bluuebunny/crossref_metadata_2025_split huggingface dataset:
The utility of the corticotropin test to diagnose adrenal insufficiency in critical illness: an update
Authors: Venkatesh Balasubramanian , Cohen Jeremy 
Published: December 2014

AbstractObjectiveOne of the most common dynamic testing procedures for assessment of adrenocortical function is the standard corticotropin or the cosyntropin test. The aim of this review was to examine the evidence base underlying the corticotropin test in the management of the critically ill patient.Data synthesisThe principle behind the corticotropin test is the demonstration of aninappropriatelylow cortisol production in response to exogenousACTH, a situation analogous to physiological stress. The corticotropin test was originally described in nonstressed subjects, and its applicability and interpretation in the setting of critical illness continues to generate controversy. Attempting to determine the prevalence of an abnormal corticotropin test in critical illness is complicated by the use of different end‐points and different populations. Moreover, the test result is also influenced by the assay used for measurement of plasma cortisol. Trials assessing the relationship between corticotropin response and severity of stress and organ dysfunction have produced divergent results, which may reflect differences in the methodology and the association being measured. Moreover, controversy exists with respect to the methodology and the interpretation with respect to the following variables: dose of corticotropin, end‐points for assessment of total or free cortisol, effect of plasma cortisol variability, adrenal blood flow and its equivalence with other tests of adrenocortical function.ConclusionsThe corticotropin test is used widely in the evaluation of adrenocortical function in the endocrine clinics. Its role in the critically ill patient is less well established. Several confounding variables exist and to have a ‘one‐size‐fits‐all’ approach with a single end‐point in the face of several methodological and pathophysiological confounders may be flawed and may result in the institution of inappropriate therapy. The current evidence does not support the use of the corticotrophin test in critical illness to assess adrenocortical function and guiding steroid therapy in critical illness.
How meta‐analytic evidence impacts clinical decision making in oral implantology: a Delphi opinion poll
Authors: Pommer Bernhard , Becker Kathrin , Arnhart Christoph , Fabian Ferenc , Rathe Florian , Stigler Robert G. 
Published: December 2014

AbstractObjectivesTo investigate the impact of meta‐analytic evidence in scientific literature on clinical decision making in the field of oral implantology.MethodsA Delphi opinion poll was performed at the meeting of the “Next Generation” Committees of the Austrian, German and Swiss Societies for Implantology (ÖGI, DGI and SGI). First, the experts gave their opinion on 20 questions regarding routine implant treatment (uninformed decisions), then they were confronted with up‐to‐date Level I evidence from scientific literature on these topics and again asked to give their opinion (informed decisions) as well as to rate the available evidence as satisfactory or insufficient. Topics involved surgical issues, such as immediate implant placement, flapless surgery, tilted and short implants and bone substitute materials, as well as opinions on prosthodontic paradigms, such as immediate loading, abutment materials and platform switching.ResultsCompared to their uninformed decisions prior to confrontation with recent scientific literature, on average, 37% of experts (range: 15–50%) changed their opinion on the topic. When originally favoring one treatment alternative, less than half were still convinced after review of meta‐analytic evidence. Discrepancy between uninformed and informed decisions was significantly associated with insufficient evidence (P = 0.014, 49% change of opinion vs. 26% on topics rated as sufficiently backed with evidence). Agreement regarding strength of evidence could be reached for eight topics (40%), in three issues toward sufficiency and in five issues toward lack of evidence.ConclusionConfrontation with literature results significantly changes clinical decisions of implantologists, particularly in cases of ambiguous or lacking meta‐analytic evidence.
Prognostic impact of hyponatraemia in patients with colorectal cancer
Authors: Choi J. S. , Bae E. H. , Ma S. K. , Kweon S. S. , Kim S. W. 
Published: December 2014

AbstractAimHyponatraemia is a common in surgical practice, but its clinical impact in patients with colorectal cancer has not been evaluated.MethodWe retrospectively assessed 2944 patients who had been admitted to Chonnam National University Hwasun Hospital, Korea with a diagnosis of colorectal cancer. In order to determine the relationship between the serum sodium level and 3‐year mortality, we categorized the patients as having normonatraemia (135–147 mEq/l), or mild (130–134 mEq/l), moderate (125–129 mEq/l) or severe hyponatraemia (< 125 mEq/l).ResultsHyponatraemia, defined as a serum sodium level of < 135 mEq/l, was evident in 27.6% of patients during hospitalization. Declining serum sodium levels were associated with increasing age, a higher number of comorbidities, a more advanced TNM stage and worsening biochemical parameters. In a multivariate Cox‐proportional regression analysis, the mortality risk was correlated with the severity of hyponatraemia [hazard ratio (HR) 1.65, 95% CI 1.38–1.96; HR 2.24, 95% CI 1.69–2.98; HR 2.20, 95% CI 1.25–3.90, for patients with mild, moderate, and severe hyponatraemia, respectively, compared with patients with normonatraemia]. An independent association between hyponatraemia and long‐term mortality was sustained among various subpopulations and patients with persistent hyponatraemia had a worse prognosis than those with hyponatraemia that resolved.ConclusionA substantial proportion of patients developed hyponatraemia during hospitalization, and the long‐term mortality risk increased even in mild cases of hyponatraemia. Hyponatraemia should be considered as an important prognostic factor in colorectal cancer.
Is group pelvic floor retraining as effective as individual treatment?
Authors: Jones H. J. S. , Gosselink M. P. , Fourie S. , Lindsey I. 
Published: December 2014

AbstractAimTraditionally, pelvic floor retraining for faecal incontinence or obstructed defaecation has been delivered to patients through individual sessions with a specialist pelvic floor nurse, a resource‐intensive practice. This study aimed to assess whether a similar outcome can be achieved by delivering retraining to patients in small groups, allowing considerable savings in the use of resources.MethodData were collected prospectively in a pelvic floor database. Patients received pelvic floor retraining either individually or in a small group setting and completed baseline and follow‐up questionnaires. Two hundred and fifteen patients were treated, 119 individually and 96 in a small group setting. Scores before and after treatment for the two settings were compared for the Gastrointestinal Quality of Life Index, the Fecal Incontinence Severity Index and the Patient Assessment of Constipation Symptoms. Additionally patients receiving group treatment completed a short questionnaire on their experience.ResultsThe median change in Gastrointestinal Quality of Life Index score was 5 (range −62 to 73) for individual treatment and 4 (range −41 to 47) for group treatment, both showing statistically significant improvement. However, there was no significant difference between the settings. Similar results were obtained with the Fecal Incontinence Severity Index and Patient Assessment of Constipation Symptoms scores for the faecal incontinence and obstructed defaecation subgroups respectively.ConclusionThe majority of patients experienced symptomatic improvement following pelvic floor retraining and there was no significant difference in the resulting improvement according to treatment setting. As treatment costs are considerably less in a group setting, group pelvic floor retraining is more cost‐effective than individual treatment.
Myocardial uptake of bone scintigraphic agents associated with increased pulmonary uptake
Authors: Bach‐Gansmo Tore , Wien Tale N. , Løndalen Ayca , Halvorsen Erling 
Published: December 2014

SummaryObjectiveDue to delivery problems with the most commonly used bone scintigraphic agent medronate‐99mTc‐methylene diphosphonate (MDP) (medronate), several regional institutions changed, at various time points, to 99mTc‐dicarboxypropane diphosphonate (DPD) (Teceos®) from 2010. Extraosseous uptake, in particular, myocardial uptake, was observed in a number of patient examined with DPD, with reduced quality of the bone scans. Additionally, an increase in pulmonary uptake was apparent in many of these patients. The aim of this quality control was to assess pulmonary soft tissue uptake in the patients with high myocardial uptake.MethodsA retrospective analysis of the 2435 bone scintigraphies performed during a 3‐year period revealed relatively intense myocardial uptake in 10 of the 1195 patients examined with DPD (Teceos®). A comparison of pulmonary uptake in a control group of age‐ and gender‐matched subjects and a control group of patients examined with the same preparation of DPD were assessed.ResultsIn patients with cardiac uptake of DPD, it could also be shown a relatively intense background uptake in the lungs with significantly higher uptake ratio over intercostals regions versus the abdomen, compared to the control groups. Furthermore, we found, as already well documented, a significantly lower bone to soft tissue uptake in these patients, as quantified by a femur to surrounding soft tissue ratio.ConclusionCardiac uptake of bone scintigraphic agents is associated with high pulmonary uptake. This may be a sign of pulmonary involvement which may give extraosseous bone tracer uptake its own importance and DPD a new role.
Exercise interventions improve postural control in children with cerebral palsy: a systematic review
Authors: Dewar Rosalee , Love Sarah , Johnston Leanne Marie 
Published: December 2014

AimThe aim of this study was to evaluate the efficacy and effectiveness of exercise interventions that may improve postural control in children with cerebral palsy (CP).MethodA systematic review was performed using American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) methodology. Six databases were searched using the following keywords: (‘cerebral palsy’ OR ‘brain injury’); AND (‘postur*’ OR ‘balance’ OR ‘postural balance’ [MeSH]); AND (‘intervention’ OR ‘therapy’ OR ‘exercise’ OR ‘treatment’). Articles were evaluated based on their level of evidence and conduct.ResultsSearches yielded 45 studies reporting 13 exercise interventions with postural control outcomes for children with CP. Five interventions were supported by a moderate level of evidence: gross motor task training, hippotherapy, treadmill training with no body weight support (no‐BWS), trunk‐targeted training, and reactive balance training. Six of the interventions had weak or conflicting evidence: functional electrical stimulation (FES), hippotherapy simulators, neurodevelopmental therapy (NDT), treadmill training with body weight support, virtual reality, and visual biofeedback. Progressive resistance exercise was an ineffective intervention, and upper limb interventions lacked high‐level evidence.InterpretationThe use of exercise‐based treatments to improve postural control in children with CP has increased significantly in the last decade. Improved study design provides more clarity regarding broad treatment efficacy. Research is required to establish links between postural control impairments, treatment options, and outcome measures. Low‐burden, low‐cost, child‐engaging, and mainstream interventions also need to be explored.
Postencephalitic epilepsy: Clinical characteristics and predictors
Authors: Singh Tarun D. , Fugate Jennifer E. , Hocker Sara E. , Rabinstein Alejandro A. 
Published: December 2014

SummaryObjectiveTo describe the etiologies, clinical presentations, outcomes, and predictors of postencephalitic epilepsy (PE) in a large series of adult patients with acute encephalitis.MethodsWe conducted a retrospective review of patients diagnosed with acute encephalitis at Mayo Clinic, Rochester, between January 2000 and December 2012. The patients were categorized into two groups based on the presence or absence ofPEat last follow‐up. Multivariate logistic regression analysis was used to analyze factors associated withPE.ResultsWe identified 198 consecutive patients (100 [50.5%] male and 98 [49.5%] female) with a median age of 58 years (range 41.8–69). Etiologies included viral infection (n = 95, 48%), autoimmune (n = 44, 22%), and unknown/others (n = 59, 30%). During hospitalization, seizures were seen in patients with autoimmune encephalitis (n = 24, 54.5%), unknown/others (n = 20, 33.9%), and viral encephalitis (n = 23, 24.2%). Interictal epileptiform discharges on electroencephalography (EEG) were present in 34 (54%), whereas periodic lateralized epileptiform discharges (PLEDs) and generalized periodic discharges (GPDs) were seen in 14 (41.2%) and 2 (5.9%) patients. Forty‐six patients with seizures (70.8%) had fluid‐attenuated inversion recovery (FLAIR)/T2abnormalities, 20 (31.3%) diffusion abnormalities, and 43 (66.2%) cortical involvement. Good outcome at discharge among patients with seizures was seen in 8/23 patients with viral etiology (34.8%), 10/24 patients with autoimmune encephalitis (45.5%), and 12/20 patients with unknown cause (60%).PEwas present in 43 patients (29.9%). On multivariate regression analysis, the factors associated withPEwere generalized seizures during hospitalization (p = 0.03), focal seizures (p ≤ 0.001), and the presence ofFLAIR/T2abnormalities on brain magnetic resonance imaging (MRI) (p = 0.003).SignificanceThe presence of seizures during hospitalization and an abnormal brainMRIare the strongest predictors of the development ofPE. The etiology of encephalitis, presence of focal neurologic deficits, and interictalEEGabnormalities did not influence the development ofPE.
Novel therapeutic approaches for haemophilia
Authors: Shetty S. , Ghosh K. 
Published: December 2014

SummaryThe major therapy for haemophilia is plasma derived or recombinant clotting factors which are evolving steadily to increase potency, stability and half‐life. Research in the area of haemophilia therapeutics, however, is not restricted only to modifications in the recombinant products, but alternate therapeutic strategies are being developed which are in different phases of experimental and clinical trials. This chapter reviews the diverse molecular innovations which are being developed for alternate therapeutic approaches in haemophilia. The data is mainly extracted from the literature and the Conference abstracts. Some of the novel therapeutic approaches include inhibition of anticoagulant pathway factors (activated protein C, antithrombin, tissue factor pathway inhibitor) by monoclonal antibodies, peptide inhibitors, DNA or RNA aptamers, use of variant coagulation factors (factor Xa, factor Va) which are more resistant to inactivation or enzymatically more active and antibody‐mediated therapy including a humanized anti‐factor IXa/X bispecific antibody mimicking factor VIII. Other approaches include nonsense mutation suppression, induction of prothrombotic microparticles by P‐selectin‐immunoglobulin chimeras, suppression of fibrinolytic potential either by antifibrinolytics or by the use of mutant molecules of fibrinolytic inhibitors. Few products are proposed as ‘stand alone’ treatment for haemophilia, while a few can be used as adjuvant therapies to recombinant factors with an aim to reduce the amount of factor intake. All efforts are underway to produce an alternate, novel drug for haemophilia which will have an increased half‐life, subcutaneously injectable, non‐immunogenic and effective both in the presence and absence of inhibitors.
Identification of potential clinically significant drug interactions in HIV‐infected patients: a comprehensive therapeutic approach
Authors: Iniesta‐Navalón C , Franco‐Miguel JJ , Gascón‐Cánovas JJ , Rentero‐Redondo L 
Published: December 2014

ObjectivesThe aim of the study was to determine the prevalence of potential clinically significant drug interactions (CSDIs) in HIV‐positive individuals and to identify associated risk factors.MethodsA cross‐sectional study was conducted including all HIV‐infected out‐patients attending the Pharmacy Service of a regional reference hospital in Murcia, south‐eastern Spain. The complete treatment was screened for possible CSDIs using the Spanish College of Pharmacists' online software resource, bot. Additionally, the severity level of the CSDIs involving antiretroviral (ARV) drugs was compared with that established in the specific antiretroviral database InteraccionesHIV.com. Multivariate logistic regression was used to identify associated risk factors.ResultsTwo hundred and sixty‐eight patients were included in the study. A total of 292 potential drug interactions were identified, of which 102 (34.9%) were CSDIs, of which 52.9% involved ARV drugs. Seven therapeutic drug classes were involved in 75% of CSDIs (protease inhibitors, benzodiazepines, nonsteroidal anti‐inflammatory drugs, nonnucleoside reverse transcriptase inhibitors, corticosteroids, antithrombotics and proton pump inhibitors). Factors independently associated with CSDIs were treatment with more than five drugs [odds ratio (OR) 15.1; 95% confidence interval (CI) 6.3–36.2], and treatment with a protease inhibitor (OR 5.3; 95% CI 2.4–11.74).ConclusionsThe findings of this study suggest that the prevalence of clinically relevant drug−drug interactions is high in HIV‐infected patients, and could represent a major health problem. Awareness, recognition and management of drug interactions are important in optimizing the pharmaceutical care of HIV‐infected patients and helping to prevent adverse events and/or loss of efficacy of the drugs administered.
Proteasome‐associated autoinflammatory syndromes: advances in pathogeneses, clinical presentations, diagnosis, and management
Authors: McDermott Amelia , Jacks Jennifer , Kessler Marcus , Emanuel Peter D. , Gao Ling 
Published: December 2014

AbstractThe disease spectrum currently known as the proteasome‐associated autoinflammatory syndromes (PRAAS) was first described in 1939 in patients who presented with recurrent fevers beginning in infancy or early childhood, which were accompanied by nodular erythema, a pernio‐like rash, and joint contractures. Since then, several syndromes, such as chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome, Nakajo–Nishimura syndrome (NNS), joint contractures, muscle atrophy, microcytic anemia and panniculitis‐induced lipodystrophy (JMP) syndrome, and Japanese autoinflammatory syndrome with lipodystrophy (JASL), have been used to categorize patients with diseases within the same spectrum. Recently, independent studies have identified mutations in the human proteasome subunit β type 8 (PSMB8) gene, which result in a sustained inflammatory response in all syndromes. Further functional studies not only suggest a causative role of PSMB8 mutations but also imply that they represent one disease spectrum, referred to as PRAAS. In this paper, we review the clinical presentations and laboratory findings of PRAAS, as well as the most recent advances in pathogeneses, diagnosis, and treatment options for patients with diseases in this spectrum.
The atypical MAPK ERK3 controls positive selection of thymocytes
Authors: Sirois Julien , Daudelin Jean‐François , Boulet Salix , Marquis Miriam , Meloche Sylvain , Labrecque Nathalie 
Published: December 2014

SummaryExtracellular signal‐regulated kinase 3 (ERK3 )is an atypical member of the mitogen‐activated protein kinase (MAPK) family. We have previously shown that ERK3 is expressed during thymocyte differentiation and that its expression is induced in mature peripheral T cells following activation of ERK1/2 by T‐cell receptor (TCR) signalling. Herein, we have investigated whether ERK3 expression is required for proper T‐cell selection. Using a knock‐in mouse model in which the coding sequence of ERK3 is replaced by the gene encoding for the β‐galactosidase reporter, we show that ERK3 is expressed by double‐positive (DP) thymocytes undergoing positive selection. In ERK3‐deficient mice with a polyclonal TCR repertoire, we observe a decrease in positive selection. This reduction in positive selection was also observed when ERK3‐deficient mice were backcrossed to class I‐ and class II‐restricted TCR transgenic mice. Furthermore, the response of DP thymocytes to in vitro TCR stimulation was strongly reduced in ERK3‐deficient mice. Together, these results show that ERK3 expression following TCR signalling is critical for proper thymic positive selection.
A study protocol of a randomized controlled trial examining the efficacy of a symptom self‐management programme for people with acute myocardial infarction
Authors: Klainin‐Yobas Piyanee , Koh Karen Wei Ling , Ambhore Anand Adinath , Chai Ping , Chan Sally Wai‐Chi , He Hong‐Gu 
Published: December 2014

AbstractAimTo report a study protocol of a randomized controlled trial examining if a symptom self‐management programme helps patients with acute myocardial infarction self‐manage their physical and psychological symptoms.BackgroundIn addition to physical conditions, people with acute myocardial infarction often experience psychological symptoms. However, there is limited empirical evidence on how to help individuals self‐manage these psychological symptoms.DesignA single‐blinded, randomized controlled trial is proposed.MethodsA convenience sample of 90 will be recruited. Eligible participants will be adult patients with acute myocardial infarction hospitalized at a tertiary hospital in Singapore. Participants will be randomly assigned to one of the three treatment groups: Intervention 1 and standard care (n = 30), Intervention 2 and standard care (n = 30) and standard care alone (n = 30). Data will be collected by self‐reported questionnaires, physiological measures and open‐ended questions. Quantitative data will be analysed by descriptive statistics, t‐test, analysis of covariance and repeated measures analysis of variance. Open‐ended questions will be analysed by content analysis.DiscussionThis study will identify a potentially efficacious symptom self‐management programme for patients with acute myocardial infarction. If the efficacy of the programme is demonstrated, the programme can be integrated into hospital services to improve patient care. A new teaching method (virtual reality–based teaching) and new teaching materials (virtual reality videos and relaxation videos) derived from this study can be offered to patients. Future research with larger samples and multi‐centre recruitment can be undertaken to further test the efficacy of the interventions.