bluuebunny/crossref_metadata_2025_split huggingface dataset:
Premature, Opportune, and Delayed Weaning in Mechanically Ventilated Patients: A Call for Implementation of Weaning Protocols in Low- and Middle-Income Countries
Authors: Diaz-Soto Maria P. , Morgan Brooks W. , Davalos Long , Herrera Phabiola , Denney Joshua , Roldan Rollin , Paz Enrique , Jaymez Amador A. , Chirinos Eduardo E. , Portugal Jose , Quispe Rocio , Brower Roy G. , Checkley William 
Published: January 2020

Objectives:
Weaning protocols establish readiness-to-wean criteria to determine the opportune moment to conduct a spontaneous breathing trial. Weaning protocols have not been widely adopted or evaluated in ICUs in low- and middle-income countries. We sought to compare clinical outcomes between participants whose weaning trials were retrospectively determined to have been premature, opportune, or delayed based on when they met readiness-to-wean criteria.

Design:
Prospective, multicenter observational study.

Setting:
Five medical ICUs in four public hospitals in Lima, Perú.

Subjects:
Adults with acute respiratory failure and at least 24 hours of invasive mechanical ventilation (n = 1,657).

Interventions:
None.

Measurements and Main Results:
We established six readiness-to-wean criteria and retrospectively categorized our sample into three weaning groups: 1) premature: if the weaning trial took place before fulfilling all criteria, 2) opportune: if the weaning trial took place within 24 hours after fulfilling the criteria, and 3) delayed: if the weaning trial took place over 24 hours after fulfilling criteria. We compared 90-day mortality, ventilator-free days, ICU-free days, and hospital-free days between premature, opportune, and delayed weaning groups. In our sample, 761 participants (60.8%) were classified as having a premature weaning trial, 196 underwent opportune weaning (15.7%), and 295 experienced delayed weaning (23.6%). There was no significant difference in 90-day mortality between the groups. Both the premature and delayed weaning groups had poorer clinical outcomes with fewer ventilator-free days (–2.18, p = 0.008) and (–3.49, p < 0.001), ICU-free days (–2.25, p = 0.001) and (–3.72, p < 0.001), and hospital-free days (–2.76, p = 0.044) and (–4.53, p = 0.004), respectively, compared with the opportune weaning group.

Conclusions:
Better clinical outcomes occur with opportune weaning compared with premature and delayed weaning. If readiness-to-wean criteria can be applied in resource-limited settings, it may improve ICU outcomes associated with opportune weaning.
Optimized cutoff maternal age for adverse obstetrical outcomes: a multicenter retrospective cohort study in Urban China during 2011 to 2012
Authors: Zhang Xiao-Lei , Liang Huan , Zhao Huan-Qiang , Wu Su-Wen , Zhou Qiong-Jie , Li Xiao-Tian 
Published: January 2020

Abstract

Background:
China's two-child policy has led to a trend of aging in pregnancy which was associated with adverse outcomes. This study aimed to identify the clinically cutoff maternal age for adverse obstetric outcomes in China.

Methods:
This secondary analysis of a multicenter retrospective cohort study included data of childbearing women from 39 hospitals collected in urban China during 2011 to 2012. Logistic regression was used to assess the adjusted odds ratios (aOR) of adverse outcomes in different age groups in comparison to women aged 20 to 24 years. The adjustments included the location of the hospital, educational level, and residence status. Clinically cutoff age was defined as the age above which the aOR continuously become both statistically (P < 0.05) and clinically (aOR > 2) significant.

Results:
Overall, 108,059 women were recruited. In primiparae, clinically cutoff maternal ages for gestational diabetes (aOR: 2.136, 95% confidence interval [CI]: 1.856–2.458, P < 0.001), placenta previa (aOR: 2.400, 95% CI: 1.863–3.090, P < 0.001), cesarean section (aOR: 2.511, 95% CI: 2.341–2.694, P < 0.001), hypertensive disorder (aOR: 2.122, 95% CI: 1.753–2.569, P < 0.001), post-partum hemorrhage (aOR: 2.129, 95% CI: 1.334–3.397, P < 0.001), and low birth weight (aOR: 2.174, 95% CI: 1.615–2.927, P < 0.001) were 27, 31, 33, 37, 41, and 41 years, respectively. In multiparae, clinically cutoff ages for gestational diabetes (aOR: 2.977, 95%CI: 1.808–4.904, P < 0.001), hypertensive disorder (aOR: 2.555, 95% CI: 1.836–3.554, P < 0.001), cesarean section (aOR: 2.224, 95% CI: 1.952–2.534, P < 0.001), post-partum hemorrhage (aOR: 2.140, 95% CI: 1.472–3.110, P < 0.001), placenta previa (aOR: 2.272, 95% CI: 1.375–3.756, P < 0.001), macrosomia (aOR: 2.215, 95% CI: 1.552–3.161, P < 0.001), and neonatal asphyxia (aOR: 2.132, 95% CI: 1.461–3.110, P < 0.001) were 29, 31, 33, 35, 35, 41, and 41 years, respectively.

Conclusions:
Early cutoff ages for gestational diabetes and cesarean section highlight a reasonable childbearing age in urban China. The various optimized cutoff ages for different adverse pregnancy outcomes should be carefully considered in childbearing women.
Interaction between postmenopausal hormone therapy and diabetes on cataract
Authors: Costanian Christy , Aubin Marie-Josée , Buhrmann Ralf , Freeman Ellen E. 
Published: January 2020

Abstract

Objective:
We investigated whether postmenopausal hormone therapy (HT) use interacts with diabetes, a risk factor for several age-related eye diseases.

Methods:
A cross-sectional analysis of women involved in the Canadian Longitudinal Study on Aging was performed. The random sample comprised of 15,320 community-dwelling women between ages 45 and 85 years old sampled from areas adjacent to 11 data collection centers across Canada. Information on menopausal status and HT were collected by self-report. Data on diabetes and eye disease were obtained by self-report of a physician diagnosis. Multivariable logistic regression was used.

Results:
After adjusting for demographic, lifestyle, and health variables, a multiplicative interaction was identified such that HT use for 10 years or more was associated with a much higher odds of a report of cataract in women with type 2 diabetes (odds ratio = 2.44, 95% confidence interval 1.49, 3.99) but not in long-term HT users with no diabetes (odds ratio = 1.03, 95% confidence interval 0.87, 1.21) (interaction term P value = 0.013). HT use was not associated with glaucoma or macular degeneration.

Conclusions:
Long-term HT use and type 2 diabetes interact in their relationship with cataract. This novel finding should be confirmed. If confirmed, women with type 2 diabetes should be informed that long-term HT use increases their risk of cataract.

Video Summary:

http://links.lww.com/MENO/A519.
Obstetrician-gynecologists’ screening and management of depression during perimenopause
Authors: Raglan Greta B. , Schulkin Jay , Juliano Laura M. , Micks Elizabeth A. 
Published: January 2020

Abstract

Objective:
Depression in women is more common during perimenopause (the time period around and during menopause) than pre and postmenopause. Obstetrician-gynecologists (ob-gyns) play a vital role in the detection and management of depression symptoms in women because for many women ob-gyns are the first and most frequent point of medical contact. This study assessed ob-gyns’ screening practices and management of depression in perimenopause.

Methods:
A survey regarding depression during perimenopause was sent to 500 practicing ob-gyns who were fellows of the American College of Obstetricians and Gynecologists and members of the Collaborative Ambulatory Research Network.

Results:
The survey response rate was 41.8% (209 of 500 surveys returned). Over a third of respondents (34.1%) reported that they did not regularly screen perimenopausal patients for depression. Higher-quality education about depression, respondent sex, and personal experience with depression were associated with higher rates of screening. While 85.7% of respondents believed that they could recognize depression in perimenopausal women, only about half (55.8%) were confident in their ability to treat these patients.

Conclusion:
Increased education of ob-gyn physicians related to depression during perimenopause may increase the screening and treatment of women during this phase of life.
Assessment Model of Radiation Doses from External Exposure to the Public after the Fukushima Daiichi Nuclear Power Plant Accident
Authors: Takahara Shogo , Iijima Masashi , Watanabe Masatoshi 
Published: January 2020

Abstract
Radiation exposure is one of most important factors to manage following a nuclear emergency. Actual measurement is the best way to obtain information concerning the dose received by the people in terms of accuracy and reliability. However, in practice, it is difficult to collect measurements from all people affected by nuclear accidents over the whole period of exposure from past to future. Therefore, probabilistic assessment using a model is needed. An assessment model of radiation doses from external exposures was developed based on the actual measurement of individual doses and ambient dose equivalent rates inside and outside houses in Fukushima City. A survey of behavioral patterns was also performed for the same purpose. In addition to our measurement and survey, we took into account the latest insights from the experiences of the Fukushima Daiichi nuclear power plant accident. Comparisons between the assessed and measured results revealed that the time-dependence of doses and the distribution of doses obtained using the developed models agree well with the results of actual measurements. Thus, our probabilistic approach was validated. Based on both our assessment and on our actual measurements, no participants were observed to receive doses in excess of 1 mSv y−1 as of 8 y after the Fukushima Daiichi nuclear power plant accident in Fukushima City.
A Review of Radon Equilibrium Factors in Underground Mines, Caves, and Thermal Spas
Authors: Chen Jing , Harley Naomi H. 
Published: January 2020

Abstract
Radon equilibrium factor Feq
is an important factor in radon progeny dose assessment. A review of published measurements of Feq
shows a range of values from 0.1 to 1.0 reported in studies from more than 26 countries measured in 173 underground mines, and 136 show caves, tourist mines, and thermal spas. The average values of F
eq are 0.38 in underground mines and 0.39 for show caves, tourist mines, and thermal spas. The wide range of Feq
in those special workplaces suggests that location-, environment-, and operation-specific values are more appropriate than a recommended average value in the calculation of lung bronchial dose. This is especially important in mines or other typically high radon exposure locations because F
eq can be used for recording an individual’s occupational radon exposure or dose.
FEATURES OF THE MACULAR AND PERIPAPILLARY CHOROID AND CHORIOCAPILLARIS IN EYES WITH NONEXUDATIVE AGE-RELATED MACULAR DEGENERATION
Authors: Nam Ki Tae , Chung Hyun Woo , Jang Sungmin , Kim Seong-Woo , Oh Jaeryung , Yun Cheolmin 
Published: January 2020

Purpose:
We investigated macular and peripapillary choroidal thickness (CT) and flow voids in the choriocapillaris in eyes with nonexudative age-related macular degeneration.

Methods:
We retrospectively reviewed the medical records of patients with nonexudative age-related macular degeneration and classified their eyes into three categories: pachydrusen, drusen, and subretinal drusenoid deposit. Mean macular and peripapillary CT and choriocapillaris flow void area were compared among the three groups.

Results:
The three groups included 29, 33, and 33 patients, respectively. The mean macular and peripapillary CT findings were 260.64 ± 75.85 µm and 134.47 ± 46.28 µm for the pachydrusen group; 163.63 ± 64.08 µm and 93.47 ± 39.07 µm for the drusen group; and 95.33 ± 28.87 µm and 56.06 ± 11.64 µm for the subretinal drusenoid deposit group (all, P < 0.001). Mean macular and peripapillary flow void area varied among the subretinal drusenoid deposit group (57.07 ± 6.16% and 55.38 ± 6.65%), drusen group (58.30 ± 6.98% and 49.11 ± 9.11%) and pachydrusen group (50.09 ± 5.77% and 45.47 ± 8.06%) (all P < 0.001).

Conclusion:
The peripapillary CT and flow voids in the choriocapillaris varied according to the features of drusen in nonexudative age-related macular degeneration eyes. Greater flow voids and thinner CT in eyes with subretinal drusenoid deposits may suggest that these eyes have diffuse choroidal abnormalities both in and outside the macula.
Pulsatile Tinnitus Caused by Internal Jugular Phlebectasia in an Adult
Authors: Meng Zhaoli , Chen Fei , Huo Yao , Sun Haocheng , Zheng Yun 
Published: January 2020

Abstract
Internal jugular phlebectasia is a rare condition. Children with internal jugular phlebectasia are often discovered by their parents when they notice a soft mass in the neck that appears when the child cries, coughs, or breathes deeply. Most internal jugular vein dilatations occur unilaterally on the right side according to the literature reports. To our knowledge, no other internal jugular phlebectasia patients reported pulsatile tinnitus as the major complaint without a soft mass in the neck. The authors reported a female adult patient with left-side internal jugular phlebectasia with pulsatile tinnitus as the major complaint without a soft mass in the neck. Internal jugular phlebectasia was diagnosed by color ultrasound of the internal jugular vein. Pure-tone audiometry, tympanometry, hemoglobin, thyroid function, and magnetic resonance imaging were made to differentiate other diseases that can cause the pulsatile tinnitus. Conservative treatment is recommended in this report. The possibility of internal jugular vein dilatation should be considered when differentiate the possible diseases that caused pulsatile tinnitus.
The Management of Head and Neck Sarcoma
Authors: Han Shengwei , Yin Xiteng , Xu Wenguang , Wang Yufeng , Han Wei 
Published: January 2020

Objective:To describe the incidence, types, features, treatment and outcomes of head and neck sarcoma managed at a treatment center in eastern China.Methods:Cases of head and neck soft tissue sarcoma and osteogenic sarcoma treated at the Stomatology Hospital of Nanjing University between 2008 and 2018 were retrospectively analyzed. Patient characteristics, site of lesion, main presenting symptoms, treatment, histology, local recurrence, development of metastatic disease, duration of follow-up and survival rates are described and compared.Results:Sixty-three patients were diagnosed with head or neck sarcoma of which 42.9% had soft tissue sarcoma and 57.1% had osteogenic sarcoma. Of soft tissue sarcoma patients, the most frequently observed histologies were fibrosarcoma and malignant fibrous histiocytoma. Of 36 cases of osteogenic sarcoma, osteosarcoma, and fibrosarcoma of bone were most frequent. Mean latency period between initial symptoms and clinical presentation was 4.5 months. Radical resection was performed on 56 patients. For 33 patients, resection and radiotherapy were used and 10 patients received a triple combination of resection, chemotherapy and radiotherapy. Within the observation period, 17 patients died.Conclusions:Head and neck sarcomas, although rare, can represent a variety of pathological diagnoses. Surgery remains the main intervention although the data suggest chemotherapy, radical resection and irradiation as treatment. Outcomes are poor with high rates of local recurrence. Positive prognostic factors were tumor-free resection margins and choice of therapy. Due to the rarity of head and neck sarcoma, information remains limited and choice of treatment should be within the focus of clinical multi-center studies.
Evaluation of the Relationship Between Olfactory Fossa Measurements and Nasal Septum Deviation for Endoscopic Sinus Surgery
Authors: Bayrak Seval , Aktuna Belgin Ceren , Orhan Kaan 
Published: January 2020

Introduction:
Endoscopic sinus surgeries (ESS) are frequently used in the treatment of optic nerve decompression, other intracranial lesions and sinonasal pathologies. The olfactory fossa can be localized on different levels in relation to the anterior cranial fossa. The aim of the present study was to evaluate the depth and width of the olfactory fossa (OF) in relation to nasal septum deviation (NSD).

Methods:
A total of 225 patient (141 female and 84 male, age range between 15 to 56 years) of cone beam computed tomography (CBCT) data was used in this study. NSD, OF width, OF depth were measured. OF depth which was grouped according to the Keros classification as Type I, II, and III was calculated. All measurements were performed bilaterally except for NSD.

Results:
In the right and left OF depth were found Keros Type I 32 (14.2%) and 30 (13.3%), Keros Type II 171 (76%) and 167 (74.2%), and Keros Type III 22 (9.8%) and 28 (12.4%) respectively. There was no statistically significant found between OF depth and NSD (P > 0.05). The mean angle of the NSD in men and women were 4.36 ± 4.69o in women 4.11 ± 4.36o, respectively. The mean width of the right OF was 2.50 ± 0.64 mm and 2.58 ± 0.72 mm for the left side and there was no statistically significant association between OF width – NSD and OF width – OF depth (P > 0.05).

Conclusion:
The anatomy of the OF should be well established before surgical intervention increase of the length of the lateral lamella is also increases the risk of developing complications such as cerebral damage, hemorrhage, and cerebrospinal fluid fistula during endoscopic sinus surgery. Although there is no significant difference between OF measurement and NSD, with three-dimensional imaging detailed research is required before endoscopic sinus surgical operations.
Intraoral Approach for Surgical Treatment of Psammomatoid Juvenile Ossifying Fibroma
Authors: Diniz Jiordanne Araújo , Siqueira Allancardi dos Santos , Araújo Gabriela Madeira , Faro Tatiane Fonseca , Torres Luiz Henrique Soares , Oliveira e Silva Emanuel Dias de , Laureano Filho José Rodrigues 
Published: January 2020

Abstract
Psammomatoid juvenile ossifying fibroma (PJOF) is a rare benign tumor that usually affects the paranasal sinuses, orbit, and skull. In most cases, extensive incisions are necessary for full access to the tumor site. The aim of this paper is to report a case of extensive PJOF in which an intraoral surgical approach was performed with complete excision of the tumor. A female patient, 18-year old had a deforming volume increase in the region of the left facial middle third with an approximate evolution time of 2 years. She complained of headache, epiphora in the left eye, and total obstruction of the left nostril. Extraoral examination showed facial asymmetry with dystopia, ocular proptosis, and considerable sclera exposition of the left eye. Tomography examination showed a mixed aspect lesion on the left side of the face, well delimited. The intraoral surgical approach was chosen for the excision of the lesion. Under general anesthesia and nasotracheal intubation, total resection was performed, followed by exodontia of the directly involved teeth. In the definitive histopathological examination, the diagnosis was confirmed. The patient is currently with 2 years and 6 months of postoperative follow-up and has good healing of intraoral surgical wounds and stable occlusion. Extraoral examination showed harmonic projection of the facial middle third, but still with excessive exposure of the sclera of the left eye due to the defect in the orbital floor. The surgical treatment of PJOF was possible by intraoral approach, even taking into account the limitations of the access and the complexity of the anatomy of the facial bones involved.
Anterior-Approach Versus Posterior-Approach Levator Advancement Surgery in Aponeurotic Ptosis
Authors: Fazil Korhan , Ozturker Can , Ozturk Karabulut Gamze , Aygit Ebru Demet , Kepez Yildiz Burcin , Taskapili Muhittin , Kaynak Pelin 
Published: January 2020

Purpose:
To compare the effectiveness and complications of levator reinsertion in aponeurotic ptosis surgery using anterior and posterior approaches.

Methods:
Seventy-eight (36 females, 42 males) patients with acquired aponeurotic ptosis were evaluated. Pre- and postoperative margin reflex distance, symmetry of height, contour and skin crease, corneal problems, and lagophthalmus were evaluated and compared between the 2 groups. Independent and paired samples t-test, Pearson Chi-square, and Fisher exact test were used to evaluate the results.

Results:
The anterior approach was performed on 43 eyelids and the posterior approach was performed on 35 eyelids. The mean age of the anterior-approach group was 62.1 ± 11 years, and posterior-approach group was 50.1 ± 15.1 years, respectively (P < 0.001). The male-female ratio was 28/15 in the anterior-approach group, and 14/21 in the posterior approach group (P = 0.027). The success rate of the anterior approach was 69.8% and the posterior approach was 57.1% (P = 0.248). The mean margin reflex distance change was statistically significant in both anterior- and posterior-approach techniques (P < 0.001, P < 0.001, respectively). Three (6.9%) patients in the anterior-approach group and 11 (31.4%) in the posterior-approach group required reoperation (P = 0.005). Lagophthalmus rates were similar (3 eyes in the anterior versus 7 eyes in the posterior group, P = 0.103).

Conclusions:
Both anterior- and posterior-approaches are effective and safe techniques for aponeurotic ptosis treatment. The posterior approach seems to be preferred by female and younger patients because there is no undesirable scar formation although it has the disadvantage of higher rates of reoperation.
Biomarker-guided treatment strategies for ovarian cancer identified from a heterogeneous panel of patient-derived tumor xenografts
Authors: Palmer Adam C. , Plana Deborah , Gao Hui , Korn Joshua M , Yang Guizhi , Green John , Zhang Xiamei , Velazquez Roberto , McLaughlin Margaret E , Ruddy David A , Kowal Colleen , Goldovitz Julie , Bullock Caroline , Rivera Stacy , Rakiec Daniel , Elliott GiNell , Fordjour Paul , Meyer Ronald , Loo Alice , Kurth Esther , Engelman Jeffrey A , Bitter Hans , Sellers William R , Sorger Peter K , Williams Juliet A 
Published: January 2020

ABSTRACTAdvanced ovarian cancers are a leading cause of cancer-related death in women. Such cancers are currently treated with surgery and chemotherapy which is often temporarily successful but exhibits a high rate of relapse after which treatment options are few. Here we assess the responses of a panel of patient-derived ovarian cancer xenografts (PDXs) to 19 mono and combination therapies, including small molecules and antibody-drug conjugates. The PDX panel aimed to mimic the heterogeneity of disease observed in patients, and exhibited a distribution of responsiveness to standard of care chemotherapy similar to human clinical data. Three monotherapies and one drug combination were found to be active in different subsets of PDXs. By analyzing gene expression data we identified gene expression biomarkers predictive of responsiveness to each of three novel targeted therapy regimens. While no single treatment had as high a response rate as chemotherapy, nearly 90% of PDXs were eligible for and responded to at least one biomarker-guided treatment, including tumors resistant to standard chemotherapy. Biomarker frequency was similar in human patients, suggesting the possibility of a new therapeutic approach to ovarian cancer and demonstrating the potential power of PDX-based trials in broadening the reach of precision cancer medicine.