bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accuracy of whole-body MRI in the assessment of splenic involvement in lymphoma
Authors: Littooij Annemieke S , Kwee Thomas C , Barber Ignasi , Granata Claudio , de Keizer Bart , Beek Frederik JA , Hobbelink Monique G , Fijnheer Rob , Stoker Jaap , Nievelstein Rutger AJ 
Published: February 2015

Background Accurate evaluation of the spleen is an important component of staging lymphoma, because this may have prognostic and therapeutic implications. Purpose To determine the diagnostic value of whole-body magnetic resonance imaging (MRI), including diffusion-weighted imaging (whole-body MRI-DWI) in the detection of splenic involvement in lymphoma. Material and Methods This IRB approved, prospective multicenter study included a total of 107 patients with newly diagnosed, histologically proven lymphoma who underwent 1.5 T whole-body MRI-DWI and FDG-PET/CT. Whole-body MRI-DWI and FDG-PET/CT were independently evaluated by a radiologist and a nuclear medicine physician, in a blinded manner. Splenic involvement at MRI was defined as splenic index > 725 cm3 or discrete nodules. At FDG-PET/CT splenic involvement was defined as splenic uptake greater than liver uptake or hypodense nodules at contrast-enhanced CT. FDG-PET/CT augmented with follow-up imaging after treatment was used as reference standard. Results Splenic involvement was detected with FDG-PET/CT in 21 patients, all demonstrating response to treatment. The sensitivity, specificity, positive predictive value, and negative predictive value of whole-body MRI-DWI for the detection of splenic involvement were 85.7 %, 96.5 %, 85.7%, and 96.5%, respectively. Three out of six discrepancies were related to suboptimal criterion of splenic size used with whole-body MRI-DWI versus the size-independent FDG uptake. Conclusion Whole-body MRI-DWI is reasonably accurate in the detection of splenic lymphomatous involvement.
Tibial and Femoral Tunnel Changes After ACL Reconstruction
Authors: Weber Alexander E. , Delos Demetris , Oltean Hanna N. , Vadasdi Katherine , Cavanaugh John , Potter Hollis G. , Rodeo Scott A. 
Published: February 2015

Background: Tunnel widening after anterior cruciate ligament reconstruction (ACL-R) is a well-accepted and frequent phenomenon, yet little is known regarding its origin or natural history. Purpose: To prospectively evaluate the cross-sectional area (CSA) changes in tibial and femoral bone tunnels after ACL-R with serial MRI. Study Design: Case series; Level of evidence, 4. Methods: Patients underwent arthroscopic ACL-R with the same surgeon, surgical technique, and rehabilitation protocol. Each patient underwent preoperative dual-energy x-ray absorptiometry and clinical evaluation, as well as postoperative time zero MRI followed by subsequent MRI and clinical examination, including functional and subjective outcome tests, at 6, 12, 24, 52, and 104 weeks. Tibial and femoral tunnel CSA was measured on each MRI at tunnel aperture (ttA and ftA), midsection (ttM and ftM), and exit (ttE and ftE). Logistic regression modeling was used to examine the predictive value of demographic data and preoperative bone quality (as measured by dual-energy x-ray absorptiometry) on functional outcome scores, manual and instrumented laxity measurements, and changes in tunnel area over time. Results: Eighteen patients (including 12 men), mean age 35.5 ± 8.7 years, underwent ACL-R. There was significant tunnel expansion at ttA and ftA sites 6 weeks postoperatively ( P = .024 and .0045, respectively). Expansion continued for 24 weeks, with progressive tunnel narrowing thereafter. Average ttA CSA was significantly larger than ftA CSA at all times. The ttM significantly expanded after 6 weeks ( P = .06); continued expansion to week 12 was followed by 21 months of reduction in tunnel diameter. The ftM and both ttE and ftE sites decreased in CSA over the 2 years. Median Lysholm and International Knee Documentation Committee scores significantly improved at final follow-up ( P = .0083 and <.0001, respectively), and patients returned to preoperative activity levels. Pivot shift significantly decreased ( P < .0001). Younger age (<30 years), male sex, and delayed ACL-R (>1 year from time of injury) predicted increased tunnel widening and accelerated expansion in CSA ( P < .005). Conclusion: Tunnel expansion after ACL-R occurs early and primarily at the tunnel apertures. Expansion may not affect clinical outcome. Younger age, male sex, and delay from injury to ACL-R may be potential risks for enlargement.
A 46-Year-Old Woman With Dyspnea From an Inhalational Exposure, Triggering Thyroid Storm and Subsequent Multi-Organ System Failure
Authors: Moraco Andrew H. , Banauch Gisela , Kopec Scott 
Published: February 2015

Background: Thyroid storm is a rare, life-threatening condition which arises in patients with thyrotoxicosis, with an annual incidence of 2 patients per 1,000,000 and a mortality rate of 11%. Case: We present the case of a 46-year-old-female with a medical history of controlled mild intermittent asthma, who presented with a severe asthma exacerbation, that triggered thyroid storm after exposure to polyurethane fumes. Conclusion: This patient represents, to the best of our knowledge, the first patient in whom the stress related to a severe asthma attack triggered the development of thyroid storm. She also is the first patient with no indication of cardiac dysfunction who developed fatal cardiac arrest after initiation of b-blockade for treatment of thyroid storm.
Exploration of Withdrawal of Life-Sustaining Therapy in Canadian Intensive Care Units
Authors: van Beinum Amanda , Hornby Laura , Ramsay Tim , Ward Roxanne , Shemie Sam D. , Dhanani Sonny 
Published: February 2015

Objective: The process of controlled donation after circulatory death (cDCD) is strongly connected with the process of withdrawal of life-sustaining therapy. In addition to impacting cDCD success, actions comprising withdrawal of life-sustaining therapy have implications for quality of palliative care. We examined pilot study data from Canadian intensive care units to explore current practices of life-sustaining therapy withdrawal in nondonor patients and described variability in standard practice. Design: Secondary analysis of observational data collected for Determination of Death Practices in Intensive Care pilot study. Setting: Four Canadian adult intensive care units. Patients: Patients ≥18 years in whom a decision to withdraw life-sustaining therapy was made and substitute decision makers consented to study participation. Organ donors were excluded. Interventions: None. Measurements and Main Results: Prospective observational data on interventions withdrawn, drugs administered, and timing of life-sustaining therapy withdrawal was available for 36 patients who participated in the pilot study. Of the patients, 42% died in ≤1 hour; median length of time to death varied between intensive care units (39-390 minutes). Withdrawal of life-sustaining therapy processes appeared to follow a general pattern of vasoactive drug withdrawal followed by withdrawal of mechanical ventilation and extubation in most sites but specific steps varied. Approaches to extubation and weaning of vasoactive drugs were not consistent. Protocols detailing the process of life-sustaining therapy withdrawal were available for 3 of 4 sites and also exhibited differences across sites. Conclusions: Standard practice of life-sustaining therapy withdrawal appears to differ between selected Canadian sites. Variability in withdrawal of life-sustaining therapy may have a potential impact both on rates of cDCD success and quality of palliative care.
Residency Program Directors’ View on the Value of Teaching
Authors: Korte Catherine , Smith Andrew , Pace Heather 
Published: February 2015

Purpose: There is no standardization for teaching activities or a requirement for residency programs to offer specific teaching programs to pharmacy residents. This study will determine the perceived value of providing teaching opportunities to postgraduate year 1 (PGY-1) pharmacy residents in the perspective of the residency program director. The study will also identify the features, depth, and breadth of the teaching experiences afforded to PGY-1 pharmacy residents. Methods: A 20-question survey was distributed electronically to 868 American Society of Health-System Pharmacists-accredited PGY-1 residency program directors. Results: The survey was completed by 322 program directors. Developing pharmacy educators was found to be highly valued by 57% of the program directors. Advertisement of teaching opportunities was found to be statistically significant when comparing program directors with a high perceived value for providing teaching opportunities to program demographics. Statistically significant differences were identified associating development of a teaching portfolio, evaluation of Advanced Pharmacy Practice Experiences students, and delivery of didactic lectures with program directors who highly value developing pharmacy educators. Conclusions: Future residency candidates interested in teaching or a career in academia may utilize these findings to identify programs that are more likely to value developing pharmacy educators. The implementation of a standardized teaching experience among all programs may be difficult.
Predictors of kidney disease in a cohort of pediatric patients with lupus
Authors: Sule S D , Moodalbail D G , Burnham J , Fivush B , Furth S L 
Published: February 2015

Introduction Children with systemic lupus erythematosus (SLE) have an increased prevalence of kidney disease compared to their adult counterparts. Our goal was to identify potential clinical and laboratory predictors of renal disease. Methods We performed a cohort study of incident and prevalent patients with SLE aged ≤19 years. Retrospective data from initial presentation until study enrollment was also collected. Laboratory and clinic data were recorded from each clinic visit including disease activity indices, autoantibodies, urinalyses, blood counts, and metabolic profile. Kidney disease was defined as the presence of abnormal renal biopsy or by American College of Rheumatology case definition for lupus nephritis. Logistic regression analyses were used to determine the association between clinical and laboratory data with kidney disease in those who had renal involvement within 30 days of SLE diagnosis. We also performed a time to event analysis to identify antecedents of renal disease. Results Forty-seven children and adolescents with SLE were followed in the cohort, 91% female and 68% black. All of the males in the cohort developed renal disease, and all within one month of the diagnosis of SLE. In logistic regression, low serum albumin (odds ratio (OR): 4.8, 95% CI: 1.9–12.5) and positive dsDNA antibodies (OR: 3.2, 95% CI: 1.7–5.9) were associated with kidney disease. In longitudinal analyses, isolated sterile pyuria (hazard ratio (HR): 3, 95% CI: 1.1–6.4) and low serum albumin (HR: 3.4, 95% CI: 1.7–6.9) were predictors of future kidney disease. The presence of antibodies against Ro were protective against renal disease (HR: 0.2, 95% CI: 0.05–0.5). Conclusion We identified variables associated with kidney disease, both at initial diagnosis of SLE and in longitudinal follow-up in a cohort of children with SLE. The recognition of these abnormal laboratory values may help clinicians identify patients at risk for kidney disease before its onset thus preventing long-term complications.
Comparison of Renoprotective Effect of Dabigatran With Low-Molecular-Weight Heparin
Authors: Yazici Suleyman , Karahan Oguz , Oral Mehmet Kerem , Bayramoğlu Zehra , Unal Mehmet , Caynak Baris , Sagbas Ertan 
Published: February 2015

Objective: The susceptibility of tissue to ischemia–reperfusion (I/R) injury is a major obstacle to tissue regeneration and cellular survival. In this study, we investigated the possible renoprotective effect of dabigatran in an experimental renal I/R model. Method: A total of 25 rats were randomly divided into 5 equal groups. The control group was used to obtain basal values of oxidant and antioxidant biomarkers. The sham group was used to obtain renal prolidase and malondialdehyde (MDA) levels after renal ischemia (for 45 minutes) and reperfusion (for 1 hour). A standard diet was followed. Oral 15 mg/kg dabigatran etexilate was administrated to group I, intraperitoneal 250 U/kg enoxaparin sodium was administrated to group II, and intraperitoneal 250 U/kg bemiparin sodium was administrated to group III for 1 week before the renal I/R was performed. Renal tissue samples were obtained during the first hour of reperfusion to detect renal prolidase and MDA levels in these groups, after which the rats were euthanized. Results: Renal prolidase levels were significantly higher in the sham group compared with the control group (1834.2 ± 982.3 U/g protein vs 238.8 ± 43.6U/g protein; P = .001). Lower prolidase levels were observed in groups II (838.7 ± 123.8 U/g protein) and III (1012.9 ± 302.3 U/g protein), and the lowest prolidase levels occurred in group I (533.8 ± 96.2 U/g protein; P < .05) when compared with the sham group. The MDA levels were significantly lower ( P < .05) in groups I, II, and III (163.9 ± 41.5, 185.4 ± 51.0, and 138.2 ± 22.6 μmol/g protein, respectively) compared with the sham group. Conclusion: Dabigatran etexilate, a univalent direct thrombin inhibitor, may protect the renal tissue more effectively when compared to low-molecular-weight heparins.
Beyond-use date determination of buprenorphine buccal solution using a stability-indicating high-performance liquid chromatographic assay
Authors: Kirk Loren Madden , Brown Stacy D 
Published: February 2015

Objectives The objectives of this study included developing and validating a stability-indicating high-performance liquid chromatographic (HPLC) method with ultraviolet (UV) detection for the determination of buprenorphine in a buccal solution for veterinary use, and applying that method to determine the stability of a 3 mg/ml buprenorphine preparation in room temperature and refrigerated storage conditions. This preparation, intended for buccal administration in feline patients, plays an important role in pain management in cats. Methods A stability-indicating HPLC method was developed and validated for system suitability, accuracy, repeatability, intermediate precision, specificity, linearity and robustness based on US Pharmacopeia (USP) General Chapter <1225>. The method was then applied to the study of potency changes over 90 days in a buccal buprenorphine solution stored at two temperatures. Results All HPLC-UV method data met acceptable criteria for the quantification of buprenorphine in a buccal solution formulation. The buprenorphine concentrations found in each stability sample remained within the 90–110% of label claim throughout the 90 days of study. All stability test bottles of the buprenorphine buccal solution retained their original appearance. For the room temperature bottles, some white particulate matter was noted in the threads of the container bottles starting at day 21. The pH of the preparations during the course of the study was in the range of 3.57–4.06 and 4.01–4.16 for the room temperature and refrigerated samples, respectively. Conclusions and relevance Pharmacists have compounded a concentrated 3 mg/ml buccal solution to use easily in the home care or outpatient setting for treatment of feline pain. Prior to this investigation, pharmacists empirically assigned beyond-use dates to this formulation based on standards in USP General Chapter <795> Pharmaceutical Compounding – Nonsterile Preparations. This study of a 3 mg/ml buprenorphine buccal solution indicates stability through 90 days.
Anaplasma phagocytophilum infection of domestic cats: 16 cases from the northeastern USA
Authors: Savidge Christine , Ewing Patty , Andrews Jan , Aucoin David , Lappin Michael R , Moroff Scott 
Published: February 2015

Objectives Anaplasma phagocytophilum is an Ixodes species-transmitted rickettsial organism that is occasionally associated with clinical abnormalities in humans, ruminants, horses, dogs and cats. While serological evidence of A phagocytophilum exposure is common in cats in Ixodes species endemic areas, reports of clinical feline anaplasmosis are few. The objective of this study was to describe the clinical and laboratory abnormalities and treatment responses in 16 cats with A phagocytophilum DNA amplified from blood. Methods Commercial laboratory electronic records were searched to find cats that had A phagocytophilum DNA amplified from their blood. Once cases were identified, the primary care veterinarian was interviewed and the medical records were reviewed. Results The cats ranged in age from 4 months to 13 years (mean 4.1 years, median 2 years). All cats lived in Ixodes scapularis endemic areas and had potential for exposure. All cats were lethargic, 15 (94%) had elevated body temperature (>39.4°C) and 14 were anorexic on initial physical examination. Other less common clinical findings included hepatosplenomegaly, ataxia, conjunctivitis and elevation of the nictitating membranes. Blood from 11 cats was evaluated by complete blood cell count; abnormalities included lymphopenia in seven (64%) cats, thrombocytopenia in seven (64%), morulae in neutrophils of three (27%), neutropenia in three (27%) and leukopenia in two (18%). Treatment responses were reported for 14 cats, and the clinical abnormalities in these cats resolved when doxycycline was administered. Conclusions and relevance This is the first published report describing A phagocytophilum morulae in neutrophils of naturally infected North American cats with infection confirmed by PCR. A phagocytophilum infection should be considered in cats evaluated for lethargy, anorexia and fever living in Ixodes species endemic areas.
Memory impairment in multiple sclerosis: Relevance of hippocampal activation and hippocampal connectivity
Authors: Hulst Hanneke E , Schoonheim Menno M , Van Geest Quinten , Uitdehaag Bernard MJ , Barkhof Frederik , Geurts Jeroen JG 
Published: February 2015

Background: Memory impairment is frequent in multiple sclerosis (MS), but it is unclear what functional brain changes underlie this cognitive deterioration. Objective: To investigate functional hippocampal activation and connectivity, in relation to memory performance in MS. Methods: Structural and functional magnetic resonance imaging data were acquired for 57 MS patients and 28 healthy controls (HCs), yielding hippocampal measures of volume, lesions, functional activation during a memory task and functional connectivity at rest. Memory function was based on two subtests of a larger neuropsychological test battery and related to hippocampal neuroimaging measures, using linear regression. Results: Hippocampal volume was lower in MS patients, as compared to HCs. In MS, hippocampal activation during the task was increased in cognitively preserved, but decreased in cognitively impaired, patients. Increased hippocampal connectivity was detected in MS patients, as compared to HCs, between the left hippocampus and the right posterior cingulate. Memory impairment in MS was explained (adjusted R2 = 0.27) by male gender, decreased hippocampal activation and increased hippocampal connectivity ( p = 0.001). Conclusions: Decreased activation of the hippocampus, increased connectivity and male gender were associated with worse memory performance in MS. These results indicate that increased activation and increased connectivity do not always coincide, and relate differently to cognitive dysfunction in MS.
Conversion from clinically isolated syndrome to multiple sclerosis: A large multicentre study
Authors: Kuhle J , Disanto G , Dobson R , Adiutori R , Bianchi L , Topping J , Bestwick JP , Meier U-C , Marta M , Costa G Dalla , Runia T , Evdoshenko E , Lazareva N , Thouvenot E , Iaffaldano P , Direnzo V , Khademi M , Piehl F , Comabella M , Sombekke M , Killestein J , Hegen H , Rauch S , D’Alfonso S , Alvarez-Cermeño JC , Kleinová P , Horáková D , Roesler R , Lauda F , Llufriu S , Avsar T , Uygunoglu U , Altintas A , Saip S , Menge T , Rajda C , Bergamaschi R , Moll N , Khalil M , Marignier R , Dujmovic I , Larsson H , Malmestrom C , Scarpini E , Fenoglio C , Wergeland S , Laroni A , Annibali V , Romano S , Martínez AD , Carra A , Salvetti M , Uccelli A , Torkildsen Ø , Myhr KM , Galimberti D , Rejdak K , Lycke J , Frederiksen JL , Drulovic J , Confavreux C , Brassat D , Enzinger C , Fuchs S , Bosca I , Pelletier J , Picard C , Colombo E , Franciotta D , Derfuss T , Lindberg RLP , Yaldizli Ö , Vécsei L , Kieseier BC , Hartung HP , Villoslada P , Siva A , Saiz A , Tumani H , Havrdová E , Villar LM , Leone M , Barizzone N , Deisenhammer F , Teunissen C , Montalban X , Tintoré M , Olsson T , Trojano M , Lehmann S , Castelnovo G , Lapin S , Hintzen R , Kappos L , Furlan R , Martinelli V , Comi G , Ramagopalan SV , Giovannoni G 
Published: February 2015

Background and objective: We explored which clinical and biochemical variables predict conversion from clinically isolated syndrome (CIS) to clinically definite multiple sclerosis (CDMS) in a large international cohort. Methods: Thirty-three centres provided serum samples from 1047 CIS cases with at least two years’ follow-up. Age, sex, clinical presentation, T2-hyperintense lesions, cerebrospinal fluid (CSF) oligoclonal bands (OCBs), CSF IgG index, CSF cell count, serum 25-hydroxyvitamin D3 (25-OH-D), cotinine and IgG titres against Epstein-Barr nuclear antigen 1 (EBNA-1) and cytomegalovirus were tested for association with risk of CDMS. Results: At median follow-up of 4.31 years, 623 CIS cases converted to CDMS. Predictors of conversion in multivariable analyses were OCB (HR = 2.18, 95% CI = 1.71–2.77, p < 0.001), number of T2 lesions (two to nine lesions vs 0/1 lesions: HR = 1.97, 95% CI = 1.52–2.55, p < 0.001; >9 lesions vs 0/1 lesions: HR = 2.74, 95% CI = 2.04–3.68, p < 0.001) and age at CIS (HR per year inversely increase = 0.98, 95% CI = 0.98–0.99, p < 0.001). Lower 25-OH-D levels were associated with CDMS in univariable analysis, but this was attenuated in the multivariable model. OCB positivity was associated with higher EBNA-1 IgG titres. Conclusions: We validated MRI lesion load, OCB and age at CIS as the strongest independent predictors of conversion to CDMS in this multicentre setting. A role for vitamin D is suggested but requires further investigation.
Telestroke, tele-oncology and teledialysis: a systematic review to analyse the outcomes of active therapies delivered with telemedicine support
Authors: Jhaveri Divita , Larkins Sarah , Sabesan Sabe 
Published: February 2015

Summary We conducted a systematic review of studies involving telemedicine supervision of active treatment for rural patients in the fields of stroke, medical oncology and nephrology. Searches were performed on the MEDLINE, CINAHL and INFORMIT databases. A total of 521 articles were found, and an additional 42 articles were identified by searching the reference lists. After removing duplicates, screening the abstracts and assessing the full text of the articles, 14 articles remained. Nine concerned telestroke, two concerned tele-oncology and three concerned teledialysis. Most studies did not undertake randomisation, allocation concealment or selective outcome reporting making their risk of bias high. There were no randomised controlled trials and most sample sizes were small. Observational studies in telestroke showed favourable outcomes when comparing face-to-face and videoconferencing-assisted thrombolysis, with no significant differences between survival and intracerebral bleeds. Although tele-oncology has been used routinely for more than 20 years, there have been few formal studies. Home dialysis supervised through videoconferencing had similar patient outcomes compared to hospital dialysis. Telemedicine supervision of active treatment for rural patients appears promising, but more rigorous studies of effectiveness, feasibility and safety are required.