bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Impact of the Affordable Care Act and Medicaid Expansion on Racial and Socioeconomic Disparities in Cancer Care
Authors: Mahal Amandeep R. , Chavez Janice , Yang David D. , Kim Daniel W. , Cole Alexander P. , Hu Jim C. , Trinh Quoc-Dien , Yu James B. , Nguyen Paul L. , Mahal Brandon A. 
Published: January 2020

Objectives:
We sought to evaluate sociodemographic disparities in insurance coverage among nonelderly adults with a common cancer after Affordable Care Act (ACA) implementation.

Patients and Methods:
In total, 109,182 patients aged 18 to 64 years diagnosed with a common cancer (lung, breast, or prostate cancer) were identified from 2010 to 2014. Multivariable logistic regressions analyzed associations between ACA implementation and uninsured rates on the basis of state approach to Medicaid expansion, stratified by race (black, white), and income (stratified at 138% Federal Poverty Line).

Results:
Uninsured rates declined after ACA implementation, with the greatest rate reductions associated with traditional Medicaid expansion (P
interaction <0.001). Racial disparities in insurance coverage were eliminated with traditional Medicaid expansion where the uninsured rate went from 10.0% to 0.95% among black patients (adjusted odds ratio [AOR]pre-aca 1.52 to AORpost-aca 0.47) but persisted with other state approaches (AORpre-aca 1.15 to AORpost-aca 1.12) (P
interaction =0.002). Furthermore, socioeconomic coverage gaps were eliminated with traditional Medicaid expansion, where the uninsured rate went from 8.4% to 1.4% among low-income (≤138% Federal Poverty Line) patients, but not with other state approaches (P
interaction <0.001).

Conclusions:
Traditional Medicaid expansion was associated with the elimination of racial and socioeconomic insurance coverage gaps. These results highlight the potential benefits and challenges of the ACA and its provisions, and could instruct ongoing policy.
Low Frequency of Mutation Testing in the United States
Authors: Florindez Jorge , Trent Jonathan 
Published: January 2020

Objective:The objective of this study was to determine whether there were survival differences associated withKITmutation testing, type ofKITmutations, and other clinical variables in patients with localized or metastatic gastrointestinal tumor (GIST).Methods:Adult patients with GIST were extracted from the Surveillance Epidemiology and End Results (SEER) database from 2010 to 2015 with follow-up through 2016. Overall survival (OS) and cancer-specific survival (CSS) were the designated endpoints.Results:A total of 3866 patients met inclusion criteria. Metastatic disease was found in 656 patients (17%), whereas localized disease was present in 3210 patients (83%).KITmutation testing was performed in 1033 patients (26.7%) with equal distribution in localized and metastatic disease (27% and 26.6%, respectively). Multivariate analysis was performed in localized and metastatic GIST. In localized GIST, black race showed worse OS (hazard ratio [HR]=1.57; 95% confidence interval [CI]: 1.26-1.96), whereas higher mitotic rate (>5/50 HPF) demonstrated poor OS (HR=1.59; 95% CI: 1.24-2.05) and CSS (HR=3.07; 95% CI: 2.07-4.54); tumor size (>10 cm) showed poor CSS (HR=5.73; 95% CI: 2.37-13.8). In metastatic GIST, black race showed poor OS (HR=1.42; 95% CI: 1.04-1.93) and CSS (HR=1.73; 95% CI: 95% CI: 1.18-2.54), whileKITtesting was associated with better OS (HR=0.64; 95% CI: 0.47-0.87) and CSS (HR=0.66; 95% CI: 0.44-0.97); treatment with tyrosine kinase inhibitors showed better OS (HR=0.67; 95% CI: 0.51-0.88). Surgical resection was associated with better OS (HR=0.56; 0.47-0.67) and CSS (HR=0.55; 95% CI: 0.42-0.72) both in localized and metastatic GIST.Conclusions:The minority of GIST patients have their tumor tested for anyKITmutation. Yet,KITtesting and therapy with tyrosine kinase inhibitors were associated with better survival in GIST patients with metastatic disease. Surgery, potentially curative for localized GIST, shows benefit in the metastatic setting.
Predictors of Distant Recurrence Following Stereotactic Body Radiation Therapy for Stage I Non–Small Cell Lung Cancer
Authors: Wong Jessica Karen , Shaikh Talha , DeMora Lyudmila , Zhang Eddie , Borghaei Hossein , Hayes Shelly B. , Kumar Sameera , Meyer Joshua E. , Hallman Mark A. 
Published: January 2020

Objective:
The objective of this study was to characterize patients at an increased risk of distant metastasis (DM) following stereotactic body radiation therapy (SBRT) for stage I non–small cell lung cancer (NSCLC).

Materials and Methods:
We identified patients undergoing SBRT for stage I NSCLC between 2005 and 2016. Patients with a prior lung cancer diagnosis, receiving a biological effective dose <100 Gy, or receiving chemotherapy were excluded. Patients underwent pretreatment staging and were classified according to the American Joint Committee for Cancer (AJCC) 8th edition staging. The primary endpoint was DM. The Kaplan-Meier method and the Cox proportional hazards model were used for survival analysis and to identify predictors of DM.

Results:
A total of 174 patients were included, with a median age 75 years (range, 49 to 96 y) and a median follow-up of 24 months (range, 3 to 123 mo). The 2- and 4-year cumulative incidences of DM were 14.2% and 19.1%, respectively. Patients who developed DM had worse overall survival versus patients developing a locoregional recurrence (P=0.023). On multivariable analysis, having stage IB disease (hazard ratio: 2.95; 95% confidence interval: 1.06-8.23; P=0.039) or a lower/middle lobe tumor (hazard ratio: 2.67; 95% confidence interval: 1.07-6.69; P=0.036) was associated with increased risk of DM. The 2-year cumulative incidences of DM were 10.9% and 35.7% (P=0.002) for patients with stage IA versus IB tumors, respectively, and 11.3% and 19.7% (P=0.049) for patients with upper lobe versus lower/middle lobe tumors, respectively.

Conclusions:
Patients with stage IB disease or lower/middle lobe tumors may have an increased risk of DM following SBRT. Randomized controlled trials are needed to further identify patients who may benefit from adjuvant systemic therapy after SBRT for stage I NSCLC.
Association of visit-to-visit variability of systolic blood pressure with cardiovascular disease, chronic kidney disease and mortality in patients with hypertension
Authors: Wan Eric Yuk Fai , Yu Esther Yee Tak , Chin Weng Yee , Fong Daniel Yee Tak , Choi Edmond Pui Hang , Lam Cindy Lo Kuen 
Published: January 2020

Objective:
This study aimed to evaluate the association between visit-to-visit variability of systolic blood pressure (SBP) and cardiovascular disease, chronic kidney disease, and mortality among hypertensive patients.

Methods:
A population-based cohort included 225 759 Chinese hypertensive adults without diabetes, cardiovascular disease, and chronic kidney disease during 2011–2012. SBP variability was determined based on standard deviations of SBP over the previous 5 years before baseline. Cox regressions adjusted with patients’ baseline characteristics, mean, and temporal trend of SBP was applied to the associations between variability and incident cardiovascular disease, chronic kidney disease and all-cause mortality.

Results:
In all, 25 714 patients with cardiovascular disease, 27 603 with chronic kidney disease, and 16 778 deaths have occurred during the median follow-up of 70.5 months (1.2 million person-years). SBP variability was continuously and positively associated with higher cardiovascular disease, chronic kidney disease and mortality risk among hypertensive patients without evidence of a threshold. Each 10-mmHg increase in SD of SBP was associated with 35% [hazard ratio 1.35, 95% confidence interval (CI) 1.30–1.39], 39% (HR 1.39, 95% CI 1.35–1.43), and 40% (HR 1.40, 95% CI 1.34–1.45) higher risk of cardiovascular disease, chronic kidney disease and mortality, respectively. HRs were attenuated with increased age, mean SBP, and Charlson index, and decreased temporal trend of systolic blood pressure, but it remained significant and consistent in most of the different subgroups.

Conclusions:
Findings suggested that SBP variability is a significant prognostic value, in addition to baseline or mean of SBP for the risk of cardiovascular disease and mortality.
CLINICAL CHARACTERISTICS AND MOLECULAR GENETIC ANALYSIS OF A COHORT OF CHINESE PATIENTS WITH CHOROIDEREMIA
Authors: Han Xiaoxu , Wu Shijing , Li Hui , Zhu Tian , Wei Xing , Zhou Qi , Sui Ruifang 
Published: January 2020

Purpose:
To describe the clinical and molecular genetic characteristics of a large cohort of Chinese patients with choroideremia (CHM).

Methods:
Forty-eight Chinese participants from 35 families with a clinical diagnosis of CHM who harbored sequence variants in the CHM gene were enrolled. Comprehensive clinical evaluations and molecular genetic analysis of the CHM gene were performed.

Results:
The median age of the 48 patients was 31.5 years (range, 5–78 years). There were 30 different sequence variants detected in 35 families; of which, 13 sequence variants were novel. The mean (±SD) best-corrected visual acuity best in logarithm of the minimum angle of resolution equivalents was 0.71 (±0.87) (range, 0.00–2.80) or approximately 20/100 in Snellen visual acuity. A significant correlation was revealed between best-corrected visual acuity best and age (P < 0.001). The trend in the change in the best-corrected visual acuity over age showed that relatively good vision remained until 20 years old. The patterns of fundus photography and fundus autofluorescence finding demonstrated that residual retinal pigment epithelium areas significantly declined in patients at the age of 20 years or older. The results of visual field and full-field electroretinography showed that these measures might be of limited value for evaluating the condition of the late stage of CHM in Chinese patients.

Conclusion:
This study described for the first time the clinical and molecular genetic characteristics of a large cohort of Chinese patients with CHM. The findings from best-corrected visual acuity best and visual field showed that the impairment of visual function in CHM might be more severe in Chinese patients than in western patients.
Temporal Wedge Defects in Glaucoma: Structure/Function Correlation With Threshold Automated Perimetry of the Full Visual Field
Authors: Wall Michael , Lee Eric J. , Wanzek Robert J. , Chong Luke X. , Turpin Andrew 
Published: January 2020

Precis:
We used the Open Perimetry Interface (OPI) to design a static automated perimetry test of the full visual field. About half of our glaucoma cohort had defects in the far peripheral inferotemporal visual field that correlate well with related damage to the superior nasal optic disc.

Aims:
To test the hypothesis that in glaucoma patients with mild visual loss, perimetric nerve fiber bundle defects present outside 30 degrees will correlate well with areas of Cirrus ocular coherence tomography (OCT) retinal nerve fiber layer thinning.

Methods:
We tested 27 consecutive glaucoma subjects with mild vision loss (mean deviation better than −4 dB) with a SITA standard test, 2 size V custom OPI tests (OPI 30-2 and OPI Peripheral) and Cirrus OCT. Two observers assigned qualitative grades to each type of visual field test based on their level of correlation with OCT retinal nerve fiber layer and ganglion cell thickness.

Results:
Discrete temporal wedge defects were found on the OPI peripheral V test in 26% of cases whereas more extensive inferior temporal loss (including inferior temporal wedge defect region) was present in 22% of other cases. OCT data correlated best with the OPI peripheral test for 8 glaucoma subjects. The OPI central 30-2 test correlated best for 9 glaucoma subjects; the remainder of subjects had equal central/peripheral correlations.

Conclusions:
About half of our glaucoma cohort have defects in the far peripheral inferotemporal visual field that correlate well with related damage to the superior nasal optic disc. Adding a threshold automated perimetry test of the far periphery improves structure/function correlations and adds useful clinical information.
Cryptococcal Pneumonia Following Influenza in an Immunocompetent Patient
Authors: McNeil Thomas , Daniel Santhosh , Gordon David L. 
Published: January 2020

Abstract
We describe the case of a 42-year-old immunocompetent man who developed severe pneumonia with Cryptococcus neoformans var. grubii following influenza A infection. With the commencement of liposomal amphotericin and flucytosine, his condition dramatically deteriorated. Secondary bacterial infection following influenza is a well-recognized phenomenon and there are increasing reports of invasive aspergillosis occurring in the critically ill; however, secondary infection with cryptococcus in the immunocompetent patient is rare. The absence of an immunological defect in our patient raises the possibility of influenza predisposing to cryptococcal infection. We hypothesize that the cause of our patient's deterioration with antifungal treatment represented either a reaction to amphotericin or a vigorous immunological response to released fungal antigen. Our experience alerts the clinician to the potential for clinical deterioration with antifungal treatment of cryptococcal pneumonia in the immunocompetent host, and raises the question of a link between influenza and cryptococcal infection.
A Case Report
Authors: Maldonado-Díaz Ellis Daniela , Delgado-Hernández Rosa Delia , Salinas-Lara Citlaltepetl , Soto-Hernández José Luis , Cárdenas Graciela 
Published: January 2020

Abstract
Fungal meningitis is often a fatal condition, particularly in immunosuppressed patients. Herein, we describe the case of a previously healthy young woman with a history of epidural anesthesia for a cesarean delivery in another hospital 3 months prior. The patient complained of chronic migraine-like headache before admission to our center. After 5 weeks, a cerebrospinal fluid culture in Sabouraud agar grew a mold, later identified as Aspergillus fumigatus. The patient died after 114 days of hospitalization despite being administered with voriconazole for 45 days. At autopsy, a pigmented mold consistent with phaeohyphomycosis was found, suggesting an unusual case of a mixed mold infection.
The Relationship Between Caregiver Reactions and Psychological Distress in Family Caregivers of Patients With Heart Failure
Authors: Hou Danhua , Chen Yu xia , He Dengxin , Zhang Xiuting , Fan Xiuzhen 
Published: January 2020

Background
Providing care often causes negative reactions and psychological distress in family caregivers of patients with heart failure. How these 2 constructs are related has not been fully explored.

Objective
The aims of this study were to describe caregiver reactions to caregiving and psychological distress and to determine the associations between caregiver reactions to caregiving and psychological distress in family caregivers of patients with heart failure.

Methods
In this secondary analysis of a cross-sectional study, the sample included 231 patients and their family caregivers. The Chinese version of the Hospital Anxiety and Depression Scale was used to assess psychological distress (ie, symptoms of anxiety and depression), and the Caregiver Reaction Assessment was used to measure both negative and positive caregiver reactions to caregiving, including financial problems, impact on schedule, health problems, lack of family support, and self-esteem.

Results
Of the participants, 15.2% and 25.5% of caregivers reported symptoms of depression and anxiety, respectively. Impact on schedule was the most common caregiver reaction, followed by financial problems. Impact on schedule was related to both the caregivers' symptoms of depression (odds ratio [OR], 1.705; P = .001) and anxiety (OR, 1.306; P = .035), whereas financial problems were only related to symptoms of anxiety (OR, 1.273; P = .011).

Conclusions
The findings suggest that interventions for reducing the negative impact on schedule of caregiving and helping to solve the caregivers' financial concerns might help to relieve their symptoms of depression and anxiety.
Opioid crisis: Placing blame or fixing the problem
Authors: Snodgrass Brett 
Published: January 2020

ABSTRACT
There is prevalent news media coverage about the opioid crisis in the United States. Overdose deaths are on the rise, but who's fault is it really? Perspective into the crisis is key if we as health care providers ever hope to change the current situation. Although overdose deaths are on the rise, opioid prescribing rates are decreasing. Considering a complex issue requires looking into to the lives of patients and their past experiences to truly identify those at risk for addiction, not just opioid addiction, but addiction as a whole. Nurse practitioners play a vital role in identifying those at greatest risk, making the identification early and assisting patients into treatment to help change the trajectory of their lives.
Trends and predictors of coronary revascularization in patients with coronary artery anomalies and acute myocardial infarction: a nationwide analysis of 8131 patients
Authors: Shah Neeraj , Agarwal Vratika , Olson Peter C. , Naniwadekar Aditi , Agarwal Anand , Patel Nainesh C. 
Published: January 2020

Objective
Acute myocardial infarction (AMI) is rarely associated with coronary artery anomalies (CAA). This confluence makes it difficult to identify and treat the culprit lesion with percutaneous coronary intervention (PCI). Our objective was to evaluate trends and predictors of revascularization in patients with CAA and AMI using a large national database.

Methods
We included adult patients with CAA presenting as ST segment elevation myocardial infarction (STEMI) or non-ST segment elevation myocardial infarction (NSTEMI) and undergoing coronary angiography from Nationwide Inpatient Sample from 2000 to 2011, using ICD-9 diagnosis code of 746.85 for CAA. Chi-square test for trend was used to compare revascularization rates over time. Multivariate logistic regression was used to identify predictors of revascularization.

Results
There were almost 4.7 million subjects with AMI undergoing coronary angiography from 2000 to 2011. Of these, there were 8131 patients with CAA, including 3425 STEMI and 4706 NSTEMI patients. Mean age of the CAA population was 59 years with 63.6% males. Overall PCI rate was 47.8% and coronary artery bypass grafting rate was 8.8%. In STEMI patients with CAA, PCI rate increased from 49.9% in 2000 to 77.8% in 2011 (P < 0.001). In NSTEMI patients with CAA, PCI rate remained unchanged from 33.3% in 2000 to 37.3% in 2011 (P = 0.34). Revascularization trends in AMI patients with CAA mirrored those in AMI patients without CAA.

Conclusion
Despite the technical challenges associated with PCI in CAA, PCI rates in STEMI patients with CAA continue to increase over time. On the contrary, PCI rates continue to remain low in CAA patients with NSTEMI, reflecting overall contemporary NSTEMI treatment trends.
Effect on mortality of different routes of administration and loading dose of aspirin in patients with ST-segment elevation acute myocardial infarction treated with primary angioplasty
Authors: Rossi Rosario , Bagnacani Alessandra , Sgura Fabio , Enrique Monopoli Daniel , Coppi Francesca , Talarico Marisa , Rolando Cristina , Boriani Giuseppe 
Published: January 2020

Background:
Aspirin is the cornerstone of the anti-platelet therapy during the acute phase of ST-segment elevation myocardial infarction (STEMI), and it can be administrated orally or intravenously. The oral loading dose of aspirin is well characterized, whereas there are little data on the optimal intravenous (IV) loading dose.

Aim:
To confirm if the mortality of patients treated with a loading dose of IV aspirin was comparable to that of patients treated with the most usual aspirin per os.

Patients and methods:
We analyzed the overall mortality during hospitalization and at 1 year follow-up among 756 consecutive patients with STEMI. Four hundred seventy-eight (63.2%) patients received per os and 278 (36.8%) IV aspirin. We divided the 278 patients of the IV aspirin group into two subgroups, based on the median value of the dose of aspirin used as a load.

Results:
The per os aspirin group took 234 ± 138 mg of aspirin per os at the first medical contact; the IV low-dose group 194 ± 87 mg, and the IV high-dose group 483 ± 194 mg of IV aspirin. No differences were observed in mortality rate after 1-year of follow-up. In-hospital mortality resulted significantly higher (9.3%) in the IV high-dose group respect to the IV low-dose one (5.0%) and per os aspirin group (6.0%) (P < 0.01 for both).

Conclusion:
In this retrospective study, high dose IV aspirin loading in STEMI increased intra-hospital mortality. Further study is necessary to define the optimal dose of intravenous aspirin in STEMI.
An effectiveness study of a wearable device (Clouclip) intervention in unhealthy visual behaviors among school-age children
Authors: Cao Yingpin , Lan Weizhong , Wen Longbo , Li Xiaoning , Pan Lun , Wang Xuan , Yang Zhikuan 
Published: January 2020

AbstractIntroduction:The study aimed to determine the effectiveness of an intervention for unhealthy visual behaviors of school-age children using a wearable device (Clouclip).Method:The design was a self-controlled prospective study. Clouclip, with the vibration alert disabled, was first applied to measure baseline near-work behaviors in the first week. The vibration alert was then enabled to signal unhealthy visual behaviors (near-work distance < 30 cm and >5 seconds, or near-work distance <60 cm for >45 minutes) for 3 weeks. Near-work behaviors were measured again at the first week and the first month after intervention, respectively. The changes in behaviors between the baseline and the first week and the first month after intervention were analyzed.Results:Sixty-seven subjects were eligible for this experiment (the mean age 10.45 ± 0.50 years, 34 boys). Children who logged sufficient wearing time (12.30 ± 0.18 hours on weekdays and 12.16 ± 0.23 hours on weekends) were included for analysis. The average daily near-work distance was significantly increased after the vibration intervention. The time ratio of near-work activity <30 cm to the total <60 cm and the frequency of continuous near-work (distance <60 cm and continuous time >30 minutes) were significantly decreased after the intervention. Although some of the effects were reversed with time following the intervention, some were observed to be maintained until the end of the observation period, and the improvement of the behaviors was more prominent in children who had a shorter near-work distance (<30 cm) at baseline.Conclusions:In conclusion, Clouclip can significantly modify near-work behaviors in school-age children and it can last a certain period of time. If these behaviors are causes of myopia development and progression, Clouclip might provide a strategy for managing myopia.
Evaluation of parenteral nutrition-associated liver disease in surgical infants for necrotizing enterocolitis
Authors: Zeng Senyan , Li Xiaoyu , Deng Chun , Li Lei , Guo Chunbao 
Published: January 2020

Abstract
The purpose of this study was to determine the factors associated with parenteral nutrition-associated liver disease (PNALD) in infants who underwent surgery for necrotizing enterocolitis (NEC) and followed up the postoperative outcomes for long term parenteral nutrition (PN).
This study included a retrospective review of 87 infants with NEC and managed surgically from July 2007 to May 2017 at the Children's Hospital, Chongqing Medical University. Clinical data and procedure information were collected and analyzed.
Among the infants included, 16.1% of patients developed PNALD. Multivariable logistic regression analysis revealed progressive clinical deterioration (OR, 5.47; 95% CI, 1.10–26.96; P = .037) was independent risk factor for PNALD whereas congenital heart disease (OR, 0.068; 95% CI, 0.008–0.55; P = .012) presentation served as a protective factor.
The current data suggested the distinct disease process for cardiac patients with NEC, which might help in the prevention and treatment of PNALD for patients with NEC.