bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prescriptions analysis by clinical pharmacists in the post‐operative period: a 4‐year prospective study
Authors: CHARPIAT B. , GOUTELLE S. , SCHOEFFLER M. , AUBRUN F. , VIALE J.‐P. , DUCERF C. , LEBOUCHER G. , ALLENET B. 
Published: January 2012

BackgroundClinical pharmacists can help prevent medication errors. However, data are scarce on their role in preventing medication prescription errors in the post‐operative period, a high‐risk period, as at least two prescribers can intervene, the surgeon and the anesthetist. We aimed to describe and quantify clinical pharmacist' intervention (PIs) during validation of drug prescriptions on a computerized physician order entry system in a post‐surgical and post‐transplantation ward. We illustrate these interventions, focusing on one clearly identified recurrent problem.MethodsIn a prospective study lasting 4 years, we recorded drug‐related problems (DRPs) detected by pharmacists and whether the physician accepted the PI when prescription modification was suggested.ResultsAmong 7005 orders, 1975 DRPs were detected. The frequency of PIs remained constant throughout the study period, with 921 PIs (47%) accepted, 383 (19%) refused and 671 (34%) not assessable. The most frequent DRP concerned improper administration mode (26%), drug interactions (21%) and overdosage (20%). These resulted in a change in the method of administration (25%), dose adjustment (24%) and drug discontinuation (23%) with 307 drugs being concerned by at least one PI. Paracetamol was involved in 26% of overdosage PIs. Erythromycin as prokinetic agent, presented a recurrent risk of potentially severe drug–drug interactions especially with other QT interval‐prolonging drugs. Following an educational seminar targeting this problem, the rate of acceptation of PI concerning this DRP increased.ConclusionPharmacists detected many prescription errors that may have clinical implications and could be the basis for educational measures.
Elevated BIS and Entropy values after sugammadex or neostigmine: an electroencephalographic or electromyographic phenomenon?
Authors: AHO A. J. , KAMATA K. , YLI‐HANKALA A. , LYYTIKÄINEN L.‐P. , KULKAS A. , JÄNTTI V. 
Published: January 2012

BackgroundSugammadex is designed to antagonize neuromuscular blockade (NMB) induced by rocuronium or vecuronium. In clinical practice, we have noticed a rise in the numerical values of bispectral index (BIS) and Entropy, two electroencephalogram (EEG) – based depth of anesthesia monitors, during the reversal of the NMB with sugammadex. The aim of this prospective, randomized, double‐blind study was to test this impression and to compare the effects of sugammadex and neostigmine on the BIS and Entropy values during the reversal of the NMB.MethodsThirty patients undergoing gynecological operations were studied. Patients were anesthetized with target‐controlled infusions of propofol and remifentanil, and rocuronium was used to induce NMB. After operation, during light propofol‐remifentanil anesthesia, NMB was antagonized with sugammadex or neostigmine. During the following 5 min, the numerical values of BIS, BIS electromyographic (BIS EMG) and Entropy were recorded on a laptop computer, as well as the biosignal recorded by the Entropy strip. The Entropy biosignal was studied off‐line both in time and frequency domain to see if NMB reversal causes changes in EEG.ResultsIn some patients, administration of sugammadex or neostigmine caused a significant rise in the numerical values of BIS, BIS EMG and Entropy. This phenomenon was most likely caused by increased electromyographic (EMG) activity. The administration of sugammadex or neostigmine appeared to have only minimal effect on EEG.ConclusionThe EMG contamination of EEG causes BIS and Entropy values to rise during reversal of rocuronium‐induced NMB in light propofol‐remifentanil anesthesia.
Nutrient and metal analyses of Chinese herbal products marketed for veterinary use
Authors: Shmalberg J. , Hill R. C. , Scott K. C. 
Published: January 2012

SummaryMany Chinese herbs and herbal mixtures are fed to domestic animals for their reputed medicinal properties. These herbs could contribute to the intake of essential nutrients and toxic metals, but their composition is mostly unknown. The purpose of this study was to measure major nutrient (crude protein, crude fat, carbohydrate, fibre) and mineral (Ca, P, Mg, K, Na, Fe, Zn, Cu, Mn, Mo, S, Al, Cd, Ni, Pb) concentrations in samples of fourteen combination formulas labelled for veterinary use and commonly administered to horses and dogs. Three single herbs, Bupleurum chinense, Curcuma zedoaria and Astragalus membranaceus, each obtained from several sources, and Yunnan Baiyao, a proprietary hemostatic mixture, were also analysed. Proximate analyses and some mineral concentrations differed (p < 0.05) among single herbs, and high concentrations of several minerals were detected in some herbal combinations. Those containing the highest concentrations [g/kg dry matter (DM)] of calcium (92.4), iron (2.6) and manganese (0.28) could provide >38%, 142% and 96%, respectively, of recommended allowances in adult dogs, and >13%, 122% and 2%, respectively, of maintenance requirements in horses, at the maximum labelled dose assuming complete availability. Concentrations of cadmium, nickel and lead were below published oral tolerance levels. Aluminium concentrations (median 380, maximum 920 mg/kg DM) were higher than has been previously reported in Chinese herbs. These nutrient analyses suggest that herbal combinations marketed to veterinarians, when fed at the maximal labelled dose, are unlikely to produce clinically relevant changes in the dietary intake of essential nutrients. However, small amounts of non‐essential contaminant minerals are present in some formulas, and further research is necessary to understand the significance of this finding.
Oxidative stress, anti‐oxidant therapies and chronic kidney disease
Authors: SMALL DAVID M , COOMBES JEFF S , BENNETT NIGEL , JOHNSON DAVID W , GOBE GLENDA C 
Published: January 2012

ABSTRACTChronic kidney disease (CKD) is a common and serious problem that adversely affects human health, limits longevity and increases costs to health‐care systems worldwide. Its increasing incidence cannot be fully explained by traditional risk factors. Oxidative stress is prevalent in CKD patients and is considered to be an important pathogenic mechanism. Oxidative stress develops from an imbalance between free radical production often increased through dysfunctional mitochondria formed with increasing age, type 2 diabetes mellitus, inflammation, and reduced anti‐oxidant defences. Perturbations in cellular oxidant handling influence downstream cellular signalling and, in the kidney, promote renal cell apoptosis and senescence, decreased regenerative ability of cells, and fibrosis. These factors have a stochastic deleterious effect on kidney function. The majority of studies investigating anti‐oxidant treatments in CKD patients show a reduction in oxidative stress and many show improved renal function. Despite heterogeneity in the oxidative stress levels in the CKD population, there has been little effort to measure patient oxidative stress levels before the use of any anti‐oxidants therapies to optimize outcome. This review describes the development of oxidative stress, how it can be measured, the involvement of mitochondrial dysfunction and the molecular pathways that are altered, the role of oxidative stress in CKD pathogenesis and an update on the amelioration of CKD using anti‐oxidant therapies.
A comparison of laparoscopic versus open rectal surgery in 114 consecutive octogenarians
Authors: White S. I. , Wright D. , Taylor C. J. 
Published: January 2012

AbstractAim  The study is a retrospective review of the short‐term outcome of all elective rectal resections in 114 consecutive octogenarian patients during the 10‐year period January 2000 to December 2009.Method  Sixty laparoscopic and 54 open resections were completed. The two groups were evenly matched for age (mean 83 years), American Society of Anesthesiologists score (mean 2.5) and pathology (malignancy 60%).Results  Morbidity and mortality were comparable with no significant differences. Only length of stay in uncomplicated recoveries was significantly different in favour of laparoscopic surgery at 10 vs 14 days, P < 0.003.Conclusion  Laparoscopic rectal resection is suitable for octogenarians.
Gore Bio‐A® Fistula Plug: a new sphincter‐sparing procedure for complex anal fistula
Authors: Ratto C. , Litta F. , Parello A. , Donisi L. , Zaccone G. , De Simone V. 
Published: January 2012

AbstractAim  The surgical treatment of a complex anal fistula remains controversial, although ‘sphincter‐saving’ operations are desirable. The Gore Bio‐A® Fistula Plug is a new bioprosthetic plug that has been proposed for the treatment of complex anal fistula. This study reports preliminary data following implantation of this plug.Method  Eleven patients with a complex anal fistula underwent insertion of Gore Bio‐A® Fistula Plugs. The disc diameter and number of tubes in the plug were adapted to the fistula to allow accommodation of the disc into a submucosal pocket, and the excess tubes were trimmed. During the follow‐up period, patients underwent clinical and physical examinations and three‐dimensional endoanal ultrasound.Results  Fistulas were high anterior transphincteric in five patients and high posterior transphincteric in six patients. All patients had a loose seton placement before plug insertion. Two, three and four tubes were inserted into the fistula plug in seven, three and one patient, respectively. The median follow‐up period was 5 months. No patient reported any faecal incontinence. There was no case of early plug dislodgement. Treatment success was noted for eight (72.7%) of 11 patients at the last follow‐up appointment.Conclusion  Implanting a Gore Bio‐A® Fistula Plug is a simple, minimally invasive, safe and potentially effective procedure to treat complex anal fistula. Patient selection is fundamental for success.
Re‐epithelialization of demucosalized stomach patch with tissue‐engineered urothelial mucosa combined with Botox A in bladder augmentation
Authors: Zhang Yuanyuan , Liu Guihua , Kropp Bradley P. 
Published: January 2012

What's known on the subject? and What does the study add?Re‐epithelialization demucosa stomach patch is important to prevent the patch being exposed to urine that might cause patch shrinkage and fibrosis formation due to urine‐derived chemical irritation. Additionally, Botox A acts by blocking the transmission of nerve impulses to smooth muscles and so paralysing the muscles, which is commonly used to relax muscle for treatment of oesophageal achalasia due to overactive smooth muscle and sphincters of gastrointestinal tract.We fabricated in vitro tissue engineered urothelial mucosa with multi‐layers of urothelium and smooth muscle layers seeded on SIS scaffold and then used this cell‐scaffold construct to cover nuke gastro patch combining with Botox A for gastrocystoplasty in a canine model.OBJECTIVE
To evaluate the demucosalized stomach patch covered with tissue‐engineered urothelium for gastrocystoplasty and to determine whether or not injections of Botox A into the re‐epithelialized stomach patch can protect the graft from contraction in a canine bladder reconstruction model.
MATERIALS AND METHODS
Gastrocystoplasty was performed in 10 adult beagles after hemi‐cystectomy using five types of stomach patch (n= 2 per group): entire stomach patches (group I); demucosalized patches (group II); demucosalized patches covered with cell‐free small intestinal submucosa (SIS) (group III); demucosalized patches with urothelial and smooth muscle cell‐seeded SIS (group IV); and demucosalized patches with the cell‐seeded SIS combined with injections of Botox A (group V).
The bladder volume/pressure and the graft sizes were measured before surgery and again 10 weeks after bladder augmentation.
The graft tissues were examined both histologically and using immunohistochemistry.
RESULTS
All dogs survived and their gastric grafts were all vital with a good blood supply.
Gastric metaplasia of urothelium appeared on the top of stomach mucosa patches in two animals in group I. There was calcification formation at the centre of the graft in one animal in group II.
As compared with urothelium that was partially covered over with stomach patches in groups II and III, stratified urothelium completely covered the demucosalized gastric patches in groups IV and V.
There was less shrinkage of the stomach grafts in groups I and V, which shrank to half of their original size, than of the stomach grafts in groups II, III, and IV, which shrank significantly to one‐quarter of their original sizes.
CONCLUSIONS
Botox A injections appear to protect the graft contraction in the re‐epithelialized stomach flaps.
The gastrocystoplasty using demucosalized patches covered with tissue‐engineered urothelial mucosa combined with an injection of Botox A could have clinical potential for use in bladder reconstruction.
Different surgical findings in congenital and acquired undescended testes
Authors: van Brakel Jocelyn , Dohle Gert R. , de Muinck Keizer‐Schrama Sabine M.P.F. , Hazebroek Frans W. 
Published: January 2012

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Much is known on the aetiology, natural course and treatment of congenital undescended testes (UDT), but these matters are less clear for acquired UDT and still debated. Several studies have examined anatomical findings in patients with UDT. However, most of these studies do not distinguish between congenital and acquired UDT.This study describes clinical and surgical differences between congenital and acquired UDT, in which full history was known for all patients. Major differences were found in preoperative testis position as well as intraoperative testis position, patency of processus vaginalis and epididymal anomalies between congenital and acquired UDT.OBJECTIVE
To compare surgical findings in congenital and acquired undescended testes (UDT).
PATIENTS AND METHODS
A review of 139 boys with 158 congenital UDT and 69 boys with 84 acquired UDT was performed. The most caudal testicular position preoperatively, testis position at surgery, patency of the processus vaginalis and epididymal anomalies were prospectively recorded.
RESULTS
In the congenital group, orchiopexy had been performed at median age (range) 4.9 (1.5–14.6) years, while the median age (range) in the acquired group was 11.9 (3.8–23.3) years. Preoperatively, only congenital UDT were found not palpable or emergent inguinal, while only acquired UDT could be manipulated in an unstable scrotal position. In comparison with congenital UDT, acquired UDT were significantly more often located at the scrotal entrance, 27/158 vs 32/84 respectively (P < 0.001). At surgery anorchia, vanished testis or testes lying intra‐abdominally were only registered in the congenital UDT group. Also 37/158 congenital UDT were located in the superficial inguinal pouch vs 52/84 of the acquired UDT (P= 0.04). In congenital UDT the processus vaginalis was wide open in 74/158, while in acquired UDT the processus vaginalis was closed in 46/84 (P < 0.001) and small open in 26/84 (P= 0.04). Epididymal anomalies were more often seen in the congenital UDT group (37%) than in the acquired group (11%).
CONCLUSION
The most caudal position of congenital UDT after manipulation before surgery was at the scrotal entrance. These testes were frequently associated with epididymal anomalies and wide open processus vaginalis. This was in contrast to acquired UDT, which can often be pushed down well below the scrotal entrance and are more likely to be situated in the superficial inguinal pouch, with a normal epididymis and closed processus vaginalis.
NHS Diabetes guideline for the perioperative management of the adult patient with diabetes*
Authors: Dhatariya K. , Levy N. , Kilvert A. , Watson B. , Cousins D. , Flanagan D. , Hilton L. , Jairam C. , Leyden K. , Lipp A. , Lobo D. , Sinclair‐Hammersley M. , Rayman G. ,   for the Joint British Diabetes Societies
Published: January 2012

Diabet. Med. 29, 420–433 (2012)AbstractThese Joint British Diabetes Societies guidelines, commissioned by NHS Diabetes, for the perioperative management of the adult patient undergoing surgery are available in full in the Supporting Information.This document goes through the seven stages of the patient journey when having surgery. These are: primary care referral; surgical outpatients; preoperative assessment; hospital admission; surgery; post‐operative care; discharge. Each stage is given its own considerations, outlining the roles and responsibilities of each group of healthcare professionals. The evidence base for the recommendations made at each stage, discussion of controversial areas and references are provided in the report.This document has two key recommendations. Firstly, that the management of the elective adult surgery patients should be with modification to their usual diabetes treatment if the fasting is minimized because the routine use of a variable rate intravenous insulin infusion is not recommended. Secondly, that poor preoperative glycaemic control leads to post‐outcomes and thus, where appropriate, needs to be addressed prior to referral for surgery.
Relationship of initial glucose level and all‐cause death in patients with ischaemic stroke: the roles of diabetes mellitus and glycated hemoglobin level
Authors: Hu G.‐C. , Hsieh S.‐F. , Chen Y.‐M. , Hsu H.‐H. , Hu Y.‐N. , Chien K.‐L. 
Published: January 2012

Background and purpose:  Previous studies demonstrated that post‐stroke hyperglycemia was associated with poor outcome in non‐diabetic patients. However, evidence was inconclusive amongst patients with diabetes. The aim of this study was to evaluate the relationship between initial glucose levels and mortality amongst patients with acute ischaemic stroke, and further, to assess whether the association varied by diabetes mellitus and glycated hemoglobin (HbA1c) levels.Methods:  Data were collected from the medical records of 1277 first‐ever stroke patients admitted to the emergency room between January 1, 2008 and June 30, 2009. Cox regression analysis was performed to assess the relationship between initial glucose level and mortality.Results:  Compared with the lowest quartile of initial glucose level, a significant association with all‐cause death [hazard ratio (HR), 2.18; 95% CI, 1.36–3.48] and cardiovascular death (HR, 1.91; 95% CI, 1.01–3.61) was seen in the highest quartile. In non‐diabetic subgroup, those patients within the highest quartile of initial glucose level had a 3.29‐fold relative risks (RR) [95% confidence interval (CI), 1.62–6.68] for all‐cause and a 2.54‐fold RR (95% CI, 1.43–8.77) for cardiovascular death compared with those within the lowest quartile. However, the association between initial glucose levels and the risk of death was not significant amongst those with diabetes (P for interaction = 0.01). In addition, the risk amongst patients with diabetes varied by the HbA1c levels.Conclusions:  A significant association was confirmed between initial glucose level and mortality in non‐diabetic ischaemic stroke patients. The possible relationship between initial glucose level, HbA1c level, and mortality amongst ischaemic stroke patients with diabetes warrants further research.
Change in the clinical activity of multiple sclerosis after treatment switch for suboptimal response
Authors: Río J. , Tintoré M. , Sastre‐Garriga J. , Nos C. , Castilló J. , Tur C. , Comabella M. , Montalban X. 
Published: January 2012

Background:  Therapy for multiple sclerosis (MS) has a partial efficacy, and a significant proportion of treated patients will develop a suboptimal response with first‐line disease‐modifying drugs (DMD). Therapy switch in patients with MS can be a strategy after a treatment failure. We studied the change in clinical activity after switching of first‐line DMD because of a treatment failure.Methods:  Relapsing‐remitting multiple sclerosis (RRMS) patients treated with interferon‐beta (IFNB) or glatiramer acetate (GA) were divided into (i) patients without change in DMD, (ii) patients with a change in DMD because of a poor response, and (iii) those with a change in DMD without relation with response. Annualized relapse rate (ARR) and relapse‐free proportions were analyzed.Results:  We identified 923 patients with RRMS. Of the 180 who experienced a change because of suboptimal response, 90 switched to another first‐line DMT, 38 to mitoxantrone, and 52 to natalizumab. Median ARR in the pre‐DMD period on first DMD and second DMD was the following: 1, 1, and 0 for switchers from IFNB to another IFNB (P = 0.0001); 0.67, 1, and 0 for switchers from GA to IFNB (P = 0.01); 1, 1, and 0 for switchers from an IFNB to GA (P = 0.02); 1.1, 1.5, 0.2 for switchers from IFNB or GA to mitoxantrone (P = 0.0001); 0.9, 1, 0 for switchers from IFNB or GA to natalizumab (P = 0.0001).Conclusions:  In patients with RRMS who have a poor response, switch to another DMD may reduce the clinical activity of the disease.
Low ankle–brachial index is a predictive factor for initial severity of acute ischaemic stroke
Authors: Lee D. H. , Kim J. , Lee H. S. , Cha M.‐J. , Kim Y. D. , Nam H. S. , Nam C. M. , Heo J. H. 
Published: January 2012

Background:  A low ankle–brachial index (ABI) is predictive of peripheral arterial disease (PAD). For unknown reasons, patients with PAD demonstrate higher vascular mortality during follow‐up than do those without. Initial stroke severity is a strong predictor of long‐term outcome and may be different between patients with and without PAD. Thus, we investigated whether a low ABI was associated with severe stroke presentation.Methods:  We enrolled 1147 first‐ever ischaemic stroke patients who underwent ABI measurements during hospitalization. Patients were categorized into the normal (≥ 0.90) or the abnormal (<0.90) ABI group. Baseline characteristics and initial National Institutes of Health Stroke Scale (NIHSS) scores were compared between the groups. We further analysed components of the NIHSS subscales in these groups.Results:  Ankle–brachial index was abnormal in 85 (7.4%) patients. Mean initial NIHSS score was higher in the abnormal ABI group (6.61 ± 6.56) than in the normal ABI group (4.36 ± 4.90) (P = 0.003). A low ABI was independently associated with higher NIHSS score in a multivariate analysis. In the abnormal ABI group, leg weakness was more severe than it was in the normal ABI group, and the contribution of leg weakness to the initial NIHSS score was higher.Conclusions:  Patients with low ABI values presented with more severe ischaemic stroke. Contribution of pre‐existing PAD to leg weakness may play a role in the initial severity of stroke in patients with PAD. Our findings suggest that poor clinical outcomes in patients with PAD may be partially explained by their increased likelihood for severe stroke.