bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left Heart Factors in Embolic Stroke of Undetermined Source in a Multiethnic Asian and North African Cohort
Authors: Kamran Saadat , Singh Rajvir , Akhtar Naveed , George Pooja , Salam Abdul , Babu Blessy , Own Ahmed , Hamid Tahir , Perkins Jonathan D. 
Published: July 2020

Background
Cardiac features diverge in Asians; however, it is not known how these differences relate to embolic stroke of unknown source (ESUS) in Southeast Asian and Eastern Mediterranean regions.

Methods and Results

A retrospective analysis of prospectively collected acute ischemic stroke data from 2014 to 2018 was performed. Stroke subtypes were noncardioembolic stroke (large‐vessel and small‐vessel disease; n=1348), cardioembolic stroke (n=532), and ESUS (n=656). Subtypes were compared by demographic, clinical, and echocardiographic factors. In multivariate logistic regression, patients with ESUS in comparison with noncardioembolic stroke were twice as likely to have left ventricular diastolic dysfunction (
P
=0.001), 3 times the odds of global hypokinesia (
P
=0.001), and >7 times the odds of left ventricular wall motion abnormalities (
P
=0.001). In the second model comparing ESUS with cardioembolic stroke, patients with ESUS were 3 times more likely to have left ventricular wall motion abnormalities (
P
=0.001) and 1.5 times more likely to have left ventricular diastolic dysfunction grade I (
P
=0.009), and 3 times more likely to have left ventricular diastolic dysfunction grades II and III (
P
=0.009), whereas age (
P
=0.001) and left atrial volume index (
P
=0.004) showed an inverse relation with ESUS. ESUS in patients ≥61 years old had higher levels of traditional risk factors such as coronary artery disease, but the coronary artery disease was not significantly different in ESUS age groups (
P
=0.80) despite higher left ventricular wall motion abnormalities (
P
=0.001).

Conclusions

Patients with ESUS and noncardioembolic stroke were younger than patients with cardioembolic stroke. While a third of the patients with ESUS >45 years old had coronary artery disease, it was unrecognized or underreported in the older ESUS age group (
≥
61 years old). In patients with ESUS from Southeast Asia and Eastern Mediterranean regions, left ventricular wall motion abnormalities and left ventricular diastolic dysfunction were related to ESUS.
The Impact of a Colorectal Care Bundle for Surgical Site Infections at an Academic Disproportionate Share Hospital With a Level I Trauma Center
Authors: Hajirawala Luv N. , Legare Timothy B. , Tiu Simon Peter T. , DeKerlegand Amy M. , Barton Jeffrey S. , Davis Kurt G. , Orangio Guy R. 
Published: July 2020

Objectives Colorectal care bundles for surgical site infections (CRCB-SSIs) have been shown to reduce SSIs following elective colorectal surgery (CRS). There are limited data evaluating the effect of CRCB-SSI at Academic Disproportionate Share Hospitals (ADSH) with significant rates of urgent and emergent cases. Methods A CRCB-SSI was implemented in April 2016. We reviewed medical records of all patients undergoing colon resections between August 2015 and December 2017. Patients were divided into preimplementation and postimplementation groups. The primary endpoint was the SSI rate, and the secondary endpoint included types of SSI (superficial, deep, organ space). Univariable and multivariable analyses were performed. A subset analysis was performed in elective cases. Results We analyzed a total of 417 patients. Of these, 116 (28%) and 301 (72%) patients were in the preimplementation and postimplementation groups, respectively. The rate of SSI decreased from 30.1% to 15.9% in the postimplementation group ( P = .0012); however, it was not statistically significant after adjusting for baseline differences (relative risk [RR] 0.65; 95% CI 0.41-1.02). The elective subset included 219 patients. The rate of SSI in this cohort decreased from 25% to 10.5% in the postimplementation group ( P = .0012) and remained significant following multivariable analysis (RR 0.41, 95% CI 0.19- 0.88). There were no differences in the subtypes of SSI. Discussion While the CRCB-SSI was effective in decreasing the postoperative SSI rate for elective cases, its effect on the overall patient population was limited. CRCB-SSIs are not enough to bring SSI rates to accepted rates in high-risk patients such as those seen at ADSH.
Pre-treatment prediction of early response to chemoradiotherapy by quantitative analysis of baseline staging FDG-PET/CT and MRI in locally advanced cervical cancer
Authors: Min Lisa A , Ackermans Leanne LGC , Nowee Marlies E , Griethuysen Joost JW van , Roberti Sander , Maas Monique , Vogel Wouter V , Beets-Tan Regina GH , Lambregts Doenja MJ 
Published: July 2020

Background Early prediction of response to concurrent chemoradiotherapy (cCRT) could aid to further optimize treatment regimens for locally advanced cervical cancer (LACC) in the future. Purpose To explore whether quantitative parameters from baseline (pre-therapy) magnetic resonance imaging (MRI) and FDG-PET/computed tomography (CT) have potential as predictors of early response to cCRT. Material and Methods Forty-six patients with LACC undergoing cCRT after staging with FDG-PET/CT and MRI were retrospectively analyzed. Primary tumor volumes were delineated on FDG-PET/CT, T2-weighted (T2W)-MRI and diffusion-weighted MRI (DWI) to extract the following quantitative parameters: T2W volume; T2W signalmean; DWI volume; ADCmean; ADCSD; MTV42%; and SUVmax. Outcome was the early treatment response, defined as the residual tumor volume on MRI 3–4 weeks after start of external beam radiotherapy with chemotherapy (before the start of brachytherapy): patients with a residual tumor volume <10 cm3 were classified as early responders. Imaging parameters were analyzed together with FIGO stage to assess their performance to predict early response, using multivariable logistic regression analysis with bi-directional variable selection. Leave-one-out cross-validation with bootstrapping was used to simulate performance in a new, independent dataset. Results T2W volume (OR 0.94, P = 0.003) and SUVmax (OR 1.15, P = 0.18) were identified as independent predictors in multivariable analysis, rendering a model with an AUC of 0.82 in the original dataset, and AUC of 0.68 (95% CI 0.41–0.81) from cross-validation. Conclusion Although the predictive performance achieved in this small exploratory dataset was limited, these preliminary data suggest that parameters from baseline MRI and FDG-PET/CT (in particular pre-therapy tumor volume) may contribute to prediction of early response to cCRT in cervical cancer.
Patient satisfaction with the ocular surface individualized medical program
Authors: Hao Ran , Chou Yilin , Wan Yu , Jiang Xiaodan , Li Xuemin 
Published: July 2020

Purpose: To improve the medical management system and the quality of medical treatment, this study aimed to assess patient satisfaction related to an ocular surface individualized medical program for dry eye, and identified patient needs that should be addressed in future. Methods: We enrolled 166 patients from the dry eye clinic at the Peking University Third Hospital from December 2017 to May 2019. An investigator followed up with all patients by telephone 2 months after the first assessment of overall patient satisfaction, expectations, and experiences. We determined patient satisfaction using a questionnaire and analyzed the results. Multivariate linear regression analysis was used to assess the predictors of overall patient satisfaction. Results: The overall patient satisfaction with the ocular surface individualized medical program skewed toward a positive assessment. Ten variables were signiﬁcantly associated with overall patient satisfaction: two involving fulﬁlment of expectations, seven involving patient-reported experiences, and one involving socio-demographics. The most important predictor of overall patient satisfaction was patient-reported experiences with the treatment outcome (β = 0.281, p < 0.001), followed by experiences with medical staff services (β = 0.240, p = 0.002), examination services (β = 0.198, p = 0.002), and interpretation and professionalism (β = 0.168, p = 0.04), expectations fulﬁlment (β = 0.147, p = 0.025), as well as age (β = −0.13, p = 0.014). Free response-style negative patient feedback suggested that examination wait time and environment needed improvement. Conclusion: Overall, the ocular surface individualized medical program is effective and is able to achieve satisfaction for most patients. The examination procedures and environment require improvements, and treatment must be made more patient-centric to improve satisfaction.
Economic impact and cost savings of teledermatology units compared to conventional monitoring at hospitals in southern Spain
Authors: Lopez-Villegas Antonio , Bautista-Mesa Rafael Jesus , Baena-Lopez Miguel Angel , Alvarez-Moreno Maria Luisa , Montoro-Robles Jesus E , Vega-Ramirez Francisco Antonio , Ordoñez-Naranjo Isabel , Hernandez-Montoya Carlos Javier , Leal-Costa Cesar , Peiro Salvador 
Published: July 2020

Introduction Asynchronous teledermatology (TD) has undergone exponential growth in the past decade, allowing better diagnosis. Moreover, it saves both cost and time and reduces the number of visits involving travel and opportunity cost of time spent on visits to the hospital. The present study performed a cost-saving analysis of TD units and assessed whether they offered a cheaper alternative to conventional monitoring (CM) in hospitals from the perspective of public health-care systems (PHS) and patients. Methods This study was a retrospective assessment of 7030 patients. A cost-saving analysis comparing TD units to CM for patients at the Hospital de Poniente was performed over a period of one year. The TD network covered the Hospital de Poniente reference area (Spain) linked to 37 primary care (PC) centres that belonged to the Poniente Health District of Almeria. Results We observed a significant cost saving for TD units compared to participants in the conventional follow-up group. From the perspective of a PHS, there was a cost saving of 31.68% in the TD group (€18.59 TD vs. €27.20 CM) during the follow-up period. The number of CM visits to the hospital reduced by 38.14%. From the patients’ perspective, the costs were lower, and the cost saving was 73.53% (€5.45 TD vs. €20.58 CM). Discussion The cost-saving analysis showed that the TD units appeared to be significantly cheaper compared to CM.
Paclitaxel, Carboplatin, and Bevacizumab in Advanced Cervical Cancer: A Treatment Response and Safety Analysis
Authors: Tao Wanjun , Yang Jia , Jiang Yongxian , Chen Wenwen , Wang Yixin 
Published: July 2020

Background: Trials reported there are beneficial effects of the addition of bevacizumab to chemotherapy in advanced cervical cancer but might have adverse effects. The purposes of the study were to evaluate the treatment response and safety of the addition of bevacizumab to paclitaxel plus carboplatin in advanced cervical cancer women. Methods: Data on treatment response, adverse effects, and overall survival of women who received paclitaxel plus carboplatin every 3 weeks (ACT cohort, n = 161) or paclitaxel, carboplatin, and bevacizumab every 3 weeks (PCB cohort, n = 127) until disease progression or severe adverse events were collected and analyzed. Results: The treatment response of paclitaxel plus carboplatin increased on addition of bevacizumab ( P = .037). Neutropenia (grade ≥3, P = .001), leukopenia (grade 4, P = .041), anemia (grade ≥3, P = .031), hypertension (grade ≥2, P = .002), and gastrointestinal fistula (grade ≥2, P = 0.006) are reported in the PCB cohort. Women of ACT and PCB cohorts reported an overall survival of 20.11 ± 3.15 months and 24.52 ± 4.05 months, respectively. Conclusions: Addition of bevacizumab increases the treatment response of paclitaxel and carboplatin chemotherapy and overall survival of women with advanced cervical cancers, but it is not well tolerated.
‘Dr. Google, I have a stomach ache’ – seasonal variations in abdominal pain: a 4-year retrospective data analysis from Google Ads keywords planner
Authors: Kamiński Mikołaj , Łoniewski Igor , Marlicz Wojciech 
Published: July 2020

Background: Internet traffic may reflect the prevalence of real-world ailments. The aim of this study was to analyse queries associated with abdominal pain and to investigate seasonal frequency and trends of searches in Poland. Methods: We analysed mean search volume from March 2015 to February 2019 of keywords associated with ‘abdominal pain’ in the Polish language generated from the Google Ads Planner. Keywords were categorised by location, feature or type of pain, concurrent symptoms, frequency and patient groups, etc. We compared differences in search volumes across seasons and years. Results: Overall, 24,673,430 queries were associated with abdominal pain in the period analysed. The number of searches associated with abdominal pain in winter increased by ~30% compared with queries searched in summer. There were significantly more searches related to abdominal pain located in the epigastric, umbilical, hypogastrium, left lumbar, left iliac and right iliac regions combined with vomiting or fever, and acute or burning sensation in cold months. We did not observe any specific patterns of pain in the right lumbar or left hypochondrium region, co-presence of flatulence, acute, cramping or persistent/chronic or strong abdominal pain. Conclusion: Internet queries associated with abdominal pain and related factors have increased in the past 4 years and present a seasonal pattern. Google Ads may be a valuable tool to assess the prevalence of complaints in under-researched regions. The observed trends in queries related to abdominal pain merely reflect the scale of the problem. The reported pattern should be verified in epidemiological studies.
Electronic cigarettes and health with special focus on cardiovascular effects: position paper of the European Association of Preventive Cardiology (EAPC)
Authors: Kavousi Maryam , Pisinger Charlotta , Barthelemy Jean-Claude , De Smedt Delphine , Koskinas Konstantinos , Marques-Vidal Pedro , Panagiotakos Demosthenes , Prescott Eva Bossano , Tiberi Monica , Vassiliou Vassilios S , Løchen Maja-Lisa 
Published: July 2020

Abstract

Background
Tobacco use is the single largest preventable risk factor for premature death of non-communicable diseases and the second leading cause of cardiovascular disease. In response to the harmful effects of tobacco smoking, the use of electronic cigarettes (e-cigarettes) has emerged and gained significant popularity over the past 15 years. E-cigarettes are promoted as safe alternatives for traditional tobacco smoking and are often suggested as a way to reduce or quit smoking. However, evidence suggests they are not harmless.

Discussion
The rapid evolution of the e-cigarette market has outpaced the legislator’s regulatory capacity, leading to mixed regulations. The increasing use of e-cigarettes in adolescents and young individuals is of concern. While the long-term direct cardiovascular effects of e-cigarettes remain largely unknown, the existing evidence suggests that the e-cigarette should not be regarded as a cardiovascular safe product. The contribution of e-cigarette use to reducing conventional cigarette use and smoking cessation is complex, and the impact of e-cigarette use on long-term cessation lacks sufficient evidence.

Conclusion
This position paper describes the evidence regarding the prevalence of e-cigarette smoking, uptake of e-cigarettes in the young, related legislations, cardiovascular effects of e-cigarettes and the impact of e-cigarettes on smoking cessation. Knowledge gaps in the field are also highlighted. The recommendations from the population science and public health section of the European Association of Preventive Cardiology are presented.
Surgical Treatment of Meniscal Extrusion: A Biomechanical Study on the Role of the Medial Meniscotibial Ligaments With Early Clinical Validation
Authors: Paletta George A. , Crane David M. , Konicek John , Piepenbrink Marina , Higgins Laurence D. , Milner John D. , Wijdicks Coen A. 
Published: July 2020

Background: Meniscal extrusion refers to meniscal displacement out of the joint space and over the tibial margin, altering knee mechanics and increasing the risk of osteoarthritis. The meniscotibial ligaments have been shown to have an important role in meniscal stability. However, it remains unclear whether an isolated lesion of the medial meniscotibial ligaments will result in meniscal extrusion and whether repairing the detached ligament will reduce extrusion. Hypothesis: A lesion of the medial meniscotibial ligament will result in meniscal extrusion, and repairing the joint capsule will eliminate the extrusion by returning the meniscus back to its original position. Study Design: Controlled laboratory study. Methods: Fresh-frozen human cadaveric knees (N = 6) were used for biomechanical testing. The test protocol involved 100 flexion-extension cycles. In full extension, meniscal extrusion was measured using ultrasound, in both an otherwise unloaded state and while subjected to a 10-N·m varus load. Each knee was tested in its native condition (baseline), after creating a detachment of the medial meniscotibial ligament, and finally with the joint capsule repaired using 3 knotless SutureTak anchors. We also performed a retrospective review of 15 patients who underwent meniscotibial ligament repair with a minimal follow-up of 5 weeks (mean, 14 weeks; range, 5-35 weeks). Results: During biomechanical testing, the mean absolute meniscal extrusion at baseline was 1.5 ± 0.6 mm. After creation of the meniscotibial ligament lesion, the mean absolute meniscal extrusion was significantly increased (3.4 ± 0.7 mm) ( P < .001). After repair, the extrusion was reduced to 2.1 ± 0.4 mm ( P < .001). Clinically, a reduction in absolute meniscal extrusion of approximately 48% was reached (1.2 ± 0.6 vs 2.4 ± 0.5 mm preoperatively; P < .001). Conclusion: This study indicates that the medial meniscotibial ligaments contribute to meniscal stability as lesions cause the meniscus to extrude and that repair of those ligaments can significantly reduce extrusion. Early clinical results using this meniscotibial ligament repair technique support our biomechanical findings, as a significant reduction in meniscal extrusion was achieved. Clinical Relevance: Our biomechanical findings suggest that repair of medial meniscotibial ligaments reduces meniscal extrusion and clinically may improve meniscal function, with the possible long-term benefit of reducing the risk for osteoarthritis.
Cardiovascular risk screening of patients with serious mental illness or use of antipsychotics in family practice
Authors: Jakobs Kirsti M. , Posthuma Anne , de Grauw Wim J. C. , Schalk Bianca W. M. , Akkermans Reinier P. , Lucassen Peter , Schermer Tjard , Assendelft Willem J. J. , Biermans Marion J. C. 
Published: July 2020

Abstract
Background
Patients with serious mental illness (SMI) and patients on antipsychotics (AP) have an elevated risk for cardiovascular diseases. In the Netherlands, the mental healthcare for these patients is increasingly taken care of by family practitioners (FP) as a result of a shift from secondary to primary care. Therefore, it is essential to increase our knowledge regarding the characteristics of this patient group and the (somatic) care provided by their FPs. The aim was to examine the rate of cardiovascular risk screening in patients with SMI or the use of AP in family practice.

Methods
We performed a retrospective cohort study of 151.238 patients listed in 24 family practices in the Netherlands.
From electronic medical records we extracted data concerning diagnoses, measurement values of CVR factors, medication and frequency of visits over a 2 year period. Primary outcome was the rate of patients who were screened for CVR factors. We compared three groups: patients with SMI/AP without diabetes or CVD (SMI/AP-only), patients with SMI/AP and diabetes mellitus (SMI/AP + DM), patients with SMI/AP and a history of cardiovascular disease (SMI/AP + CVD). We explored factors associated with adequate screening using multilevel logistic regression.

Results
We identified 1705 patients with SMI/AP, 834 with a SMI diagnosis, 1150 using AP. The screening rate for CVR in the SMI/AP-only group (n = 1383) was adequate in 8.5%. Screening was higher in the SMI/AP − +DM (n = 206, 68.4% adequate, OR 24.6 (95%CI, 17.3–35.1) and SMI/AP + CVD (n = 116, 26.7% adequate, OR 4.2 (95%CI, 2.7–6.6). A high frequency of visits, age, the use of AP and a diagnosis of COPD were associated with a higher screening rate. In addition we also examined differences between patients with SMI and patients using AP without SMI.

Conclusion
CVR screening in patients with SMI/AP is performed poorly in Dutch family practices. Acceptable screening rates were found only among SMI/AP patients with diabetes mellitus as comorbidity. The finding of a large group of AP users without a SMI diagnosis may indicate that FPs often prescribe AP off-label, lack information about the diagnosis, or use the wrong code.
Addressing knowledge gaps in Parkinson’s disease: a report on the Movement Disorder Society’s Centre-to-Centre initiative to improve Parkinson’s disease services in Lao People’s Democratic Republic
Authors: Phokaewvarangkul Onanong , Vorachit Somchit , Phoumindr Appasone , Keosodsay Saysavath , Postuma Ronald B. , Meissner Wassilios G. , Bhidayasiri Roongroj 
Published: July 2020

Abstract
Background
Lao People’s Democratic Republic (Lao PDR) has only nine neurologists for seven million people; none have formal training in Parkinson’s disease (PD). Medical specialists require sufficient PD knowledge to provide high-quality care.

Methods
This study outlines a Centre-to-Centre programme for developing PD expertise in underserved regions through a tailored two-year educational enterprise between an established movement disorder mentor centre at Chulalongkorn University in Thailand and mentee centres in Lao PDR. Background knowledge of 80 Laotian physicians was assessed using a validated PD knowledge questionnaire containing 26 questions divided into 3 sections (diagnosis, therapeutic options, disease course) before and immediately after one-day kick-start training. Responses were compared across physicians’ demographic groups.

Results
Of 80 respondents, 50 (62.5%) were board-certified physicians, of which 27 (54%) specialised in internal medicine. Apparent knowledge gaps were shown by a 51.2% correct response rate for total score, 52.8% for diagnosis, 50.6% for therapeutic options, and 48.2% for disease course. No significant differences in total score or any domain sub-scores between neurologists and other specialties were found. Many did not know which non-motor symptoms could occur as prodromal symptoms or late in course of PD. Incorrect responses mainly reflected a lack of knowledge of the impact of medication on disease. Total and domain sub-scores significantly improved after the course (p < 0.05, each). The size of difference of the means was significant for the total score (d = 0.82), therapeutic option (d = 0.56), and disease course (d = 0.68) sub-scores.

Conclusions
Significant improvement of PD knowledge amongst Laotian physicians is demonstrated after a training course, focusing on practical management of PD. Our findings highlight the importance of continued medical education, especially PD-specific training.