bluuebunny/crossref_metadata_2025_split huggingface dataset:
Yolk Sac Tumors of the Head and Neck in Aicardi Syndrome
Authors: Epperson Madison V. , Born Hayley L. , Wang Dehua , Myer Charles M. 
Published: October 2019

Objectives: To understand that yolk sac tumors (YSTs) of the head and neck (H&N) are exceedingly rare and typically carry a poor prognosis. To acknowledge the possibility of increased incidence in patients with Aicardi Syndrome and the ramifications this has on early diagnosis and treatment in this population. Methods: To date, four germ cells tumors of the H&N have been reported in patients with Aicardi Syndrome. This report presents the second known case of a H&N YST in a patient with Aicardi syndrome. In both cases, the patient was initially misdiagnosed given unconvincing radiologic evidence. However, tissue diagnosis and elevated alpha-fetoprotein (AFP) levels were suggestive of a YST. Results: In contrast to the poor prognosis previously described, both patients with Aicardi syndrome had an excellent chemotherapeutic response exhibited by normalization of AFP levels and imaging. Conclusions: Rare germ cell tumors of the H&N, such as YSTs, have now been documented in several patients with Aicardi syndrome, indicating a possible association given the rarity of these tumors in the population. YSTs should be considered in the differential diagnosis of H&N masses in these patients, with emphasis on early tissue diagnosis and treatment.
The Impact of Medical Scribes on Patient Satisfaction in an Academic Otolaryngology Clinic
Authors: Keefe Katherine R. , Levi Jessica R. , Brook Christopher D. 
Published: October 2019

Objectives:Evidence shows that scribes can improve provider efficiency and satisfaction in several settings, but is mixed on whether scribes improve patient satisfaction. We studied whether scribes improved patient satisfaction in an academic otolaryngology clinic.Methods:The authors performed a retrospective review of patient responses to the Press Ganey survey between 12/2016 and 12/2017. Their responses about satisfaction with the provider and wait times were examined. Three providers worked with scribes during this year; each spent six months with a scribe and six without. The authors compared survey responses from periods with and without scribes using the Fischer exact test. Average overall provider ratings were compared using the Student’s t-test.Results:A total of 87 patients filled out Press Ganey surveys for the 3 providers over the year: 54 for visits without scribes, and 33 for visits with scribes. Fischer exact analysis demonstrated no significant difference in satisfaction with providers and wait times for both individual providers and all providers combined (all P > .05). There was also no difference in patients’ likelihood of recommending the provider’s office ( P = .91). Overall provider rating (0-10 scale) was high without scribes (9.48 ± 1.06) and was unchanged by the presence of scribes (9.53 ± 0.8) ( P = .97).Conclusion:Patient satisfaction with wait times and providers was high overall and was not affected by the presence of a medical scribe.
A comparison of high versus low dose of exercise training in exercise-based cardiac rehabilitation: a randomized controlled trial with 12-months follow-up
Authors: Petersen Annemette Krintel , Oestergaard Lisa Gregersen , van Tulder Maurits , Laustsen Sussie 
Published: October 2019

Objective: To assess if a higher dose of exercise training in exercise-based cardiac rehabilitation could affect improvements in aerobic capacity and muscle strength. Design: Assessor-blinded randomized controlled trial with 12-months follow-up. Setting: Aarhus University Hospital, Aarhus, Denmark. Subjects: A total of 164 cardiac patients referred to exercise-based cardiac rehabilitation were recruited. Interventions: Patients were randomized to 1-hour exercise sessions either three times weekly for 12 weeks (36 sessions, high-dose group) or twice weekly for 8 weeks (16 sessions, low-dose group). The same standardized exercise and intensity protocol including aerobic and muscle strength training was used in all participants. Main measures: Primary outcome was changes in VO2peak. Secondary outcomes were changes in maximal workload, muscle strength and power. Measures were obtained at baseline, after termination of the rehabilitation programme and at follow-up after 6 and 12 months. Results: After the end of intervention, statistically significant between-group differences were seen in favour of the high-dose group in all outcomes: VO2peak 2.6 (mL kg−1 min−1) (95% confidence interval (CI): 0.4–4.8), maximal workload 0.3 W kg−1 (95%CI: 0.02–0.5), isometric muscle strength 0.7 N m kg−1 (95%CI: 0.1–1.2) and muscle power 0.3 W kg−1 (95%CI: 0.04–0.6). After 12 months, a significant between-group difference only persisted in VO2peak and maximal workload. Conclusion: A higher dose of exercise training had a small effect on all outcomes at termination of intervention. A long-term effect persisted in VO2peak and maximal workload. Although the effect was small, it is an important finding because VO2peak is the most important predictor of all-cause mortality in cardiac patients.
Clinical pharmacology of the dual orexin receptor antagonist ACT-541468 in elderly subjects: Exploration of pharmacokinetics, pharmacodynamics and tolerability following single-dose morning and repeated-dose evening administration
Authors: Muehlan Clemens , Boehler Margaux , Brooks Sander , Zuiker Rob , van Gerven Joop , Dingemanse Jasper 
Published: October 2019

Background: The dual orexin receptor antagonist ACT-541468 showed sedative pharmacodynamic effects during initial clinical testing in adult subjects. The present study explored pharmacokinetics, pharmacodynamics and tolerability in healthy elderly subjects. Methods: Double-blind, placebo-controlled, randomised, single-ascending dose study in 24 male/female elderly (65–80 years, 5, 15 and 25 mg in the morning, 6/2 active/placebo per group). Additionally, 10 subjects (8/2 active/placebo) received 25 mg for 7 days in the evening. Pharmacokinetics, pharmacodynamics (saccadic peak velocity, adaptive tracking, body sway, visual analogue scales according to Bowdle and Bond and Lader, Karolinska Sleepiness Scale) and tolerability were assessed. In particular, pharmacodynamics results are to be interpreted exploratorily. Results: Absorption was quick with a median time to maximum concentration of ∼ 1.0 h. The mean elimination half-life was 8.5–9.8 h, the area under the curve and the maximum plasma concentration increased proportionally with dose. Following repeated evening administration of 25 mg, minimal accumulation was observed. There were no pharmacodynamic effects at 5 mg. At 15 mg, saccadic peak velocity (degree/s; SD) was reduced (69; 38), while other variables showed no effects. At 25 mg, effects on all objective pharmacodynamic parameters were observed. At 8–12 h post-dose, there were no differences to placebo and no next-day effects on pharmacodynamic variables after evening administration. Elderly subjects reported fewer adverse events compared to adults in previous studies. Conclusion: ACT-541468 in elderly subjects was well tolerated and pharmacokinetics and pharmacodynamics are compatible with a drug for the treatment of insomnia. Clinicaltrials.gov: NCT02571855
Impact of tricyclic antidepressants, selective serotonin reuptake inhibitors, and other antidepressants on overall survival of patients with advanced lung cancer from 2004 to 2014: University of Cincinnati experience
Authors: Abdel Karim Nagla Fawzy , Hassan Rammey , Siddiqi Nabeela Iffat , Eldessouki Ihab , Gaber Ola , Rahouma Mohamed , Kamel Mohamed , Yellu Mhender , Gulati Shuchi , Xie Changchun , Magdy Mohamed , Pruemer Jane 
Published: October 2019

Objectives To evaluate and categorize the survival benefit of tricyclic antidepressants (TCAs) in lung cancer patients based on systematic computational drug repositioning data. Methods Data were retrospectively extracted from the medical records of non-small cell lung cancer (NSCLC) patients from the University of Cincinnati Cancer Medical Center database. Patients receiving antidepressants during their course of anti-cancer treatment were compared with those without antidepressants. Data were analyzed using Kaplan–Meier survival curves with the log-rank test, and overall survival (OS) was calculated from the date of diagnosis until last follow-up or death. Results The median OS at 2 and 5 years for patients on antidepressants was 20.3 months (54.7% and 42%) vs 44.3 months (47.6% and 43.2%), which was not significant. The median OS for patients receiving TCAs, selective serotonin reuptake inhibitors, and other antidepressants was 3.17 months, 31.33 months, and 18.50 months, respectively. Conclusion We found no significant survival benefit for TCA use in combination with anti-cancer agents in NSCLC patients.
Quantifying the number of lymph nodes for examination in breast cancer
Authors: Sun Liping , Li Ping , Ren He , Liu Gang , Sun Lining 
Published: October 2019

Objective Examining the correct number of lymph nodes when diagnosing breast cancer invasion is still a problem. This work aimed to develop a qualification model that estimates the possibility of missing nodes and the number of lymph nodes that need to be examined. Methods By analyzing lymph node invasion of 303,760 breast cancer samples with primary tumor stage and the number of examined and positive lymph nodes from the Surveillance, Epidemiology and End Results database using a beta-binomial model, the number of nodes that should be examined was quantified in different stages. Results In general, to reduce the possibility of missing positive nodes to less than 10%, 21 lymph nodes should be examined; thus, the current median of dissected nodes (12) is not adequate. The number of nodes needed to be dissected for stages T1, T2, and T3 are 8, 37, and 87, respectively. Currently, the median number of node dissections for these stages were 12, 13, and 14, respectively. The clinical significance of the nodal staging score was validated with survival information. Conclusion Currently, the number of lymph nodes dissected in breast cancer are excessive for T1 but insufficient for T2 and T3.
Defining the north Australian monsoon onset: A systematic review
Authors: Lisonbee Joel , Ribbe Joachim , Wheeler Matthew 
Published: October 2019

The annual Australian monsoon pattern includes an onset, or the much anticipated first active monsoon period of the season, but defining the monsoon onset has proven to be problematic. Since the first Australian monsoon onset definition by Troup in 1961 there have been many others presented. There appears to be no universally accepted method to define the Australian monsoon onset, and therefore, we present here an analysis of the methods that have been proposed. The aim of this paper is to systematically review the different methods used to define the Australian monsoon onset, adding to the work that has been done by other reviews for monsoon systems around the world. For the first time, we identify the 25 different methods that have been published for the Australian monsoon/wet season onset and compare them to identify how well they align. When considering the 57 seasons where more than one onset definition is provided, the range of dates within the season can range over several months, with an average range of 44 days and the largest range within a season of 78 days. Thus, we show that different onset definitions are capturing different events altogether and pin the ‘onset’ to different dates throughout the progression of the north Australian wet season. Some capture a ‘wet season onset’ while others capture the dynamical overturning of the atmosphere (i.e. the monsoon). In conclusion, our analysis finds that there is still a lack in real-time monitoring or prognostic capabilities of monsoon onset dates as well as limited operational applicability despite a plethora of definitions.
Preoperative noninvasive artery flow volume and maturation of arteriovenous fistulae: A single surgeon’s experience from 403 cases
Authors: Blessios George , Hlepas Alexander , Diaz Alonso 
Published: October 2019

Background: Preoperative Doppler ultrasound evaluation of arteriovenous fistula inflow artery includes measurements of arterial diameter and flow volume. The purpose of this study was to evaluate the significance of flow volume to arteriovenous fistula maturation rate. Study design: Review of consecutive patients who underwent arteriovenous fistula creation by a single surgeon. Cases with available preoperative arterial diameter and flow volume were analyzed. Primary end point was arteriovenous fistula failure to mature. Information collected included demographics, Doppler ultrasound reports, level of inflow artery, operative reports, and outcomes to the time of arteriovenous fistula maturation or failure. Risk factors were identified by logistic regression analysis. Outcomes were compared by odds ratio. Results: Four hundred and three cases were identified. Arterial diameter and flow volume were both independent significant risk factors affecting arteriovenous fistula maturation rate (p = 0.001). Arterial diameter of <2.5 mm and flow volume of <20 mL/min predicted failure to mature with 95% specificity. Further comparison of cases with optimal arterial diameter but flow volume of <20 mL/min showed increased failure to mature rate compared to the combination of optimal arterial diameter with optimal flow volume (p = 0.01) Conclusion: Preoperative arterial diameter and flow volume values were both significant independent variables affecting arteriovenous fistula maturation rate. However, flow volume of <20 mL/min remained a significant risk factor to failure-to-mature rate, despite optimal arterial diameter.
The effect of breastfeeding on postpartum fructosamine and HbA1c values after normal pregnancy
Authors: Kearse Cynthia , Carson Michael P , Kane Maureen , Fitzgerald Rosemary , Ragone Patricia , Plante Lauren 
Published: October 2019

Introduction Breastfeeding can lower postpartum oral glucose tolerance test results by 5%. Similar data do not exist regarding fructosamine and HbA1c. The primary outcome was to determine if breastfeeding would lower fructosamine values by 5%. Methods At the 4–8 week postpartum visit, women with uncomplicated pregnancies were given a questionnaire and had blood drawn for fructosamine and HbA1c. Results Breastfeeding ( n = 22) and non-breastfeeding women ( n = 28) were demographically similar, including postpartum weight loss. The respective values among breastfeeding and non-breastfeeding women were: fructosamine 2.20 versus 2.21 mmol/L; HbA1c 5.2% versus 5.2%. Only two of the seven women with an HbA1c of 5.7% or more had an abnormal fructosamine. Conclusion After uncomplicated pregnancies, breastfeeding was not associated with lower levels of postpartum fructosamine or HbA1c. Future research to improve screening for persistent postpartum dysglycemia in high-risk populations can utilize these tests without concern that results will be confounded by breastfeeding.
microRNA-329 reduces bone cancer pain through the LPAR1-dependent LPAR1/ERK signal transduction pathway in mice
Authors: Wu Xian-Ping , Yang Yan-Ping , She Rui-Xuan , Xing Zu-Min , Chen Han-Wen , Zhang Yi-Wen 
Published: October 2019

Background: Bone cancer pain (BCP) is a common symptom occurring among patients with cancer and has a detrimental effect on their quality of life. Growing evidence has implicated microRNA-329 (miR-329) in the progression of bone diseases. In the present study, we aimed to elucidate the potential effects of miR-329 on BCP in a BCP mouse model via binding to lysophosphatidic acid receptor 1 (LPAR1) through the LPAR1/extracellular signal-regulated kinase (ERK) signaling pathway. Methods: Initially, a BCP mouse model was established via injection of 4 × 104 murine breast tumor (4T1 cell) cells (4 μl). The interaction between miR-329 and LPAR1 was identified using a bioinformatics website and dual luciferase reporter gene assay. The modeled mice were subsequently treated with miR-329 mimic, LPAR1 shRNA, or both, in order to examine the effect of miR-329 on the paw withdrawal threshold (PWT) and paw withdrawal latency (PWL) of mice, the expression of LPAR1/ERK signaling pathway-related genes. Results: The positive expression rate of LPAR1 protein and extent of ERK1/2 phosphorylation were increased in BCP mouse models. LPAR1 is a target gene of miR-329, which can inhibit the expression of LPAR1. In response to miR-329 overexpression and LPAR1 silencing, BCP mice showed increased PWT and PWL, along with decreased LPAR1 expression and ratio of p-ERK/ERK. Conclusions: Altogether, the results obtained indicated that miR-329 can potentially alleviate BCP in mice via the inhibition of LPAR1 and blockade of the LPAR1/ERK signaling pathway, highlighting that upregulation of miR-329 could serve as a therapeutic target for BCP treatment.
Zoledronic acid plus methylprednisolone versus zoledronic acid or placebo in symptomatic knee osteoarthritis: a randomized controlled trial
Authors: Cai Guoqi , Laslett Laura L , Aitken Dawn , Cicuttini Flavia , March Lyn , Hill Catherine , Winzenberg Tania , Jones Graeme 
Published: October 2019

Background: The aim of this study was to compare the efficacy and safety of zoledronic acid (ZA) plus intravenous methylprednisolone (VOLT01) to ZA, and placebo for knee osteoarthritis. Methods: A single-center, double-blind, randomized controlled trial (RCT) was carried out. Adults (aged ⩾50 years) with knee osteoarthritis, significant knee pain [⩾40 mm on a 100 mm visual analog scale (VAS)], and magnetic resonance imaging-detected bone marrow lesion (BML) were randomized to receive a one-off administration of VOLT01, ZA, or placebo. The primary hypothesis was that VOLT01 was superior to ZA in having a lower incidence of acute phase responses (APRs) over 3 days. Secondary hypotheses were that VOLT01 was noninferior to ZA, and both treatments were superior to placebo in decreasing BML size over 6 months and in improving knee pain [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and VAS] and function (WOMAC) over 3 and 6 months. Results: A total of 117 patients (62.2 ± 8.1 years, 63 women) were enrolled. The incidence of APRs was similar in the VOLT01 (90%) and ZA (87%) groups ( p = 0.74). VOLT01 was superior to ZA in improving knee pain and function after 6 months and noninferior to ZA in reducing BML size. However, BML size change was small in all groups and there were no between-group differences. Compared with placebo, VOLT01 but not ZA improved knee function and showed a trend toward improving knee pain after 6 months. Conclusions: Administering intravenous methylprednisolone with ZA did not reduce APRs or change knee BML size over 6 months, but in contrast to ZA or placebo, it may have a beneficial effect on symptoms in knee osteoarthritis. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12613000039785.
Patterns of Sharps Handling and Disposal Among Insulin-Using Patients With Diabetes Mellitus
Authors: Montoya Jordan M. , Thompson Bithika M. , Boyle Mary E. , Leighton Melinda E. , Cook Curtiss B. 
Published: October 2019

Background: The objective of this study was to assess disposal patterns for “sharps” among a cohort of patients with diabetes mellitus (DM) receiving insulin therapy. Method: A convenience sample of inpatients and outpatients was surveyed about how they disposed of sharps, how often they reused lancets and needles, and what education they had received about proper disposal. Safe disposal was defined as discarding sharps into a formal sharps or sealable container; otherwise, disposal was categorized as unsafe. Results: Of 150 respondents, 56% were men and 75% were white. The mean (SD) age was 56 (15) years; duration of DM, 20 (13) years; and hemoglobin A1c, 8.1% (2.0%). Half the respondents reused a lancet two or more times, and 21% reused an insulin needle two or more times. Thirty-eight percent of respondents discarded lancets unsafely, and 33% discarded insulin needles unsafely, typically by throwing these items into household trash. Most respondents (75%) discarded insulin pens, vials, cartridges, insulin pump supplies, and continuous glucose monitor sensors into household trash. Most (64%) indicated that they had not received education on safe sharps-disposal practices, and 84% had never visited their municipal website for information on medical waste disposal. Conclusion: Approximately one-third of patients unsafely disposed of sharps. Unsafe disposal could cause millions of sharps to appear in the municipal solid waste stream, thereby posing a substantial public health hazard. Point-of-care patient education is important, but a broader public health campaign may be required.
System Accuracy Assessment of a Combined Invasive and Noninvasive Glucometer
Authors: Pfützner Andreas , Demircik Filiz , Pfützner Johannes , Kessler Kim , Strobl Stephanie , Spatz Jan , Pfützner Anke H. , Lier Alexander 
Published: October 2019

Background: The pain associated with pricking the fingertip for blood glucose self-testing is considered to be a major burden in diabetes treatment. This study was performed to evaluate the system accuracy of the invasive TensorTip Combo Glucometer (CoG) device component in accordance with ISO15197:2015 requirements and to explore the accuracy of the noninvasive tissue glucose prediction component. Methods: One hundred samples were obtained from people with type 1 and type 2 diabetes and healthy volunteers (43 females, 57 males; age: 53 ± 16 years), with glucose distribution as requested by the ISO standard. Three strip lots were tested twice by healthcare professionals in comparison to YSI 2300 Stat Plus reference method followed by a noninvasive tissue glucose reading (NI-CoG). Mean Absolute (Relative) Difference (MARD) was calculated and a consensus error grid (CEG) analysis was performed. Results: The ISO system accuracy criteria were met with the invasive strip technology by 586/600 of the data points (97.1%) and for each strip lot separately. All invasive results (100%) were within CEG-zone A and total MARD was calculated to be 7.1%. With the noninvasive reading, 99% of raw data points were in A + B (91.1% and 7.8%), and the total MARD was calculated to be 18.1%. Discussion: The invasive component of the CoG device was shown to be in full compliance with the current ISO15197 criteria. Good results were also obtained with the NI-CoG tissue glucose prediction. This noninvasive technology would potentially be suitable for frequent pain-free glucose monitoring in many people with diabetes.