bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Expert Patient Program as a Tool to Empower People With Multiple Sclerosis
Authors: Robles-Sanchez Miguel-Angel , Cruz-Díaz Verónica , Amil-Bujan Paloma , Sastre-Garriga Jaume , Ramió-Torrentà Lluís , Bertran-Noguer Carme 
Published: May 2020

ABSTRACT

BACKGROUND: Multiple sclerosis (MS) affects approximately 50 000 people in Spain, so it is essential to implement health interventions that respond to their needs and demands. Expert patient programs may facilitate health-related empowerment through peer learning, but their particular features need to be tailored to MS. METHODS: Qualitative research was used to examine the needs and demands of people with MS in relation to the management of MS with the aim of designing a specific program to enable empowerment. Data gathered from focus group interviews were coded and grouped using thematic analysis with independent peer review. RESULTS: The identified needs and demands focused on improving MS knowledge and acquiring the skills to promote self-management and autonomy. An MS expert patient program should address the impact of MS, its integrated treatment, and health promotion. The program's design should follow an open script with small groups and the support of healthcare professionals. Participants showing a need for help and an absence of comorbidities that prevent interaction should be included. Expert patients should have a positive outlook on their health, experience-based knowledge, and leadership and communication skills. The identified potential benefits were an improvement in knowledge, quality of life, and the normalization of the patient's health situation. CONCLUSION: The needs and demands of people with MS focused on enhancing knowledge about all aspects of the disease and on acquiring skills to promote self-management, autonomy, and empowerment. Program design and content were identified enabling determination of the characteristics needed to resolve these issues and develop an expert patient program for people with MS in Spain.
Prehabilitation: metabolic considerations
Authors: Chabot Katherine , Gillis Chelsia , Carli Franco 
Published: May 2020

Purpose of review
The major components of ERAS attenuate the inflammatory response and modulate metabolism in direction of sparing body protein and preserving function. However, these perioperative interventions might have limited effectiveness on postoperative outcomes if preoperative risk factors are not addressed and optimized.

Recent findings
The preoperative metabolic perturbations characterized by insulin resistance and sarcopenia might predispose patients to a higher degree of postoperative catabolism. High-risk populations for such metabolic disturbances include elderly and frail patients, and patients with metabolic syndrome. Research on the effect of prehabilitation on perioperative metabolism is limited, but recent findings suggest that interventions designed to improve insulin sensitivity prior to surgery might represent a promising therapeutic target to minimize surgical complications.

Summary
The present paper will discuss the metabolic implications of modulating preoperative risk factors with elements of multimodal prehabilitation, such as exercise training and nutrition.
Optimal thresholds for ultrasound attenuation parameter in the evaluation of hepatic steatosis severity: evidence from a cohort of patients with biopsy-proven fatty liver disease
Authors: Zhu Sheng-Hao , Zheng Kenneth I. , Hu Di-Shuang , Gao Feng , Rios Rafael S. , Li Gang , Li Yang-Yang , Byrne Christopher D. , Targher Giovanni , Chen Yong-Ping , Zheng Ming-Hua 
Published: May 2020

Objective
FibroTouch is a newly developed device to assess ultrasound attenuation parameter (UAP) and liver stiffness measurement to quantify hepatic steatosis and fibrosis, respectively. However, there is currently a lack of defined thresholds of UAP to diagnose different stages of hepatic steatosis. We aimed to assess the optimal thresholds of UAP for hepatic steatosis in individuals with biopsy-proven fatty liver disease (FLD).

Methods
We enrolled 497 adults with FLD undergoing FibroTouch and liver biopsy. Area under the receiver operating characteristic curve (AUROC) was performed to calculate the performance of UAP in staging hepatic steatosis. Hepatic steatosis >33% was defined as significant steatosis. We determined the optimal cutoff values of UAP and the sensitivity or specificity higher than 90%. Sensitivity, specificity, positive predictive value and negative predictive value were subsequently calculated.

Results
The median UAP for the enrolled patients was 308 dB/m. Multivariable logistic regression analysis showed that UAP was associated with significant steatosis [adjusted-odds ratio 1.05, 95% confidence interval (CI), 1.02–1.09; P = 0.001]. The AUROCs for S ≥ 1, S ≥ 2 and S = 3 were 0.88 (95% CI, 0.84–0.91), 0.77 (95% CI, 0.73–0.81), and 0.70 (95% CI, 0.63–0.77), respectively. The optimal UAP cutoffs were 295 dB/m for S ≥ 1, 314 dB/m for S ≥ 2, and 324 dB/m for S = 3. Almost identical results were observed in the subgroup of patients with biopsy-confirmed nonalcoholic fatty liver disease (n = 435).

Conclusion
We found that the AUROC values of UAP by FibroTouch were ranging from 0.70 to 0.88 for assessing hepatic steatosis severity. These UAP cutoffs could be applicable for clinical use.
Calciprotein particles: mineral behaving badly?
Authors: Smith Edward R. , Hewitson Tim D. , Jahnen-Dechent Willi 
Published: May 2020

Purpose of review
Calciprotein particles (CPP) are formed in supersaturated solutions of calcium, phosphate and the mineral-binding protein fetuin-A. CPP have garnered considerable interest as potential mediators of mineral stress, but little consideration has been given to their origin, clearance and role in metabolism.

Recent findings
CPP are made whilst buffering the mineral absorbed from the intestine after a meal or during remodelling of bone matrix. The postprandial rise in circulating CPP rise may be sensed by osteoblasts/osteocytes in bone, stimulating the secretion of the master phosphatonin fibroblast growth factor 23. Amorphous calcium phosphate-containing CPP are rapidly cleared by endothelial cells in the liver whereas crystalline apatite-containing CPP are filtered by phagocytic cells of the reticuloendothelial system. Impaired excretory function in kidney disease may lead to accumulation of CPP and its precursors with possible pathological sequalae. Inability to stabilize CPP in fetuin-A-deficiency states can result in intraluminal precipitation and inflammatory cascades if other mineralisation regulatory networks are compromised.

Summary
CPP allow efficient transport and clearance of bulk calcium phosphate as colloids without risk of precipitation. As circulating factors, CPP may couple dietary mineral exposure with endocrine control of mineral metabolism in bone, signalling the need to dispose of excess phosphate from the body.
EsoFLIP for esophageal dilation: proposed advantages
Authors: Baumann Alexandra J. , Carlson Dustin A. 
Published: May 2020

Purpose of review
The EsoFLIP integrates impedance planimetry technology into a dilator balloon capable of dilating from diameters between 10 and 30 mm via controlled volumetric distension while providing real-time visualization and objective measurement during the dilation procedure, potentially negating the need for fluoroscopy. This review aims to describe the use and application of EsoFLIP and the potential advantages this novel technology may afford.

Recent findings
Small pilot and retrospective studies demonstrate EsoFLIP feasibility and safety, but larger studies are needed to understand its impact on clinical outcomes.

Summary
EsoFLIP is an appealing new technology that offers advantages in therapeutic dilation of the lower esophageal sphincter in achalasia or of esophageal strictures because of previous surgery, gastroesophageal reflux disease, or radiation.
The burden of cost in inflammatory bowel disease: a medical economic perspective
Authors: Beard Jonathan A. , Click Benjamin H. 
Published: May 2020

Purpose of review
The cost of care for inflammatory bowel disease (IBD) has nearly doubled over the last two decades. With evolving treatment paradigms utilizing costly but efficacious biologic agents earlier and more often, the cost burden is only expected to worsen. The purpose of this review is to explore the current economic landscape and drivers of IBD healthcare costs along with potential mechanisms for improving value and cost-effectiveness of IBD care.

Recent findings
The prevalence of IBD continues to rapidly expand with costs following suit. As compensation models change, the medical community is more incentivized than ever to develop cost reduction strategies including incorporation of high-value care measures, cooperative data aggregation, and technological solutions, with many of these interventions demonstrating promising results.

Summary
IBD is an expensive chronic disease with payments only expected to rise. In light of this financial conundrum, new practice models, such as the IBD specialty medical home and remote telemedicine, are being tested with an emphasis on cost reduction. Many of these strategies are demonstrating improved patient outcomes while also curbing expenses. These early successes set the stage for continued cooperation, collaboration, and growth in value-based management of IBD.
Gaining resilience and reducing stress in the age of COVID-19
Authors: Lupe Stephen E. , Keefer Laurie , Szigethy Eva 
Published: May 2020

Purpose of review
The world is experiencing the evolving situation associated with the outbreak of the Corona Virus Disease-2019 (COVID-19) virus, and there is more of need than ever for stress management and self-care. In this article, we will define the physiological, psychological and social aspects, stages, and components of stress reactions in the context of COVID-19, review the relevant literature on stress reactions, and offer some guidance on how to help patients mitigate the physiological and psychological impact of the pandemic through resilience-building techniques.

Recent findings
There is continued evidence that the fight or flight response involves activation throughout the body at physiological, biochemical and immune levels. This response can be mitigated through increasing parasympathetic nervous system activation as well as cognitive and behavioral interventions.

Summary
This article will review the stress, provide a theoretical layout to predict upcoming response, and offer clinicians some practical interventions to employ as the stress of the COVID-19 pandemic continues.
Plant homeodomain finger protein 6 in the regulation of normal and malignant hematopoiesis
Authors: Miyagi Satoru , Iwama Atsushi 
Published: May 2020

Purpose of review
Even though an increasing amount of sequencing data on the leukemia genome has highlighted a tumor-suppressive function for plant homeodomain finger protein 6 (PHF6), its role in the hematopoietic system remained elusive until recently. The purpose of this review is to describe the role of PHF6 in normal hematopoiesis and leukemogenesis based on recent findings from knockout mouse models.

Recent findings
In a mouse model, the loss of Phf6 enhanced the bone marrow repopulating capacity of hematopoietic stem cells (HSCs) during serial transplantations without transforming hematopoietic cells, whereas donor mice, which lacked Phf6 expression in the hematopoietic system, did not show any apparent phenotypes in the steady-state. Mechanistically, Phf6 activates effectors in the tumor necrosis factor α (Tnfα) pathway. Therefore, a Phf6 deficiency attenuates the expression of the effectors and confers resistance against Tnfα-mediated growth inhibition to HSCs. Moreover, the loss of Phf6 promoted the development of leukemia induced by aberrant TLX3 expression or an active NOTCH mutation.

Summary
Phf6 restricts the self-renewal of HSCs by governing the Tnfα pathway. Phf6 fulfills a tumor-suppressive function, and its loss synergizes with leukemic lesions to promote the onset of hematological malignancies.
Regulation of stress-induced hematopoiesis
Authors: Anderson Georgina A. , Rodriguez Melanie , Kathrein Katie L. 
Published: May 2020

Purpose of review
The hematopoietic compartment is tasked with the establishment and maintenance of the entire blood program in steady-state and in response to stress. Key to this process are hematopoietic stem cells (HSCs), which possess the unique ability to self-renew and differentiate to replenish blood cells throughout an organism's lifetime. Though tightly regulated, the hematopoietic system is vulnerable to both intrinsic and extrinsic factors that influence hematopoietic stem and progenitor cell (HSPC) fate. Here, we review recent advances in our understanding of hematopoietic regulation under stress conditions such as inflammation, aging, mitochondrial defects, and damage to DNA or endoplasmic reticulum.

Recent findings
Recent studies have illustrated the vast mechanisms involved in regulating stress-induced hematopoiesis, including cytokine-mediated lineage bias, gene signature changes in aged HSCs associated with chronic inflammation, the impact of clonal hematopoiesis and stress tolerance, characterization of the HSPC response to endoplasmic reticulum stress and of several epigenetic regulators that influence HSPC response to cell cycle stress.

Summary
Several key recent findings have deepened our understanding of stress hematopoiesis. These studies will advance our abilities to reduce the impact of stress in disease and aging through clinical interventions to treat stress-related outcomes.
Multifocal Recurrent Microcystic Adnexal Carcinoma
Authors: Teixeira Jeffrey C. , Patel Vishal , Goodman Joseph 
Published: May 2020

Abstract
Microcystic adnexal carcinoma (MAC) is a rare and locally aggressive neoplasm with preponderance for local recurrence but rarely nodal or distant metastasis. A 38-year-old male was referred to our clinic for definitive treatment of known recurrent and concern for multifocal MAC from previous biopsy. The patient was treated with modified Mohs and reconstruction with an anterolateral thigh (ALT) free flap for tissue coverage. This case highlights the rare nature of multifocal MAC, treatment challenges of Mohs clearance versus wide local excision, and reconstructive challenge associated with large post treatment defects.
Central Retinal Artery Occlusion Following Prone Transcranial Surgery for Craniosynostosis and Discussion of Risk Factors
Authors: Roumeliotis Grayson , Campbell Stewart , Das Sumit , Hildebrand Goran Darius , Charbel Issa Peter , Jayamohan Jayaratnam , Lawrence Tim , Magdum Shailendra , Wall Steven , Johnson David 
Published: May 2020

Abstract
Vision loss is a known rare complication of prone positioning during surgery. Vision loss following prone surgery is most commonly attributed to direct pressure on the eye but can also be caused by central retinal artery occlusion (CRAO) in the absence of pressure on the eye. Central retinal artery occlusion has not been previously described following prone transcranial surgery for craniosynostosis. We present two cases of monocular CRAO following prone calvarial expansion. A multidisciplinary root cause analysis suggested that raised intracranial pressure and intraoperative tranexamic acid may have been risk factors for the development of CRAO in these cases as no conventional risk factors for CRAO following prone surgery were present. Because of this, we retrospectively reviewed all prone transcranial procedures performed at the Oxford Craniofacial Unit for the presence of raised intracranial pressure and intraoperative tranexamic acid use. A total of 662 prone procedures have been performed between 1994 and March, 2019. Tranexamic acid has been used routinely in all transcranial procedures since 2012 and in the last 311 consecutive prone cases. Fifty-one (7.7%) prone procedures were performed for raised intracranial pressure, and tranexamic acid was used in the 33 most recent of these. Since the implementation of standard intraoperative administration of tranexamic acid there have been 2 cases of CRAO following prone surgery. The overall incidence of CRAO was 0.3% but was 6% in the context of raised intracranial pressure and tranexamic acid use. Prone positioning raised intracranial pressure and tranexamic acid use together may represent a potent combination of risk factors for CRAO.
COVID-19 Pandemic and its Impact on Craniofacial Surgery
Authors: Andrews Brian T. , Garg Ravi , Przylecki Wojciech , Habal Mutaz 
Published: May 2020

Abstract
In late 2019, a novel coronavirus strain, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), also known as coronavirus disease 2019 (COVID-19), triggered a global pandemic as the virus spread from the Wuhan Province, China, across all continents. Although infrequent, severe respiratory infection and death caused by SARS-CoV-2 is disproportionately high amongst healthcare providers such as craniofacial surgeons who work in the head and neck region. Factors this impact SARS-CoV-2 transmission include: (1) high viral loads in the mucosa of the oral and nasopharynx, (2) limited and/or imprecise disease screening/confirmation testing, (3) access to and appropriate use of personal protective equipment (PPE).
Functional and Cognitive Decline Among Older Adults After High-risk Surgery
Authors: Suwanabol Pasithorn A. , Li Yun , Abrahamse Paul , De Roo Ana C. , Vu Joceline V. , Silveira Maria J. , Mody Lona , Dimick Justin B. 
Published: May 2020

Objective:
The aim of this study was to determine whether older adults are at higher risk of lasting functional and cognitive decline after surgery, and the impact of decline on survival and healthcare use.

Summary Background Data:
Patient-centered outcomes after surgery are poorly characterized.

Methods:
Using data from the Health and Retirement Study linked with Medicare, we matched older adults (≥65 years) who underwent one of 163 high-risk elective operations (ie, inpatient mortality of ≥1%) with nonsurgical controls between 1992 and 2012. Functional decline was defined as an increase in the number of activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs) requiring assistance from baseline. Cognitive decline was defined by worse response to a test of memory and mental processing from baseline. Using logistic regression, we examined whether surgery was associated with functional and cognitive decline, and whether declines were associated with poorer survival and increased healthcare use.

Results:
The matched cohort of patients who did not undergo surgery consisted of 3591 (75%) participants compared to 1197 (25%) who underwent surgery. Patients who underwent surgery were at higher risk of functional and cognitive declines [adjusted odds ratio (aOR) 1.52, 95% confidence interval (CI): 1.23–1.87 and aOR 1.32, 95% CI: 1.03–1.71]. Declines were associated with poorer long-term survival [hazard ratio (HR) 1.67, 95% CI: 1.43–1.94 and HR 1.35, 95% CI: 1.15–1.58], and were significantly associated with nearly all measures of increased healthcare utilization (P < 0.001).

Conclusion:
Older adults undergoing high-risk surgery are at increased risk of developing lasting functional and cognitive declines.
Safety of Percutaneous Cholecystostomy Early Removal: A Retrospective Cohort Study
Authors: Di Martino Marcello , Miguel Mesa Diana , Lopesino González José María , de la Hoz Rodríguez Ángela , Martín-Pérez Elena 
Published: May 2020

Introduction:
There are no strong recommendations regarding the management of percutaneous cholecystostomy (PC). The aim of this study was to assess the safety of early PC removal in terms of complications and recurrent disease.

Materials and Methods:
Retrospective observational study of consecutive patients who underwent PC for acute cholecystitis from January 2012 to December 2017. We first evaluated PC-related complications and recurrent disease in patients whose drainage was removed as inpatients (IPR) or as outpatients (OPR). Patients were then divided into 2 groups according to the timing of PC removal: G1 with the PC removed within the first 7 days after its collocation and G2 with the PC removed after 7 days.

Results:
We included 151 patients. Patients in the OPR group had their catheters removed after 52 days (26 to 67 d) while the IPR group after 8 days (6 to 11 d); P<0.001. No difference was seen regarding complications, recurrent disease rate, or readmissions.
G1 was comprised of 56 patients (37.1%), whereas G2 had 95 (62.9%). When G1 was compared with G2, no differences were seen in terms of complications. However, G1 presented a shorter duration of antibiotic treatment with 11 days (8 to 14 d) versus 15 days (12 to 23 d) in G2; P<0.001, but had a higher rate of recurrent disease 32.1% versus 14.7% in G2; P=0.014 and a higher rate of readmission 30.3% versus 13.6% in G2; P=0.019.

Conclusions:
Removal of the PC during the index admission was not associated with a higher risk of complications. However, the PC removal before 7 days could be related to an increase in recurrent disease and readmissions.
Prognostic Significance of Cyclic Seizures in Status Epilepticus
Authors: Zorlu Musab M. , Chuang David T. , Buyukozkan Mustafa , Aydemir Seyhmus , Zarnegar Reza 
Published: May 2020

Purpose:
Status epilepticus (SE) is a commonly encountered neurologic condition associated with high mortality rates. Cyclic seizures (CS) are a common form of SE, but its prognostic significance has not been well established. In this retrospective study, the mortality of cyclic versus noncyclic forms (NCSs) of SE are compared.

Methods:
A total of 271 patients were identified as having seizures or SE on EEG reports, of which 65 patients were confirmed as having SE. Based on EEG characteristics, the patients were then classified as cyclic or noncyclic patterns. Cyclic seizures were defined as recurrent seizures occurring at nearly regular and uniform intervals. Noncyclic form included all other patterns of SE. Pertinent clinical data were collected and reviewed for each case.

Results:
Of the 65 patients with SE, 25 patients had CS and 40 patients had NCS. Patients with CS showed a lower rate of in-hospital mortality although not statistically significant (P = 0.19). When looking at patients younger than 75 years, the CS group had significantly lower in-hospital mortality rate (P = 0.007).

Conclusions:
The findings of this study suggest that CS may have a more favorable outcome compared with NCS in patients younger than 75 years. This study is also the first to report the rate of CS among all cases of confirmed SE (38%). Future studies with a larger sample size are needed to further evaluate the difference in outcome between CS and NCS.