bluuebunny/crossref_metadata_2025_split huggingface dataset:
Projected Health Care Associated Costs of Workplace-Related Traumatic Amputation After 10, 15, and 20 Years: Part I: Lower Limb
Authors: Wanamaker Andrea B. , Andridge Rebecca R. , Chaudhari Ajit M.W. 
Published: March 2019

ABSTRACT

Introduction
Previous research has determined the impact of different types of lower-limb prostheses on functional and biomechanical outcomes. Little work, however, has examined the effect of amputation and prostheses on health care costs. The purpose of this investigation was to estimate long-term health care associated costs in individuals with lower-limb amputation of varying limb loss level.

Materials and Methods
An insurance claims database was obtained via a public records request from the Ohio Bureau of Workers’ Compensation for 361 persons who experienced a traumatic injury in the workplace that resulted in lower-limb amputation. Insurance claims included costs associated with prosthetic limbs and equipment, general hospital care, physical therapy, vocational therapy, prescription medication, and additional health care categories. The population was categorized into two limb loss levels: persons with unilateral transtibial amputation and persons with transfemoral amputation. Prosthetic insurance claim codes were examined to determine and classify the type of prostheses prescribed, based on Medicare guidelines for activity levels (K1–K4), to estimate yearly health care costs associated with each type of prosthesis. These data were used to construct Markov decision models to estimate the expected distribution of long-term (10, 15, and 20 years) health care costs after receiving a prosthesis associated with transtibial and transfemoral amputation.

Results
Sixty-two persons with transfemoral amputation and 108 persons with transtibial amputation met our inclusion/exclusion criteria. Average time between prosthesis prescriptions varied based on activity and limb loss levels, and on average, individuals with transtibial amputation received a new prosthesis every 1.3 ± 1.6 years and individuals with transfemoral amputation every 2.3 ± 1.8 years. Annual costs associated with activity and limb loss levels varied greatly over time, ranging from $3,000 to $150,000 per patient. Projected health care associated costs totaled $546,067 ± $293,411 and $253,766 ± $142,206 over 20 years for transfemoral and transtibial amputations, respectively.

Conclusions
The results of this cost investigation provide new information regarding all aspects of health care for individuals with lower-limb amputation, including trends in prosthesis prescription and yearly costs, and how prosthetic prescription may alter these long-term costs.
Implementation of a virtual patient-centered weight loss maintenance behavior competency assessment in adults with obesity
Authors: Brunacini Kevin 
Published: March 2019

ABSTRACT

Background:
Evidence shows that 95%–98% of individuals who undergo a diet for weight loss purposes will gain back their weight within 5 years.

Local problem:
No standardized method exists to assess weight loss maintenance (WLM) behavior competencies in patients who lose weight within a telehealth nutritional counseling private practice. Incorporating this assessment can be used to increase patient self-efficacy and predict a patient's likelihood of long-term weight success.

Methods:
A quality improvement project, implementing four rapid plan-do-study-act cycles, was conducted. Each cycle included tests of change related to team and patient engagement, implementation of a WLM assessment, and an audit adherence. Data were analyzed using run charts to evaluate the impact of interventions on outcomes.

Interventions:
The clinical team submitted a weekly WLM competency survey. A patient intake form was completed to identify behavior risks, followed by implementation of a WLM assessment in weekly follow-ups. A team adherence audit was completed and submitted every week.

Results:
Team WLM competency levels increased 32%, averaging 82% at study conclusion. Completion of the patient intake form reached and held at 100% for the entire duration. Team usage of the WLM assessment peaked at 97%, correlating to increased patient behavior competence by 27.5% as the patient advanced. Team adherence gradually increased, peaking at 100%.

Conclusions:
Patient screening forms and audit logs created a standardized process to collect, deliver, and better coordinate care. The findings suggest that patients who embodied higher behavioral competence will have a greater likelihood of sustaining their weight results and become the successful 2%–5% of weight maintainers.
Omega-3 and ranibizumab for age-related macular degeneration
Authors: Meng Yan , Liu Hong-wei , Sun Peng , Zhou Ping-ping , Wang Jian-jie 
Published: March 2019

Abstract

Background:
Omega-3 and ranibizumab (O3R) has been reported to treat age-related macular degeneration (ARMD) effectively. However, up to the present, no systematic review specifically addressed the efficacy of O3R for the treatment of ARMD. Therefore, in this study, we will propose to assess the efficacy and safety of O3R for the treatment of ARMD.

Methods:
We will search PUMBED, EMBASE, CINAHI, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, Wanfang Data, as well as the gray literature from inception up to the present. We will accept randomized controlled trials for assessing the efficacy and safety of O3R for ARMD. The primary outcomes include change in best corrected visual acuity and central retinal thickness. The secondary outcomes consist of changes in subfoveal choroidal thickness, macular atrophy, retinal average sensitivity, contrast sensitivity, glare disability, and quality of life. In addition, incidence and severity of adverse events will also be evaluated. Cochrane Collaboration tool will be used to assess the risk of bias for each included study. In addition, Grading of Recommendations Assessment, Development, and Evaluation tool will be utilized to assess the overall strength of the evidence. Two authors will independently carry out all procedures and any divergences will be solved through discussion with a third author. If it is possible, we will conduct meta-analysis and subgroup analysis concerning different interventions, risk of bias, and outcome measurements.

Results:
In this proposed study, we outline details of the aims and methods of efficacy and safety of O3R for the treatment of ARMD.

Conclusion:
The findings of this systematic review will summarize current evidence of O3R for the treatment of patients with ARMD.

Dissemination and ethics:
The results of the present study are expected to be published by peer-reviewed journals. This is a literature-based study. Thus, ethical approval is unnecessary for this study.

Systematic review registration:
PROSPERO CRD42019121177.
Efficacy and safety of adjunctive corticosteroids therapy for patients with severe community-acquired pneumonia
Authors: Huang Jing , Guo Jiquan , Li Hongtao , Huang Weibin , Zhang Tiantuo 
Published: March 2019

Abstract

Background:
The systemic use of corticosteroids for patients in severe community-acquired pneumonia (CAP) remains disputed in clinical practice. We undertook a systematic review and meta-analysis to assess the efficacy and safety of corticosteroids in patients with severe CAP.

Methods:
We searched MEDLINE (1946 to June 2018), EMBASE (1966 to June 2018), and the Cochrane Library database for randomized controlled trials (RCTs) conducted for severe CAP. The endpoints of the study included total mortality, length of intensive care unit (ICU) stay and mechanical ventilation.

Results:
Nine trials which contained 914 patients were included for final meta-analysis. Of the 488 patients in the corticosteroid group, there were 37 deaths (7.58%) and 56 deaths occurred in 426 patients in the control group (13.1%). Corticosteroid therapy was associated with a lower rate of all-cause mortality compared to control (odd ratio [OR] 0.63, 95% confidence interval [CI] 0.42–0.95, P = .03). Subgroup analysis was conducted to show that the drug type modified the effect of steroids for mortality rate: prednisolone or methylprednisolone therapy (OR 0.37, 95% CI 0.19–0.72) reduced total mortality, whereas hydrocortisone use did not (OR 0.90, 95% CI 0.54–1.49). We found the length of ICU stay was significantly shorter in the steroid group compared to control (MD −2.52 days, 95% CI −4.88 to −0.15; P = .04). And there was a reduction trend in the need for mechanical ventilation in corticosteroid group (OR 0.53, 95% CI 0.28–1.02; P = .06). There was no trend towards more adverse events in the corticosteroid arm compared to control (OR 0.92, 95% CI 0.58–1.47; P = .74).

Conclusion:
Overall, adjunctive systemic corticosteroids therapy was effective and safe for patients with severe CAP. In addition, the effects of mortality may differ according to the type of corticosteroids.
miRNAs expression of oral squamous cell carcinoma patients
Authors: Chamorro Petronacci Cintia Micaela , Pérez-Sayáns Mario , Padín Iruegas María Elena , Suárez Peñaranda José M. , Lorenzo Pouso Alejandro Ismael , Blanco Carrión Andrés , García García Abel 
Published: March 2019

Abstract
microRNA expression patterns have provided new directions in the search of biomarkers with prognostic value and even in the search of novel therapeutic targets for several neoplasms. Specifically, miRNAs profiling in oral squamous cell carcinoma (OSCC) represents a web of intrigue in the study of oral carcinogenesis. The objective of the present study was twofold:
The first study phase comprised case-control groups: A) 8 OSCC-affected patients and 8 healthy controls. Microarray technology (Affymetrix miRNA Array Plate 4.1) was used for miRNAs expression profile. Deregulated miRNAs were studied using Diana Tools miRPath 3.0 to associate miRNA targets with molecular pathways via Kyoto Encyclopedia of Genes and Genomes (KEGG). In a second phase, 2 miRNAs chosen for the subsequent RT-qPCR validation were studied in a second OSSC cohort (n = 8).
Microarray analysis identified 80 deregulated miRNAs (35 over-expressed and 45 under-expressed). Two miRNAs (miR-497-5p and miR-4417) were chosen for further validation via RT-qPCR. Prognostic analysis did not ascertain relevant relation between miR-497-5p or miR-4417 expression and clinical or pathological parameters, except high miR-4417 in the case of nodular affectation (P = .035) and diminished miR-497-5p radiotherapy-treated patients (P = .05). KEGG analysis revealed that deregulated miRNAs were implicated in several biological pathways such as Proteoglycans in cancer.
Our data suggest an altered miRNAs profiling in OSCC-affected patients. We have verified the altered expression of miR-497-5p and miR-4417 in OSCC samples and related the deregulated miRNAs with the ‘proteoglycans in cancer’ pathway. Further longitudinal studies with large samples are warranted to confirm the present findings.
Evaluation of three-dimensional iterative image reconstruction in C-arm-based interventional cone-beam CT
Authors: Suzuki Shigeru , Katada Yoshiaki , Takayanagi Tomoko , Sugawara Haruto , Ishikawa Takuya , Yamamoto Yuzo , Wada Hiroo 
Published: March 2019

Abstract
We compared images obtained using a three-dimensional iterative image reconstruction (3D-IIR) algorithm for C-arm-based interventional cone-beam computed tomography (CBCT) with that using the customary reconstruction technique to quantify the effect of reconstruction techniques on image quality.
We scanned 2 phantoms using an angiography unit with digital flat-panel system—an elliptical cylinder acrylic phantom to evaluate spatial resolution and a Catphan phantom to evaluate CT number linearity, image noise, and low-contrast resolution. Three-dimensional imaging was calculated using Feldkamp algorithms, and additional image sets were reconstructed using 3D-IIR at 5 settings (Sharp, Default, Soft+, Soft++, Soft+++). We evaluated quality of images obtained using the 6 reconstruction techniques and analyzed variance to test values of the 10% value of each MTF, mean CT number, and contrast-to-noise ratio (CNR), with P < .05 considered statistically significant.
Modulation transfer function curves and CT number linearity among images obtained using the customary technique and the 5 3D-IIR techniques showed excellent agreement. Noise power spectrum curves demonstrated uniform noise reduction across the spatial frequency in the iterative reconstruction, and CNR obtained using all but the Sharp 3D-IIR technique was significantly better than that using the customary reconstruction technique (Sharp, P = .1957; Default, P = .0042; others, P < .0001). Use of 3D-IIR, especially the Soft++ and Soft+++ settings, improved visualization of low-contrast targets.
Use of a 3D-IIR can significantly improve image noise and low-contrast resolution while maintaining spatial resolution in C-arm-based interventional CBCT, yielding higher quality images that may increase safety and efficacy in interventional radiology.
Laparoscopic surgery
Authors: Yu Xiaoming , Cai He , Guan Jing , Zheng Xingbang , Han Hongjing 
Published: March 2019

Abstract
Patients who undergo several in-vitro fertilization (IVF) treatment cycles and fail to conceive present a frustrating problem to the clinician. When 1 cycle of IVF treatment fails, should we offer the couples to choose additional cycle of IVF instead of evaluation of the potential peritoneal factor? In cases of otherwise unexplained infertility, the investigation cannot be considered to be complete until laparoscopy has been performed. The aim of the study is to investigate the fertility outcome of laparoscopic treatment in infertile women with repeated IVF failures.
This is a retrospective case-control study conducted in a tertiary care, academic teaching hospital from January 2012 to December 2015. Patients recruited in this study were classified into 2 groups. Study group (n = 45) were offered laparoscopy for evaluation of infertility, control group (n = 45) elected to proceed to IVF without laparoscopy. Diagnostic laparoscopy and subsequent excision of suspected endometriotic lesions, lysis of adhesion and treatment of tubal pathology were performed when indicated.
Forty-four (97.8%) patients in study had pelvic pathologies and the treatment was performed at the same time. Twenty-four patients in study group conceived including 16 patients conceived spontaneously and 14 patients conceived with additional IVF following laparoscopy management. There was a significant difference in the ongoing pregnancy rates between patients conceived through IVF in study group and control group (41.9% vs 19.6%, P
< .05).
Laparoscopy in women with normal hysterosalpingography but recurrent IVF failures can detect unrecognized pelvic pathologies. Laparoscopy evaluation prior to additional cycle of IVF seems to improve the subsequent pregnancy rate.
Comparison of laminectomy and fusion vs laminoplasty in the treatment of multilevel cervical spondylotic myelopathy
Authors: Yuan Xiaojun , Wei Chunmei , Xu Wenhua , Gan Xinrong , Cao Shengsheng , Luo Jiaquan 
Published: March 2019

Abstract

Purpose:
The purpose of this study is to evaluate the clinical safety and efficacy between laminectomy and fusion (LF) versus laminoplasty (LP) for the treatment of multi-level cervical spondylotic myelopathy (CSM).

Methods:
The authors searched electronic databases using PubMed, MEDLINE, Embase, Cochrane Controlled Trial Register, and Google Scholar for relevant studies that compared the clinical effectiveness of LF and LP for the treatment of patients with multilevel CSM. The following outcome measures were extracted: the Japanese Orthopaedic Association (JOA) scores, cervical curvature index (CCI), visual analog scale (VAS), Nurich grade, reoperation rate, complications, rate of nerve palsies. Newcastle Ottawa Quality Assessment Scale (NOQAS) was used to evaluate the quality of each study. Data analysis was conducted with RevMan 5.3.

Results:
A total of 14 studies were included in our meta-analysis. No significant difference was observed in terms of postoperative Japanese Orthopaedic Association score (P = .29), visual analog scale neck pain (P = .64), cervical curvature index (P = .24), Nurich grade (P = .16) and reoperation rate (P = .21) between LF and LP groups. Compared with LP group, the total complication rate (OR 2.60, 95% CI 1.85, 3.64, I
2 = 26%, P < .00001) and rate of nerve palsies (OR 3.18, 95% CI 1.66, 6.11, I
2 = 47%, P = .0005) was higher in the LF group.

Conclusions:
Our meta-analysis reveals that surgical treatments of multilevel CSM are similar in terms of most clinical outcomes using LF and LP. However, LP was found to be superior than LF in terms of nerve palsy complications. This requires further validation and investigation in larger sample-size prospective and randomized studies.
SCN1B and SCN2B gene variants analysis in dravet syndrome patients
Authors: Gong Jiao-E. , Liao Hong-Mei , Long Hong-Yu , Li Xiang-Min , Long Li-Li , Zhou Luo , Gu Wen-Ping , Lu Shao-Hua , Qu Qiang , Yang Li-Min , Xiao Bo , Qu Jian 
Published: March 2019

Abstract
Previous research identified SCN1B variants in some cases of Dravet syndrome (DS). We investigated whether SCN1B and SCN2B variants are commonly happened in DS patients without SCN1A variants. A total of 22 DS patients without SCN1A variants and 100 healthy controls were enrolled in this genetic study. DNA from DS patients was sequenced by Sanger method in whole exons of SCN1B and SCN2B genes. We identified two exon variants (c.351C>T, p.G117G and c.467C>T, p.T156M), which were present both in 1000 egenomes database and in healthy controls with a frequency of 0.54% and 4%, 0.06% and 0%, respectively. Additionally, eight intron or 3 prime UTR variants showing benign clinical significance have also been identified. Our results suggest that variants of SCN1B and SCN2B may not be common causes of DS according to our data. Further large sample-size cohort studies are needed to confirm our conclusion.
Neuropeptide Y and dipeptidyl peptidase IV in normally cycling and postmenopausal women
Authors: Kluess Heidi A. , Neidert Leslie E. , Sandage Mary J. , Plexico Laura W. 
Published: March 2019

AbstractThe purpose was to investigate changes in neuropeptide Y (NPY) protein and dipeptidyl peptidase IV (DPP-IV) activity in the plasma and saliva in normally cycling women and women after menopause. We recruited 7 cycling women and 7 postmenopausal women for a cross-sectional, prospective pilot study. Blood via venipuncture and saliva samples were taken at each point in the menstrual cycle (premenopausal) or once per week (postmenopausal) for 2 months. Blood and saliva were analyzed for estrogen, NPY using ELISA and DPP-IV activity using a fluorometric assay. Plasma β-estradiol was an average of 96.45 ± 57.04 pg/mL over 2 cycles in the premenopausal group and 1.72 ± 0.35 pg/mL over 2 months in the postmenopausal group (P < .05). In the cycling group, there were no significant differences in saliva or plasma NPY or DPP-IV over the cycle. For the postmenopausal group, salivary NPY and DPP-IV did not change over 2 months. Plasma NPY was lowest in the middle 2 weeks (average: 0.52 ± 0.10 ng/mL) compared to the first and fourth weeks (average of week 1 and 4: 0.60 ± 0.14 ng/mL;P < .05). Plasma NPY in postmenopausal women was higher overall (0.56 ± 0.13 ng/mL) compared to cycling women (0.30 ± 0.11 ng/mL;P < .05). Plasma DPP-IV activity was unchanged by time in the postmenopausal group. Saliva DPP-IV and saliva NPY in the cycling group had a significant negative correlation (R = −0.95;P < .05). We found that saliva measures of NPY and DPP-IV activity appear to be poor estimates of plasma concentrations and activities, but a larger sample size is required to conform this. Differences in plasma NPY concentrations between the groups and the relationship between salivary NPY and DPP-IV suggests that there may be some unique differences between these groups.
Spontaneous bleeding of thoracoacromial artery mimicking tunneled cuffed catheter-related complication
Authors: Nam Mann Hua , Tsai Ming-Hsien , Fang Yu-Wei , Lin Mi-Chu 
Published: March 2019

Abstract

Rationale:
The chronic complications caused by the tunneled cuffed catheter in chronic dialysis patients are infection and catheter dysfunction. While bleeding due to this access can occur occasionally.

Patient concerns:
We present a 92-year-old woman with a 6-year history of regular hemodialysis (HD). For the past 2 years, she has been receiving HD via a tunneled cuffed catheter placed in the right internal jugular vein. She suffered from a right chest subcutaneous hematoma near the catheter without recent trauma. The increasing size of hematoma after dialysis, and the oozing from the outlet of the catheter were also observed.

Diagnosis:
Computed tomography of chest and angiography were done and showed that the hematoma was caused by thoracoacromial artery bleeding, which was near the puncture site of the tunneled cuffed catheter.

Interventions:
Fluid resuscitation, blood transfusion, surgical drainage, and parenteral antibiotics were prescribed.

Outcomes:
Patient recovered fully without any further sequelae.

Lessons:
Spontaneous bleeding of thoracoacromial artery is rare and clinicians should keep in mind as a differential diagnosis in patient with new-onset hematoma over anterior chest wall. Early diagnosis and treatment are important in such cases.
Treatment of a patient with breast cancer and glucose 6-phosphate dehydrogenase deficiency
Authors: Chung Wei-Pang , Hsu Ya-Tin , Chen Ya-Ping , Hsu Hui-Ping 
Published: March 2019

Abstract

Rationale:
Glucose 6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic disorder of red blood cells that cause hemolytic anemia. Some anticancer drugs are reported to trigger oxidative stress; however, events of hemolysis are rarely discussed in patients with G6PD deficiency required oncologic treatments.

Patient concerns:
Here we reported a young woman with G6PD deficiency safely undergoing breast cancer treatment.

Diagnosis:
A 29-year-old patient was diagnosed with advanced cancer of the right breast with tumors positive for hormone receptor and human epidermal growth factor receptor 2.

Interventions:
The patient received chemotherapy with doxorubicin, cyclophosphamide, and docetaxel. During the administration of docetaxel, trastuzumab was concurrently administered and was continued after the completion of docetaxel. The patient underwent adjuvant radiotherapy; meanwhile, tamoxifen was administered as adjuvant endocrine treatment.

Outcomes:
The treatment process was smooth. There was no evidence of hemolytic anemia. Except for hot flushes, the patient lives without remarkable side effects from ongoing or previous treatments.

Lessons:
Some patients have both G6PD deficiency and malignancy in a geographic area with relatively high incidence of the enzymatic disorder and certain types of cancer. We suggest that our report can contribute to the concern regarding the safety of patients with G6PD deficiency undergoing cancer treatment.