bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recombinant human C1 inhibitor for the prophylaxis of hereditary angioedema attacks: a pilot study
Authors: Reshef A. , Moldovan D. , Obtulowicz K. , Leibovich I. , Mihaly E. , Visscher S. , Relan A. 
Published: November 2012

AbstractBackgroundHereditary angioedema (HAE) is a disease characterized by recurrent tissue swelling affecting various body locations. Recent literature shows that patients with frequent attacks may benefit from long‐term prophylaxis. This study evaluated the safety and prophylactic effect of weekly administrations of recombinant C1INH (rhC1INH).MethodsPatients with a history of HAE attacks occurring ≥every 2 weeks received a once weekly administration of 50 U/kg rhC1INH. Hereditary angioedema attack history was collected at screening. Breakthrough attacks during the study were recorded at each visit. Following a 2‐week run‐in period, HAE patients received 8 weekly rhC1INH administrations and were followed‐up for an additional 6 weeks. Efficacy was evaluated by comparing the HAE attack incidence during the treatment period to the historical attacks over the previous 2 years. Safety evaluation was based on clinical laboratory and adverse events (AEs) reports.ResultsThe 25 participants reported a mean of 0.9 attacks/week over the past 2 years. The mean breakthrough attack rate during the treatment period was 0.4 attacks/week (95% CI 0.28–0.56). A total of 30 treatment‐emergent‐AEs were reported in 13 patients, all mild to moderate. One patient died from a laryngeal attack 25 days after last study drug administration. The only possible drug related AEs reported were dry mouth, dizziness and anxiety in one patient and hypotension in another. There were no allergic AEs and no neutralizing antibodies observed.ConclusionsWeekly administrations of 50 U/kg rhC1INH appeared to reduce the frequency of HAE attacks and were generally safe and well tolerated.
Peripartum outcomes and anaesthetic management of parturients with moderate to complex congenital heart disease or pulmonary hypertension*
Authors: Maxwell B. G. , El‐Sayed Y. Y. , Riley E. T. , Carvalho B. 
Published: November 2012

SummaryWe performed a retrospective cohort analysis of pregnancies among women with moderate to complex congenital heart disease or pulmonary hypertension over a 12‐year period, resulting in a cohort of 107 cases in 65 women. Neuraxial analgesia or anaesthesia was provided in 84%, 89% and 95% of spontaneous vaginal, operative vaginal and caesarean deliveries, respectively. The caesarean delivery rate was 43% compared to our institution average of 27% over the same period (p = 0.02), and 38% had operative vaginal deliveries compared to a 10.5% institution rate (p < 0.01). Invasive monitoring was used in 28% of all deliveries. There were one maternal and two neonatal deaths. This study provides detailed anaesthetic and peripartum management of women with congenital heart disease, a patient population in whom evidence‐based practice and data are largely lacking. We observed a predominance of neuraxial anaesthetic techniques, increased caesarean and operative delivery rates, and favourable maternal and neonatal outcomes. Multicentre studies and registries to compare anaesthetic and obstetric management strategies further and delineate risk factors for adverse outcomes are required.
The association of pre‐operative physical fitness and physical activity with outcome after scheduled major abdominal surgery
Authors: Dronkers J. J. , Chorus A. M. J. , van Meeteren N. L. U. , Hopman‐Rock M. 
Published: November 2012

SummaryWe studied whether reported physical activity and measurements of fitness (hand, leg and inspiration) were associated with postoperative in‐hospital mortality, length of stay and discharge destination in 169 patients after major oncological abdominal surgery. In multivariate analysis, adequate activity level (OR 5.5, 95% CI 1.4–21.9) and inspiratory muscle endurance (OR 5.2, 95% CI 1.4–19.1) were independently associated with short‐term mortality, whereas conventional factors, such as age and heart disease, were not. Adequate activity level (OR 6.7, 95% CI 1.4–3.0) was also independently associated with discharge destination. The factors that were independently associated with a shorter length of hospital stay were as follows: absence of chronic obstructive pulmonary disease (HR 0.6, 95% CI 0.3–1.1); adequate activity level (HR 0.6, 95% CI 0.4–0.8); and inspiratory muscle strength (HR 0.6, 95% CI 0.5–0.9). For all postoperative outcomes physical activity and fitness significantly improved the predictive value compared with known risk factors, such as age and comorbidities. We conclude that pre‐operative questionnaires of physical activity and measurements of fitness contribute to the prediction of postoperative outcomes.
A review of enhanced recovery for thoracic anaesthesia and surgery
Authors: Jones N. L. , Edmonds L. , Ghosh S. , Klein A. A. 
Published: November 2012

SummaryDuring the past decade, there has been a dramatic increase in the number of thoracic surgical procedures carried out in the UK. The current financial climate dictates that more efficient use of resources is necessary to meet escalating demands on healthcare. One potential means to achieve this is through the introduction of enhanced recovery protocols, designed to produce productivity savings by driving reduction in length of stay. These have been promoted by government bodies in a number of surgical specialties, including colorectal, gynaecological and orthopaedic surgery. This review focuses on aspects of peri‐operative care that might be incorporated into such a programme for thoracic anaesthesia, for which an enhanced recovery programme has not yet been introduced in the UK, and a review of the literature specific to this area of practice has not been published before. We performed a comprehensive search for published work relating to the peri‐operative management and optimisation of patients undergoing thoracic surgery, and divided these into appropriate areas of practice. We have reviewed the specific interventions that may be included in an enhanced recovery programme, including: pre‐optimisation; minimising fasting time; thrombo‐embolic prophylaxis; choice of anaesthetic and analgesic technique and surgical approach; postoperative rehabilitation; and chest drain management. Using the currently available evidence, the design and implementation of an enhanced recovery programme based on this review in selected patients as a package of care may reduce morbidity and length of hospital stay, thus maximising utilisation of available resources.
Arrhythmogenic risk of pulmonary artery catheterisation in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation
Authors: Bergmann L. , Großwendt T. , Kahlert P. , Konorza T. , Wendt D. , Thielmann M. , Heusch G. , Peters J. , Kottenberg E. 
Published: November 2012

SummaryMany clinicians consider severe aortic stenosis to be a contraindication to pulmonary artery catheterisation, except during open heart surgery with cardiopulmonary bypass. This is due to the perceived high risk of arrhythmia, although the true incidence of ventricular tachycardia and fibrillation remains unclear. We conducted a retrospective study to estimate the incidence of severe arrhythmias during pulmonary artery catheterisation in 380 patients with severe aortic stenosis scheduled for transcatheter aortic valve implantation. Ventricular fibrillation was seen in only one patient (0.26%), and this was successfully terminated by external defibrillation. No episodes of ventricular tachycardia were recorded and there were also no arrhythmias during removal of the catheter. We have therefore concluded that pulmonary artery catheterisation in patients with severe aortic stenosis is not associated with a high incidence of ventricular fibrillation or tachycardia, allowing pulmonary artery pressure monitoring to be performed relatively safely in such patients.
Dedicated emergency theatres improve service delivery and surgeons' job satisfaction
Authors: Stupart Douglas A. , Watters David A. , Guest Glenn D. , Cuthbert Vanessa , Ryan Shannon 
Published: November 2012

AbstractBackgroundThere are well‐described benefits to separating emergency and elective surgery. Geelong Hospital lacked the resources to implement a separate acute surgical unit, but instituted daily dedicated emergency general surgery operating sessions, managed by an on‐site consultant. This study aims to assess the impact of this on service delivery and surgeons' job satisfaction.MethodsFrom 1 February 2011, daily half‐day operating lists were allocated for general surgical emergencies. Patients treated on these lists were studied prospectively until 31 December 2011. Theatre waiting times and hospital stay were compared with the previous year. A quality‐of‐life questionnaire was administered to participating surgeons before the project commenced and after 6 months.ResultsA total of 966 patients underwent surgery during an emergency general surgery admission in the control period, and 984 underwent surgery during the study period. The median time from arrival in the emergency department (ED) to surgery was reduced from 19 (18–21) h in the control group to 18 (17–19) h in the study group (P = 0.033). The time from booking surgery to operation was reduced from 4.8 (4.3–5.4) h to 3.9 (3.5–4.3) h (P < 0.0001). For patients undergoing emergency laparotomy, the time from booking to surgery was reduced from 3.1 (2.2–4.1) to 2.4 (1.8–2.9) h, and hospital stay was reduced from 13 (11–15) to 10 (9–12) days (P = 0.0089). The surgeons' responses to the questionnaires showed improvement in job satisfaction (P < 0.0001).ConclusionThis intervention has improved service delivery for emergency surgery patients, and improved the participating surgeons' job satisfaction.
Review article: a comparison of glucagon‐like peptides 1 and 2
Authors: Janssen P. , Rotondo A. , Mulé F. , Tack J. 
Published: November 2012

SummaryBackgroundRecent advancements in understanding the roles and functions of glucagon‐like peptide 1 (GLP‐1) and 2 (GLP‐2) have provided a basis for targeting these peptides in therapeutic strategies.AimTo summarise the preclinical and clinical research supporting the discovery of new therapeutic molecules targeting GLP‐1 and GLP‐2.MethodsThis review is based on a comprehensive PubMed search, representing literature published during the past 30 years related to GLP‐1 and GLP‐2.ResultsAlthough produced and secreted together primarily from L cells of the intestine in response to ingestion of nutrients, GLP‐1 and GLP‐2 exhibit distinctive biological functions that are governed by the expression of their respective receptors, GLP‐1R and GLP‐2R. Through widespread expression in the pancreas, intestine, nervous tissue, et cetera, GLP‐1Rs facilitates an incretin effect along with effects on appetite and satiety. GLP‐1 analogues resistant to degradation by dipeptidyl peptidase‐IV and inhibitors of dipeptidyl peptidase‐IV have been developed to aid treatment of diabetes and obesity. The GLP‐2R is expressed almost exclusively in the stomach and bowel. The most apparent role for GLP‐2 is its promotion of growth and function of intestinal mucosa, which has been targeted for therapies that promote repair and adaptive growth. These are used as treatments for intestinal failure and related conditions.ConclusionsOur growing understanding of the biology and function of GLP‐1, GLP‐2 and corresponding receptors has fostered further discovery of fundamental biological function as well as new categories of potent therapeutic medicines.
Insulin resistance predicts sustained virological response to treatment of chronic hepatitis C independently of the IL28b rs12979860 polymorphism
Authors: del Campo J. A. , Ampuero J. , Rojas L. , Conde M. , Rojas Á. , Maraver M. , Millán R. , García‐Valdecasas M. , García‐Lozano J. R. , González‐Escribano M. F. , Romero‐Gómez M. 
Published: November 2012

SummaryBackgroundInsulin resistance has been strongly associated with the attainment of sustained viral response (SVR) in hepatitis C patients.AimTo determine, in a cohort of Spanish patients with chronic hepatitis C treated with peginterferon plus ribavirin (P+R), whether insulin resistance predicts SVR independently of interleukin‐28B rs12979860 polymorphism.MethodsInsulin resistance was measured as [HOMA‐IR = Insulin (IU/mL)*glucose (mmol/L)/22.5]. Genotype, viral load and histological fibrosis using Scheuer score were also measured. Binary logistic regression analysis was used for statistical purposes.ResultsIn a cohort of 240 patients [78% genotype 1, 24% showing advanced fibrosis, 71% high viral load (≥800 000 IU/mL), 31% IL28b genotype CC and 50% with HOMA >2] treated with P+R, 126 (53%) reached SVR. HOMA‐IR index (HOMA <2: 63% vs. HOMA >2: 42%; P = 0.001 and IL28b (genotype CC: 68% vs. genotype CT/TT: 45%; P = 0.002) were significantly associated with SVR. In multivariable logistic regression analysis in the overall cohort, variables independently associated were: viral genotype OR: 0.29 (95% CI: 0.11–0.78), P = 0.01; fibrosis OR: 1.62 (95% CI: 1.22–2.16), P = 0.001; HOMA‐IR OR: 1.22 (95% CI: 1.02–1.47), P = 0.03; and IL28B genotype OR: 2.43 (95% CI: 1.45–4.07), P = 0.001. The analyses also showed that degree of steatosis, HOMA‐IR >2, mild fibrosis and IL28B CC genotype were significantly related to SVR in patients infected with HCV genotypes 1&4, but not in those with genotypes 2&3. No differences were seen in glucose, insulin level or HOMA‐IR index segregated according to IL28B genotypes.ConclusionOur results suggest that insulin resistance, fibrosis stage and IL28B polymorphisms were independent variables associated with sustained viral response.
Short‐term efficacy of tacrolimus in steroid‐refractory ulcerative colitis – experience in 130 patients
Authors: Schmidt K. J. , Herrlinger K. R. , Emmrich J. , Barthel D. , Koc H. , Lehnert H. , Stange E. F. , Fellermann K. , Büning J. 
Published: November 2012

SummaryBackgroundSteroid‐refractory ulcerative colitis (UC) remains a challenging condition warranting surgery upon failure of pharmacological treatment. Calcineurin inhibitors or infliximab are alternatives in this situation. Data on the efficacy and safety of tacrolimus in this setting are limited.AimTo study the short‐term efficacy and safety of tacrolimus in moderate‐to‐severe steroid‐refractory UC. The role of thiopurines in this situation and predictors of colectomy were evaluated.MethodsIn three centers, all charts from tacrolimus‐treated patients with steroid‐refractory UC were reviewed. Efficacy was assessed by colectomy‐free survival and clinical remission at 3 months.ResultsWe identified 130 patients with pancolitis in 75 (59%), left‐sided disease in 35 (27%) and proctitis in 18 patients (14%) (disease localisation not obtainable in two patients). The median age was 40 (range: 18–81). Clinical activity according to the median Lichtiger score decreased from 13 (range: 4–17) at baseline to 3 (0–14) at week 12. Eighteen patients underwent colectomy within the first 3 months of treatment with tacrolimus (14%). Clinical remission was achieved in 94 patients (72%) in this period. Thiopurines given in parallel to tacrolimus tended to limit colectomy and significantly increased remission (P = 0.002) in the short‐term. No other predictors of colectomy or remission were identified. Side effects were noticed in 53% of patients and no severe events occurred.ConclusionThis large survey confirms the efficacy and safety of tacrolimus in patients with steroid‐refractory ulcerative colitis.
The natural history of eosinophilic oesophagitis in the transition from childhood to adulthood
Authors: Menard‐Katcher P. , Marks K. L. , Liacouras C. A. , Spergel J. M. , Yang Y.‐X. , Falk G. W. 
Published: November 2012

SummaryBackgroundEosinophilic oesophagitis (EoE) is a chronic inflammatory condition affecting both children and adults. Little is known about the natural history of EoE in the transition from childhood into adulthood.AimTo determine the prevalence of EoE symptoms and impact of EoE on quality of life among adults diagnosed with EoE during childhood.MethodsThis is a cross‐sectional study of EoE patients from the Children's Hospital of Philadelphia EoE registry. Patients ≥18 years diagnosed with EoE during childhood were administered validated dysphagia [Mayo Dysphagia Questionnaire (MDQ)‐30] and Quality of Life (PAGI‐QOL) questionnaires. Ongoing EoE treatments were ascertained.ResultsA total of 140 EoE patients ≥18 years were identified; 53 completed all questions. Only 6 (11%) subjects had positive (n = 2) or indeterminate (n = 4) dysphagia scores. However, of 47 patients with negative scores, 18 (37%) reported ongoing difficulty swallowing. The mean PAGI‐QOL score was 4.58/5. The dietary dimension score was 3.73/5. Current pharmacological EoE treatments were topical steroids (3/53) and interleukin‐5 antagonists (3/53). Additionally, 26/53 (49%) were on PPI therapy and 40/53 (76%) were following allergy directed diets.ConclusionsThe majority of young adults diagnosed with EoE during childhood continue to require pharmacological treatment and/or dietary modification for EoE. A substantial proportion of this population experiences ongoing swallowing difficulties that a standard dysphagia questionnaire fails to capture. Dietary quality of life, but not total quality of life, appears to be adversely affected. These data suggest that EoE diagnosed during childhood remains a significant medical issue during early adulthood, and that better EoE symptom measurement instruments are needed.
The Politics of Home Birth in the United States
Authors: Declercq Eugene 
Published: November 2012

AbstractHome birth has emerged as a political issue in several states in the United States, and this essay examines two aspects of home births politics. First, legislative battles over home birth policy do not conform to our typical models of partisan (i.e., Democratic vs Republican) politics, and attempts at advocacy cannot rely on classical strategies of alignment with a dominant party in a state. Second, the debates over home birth have increasingly begun to parallel current partisan battles in their emotion and intensity with the related gridlock and reluctance to consider compromises that are often necessary to achieve policy goals. This essay calls for a greater willingness for all sides to approach home birth less as an ideological mission and more as a health policy challenge to support consumers interested in an integrated system of care. (BIRTH 39:4 December 2012)
Evidence‐Based Medicine and Perinatal Care: From Dawn to Dusk
Authors: Keirse Marc J. N. C. 
Published: November 2012

AbstractSince the concept of “evidence‐based medicine” was first launched 20 years ago as a new method of teaching the practice of medicine, it has had an enormous impact on practice in many fields of health care. From the very start, professionals in pregnancy and perinatal care were at the forefront of attempts to collect good evidence systematically on the benefits and harms of health care interventions during pregnancy and in and around childbirth. Perinatal practice has largely benefitted from that endeavor. However, it has also suffered from the ill‐effects of the narrow view that evidence, to be good evidence, needs to be randomized evidence. Twenty years on, it may be time to reflect on what is meant by evidence and how to use it, not as a doctrine or dogma, but as a valuable tool and a tremendous asset to improve outcomes for mothers and babies. (BIRTH 39:4 December 2012)
Breastfeeding Triumphs
Authors: Lawrence Ruth A. 
Published: November 2012

AbstractThe Renaissance of breastfeeding is at hand. With the energy of an epidemic and the passion of a crusade, breastfeeding has become the norm for infant feeding. The World Health Organization (WHO) and the Centers for Disease Control and Prevention have affirmed breastfeeding's value to public health. Strong organizations such as the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Association of Family Practice, and the Academy of Breastfeeding Medicine have confirmed the value of human milk. The discussion is over. Leading the charge is an eclectic group of health professionals and women, but the cause cannot rest. Efforts to change hospital behavior are key, but the support for mother‐baby couples at home for the weeks and months that follow has just begun. Duration is the challenge. Employment and employers comprise one arm of the campaign. The other arms of the effort are under construction. Now is a time to move ahead, not rest on past achievement. (BIRTH 39:4 December 2012)
Ethics and “Normal Birth”
Authors: Lyerly Anne Drapkin 
Published: November 2012

AbstractThe concept of “normal birth” has been promoted as ideal by several international organizations, although debate about its meaning is ongoing. In this article, I examine the concept of normalcy to explore its ethical implications and raise a trio of concerns. First, in its emphasis on nonuse of technology as a goal, the concept of normalcy may marginalize women for whom medical intervention is necessary or beneficial. Second, in its emphasis on birth as a socially meaningful event, the mantra of normalcy may unintentionally avert attention to meaning in medically complicated births. Third, the emphasis on birth as a normal and healthy event may be a contributor to the long‐standing tolerance for the dearth of evidence guiding the treatment of illness during pregnancy and the failure to responsibly and productively engage pregnant women in health research. Given these concerns, it is worth debating not just what “normal birth” means, but whether the term as an ideal earns its keep. (BIRTH 39:4 December 2012)