bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antibacterial therapeutic drug monitoring in cerebrospinal fluid: difficulty in achieving adequate drug concentrations
Authors: Lonsdale Dagan O. , Udy Andrew A. , Roberts Jason A. , Lipman Jeffrey 
Published: November 2012

This report illustrates the difficulty in managing CNS infection in neurosurgical patients, the altered drug pharmacokinetics associated with critical illness, and the role that therapeutic drug monitoring (TDM) of CSF can play in assisting clinical decision making.
The authors present a case of external ventricular drain–related ventriculitis in a critically ill patient who initially presented with a subarachnoid hemorrhage. They discuss the physiological changes found in such patients, in particular augmented renal clearance (demonstrated in this patient by a measured creatinine clearance of 375 ml/min/1.73 m2), noting the effect this had on drug pharmacokinetics and leading to dosing requirements 2–3 times those recommended in standard regimens.
The authors consider the bacterial “kill” characteristics of 2 different antibacterial agents (meropenem and vancomycin) and describe the unique approach of using plasma and CSF TDM to achieve optimal drug exposure at the site of infection while limiting toxic side effects. The authors demonstrate that simply using plasma TDM as a surrogate marker for drug concentration in the CNS may lead to underdosing, exemplified in this patient by CSF vancomycin concentrations as little as 13% of that in plasma. Finally, by measuring CSF and plasma ratios, the authors illustrate the disparity in pharmacokinetic properties between drugs, reminding the clinician of the importance of CNS penetration when selecting antibacterial agents in such cases.
This work raises an important hypothesis in the accurate prescription of antibacterial agents in neurosurgical critical care, namely underdosing in the context of augmented elimination and impaired target site penetration. However, prior to any recommendations regarding empirical dose modification, more data are clearly needed, particularly with respect to the safety and efficacy of such an approach. In this respect, the authors would advocate further research using TDM in the management of CNS infection in this setting, in addition to work defining plasma and CSF concentrations associated with antibacterial efficacy and toxicity.
Glycerol rhizotomy and radiofrequency thermocoagulation for trigeminal neuralgia in multiple sclerosis
Authors: Bender Matthew T. , Pradilla Gustavo , Batra Sachin , See Alfred P. , James Carol , Pardo Carlos A. , Carson Benjamin S. , Lim Michael 
Published: November 2012

Object
Patients with trigeminal neuralgia due to multiple sclerosis (TN-MS) and idiopathic TN (ITN) who underwent glycerol rhizotomy (GR) and radiofrequency thermocoagulation with glycerol rhizotomy (RFTC-GR) were compared to investigate the effectiveness of these percutaneous ablative procedures in the TN-MS population.

Methods
Between 1998 and 2010, 822 patients with typical TN were evaluated; 63 (8%) had TN-MS and 759 (92%) had ITN. Pain relief comparisons were made between 22 GR procedures in patients with TN-MS and 470 GR procedures in patients with ITN; 50 RFTC-GR procedures in patients with TN-MS and 287 RFTC-GR procedures in patients with ITN were compared. Analysis of time to recurrence included only procedures that achieved complete pain relief without medications.

Results
After 15 of the GR procedures (68%) in patients with TN-MS and 315 of the procedures (67%) in those with ITN, the patients were pain free without medications (p = 0.736). After 36 of the RFTC-GR procedures (72%) in patients with TN-MS and 210 of the procedures (73%) in those with ITN, the patients were pain free without medications (p = 0.657). The difference in pain relief between GR and RFTC-GR for patients with TN-MS was not significant (p = 0.447). The median time to failure of GR was 20 months in patients with TN-MS compared with 25 months in those with ITN (p = 0.403). The median time to failure of RFTC-GR was 26 months in the TN-MS population compared with 21 months in the ITN population (p = 0.449). Patients with TN-MS experienced similar times to recurrence whether they were treated with GR or RFTC-GR (p = 0.431).

Conclusions
Pain relief and durability of relief outcomes of GR and RFTC-GR were similar in patients with TN-MS and ITN, reinforcing their use as preferred treatments of TN-MS. The GR and RFTC-GR achieved comparable outcomes in patients with TN-MS, suggesting that both can be used to good effect.
Clinical features and functional recovery of traumatic isolated oculomotor nerve palsy in mild head injury with sphenoid fracture
Authors: Lin Chao , Dong Yan , Lv Liquan , Yu Mingkun , Hou Lijun 
Published: November 2012

Object
The aim of this study was to provide information about long-term functional outcome in patients with isolated oculomotor nerve palsy following minor head injury and to discuss surgical treatment of these patients, especially those with accompanying sphenoid fracture.

Methods
A retrospective analysis was made of 26 patients with traumatic isolated oculomotor nerve palsy. The severity of oculomotor nerve palsy and the functional recovery were evaluated based on extraocular muscle movement, eyelid movement, and pupil size. On average, patients were evaluated 3.6 days after the initial injury, and the average follow-up period was 14.2 months (range 3 months–2 years).

Results
Twenty men and six women were enrolled in this study. The most common cause of trauma was motor vehicle accident in 17 (65.4%) of 26. Among all the recorded symptoms, internal ophthalmoplegia was most frequently seen. The recovery rates of ptosis, external ophthalmoplegia, and internal ophthalmoplegia were 95% (19 of 20 patients), 83.3% (15 of 18 patients), and 50% (13 of 26 patients), respectively. The 6 patients with sphenoid fracture underwent surgical decompression of the superior orbital fissure, after which all patients experienced recovery from ptosis and external ophthalmoplegia and 66.7% (4 of 6 patients) recovered from internal ophthalmoplegia.

Conclusions
Limited eye movement may be a major factor that negatively affects functional recovery after mild head injury. Sphenoid fracture might be one of the potential mechanisms involved in traumatic isolated oculomotor nerve palsy after mild head injury. Surgical decompression should be considered when there is evidence of bone compression of the superior orbital fissure.
Pharmacokinetics of isoniazid with or without ofloxacin
Authors: Brown Sinyeofori A , Ezejiofor Ndidiamaka A , Orisakwe Orish E 
Published: November 2012

Objective of the resent study was to determine the effect of ofloxacin (OXC) on the pharmacokinetics of isoniazid (INH). Five healthy volunteers aged 18  39 years participated in this study after an informed consent. The study was carried out in two phases with an interval of one-week drug wash out period in between phases. In phase one (INH alone), each subject received 300mg of isoniazid (INH) with 350ml of water after an overnight fast. The subjects were made to fast 2 hours post drug. In phase two (INH + OXC), each subject was administered with 300mg of INH in combination with 200mg of OXC observing all the protocol in phase one. The concentration of INH in plasma, saliva and urine of the subjects at predetermined time intervals were measured spectrophotometrically in the two phases over a period of 0 - 48 hours. Various pharmacokinetics parameters were calculated. From the study it is evident that Ofloxacin (OXC) increased the rate and extent of absorption of isoniazid. The absorption half-life (t1/2a) and the maximum concentration and absorption time (Cmax, Tmax) of isoniazid (INH) were increased in the presence of OXC. The urinary excretion of isoniazid was also increased by ofloxacin. The salivary concentration of isoniazid was less than the corresponding plasma drug concentrations, a pattern also found in similar studies. Thus it can be concluded that Ofloxacin increases absorption kinetics and urinary excretion of Isoniazid.DOI: http://dx.doi.org/10.3329/icpj.v1i12.12449 International Current Pharmaceutical Journal 2012, 1(12): 403-409
Formulation and evaluation of solid self micro emulsifying drug delivery system using aerosil 200 as solid carrier
Authors: Bhagwat Durgacharan Arun , DSouza John Intru 
Published: November 2012

Improvement of bio-availability of poorly water soluble drugs presents one of the furthermost challenge in drug formulations. One of the most admired and commercially viable formulation approach for this challenge is solid self micro emulsifying drug delivery system (S-SMEDDS). There are many techniques to convert liquid SMEDDS to solid, but an adsorption technique is simple and economic. Hence aim of present study was to develop S-SMEDDS of poorly water soluble drug Telmisartan (TEL) using Aerosil 200 as solid carrier. Liquid SMEDDS was prepared using Acrysol EL 135, Tween 80 and PEG 400 as oil, surfactant and co-surfactant and was converted to S-SMEDDS by adsorbing it on Aerosil 200. Prepared S-SMEDDS was evaluated for flow properties, drug content, reconstitution properties, DSC, SEM, in-vitro drug release and ex-vivo intestinal permeability study. Results showed that prepared S-SMEDDS have good flow property with 99.45 ± 0.02% drug content. Dilution study by visual observation showed that there was spontaneous micro emulsification and no sign of phase separation. Droplet size was found to be 0.34 µm with polydispersity index of 0.25. DSC thermogram showed that crystallization of TEL was inhibited. SEM photograph showed smooth surface of S-SMEDDS with less aggregation. Drug releases from S- SMEDDS were found to be significantly higher as compared with that of plain TEL. Ex-vivo intestinal permeability study revealed that diffusion of drug was significantly higher from S-SMEDDS than that of suspension of plain TEL. Study concluded that S-SMEDDS can effectively formulated by adsorption technique with enhanced dissolution rate and concomitantly bioavailability.DOI: http://dx.doi.org/10.3329/icpj.v1i12.12451 International Current Pharmaceutical Journal 2012, 1(12): 414-419
Low Phosphate Alters Lateral Root Setpoint Angle and Gravitropism
Authors: Bai Hanwen , Murali Bhavna , Barber Kevin , Wolverton Chris 
Published: November 2012

• Premise of the study: Lateral roots, responsible for water and nutrient uptake, maintain nonvertical angles throughout development. Soil phosphate is one limiting nutrient for plant growth that is known to induce changes to root system architecture, such as increased lateral root formation. This study seeks to determine whether phosphate concentration affects lateral root orientation in addition to its previously described influences on root architecture.• Methods: Images of intact Arabidopsis root systems were recorded for 24 h, and lateral root tip angles were measured for wild‐type and mutant pgm‐1 and pin3‐1 roots on a full or low phosphate medium. Setpoint angles of unstimulated root systems were determined, as were gravitropic responses of lateral roots over time.• Key results: The root system setpoint angles of wild‐type and mutant pin3‐1 roots showed a shift toward a more vertical orientation on low orthophosphate (Pi) medium. The gravitropic responses of both pgm‐1 and pin3‐1 roots on low Pi medium was elevated relative to control Pi medium. Mutations in two phosphate transporters with high levels of expression in the root showed a gravitropic response similar to wild‐type roots grown on low Pi, supporting a role for Pi status in regulating lateral root gravitropism.• Conclusions: Lateral root orientation and gravitropism are affected by Pi status and may provide an important additional parameter for describing root responses to low Pi. The data also support the conclusion that gravitropic setpoint angle reacts to nutrient status and is under dynamic regulation.
Clinical Outcomes of Peritoneal Dialysis Patients Transferred from Hemodialysis: A Matched Case–Control Study
Authors: Zhang Li , Cao Tao , Li Zhibin , Wen Qiong , Lin Jianxiong , Zhang Xiaodan , Guo Qunying , Yang Xiao , Yu Xueqing , Mao Haiping 
Published: November 2012

Objective Our study aimed to evaluate clinical outcomes of patients transferred to peritoneal dialysis (PD) because of complications related to hemodialysis (HD). Methods In a 1:2 matched case–control study, we compared patient and technique survival between patients initially treated with HD for at least 3 months and then transferred to PD (transfer group) and patients started on and continuing with PD (no-transfer group). Results All baseline characteristics except for initial residual urinary output were comparable between the groups. Compared with patients in the transfer group, patients in the no-transfer group had a higher initial daily residual urinary output [850 mL (range: 600 – 1250 mL) vs 0 mL (range: 0 – 775 mL/d), p = 0.000]. The main reasons for transfer to PD were vascular access problems and cardiovascular disease. Patient survival and technique failure rates did not significantly differ between the groups ( p > 0.05). The 1-, 3-, and 5-year patient survival rates were 80.0%, 53.7%, and 27.6% in the transfer group and 89.7%, 60.2%, and 43.1% in the no-transfer group. Age (per 10 years) and serum albumin were independent risk factors for long-term survival in PD patients. Relative risk of either death or technique failure was not significantly increased in patients transferred from HD. Conclusions Patients who transferred to PD after failing HD had outcomes on PD similar to those for patients who started with and were maintained on PD. Age (per 10 years) and serum albumin were independent risk factors for long-term survival in PD patients.
Acute Peritoneal Dialysis in Neonates with Acute Kidney Injury and Hypernatremic Dehydration
Authors: Yildiz Nurdan , Erguven Müferet , Yildiz Metin , Ozdogan Tutku , Turhan P℩nar 
Published: November 2012

Objective We aimed to evaluate the efficacy of acute peritoneal dialysis (PD) and clinical outcomes in neonates with acute kidney injury (AKI) and hypernatremic dehydration. Methods The medical records of 15 neonates with AKI and hypernatremic dehydration who were treated with acute PD were reviewed. The diagnoses were AKI with hypernatremic dehydration with or without sepsis in 13 patients and AKI with hypernatremia and congenital nephropathy in 2 patients. The main indications for PD were AKI with some combination of oligoanuria, azotemia, hyperuricemia, and metabolic acidosis unresponsive to initial intensive medical treatment. Results The mean age of the patients at dialysis initiation was 11.9 ± 9 days, and the mean duration of PD was 6.36 ± 4.8 days. In 7 patients (46.7%), hypotension required the use of vasopressors, and in 6 patients (40%), mechanical ventilation was required. Peritoneal dialysis–related complications occurred in 7 patients (46.7%), the most common being catheter malfunction ( n = 6). Four episodes of peritonitis occurred in the 15 patients (26.7%), 2 episodes in patients with congenital renal disease and 2 episodes in patients with sepsis and multiorgan failure, who did not survive. Congenital renal disease, septicemia, and the need for mechanical ventilation were important factors influencing patient survival. All patients with no pre-existing renal disease or sepsis recovered their renal function and survived. Conclusions In neonates with AKI and hypernatremic dehydration, PD is safe and successful, and in patients without congenital renal disease or sepsis, the prognosis is good. Peritoneal dialysis should be the treatment of choice in neonates with AKI and hypernatremic dehydration who do not respond to appropriate medical treatment.
Ultrafiltration Characteristics of Glucose Polymers with Low Polydispersity
Authors: Leypoldt John K. , Hoff Catherine M. , Piscopo Dean , Carr Seraya N. , Svatek Jessica M. , Holmes Clifford J. 
Published: November 2012

Background Icodextrin, a glucose polymer with a polydispersity [ratio of weight-average molecular weight (Mw) to number-average molecular weight] of approximately 2.6, has been shown, compared with glucose, to provide superior ultrafiltration (UF) efficiency [ratio of UF to carbohydrate (CHO) absorbed] when used as an osmotic agent during a long-dwell peritoneal dialysis exchange. In an experimental rabbit model, we evaluated the effect of Mw on the UF and UF efficiency of glucose polymers with low polydispersity. Methods A crossover trial in female New Zealand White rabbits (2.20 – 2.65 kg) with surgically implanted peritoneal catheters evaluated two glucose polymers at nominal concentrations of 7.5 g/dL: a 6K polymer (Mw: 6.4 kDa; polydispersity: 2.3) and a 19K polymer (Mw: 18.8 kDa; polydispersity: 2.0). Rabbits were randomized to receive either the 6K ( n = 11) or the 19K ( n = 12) solution during the first exchange (40 mL/kg body weight). The alternative solution was evaluated in a second exchange 3 days later. During each 4-hour dwell, the UF and total glucose polymer CHO absorbed were determined. Results The UF was higher for the 6K ( p < 0.0001) than for the 19K polymer (mean ± standard deviation: 73.6 ± 30.8 mL vs. 43.0 ± 20.2 mL), as was the amount of CHO absorbed (42.5% ± 9.8% vs. 35.7% ± 11.0%, p = 0.021). In spite of higher CHO absorption, an approximately 50% higher ( p = 0.029) UF efficiency was achieved with the 6K polymer (28.3 ± 18.8 mL/g) than with the 19K polymer (19.0 ± 11.3 mL/g). The results were independent of the order of the experimental exchanges. Conclusions Glucose polymers with low polydispersity are effective osmotic agents in a rabbit model. The low-Mw polymer was more effective at generating UF and had a higher UF efficiency, but those results came at the expense of the polymer being more readily absorbed from the peritoneal cavity.
Quantitative Radiographic Features of Early Knee Osteoarthritis: Development Over 5 Years and Relationship with Symptoms in the CHECK Cohort
Authors: KINDS MARGOT B. , MARIJNISSEN ANNE C.A. , BIJLSMA JOHANNES W.J. , BOERS MAARTEN , LAFEBER FLORIS P.J.G. , WELSING PACO M.J. 
Published: November 2012

Objective.To evaluate whether computer-assisted, interactive digital analysis of knee radiographs enables identification of different quantitative features of joint damage, and to evaluate the relationship of such features with each other and with clinical characteristics during 5-year followup in early osteoarthritis (OA).Methods.Knee radiographs from the Cohort Hip and Cohort Knee (CHECK) study, including 1002 individuals with early OA complaints, were evaluated for different measures with knee images digital analysis (KIDA). To aid definition of different radiographic features of OA, principal component analysis of KIDA was used. Features were correlated (Pearson) to each other, evaluated for changes over time, and related to clinical outcome (Western Ontario and McMaster Universities Osteoarthritis Index for pain and function) using baseline, 2-year, and 5-year followup data.Results.The identified radiographic features were joint space width (JSW: minimum, medial, lateral), varus angle, osteophyte area, eminence height, and bone density. The features progressed in severity at different times during followup: early (medial JSW, osteophyte area), late (minimum and lateral JSW, eminence height), and both early and late (varus angle, bone density). Correlations between different radiographic features varied between timepoints. The JSW features were most strongly related to each other (largest r = 0.82), but also, e.g., osteophytes and bone density were correlated (largest r = 0.33). The relationships with clinical outcome varied over time, but were most commonly found for osteophyte area and JSW.Conclusion.In this early OA cohort, different radiographic features were identified that progressed at different rates between timepoints. The relations between radiographic features and with clinical outcome varied over time. This implies that longitudinal evaluation of different features can improve insight into progression of OA.
Is Vasculopathy Associated with Systemic Sclerosis More Severe in Men?
Authors: PANOPOULOS STYLIANOS T. , BOURNIA VASILIKI-KALLIOPI , SFIKAKIS PETROS P. 
Published: November 2012

Objective.To identify possible differences in morbidity and mortality between men and women with systemic sclerosis (SSc) by examining a homogeneous cohort at a single academic center.Methods.Demographic, clinical, and outcome data for all 231 patients of Greek origin with SSc who were examined between 1995 and 2011 in our department (200 women) were recorded in consecutive 3-year intervals from disease onset; data were analyzed retrospectively.Results.Factors comparable between sexes were age (yrs ± SD) at disease onset (46 ± 15 vs 46 ± 15), diffuse skin involvement (61.3% of men vs 46.4% of women), and anti-Scl-70 antibody positivity (66.6% of men vs 59.2% of women). Also comparable were prevalence of interstitial lung disease, upper or lower gastrointestinal (GI) tract involvement, and echocardiographic findings during the first, second, and third 3-year intervals from disease onset (2904 patient-yrs). In contrast, vasculopathy occurred earlier in men. During the first 3 years digital ulcers developed in 54% of men versus 31% of women (p = 0.036) and renal crisis developed in 17% of men versus 3% of women (p = 0.006). No significant differences regarding social history, smoking, medical history, or disease management were identified. After excluding non-SSc-related deaths, survival was worse in men (p = 0.005, Kaplan-Meier analysis) with significantly lower 6- and 12-year cumulative rates (77.2% and 53.8%, respectively, in men vs 97.3% and 89.2% in women).Conclusion.Results derived from an unselected SSc population indicate that the disease is more severely expressed in men than in women, a finding that could be related to more rapid development of vasculopathy in men. Studies are warranted in other single-center cohorts to confirm these findings.
Consensus Statements for the Use of Administrative Health Data in Rheumatic Disease Research and Surveillance
Authors: BERNATSKY SASHA , LIX LISA , O’DONNELL SIOBHAN , LACAILLE DIANE ,   CANRAD Network
Published: November 2012

Objective.Administrative data are increasingly being used for research and surveillance about rheumatic diseases. However, literature reviews have revealed a lack of consistency in methods for conducting observational rheumatic disease studies, a situation that can lead to findings that cannot be compared. Our purpose was to develop best-practice consensus statements about the use of administrative data for rheumatic disease research and surveillance in Canada.Methods.We convened 52 decision makers, epidemiologists, clinicians, and researchers to a 2-day workshop. Prior to this, participants formed working groups to examine 3 best-practice categories: case definitions, epidemiology methods, and comorbidity and outcomes measurement. The groups conducted systematic or scoping reviews on key topics. At the workshop, evidence from the reviews was presented and consensus-building techniques were used to develop the best-practice statements. The statements were presented, discussed, revised (as needed), and then subjected to voting.Results.Thirteen best-practice consensus statements were developed and endorsed by consensus. For the first category, these consensus statements addressed validation techniques for rheumatic disease case definitions and case ascertainment bias. The consensus statements for epidemiology methods focused on confounding and drug exposure measurement. For comorbidity and outcomes measurement, consensus statements were developed for multiple conditions, including osteoporosis and fragility fractures, cancer, infections, cardiovascular disease, and renal disease. Strengths and limitations of administrative data were identified in relation to each topic.Conclusion.Our best-practice consensus statements are consistent with other recent guidelines, including those for rheumatic disease biologics registries, but address additional issues specific to administrative data. Continuing work focuses on disseminating these consensus statements to multiple audiences.