with pain catastrophizing (r = 0.504, P = 0.001) and depression symptoms (r = 0.361, P = 0.024). The findings suggest common mechanisms underlying a dysfunctional nociceptive system in both PVD and PBS. The intersubject variability in the level of dysfunction and its association with disease severity recommends a personalized pain treatment that may alleviate daily pain and dysfunction in patients with CPPS.
Side effects can enhance treatment response through expectancy effects: an experimental analgesic randomized controlled trial
Authors: Berna Chantal , Kirsch Irving , Zion Sean R. , Lee Yvonne C. , Jensen Karin B. , Sadler Pamela , Kaptchuk Ted J. , Edwards Robert R. 
Published: February 2017

Abstract
In randomized controlled trials, medication side effects may lead to beliefs that one is receiving the active intervention and enhance active treatment responses, thereby increasing drug–placebo differences. We tested these hypotheses with an experimental double-blind randomized controlled trial of a nonsteroidal anti-inflammatory drug with and without the addition of atropine to induce side effects. One hundred healthy volunteers were told they would be randomized to either combined analgesics that might produce dry mouth or inert placebos. In reality, they were randomized double blind, double-dummy to 1 of the 4 conditions: (1) 100 mg diclofenac + 1.2 mg atropine, (2) placebo + 1.2 mg atropine, (3) 100 mg diclofenac + placebo, or (4) placebo + placebo, and tested with heat-induced pain. Groups did not differ significantly in demographics, temperature producing moderate pain, state anxiety, or depression. Analgesia was observed in all groups; there was a significant interaction between diclofenac and atropine, without main effects. Diclofenac alone was not better than double-placebo. The addition of atropine increased pain relief more than 3-fold among participants given diclofenac (d = 0.77), but did not enhance the response to placebo (d = 0.09). A chain of mediation analysis demonstrated that the addition of atropine increased dry mouth symptoms, which increased beliefs that one had received the active medication, which, in turn, increased analgesia. In addition to this indirect effect of atropine on analgesia (via dry mouth and beliefs), analyses suggest that among those who received diclofenac, atropine directly increased analgesia. This possible synergistic effect between diclofenac and atropine might warrant future research.
Return to work helps maintain treatment gains in the rehabilitation of whiplash injury
Authors: Sullivan Michael , Adams Heather , Thibault Pascal , Moore Emily , Carriere Junie S. , Larivière Christian 
Published: February 2017

Abstract
This study examined the relation between return to work and the maintenance of treatment gains made over the course of a rehabilitation intervention. The study sample consisted of 110 individuals who had sustained whiplash injuries in rear collision motor vehicle accidents and were work-disabled at the time of enrolment in the study. Participants completed pre- and post-treatment measures of pain severity, disability, cervical range of motion, depression, posttraumatic stress symptoms, and catastrophizing. Pain severity was assessed again at 1-year follow-up. At 1-year follow-up, 73 participants had returned to work and 37 remained work-disabled. Analyses revealed that participants who returned to work were more likely to maintain treatment gains (77.5%) than participants who remained work-disabled (48%), χ2 = 6.3, P < 0.01. The results of a regression analysis revealed that the relation between return to work and the maintenance of treatment gains remained significant (β = 0.30, P < 0.01), even when controlling for potential confounders such as pain severity, restricted range of motion, depression, and pain catastrophizing. The Discussion addresses the processes by which prolonged work-disability might contribute to the failure to maintain treatment gains. Important knowledge gaps still remain concerning the individual, workplace, and system variables that might play a role in whether or not the gains made in the rehabilitation of whiplash injury are maintained. Clinical implications of the findings are also addressed.
The Effect of Glycopyrrolate on Nocturnal Sialorrhea in Patients Using Clozapine
Authors: Man Wai Hong , Colen–de Koning Jantine C.A. , Schulte Peter F.J. , Cahn Wiepke , van Haelst Ingrid M.M. , Doodeman Hieronymus J. , Egberts Toine C.G. , Heerdink Eibert R. , Wilting Ingeborg 
Published: February 2017

Abstract

Background
Nocturnal sialorrhea is one of the most frequent adverse events in clozapine treatment. Symptomatic management of sialorrhea usually consists of off-label treatment with anticholinergic agents. The aim of the current study is to evaluate the efficacy and safety of glycopyrrolate in patients using clozapine that experience sialorrhea.

Methods
In a double-blind randomized crossover trial, patients with nocturnal sialorrhea (n = 32) were randomized to treatment with glycopyrrolate 1 mg or placebo. This double-blinded phase was followed by an optional open label extension phase with glycopyrrolate 2 mg. Exposure periods consisted of 6 consecutive days and were separated with 1 washout week. The primary outcome was clinical improvement of nocturnal sialorrhea assessed by the Patient Global Impression of Improvement (PGI-I).

Results
The proportion of patients with a clinical improvement according to PGI-I did not significantly differ between 1 mg and placebo (18.8% vs 6.3%, P = 0.289); however, in patients using glycopyrrolate 2 mg once daily versus placebo, it did (43.5% vs 6.3%, P = 0.039). Glycopyrrolate was not associated with severe adverse events or worsening of cognitive adverse events.

Conclusions
Glycopyrrolate 1 mg was not superior to placebo, whereas 2 mg showed a significant clinical improvement of nocturnal sialorrhea compared with placebo. Glycopyrrolate seemed to be a tolerable anticholinergic agent in the treatment of clozapine-associated sialorrhea.
Activating and Sedating Adverse Effects of Second-Generation Antipsychotics in the Treatment of Schizophrenia and Major Depressive Disorder
Authors: Citrome Leslie 
Published: February 2017

Abstract

Purpose/Background
Activating and sedating adverse effects of antipsychotics can be obstacles to their use.

Methods/Procedures
This study quantified the activating and sedating properties of first-line oral second-generation antipsychotics by examining the rates of adverse reactions as reported in product labeling for the indications of schizophrenia and adjunctive treatment of major depressive disorder. Additional data sources included regulatory documents, study synopses, and published study reports. Attributable risk increase and number needed to harm (NNH) were calculated for each agent versus placebo.

Findings/Results
Heterogeneity among the different antipsychotics regarding activating or sedating adverse events was observed, with some agents displaying the potential for both activating and sedating properties. For agents indicated for the treatment of schizophrenia, predominantly activating medications include lurasidone (NNH, 11 for akathisia vs 20 for somnolence) and cariprazine (NNH, 15 for akathisia vs 65 for somnolence-combined terms). Similarly activating and sedating are risperidone (NNH, 15 for akathisia vs 13 for sedation) and aripiprazole (NNH, 31 for akathisia vs 34 for somnolence). Predominantly sedating are olanzapine, quetiapine immediate and extended release, ziprasidone, asenapine, and iloperidone. Agents that are neither activating nor sedating are paliperidone and brexpiprazole. For major depressive disorder, the overall findings regarding activation and sedation appear similar to those seen with schizophrenia. Data extracted were limited to those available from registrational studies that contributed to the adverse event tables contained in the product labels. Postregistrational comparative studies may yield different outcomes.

Implications/Conclusions
Differences in tolerability profiles regarding activation and sedation have implications in terms of selecting the optimal antipsychotic for a given individual.
5-HT6 Receptor Antagonist as an Adjunct Treatment Targeting Residual Symptoms in Patients With Schizophrenia
Authors: Morozova Margarita , Burminskiy Denis , Rupchev George , Lepilkina Taissia , Potanin Sergey , Beniashvili Allan , Lavrovsky Yan , Vostokova Natalia , Ivaschenko Alexander 
Published: February 2017

Abstract

Background
Treating patients who experience residual psychotic symptoms during remission of schizophrenia remains one of the most challenging problems. The mechanisms underlying these symptoms differ from those of acute hallucinations and delusions. 5-HT6 receptor antagonists have been considered promising agents in treatment of residual psychotic symptoms and cognitive dysfunction. The aim of the study was to assess the efficacy of a selective 5-HT6 inhibitor Avisetron in the reduction of residual psychotic symptoms in patients with schizophrenia on stable antipsychotic therapy.

Methods
Eighty clinically stable outpatient subjects with schizophrenia with residual psychotic symptoms were randomized in a double-blind manner to 6 weeks of Avisetron or placebo at 1:1 ratio. Subjects received 8 mg of Avisetron or placebo on top their stable antipsychotic treatment. Standard clinical scales and cognitive tests were used for endpoint assessment. The primary efficacy endpoint was the mean reduction of total Positive and Negative Syndrome Scale score after 6 weeks of treatment.

Results
No significant differences in the primary and secondary endpoints were found between the groups. However, based on the subgroup analysis, the significant improvement of total Positive and Negative Syndrome Scale score and residual psychotic symptoms was observed in female patients.

Conclusions
It was a negative study with unexpected benefits of the drug only in females. We hypothesized that the role of patients' sex can impact the treatment response to serotonergic drugs in general. We suggest a possible synergistic interaction between estrogen and Avisetron by means of modulating the effect of estrogens on the serotonergic system. Future studies targeting the sex-related effects of serotonergic drugs are warranted.
The Art of Pharmacotherapy
Authors: de Leon Jose , De las Cuevas Carlos 
Published: February 2017

Abstract

Purpose/Background
This commentary deals with the neglected issue of the art of psychopharmacology by recounting the authors’ journeys.

Methods/Procedures
First, a model of medical science situated within the history of medicine is described including (1) a limitation of the mathematical model of science, (2) the distinction between mechanistic science and mathematical science, (3) how this distinction is applied to medicine, and (4) how this distinction is applied to explain pharmacology to psychiatrists. Second, the neglected art of psychopharmacology is addressed by explaining (1) where the art of psychopharmacotherapy was hiding in the first author’s psychopharmacology research, (2) how the Health Belief Model was applied to the art of medicine, (3) how the second author became interested in the Health Belief Model, and (4) his studies introducing the Health Belief Model in psychopharmacology. The authors’ collaboration led to: (1) study of the effect of pharmacophobia on poor adherence and (2) reflection on the limits of the art of psychopharmacology.

Findings/Results
Low adherence was found in 45% (116/258) of psychiatric patients with pharmacophobia versus 22% (149/682) in those with no pharmacophobia, providing an odds ratio of 2.9 (95% confidence interval, 2.2–4.0) and an adjusted odds ratio of 2.5 (95% confidence interval, 1.8–3.5) after adjusting for other variables contributing to poor adherence.

Implications/Conclusions
Different cognitive patterns in different patients may contribute to poor adherence. Specific interventions targeting these varying cognitive styles may be needed in different patients to improve drug adherence.
Performance Plateau in Prelingually and Postlingually Deafened Adult Cochlear Implant Recipients
Authors: Cusumano Cristen , Friedmann David R. , Fang Yixin , Wang Binhuan , Roland J. Thomas , Waltzman Susan B. 
Published: February 2017

Objective:
To characterize the performance plateau after unilateral cochlear implantation (CI) in prelingually and postlingually deafened adults and to compare their relative progress.

Study Design:
Retrospective chart review.

Setting:
Tertiary referral center.

Patients:
Prelingually and postlingually deaf adults who received a unilateral CI and completed a minimum of 2 years of follow-up at our center.

Intervention:
Unilateral CI.

Main Outcome Measures:
: Standard speech perception testing (consonant-nucleus-consonant [CNC] monosyllabic word test and hearing in noise test [HINT] or AzBio sentence test) were performed preoperatively and 3 and 12 months postoperatively, and annually thereafter.

Results:
In postlingually deaf patients (n = 102), there was a significant improvement in word scores for 3 years postimplantation (p < 0.01). Beyond the 3 years postoperative time point, word scores continued to improve, albeit at a flatter rate. In prelingually deaf patients (n = 16) word scores improved significantly for 5 years postimplantation (p = 0.03).

Conclusions:
Adults with postlingual deafness undergoing unilateral CI show significant improvement in speech perception for 3 years postimplantation, at which point their performance continues to improve, albeit at a flatter rate. The performance of adults with prelingual deafness improves significantly as late as 5 years postimplantation. These time intervals reflect a change to the currently reported 6 to 12 months period and should impact on counseling, especially in the prelingual CI candidate.
Cochlear Implantation in Children With Congenital Single-Sided Deafness
Authors: Thomas Jan Peter , Neumann Katrin , Dazert Stefan , Voelter Christiane 
Published: February 2017

Objective:
To determine audiological and clinical results of cochlear implantation in children with congenital single sided deafness (SSD), with an emphasis on children implanted before and after 6 years of age.

Study Design:
Retrospective study.

Setting:
Tertiary referral center.

Subjects:
Twenty one children with congenital SSD who were implanted aged 10 months to 11;3 years.

Intervention:
Unilateral cochlear implantation.

Main Outcome Measures:
Speech recognition in noise via the German Oldenburg Sentence Test for Children (OlKiSa), lateralization ability, and subjective evaluation of hearing results using self- and third-party assessment questionnaires.

Results:
Significant improvements of all three aspects of true binaural hearing were found. The most striking improvement was the combined head shadow effect by 2.11 dB (squelch effect: 0.95 dB, summation effect 0.98 dB). An improvement of lateralization ability was also demonstrated. Parents had a high overall level of satisfaction with their children's cochlear implantation. Subjective benefit was verified in all three subscales of the Speech, Spatial, and Qualities of Hearing Questionnaire. No significant difference was found between subjects implanted before the age of 6 with those implanted later. Three of the five subjects with a follow-up of greater than 3 years were limited users or nonusers.

Conclusions:
Cochlear implant (CI) provision provides children with congenital SSD with significant audiological and subjective benefits which can be seen even in children implanted after the age of 3;6. The problem of limited use and nonuser, however, should not be ignored and has to be considered for further studies.
Benign Temporomandibular Joint Lesions Presenting as Masses in the External Auditory Canal
Authors: Williams Ryan A. , Jackler Robert K. , Corrales C. Eduardo 
Published: February 2017

Objective:
Describe benign lesions arising from the temporomandibular joint (TMJ) that presented as masses in the external auditory canal (EAC).

Study Design:
Retrospective case series of two academic medical centers.

Patients:
Six patients with lesions emanating from the TMJ that presented as EAC masses. Lesions included pigmented villonodular synovitis (PVNS), nodular fasciitis, foramen of Huschke herniation with salivary fistula, fibroepithelial polyp, superficial angiomyxoma, and giant cell tumor (GCT).

Intervention:
Surgical resection.

Main Outcome Measures:
Tumor control, TMJ function, and hearing.

Results:
All patients presented with hearing loss, TMJ pain, and otalgia. Three patients with EAC occluding masses developed entrapment cholesteatoma between the mass and tympanic membrane. Following surgical resection, four patients were free of disease. The patient with PVNS has a stable remnant at 3 years follow up and the patient with giant cell tumor is under active surveillance. Hearing improved in three patients, remained stable in one patient, and worsened in two patients. All had resolution of their TMJ and ear pain.

Conclusions:
EAC masses of uncertain origin should be imaged preoperatively to exclude lesions best not biopsied (e.g., encephalocele, facial nerve schwannoma, paraganglioma). In the differential of EAC masses, lesions emanating from the TMJ need to be considered, especially for those based anteriorly. Understanding the extent of TMJ involvement is crucial for surgical planning which optimizes outcome. Goals for therapy are to control the underlying disease process, restore patency of the EAC, improve hearing, and preserve function of TMJ.
Factors Associated With Mortality in Continuous Renal Replacement Therapy for Pediatric Patients With Acute Kidney Injury*
Authors: Choi Seung Jun , Ha Eun-Ju , Jhang Won Kyoung , Park Seong Jong 
Published: February 2017

Objectives:
To analyze the epidemiology of pediatric acute kidney injury requiring continuous renal replacement therapy and identify prognostic factors affecting mortality rates.

Design:
Retrospective analysis.

Setting:
PICU of a tertiary medical center.

Patients:
One hundred-twenty three children diagnosed with acute kidney injury requiring continuous renal replacement therapy.

Interventions:
None.

Measurements and Main Results:
Vasoactive-Inotropic Score, arterial blood gas analysis, blood chemistry at continuous renal replacement therapy initiation, the extent of fluid overload 24 hours prior to continuous renal replacement therapy initiation, Pediatric Risk of Mortality III score at admission, and need for mechanical ventilation during continuous renal replacement therapy were compared in survivors and nonsurvivors. Out of 1,832 patient admissions, 185 patients (10.1%) developed acute kidney injury during the study period. Of these, 158 patients were treated with continuous renal replacement therapy, and finally, 123 patients were enrolled. Of the enrolled patients, 50 patients died, corresponding to a mortality rate of 40.6%. The survivor group and the nonsurvivor group were compared, and the following factors were associated with an increased risk of mortality: higher Pediatric Risk of Mortality III score at admission and Vasoactive-Inotropic Score when initiating continuous renal replacement therapy, increased fluid overload 24 hours before continuous renal replacement therapy initiation, and need for mechanical ventilation during continuous renal replacement therapy. The percentage of fluid overload difference between the survivors and the nonsurvivors was 1.2% ± 2.2% versus 4.1% ± 4.6%, respectively. Acidosis, elevated lactic acid and blood urea nitrogen, and lower serum creatinine level were laboratory parameters associated with increased mortality. On multivariate analysis, Vasoactive-Inotropic Score, need for mechanical ventilation, blood urea nitrogen, and creatinine level were statistically significant. (Odds ratio: 1.040, 6.096, 1.032, and 0.643, respectively.)

Conclusions:
A higher Vasoactive-Inotropic Score, need for mechanical ventilation, elevated blood urea nitrogen, and lower creatinine level were associated with increased mortality in pediatric acute kidney injury patients who underwent continuous renal replacement therapy. Lower creatinine levels may be associated with increased mortality in the context of fluid overload, which is correlated with a reduced chance of survival.
Ultrasound-Guided Subclavian Vein Cannulation in Low Birth Weight Neonates
Authors: Lausten-Thomsen Ulrik , Merchaoui Zied , Dubois Cécile , Eleni Dit Trolli Sergio , Le Saché Nolwenn , Mokhtari Mostafa , Tissières Pierre 
Published: February 2017

Objectives:
Central venous access in critically ill, small infants remains technically challenging even in experienced hands. Several vascular accesses exist, but the subclavian vein is often preferred for central venous catheter insertion in infants where abdominal malformation and/or closure of the vein preclude the use of umbilical venous catheters, as catheterization of the subclavian vein is easier in very short necks than the internal jugular vein for age-related anatomical reasons. The subclavian vein approach is yet relatively undescribed in low birth weight infants (i.e., < 2,500 g), and this study aims to explore the feasibility of this technique in very small infants.

Design:
Retrospective data collection of prospectively registered data on central venous catheter insertion in infants.

Setting:
Neonatal ICU and PICU at a university hospital.

Patients:
One hundred and five newborn children hospitalized in at the ICU.

Interventions:
An ultrasound-guided supraclavicular approach was applied on all infants who had an subclavian vein catheterization during a 30-month period from January 2013 to July 2015.

Measurements and Main Results:
One hundred seven supraclavicular subclavian vein catheters were placed in 105 children weighing less than 5,000 g. Among those, 40 patients weighed less than 2,500 g and 10 patients weighed less than 1,500 g. Successful central venous catheter insertion, defined as the correct placement of a functional double-lumen catheter (3F or 4F), was obtained in 97.3%. All three registered failed attempts were due to hematomas from venous bleeding and occurred in infants weighing greater than 2,500 g. No case of accidental arterial puncture or pleural puncture was registered.

Conclusions:
This large series of subclavian vein catheterizations in small infants demonstrates the feasibility of subclavian vein catheterizations even in very small neonates weighing less than 1,500 g.