bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rural health issues in rheumatology: a review
Authors: Lennep Day S. , Crout Teresa , Majithia Vikas 
Published: January 2020

Purpose of review
Early access to rheumatology is imperative to achieve appropriate outcomes in rheumatologic diseases. But there seems to be a significant gap and disparity in the access to rheumatology care between urban and rural areas. This review was undertaken to analyze this issue.

Recent findings
A significant delay in diagnosis of rheumatic disorder has been correlated to the travel distance to rheumatologist. It is also clear that currently, a significant rheumatology workforce shortage exists and is projected to worsen significantly, thereby making this gap and disparity much bigger.

Summary
The scope of this gap and disparity in rheumatology care for rural patients remains incompletely defined and quantified. It is felt to be a significant issue and it is important to invest resources to obtain information about its scope. In addition, a number of solutions already exist which can be implemented using current network and infrastructure. These include relatively low-cost interventions such as patient navigator, remote rheumatology experts and if possible tele-rheumatology. These interventions can assist temporarily but a major improvement will require policy change at federal and state government level as well as involvement, buy-in, and incentivization of the providers and health networks providing rheumatology care.
Posterior Vertebral Column Resection Combined With Bone Cement Augmentation of Pedicle Screw Fixation for Treatment of Severe Vertebral Compression Fractures With Kyphotic Deformity
Authors: Ma Zheng , Jiao Jianbao , Yang Dalong , Ding Wenyuan 
Published: January 2020

Study Design:
This was a retrospective study.

Objective:
Severe osteoporotic vertebral compression fractures with kyphotic deformity are difficult to treat. The objective of this study was to investigate the clinical efficacy of posterior vertebral column resection (PVCR) combined with bone cement augmentation of pedicle screw fixation in the treatment of severe vertebral compression fractures with kyphotic deformity.

Summary of Background Data:
The data of patients with a severe vertebral compression fracture and kyphotic deformity treated at our university between October 2013 and October 2017 were retrospectively reviewed.

Materials and Methods:
All patients underwent PVCR combined with bone cement augmentation of pedicle screw fixation and anterior column reconstruction. The operative time, intraoperative blood loss, postoperative complications, and screw stability at the last follow-up in all patients were documented. The clinical benefits were evaluated by the Visual Analog Scale (VAS) score, Oswestry Dysfunction Index (ODI), Japanese Orthopedic Association (JOA) scores, and Frankel classification.

Results:
The mean Cobb angle, sagittal vertical axis, VAS score, JOA score, and ODI were 48.5±6.9 degrees, 44.0±5.7, 6.5±1.5, 11.2±2.7, and 59.0±5.7 before surgery, respectively. The average follow-up period was 28.7±3.2 months. The Frankel grade in 5 patients with neurological impairment improved from D to E after surgery. The average Cobb angles for kyphotic deformity, sagittal vertical axis, VAS score, JOA score, and ODI were 9.5±3.8 degrees, 18.3±3.5, 2.6±1.2, 20.5±3.6, and 20.7±4.0, respectively, at the last follow-up (all P<0.05 compared with before surgery).

Conclusions:
For patients with severe vertebral compression fractures and kyphotic deformity, PVCR combined with bone cement augmentation of pedicle screw fixation can restore the spine sequence to achieve good clinical efficacy. Clinical trials are necessary for confirmation.
Heterotopic Ossification After an Achilles Tendon Rupture Cannot Be Prevented by Early Functional Rehabilitation: A Cohort Study
Authors: Magnusson S. Peter , Agergaard Anne-Sofie , Couppé Christian , Svensson René B. , Warming Susan , Krogsgaard Michael R. , Kjaer Michael , Eliasson Pernilla 
Published: January 2020

Abstract

Background
Tendon loading might play a role in the development of heterotopic ossification after Achilles tendon ruptures. Early heavy loading on a healing tendon in animals has been shown to prolong the proinflammatory response, and inflammatory cells are thought to drive heterotopic ossification formation. Taken together, this suggests that early rehabilitation might influence heterotopic ossification development.

Questions/purposes
The purposes of this study were to investigate (1) whether the presence of heterotopic ossification after Achilles tendon ruptures influences clinical outcome and (2) whether early mobilization or weightbearing prevents the development of heterotopic ossification.

Methods
This was a retrospective analysis of 69 patients from a previous clinical trial. All patients were treated surgically, but with three different early rehabilitation protocols after surgery: late weightbearing and ankle immobilization, late weightbearing and ankle mobilization, and early weightbearing and ankle mobilization. Plain radiographs taken 2, 6, 12, 26, and 52 weeks postoperatively were analyzed for heterotopic ossification, which was detected in 19% of patients (13 of 69) at 52 weeks. Heterotopic ossification was measured, scored, and correlated to clinical outcomes; heel-raise index (HRI), ankle joint ROM, tendon strain, Achilles tendon rupture score (ATRS), and Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire scores at 26 and 52 weeks postoperatively.

Results
Heterotopic ossification had no adverse effects on patient-reported outcomes (ATRS or VISA-A), tendon strain, or ROM. In fact, patients with heterotopic ossification tended to have a better HRI at 52 weeks compared with patients without (mean difference 14% [95% CI -0.2 to 27]; p = 0.053). Neither the occurrence (heterotopic ossification/no heterotopic ossification) nor the heterotopic ossification severity (ossification score) differed between the three rehabilitation groups. Seventeen percent of the patients (four of 24) with early functional rehabilitation (early weightbearing and ankle joint mobilization exercise) had heterotopic ossification (score, 2-3) while late weightbearing and immobilization resulted in heterotopic ossification in 13% of the patients (score, 3-4).

Conclusions
Heterotopic ossification occurs relatively frequently after Achilles tendon ruptures but appears to have no adverse effects on functional outcomes. Furthermore, heterotopic ossification develops during the first 6 weeks after rupture, and weightbearing or ankle-joint mobilization does not prevent this from occurring.

Level of Evidence
Level III, prognostic study.
Income-based inequalities in hypertension and in undiagnosed hypertension: analysis of Health Survey for England data
Authors: Scholes Shaun , Conolly Anne , Mindell Jennifer S. 
Published: January 2020

Objective:
To quantify income-based inequalities in hypertension and in undiagnosed hypertension.

Methods:
We used nationally representative data from 28 002 adults (aged 16 years and older) living in private households who participated in the cross-sectional Health Survey for England 2011–2016. Using bivariate probit regression modelling, we jointly modelled hypertension and self-reported previous diagnosis of hypertension by a doctor or nurse. We then used the model estimates to quantify inequalities in undiagnosed hypertension. Inequalities, using household income tertiles as an indicator of socioeconomic status, were quantified using average marginal effects (AMEs) after adjustment for confounding variables.

Results:
Overall, 32% of men and 27% of women had survey-defined hypertension (measured blood pressure ≥140/90 mmHg and/or currently using medicine to treat high blood pressure). Higher proportions (38% of men and 32% of women) either self-reported previous diagnosis or had survey-defined hypertension. Of these, 65% of men and 70% of women had diagnosed hypertension. Among all adults, participants in low-income versus high-income households had a higher probability of being hypertensive [AMEs: men 2.1%; 95% confidence interval (CI): −0.2, 4.4%; women 3.7%; 95% CI: 1.8, 5.5%] and of being diagnosed as hypertensive (AMEs: men 2.0%; 95% CI: 0.4, 3.7%; women 2.5%; 95% CI: 1.1, 3.9%). Among those classed as hypertensive, men in low-income households had a marginally lower probability of being undiagnosed than men in high-income households (AME: −5.2%; 95% CI: −10.5, 0.1%), whereas no difference was found among women.

Conclusion:
Our findings suggest that income-based inequalities in hypertension coexist with equity in undiagnosed hypertension.
Gender Differences in Depression: Biological, Affective, Cognitive, and Sociocultural Factors
Authors: Hyde Janet S. , Mezulis Amy H. 
Published: January 2020

Abstract
The odds ratio (OR) for gender differences in major depression is 1.95, averaged meta-analytically over all ages and nations. The gender difference appears by age 12, OR = 2.37, and peaks at OR = 3.02 for ages 13–15. Using the ABC (affective, biological, cognitive) model as a framework within a vulnerability-stress approach, we consider the evidence for biological vulnerabilities (genes, pubertal hormones, and pubertal timing), affective vulnerabilities (temperament), and cognitive vulnerabilities (negative cognitive style, objectified body consciousness, and rumination). The impact of stress is central to the vulnerability-stress model, and we review evidence on gender differences in stress exposure, emphasizing gender differences in sex-related traumas such as child sexual abuse and rape. Finally, we examine sociocultural factors that may contribute to the gender difference, including the media and gender inequality. An implication for research methods is that single-gender designs should be questioned. Regarding clinical implications, the vulnerabilities and stressors identified in this review should contribute to personalized interventions with depressed individuals, especially depressed women.
A Study of Histopathologic Evaluation and Clinical Correlation for Isolated Congenital Myogenic Ptosis and Aponeurotic Ptosis
Authors: Nalci Baytaroğlu Hilal , Kaya Bengisu , Korkusuz Petek , Hoşal Melek B. 
Published: January 2020

Purpose:
To evaluate light microscopy and transmission electron microscopy findings of levator muscle/aponeurosis materials and their correlation with clinical findings in isolated congenital myogenic and aponeurotic blepharoptosis.

Methods:
Demographic and clinical data were obtained from patients. Qualitative and quantitative evaluations for muscle fiber morphology were performed using light microscopy and transmission electron microscopy on tissue samples which were obtained from the most proximal part of the aponeurosis excised during levator muscle/aponeurosis resection surgery.

Results:
Seventeen (55%) of the cases were isolated congenital myogenic ptosis, and 14 (45%) were aponeurotic ptosis. Muscle bundle splitting, cytoplasmic loss, and centrally located nuclei were observed in both groups. Muscle tissue covered 25% of the sample in 67% of the cases, 50% in 11%, 75% in 11%, and 100% in 11% in the myogenic group. In the aponeurotic group, muscle tissue covered 25% of the sample in 44.5% of the cases, 50% in 11%, and 100% in 44.5% (χ
2, p = 0.52). Myofibrillar loss areas accompanied by Z-line disorganization which were occupied by degenerated organelles were present in both groups under transmission electron microscopy, and findings were not significantly different between groups (χ
2, p > 0.05). Mean mitochondrial diameter was significantly larger in aponeurotic ptosis (Mann-Whitney U, p = 0.047). No correlation was found between functional and microscopic parameters.

Conclusion:
Decreased amount of striated muscle and the presence of fiber damage indicators were observed in both groups. Muscle fiber loss in myogenic ptosis may be a feature of muscle dysgenesis. Ultrastructural damage in aponeurotic ptosis may be explained with increased oxidative stress or long-term contractile stress. Further genetic and immunohistochemical studies will be helpful to further understand the pathogenesis of diseases.
Comparison of Positive Results With End-Point and Real-Time Polymerase Chain Reaction Assays for the Diagnosis of Pneumocystis Pneumonia
Authors: Zhou Shiwei , Kauffman Carol A. , Miceli Marisa H. 
Published: January 2020

Background
The definitive diagnosis of Pneumocystis pneumonia requires direct visualization of the organism; in recent years, polymerase chain reaction (PCR) assays, although not standardized, have become widely used diagnostic tools. A concern is that newer, more sensitive PCR assays will not differentiate colonization from infection. We evaluated the clinical implications of 2 different PCR assays for the diagnosis of Pneumocystis pneumonia.

Methods
Adult patients with a bronchoalveolar lavage or sputum sample positive for Pneumocystis by PCR from February 2014 to February 2018 were studied. Samples were tested with end-point (EP) PCR before February 2017 and with real-time (RT) PCR after February 2017. A strict case definition based on host factors, clinical presentation, radiological and pathological findings, and response to therapy was used to categorize cases as proven, probable, possible, and no Pneumocystis pneumonia. Positive EP-PCR and RT-PCR results were deemed to be true positives or false positives based on this categorization of patients.

Results
Of 1693 patients tested, 153 (9%) had a positive PCR test result, and 118 met the case definitions for proven (n = 2), probable (n = 70), and possible (n = 46) Pneumocystis pneumonia., Among 35 patients with a positive PCR test result who did not the meet criteria for Pneumocystis infection and who had a verified alternative diagnosis, 8 (23%) were false positive by EP-PCR and 27 (77%) by RT-PCR (P < 0.0001). Among the 27 patients who did not have host factors that would classically place them at risk of Pneumocystis infection, RT-PCR gave significantly more false-positive results (n = 12; 44%) than did EP-PCR (n = 2; 7%; P < 0.001).

Conclusions
Reverse transcription PCR gave significantly more positive results than did EP-PCR in patients who likely were colonized only and did not have Pneumocystis infection. Host risk factors, clinical presentation, and radiological findings should be considered before ordering PCR testing for Pneumocystis.
Crossover Study of Kinematic, Kinetic, and Metabolic Performance of Active Persons with Transtibial Amputation Using Three Prosthetic Feet
Authors: Lura Derek J. , Carey Stephanie L. , Miro Rebecca M. , Kahle Jason T. , Highsmith M. Jason 
Published: January 2020

ABSTRACT

Introduction
This study was a double-blinded, randomized, repeated measures test of 14 persons with a unilateral transtibial amputation (TTA) walking and running on the Vari-Flex, Elite Blade, and the Re-Flex Rotate feet, with comparisons to persons without an amputation. The goal of the study was to compare ankle flexion, ankle moment, step length, ground reaction force (GRF), and metabolic cost of similar prosthetic feet for walking and running.

Materials and Methods
Marker-based motion capture, GRF, and metabolic data were recorded, whereas participants walked and ran on a treadmill at self-selected speeds. Data were statistically analyzed for significant differences between conditions and groups using a multivariate analysis, with post hoc Tukey's test for multiple comparisons.

Results
Plantarflexion was found to be significantly lower for prosthetic conditions than the contralateral and control conditions. Control participants had a shorter step length during walking. GRFs were generally lower for control and contralateral limbs. Heart rate, oxygen uptake, and self-selected speed were higher for TTAs than controls for walking and running.

Conclusions
Differences between prosthetic feet included in this study were minimal. Although significant differences between TTAs and controls were found, these differences were confounded by the difference in self-selected speeds.
Validation of the InBody BPBIO250 oscillometric blood pressure monitor for professional office use in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard
Authors: Kollias Anastasios , Gravvani Areti , Anagnostopoulos Ioannis , Kyriakoulis Konstantinos G. , Bountzona Ioanna , Menti Ariadni , Stergiou George S. 
Published: January 2020

Objective
The aim of this study was to evaluate the accuracy of the InBody BPBIO250 oscillometric upper-arm professional office blood pressure (BP) monitor in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018).

Methods
Subjects were recruited to fulfil the age, gender, BP, and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method. Two cuffs of the test device were used for arm circumference 22–32 (medium) and 32–42 cm (large).

Results
Ninety-seven subjects were recruited and 88 were analyzed. For validation criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 1.9 ± 5.9/0.9 ± 4.9 mmHg (systolic/diastolic). For criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 4.78/4.31 mmHg (systolic/diastolic).

Conclusion
The InBody BPBIO250 professional oscillometric device for office BP measurement fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in general population and can be recommended for clinical use.
Multicenter experience with percutaneous coronary intervention for chronic total occlusion in Korean population: analysis of the Korean nationwide multicenter chronic total occlusion registry
Authors: Rha Seung-Woon , Choi Byoung Geol , Choi Se Yeon , Choi Cheol Ung , Gwon Hyeon-Cheol , Chae In-Ho , Kim Hyo-Soo , Park Hun Sik , Lee Seung-Hwan , Kim Moo-Hyun , Hur Seung-Ho , Jang Yangsoo 
Published: January 2020

Objectives
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains challenging because of limited success and higher target vessel failure rates. Detailed safety and efficacy data for CTO-PCI from a multicenter real-world Korean registry are limited.

Methods
Since May 2007, the Korean multicenter retrospective CTO registry has enrolled 3271 patients who underwent CTO-PCI at 26 major medical centers. Baseline clinical, angiographic, and procedural characteristics and 12-month major adverse cardiac event (MACE) rates after PCI were retrospectively collected.

Results
Baseline cardiovascular risk factors included: male sex, 73.8%; prior myocardial infarction (MI), 14.8%; prior PCI, 26.6%; hypertension, 62.3%; diabetes mellitus, 34.8%; dyslipidemia, 33.3%; and current smoker, 30.9%. Pre-PCI myocardial viability testing was performed in 23.6% of patients and pre-PCI cardiac computed tomography (CT) in 17.6%. CTO arterial lesions were distributed as follows: right coronary, 41.0%; left anterior descending, 40.0%; left circumflex, 22.5%; and left main, 0.4%. Unfavorable lesion morphology was detected by angiography in 38.1%. Intravascular ultrasound guidance and the retrograde approach were utilized in 23.6 and 3.1% of CTO-PCI procedures, respectively. More than 75% of patients received drug-eluting stents (sirolimus-eluting, 26.5%; paclitaxel-eluting, 23.8%; zotarolimus-eluting, 23.4%; everolimus-eluting, 11.0%; and others, 4.0%). The overall success rate was 81.6% (2672/3271 patients). Twelve-month event rates were: total mortality, 2.4%; any MI, 0.7%; target lesion revascularization, 4.4%; target vessel revascularization, 6.7%; and total MACE, 9.4%.

Conclusions
Twelve-month success rates, safety profiles, and cumulative clinical outcomes of Korean CTO patients were favorable post-PCI. Long-term follow-up of larger study populations is necessary to validate our findings.
The prognostic value of the ratio of neutrophils to lymphocytes before and after intensity modulated radiotherapy for patients with nasopharyngeal carcinoma
Authors: Liu Jing , Wei Changwu , Tang Haijun , Liu Yun , Liu Wenqi , Lin Chengsen 
Published: January 2020

Abstract
This study aimed to determine the impact of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) on the prognosis of nasopharyngeal carcinoma (NPC) before and after intensity modulated radiotherapy (IMRT).
Pre/post-treatment and changes in inflammatory biomarker levels of 207 patients who were diagnosed with NPC and received IMRT between January 2012 and December 2014 were analyzed, and the cellular biomarker analyses were from patient blood. ROC (receiver operating characteristic) analysis was used to decide the optimal cutoff values of NLR and changes in NLR (ΔNLR) and PLR (ΔPLR). The Kaplan–Meier and logarithmic rank methods were used to compare overall survival times between groups. Univariate analysis was used to investigate the effects of age, gender, histology, Karnofsky performance score (KPS), TNM stage, clinical stage, course of disease and lymphocyte, neutrophil and platelet counts as well as alkaline phosphatase (ALP) levels on the prognosis of NPC. The independent predictors of OS were determined by Cox multivariate regression analysis.
The optimal cut-off values of NLR, PLR, ΔNLR and ΔPLR were 2.49, 155.82, 1.80, and 100.00, respectively. These were used to classify patients into high (NLR > 2.49) and low NLR groups (NLR < 2.49); high (PLR>155.82) and low (PLR < 155.82) PLR groups; high (ΔNLR>1.80) and low ΔNLR groups (ΔNLR < 1.80); high (ΔPLR > 100.00) and low ΔPLR groups (ΔPLR < 100.00). TNM stage, clinical stage and ALP levels were highly correlated with high NLR and PLR. Cox multivariate regression analysis suggested that the ΔNLR (HR = 2.89, 95% CI: 1.33∼2.78) was independent of the characteristics for NPC.
As a novel inflammatory index, ΔNLR appears to have some predictive power for the prognosis of patients with NPC.