bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Posttransplant Mortality for Autoimmune Hepatitis Compared With Other Autoimmune Liver Diseases
Authors: Lee Jennifer Y. , Danford Christopher J. , Patwardhan Vilas R. , Bonder Alan 
Published: October 2019

Goals:
We sought to compare posttransplant outcomes between autoimmune liver disease.

Background:
Autoimmune liver diseases, namely primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and autoimmune hepatitis (AIH) generally have favorable posttransplant outcomes. PSC is known to require more retransplantation compared with PBC, however, comparisons to AIH are lacking. We sought to compare graft survival and the need for retransplant in AIH compared with other autoimmune liver disease.

Study:
We compared posttransplant graft survival among the 3 entities using Cox regression and competing for risk analyses using the United Network for Organ Sharing (UNOS) database.

Results:
We found AIH is associated with significantly decreased graft survival compared with PBC [hazard ratio: 0.86; 95% confidence interval (CI): 0.77-0.96] and PSC (hazard ratio: 0.89; 95% CI: 0.8-0.99) after controlling for potential confounders. This is mainly driven by posttransplant death. On competing for risk analysis, AIH was associated with higher risk of death compared with PBC [subdistribution hazard ratio (SHR): 0.79; 95% CI: 0.7-0.89] and PSC (SHR: 0.72; 95% CI: 0.64-0.82) and lower risk of retransplant compared with PSC (SHR: 1.48; 95% CI: 1.19-1.8).

Conclusion:
As prior studies have shown the similar risk of disease recurrence in AIH and PSC, our study indicates at least part of the increased posttransplant mortality in AIH may be due lower retransplantation rate in this population.
Simultaneous local excision of synchronous rectal polyps by transanal endoscopic microsurgery
Authors: Issa Nida , Fenig Yaniv , Schmilovitz-Weiss Hemda , Khatib Muhammad , Nissim Bachar Gil , Gingold-Belfer Rachel , Yassin Mustafa 
Published: October 2019

Background:
The approach to surgical resection of multiple rectal lesions when endoscopic polypectomy is unsuccessful has historically been radical rectal resection with total mesorectal excision. This approach is fraught with high morbidity and mortality. We explored the possibility of performing one transanal endoscopic microsurgery procedure to resect multiple synchronous rectal lesions.

Materials and methods:
A retrospective analysis of all adult patients undergoing transanal endoscopic microsurgery at a single institution between 2004 and 2015. Clinical, demographic, and pathologic data were analyzed for all patients with synchronous rectal lesions that were excised via one transanal endoscopic microsurgery procedure.

Results:
Of the 158 patients who underwent transanal endoscopic microsurgery during the study period, 14 (8.8%) had two or more synchronous rectal lesions resected. The mean tumor size was 2.5 cm (range 0.5–3.5). The mean distance from the anal verge for the upper/proximal lesions: 10 ± 2.5 cm, and for the lower/distal lesions: 7 ± 2 cm. Mean operative time was 112 minutes (range 75–170). Median hospitalization time was 3 days (range 2–4). Two patients had urinary retention. No other complications were noted. All the transanal endoscopic microsurgery specimens were with clear margins.

Conclusion:
Transanal endoscopic microsurgery is a safe and feasible procedure for patients with multiple rectal lesions. We demonstrate no increase in surgical time, completeness of specimen resection, no increase in complications or hospital length or stay when compared to patients undergoing transanal endoscopic microsurgery for a single lesion.
Response to Propoxyphene Market Withdrawal
Authors: Jeffery Molly M. , Morden Nancy E. , Larochelle Marc , Shah Nilay D. , Hooten W. Michael , Meara Ellen 
Published: October 2019

Objective:
Experts cautioned that patients affected by the November 2010 withdrawal of the opioid analgesic propoxyphene might receive riskier prescriptions. To explore this, we compared drug receipts and outcomes among propoxyphene users before and aftermarket withdrawal.

Study Design:
Using OptumLabs data, we studied 3 populations: commercial, Medicare Advantage (MA) aged (age 65+ y) and MA disabled (age below 65 y) enrollees. The exposed enrollees received propoxyphene in the 3 months before market withdrawal (n=13,622); historical controls (unexposed) received propoxyphene 1 year earlier (n=9971). Regression models estimated daily milligrams morphine equivalent (MME), daily prescription acetaminophen dose, potentially toxic acetaminophen doses, nonopioid prescription analgesics receipt, emergency room visits, and diagnosed falls, motor vehicle accidents, and hip fractures.

Principal Findings:
Aged MA enrollees illustrate the experience of all 3 populations examined. Following the market withdrawal, propoxyphene users in the exposed cohort experienced an abrupt decline of 69% in average daily MME, compared with a 14% decline in the unexposed. Opioids were discontinued by 34% of the exposed cohort and 18% of the unexposed. Tramadol and hydrocodone were the most common opioids substituted for propoxyphene. The proportion of each group receiving ≥4 g of prescription acetaminophen per day decreased from 12% to 2% in the exposed group but increased from 6% to 8% among the unexposed. Adverse events were rare and not significantly different in exposed versus unexposed groups.

Conclusions:
After propoxyphene market withdrawal, many individuals experienced abrupt discontinuation of opioids. Policymakers might consider supporting appropriate treatment transitions and monitoring responses following drug withdrawals.
Thirty-Day Hospital Readmission Among Homeless Individuals With Medicaid in Massachusetts
Authors: Racine Melanie W. , Munson David , Gaeta Jessie M. , Baggett Travis P. 
Published: October 2019

Background:
National efforts are underway to reduce hospital readmissions. Few studies have used administrative data to provide a global view of readmission among people experiencing homelessness, who often utilize multiple hospital systems.

Objective:
To examine the 30-day hospital readmission rate and factors associated with readmission following discharge among homeless Medicaid members in Massachusetts.

Methods:
We analyzed medical record and Medicaid administrative data for 1269 hospitalizations between 2013 and 2014 for 458 unique patients attributed to Boston Health Care for the Homeless Program. Generalized Estimating Equations were used to investigate factors associated with readmission.

Results:
Of all hospitalizations, 27% resulted in readmission, more than double the average national Medicaid readmission rate. Leaving against medical advice was associated with increased readmission, while having a Health Care for the Homeless primary care practitioner was associated with reduced readmission. Among the most frequently admitted individuals, being discharged to medical respite care was associated with reduced readmission.

Conclusions:
To break the readmission cycle, health care providers serving homeless individuals could focus on assuring access to medical respite care and extending outreach efforts that increase primary care engagement. This may be especially important for accountable care systems, as safety net providers increasingly assume financial risk for patients’ total cost and quality of care.
Exploring Use of Endoscopy Simulation in North American Pediatric Gastroenterology Fellowship Training Programs
Authors: Gabrani Aayush , Monteiro Iona M. , Walsh Catharine M. 
Published: October 2019

ABSTRACTObjectives:Increasing evidence supports simulation‐based training; however, limited data exist regarding its use in pediatric gastroenterology (GI). We explored the use of simulation‐based endoscopy training in pediatric GI fellowship programs across North America.Methods:GI fellowship program directors (PDs) from the United States and Canada were surveyed between August to November 2018. The pretested, electronic survey comprised 3 sections: program demographics; details of current simulation‐based training; and PDs’ perceptions of endoscopy simulation. Responses were analyzed using descriptive statistics.Results:Forty‐three of 71 (61%) PDs responded (6 Canadian, 37 US). Programs were predominantly academic (95%) and enrolled 1.87 ± 1.01 fellows/yr. Twenty‐four programs (56%) reported using simulation for endoscopy training, whereas 8 (19%) used simulation for nonprocedural education. Only 2 programs (5%) used endoscopy simulation for assessment. Of those using simulation (n = 24), upper endoscopy and colonoscopy were trained most frequently, and mechanical simulators were used most commonly. Eight programs (33%) required simulation training prior to clinical performance. Although 10 programs (42%) provided protected training time, only 2 (8%) tracked hours. Three programs (13%) reported having an organized curriculum and 6 (25%) train their endoscopic trainers. Cost, time constraints, and lack of a standardized curriculum were perceived as key barriers to integration. Most PDs reported a need for endoscopy simulation to train both technical and nontechnical skills; however, they felt simulation cannot replace clinical experience.Conclusion:PDs recognize the potential importance of endoscopy simulation, particularly for novices; however, only 56% report using it. Perceived barriers indicate the need for inexpensive portable simulators and a validated pediatric simulation curriculum to promote uptake.
Immigrant Women's Experiences as Mothers in the United States
Authors: Oerther Sarah , Lach Helen W. , Oerther Daniel 
Published: October 2019

Abstract

Background:
Immigrant mothers are raising an increasing proportion of the population of children in the United States.

Purpose:
The purpose of this review was to explore existing research on immigrant women's experiences of being mothers in the United States and identify key concepts, gaps in the literature, and implications for future research that builds on the strengths of immigrant women while addressing their unique challenges.

Study Design and Methods:
In this scoping review, Ovid MEDLINE, CINAHL, SCOPUS, Web of Science, JUSTOR, and PsycINFO databases were searched using a combination of applicable key words.

Results:
Twenty-two articles were selected. Few studies were identified. Analyses revealed a broad array in purpose, populations, theoretical frameworks, settings, study instruments, and practices, making comparison difficult. Although mothering is a universal experience among women who have children, little is known about the broad experiences of immigrant women from different cultures.

Clinical Implications:
Immigrant mothers are not a monolithic group. More research is needed to provide a deeper understanding of strengths, challenges, and solutions of various immigrant groups, which can facilitate development of nursing interventions that support immigrant women and their children in the United States, and strengthen their families.
Population Level-Impact and Herd Effects Following the Introduction of Human Papillomavirus Vaccination Programmes: Updated Systematic Review and Meta-analysis
Authors: Drolet Mélanie , Bénard Élodie , Pérez Norma , Brisson Marc 
Published: October 2019

(Abstracted from Lancet 2019;394:497–509)
To date, a total of 99 countries and territories have introduced population-level human papillomavirus (HPV) vaccination programs. Early adopting countries have served as models and produced observational and epidemiological data on the ability of such programs in preventing HPV-related infections and diseases.
Management of Preexisting Diabetes in Pregnancy: A Review
Authors: Alexopoulos Anastasia-Stefania , Blair Rachel , Peters Anne L. 
Published: October 2019

(Abstracted from JAMA 2019;321(18):1811–1819)
Preexisting diabetes complicates 0.9% of pregnancies in the US and increases the risk of adverse maternal and neonatal outcomes, specifically linked to preeclampsia, congenital anomalies, preterm delivery, and stillbirth. With type 1 and type 2 diabetes becoming more common, clinicians need to review planning and optimization of glycemic control with patients before pregnancy to mitigate the risk associated with diabetes.
Preimplantation Genetic Testing for Aneuploidy by Microarray Analysis of Polar Bodies in Advanced Maternal Age: A Randomized Clinical Trial
Authors: Verpoest Willem , Staessen Catherine , Bossuyt Patrick M. , Goossens Veerle , Altarescu Gheona , Bonduelle Maryse , Devesa Martha , Eldar-Geva Talia , Gianaroli Luca , Griesinger Georg , Kakourou Georgia , Kokkali Georgia , Liebenthron Jana , Magli Maria-Cristina , Parriego Monica , Schmutzler Andreas G. , Tobler Monica , van der Ven Katrin , Geraedts Joep , Sermon Karen 
Published: October 2019

(Abstracted from Human Reproduction 2018;33(9):1767–1776)
Preimplantation genetics for aneuploidy (PGT-A) has shown mixed results on pregnancy rates when applied at the cleavage stage of development due to a high rate of mosaicism and limitations of the comprehensive chromosomal screening technology, FISH, which was available at the time. A pilot study aiming to address this found that array comparative genomic hybridization (aCGH) analysis of both polar bodies possessed 94% concordance with the chromosome analysis of the resulting fertilized oocytes.
FDG PET/CT of Cervical Gout With Spinal Cord Compression
Authors: Emsen Berivan , Fitoussi Alexandre , Chalaye Julia , Adam Clovis , Itti Emmanuel 
Published: October 2019

AbstractWe report FDG PET/CT images of a 63-year-old woman referred for characterization of osteolytic lesions of the cervical spine. This patient with chronic renal failure had a history of follicular thyroid carcinoma with undifferentiated cells, treated by a total thyroidectomy, completed by radioactive iodine in 2017. Because of cancer history, a FDG PET/CT was performed and showed multiple moderately hypermetabolic osteolytic lesions of the spine from C3 to T1, with joint erosion on CT. A laminectomy was performed for cervical spinal cord decompression and revealed a gouty tophus.
A New Suture Technique for Peritoneal Flap Closure in TAPP: A Prospective Randomized Controlled Trial
Authors: Zhu Yilin , Liu Yuchen , Wang Minggang 
Published: October 2019

Purpose:
To facilitate the suture step, we describe a new suture method for laparoscopic closure of the peritoneal flap in transabdominal preperitoneal (TAPP). A prospective randomized controlled trial was carried out to evaluate the efficacy of the new suture method compared with the conventional method.

Methods:
Eighty patients who presented to our hospital in May 2019 with primary unilateral inguinal hernia were randomized into the conventional suture method group and the new suture group for TAPP repairs. The primary outcome was the suture time to complete the peritoneal flap closure. Secondary outcomes included the number of cases of peritoneum tearing, need for additional suture, and suture line breaking.

Results:
The suture time in the new suture method group was significantly shorter than that of the conventional group (715.3±132.4 s vs. 840.71±137.9 s, P<0.001); furthermore, there were significantly less number of cases of peritoneal tearing in the new suture method group than in the conventional suture method group (4 vs. 11, P<0.01).

Conclusions:
The new suture method is relatively easy to learn for beginners performing TAPP procedures, as compared with the conventional method, and less peritoneal tearing is encountered when using this method for peritoneal flap closure.
Mechanisms and treatment of bone pain in multiple myeloma
Authors: Davies Matthew Philip , Fingas Sam , Chantry Andrew 
Published: October 2019

Purpose of review
Multiple myeloma is a haematological malignancy of differentiated B lymphocytes, known as plasma cells. The disease is common in the UK (incidence of 9 cases per 100 000 people) and the most frequent presentation is bone pain caused by skeletal damage. Patients with myeloma also experience neuropathic pain induced by chemotherapy. The management of pain in multiple myeloma is frequently demanding and often sub-optimally addressed. This review seeks to summarize a rational approach to the management of pain experienced by multiple myeloma patients.

Recent findings
Bone pain has a dramatic detrimental impact on a patient's physical capacity, and therefore, quality of life. Various mechanisms of bone pain have been elucidated; however, neuropathic bone pain in multiple myeloma is not completely understood. Potential mechanisms for this phenomenon; namely increased intraosseous pressure and the acidity of the bone marrow in the disease state will be interrogated. The current analgesic pathways used to treat multiple myeloma bone pain and new advances in therapies that may confer future benefit to patients will briefly be reviewed.

Summary
Holistic care and the provision of an array of pain relief methods is required to achieve effective pain control in multiple myeloma bone pain and requires a concerted effort from the healthcare team to be realized.
Functional Fitness in Older Adults
Authors: Yang Ya-Ping , Lin Hsiu-Ching , Chen Kuei-Min 
Published: October 2019

Background:
Using multiple interventions can increase muscle strength in older adults. A functional fitness test is a useful instrument to identify the effectiveness of physical functioning among older adults. However, the results in previous studies with regard to improvements in their physical function are inconsistent.

Aim:
To synthesize the intensity and interval of the effective interventions on physical functioning in community-dwelling older adults.

Methods:
A systematic review and meta-analysis on the related literature was conducted. The databases searched were PubMed, EBSCO, and Cochrane Trials. Papers published from January 1, 2013, to December 31, 2017, were subjected to a computerized search. The inclusion criteria were that the randomized controlled trials examined a healthy and community-dwelling older adult population, and the instrument used to evaluate functional fitness was based on “functional fitness” or “senior fitness.” Two reviewers independently assessed the methodological quality of each trial, including study participants, allocation, blinding, data analysis, duration of follow-up and loss to follow-up, intervention, inclusion criteria, outcome measurements, and other biases.

Results:
Among the 218 trials, only 5 randomized control trials were synthesized in this systematic review. These works examined the effects of the intensity, interval, and duration of intervention programs based on elastic band exercise, aerobic training and combined aerobic and resistance training, Tai Chi with TheraBand resistance exercise, and Tai Chi and Thai Yoga exercise.

Conclusions:
A 1-hour intervention program, including 10 to 15 minutes of warm-up, 30 to 40 minutes of main exercise, and 5 to 10 minutes of cool-down stages, for 2 to 3 sessions per week, and continuing for 12 to 16 weeks, was the effect intervention for community-dwelling healthy older adults to enhance their upper body strength, lower body flexibility, and agility balance.
Effects of Tai Chi Combined With Theraband Training on Physical Fitness, Psychological Well-being, and Pain in Older Sedentary Office Workers
Authors: Qi Meiling , Moyle Wendy , Jones Cindy , Weeks Benjamin 
Published: October 2019

Objectives:
The aim of this study was to compare the effectiveness of Tai Chi combined with Theraband training with Tai Chi exercise–only on physical fitness, psychological well-being, and pain in older sedentary office workers.

Materials and Methods:
Forty sedentary office workers older than 55 years were recruited and randomly assigned to an intervention or control group. Both groups received Tai Chi exercise for 12 weeks, 3 times per week, whereas participants in the intervention group also held a Theraband using 2 hands when practicing Tai Chi. Physical and psychological measurements and pain scores were collected at baseline, week 6, and week 12.

Results and Conclusions:
The results showed a significant improvement in lower-limb and right upper-limb strength after the Tai Chi combined with Theraband intervention. Future research might extend the length of the intervention.
Bihemispheric changes associated with cognition in patients with chronic brainstem stroke
Authors: Ahn Dahyun , Kyeong Sunghyon , Kang Hyunkoo , Kim Dae Hyun 
Published: October 2019

Objective:
We aimed to identify brain changes associated with preserved cognitive function in patients with chronic brainstem stroke.

Methods:
Twelve patients with chronic brainstem stroke and 24 age-matched healthy controls were included in this retrospective study. All participants underwent T1-weighted, diffusion tensor, and resting-state functional MRI. Gray matter density, fractional anisotropy, and mean diffusivity maps from diffusion tensor imaging and seven cognition-related independent component maps from resting-state functional MRI were used to identify differences in brain volume, structural connectivity, and functional connectivity. Independent t-tests were used to determine the statistical significance of changes in gray matter density, fractional anisotropy, mean diffusivity, and inter-network functional connectivity maps.

Results:
Bilateral cerebellum volumes and structural connectivity of the diffuse bilateral cerebral hemispheres were significantly lower in the patient than in the control group. However, patients exhibited increased gray matter volume and increased structural connectivity of the temporal lobe in the contra-lesional hemisphere and basal forebrain, compared with healthy controls. Furthermore, the intra-network functional connectivity in the frontal and temporal lobes was significantly higher in patients than in controls (P
FWE < 0.05).

Conclusion:
In the patient group, the brain regions mainly associated with the cholinergic system exhibited increased volume, structural connectivity, and functional connectivity. In contrast, the regions connected with the brainstem via cortico-ponto-cerebellar fibers exhibited decreased volume or structural connectivity. Cognitive function may be preserved in patients with brainstem stroke due to significant increases in frontal and temporal inter-network connectivity.
PheWAS-ME: A web-app for interactive exploration of multimorbidity patterns in PheWAS
Authors: Strayer Nick , Shirey-Rice Jana K , Shyr Yu , Denny Joshua C. , Pulley Jill M. , Xu Yaomin 
Published: October 2019

AbstractSummaryElectronic health records (EHRs) linked with a DNA biobank provide unprecedented opportunities to use big data for biomedical research in precision medicine. The Phenome-wide association study (PheWAS) is a widely used technique for high-throughput evaluation of relationships between a set of genetic variants and a large collection of clinical phenotypes recorded in EHRs. PheWAS analyses are typically presented as static tables and charts of summary statistics obtained from statistical tests of association between pairs of a genetic variant and individual phenotypes. Comorbidities are common and typically lead to complex, multivariate gene-disease association signals that are challenging to interpret. Discovering and interrogating multimorbidity patterns and their influence in PheWAS is difficult and time-consuming. Here, we present a web application to visualize individual-level genotype and phenotype data side-by-side with PheWAS analysis results in an interactive dashboard, allowing researchers to explore multimorbidity patterns and their associations with a genetic variant of interest. We expect this application to enrich PheWAS analyses by illuminating clinical multimorbidity patterns present in the data.AvailabilityA demo PheWAS-ME application is publicly available at https://prod.tbilab.org/phewas_me/. A sample simulated-dataset is provided for exploration with the option to upload custom PheWAS results and corresponding individual-level data. The source code is available as an R package on GitHub (https://github.com/tbilab/multimorbidity_explorer).