bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch: the Nordic-Baltic Bifurcation Study IV
Authors: Kumsars Indulis , Holm Niels Ramsing , Niemelä Matti , Erglis Andrejs , Kervinen Kari , Christiansen Evald Høj , Maeng Michael , Dombrovskis Andis , Abraitis Vytautas , Kibarskis Aleksandras , Trovik Thor , Latkovskis Gustavs , Sondore Dace , Narbute Inga , Terkelsen Christian Juhl , Eskola Markku , Romppanen Hannu , Laine Mika , Jensen Lisette Okkels , Pietila Mikko , Gunnes Pål , Hebsgaard Lasse , Frobert Ole , Calais Fredrik , Hartikainen Juha , Aarøe Jens , Ravkilde Jan , Engstrøm Thomas , Steigen Terje K , Thuesen Leif , Lassen Jens F 
Published: January 2020

BackgroundIt is still uncertain whether coronary bifurcations with lesions involving a large side branch (SB) should be treated by stenting the main vessel and provisional stenting of the SB (simple) or by routine two-stent techniques (complex). We aimed to compare clinical outcome after treatment of lesions in large bifurcations by simple or complex stent implantation.MethodsThe study was a randomised, superiority trial. Enrolment required a SB≥2.75 mm, ≥50% diameter stenosis in both vessels, and allowed SB lesion length up to 15 mm. The primary endpoint was a composite of cardiac death, non-procedural myocardial infarction and target lesion revascularisation at 6 months. Two-year clinical follow-up was included in this primary reporting due to lower than expected event rates.ResultsA total of 450 patients were assigned to simple stenting (n=221) or complex stenting (n=229) in 14 Nordic and Baltic centres. Two-year follow-up was available in 218 (98.6%) and 228 (99.5%) patients, respectively. The primary endpoint of major adverse cardiac events (MACE) at 6 months was 5.5% vs 2.2% (risk differences 3.2%, 95% CI −0.2 to 6.8, p=0.07) and at 2 years 12.9% vs 8.4% (HR 0.63, 95% CI 0.35 to 1.13, p=0.12) after simple versus complex treatment. In the subgroup treated by newer generation drug-eluting stents, MACE was 12.0% vs 5.6% (HR 0.45, 95% CI 0.17 to 1.17, p=0.10) after simple versus complex treatment.ConclusionIn the treatment of bifurcation lesions involving a large SB with ostial stenosis, routine two-stent techniques did not improve outcome significantly compared with treatment by the simpler main vessel stenting technique after 2 years.Trial registration numberNCT01496638.
Over-Testing for Suspected Pulmonary Embolism in American Emergency Departments
Authors: Kline Jeffrey A. , Garrett John S. , Sarmiento Elisa J. , Strachan Christian C. , Courtney D. Mark 
Published: January 2020

Background:
No recent data have investigated rates of diagnostic testing for pulmonary embolism (PE) in US emergency departments (EDs), and no data have examined computed tomographic pulmonary angiography (CTPA) rates in subgroups at high risk for adverse imaging outcomes, including young women and children. We hypothesized that over-testing for PE remains a problem.

Methods and Results:

We used electronic health record and billing data for 16 EDs in Indiana and 11 hospitals in the Dallas-Fort Worth area from 2016 to 2019 to locate ED patients who had any of the following: D-dimer, CTPA, scintillation ventilation perfusion lung scanning or formal pulmonary angiography. The primary outcomes were ED encounter volume-adjusted CTPA rate, PE yield rate with subgroup reporting for children (<18 years) and women under 45 years. We also examined the most frequent diagnoses. From a total visit volume of 1 828 010 patient encounters, 97 125 (5.3% of the total volume) had a diagnostic test for PE, including 25 870 patients who had CTPA order without D-dimer (59% of all tests for PE). The yield rate for PE from CTPA scans was 1.3% (1.1%–1.5%) in Indiana and 4.8% (4.2%–5.1%) in Dallas-Fort Worth (pooled rate 3.1%). Linear regression showed that increased D-dimer ordering correlated with increased PE yield rate (Pearson’s R
2
=0.43;
P
<0.001). From the pooled sample, 59% of CTPAs done were in women, with 21% of all CTPAs performed on women under 45 years of age, and 1.4% (1.3%–1.5%) on children. The most frequent diagnoses were symptom-based descriptions of chest pain (34%) and shortness of breath (6.5%) and the condition-based diagnosis of pneumonia (4.1%).

Conclusions:
Over-testing for PE in American EDs remains a major public health problem. Centers with higher D-dimer ordering had higher yield of PE on CTPA. These data suggest the potential for implementation of D-dimer based protocols to reduce low-yield CTPA ordering.
Cognitive behavioral therapy for perinatal anxiety: A randomized controlled trial
Authors: Green Sheryl M , Donegan Eleanor , McCabe Randi E , Streiner David L , Agako Arela , Frey Benicio N 
Published: January 2020

Background:Up to one in five women meet diagnostic criteria for an anxiety disorder during the perinatal period (i.e. pregnancy and up to 1 year postpartum). While psychotropic medications are effective, they are associated with risks for mothers and babies. There is a growing demand for evidence-based non-pharmacological treatments for perinatal anxiety.Objective:To evaluate the effectiveness of a cognitive behavioral group therapy protocol for perinatal anxiety.Methods:In total, 96 women were randomized to cognitive behavioral group therapy or waitlist at a clinic specializing in women’s mental health. Participants were 22–41 years of age, pregnant or up to 6 months postpartum and had an anxiety disorder with or without comorbid depression.Results:Compared to waitlist, participants in cognitive behavioral group therapy reported significantly greater reductions in the primary outcome of anxiety (State-Trait Inventory of Cognitive and Somatic Anxiety, η2p = .19; Hamilton Anxiety Rating Scale, η2p = .16), as well as in secondary outcomes including worry (Penn State Worry Questionnaire, η2p = .29), perceived stress (Perceived Stress Scale, η2p = .33) and depressive symptoms (Edinburgh Postnatal Depression Scale, η2p = .27; Montgomery–Åsberg Depression Rating Scale, η2p = .11). Maternal status (pregnant, postpartum) and medication use were unrelated to treatment outcomes. All gains were maintained, or continued to improve, at 3-month follow-up.Conclusion:Cognitive behavioral group therapy was effective in improving anxiety and related symptoms among women with anxiety disorders in the perinatal period.
‘I wanted my child dead’ – Physical, social, cognitive, emotional and spiritual life stories of Turkish parents who give care to their children with schizophrenia: A qualitative analysis based on empowerment approach
Authors: Akgül Gök Fulya , Duyan Veli 
Published: January 2020

Background: Schizophrenia deeply affects both the lives of patients and their families. The fact that schizophrenic patients in Turkey generally maintain their lives with their families may lead to serious problems for families and parents. Aims: The main purposes of this research are to determine the physical, social, cognitive, emotional and spiritual lives of parents of children with schizophrenia with the main concepts of the empowerment approach. Method: The research was carried out with the qualitative research method. In-depth interviews were conducted with 30 parents in total, that is, 15 mothers and 15 fathers, through semi-structured interview form. Maxqda 2018 was used for the analysis of the research data. Results: According to the research result, it is determined that the parents have problems due to physical, social, cognitive, emotional and spiritual disease process; gender perspective and roles; domestic functionality; social environment, social perception; and issues related to services. Conclusion: Considering the parents who are affected by the disease process which is a particularly quite difficult process and who affect the process, to recognize the situations that lead them to gain strength and that make them powerless in personal, interpersonal and political aspects, to activate the existing resources and to create new resources are highly important factors for them to cope with the disease process effectively.
New Developmentalism, Public Policies, and Regional Inequalities in Brazil: The Advances and Limitations of Lula’s and Dilma’s Governments
Authors: Cardozo Soraia Aparecida , Martins Humberto 
Published: January 2020

Considered from the perspective of new developmentalism, the implementation of regional development policies under the Lula and Dilma governments was limited. The recovery of state activity was accompanied by the maintenance of macroeconomic policies characterized as neoliberal. In this context, social and sectoral policies had important impacts on the poorer regions in which economic and social problems are concentrated, but they were not focused on reducing regional inequalities and therefore did not substantially change the historically high level of those inequalities. Considerada da perspectiva do novo desenvolvimentismo, a implementação de políticas de desenvolvimento regional sob os governos Lula e Dilma era limitada. A recuperação da atividade estatal foi acompanhada pela manutenção de políticas macroeconômicas caracterizadas como neoliberais. Nesse contexto, as políticas sociais e setoriais tiveram impactos importantes nas regiões mais pobres nas quais os problemas econômicos e sociais estão concentrados, mas não se concentraram na redução das desigualdades regionais e, portanto, não alteraram substancialmente o nível historicamente alto dessas desigualdades.
Safety of co-placement of ventriculoperitoneal shunt and percutaneous radiologic gastrostomy
Authors: Choi Seung Myun , Han Kichang , Kim Gyoung Min , Kwon Joon Ho , Lee Junhyung , Kim Man-Deuk , Won Jong Yun 
Published: January 2020

Background There is little evidence about the safety of co-placement of percutaneous radiologic gastrostomy in patients with ventriculoperitoneal shunt. Purpose To investigate the safety of co-placement of percutaneous radiologic gastrostomy tube and ventriculoperitoneal shunt. Material and Methods Between July 2006 and June 2018, 1015 patients underwent percutaneous radiologic gastrostomy placement at our institution. Those who had undergone both ventriculoperitoneal shunt and percutaneous radiologic gastrostomy placement were selected. Patient data, including baseline characteristics, percutaneous radiologic gastrostomy types, temporal relationship between the procedures, and ventriculoperitoneal shunt infection, were retrospectively reviewed. Results Nineteen patients received percutaneous radiologic gastrostomy and ventriculoperitoneal shunt co-placement. The percutaneous radiologic gastrostomy types were pigtail-retained gastrostomy (n = 12) and pull-type gastrostomy (n = 7). Ventriculoperitoneal shunt was placed before percutaneous radiologic gastrostomy in 15 patients (79%) and vice versa in four patients (21%). Mean interval between the two procedures was 361 days (range 3–1833 days). Only one case (5.3%) of ventriculoperitoneal shunt infection occurred and it was successfully managed conservatively. There was no significant difference in the incidence of complications between the ventriculoperitoneal shunt before percutaneous radiologic gastrostomy group and the opposite group ( P = 0.789). Moreover, there was no significant difference in complication rates between the two gastrostomy catheter types ( P = 0.368). Conclusions Co-placement of percutaneous radiologic gastrostomy and ventriculoperitoneal shunt seems safe and should not be considered a contraindication. Moreover, the percutaneous radiologic gastrostomy and ventriculoperitoneal shunt should be placed as far from each other as possible.
The apparent diffusion coefficient (ADC) on 3-T MRI differentiates myometrial invasion depth and histological grade in patients with endometrial cancer
Authors: Reyes-Pérez Juan Armando , Villaseñor-Navarro Yolanda , Jiménez de los Santos Mayra Evelia , Pacheco-Bravo Irlanda , Calle-Loja Maricela , Sollozo-Dupont Isabel 
Published: January 2020

Background Diffusion-weighted magnetic resonance imaging (DW-MRI) with apparent diffusion coefficient (ADC) measurement provides additional information about tumor microstructure with potential relevance for staging and predicting aggressive disease in patients with endometrial cancer (EC). Purpose To determine whether ADC values in EC diverge according to the tumor’s histologic grade and myometrial invasion depth. Material and Methods A sample of 48 pathologically confirmed cases of EC were reviewed retrospectively. The sample was distributed as follows: G1 (n = 9); G2 (n = 18); G3 (n = 21); with myometrial invasion <50% (n = 31); and with myometrial invasion ≥50% (n = 17). DW images were performed at 3.0T with b factors of 0–1000/mm2. The region of interest (ROI) was defined within the tumor with T1-weighted and T2-weighted imaging and copied manually to an ADC map. The tumor’s grade and myometrial invasion’s depth were determined by postoperative histopathological tests. Results The means of ADCmin and ADCmean values were significantly lower for patients with G2 and G3 endometrial tumors than G1. The same tendency was observed in myometrial invasion, as both ADCmin and ADCmean values were lower for patients with deep than for those with superficial myometrial invasion. The cut-off values of the ADCmin and ADCmean that predicted high-grade tumors were 0.69 × 10−3 mm2/s and 0.82 × 10−3 mm2/s, respectively, while those for myometrial infiltration were 0.70 × 10−3 mm2/s (ADCmin) and 0.88 × 10−3 mm2/s (ADCmean). Conclusion ADCmin and ADCmean values correlated with histologic tumor grade and myometrial invasion depth; therefore, it is suggested that ADC on MRI may be a useful indicator to predict malignancy of ECs.
Zinc Supplementation and Fortification in Mexican Children
Authors: Rodríguez-Carmona Yanelli , Denova-Gutiérrez Edgar , Sánchez-Uribe Edgar , Muñoz-Aguirre Paloma , Flores Mario , Salmerón J. 
Published: January 2020

Background: Zinc is an essential micronutrient for human health. Approximately 1.4% of deaths worldwide are related to zinc deficiency. In Mexico, 33% of children younger than 5 years are zinc deficient. Objective: To give an overview of zinc supplementation and fortification in children younger than 5 years through the analysis of current regulations in Mexico, the availability of these products, and the opinion of Mexican experts in this field. Methods: We gave an overview of zinc supplementation and fortification strategies in the Mexican pediatric population by conducting a literature review of Mexican studies and national standards concerning zinc supplementation and fortification. Semistructured interviews were conducted with personnel from the main producers of zinc supplements and fortified products and from social assistance programs in Mexico. Results: Zinc supplementation in Mexico has been associated with reduction in the duration and incidence of diarrhea. Through interviews with experts, we identified several barriers in achieving adequate zinc consumption such as problems in social assistance programs that distribute zinc-fortified foods, lack of specific dietary recommendations regarding the intake of zinc, lack of regulation of nonpatented zinc supplements, and inconsistencies in public health actions due to political and administrative changes. Conclusion: Despite current regulation and efforts made by social assistance programs, zinc deficiency continues to be a prevalent public health issue. Mexico requires an in-depth analysis of existing barriers and alternatives in order to reduce zinc deficiency.
Evaluation of Vitamin B12 Monitoring in Veterans With Type 2 Diabetes on Metformin Therapy
Authors: Runeberg Haley A. , Higbea Ashley M. , Weideman Rick A. , Alvarez Carlos A. 
Published: January 2020

Background: Studies have shown an association between metformin use and vitamin B12 deficiency. Since 2017, the American Diabetes Association (ADA) Standards of Medical Care in Diabetes Guideline has included a recommendation for periodic vitamin B12 measurements in metformin-treated patients, especially those with anemia or peripheral neuropathy. Objective: To determine the overall incidence and impact of the ADA Guideline on vitamin B12 monitoring in a veteran population on long-term metformin therapy. Methods: Retrospective chart review was performed for patients on metformin who started therapy prior to 2005 at the VA North Texas Health Care System (VANTXHCS). The primary outcome was the proportion of patients with at least 1 vitamin B12 level drawn during 2016 versus 2018. Metformin dose and duration, vitamin B12 supplementation, and incident neuropathy prescriptions or diagnosis were also analyzed. Results: Of 394 patients included for the primary outcome, 136 (34.5%) had at least 1 vitamin B12 level in 2016 versus 198 (50.3%) patients in 2018 (odds ratio: 1.94, P < .001). Of the 394 patients, 157 were diagnosed with neuropathy or prescribed a medication for neuropathy without a vitamin B12 level in the previous year or with a low level that was not supplemented. Conclusion: Vitamin B12 monitoring significantly increased between 2016 and 2018, aligning with the release of the 2017 ADA guidelines. However, a large proportion of patients were identified who were diagnosed with or treated for neuropathy without adequate vitamin B12 monitoring.
Potential cross-reactivity of polysorbate 80 and cremophor: A case report
Authors: Bibera Mark Allen T , Lo Kristina M K , Steele Aaron 
Published: January 2020

Introduction Anaphylactic and hypersensitivity reactions are known adverse effects of many drug products and may be due to the inactive ingredients of the drug formulation. Specifically for paclitaxel and docetaxel, it is their excipients (cremophor and polysorbate 80, respectively) that have been identified as being most likely responsible for these reactions. Case report The patient is a 39-year-old female, with a history of breast cancer and no known allergies, who was scheduled to start chemotherapy. While being administered fosaprepitant, she reported shortness of breath and was noted to be hypotensive and flushed. Two months later, the patient returned to clinic to start weekly paclitaxel. During the administration of the paclitxel test dose, the patient reported difficulty breathing, flushing, and chest tightness. Management and outcome: Both medication reactions were managed with epinephrine and other supportive medications. Fosaprepitant was taken out of the patient’s antiemetic regimen for future cycles and paclitaxel was switched to nab-paclitaxel. Discussion It is well documented that paclitaxel and fosaprepitant have the potential to cause hypersensitivity reactions due to their excipients. While it is likely that each reaction was a unique event, it is difficult to ignore the possibility of cross-reactivity due to the presence of oleic acid in both excipients.
Embolization of visceral arterial aneurysms: Simulation with 3D-printed models
Authors: Shibata Eisuke , Takao Hidemasa , Amemiya Shiori , Ohtomo Kuni , Abe Osamu 
Published: January 2020

Objectives The present technical article aimed to describe the efficacy of three-dimensional (3D)-printed hollow vascular models as a tool in the preoperative simulation of endovascular embolization of visceral artery aneurysms. Methods From November 2015 to November 2016, four consecutive endovascular treatments of true visceral artery aneurysms were preoperatively simulated with 3D-printed hollow models. The mean age of the patients (one male and three females) was 54 (range: 40–71) years. Three patients presented with splenic artery aneurysm and one with anterior pancreaticoduodenal artery aneurysm. The average diameter of the aneurysms was 16.5 (range: 10–25) mm. The 3D-printed hollow models of the visceral artery aneurysms and involved arteries were created using computed tomography angiography data of the patients. After establishing treatment plans by simulations with the 3D-printed models, all patients received endovascular treatment. Results All four hollow aneurysm models were successfully fabricated and used in the preoperative simulation of endovascular treatment. In the preoperative simulations with 3D-printed hollow models, splenic aneurysms were embolized with coils and/or n-butyl-2-cyanoacrylate to establish the actual treatment plans, and a small arterial branch originating from an anterior pancreaticoduodenal artery aneurysm was selected to obtain feedback regarding the behavior of catheters and guidewires. After establishing treatment plans by simulations, the visceral artery aneurysms of all patients were successfully embolized without major complications and recanalization. Conclusions Simulation with 3D-printed hollow models can help establish an optimal treatment plan and may improve the safety and efficacy of endovascular treatment for visceral artery aneurysms.
Evaluating recanalization of relevant lenticulostriate arteries in acute ischemic stroke using high-resolution MRA at 7T
Authors: Suzuki Takafumi , Natori Tatsunori , Sasaki Makoto , Miyazawa Haruna , Narumi Shinsuke , Ito Kohei , Kamada Asami , Yoshida Makiko , Tsuda Keisuke , Yoshioka Kunihiro , Terayama Yasuo 
Published: January 2020

Background Occluded major intracranial arteries can spontaneously recanalize in patients with acute ischemic stroke mainly due to embolic mechanisms. However, it remains unknown whether recanalization can occur in perforating arteries, such as lenticulostriate arteries. Therefore, in the present study, we assessed changes suggesting recanalization of the lenticulostriate arteries in patients with acute ischemic stroke of the lenticulostriate artery territory using high-resolution magnetic resonance angiography (HR-MRA) at 7T. Methods We prospectively examined 39 consecutive patients with acute infarcts confined within the lenticulostriate artery territory. Using a 7T scanner during the acute period and one month thereafter, we evaluated imaging findings indicating the recanalization of the relevant lenticulostriate arteries, following which we examined differences in other imaging findings and clinical characteristics between patients with/without recanalization. Results HR-MRA findings suggestive of recanalization (i.e. patent lenticulostriate arteries within acute infarct lesions with/without hemorrhagic changes) were observed in 8 (25%) of 32 patients who were eligible for analyses. These findings were detected in three and five patients on the baseline and follow-up images, respectively. The lengths of relevant lenticulostriate arteries on the follow-up MRA were significantly larger in patients with recanalization than in those without ( P = 0.01). However, there were no significant differences in the infarct volume or clinical outcomes between the recanalization and non-recanalization groups. Conclusion HR-MRA at 7T revealed that recanalization of the relevant lenticulostriate arteries can occur in patients with acute ischemic stroke confined to the lenticulostriate artery territory.