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The 100 most-cited articles on aortic dissection
No full textAbstract
Background
To identify and characterize the most frequently cited articles that have been published on aortic dissection.
Methods
A list of the 100 most frequently cited publications (T100) about aortic dissection was generated by performing a searching of the Science Citation Index--Expanded using \u201caortic dissection\u201d as the search term. Basic information about the articles was recorded, including number of citations, journal title, journal impact factor, time since publication, first author\u2019s country, topic/subspecialty of the research, and publication type.
Results
We finally included 180 articles on aortic dissection, from which we identified the 100 most frequently cited articles (T100). The most frequently cited article received 1079 citations, while the least frequently cited article received 68 (mean140.5 citations per article). The T100 originated from 19 countries, with more than half of them originating from the USA ( n \u2009=\u200997). The T100 articles were published from 1955 to 2013, with 79% published during the period 1990\u20132009. In addition, there were 40 different journals with Circulation having the most citations ( n \u2009=\u200938). Regarding the article type, there were 21 basic and 140 clinical research articles, one meta-analysis, and 18 review articles. Reviews had the highest mean number of citations (mean 235.5 citations per article).
Conclusions
Our study provides a historical perspective on the progress of dissection research, and helps to identify the quality of the work, the discoveries made, and the trends steering the studies
Prevalence of frailty in Canadians 18\u201379 years old in the Canadian Health Measures Survey
No full textAbstract
Background
There is little certainty as to the prevalence of frailty in Canadians in younger adulthood. This study examines and compares the prevalence of frailty in Canadians 18\u201379 years old using the Accumulation of Deficits and Fried models of frailty.
Methods
The Canadian Health Measures Study data were used to estimate the prevalence of frailty in adults 18\u201379 years old. A 23-item Frailty Index using the Accumulation of Deficits Model (cycles 1\u20133; n \u2009=\u200910,995) was developed; frailty was defined as having the presence of 25% or more indices, including symptoms, chronic conditions, and laboratory variables. Fried frailty (cycles 1\u20132; n \u2009=\u20097,353) included the presence of \u22653 criteria: exhaustion, physical inactivity, poor mobility, unintentional weight loss, and poor grip strength.
Results
The prevalence of frailty was 8.6 and 6.6% with the Accumulation of Deficits and the Fried Model. Comparing the Fried vs. the Accumulation of Deficits Model, the prevalence of frailty was 5.3% vs. 1.8% in the 18\u201334 age group, 5.7% vs. 4.3% in the 35\u201349 age group, 6.9% vs. 11.6% in the 50\u201364 age group, and 7.8% vs. 20.2% in the 65+ age group. Some indices were higher in the younger age groups, including persistent cough, poor health compared to a year ago, and asthma for the accumulation of deficits model, and exhaustion, unintentional weight loss, and weak grip strength for the Fried model, compared to the older age groups.
Conclusions
These data show that frailty is prevalent in younger adults, but varies depending on which frailty tool is used. Further research is needed to determine the health impact of frailty in younger adults
Comparison of developmental milestone attainment in early treated HIV-infected infants versus HIV-unexposed infants: a prospective cohort study
No full textAbstract
Background
Infant HIV infection is associated with delayed milestone attainment. The extent to which effective antiretroviral therapy (ART) prevents these delays is not well defined.
Methods
Ages at attainment of milestones were compared between HIV-infected (initiated ART by age <5\ua0months), and HIV-unexposed uninfected (HUU) infants. Kaplan Meier analyses were used to estimate and compare (log-rank tests) ages at milestones between groups. Adjusted analyses were performed using Cox proportional hazards models.
Results
Seventy-three HIV-infected on ART (median enrollment age 3.7\ua0months) and 92 HUU infants (median enrollment age 1.6\ua0months) were followed prospectively. HIV-infected infants on ART had delays in developmental milestone attainment compared to HUU: median age at attainment of sitting with support, sitting unsupported, walking with support, walking unsupported, monosyllabic speech and throwing toys were each delayed (all p -values <0.0005). Compared with HUU, the subset of HIV-infected infants with both virologic suppression and immune recovery at 6\ua0months had delays for speech (delay: 2.0\ua0months; P\u2009= \u20090.0002) and trend to later walking unsupported. Among HIV-infected infants with poor 6-month post-ART responses (lacking viral suppression and immune recovery) there were greater delays versus HUU\ua0for: walking unsupported (delay: 4.0\ua0months; P\u2009= \u20090.0001)\ua0and speech (delay: 5.0\ua0months; P \u2009<\u20090.0001).
Conclusions
HIV infected infants with viral suppression on ART had better recovery of developmental milestones than those without suppression, however, deficits persisted compared to uninfected infants. Earlier ART may be required for optimized cognitive outcomes in perinatally HIV-infected infants.
Trial registration
NCT00428116 ; January 22, 2007
Non-invasive respiratory support for infants with bronchiolitis: a national survey of practice
No full textAbstract
Background
Bronchiolitis is a common respiratory illness of early childhood. For most children it is a mild self-limiting disease but a small number of children develop respiratory failure. Nasal continuous positive airway pressure (nCPAP) has traditionally been used to provide non-invasive respiratory support in these children, but there is little clinical trial evidence to support its use. More recently, high-flow nasal cannula therapy (HFNC) has emerged as a novel respiratory support modality. Our study aims to describe current national practice and clinician preferences relating to use of non-invasive respiratory support (nCPAP and HFNC) in the management of infants (<12\ua0months old) with acute bronchiolitis.
Methods
We performed a cross-sectional web-based survey of hospitals with inpatient paediatric facilities in England and Wales. Responses were elicited from one senior doctor and one senior nurse at each hospital. We analysed the proportion of hospitals using HFNC and nCPAP; clinical thresholds for their initiation; and clinician preferences regarding first-line support modality and future research.
Results
The survey was distributed to 117 of 171 eligible hospitals; 97 hospitals provided responses (response rate: 83%). The majority of hospitals were able to provide nCPAP (89/97, 91.7%) or HFNC (71/97, 73.2%); both were available at 65 hospitals (67%). nCPAP was more likely to be delivered in a ward setting in a general hospital, and in a high dependency setting in a tertiary centre. There were differences in the oxygenation and acidosis thresholds, and clinical triggers such as recurrent apnoeas or work of breathing that influenced clinical decisions, regarding when to start nCPAP or HFNC. More individual respondents with access to both modalities (74/106, 69.8%) would choose HFNC over nCPAP as their first-line treatment option in a deteriorating child with bronchiolitis.
Conclusions
Despite lack of randomised trial evidence, nCPAP and HFNC are commonly used in British hospitals to support infants with acute bronchiolitis. HFNC appears to be currently the preferred first-line modality for non-invasive respiratory support due to perceived ease of use
Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among adult eating disorder patients
No full textAbstract
Background
Very little is known about the prevalence of ADHD symptoms in Bulimia Nervosa and Binge Eating Disorder and even less in other eating disorders. This knowledge gap is of clinical importance since stimulant treatment is proven effective in Binge Eating Disorder and discussed as a treatment possibility for Bulimia Nervosa. The objective of this study was to explore the prevalence and types of self-reported ADHD symptoms in an unselected group of eating disorder patients assessed in a specialized eating disorder clinic.
Methods
In total 1165 adults with an eating disorder were assessed with a battery of standardized instruments, for measuring inter alia ADHD screening, demographic variables, eating disorder symptoms and psychiatric comorbidity. Chi-square tests were used for categorical variables and Kruskal-Wallis tests for continuous variables.
Results
Almost one third (31.3\ua0%) of the patients scored above the screening cut off indicating a possible ADHD. The highest prevalence rates (35\u201337\ua0%) were found in Bulimia Nervosa and Anorexia Nervosa bingeing/purging subtype, while Eating Disorder Not Otherwise Specified type 1\u20134 and Binge Eating Disorder patients reported slightly below average (26\u201331\ua0%), and Anorexia Nervosa restricting subtype patients even lower (18\ua0%). Presence of binge eating, purging, loss of control over eating and non-anorectic BMI were related to results indicating a possible ADHD. Psychiatric comorbidity correlated to ADHD symptoms without explaining the differences between eating disorder diagnoses.
Conclusions
There is a high frequency of ADHD symptoms in patients with binge eating/purging eating disorders that motivates further studies, particularly concerning the effects of ADHD medication. The finding that the frequency of ADHD symptoms in anorexia nervosa with binge eating/purging is as high as in bulimia nervosa highlights the need also for this group
Low back pain and limitations of daily living in Asia: longitudinal findings in the Thai cohort study
No full textAbstract
Background
Low back pain (LBP) is a major cause of disability throughout the world. However, longitudinal evidence to relate low back pain and functional limitations is mostly confined to Western countries. In this study, we investigate the associations between low back pain and functional limitations in a prospective cohort of Thai adults.
Methods
We analysed information from the Thai Cohort Study of adult Open University adults which included 42,785 participants in both 2009 and 2013, with the majority aged 30 to 65\ua0years and residing nationwide. We used multivariate logistic regression to explore the longitudinal associations between LBP in 2009 and 2013 (\u2018never\u2019: no LBP in 2009 or 2013; \u2018reverting\u2019: LBP in 2009 but not in 2013; \u2018incident\u2019: no LBP in 2009 but LBP in 2013; and \u2018chronic\u2019: reporting LBP at both time points) and the outcome of functional limitations relating to Activities of Daily Living (ADL) in 2013.
Results
Low back pain was common with 30% of cohort members reporting low back pain in both 2009 and 2013 (\u2018chronic LBP\u2019). The \u2018chronic LBP\u2019 group was more likely than the \u2018never\u2019 back pain group to report functional limitations in 2013: adjusted odds ratios 1.60 [95% Confidence Interval: 1.38\u20131.85] for difficulties getting dressed; 1.98 [1.71\u20132.30] for walking; 2.02 [1.71\u20132.39] for climbing stairs; and 3.80 [3.38\u20134.27] for bending/kneeling. Those with \u2018incident LBP\u2019 or \u2018reverting LBP\u2019 both had increased odds of functional limitations in 2013 but the odds were not generally as high.
Conclusions
Our nationwide data from Thailand suggests that LBP is a frequent public health problem among economically productive age groups with adverse effects on the activities of daily living. This study adds to the limited longitudinal evidence on the substantial impact of low back pain in Southeast Asia
Trends in hospital admissions due to antidepressant-related adverse drug events from 2001 to 2011 in the U.S.
No full textAbstract
Background
Depression is a prevalent mental health disorder and the fourth leading cause of disability in the world as per the World Health Organization. Use of antidepressants can lead to adverse drug events (ADEs), defined as any injury resulting from medication use. This study aimed to examine changes in hospital admissions due to antidepressant-related ADEs (ArADEs) among different socio-demographic groups and changes in lengths of stay (LOS) and hospital charges in ArADE admissions from 2001 to 2011.
Methods
The Healthcare Cost and Utilization Project database was used. ArADE admissions in different socio-demographic groups were examined including characteristics such as age, gender, rural/urban, and income. LOS and hospital charges for ArADE cases were compared between 2001 and 2011. Chi-square test and t test were used for statistical analyses.
Results
There were 17,375 and 20,588 ArADE related admissions in 2001 and 2011, respectively. There was a 17.6% increase among the group of 18 to 64\ua0years old and a 64.8% increase among the group of 65\ua0years or older while the other age groups experienced decreased admission rates. Males and females had similar increases. Patients from the lower income areas experienced a two-fold increase while those from the higher income areas experienced a decrease. The mean LOS for all ArADE related admissions increased from 2.18 to 2.81\ua0days and mean hospital charges increased from 21,572.5.
Conclusions
There was an increase in ArADE hospital admissions. The greater increase in ArADE admissions among elderly, urban or low-income patients should be noted and addressed by practitioners and policy makers. The large increase in hospital charges needs further research
Outcome following valve surgery in Australia: development of an enhanced database module
No full textAbstract
Background
Valvular heart disease, including rheumatic heart disease (RHD), is an important cause of heart disease globally. Management of advanced disease can include surgery and other interventions to repair or replace affected valves. This article summarises the methodology of a study that will incorporate enhanced data collection systems to provide additional insights into treatment choice and outcome for advanced valvular disease including that due to RHD.
Methods
An enhanced data collection system will be developed linking an existing Australian cardiac surgery registry to more detailed baseline co-morbidity, medication, echocardiographic and hospital separation data to identify predictors of morbidity and mortality outcome following valve surgery.
Discussion
This project aims to collect and incorporate more detailed information regarding pre and postoperative factors and subsequent morbidity. We will use this to provide additional insights into treatment choice and outcome
Food-specific sublingual immunotherapy is well tolerated and safe in healthy dogs: a blind, randomized, placebo-controlled study
No full textAbstract
Background
Food allergies are increasing in prevalence but no treatment strategies are currently available to cure dogs with food allergy. Over the past decade, experimental food allergen-specific sublingual immunotherapy (FA-SLIT) has emerged as a potential treatment for food allergies in human medicine. However, FA-SLIT has not been investigated in dogs. Therefore, the objective of this study was to prospectively evaluate the safety, tolerability and dispenser sterility of FA-SLIT in healthy dogs before testing it in food allergic dogs.
Eight experimental healthy beagle dogs, never orally exposed to peanut, were randomized in two groups to receive SLIT with peanut or placebo for 4\ua0months. Subjects were monitored daily for local and systemic adverse effects. Blood samples for complete blood count and serum biochemistry, and urine for urinalysis were collected and the dogs\u2019 body weight was recorded at day 0, 35 and 119 of the SLIT treatment. Sera for the determination of peanut-specific IgG and IgE were collected at day 0, 35, 49, 70, 91, 105 and 119. Intradermal tests were performed before (day 0) and after (day 119) the experiment. The content of each dispenser used to administer treatment or placebo was tested for sterility after usage. In order to assess the presence or absence of sensitization, dogs were challenged 6\ua0months after the end of the study with 2000\ua0\u3bcg of peanut extract daily for 7 to 14\ua0days.
Results
All dogs completed the study. The treatment did not provoke either local or systemic side-effects. Peanut-specific IgG significantly increased in treatment group. Even though a significant increase in peanut-specific IgE was also seen, intradermal tests were negative in all dogs before and after the experiment, and the challenge test did not trigger any adverse reactions in the treated dogs, which shows the protocol did not cause sensitization to peanut, but nevertheless primed the immune system as indicated by the humoral immune response. All dispenser solutions were sterile.
Conclusions
Our results demonstrate that the used peanut-SLIT protocol is well tolerated and safe in healthy dogs. Further studies should evaluate tolerability, safety and efficacy in dogs with food allergy
Pharmacokinetics and in vitro efficacy of salicylic acid after oral administration of acetylsalicylic acid in horses
No full textAbstract
Background
Although acetylsalicylic acid (ASA) is not frequently used as a therapeutic agent in horses, its metabolite SA is of special interest in equestrianism since it is a natural component of many plants used as horse feed. This led to the establishment of thresholds by horse sport organizations for SA in urine and plasma. The aim of this study was to investigate plasma and urine concentrations of salicylic acid (SA) after oral administration of three different single dosages (12.5\ua0mg/kg, 25\ua0mg/kg and 50\ua0mg/kg) of acetylsalicylic acid (ASA) to eight horses in a cross-over designed study.
Results
In the 12.5\ua0mg/kg group, SA concentrations in urine peaked 2\ua0h after oral administration (2675\ua0\u3bcg/mL); plasma concentrations peaked at 1.5\ua0h (17\ua0\u3bcg/mL). In the 25\ua0mg/kg group, maximum concentrations were detected after 2\ua0h (urine, 2785\ua0\u3bcg/mL) and 1.5\ua0h (plasma, 23\ua0\u3bcg/mL). In the 50\ua0mg/kg group, maximum concentrations were observed after 5\ua0h (urine, 3915\ua0\u3bcg/mL) and 1.5\ua0h (plasma, 45\ua0\u3bcg/mL). The plasma half-life calculated for SA varied between 5.0 and 5.7\ua0h. The urine concentration of SA fell below the threshold of 750\ua0\u3bcg/mL (set by the International Equestrian Federation FEI and most of the horseracing authorities) between 7 and 26\ua0h after administration of 12.5 and 25\ua0mg/kg ASA and between 24 and 36\ua0h after administration of 50\ua0mg/kg ASA. For ASA, IC
50
were 0.50\ua0\u3bcg/mL (COX-1) and 5.14\ua0\u3bcg/mL (COX-2). For salicylic acid, it was not possible to calculate an IC
50
for either COX due to insufficient inhibition of both cyclooxygenases.
Conclusion
The established SA thresholds of 750\ua0\u3bcg//mL urine and 6.5\ua0\u3bcg/mL plasma appear too generous and are leaving space for misuse of the anti-inflammatory and analgetic compound ASA in horses