bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmacological adjuncts for chronic venous ulcer healing: a systematic review
Authors: Varatharajan Lavanya , Thapar Ankur , Lane Tristan , Munster Alex B , Davies Alun Huw 
Published: June 2015

Background The aim of this study was to systematically review the current evidence and determine whether there is a clinical benefit for using pharmacological agents as adjunctive treatment for chronic venous ulcers. Method A systematic review of the MEDLINE and EMBASE (from 1 January 1947 through 15 August 2013) and Cochrane databases (from inception through 15 August 2013) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were all randomised controlled trials investigating pharmacological adjuncts for the treatment of venous ulcers with a minimum sample size of 20 patients for each treatment arm. Results Ten relevant articles were identified; one pilot randomised controlled trial and four Cochrane reviews were included. Pentoxifylline, aspirin, sulodexide, mesoglycan, flavonoids, thromboxane A2 antagonist (ifetroban), zinc, prostaglandin and prostacyclin analogues were the drugs reviewed. Pentoxifylline was found to be more effective than placebo in terms of complete ulcer healing or in causing a significant improvement (greater than 60% reduction in ulcer size) (RR 1.70, 95% CI 1.30 to 2.24). Aspirin and flavonoids show potential to be effective adjuncts but methodological shortcomings and issues with bias limit the validity of results from trials involving each of these drugs, respectively. There was no significant difference between placebo and Ifetroban and likewise pooled results from trials investigating sulodexide and zinc showed no benefit in comparison to placebo. Conclusion Many systemic pharmacological agents have been investigated as adjuncts to venous ulcer healing; however, pentoxifylline (400 mg, three times a day) is currently the only drug that has promising evidence to support its use. Other compounds are in early stage research.
Ligamentization of Autogenous Hamstring Grafts After Anterior Cruciate Ligament Reconstruction
Authors: Dong Shikui , Xie Guoming , Zhang Yang , Shen Peng , Huangfu Xiaoqiao , Zhao Jinzhong 
Published: June 2015

Background: In previous studies, unimodal, small-diameter collagen fibrils have been commonly observed as the final collagen ultrastructure of the implanted grafts used in anterior cruciate ligament (ACL) reconstruction. However, the native ACL and hamstring tendon show bimodal collagen fibril distribution, consisting of both large- and small-diameter collagen fibrils. Hypothesis: Bimodal collagen fibril distribution of the graft is a common phenomenon after ACL reconstruction with hamstring tendon grafts and is time dependent. Study Design: Controlled laboratory study. Methods: A total of 52 patients who underwent double-bundle ACL reconstruction using autogenous hamstring tendons and who also underwent second-look arthroscopic surgery were enrolled. The patients were divided into 2 groups according to the time interval between the 2 operations: the midterm group (27 patients), with a 13- to 30-month time interval between operations, and the long-term group (25 patients) with a 31- to 62-month interval. During the second-look arthroscopic procedures, ACL graft biopsies were performed. Normal ACL tissues were harvested from 9 patients who underwent total knee replacement, and biopsy specimens of the to-be-grafted semitendinosus tendon tissues were also harvested from another 9 patients who underwent ACL reconstruction with hamstring tendons, which were designated as normal controls. Graft vascularity, cellularity, metaplasia, cellular metabolism, and collagen fibril distribution were analyzed. Results: Large-diameter (>100 nm) collagen fibrils were detected in 81.5% of the specimens in the midterm group and in 68.0% of the specimens in the long-term group. A typical bimodal distribution mode was observed in 62.6% of the specimens in the midterm group and in 52.0% of the specimens in the long-term group. There was no significant difference between groups with respect to the presence of large-diameter collagen fibrils, bimodal distribution, graft vascularity, cellularity, metaplasia, or cellular metabolic status. Conclusion: Graft ultrastructural maturation, characterized by large-diameter collagen fibrils and a bimodal collagen fibril distribution, is a common phenomenon and is not time dependent in the midterm to long term. Clinical Relevance: After hamstring tendon ACL reconstruction, the implanted grafts can transform into ACL-like tissue with a similar ultrastructure and metabolism, implying their usefulness as grafts.
The Impact of Health Literacy Level on Inhaler Technique in Patients With Chronic Obstructive Pulmonary Disease
Authors: Beatty Collin R. , Flynn Laura A. , Costello Tracy J. 
Published: June 2015

Background: Inhaled medications are recommended as first-line treatment for chronic obstructive pulmonary disease (COPD) and can reduce exacerbations and hospitalizations. Low health literacy is associated with poor inhaler technique. Objective: This study examined whether handouts written specifically for patients with low health literacy are more effective in showing patients how to use their medications when compared to standard education materials. Methods: A prospective, experimental study was performed at a community-based hospital. Patients included in the study were admitted to the hospital with a diagnosis of COPD, taking at least 1 inhaled medication and identified as having low health literacy based on a Rapid Estimate of Adult Literacy in Medicine—Short Form. Low health literacy handouts were compared against the standard hospital educational materials for inhalers. Correct technique during each demonstration was evaluated using a standardized checklist. Results: Mean baseline scores for inhaler technique were 12.2 ± 2.2 steps correct for the control group and 13.4 ± 1.3 for the low health-literacy group of the 18 maximum points ( P = nonsignificant). The mean change in inhaler technique score for the control group was 1.0 ± 1.8, while the mean change in inhaler technique score for the low health-literacy group was 2.1 ± 2.7 ( P = .03).
Assessment of Tissue Level of Histone Deactylase-2 (HDAC-2) in Patients With Mycosis Fungoides
Authors: El Tawdy Amira , Amin Iman , Abdel Hay Rania , Rashed Laila , Gad Zeiad 
Published: June 2015

Background: Histone deactylases (HDAC) have a role in the pathogenesis of mycosis fungoides (MF) through their actions on different apoptosis pathways. Objective: To assess the possible role played by HDAC-2 in MF by estimating the tissue expression of HDAC2 mRNA in different stages of MF. Methods: This study included 28 MF patients and 30 controls. The HDAC-2 levels were detected by real-time polymerase chain reaction (PCR). Correlations of HDAC-2 levels with clinical presentation and different stages of MF were analyzed. Results: Mean HDAC-2 level was significantly higher in patients ( P < .001) than in controls. HDAC-2 highest mean value was significantly detected in patients with stage IIb, and the lowest mean value was detected in patients with stage Ia ( P < .001). Conclusion: Up-regulation of tissue HDAC-2 in MF patients might develop a new approach in the understanding of the pathogenesis of MF. Histone deactylases are important targets for molecular cancer therapeutics.
Waikato Teledermatology: a pilot project for improving access in New Zealand
Authors: McGoey Suzanne T , Oakley Amanda , Rademaker Marius 
Published: June 2015

Introduction Teledermatology can improve access to specialist dermatological advice. We describe a retrospective review of the first 12 months of Waikato Teledermatology (WT), a low-cost, secure, website-based, store-and-forward teledermatology network using the Collegium Telemedicus platform. Methods We determined specialist response time, referral metrics, patient diagnosis and progress reports from the network’s database. The programme’s value was evaluated by post-pilot online surveys of referrers and specialist dermatologists. Results WT was used by 31 referring doctors for 309 consultations with four dermatologists between July 2013 and June 2014. Mean and median specialist response time was 2.07 hours (range: 0.13–5.64 hours). The researchers categorized the referrals as tumours (56.8%) and rashes (43.2%), including inflammatory dermatoses (51.9%), infection (18.1%), uncertain (16.5%), miscellaneous (7.5%), and of environmental origin (6%). Thirty tumours were biopsied, including nine melanomas and three basal cell carcinomas. A total of 158 progress reports and 35 survey responses were received. Reported advantages included decreased delay, improved accuracy of diagnosis and treatment compared to that made without specialist input, decreased unnecessary procedures such as biopsies of undiagnosed conditions, and increased appropriate referrals for face-to-face assessment, thus leading to cost savings for the patient and the health care system. The major disadvantages were the time burden for clinicians to complete consultations, the lack of integration with the patients’ usual electronic medical record and absence of funding. Discussion WT proved an effective and acceptable approach to improving patient access to dermatologic services.
Development and piloting of a decision aid for women considering participation in the Sentinel Node Biopsy versus Axillary Clearance 2 breast cancer trial
Authors: Juraskova Ilona , Butow Phyllis , Fisher Alana , Bonner Carissa , Anderson Caroline , Bu Stella , Scarlet Jenni , Stockler Martin R , Wetzig Neil , Ung Owen , Campbell Ian 
Published: June 2015

Background/aims: This study aimed to (1) develop a decision aid for women considering participation in the Sentinel Node Biopsy versus Axillary Clearance 2 (SNAC-2) breast cancer surgical trial and (2) obtain evidence on its acceptability, feasibility, and potential efficacy in routine trial clinical practice via a two-stage pilot. Methods: The decision aid was developed according to International Patient Decision Aid Standards. Study 1: an initial pilot involved 25 members of the consumer advocacy group, Breast Cancer Network Australia. Study 2: the main pilot involved 20 women eligible to participate in the SNAC-2 trial in New Zealand. In both pilots, a questionnaire assessed: information and involvement preferences, decisional conflict, SNAC-2 trial-related understanding and attitudes, psychological distress, and general decision aid feedback. A follow-up telephone interview elicited more detailed feedback on the decision aid design and content. Results: In both pilots, participants indicated good subjective and objective understanding of SNAC-2 trial and reported low decisional conflict and anxiety. The decision aid was found helpful when deciding about trial participation and provided additional, useful information to the standard trial information sheet. Conclusion: The development and two-stage piloting process for this decision aid resulted in a resource that women found very acceptable and helpful in assisting decision-making about SNAC-2 trial participation. The process and findings provide a guide for developing other trial decision aids.
Applying the intention-to-treat principle in practice: Guidance on handling randomisation errors
Authors: Yelland Lisa N , Sullivan Thomas R , Voysey Merryn , Lee Katherine J , Cook Jonathan A , Forbes Andrew B 
Published: June 2015

Background: The intention-to-treat principle states that all randomised participants should be analysed in their randomised group. The implications of this principle are widely discussed in relation to the analysis, but have received limited attention in the context of handling errors that occur during the randomisation process. The aims of this article are to (1) demonstrate the potential pitfalls of attempting to correct randomisation errors and (2) provide guidance on handling common randomisation errors when they are discovered that maintains the goals of the intention-to-treat principle. Methods: The potential pitfalls of attempting to correct randomisation errors are demonstrated and guidance on handling common errors is provided, using examples from our own experiences. Results: We illustrate the problems that can occur when attempts are made to correct randomisation errors and argue that documenting, rather than correcting these errors, is most consistent with the intention-to-treat principle. When a participant is randomised using incorrect baseline information, we recommend accepting the randomisation but recording the correct baseline data. If ineligible participants are inadvertently randomised, we advocate keeping them in the trial and collecting all relevant data but seeking clinical input to determine their appropriate course of management, unless they can be excluded in an objective and unbiased manner. When multiple randomisations are performed in error for the same participant, we suggest retaining the initial randomisation and either disregarding the second randomisation if only one set of data will be obtained for the participant, or retaining the second randomisation otherwise. When participants are issued the incorrect treatment at the time of randomisation, we propose documenting the treatment received and seeking clinical input regarding the ongoing treatment of the participant. Conclusion: Randomisation errors are almost inevitable and should be reported in trial publications. The intention-to-treat principle is useful for guiding responses to randomisation errors when they are discovered.
‘I don’t want to cause any trouble’: the attitudes of hospital patients towards patient empowerment strategies to reduce healthcare-acquired infections
Authors: Seale Holly , Travaglia Joanne , Chughtai Abrar A , Phillipson Lyn , Novytska Yuliya , Kaur Rajneesh 
Published: June 2015

Background: Patients have, traditionally, been assumed to be the passive party in the healthcare-associated infections equation, with relatively little research focused on the patients’ perspective. This study aimed to explore the attitudes of hospital patients towards patient empowerment as one of the key components of patient engagement. Methods: Semi-structured interviews were undertaken with surgical patients from a major public hospital in Sydney, Australia. Findings: While participants acknowledged that patients could play a role in preventing infections while in hospital, that role was largely associated with maintaining their own personal hygiene. No reference was made to patients interacting with staff members. Some participants said that they would feel comfortable and happy to engage with staff, while others voiced concerns. Some about not wanting to ‘cause trouble or start fires’ and therefore would not tell staff members to perform hand hygiene. Some participants articulated a fear that their care may be negatively affected if they directly engaged or confronted clinicians about their behaviours. Conclusion: We found that patient engagement remains an underused method of preventing healthcare-associated infections, and the deep-seated public fears about individual vulnerabilities still need to be addressed.
Endophthalmitis due to an intra-ocular linear foreign body in a cat
Authors: Delgado Esmeralda 
Published: June 2015

Case summary An unusual case of an intraocular linear foreign body that migrated from the oral cavity, causing a severe endophthalmitis, in a cat is described. A 2-year-old female domestic shorthair cat presented with signs of infection from the left eye that had begun 2 weeks previously. Despite having been prescribed oral and topical antibiotics, there was a progressive worsening of the clinical signs. On ophthalmic examination the cat presented with severe endophthalmitis, secondary glaucoma and exposure keratitis of the left eye. Radiography demonstrated the presence of an intraocular linear metallic foreign body compatible with a sewing needle. During enucleation, when the globe was extracted, the sewing needle stayed in the orbit. When the needle was pulled away, a piece of thread was also retrieved, which demonstrated that the linear foreign body had migrated retrogradely from the oral cavity to the orbit through the pterygopalatine fossa. Surgical recovery was uneventful. Relevance and novel information Intraocular foreign bodies may present in a variety of ways, which may hinder their clinical detection. The management and prognosis depend on the composition and location of the foreign body, as well as the possible presence of secondary infection. To the author’s knowledge, this is the first time that a case of severe endophthalmitis following retrograde intraocular migration of a linear foreign body from the oral cavity to the orbit through the pterygopalatine fossa in a cat has been reported.
Probable vasovagal reaction following cystocentesis in two cats
Authors: Odunayo Adesola , Ng Zenithson Y , Holford Amy Lynn 
Published: June 2015

Case summary This case report describes an acute reaction, thought to be vagally mediated, in two cats immediately following cystocentesis. Both cats were being evaluated for feline idiopathic cystitis and developed bradycardia, hypersalivation, urination and weakness after a blind cystocentesis. Both cats recovered uneventfully with supportive care. Relevance and novel information A vagally mediated response may occur in cats after cystocentesis, which is a common procedure performed by veterinary professionals in cats. This response may be very profound and dramatic. Affected cats will likely make an uneventful recovery. This vagally mediated response to cystocentesis, though reported by word of mouth among veterinarians, has not been described in the literature. This is the first documentation of its occurrence in cats.
Otogenic meningoencephalomyelitis due to Cryptococcus gattii (VGII) infection in a cat from Western Australia
Authors: Siak Meng K , Paul Amanada , Drees Randi , Arthur Ian , Burrows Amanda K , Tebb Anna J , Malik Richard 
Published: June 2015

Case summary A 7-year-old spayed domestic longhair cat from Perth, Western Australia, presented with left-sided head tilt, dysphonia, head shaking, inappetence and weight loss. A polypoid lesion had previously been removed from the external ear canal. Otitis media with extension into the external ear canal was suspected and investigated using video-otoscopy and computed tomography examination. Invasive disease with extension from the middle ear to the base of the skull, and intracranial extension into the caudal fossa and cranial cervical vertebral canal was detected. Cytology of external ear canal exudate showed capsulated budding yeasts and Cryptococcus gattii VGII was cultured. Treatment with amphotericin B infusions and oral fluconazole was prescribed, with nutritional support via oesophagostomy tube. The cat clinically recovered 12 months after treatment commenced. Relevance and novel information This case report describes the successful medical treatment of otogenic meningoencephalomyelitis due to C gattii (VGII) infection in a cat.
Cannabis-induced alterations in brain activation during a test of information processing speed in patients with MS
Authors: Pavisian Bennis , Staines W Richard , Feinstein Anthony 
Published: June 2015

Objective The objective of this article is to determine the functional brain correlates of information processing speed in multiple sclerosis (MS) patients who smoke cannabis and those who are drug naïve. Methods Two neurologically and demographically matched samples of MS patients were enrolled, those who smoked cannabis daily ( n = 20) and those who were cannabis naïve ( n = 19). All participants completed the Brief Repeatable Battery of Neuropsychological Tests and underwent fMRI testing during which they were administered a modified version of the Symbol Digit Modalities Test (mSDMT). Results The cannabis group responded slower in nine of 11 blocks of the mSDMT ( p < 0.001), showing a trend toward a slower response time ( p < 0.08), but did not differ in the accuracy of response ( p < 0.18). Both groups displayed activation in a prefrontal cortex-parietal network associated with information processing speed. When compared to the cannabis-naïve group, cannabis users showed less activation in the right ( p = 0.009) and left ( p = 0.001) thalami and increased activation in the anterior cingulate ( p = 0.006). Conclusion Regular cannabis use in MS patients is associated with slower information processing speed and a pattern of cerebral activity that differs from cannabis-naïve individuals, most notably in a bilateral reduction of thalamic activity.
Intertrochanteric Femur Fracture Stability
Authors: Voleti Pramod B. , Liu Stephen Y. , Baldwin Keith D. , Mehta Samir , Donegan Derek J. 
Published: June 2015

Introduction: Intertrochanteric (IT) femur fractures are common in elderly patients who are often in poor general health. Intertrochanteric fractures are classified as stable or unstable, taking into account fracture morphology and involvement of the posteromedial calcar. The purpose of this study is to determine whether IT fracture stability can be used as a marker for general health or as a predictor of postoperative medical complications in elderly patients. Materials and Methods: We reviewed the records of all patients treated for IT fractures at our institution over the past 7 years. We excluded patients who were younger than 60 years, polytraumatized, involved in high-energy mechanisms of injury, managed nonoperatively, with hardware from previous surgery, or missing preoperative radiographs. Ninety-three patients were included in the present series. Three orthopedic surgeons independently reviewed all preoperative radiographs and classified each fracture as either stable or unstable. Interrater reliability was .77 (substantial) and consensus designation was assigned by majority. We reviewed charts for age, gender, time to surgery, length of hospital stay, type of surgery, estimated blood loss, American Society of Anesthesiologists (ASA) classification, and postoperative medical complications. Univariate and multivariate statistical analyses were conducted to determine the relationship of fracture stability on ASA class and medical complications. Results: Intertrochanteric fracture stability had no detectable relationship with ASA class ( P = .497). On univariate analysis, stability was not significantly related to medical complications ( P = .421). Our multivariate analysis found that only ASA was related to medical complications ( P = .004), and fracture stability was not related to complications ( P = .538). Conclusion: Intertrochanteric fracture stability does not appear to be a marker for poor general health or to predict postoperative medical complications in elderly patients in this limited study. ASA class was predictive of medical complications. Interestingly, medical complications were 8% greater in patients with unstable fractures than in patients with stable fractures.
Efficiency of high-dose cytarabine added to CY/TBI in cord blood transplantation for myeloid malignancy
Authors: Arai Yasuyuki , Takeda June , Aoki Kazunari , Kondo Tadakazu , Takahashi Satoshi , Onishi Yasushi , Ozawa Yukiyasu , Aotsuka Nobuyuki , Kouzai Yasuji , Nakamae Hirohisa , Ota Shuichi , Nakaseko Chiaki , Yamaguchi Hiroki , Kato Koji , Atsuta Yoshiko , Takami Akiyoshi 
Published: June 2015

Key Points
HDCA plus CY/TBI improved overall survival relative to CY/TBI in CBT for myeloid malignancy. HDCA suppressed relapse but did not increase the incidence of severe adverse events or nonrelapse mortality.