bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optic Nerve Head Perfusion Before and After Intravitreal Antivascular Growth Factor Injections Using Optical Coherence Tomography-based Microangiography
Authors: Wen Joanne C. , Chen Chieh-Li , Rezaei Kasra A. , Chao Jennifer R. , Vemulakonda Atma , Luttrell Ian , Wang Ruikang K. , Chen Philip P. 
Published: February 2019

Purpose:
To use optical coherence tomography angiography (OCTA) to evaluate the changes in optic nerve head perfusion following intravitreal antivascular endothelial growth factor injections.

Methods:
Preinjection and postinjection intraocular pressure (IOP) and OCTA images were taken of both the injected and uninjected fellow eyes.

Results:
Mean preinjection IOP was 16.6±4.7 mm Hg, which increased to a mean of 40.3±13.0 mm Hg (P<0.0001) during the first postinjection image and remained elevated at 36.1±11.5 mm Hg (P<0.0001) during the second postinjection image. Although no significant change was observed in flux, vessel area density, or normalized flux when comparing the OCTA preinjection and first postinjection images, a significant decrease at the second postinjection image was observed (P=0.03, 0.02, and 0.03, respectively). No significant change was observed in the uninjected fellow eye during the same time period (P=0.47, 0.37, and 0.38, respectively).

Conclusions:
Following an antivascular endothelial growth factor injection, mean IOP increased significantly and OCTA imaging of the optic nerve demonstrated a mild but significant decrease in optic nerve head perfusion parameters. Clinicians performing these injections should be aware of these findings and monitor the status of the optic nerve in patients undergoing injections.
Pain coping skills training for African Americans with osteoarthritis: results of a randomized controlled trial
Authors: Allen Kelli D. , Somers Tamara J. , Campbell Lisa C. , Arbeeva Liubov , Coffman Cynthia J. , Cené Crystal W. , Oddone Eugene Z. , Keefe Francis J. 
Published: February 2019

Abstract
African Americans bear a disproportionate burden of osteoarthritis (OA), but they have been underrepresented in trials of behavioral interventions for pain. This trial examined a culturally tailored pain coping skills training (CST) program, compared to a wait list control group, among 248 African Americans with knee or hip OA. The pain CST program involved 11 telephone-based sessions over 3 months. Outcomes were assessed at baseline, 3 months (primary), and 9 months, and included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (primary outcome), WOMAC total score and function subscale, PROMIS Pain Interference, Short-Form 12 Mental and Physical Composite Subscales, Coping Strategies Questionnaire—Total Coping Attempts, Pain Catastrophizing Scale, Patient Health Questionnaire-8, Arthritis Self-Efficacy Scale, and Patient Global Impression of Arthritis Symptom Change. Linear mixed models were fit for all outcomes. There were no significant between-group differences in WOMAC pain score at 3 months (−0.63 [95% confidence interval −1.45, 0.18]; P = 0.128) or 9 months (−0.84 [95% confidence interval −1.73, 0.06]; P = 0.068). Among secondary outcomes, at 3 months, there were significant differences, in favor of the CST group, for Coping Strategies Questionnaire Total Coping Attempts, Pain Catastrophizing Scale, Arthritis Self-Efficacy, and Patient Global Impression of Arthritis Symptom Change (P < 0.01). Coping Strategies Questionnaire Total Coping Attempts, Arthritis Self-Efficacy, and Patient Global Assessment Change were also significantly improved at 9 months in the CST group, compared with wait list (P < 0.01). The culturally tailored pain CST program did not significantly reduce pain severity but did improve key measures of pain coping and perceived ability to manage pain among African Americans with OA.
Motivational Interviewing: Improving Confidence With Self-care Management in Postoperative Thoracolumbar Spine Patients
Authors: Scheffel Kimberly , Amidei Christina , Fitzgerald Kathleen A. 
Published: February 2019

ABSTRACT
Patients undergoing thoracic or lumbar spine surgery often lack confidence with self-care management of symptoms contributing to disability, such as pain, lack of sleep, depression, and immobility. The purpose of this pilot study was to examine whether a targeted motivational interview, focused on evidence-based recommendations to manage postoperative symptoms related to thoracolumbar spine surgery, would improve patient confidence with self-care management of their symptom-related disability. A quasiexperimental, 1-group, pretest-posttest design was used on a convenience sample of 15 adult surgical spine patients at a large university spine center. Level of disability was measured using the Oswestry Disability Index (ODI). Confidence with self-care management of symptom-related disability was measured using the Health Confidence Index (HCI). Paired samples t tests were completed on participants’ preintervention and postintervention scores on the HCI and ODI and on each of the 10 items that the ODI questionnaire addresses. The results of the paired samples t test on participants’ HCI scores showed a statistically significant improvement in participants’ confidence with self-care management of symptom-related disability from pretest (mean [SD], 6.73 [2.12]) to posttest (mean [SD], 8.73 [1.43]), conditions: t
14
= −3.80, P = .002. Motivational interviewing is a beneficial intervention for health professionals to incorporate into practice to encourage the implementation of various health promoting behaviors that improve confidence with self-care management of symptoms in postoperative thoracolumbar spine patients.
Opioid Prescribing Education for Physician Assistant Students: A Physician Assistant Educator Survey
Authors: Yorkgitis Brian K. , Garbas Bre , Cole Debra 
Published: February 2019

Purpose
The United States is facing an opioid public health crisis. Educating providers is essential for addressing this epidemic. This study sought to understand how physician assistant (PA) programs are educating students in opioid prescribing to avoid addiction.

Methods
An Internet-based survey was sent to PA educators about the current landscape of opioid prescribing education (OPE) and opioid addiction education (OAE) at their institutions.

Results
Eighty-eight completed surveys were analyzed to gauge opioid education in PA school: 49 (55.7%) educators have a mandatory OPE in their curriculum with most dedicating one hour to 3 hours (27, 55.1%) on this topic. Mandatory OAE was noted by 44 (50.0%) educators with one hour to 3 hours dedicated being the most common (24, 54.5%) amount of time. The most common method of instruction for both OPE and OAE was didactic lectures.

Conclusions
While some programs deliver OPE and OAE to PA students, the need exists for more programs to adopt this education.
Impact Testing of Prosthetic Feet for High-Activity Prosthesis Users: A Pilot Study
Authors: Nickel Eric , Voss Gregory , Morin Steve , Koehler-McNicholas Sara , Hendershot Brad D. , Schnall Barri L. , Gravely Amy , Barrons Kyle , Mion Spencer , Hansen Andrew 
Published: February 2019

ABSTRACT

Introduction
There is currently no accepted test standard for prosthetic feet to demonstrate durability to impact loading such as that encountered in physically demanding professions (e.g., construction, farming, or military service). The goal of the study was to build a system to pilot test the impact resilience of a selection of prosthetic feet marketed for high-activity prosthesis users.

Materials and Methods
Three specimens each of nine prosthetic feet (n = 27 total) were selected by prosthetists at the Minneapolis VA Health Care System (with specifications in accordance with an associated human-subjects research study, n = 3). Maximum drop height without failure was used to assess impact resilience. Drop testing was performed using a custom system with an electromagnet to lift and release a weighted frame in increments of 10 cm until failure. The test specimens were organized into three sets, each with one specimen of each foot with the spring category for a particular user mass. Sets A, B, and C were tested with 45.9, 57.8, and 61.5 kg, respectively (101, 127, and 135 lb, respectively) simulating the mass of the user plus an added 22 kg (48 lb) of worn/carried load, then divided by two to represent even load distribution to both legs at impact.

Results
The feet withstood drop heights without failure ranging from 20 cm to 100 cm. The type of foot was found to significantly affect maximum drop height (P = 0.014). Effect sizes for comparisons of individual feet range from 0.15 to 3.17 with the median effect size being 0.94, which is considered “large.”

Conclusions
The test system successfully measures impact resilience and is sensitive to foot type. Large effect sizes indicate substantial differences between prosthetic feet marketed for active prosthesis users.
How to deal with severe acute pancreatitis in the critically ill
Authors: De Waele Elisabeth , Malbrain Manu L.N.G. , Spapen Herbert D. 
Published: February 2019

Purpose of review
To review recent literature on the management of patients with severe acute pancreatitis (SAP) admitted to an ICU.

Recent findings
SAP is a devastating disease associated with a high morbidity and mortality. Recent evidence advocates adequate risk assessment and severity prediction (including intra-abdominal pressure monitoring), tailored fluid administration favoring balanced crystalloids, withholding prophylactic antibiotic therapy, and early detection and treatment of extra-pancreatic and fungal infections. Urgent (within 24–48 h after diagnosis) endoscopic retrograde cholangiopancreatography is indicated when persistent biliary obstruction or cholangitis are present. Corticosteroid therapy (mainly dexamethasone) can reduce the need for surgical interventions, length of hospital stay, and mortality. Peritoneal lavage may significantly lower morbidity and mortality. Hemofiltration may offer substantial benefit but more studies are needed to prove its efficacy. Enteral feeding using a polymeric formula and provided early through a nasogastric tube is recommended but has no survival benefit compared with parenteral nutrition. Probiotics could be beneficial, however no clear recommendations can be made.

Summary
Management of SAP is multimodal with emphasis on monitoring, adequate fluid resuscitation, avoiding prophylactic use of antibiotics, cause-directed procedures or treatment, and organ support. There is a role for early enteral nutrition including probiotics.
Observation of the curative effect of device-guided rehabilitation on respiratory function in stable patients with chronic obstructive pulmonary disease
Authors: Wang Jing , Guo Shuai , Zeng Ming , Yu Peng , Mo Weiqiang 
Published: February 2019

Abstract

Background:
Chronic obstructive pulmonary disease (COPD) is a serious lung disease for individuals in middle age and especially in old people. The study was aimed to observe the curative effect of device-guided rehabilitation on respiratory functions in stable COPD patients.

Methods:
Sixty-seven stable COPD patients were enrolled and assigned to the experiment group (n = 36) and the control group (n = 31). The conventional pulmonary rehabilitation treatments, including pursed lips breathing (PLB) and abdominal breathing training, were applied in the control group. Respiratory muscle training of the experiment group was performed using the respiratory endurance training device combined with traditional techniques. Both groups were assessed by 6-minute walk test (6MWT), COPD assessment test (CAT), body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index. Besides, the pulmonary function (FVC%, FEVl%) were measured at 6 months before and after treatment.

Results:
After treatment, the 6MWT, CAT, BODE index were significantly increased compared with pre-treatment in both groups (P < .01), but not FVC% and FEVl%. Compared with the control group, the combination therapy in the experiment group could significantly improve the 6MWT (P = .0094), CAT (P = .0071) and BODE index (P = .0064) as well as the changes of 6MWT (P < .01), CAT (P < .01), and BODE index (P < .01) before and after treatment.

Conclusions:
The traditional respiratory training combined with device-guided pulmonary rehabilitation can improve the respiratory muscle function and athletic ability in stable COPD patients.
Association of loss of muscle mass with mortality in liver cirrhosis without or before liver transplantation
Authors: Chang Ke-Vin , Chen Jin-De , Wu Wei-Ting , Huang Kuo-Chin , Han Der-Sheng 
Published: February 2019

Abstract

Background:
Liver cirrhosis is a risk factor for the loss of muscle mass, which is associated with numerous adverse health outcomes. This meta-analysis aimed to examine whether loss of muscle mass was a predictor of increased mortality in cirrhotic patients without or before liver transplantation.

Methods:
Without language restriction, PubMed and Embase were searched for articles published from the earliest records to December 2018 investigating the influence of loss of muscle mass on survival of cirrhotic patients. Those who had undergone liver transplantation and had hepatocellular carcinoma were excluded. The main outcome was the hazard ratio (HR) for the association of mortality with loss of muscle mass, and the secondary outcome was the association of loss of muscle mass with Child-Pugh class and death caused by severe infection.

Results:
The meta-analysis included 16 observational studies, comprising 4070 participants. The pooled crude and adjusted HRs for the association of mortality with loss of muscle mass were 2.05 (95% confidence interval [CI], 1.51–2.78) and 2.36 (95% CI, 1.61–3.46). Using Child-Pugh Class A as reference, the odds ratios (ORs) for the association of loss of muscle mass with Child-Pugh Class B and Class C were 1.68 (95% CI, 0.96–2.92) and 1.94 (95% CI, 0.66–5.65). Patients with loss of muscle mass were likely to have infection-related mortality (OR = 3.38, 95% CI, 0.61–18.88) but the association did not reach statistical significance.

Conclusions:

Loss of muscle mass is associated with mortality in cirrhotic patients without or before liver transplantation. Future studies should be conducted to explore whether exercise and nutritional supplementation can reverse muscle mass loss and improve long-term survival.
Relative efficacy and safety of early lactate clearance-guided therapy resuscitation in patients with sepsis
Authors: Pan Jianzhen , Peng Milin , Liao Chao , Hu Xia , Wang Aimin , Li Xiangmin 
Published: February 2019

Abstract

Objective:
Compelling evidence has shown that aggressive resuscitation bundles are one of the cornerstones of the successful treatment of patients with sepsis. Recent studies suggest that lactate normalization during resuscitation is a more powerful indicator of resuscitative adequacy; however, early lactate clearance-guided therapy is still not recommended. We performed this meta-analysis to evaluate the effect of early lactate clearance-directed therapy as a potentially more effective resuscitation target.

Methods:
Studies were identified using PubMed, Embase, and the Cochrane Library without region, publication type, or language restrictions. Randomized trials were included when they compared the efficacy and safety of lactate clearance-guided resuscitation versus central venous oxygen saturation (ScvO2)-guided therapy. The primary outcome was mortality, and the secondary outcomes were intensive care unit (ICU) stay, length of hospital stay, mechanical ventilation time, Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score, and Sepsis-related Organ Failure Assessment (SOFA) score.

Results:
Seven randomized controlled trials encompassing 1301 cases were reviewed. Compared with guided ScvO2 therapy, early lactate clearance-directed therapy was associated with decreased in-hospital mortality (relative ratio [RR] 0.68, 95% confidence interval [CI] 0.56 to 0.82), shorter ICU stay (mean difference [MD] −1.64 days, 95% CI −3.23 to −0.05), shorter mechanical ventilation time (MD −10.22 hours, 95% CI −15.94 to −4.5), and lower APACHE-II scores (MD −4.47, 95% CI −7.25 to −1.69). However, patients undergoing early lactate clearance-guided therapy had similar lengths of hospital stay and similar SOFA scores.

Conclusions:
As a specific indicator of resuscitation outcome, lactate clearance alone is superior to ScvO2 alone during a standard resuscitation paradigm. The optimal or desired rate of lactate clearance is still a contentious area. To guide resuscitation and normalize lactate levels in patients, repeating lactate measurements every 2 hours until the patient has met a lactate clearance of 10% or greater may be helpful.

Trial registration number:
PROSPERO CRD42018100515.
Systematic review of treatment strategy for recurrent hepatocellular carcinoma
Authors: Wang Hong-Liang , Mo Dun-Chang , Zhong Jian-Hong , Ma Liang , Wu Fei-Xiang , Xiang Bang-De , Li Le-Qun 
Published: February 2019

Abstract

Aims:
The aim of our systematic review was to compare the efficacy of salvage liver transplantation (SLT) versus curative locoregional therapy (CLRT) for patients with recurrent hepatocellular carcinoma (HCC).

Methods:
Studies comparing the SLT with CLRT for patients with recurrent HCC were selected from database of PubMed, EMBASE, and Cochrane library. The outcomes including overall survival, disease-free survival, and complications were abstracted. Individual and pooled odds ratio (OR) with 95% confidence interval of each outcome was analyzed.

Results:
Seven retrospective studies involving 840 patients were included. There is no difference between SLT and CLRT group regarding the1- and 3-year overall survival rates. However, the 5-year overall survival and 1-, 3-, 5-year disease-free survival were significantly higher after SLT than after CLRT (OR = 1.62, 95% CI 1.09–2.39, P = .02; OR = 4.08, 95% CI 1.95–8.54, P = .0002; OR = 3.63, 95% CI 2.21–5.95, P <.00001; OR = 5.71, 95% CI 2.63–12.42, P <.0001, respectively). But CLRT was associated with fewer complications and shorter hospital-stay compared with SLT. For SLT compared with repeat hepatectomy (RH), the subgroup analysis indicated that SLT group had a significantly higher 3- and 5-years disease-free survival than the RH group (OR = 3.23, 95% CI 1.45–7.20, P = .004; OR = 4.79, 95% CI 1.88–12.25, P = .001, respectively).

Conclusion:
The efficacy of SLT may be superior to that of CLRT in the treatment of recurrent HCC. However, considering the similar overall survival rate and current situation of donor shortage, RH is still an important option for recurrence HCC.
Acute fibrinous and organizing pneumonia
Authors: Wang Yuanhui , Li Yuwen , Wang Qian , Zhang Lili , Li Jun , Zhu Chuanlong 
Published: February 2019

Abstract

Rationale:
Acute fibrinous and organizing pneumonia (AFOP) is an uncommon type of acute lung injury associated with infection, connective tissue disorders, drug exposure, and hematologic malignancies.

Patient concerns:
A 53-year-old female presented with intermittent fever, chills, and dry cough since 10 days. Chest computed tomography scan showed multiple bilateral patchy infiltrates. PPD skin test was positive but tuberculosis antibody test and T-SPOT were negative.

Diagnoses:
Histologic examination revealed massive fibrinous exudation with organization within alveolar spaces and scattered neutrophilic infiltrates, which was consistent with AFOP.

Interventions:
This patient was treated with prednisolone therapy.

Outcomes:
Chest radiograph improvement and symptom improvement, including fever and respiratory symptoms, was observed after 2 week of oral prednisolone treatment. After 9-month of treatment, the patient was asymptomatic with stable disease and improved quality of life.

Lessons:
AFOP has unique pathologic manifestations; however, the condition is liable to be misdiagnosed as community-acquired pneumonia ortuberculosis. Antibiotics are ineffective, while some patients show good response to glucocorticoid therapy.
Circulating long noncoding RNA ZNFX1 antisense RNA negatively correlates with disease risk, severity, inflammatory markers, and predicts poor prognosis in sepsis patients
Authors: Xu Yahuan , Shao Bibo 
Published: February 2019

Abstract
This study aimed to investigate the correlation of long noncoding RNA (lncRNA) ZNFX1 antisense RNA (ZFAS1) with disease risk, severity, inflammation markers, and prognosis in sepsis patients.
A total of 202 sepsis patients were consecutively enrolled, and 200 healthy volunteers were also recruited as healthy controls (HCs). Plasma samples of all patients and HCs were collected. LncRNA ZFAS1 expression was determined by quantitative polymerase chain reaction assay and inflammatory cytokines levels were detected by enzyme-linked immunosorbent assay.
The median value of lncRNA ZFAS1 expression in sepsis patients was (0.639 [0.325–1.071]), which was lower compared to HCs (1.957 [0.876–3.245], P < .001], and receiver operating characteristics (ROC) curve revealed that lncRNA ZFAS1 expression had a good diagnostic value for sepsis with area under curve (AUC) of 0.814 (95% confidence interval [CI]: 0.771–0.857). Spearman test disclosed that lncRNA ZFAS1 expression was negatively correlated with Acute Physiology and Chronic Health Evaluation (APACHE) II score (r = −0.505, P < .001), and it was negatively associated with levels of C-creative protein (r = −0.241, P = .001), tumor necrosis factor-α (r = −0.253, P < .001), and interleukin (IL)-6 (r = −0.177, P = .012) while positively associated with IL-10 level (r = 0.173, P = .014). Also, lncRNA ZFAS1 expression was lower in survivor group compared to nonsurvivor group (P < .001), and it presented with a good predictive value on distinguishing nonsurvivors from survivors in sepsis patients with AUC of 0.628 (95% CI: 0.538–0.717).
Circulating lncRNA ZFAS1 expression negatively correlates with disease risk, severity, and inflammatory markers levels, and might predict worse survival in sepsis patients.
Relationship of the ORBIT and HAS-BLED scores with Killip class 3-4 in patients with ST-segment elevation myocardial infarction
Authors: Zhang Qing , Zhou Lei , Cai Hong-Li , Lu Hui-He 
Published: February 2019

AbstractHeart failure (HF) complicating ST-segment elevation myocardial infarction (STEMI) is recognized as an ominous complication. The HAS-BLED and Outcomes Registry for Better Informed Treatment (ORBIT) scores are used to assess the bleeding risk in patients with anticoagulated atrial fibrillation. This study aimed to investigate the relationship of the ORBIT and HAS-BLED scores with Killip class 3-4 in patients with STEMI.639 patients with STEMI were enrolled in this study. The ORBIT and HAS-BLED scores were recorded after admission, and all patients were divided into 2 groups: the Killip class 1-2 and Killip class 3-4 groups. Different clinical parameters were compared. The predictive values of the ORBIT and HAS-BLED scores for Killip classes 3 to 4 were assessed using receiver-operating characteristic (ROC) analyses. Univariate and multivariate logistic analyses were used to evaluate the relationships between variables and Killip class 3-4.The ORBIT and HAS-BLED scores were higher in the Killip class 3-4 group than in the Killip class 1-2 group (P < .05). The areas under the ROC curve of the ORBIT and HAS-BLED scores for predicting the higher Killip classification were 0.818 (95% CI: 0.786–0.847,P < .0001) and 0.674 (95% CI: 0.636–0.710,P < .0001), respectively. In multivariate logistic analysis, the high ORBIT score was positively associated with Killip classes 3 to 4 after adjustment (odds ratio: 2.306, 95% CI: 1.084–4.911,P = .012).A graded relationship was found in the elevated ORBIT and HAS-BLED scores and Killip classes 3 to 4 in patients with STEMI. The ORBIT score is independently associated with the Killip 3-4 in patients with STEMI.