bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ketamine With and Without Midazolam for Gastrointestinal Endoscopies in Children
Authors: Brecelj Jernej , Kamhi Trop Tina , Orel Rok 
Published: December 2011

ABSTRACTObjectives:Numerous publications on sedation of and anaesthesia for diagnostic procedures in children prove that no ideal scheme is available. Therefore, we decided to study the protocol with midazolam and ketamine used by nonanaesthetists at our institution. The study aimed to establish the lowest effective starting dose of ketamine and to estimate a difference in the frequency of adverse reactions with or without the use of midazolam as premedication, with special stress on emergence reactions.Methods:During 1 year we prospectively randomised children scheduled for gastrointestinal endoscopies to a first group with and to a second group without midazolam premedication. The starting ketamine dose was increased until the appropriate dissociative state was reached. Physiological functions were closely monitored and adverse reactions noted.Results:The median age of 201 analysed patients (111 girls, 90 boys) was 8.2 years. The median starting dose of ketamine was 0.97 mg/kg (the group with midazolam premedication) and 0.99 mg/kg TT (without midazolam premedication). Laryngospasm was observed in 6 patients without statistical difference between the 2 groups. All of the adverse reactions were short lasting; they resolved by symptomatic treatment without complications. Emergence reactions during the observation period at the hospital occurred more often in the group sedated with ketamine without midazolam premedication (P= 0.02).Conclusions:The sedation protocol with ketamine is safe and efficient. The starting dose of ketamine should be at least 1 mg/kg. There is an advantage to the use of midazolam as premedication before ketamine in paediatric patients because the frequency of emergence reactions in hospital was reduced compared with sole ketamine use.
Evidence that the Agr‐like quorum sensing system regulates the toxin production, cytotoxicity and pathogenicity of Clostridium perfringens type C isolate CN3685
Authors: Vidal Jorge E. , Ma Menglin , Saputo Julian , Garcia Jorge , Uzal Francisco A. , McClane Bruce A. 
Published: December 2011

SummaryClostridium perfringens possesses at least two functional quorum sensing (QS) systems, i.e. an Agr‐like system and a LuxS‐dependent AI‐2 system. Both of those QS systems can reportedly control in vitro toxin production by C. perfringens but their importance for virulence has not been evaluated. Therefore, the current study assessed whether these QS systems might regulate the pathogenicity of CN3685, a C. perfringens type C strain. Since type C isolates cause both haemorrhagic necrotic enteritis and fatal enterotoxemias (where toxins produced in the intestines are absorbed into the circulation to target other internal organs), the ability of isogenic agrB or luxS mutants to cause necrotizing enteritis in rabbit small intestinal loops or enterotoxemic lethality in mice was evaluated. Results obtained strongly suggest that the Agr‐like QS system, but not the LuxS‐dependent AI‐2 QS system, is required for CN3685 to cause haemorrhagic necrotizing enteritis, apparently because the Agr‐like system regulates the production of beta toxin, which is essential for causing this pathology. The Agr‐like system, but not the LuxS‐mediated AI‐2 system, was also important for CN3685 to cause fatal enterotoxemia. These results provide the first direct evidence supporting a role for any QS system in clostridial infections.
Living‐donor liver transplantation for propionic acidemia
Authors: Kasahara Mureo , Sakamoto Seisuke , Kanazawa Hiroyuki , Karaki Chiaki , Kakiuchi Toshihiko , Shigeta Takanobu , Fukuda Akinari , Kosaki Rika , Nakazawa Atsuko , Ishige Mika , Nagao Masayoshi , Shigematsu Yosuke , Yorifuji Tohru , Naiki Yasuhiro , Horikawa Reiko 
Published: December 2011

Kasahara M, Sakamoto S, Kanazawa H, Karaki C, Kakiuchi T, Shigeta T, Fukuda A, Kosaki R, Nakazawa A, Ishige M, Nagao M, Shigematsu Y, Yorifuji T, Naiki Y, Horikawa R. Living‐donor liver transplantation for propionic acidemia.Abstract: Propionic acidemia is a rare autosomal recessive disorder affecting the catabolism of branched‐chain amino acids because of a genetic defect in PCC. Despite the improvements in medical treatment with protein restriction, sufficient caloric intake, supplementation of l‐carnitine, and metronidazole, patients with the severe form of propionic acidemia have life‐threatening metabolic acidosis, hyperammonemia, and cardiomyopathy, which results in serious neurologic sequelae and sometimes death. This study retrospectively reviewed three children with neonatal‐onset propionic acidemia who received LDLT. Between November 2005 and December 2010, 148 children underwent LDLT, with an overall patient survival of 90.5%, in our center. Three patients were indicated for transplantation because of propionic acidemia. All recipients achieved a resolution of metabolic derangement and better quality of life with protein restriction and medication, although urine methylcitrate and serum propionylcarnitine levels did not decrease markedly. LT can reduce the magnitude of progressive cardiac/neurologic disability as a result of poor metabolic control. Further evaluation is therefore required to determine the long‐term suitability of this treatment modality.
Racial disparities in job strain among American and immigrant long‐term care workers
Authors: Hurtado D.A. , Sabbath E.L. , Ertel K.A. , Buxton O.M. , Berkman L.F. 
Published: December 2011

HURTADO D.A., SABBATH E.L., ERTEL K.A., BUXTON O.M. & BERKMAN L.F. (2012) Racial disparities in job strain among American and immigrant long‐term care workers. International Nursing Review59, 237–244Background:  Nursing homes are occupational settings, with an increasing minority and immigrant workforce where several psychosocial stressors intersect.Aim:  This study aimed to examine racial/ethnic differences in job strain between Black (n = 127) and White (n = 110) immigrant and American direct‐care workers at nursing homes (total n = 237).Methods:  Cross‐sectional study with data collected at four nursing homes in Massachusetts during 2006‐2007. We contrasted Black and White workers within higher‐skilled occupations such as registered nurses or licensed practical nurses (n = 82) and lower‐skilled staff such as certified nursing assistants (CNAs, n = 155).Results:  Almost all Black workers (96%) were immigrants. After adjusting for demographic and occupational characteristics, Black employees were more likely to report job strain, compared with Whites [relative risk (RR): 2.9, 95% confidence interval (CI) 1.3 to 6.6]. Analyses stratified by occupation showed that Black CNAs were more likely to report job strain, compared with White CNAs (RR: 3.1, 95% CI: 1.0 to 9.4). Black workers were also more likely to report low control (RR: 2.1, 95% CI: 1.1 to 4.0). Additionally, Black workers earned $2.58 less per hour and worked 7.1 more hours per week on average, controlling for potential confounders.Conclusion:  Black immigrant workers were 2.9 times more likely to report job strain than White workers, with greater differences among CNAs. These findings may reflect differential organizational or individual characteristics but also interpersonal or institutional racial/ethnic discrimination. Further research should consider the role of race/ethnicity in shaping patterns of occupational stress.
Age‐related changes in mechanical properties of the Achilles tendon
Authors: Waugh C. M. , Blazevich A. J. , Fath F. , Korff T. 
Published: December 2011

AbstractThe stiffness of a tendon, which influences muscular force transfer to the skeleton and increases during childhood, is dependent on its material properties and dimensions, both of which are influenced by chronic loading. The aims of this study were to: (i) determine the independent contributions of body mass, force production capabilities and tendon dimensions to tendon stiffness during childhood; and (ii) descriptively document age‐related changes in tendon mechanical properties and dimensions. Achilles tendon mechanical and material properties were determined in 52 children (5–12 years) and 19 adults. Tendon stiffness and Young’s modulus (YM) were calculated as the slopes of the force–elongation and stress‐strain curves, respectively. Relationships between stiffness vs. age, mass and force, and between YM vs. age, mass and stress were determined by means of polynomial fits and multiple regression analyses. Mass was found to be the best predictor of stiffness, whilst stress was best related to YM (< 75 and 51% explained variance, respectively). Combined, mass and force accounted for up to 78% of stiffness variation. Up to 61% of YM variability could be explained using a combination of mass, stress and age. These results demonstrate that age‐related increases in tendon stiffness are largely attributable to increased tendon loading from weight‐bearing tasks and increased plantarflexor force production, as well as tendon growth. Moreover, our results suggest that chronic increases in tendon loading during childhood result in microstructural changes which increase the tendon’s YM. Regarding the second aim, peak stress increased from childhood to adulthood due to greater increases in strength than tendon cross‐sectional area. Peak strain remained constant as a result of parallel increases in tendon length and peak elongation. The differences in Achilles tendon properties found between adults and children are likely to influence force production, and ultimately movement characteristics, which should be explicitly examined in future research.
Is Patient Safety Improving? National Trends in Patient Safety Indicators: 1998–2007
Authors: Downey John R. , Hernandez‐Boussard Tina , Banka Gaurav , Morton John M. 
Published: December 2011

ContextEmphasis has been placed on quality and patient safety in medicine; however, little is known about whether quality over time has actually improved in areas such as patient safety indicators (PSIs).ObjectiveTo determine whether national trends for hospital PSIs have improved from 1998 to 2007.Design, Setting, and ParticipantsUsing PSI criteria from the Agency for Healthcare Research and Quality, PSIs were identified in the Nationwide Inpatient Sample (NIS) for all eligible inpatient admissions between 1998 and 2007. Joinpoint regression was used to estimate annual percentage changes (APCs) for PSIs.Main Outcome MeasureAnnual percent change for PSIs.ResultsFrom 1998 to 2007, 7.6 million PSI events occurred for over 69 million hospitalizations. A total of 14 PSIs showed statistically significant trends. Seven PSIs had increasing APC: postoperative pulmonary embolism or deep vein thrombosis (8.94), postoperative physiological or metabolic derangement (7.67), postoperative sepsis (7.17), selected infections due to medical care (4.05), decubitus ulcer (3.05), accidental puncture or laceration (2.64), and postoperative respiratory failure (1.46). Seven PSIs showed decreasing APCs: birth trauma injury to neonate (−17.79), failure to rescue (−6.05), postoperative hip fracture (−5.86), obstetric trauma–vaginal without instrument (−5.69), obstetric trauma–vaginal with instrument (−4.11), iatrogenic pneumothorax (−2.5), and postoperative wound dehiscence (−1.8).ConclusionThis is the first study to establish national trends of PSIs during the past decade indicating areas for potential quality improvement prioritization. While many factors influence these trends, the results indicate opportunities for either emulation or elimination of current patient safety trends.
Comparative Survival Literature in Intensive Hemodialysis: Limitations and Future Directions
Authors: Pauly Robert P. , Klarenbach Scott W. , Komenda Paul 
Published: December 2011

AbstractModality comparisons focusing on survival outcomes of nocturnal hemodialysis (NHD) or short daily hemodialysis (SDHD) versus other treatment paradigms of end‐stage renal disease (ESRD) are sparse. The existing literature consists of cohort studies that are small, retrospective, underpowered, and poorly controlled. The only randomized controlled trial that included mortality as part of a complex composite endpoint is unable to provide information on survival only. Even if concerns with internal validity of this literature are set aside, the generalizability of a few hundred NHD and SDHD patients is an important consideration as it remains uncertain whether or not the purported survival benefits of intensive hemodialysis readily translate into similar benefits for the global ESRD population. The most feasible and definitive study design to compare NHD or SDHD to other treatment modalities (and to each other) is a large, prospective, matched cohort study.
Risk of Hypoglycemia in Older Veterans with Dementia and Cognitive Impairment: Implications for Practice and Policy
Authors: Feil Denise G. , Rajan Mangala , Soroka Orysya , Tseng Chin‐Lin , Miller Donald R. , Pogach Leonard M. 
Published: December 2011

ObjectivesTo examine the relationship between management of diabetes mellitus and hypoglycemia in older adults with and without dementia and cognitive impairment.DesignCross‐sectional database analysis of veterans aged 65 years and older stratified according to dementia, cognitive impairment, age, antiglycemic medications, and glycosylated hemoglobin (Hba1c) level.SettingResearch database with linked clinical, laboratory, pharmacy, and International Classification of Diseases, Ninth Revision, Clinical Modification, codes.ParticipantsFour hundred ninety‐seven thousand nine hundred veterans aged 65 and older with diabetes mellitus who obtained services from the Department of Veterans Affairs in fiscal years (FYs) 2002 and 2003.MeasurementsHypoglycemia, the outcome variable, was identified from outpatient visits, emergency department and inpatient admission codes in FY2003. Independent variables (FY2002–03) included dementia and cognitive impairment, comorbid conditions, extended care and nursing home stays, demographics, antiglycemic medication, and HbA1c levels.ResultsPrevalence of combined dementia and cognitive impairment was 13.1% for individuals aged 65 to 74 and 24.2% for those aged 75 and older. Mean HbA1c levels were 7.0 ± 1.3% for all participants and 6.9 ± 1.3% for those with dementia. The proportion of participants taking insulin was higher in those with dementia or cognitive impairment (30%) than in those with neither condition (24%). Of all participants taking insulin, more with dementia (26.5%) and cognitive impairment (19.5%) were hypoglycemic than of those with neither condition (14.4%). For all participants, unadjusted odds ratios (ORs) for hypoglycemia were 2.42 (95% confidence interval (CI) = 2.36–2.48) for dementia and 1.72 (95% CI = 1.65–1.79) for cognitive impairment; adjusted ORs were 1.58 (95% CI = 1.53–1.62) for dementia and 1.13 (95% CI = 1.08–1.18) for cognitive impairment.ConclusionDiabetes mellitus was managed more intensively in older veterans with dementia and cognitive impairment, and dementia and cognitive impairment were independently associated with greater risk of hypoglycemia.
The Impact of Atrial Fibrillation Ablation on Left Atrial Function: Association with Baseline Left Atrial Function
Authors: MASUDA MASAHARU , INOUE KOICHI , IWAKURA KATSUOMI , OKAMURA ATSUNORI , KOYAMA YASUSHI , KIMURA RYUSUKE , TOYOSHIMA YUKO , ITO NORIHISA , KOMURO ISSEI , FUJII KENSHI 
Published: December 2011

Background:

The effect of atrial fibrillation (AF) ablation on left atrial (LA) function has not been sufficiently determined.
Methods:

We enrolled 115 consecutive patients with paroxysmal or persistent AF that underwent AF ablation. Multidetector computed tomography was performed in sinus rhythm before and 3 months after ablation to evaluate LA volume (LAV) and function. Estimates of maximum and minimum LAV were used to calculate LA emptying fraction (LAEF) ([maximum–minimum LAV]/maximum LAV × 100).
Results:

AF ablation significantly decreased maximum LAV (59.0 ± 20.4 to 53.3 ± 16.7 cm3, P = 0.001), and maintained LAEF (44.5 ± 13.1% to 43.7 ± 10.9%, P = 0.49). The larger the baseline maximum LAV, the greater the decrease in LAV after ablation, and a smaller baseline LAEF was associated with a larger recovery of LAEF after ablation (regression coefficient =−0.45 and −0.56, respectively, P < 0.0001). Multivariable analyses revealed that an impaired baseline LAEF was an independent predictor of an improvement in LA function (an increase in LAEF of >10%; odds ratio [OR] = 0.88, P < 0.0001), while an older age and preserved baseline LAEF were independently associated with a deterioration of LA function (a decrease in LAEF of >10%; OR = 1.06, P = 0.03; and OR = 1.10, P = 0.0001).
Conclusions:

AF ablation appears to have a beneficial effect on LA function in patients with impaired LA function at baseline. However, it may reduce LA function in patients with an older age and preserved baseline LAEF. (PACE 2011;1–8)
Cardiac Device‐Related Endocarditis Complicated by Spinal Abscess
Authors: RODRIGUEZ YASSER , GREENSPON ARNOLD J. , SOHAIL MUHAMMAD R. , CARRILLO ROGER G. 
Published: December 2011

Background:

Infective endocarditis is the most serious manifestation of cardiac device infection and metastatic seeding of distant sites has been reported. However, the association between device‐related endocarditis and spinal abscess has not been fully described.
Methods:

We reviewed hospital records at three high‐volume cardiovascular referral centers from January 2005 to October 2010. Device‐related endocarditis was confirmed in all cases with positive blood cultures and transesophageal echocardiogram revealing lead and/or valvular vegetations. Six patients with spinal abscesses in association with device‐related endocarditis were identified.
Results:

A total of 384 patients met the clinical criteria for device‐related endocarditis. Among these, infection was complicated by spinal abscess formation in six (1.5%) cases. The mean age of patients was 69.3 ± 11.8 years (47–82 years). The predominant clinical manifestations in these six patients included a recent history of fever (six), malaise (four), and neurological or meningeal signs (five). Spinal abscesses were diagnosed by magnetic resonance imaging in two and computed tomography scans in four of the cases. The causative pathogens were methicillin‐resistant Staphylococcus aureus (three), methicillin‐sensitive S. aureus (one), coagulase‐negative Staphylococci (two), and Enterococcus fecalis (one). All patients underwent complete device removal with no procedure‐related complications. Two patients died in the hospital, two were discharged with permanent neurological deficits, and the remaining two recovered with no permanent neurologic sequelae.
Conclusion:

Device‐related endocarditis must be considered in patients who present with a spinal abscess and bacteremia. Early recognition of this scenario is imperative in order to avoid permanent neurological sequelae and patient mortality. Early imaging, appropriate parenteral antimicrobial therapy, and expedited removal of all cardiac hardware are pivotal for optimal management. (PACE 2011;1–7)
Thoracic Spinal Cord Stimulation Improves Cardiac Contractile Function and Myocardial Oxygen Consumption in a Porcine Model of Ischemic Heart Failure
Authors: LIU YUAN , YUE WEN‐SHENG , LIAO SONG‐YAN , ZHANG YUELIN , AU KA‐WING , SHUTO CHIKA , HATA CARY , PARK EULJOON , CHEN PETER , SIU CHUNG‐WAH , TSE HUNG‐FAT 
Published: December 2011

Thoracic Spinal Cord Stimulation. Background: Prior experimental studies show that thoracic spinal cord stimulation (SCS) improves left ventricular (LV) ejection fraction (LVEF). The mechanism of this improvement in the LV contractile function after SCS and its effects on the myocardial oxygen consumption remains unknown.Methods and Results: We performed thoracic SCS (T1‐T2 level) followed by 4 weeks of rapid ventricular pacing in 9 adult pigs with ischemic heart failure (HF) induced by myocardial infarction (MI). At 24 hours off‐pacing, detailed echocardiogram and invasive hemodynamic assessment were performed to determine LV contractile function and myocardial oxygen consumption. Serum norepinephrine level was measured before and after SCS. SCS was performed on 2 occasions for 15 minutes, 30 minutes apart (recovery) with 50 Hz frequency (pulse width 0.2 millisecond, 90% of motor threshold at 2 Hz output). Echocardiogram revealed significant decrease in LVEF (33.8 ± 1.8% vs 66.5 ± 1.7%, P < 0.01) after induction of MI and HF. Compared with MI and HF, acute SCS significantly increased LVEF and +dP/dt (all P < 0.05). Withdrawal of SCS during recovery decreased +dP/dt, but not LVEF that increased again with repeated SCS. Myocardial oxygen consumption also significantly decreased during SCS compared with MI and HF (P = 0.006) without any change in serum norepinephrine level (P = 0.9). Speckle tracking imaging showed significant improvement in global and regional circumferential strains over the infarcted mid and apical regions, decreased in time to peak circumferential strain over the lateral and posterior wall after SCS, and the degree of intraventricular dyssynchrony during SCS compared with MI and HF (P < 0.05).Conclusions: In a porcine model of ischemic HF, acute SCS improved global and regional LV contractile function and intraventricular dyssynchrony, and decreased myocardial oxygen consumption without elevation of norepinephrine level. (J Cardiovasc Electrophysiol, Vol. 23, pp. 534‐540, May 2012)
The Parasite that Causes Whirling Disease, Myxobolus cerebralis, is Genetically Variable Within and Across Spatial Scales
Authors: Lodh Nilanjan , Kerans Billie L. , Stevens Lori 
Published: December 2011

ABSTRACTUnderstanding the genetic structure of parasite populations on the natural landscape can reveal important aspects of disease ecology and epidemiology and can indicate parasite dispersal across the landscape. Myxobolus cerebralis (Myxozoa: Myxosporea), the causative agent of whirling disease in the definitive host Tubifex tubifex, is native to Eurasia and has spread to more than 25 states in the USA. The small amounts of data available to date suggest that M. cerebralis has little genetic variability. We examined the genetic variability of parasites infecting the definitive host T. tubifex in the Madison River, MT, and also from other parts of North America and Europe. We cloned and sequenced 18S ribosomal DNA and the internal transcribed spacer‐1 (ITS‐1) gene. Five oligochaetes were examined for 18S and five for ITS‐1, only one individual was examined for both genes. We found two different 18S rRNA haplotypes of M. cerebralis from five worms and both intra‐ and interworm genetic variation for ITS‐1, which showed 16 different haplotypes from among 20 clones. Comparison of our sequences with those from other studies revealed M. cerebralis from MT was similar to the parasite collected from Alaska, Oregon, California, and Virginia in the USA and from Munich, Germany, based on 18S, whereas parasite sequences from West Virginia were very different. Combined with the high haplotype diversity of ITS‐1 and uniqueness of ITS‐1 haplotypes, our results show that M. cerebralis is more variable than previously thought and raises the possibility of multiple introductions of the parasite into North America.