bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosis and management of congenital absence of pericardium: a case report
Authors: Bouchard Melissa , Hoschtitzky A , Gatzoulis M 
Published: December 2019

Abstract

Background
Absence of the pericardium is a rare congenital defect with an approximate incidence of &lt;1/10 000. We review a case of complete pericardial agenesis in a symptomatic patient with gross cardiac mobility, for which pericardial reconstruction was undertaken successfully.

Case summary
A 24-year-old otherwise fit and well patient, with debilitating exertional chest pain was found to have complete pericardial agenesis on the left side and on the diaphragmatic surface. There was gross cardiac mobility demonstrated on cardiac magnetic resonance imaging. His pericardium was reconstructed surgically using Gore-tex® patches. There were no complications, and the patient was discharged 8 days later. Three months later at follow-up, the patient required no analgesia and has had complete resolution of his chest pains.

Discussion
Congenital hemi-pericardial agenesis is a very rare condition which often remains undetected due to its asymptomatic nature. It is important to consider this as a differential diagnosis of exertional chest pains. Cardiac magnetic resonance imaging remains the investigation of gold standard. There is no consensus on whether surgical intervention in symptomatic or asymptomatic patients has any prognostic value. However, we have demonstrated that by reconstructing the pericardium in a highly symptomatic patient, there has been a resolution in size of a previously dilated right ventricle and most importantly an improvement in quality of life.
Cardiac magnetic resonance imaging in a patient with temporary external pacemaker: a case report
Authors: Chaudhry Uzma , Svensson Jonas , Mosén Henrik , Mörtsell David 
Published: December 2019

Abstract

Background
Magnetic resonance imaging (MRI) is increasingly becoming the imaging modality of choice for many clinical disorders due to superior image quality and absence of radiation. However, access to MRI remains limited for most patients with cardiac implantable electronic devices due to potential safety concerns. In line with guidelines, there is no absolute contraindication to perform MRI, but warrants careful risk-benefit assessment.

Case summary
A 59-year-old man was admitted with a 5-day history of central chest pain and few week’s history of general malaise, dry cough, and breathlessness. Electrocardiogram confirmed complete atrioventricular block (CAVB). A slight increase in cardiac enzyme was noted. Coronary angiogram revealed atheromatous changes, but no obstructive coronary lesion. A temporary transvenous pacemaker was inserted. Transthoracic echocardiogram confirmed a dilated left ventricle with severely reduced left ventricular function. To facilitate diagnosis (hence prognosis), management and mobilization, investigation with cardiovascular magnetic resonance (CMR) was warranted but contraindicated by the temporary transvenous pacemaker. An active fixation pacemaker lead was therefore placed in the right ventricle via percutaneous puncture of the right subclavian vein and connected to a pulse generator, both secured to the skin with sutures and adhesive medical dressing. Appropriate device programming and close patient monitoring ensured that CMR could be performed without any adverse effects. A diagnosis of acute myocarditis was confirmed. Regular device interrogation during an extended 3-week period with temporary pacing ruled out any device failure. As there was no resolution of CAVB, the patient received a dual-chamber pacemaker.

Discussion
Cardiovascular magnetic resonance was feasible and safely performed on a patient with a temporary permanent external pacemaker system using a standard screw-in pacing lead and a regular pulse generator fixed to the skin. Although more studies are needed for generalizability, CMR may be used in highly selected patients with a temporary pacemaker.
The practical management of fluid retention in adults with right heart failure due to pulmonary arterial hypertension
Authors: Stickel Simone , Gin-Sing Wendy , Wagenaar Martha , Gibbs J Simon R 
Published: December 2019

Abstract
Our aim with this review is to provide practical advice and management support for nurses and other healthcare practitioners in managing fluid retention in adults with right heart failure (RHF) due to pulmonary arterial hypertension (PAH). Vigilant management of RHF is important for maintaining patient quality of life, as fluid overload can lead to abdominal bloating (ascites) and peripheral oedema, which also has a major impact on patients’ morbidity and mortality. Patients with RHF should be assessed regularly for signs of fluid retention. If fluid overload develops, it is important to determine whether it is caused by the progression of PAH, a side effect of PAH-specific treatment, or another drug or comorbid condition, as this affects both the prognosis and the management strategy. Right heart failure can be treated with both pharmacological and non-pharmacological interventions to reduce fluid retention; including altering fluid and salt intake, weight monitoring, and use of diuretics. All patients on diuretics should be regularly monitored for renal dysfunction and electrolyte imbalance and given advice on how to manage the side effects associated with diuretic use. Fluid retention is often assessed and treated in clinical practice by specialist nurses, who act as a key patient contact providing advice and information on symptom management. This review provides an overview of the challenges related to fluid retention, including strategies to help patients manage symptoms and side effects of treatment.
A Stage for the Unknown? Reconciling Postwar Communities through Theatre-Facilitated Dialogue
Authors: Dirnstorfer Anne , Saud Nar Bahadur 
Published: December 2019

Abstract
The article explores the potential of theatre art in transitional justice, particularly in the field of reconciliation and healing. Presenting the context of reconciliation in Nepal 10 years after the end of the armed conflict, the authors argue for complementary processes of top-down and community-based, bottom-up approaches by introducing the concept of ‘theatre-facilitated dialogue’ as a way to strategically integrate Playback Theatre in peacebuilding. Analyzing the project ‘EnActing Dialogue,’ the article elaborates on the learnings from theatre-facilitated dialogue work in communities where ex-combatants of the Nepali People’s Liberation Army have settled. Based on the theoretical overview of secondary resources, the authors’ participatory observations, on informal interviews and quantitative data, the study explores how artistically enacted storytelling supports bottom-up reconciliation. By staging a noncognitive dialogue through storytelling, music and theatre, Playback Theatre contributes to the deconstruction of war-related identities, an understanding of root causes, as well as personal healing and relationship building at community level.
Higher-Level Phylogeny and Reclassification of Lampyridae (Coleoptera: Elateroidea)
Authors: Martin Gavin J , Stanger-Hall Kathrin F , Branham Marc A , Da Silveira Luiz F L , Lower Sarah E , Hall David W , Li Xue-Yan , Lemmon Alan R , Moriarty Lemmon Emily , Bybee Seth M 
Published: December 2019

AbstractFireflies (Lampyridae Rafinesque) are a diverse family of beetles which exhibit an array of morphologies including varying antennal and photic organ features. Due in part to their morphological diversity, the classification within the Lampyridae has long been in flux. Here we use an anchored hybrid enrichment approach to reconstruct the most extensive molecular phylogeny of Lampyridae to date (436 loci and 98 taxa) and use this phylogeny to evaluate the higher-level classification of the group. None of the currently recognized subfamilies were recovered as monophyletic with high support. We propose several classification changes supported by both phylogenetic and morphological evidence: 1) Pollaclasis Newman, Vestini McDermott (incl. Vesta Laporte, Dodacles Olivier, Dryptelytra Laporte, and Ledocas Olivier), Photoctus McDermott, and Araucariocladus Silveira & Mermudes are transferred to Lampyridae incertae sedis, 2) Psilocladinae Mcdermott, 1964status novum is reestablished for the genus Psilocladus Blanchard, 3) Lamprohizini Kazantsev, 2010 is elevated to Lamprohizinae Kazantsev, 2010status novum and Phausis LeConte is transferred to Lamprohizinae, 4) Memoan Silveira and Mermudes is transferred to Amydetinae Olivier, and 5) Scissicauda McDermott is transferred to Lampyrinae Rafinesque.
Keeping salamanders off the streets: evaluating and modifying one of the first US amphibian road tunnels 30 years after installation
Authors: Hedrick Brandon P , Vander Linden Abby , Cordero Samantha A , Watt Edward , O’Roark Patrick M , Cox Samantha L , Sutherland Christopher 
Published: December 2019

AbstractWildlife tunnels are often installed under busy roads to help a variety of animals, from small frogs to bears, safely cross roads that bisect their habitats. One of the first roadway wildlife tunnel systems designed specifically for amphibian use in the USA was installed along Henry Street in Amherst, Massachusetts, in 1987 to protect spotted salamanders (Ambystoma maculatum). These salamanders cross Henry Street during their annual migration to their breeding pools. In recent years, volunteers monitoring the site suggested that salamanders were no longer using the tunnels. To evaluate this concern, we conducted salamander counts in 2016, 2017 and 2018 to quantify tunnel use. In 2016, 11% of observed salamanders used the tunnels—a substantial decrease from 68% in 1988, 1 year after tunnel installation, when the tunnels were last evaluated. Following 2016, we implemented two tunnel modifications: adding a light to the far end of tunnels (2017) and placing a ramp at tunnel entrances to reduce balking (2018). However, salamander tunnel use was not increased significantly by either the light modification or the ramp modification. Previous studies have demonstrated that salamanders prefer minimum tunnel apertures of &gt;0.4 m, so it is likely that the 0.2 m apertures at Henry Street are too small. While many studies have evaluated amphibian tunnel use in laboratory and field settings, ours was one of the first studies to examine tunnel usage data long after initial installation. These long-term data are critical for evaluating factors necessary for maintaining wildlife tunnel effectiveness over decades.
A conceptual model to increase the visibility and usage of cultural heritage objects: The case of UNESCO’s Memory of the World list1
Authors: Akça Sümeyye 
Published: December 2019

Abstract
Cultural heritage connects the past with the future by forming an integral part of the identities of societies. Thus, countries must protect their cultural heritage and create policies to ensure that people benefit today and pass the heritage on to future generations. Beyond physical protection in the face of globalization, increasing access to cultural heritage is necessary to ensure participation and evaluate practices from an international perspective. Advances in computer and communication technologies are being exploited for these requirements. Acquiring knowledge about and interacting with cultural objects in any part of the world today is possible through the digital humanities approach. In this study, a conceptual model was formed to increase visibility and usage of Kandilli Observatory and Earthquake Research Institute Manuscripts, the Hittite cuneiform tablets from Bogazköy, the works of Ibn Sina at the Süleymaniye Manuscript Library, Evliya Çelebi’s ‘Book of Travels’, and the Old Assyrian Merchant Archives of Kültepe registered in UNESCO’s Memory of the World List. In this model, which is prepared with the digital humanities approach, best practices applied in the field are considered as examples in the literature. Suggestions are made on how to utilize digital humanities tools to increase access and visibility by revealing the economic, social, and cultural values of the works based on the model.
Effect of Helicobacter pylori infection on the risk of acute coronary syndrome: A systematic review and meta-analysis
Authors: Fang Yizhen , Fan Chunming , Xie Huabin 
Published: December 2019

Abstract

Background:
Numerous studies have illustrated the association between Helicobacter pylori (H pylori) infection and acute coronary syndrome (ACS). However, the results are contradictory. Therefore, we conducted the meta-analysis to identify the association between H pylori and ACS.

Methods:
We performed a systematic search through electronic databases (Excerpta Medica Database, PubMed, Cochrane Library, and Web of Science). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with a random effect model. We also carried out the sensitivity analysis and publication bias.

Results:
Forty-four eligible studies involving 7522 cases and 8311 controls were included. The pooled result showed that H pylori infection was associated with an increase risk of ACS (OR = 2.03, 95% CI 1.66–2.47). In addition, similar results were obtained in subgroups of study quality, area, human development index, and H pylori detection method. The OR for developing countries was significantly higher than developed countries (OR = 2.58 vs OR = 1.69). Moreover, H pylori with cytotoxin-associated antigen A was also significantly associated with an increase risk of ACS (OR = 2.39, 95% CI 1.21–4.74).

Conclusion:
The meta-analysis suggested that H pylori infection was associated with an increased risk of ACS, especially in developing countries. H pylori is easily screened and can be treated with a wide range of drugs. Thus, more high-quality and well-designed studies are needed to confirm whether the treatment of H pylori is an effective way to reduce ACS risk.
Hamartoma of the breast in a man
Authors: Li Mengxin , Lin Gu , You Wu , Zhen Wang , Xu Chengzhao , Hong Jinghui , Ye Du , Dong Song 
Published: December 2019

Abstract

Rationale:
Mammary hamartoma is a rare benign breast tumor, composed of ducts, lobules, fibers, and adipose tissue. We describe a mammary hamartoma in a man; this is the fourth case being reported in the literature.

Patient concerns:
A 30-year-old man presented with a 1-month history of a painless mass in his right breast.

Diagnosis:
Ultrasound imaging and mammography revealed a lesion, approximately 2.0 cm × 2.0 cm in size, in the right breast, which was considered to be either a lipomyoma or an adenoma fibrosum.

Interventions:
The mass was surgically resected. Pathological examination confirmed the diagnosis of mammary hamartoma.

Outcomes:
The patient was discharged from the hospital after surgery. There was no sign of reoccurrence during a 1-year follow-up period.

Lessons:
At present, mammary hamartoma is considered to be a benign lesion, usually treated by surgical resection. Some reports have suggested a possible association between a hamartoma and the development of breast malignancy. The pathology and biology of an association between a mammary hamartoma and malignancy have not been defined to date.
A Decomposition Method to Assess the Contributions of Geographic and Nongeographic Factors to White-Black Disparities in Health Care
Authors: Huckfeldt Peter J. , Escarce José J. , Pane Joseph D. , Popescu Ioana 
Published: December 2019

Background:
Black-white gaps in high-quality hospital use are documented, but the relative contributions of various factors are unclear. The objective of this study was to quantify the contributions of differences in geographic and nongeographic factors to the gap, using decomposition methods and data for coronary heart disease.

Research Design:
We identified white and black fee-for-service beneficiaries aged 65 or older who were hospitalized for acute myocardial infarction (AMI) or coronary artery bypass grafting (CABG) surgery during 2009–2011. We categorized hospitals with AMI mortality rates in the lowest quintile as high-quality hospitals. We first decomposed the white-black gap in high-quality hospital use into a component due to racial differences in region of residence and a within-region component. We then decomposed the within-region differences into contributions due to racial differences in geographic proximity to high-quality hospitals and due to nongeographic factors.

Results:
The white-black gap in high-quality hospital use was smaller for AMI than for CABG (1.7 percentage points vs. 7.5 percentage points). For AMI, region of residence contributed more to the gap than within-region differences (1.0 percentage point vs. 0.6 percentage points), while for CABG, within-region differences prevailed (2.0 percentage points vs. 5.4 percentage points). For both conditions, the within-region white-black difference in high-quality hospital use was mainly driven by nongeographic factors.

Conclusions:
Decomposition methods are a useful tool in quantifying the contributions of various factors to the white-black gap in high-quality hospital use and could inform local policy aimed at reducing disparities in hospital quality.
Copy Number Variations in Wilms Tumor: A Pilot Study From India
Authors: Rahiman Emine A. , Singh Minu , Bhatia Prateek , Kakkar Nandita , Trehan Amita , Bansal Deepak 
Published: December 2019

Background:
The prognostic role of copy number variation is upcoming in Wilms tumor, and its identification will help in tailored therapy for improved cure.

Study Design:
This was a retrospective, nested case-control, pilot study.

Materials and Methods:
Formalin-fixed paraffin-embedded blocks of nephrectomy specimens were retrieved for the study and control groups (children with relapse and survivors for ≥2 y). Multiplex ligand probe amplification (MRC-Holland probe-mix P 380 A1) was performed, with 3 reference samples of normal kidney DNA run for every 7 cases.

Results:
At least 1 variation was detected in 41 (97.8%) specimens. Loss of heterozygosity 1p was not observed. Loss of 16q, 1q gain, and MYCN gain were observed in 5 (11.9%), 29 (69%), and 39 (92.9%) specimens, respectively. The occurrence of copy number variations was similar in both groups: 1q gain: 15 versus 14 (P=1.0), 16q loss: 4 versus 1 (P=0.34), MYCN gain: 19 versus 20 (P=1.0). The gain of 1q, 16p loss, and MYCN gain did not differ across stage or age.

Conclusions:
The gain of 1q, MYCN gain, and 16p loss were identified. A higher occurrence of 1q gain and MYCN gain and a lack of difference in the distribution of variations among survivors and those with a relapse suggest a different molecular profile of Wilms tumor in Indian children.
The Impact of Socioeconomic Deprivation on Clinical Outcomes for Pancreatic Adenocarcinoma at a High-volume Cancer Center
Authors: Powers Benjamin D. , Fulp William , Dhahri Amina , DePeralta Danielle K. , Ogami Takuya , Rothermel Luke , Permuth Jennifer B. , Vadaparampil Susan T. , Kim Joon-Kyung , Pimiento Jose , Hodul Pamela J. , Malafa Mokenge P. , Anaya Daniel A. , Fleming Jason B. 
Published: December 2019

Objective:
To assess the impact of a granular measure of SED on pancreatic surgical and cancer-related outcomes at a high-volume cancer center that employs a standardized clinic pathway.

Summary of Background Data:
Prior research has shown that low socioeconomic status leads to less treatment and worse outcomes for PDAC. However, these studies employed inconsistent definitions and categorizations of socioeconomic status, aggregated individual socioeconomic data using large geographic areas, and lacked detailed clinicopathologic variables.

Methods:
We conducted a retrospective cohort study of 1552 PDAC patients between 2008 and 2015. Patients were stratified using the area deprivation index, a validated dataset that ranks census block groups based on SED. Multivariable models were used in the curative surgery cohort to predict the impact of SED on (1) grade 3/4 Clavien-Dindo complications, (2) initiation of adjuvant therapy, (3) completion of adjuvant therapy, and (4) overall survival

Results:
Patients from high SED neighborhoods constituted 29.9% of the cohort. Median overall survival was 28 months. The rate of Clavien-Dindo grade 3/4 complications was 14.2% and completion of adjuvant therapy was 65.6%. There was no evidence that SED impacted surgical evaluation, receipt of curative-intent surgery, postoperative complications, receipt of adjuvant therapy or overall survival.

Conclusions:
Although nearly one-quarter of curative-intent surgery patients were from high SED neighborhoods, this factor was not associated with measures of treatment quality or survival. These observations suggest that treatment at a high-volume cancer center employing a standardized clinical pathway may in part address socioeconomic disparities in pancreatic cancer.
Perioperative Lung Resection Outcomes After Implementation of a Multidisciplinary, Evidence-based Thoracic ERAS Program
Authors: Haro Greg J. , Sheu Bonnie , Marcus Sivan G. , Sarin Ankit , Campbell Lundy , Jablons David M. , Kratz Johannes R. 
Published: December 2019

Objective:
This prospective study evaluated perioperative lung resection outcomes after implementation of a multidisciplinary, evidence-based Thoracic Enhanced Recovery After Surgery (ERAS) Program in an academic, quaternary-care center.

Background:
ERAS programs have the potential to improve outcomes, but have not been widely utilized in thoracic surgery.

Methods:
In all, 295 patients underwent elective lung resection for pulmonary malignancy from 2015 to 2019 PRE (n = 169) and POST (n = 126) implementation of an ERAS program containing all major ERAS Society guidelines. Propensity score-matched analysis, based upon patient, tumor, and surgical characteristics, was utilized to evaluate outcomes.

Results:
After ERAS implementation, there was increased minimally invasive surgery (PRE 39.6%→POST 62.7%), reduced intensive care unit utilization (PRE 70.4%→POST 21.4%), improved chest tube (PRE 24.3%→POST 54.8%) and urinary catheter (PRE 20.1%→POST 65.1%) removal by postoperative day 1, and increased ambulation ≥3× on postoperative day 1 (PRE 46.8%→POST 54.8%). Propensity score-matched analysis that accounted for minimally invasive surgery demonstrated that program implementation reduced length of stay by 1.2 days [95% confidence interval (CI) 0.3–2.0; PRE 4.4→POST 3.2), morbidity by 12.0% (95% CI 1.6%–22.5%; PRE 32.0%→POST 20.0%), opioid use by 19 oral morphine equivalents daily (95% CI 1–36; PRE 101→POST 82), and the direct costs of surgery and hospitalization by $3500 (95% CI $1100–5900; PRE $23,000→POST $19,500). Despite expedited discharge, readmission remained unchanged (PRE 6.3%→POST 6.6%; P = 0.94).

Conclusions:
The Thoracic ERAS Program for lung resection reduced length of stay, morbidity, opioid use, and direct costs without change in readmission. This is the first external validation of the ERAS Society thoracic guidelines; adoption by other centers may show similar benefit.