bluuebunny/crossref_metadata_2025_split huggingface dataset:
Presentation patterns and prognosis of 109 isolated venous injuries in 99 patients
Authors: Kakkos Stavros K , Tsolakis Ioannis A , Markopoulos George , Maroulis Ioannis , Koletsis Efstratios , Fligou Fotini , Panagopoulos Konstantinos , Papadoulas Spyros , Lampropoulos George , Ntouvas Ioannis , Nikolakopoulos Konstantinos M , Papageorgopoulou Chrysanthi P , Kouri Anastasia 
Published: March 2019

Objectives To identify outcome predictors of isolated venous injuries (VIs). Methods Retrospective analysis of prospectively collected information. Results A total of 99 patients with 109 isolated VI were included. All-cause mortality was 18/99 (18%) and mortality related to the VI was 10/99 (10%). On multivariate analysis, independent predictors of all-cause mortality included age (odds ratio – OR – 1.06, p = 0.042), external cause – trauma and foreign body retention – of VI (OR 34.62, p = 0.002) and the number of red blood cell units transfused intraoperatively (OR 2.10, p < 0.001), while independent predictors of VI-related mortality included external cause of VI (OR 47.60, p = 0.001) and the number of red blood cell units transfused intraoperatively (OR 1.72, p = 0.003). Conclusions VIs due to external causes have a high mortality rate. On the other hand, VIs due to internal causes (iatrogenic injuries during a surgical procedure) are managed promptly and have a very low mortality related to the VI.
Age-dependent overall survival benefit of androgen deprivation therapy for metastatic prostate cancer
Authors: Keating Matthew J , Giscombe Lisa , Tannous Toufic , Reddy Nishitha , Mukkamalla Shiva Kumar R , DeSouza Andre , Rathore Ritesh 
Published: March 2019

Background Androgen deprivation therapy (ADT) remains a standard of care in metastatic prostate cancer. Recent prospective trials have explored addition of chemotherapy to ADT. We retrospectively examined overall survival in metastatic prostate cancer patients treated with ADT, chemotherapy plus ADT (C + ADT), or observation from 2004 to 2010 using National Cancer Database data. Methods Using the National Cancer Database, 21,977 patients with metastatic prostate cancer diagnosed from 2004 to 2010 were identified. Multivariate logistic regression, Kaplan-Meier survival analysis and Cox proportional hazards regression modeling were implemented, with overall survival as the primary endpoint. Results Five-year overall survival was 13.6% in patients aged ≥ 75 years vs. 30.1% (age 65–74) and 34.5% (age 18–64). Subgroup analysis of age-based cohorts (<65 and ≥65 years) showed poor overall survival for C + ADT vs. ADT alone, both in younger (HR 1.35, 95% CI 1.21–1.50; p < 0.0001) as well as older (HR 1.21, 95% CI 1.08–1.34; p = 0.0006) populations. Younger patients had no significant difference in overall survival for observation vs. ADT (HR 0.99, 95% CI 0.92–1.08; p = 0.9121). Besides age, other factors impacting overall survival included race, rural/urban settings, comorbidity score, income, PSA and radiation. Discussion Younger patients had no significant difference in overall survival between observation or ADT. This implies a group of younger patients in whom ADT does not confer any overall survival benefit. Future clinical trials with genetic and biologic markers are needed to delineate which subgroups would not benefit from C + ADT or ADT alone. This is of utmost clinical importance given the negative impact of ADT on quality of life and comorbidities.
Nivolumab-induced hypothyoidism with consequent hypothyroid related myopathy
Authors: Johnson Eric D , Kerrigan Katie , Butler Katerina , Patel Shiven B 
Published: March 2019

Purpose Nivolumab is a fully human IgG4 programmed death 1 immune checkpoint inhibitor (ICI) antibody that has anti-tumor activity by selectively blocking the interaction of the programmed death 1 receptor with its two known programmed death ligands PD-L1 and PD-L2. In doing so, this immune checkpoint inhibitor removes the negative signal stifling T cell activation and proliferation within the tumor microenvironment and demonstrates favorable antitumor activity. Case report We report an interesting case of immune checkpoint inhibitor-induced primary hypothyroidism with associated hypothyroid myopathy in a young patient with surgically resected stage IIIB melanoma receiving adjuvant nivolumab. He presented 12 weeks into therapy with severe myalgias, arthralgias, and intermittent disequilibrium of unclear etiology. Laboratory evaluation demonstrated a significant elevation in thyroid stimulating hormone and creatine kinase with an undetectable free T4 with standard laboratory measurement. With thyroid hormone replacement therapy alone, he had rapid improvement in his musculoskeletal symptoms and laboratory parameters over a three-week period. Discussion This case emphasizes the serious nature of endocrine immune-related adverse events in patients receiving immune checkpoint inhibitors. Additionally, it highlights that unlike most other immune-related adverse events, endocrine immune-related adverse events can generally be managed with adequate hormone replacement alone with swift improvements in symptoms. This allows patients to continue immune checkpoint inhibitors safely without immunosuppression which may dampen the anti-tumor activity of these agents. Conclusion This case highlights the importance of early recognition and the appropriate management of endocrine immune-related adverse events to maximize patient safety and good outcomes.
Mapping the microbial interactome: Statistical and experimental approaches for microbiome network inference
Authors: Dohlman Anders B , Shen Xiling 
Published: March 2019

Advances in high-throughput sequencing have ushered in a new era of research into the gut microbiome and its role in human health and disease. However, due to the unique characteristics of microbiome survey data, their use for the detection of ecological interaction networks remains a considerable challenge, and a field of active methodological development. In this review, we discuss the landscape of existing statistical and experimental methods for detecting and characterizing microbial interactions, as well as the role that host and environmental metabolic signals play in mediating the behavior of these networks. Numerous statistical tools for microbiome network inference have been developed. Yet due to tool-specific biases, the networks identified by these methods are often discordant, motivating a need for the development of more general tools, the use of ensemble approaches, and the incorporation of prior knowledge into prediction. By elucidating the complex dynamics of the microbial interactome, we will enhance our understanding of the microbiome’s role in disease, more precisely predict the microbiome’s response to perturbation, and inform the development of future therapeutic strategies for microbiome-related disease.Impact statementThis review provides a comprehensive description of experimental and statistical tools used for network analyses of the human gut microbiome. Understanding the system dynamics of microbial interactions may lead to the improvement of therapeutic approaches for managing microbiome-associated diseases. Microbiome network inference tools have been developed and applied to both cross-sectional and longitudinal experimental designs, as well as to multi-omic datasets, with the goal of untangling the complex web of microbe-host, microbe-environmental, and metabolism-mediated microbial interactions. The characterization of these interaction networks may lead to a better understanding of the systems dynamics of the human gut microbiome, augmenting our knowledge of the microbiome’s role in human health, and guiding the optimization of effective, precise, and rational therapeutic strategies for managing microbiome-associated disease.
Explant of aortic stent grafts following endovascular aneurysm repair
Authors: Boyle E , McHugh SM , Elmallah A , Lynch M , McGuire D , Ahmed Z , Canning C , Colgan MP , O’Neill SM , O’Callaghan A , Martin Z , Madhavan P 
Published: March 2019

Background Failure of endovascular aneurysm repair may require explant of the stent graft in a subset of patients. We sought to assess outcomes in a cohort of patients undergoing explant of endovascular aneurysm repair in both emergency and elective settings. Methods Patients undergoing explant of endovascular aneurysm repair were identified from a prospectively maintained database, with additional information obtained through retrospective analysis of medical records. Results Over a 21-year period, 1997–2018 (May), there were 597 endovascular aneurysm repair procedures performed in our institution for abdominal aortic aneurysm. There were 19 endovascular aneurysm repair explants; five of these were referrals from other vascular centres. The median age was 73 years (range 46–81). The median length of time from insertion to explant was 39.2 months (range 0–153). Indications for elective explant were type Ia endoleak (n = 4), type 1b endoleak (n = 1), type II endoleak with increasing sac size (n = 1), type I/III endoleak (n = 1), type IV endoleak (n = 1), and increasing sac size without evident endoleak (type V, n = 2). The remaining nine cases were emergency procedures, with four patients presenting with rupture post endovascular aneurysm repair, four patients presenting with acute stent thrombosis, of which one also had a type 1a endoleak and one aorto-enteric fistula. There were no mortalities in the elective group and three mortalities in the emergency group (0 vs 33.3%, p = 0.087). Overall 30-day mortality was 15.8% Conclusion Explant of aortic stent grafts can be associated with high mortality and morbidity rates, especially in the emergent setting. Patient and device selection and post-operative surveillance remain vitally important to optimise outcomes post endovascular aneurysm repair.
Saphenous vein diameter is a single risk factor for early recanalization after endothermal ablation of incompetent great saphenous vein
Authors: Kemaloğlu Cemal 
Published: March 2019

Background and aim The aim of this study was to compare endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) techniques for efficacy and side effects for great saphenous vein (GSV) ablation. Materials and methods Two hundred twenty-one patients and 287 extremities that underwent GSV ablation with EVLA and RFA methods were analysed retrospectively; 135 GSVs were treated with EVLA, 152 GSVs were treated with RFA. Physical examination and Ultrasound (US) records at the first week, first month and third month were evaluated. Recanalization, endothermal heat-induced thrombosis formation, presence of ecchymosis greater than 10 cm and GSV diameter parameters were statistically analyzed. Results In the RFA group, 96.7% of the GSVs that were ablated were occluded at the end of the third month. In the EVLA group, this rate was 92.6%. There was no statistically significant difference between success of ablation ( P = 0.118). In the RFA group, ecchymotic areas, that is larger than 10 cm diameter were observed in 16 extremities, whereas in the EVLA group, 66 of 135 (48.9%) limbs were found to have ecchymotic area larger than 10 cm ( P < 0.001). More recanalizations were observed in GSVs larger than 10 mm in diameter which was statistically significant ( P < 0.001). Conclusion Both EVLA and RFA methods are effective in treating GSV reflux. Compared to the EVLA, less ecchymosis occurs after RFA procedures. Regardless of the type of method used, the GSV diameter is a single predictor of recanalization.
Granulomatosis with polyangiitis and pregnancy: A case report and review of the literature
Authors: Daher A , Sauvetre G , Girszyn N , Verspyck E , Levesque H , Le Besnerais M 
Published: March 2019

The association of granulomatosis with polyangiitis and pregnancy is rare and therapeutic options are limited by the risk of teratogenicity and fetotoxicity. There is a paucity of published literature to guide clinical decision-making in these cases. We report the case of a 26-year-old woman with no medical history who presented at 21 weeks of gestation with a bilateral sudden loss of hearing and erosive rhinitis. The diagnosis of granulomatosis with polyangiitis was confirmed radiologically and biologically. Corticosteroids were not enough to stabilize the disease and she received intravenous immunoglobulins with remission. A successful delivery of a healthy male newborn was done at 36 weeks. A review of all published literature on granulomatosis with polyangiitis in pregnancy between 1970 and 2017 is presented. Trial registration: Not applicable.
Myotonic disorders and pregnancy
Authors: Morton Adam 
Published: March 2019

Myotonic disorders represent significant risk in pregnancy due to their complexity and the risk of maternal and fetal complications. Care of these pregnancies requires detailed pre-conception counselling, close monitoring of mother and fetus during the pregnancy and a delivery and postpartum plan involving a multidisciplinary team approach. A case of a woman with myotonia congenita diagnosed in pregnancy is presented, the general principles of care of women with myotonic disorders discussed, and care of the specific conditions in pregnancy reviewed. Trial registration: Not applicable.
The case for extended thromboprophylaxis in medically hospitalised patients – not yet made
Authors: Cao Jacob Y , Lee Seung Yeon , Dunkley Scott , Adams Mark , Keech Anthony 
Published: March 2019

Abstract

Background
The role of extended thromboprophylaxis is established for surgical patients, but not yet for hospitalised medical patients.

Design
This systematic review and meta-analysis sought to explore the role of extended thromboprophylaxis for medically ill hospitalised patients.

Methods
Medline, EMBASE and Cochrane Libraries were searched and five randomised controlled trials were identified, comprising 20,046 extended and 20,078 standard duration thromboprophylaxis patients.

Results
Allocation to extended treatment, compared with standard duration therapy, significantly reduced the risk of symptomatic deep vein thrombosis (relative risk (RR) 0.47, 95% confidence interval (CI) 0.29–0.78, P = 0.003) and non-fatal pulmonary embolism (RR 0.59, 95% CI 0.39–0.91, P = 0.02). The risk of venous thromboembolism-related death was comparable between the extended and standard duration treatment groups (RR 0.81, 95% CI 0.6–1.09, P = 0.16). Extended treatment also doubled the risk of major bleeding (RR 2.04, 95% CI 1.42–2.91, P &lt; 0.001), without significantly affecting the risk of intracranial bleeding or bleeding-associated death. The cost of preventing one symptomatic deep vein thrombosis and non-fatal pulmonary embolism was found to be £24,972 (€27,969) and £45,148 (€50,566), respectively, which outweigh the direct cost of managing established venous thromboembolism as previously reported.

Conclusions
Extended duration thromboprophylaxis caused a reduction in the risk of venous thromboembolic events, but also a numerically comparable increase in major bleeding. Further trials are required in high-risk subpopulations who may derive mortality benefits from treatment. Only then could a change in current policy and practice be supported.
Independent Influence of Spinal Cord Injury Level on Thermoregulation during Exercise
Authors: FORSYTH PETA , MILLER JOANNA , PUMPA KATE , THOMPSON KEVIN G. , JAY OLLIE 
Published: March 2019

ABSTRACT

Purpose
This study aimed to establish the true influence of spinal cord injury (SCI) level on core temperature and sweating during exercise in the heat independently of biophysical factors.

Methods
A total of 31 trained males (8 with tetraplegia [TP; C5–C8], 7 with high paraplegia [HP; T1–T5], 8 with low paraplegia [LP; T6–L1], and 8 able bodied [AB]) performed 3 × 10 min of arm ergometry with 3-min rest at a metabolic heat production of (a) 4.0 W·kg−1 (AB vs TP) or (b) 6.0 W·kg−1 (AB vs HP vs LP), in 35°C, 50% relative humidity. Esophageal (T
es) and local skin temperatures and local sweat rate (LSR) on the forehead and upper back were measured throughout.

Results
Change in T
es was greatest in TP (1.86°C ± 0.32°C vs 0.29°C ± 0.07°C, P < 0.001) and greater in HP compared with LP and AB, reaching 1.20°C ± 0.50°C, 0.66°C ± 0.23°C, and 0.53°C ± 0.12°C, respectively (P < 0.001). Approximately half of the variability in end-trial ΔT
es was described by SCI level in paraplegics (adjusted R
2 = 0.490, P = 0.005). Esophageal temperature onset thresholds of sweating at the forehead and upper back were similar among HP, LP, and AB, whereas no sweating was observed in TP. Thermosensitivity (ΔT
es vs ΔLSR) was also similar, except for LP demonstrating lower thermosensitivity than AB at the upper back (0.78 ± 0.26 vs 1.59 ± 0.89 mg·cm−2·min−1, P = 0.039). Change in skin temperature was greatest in denervated regions, most notably at the calf in all SCI groups (TP, 2.07°C ± 0.93°C; HP, 2.73°C ± 0.68°C; LP, 2.92°C ± 1.48°C).

Conclusion
This study is the first to show the relationship between ΔT
es and SCI level in athletes with paraplegia after removing variability arising from differences in metabolic heat production and mass. Individual variability in ΔT
es is further reduced among athletes with TP because of minimal evaporative heat loss secondary to an absence of sweating.
Mixed method survey to assess the problems and propose solutions for implementation of CME/CPD in Sindh, Pakistan
Authors: Shah Nighat Ali , Soomro Marium , Musharraf Mehjabeen , Shaikh Shiraz 
Published: March 2019

Objectives: To determine the type of CME/CPD sessions attended by doctors, identify the problems with implementation of CME/CPD program and propose possible solutions for successful implementation of CME/CPD Program.
Methods: This was a concurrent triangulation mixed method study. Quantitative questionnaires were filled by faculty and physicians from different specialties. The qualitative component had both focus groups and in depth interviews conducted with different professional bodies (PMA), faculty JSMU, College of Family Physicians. This study was done in 2016-2017.
Results: More than half of the participants (53.6%) reported that CPD/CME should be mandatory. Doctors who had graduated from outside Karachi were significantly less likely to report CPD/CME to be mandatory as compared to graduates from Karachi (p=0.004).Top three factors which influenced HCP’s to attend CPD/CME included career progression (65.1%), interest (54.7%) and knowledge gap (50.5%). The most common perceived barriers were lack of study leave, cost and work-life imbalance. The implementation issues expressed by different stakeholders included lack of doctor’s interest, busy clinical schedule and poor accessibility.
Conclusion: Mostly medical practioners believe that CPD program is an important step toward enabling physicians to demonstrate their competency and professionalism to themselves and others. The PM&DC has to take practical steps to evaluate the cognitive, clinical, and humanistic attributes of certified doctors.
How to cite this:Shah N, Soomro M, Musharraf M, Shaikh S. Mixed method survey to assess the problems and propose solutions for implementation of CME/CPD in Sindh, Pakistan. Pak J Med Sci. 2019;35(2):555-560. doi: https://doi.org/10.12669/pjms.35.2.243
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The Efficacy of Split-Dose Bowel Preparations for Polyp Detection: A Systematic Review and Meta-Analysis
Authors: Zawaly Kathleen , Rumbolt Colin , Abou-Setta Ahmed M. , Neilson Christine , Rabbani Rasheda , Zarychanski Ryan , Singh Harminder 
Published: March 2019

INTRODUCTION:
Split-dose bowel preparation leads to superior colon cleansing for colonoscopy. However, the magnitude of benefit in detecting colonic polyps is uncertain. We performed a systematic review to synthesize the data on whether using a split-dose bowel preparation regimen improves the detection of polyps when compared with other dosing methods or regimen products.

METHODS:
We searched MEDLINE, EMBASE, and CENTRAL databases (from the inception to June 2017) for randomized controlled trials that assessed the following: split-dose vs day-before, split-dose vs same-day (as colonoscopy), or different types of split-dose regimens for patients undergoing colonoscopy. We excluded studies limited to inpatients, children, or individuals with inflammatory bowel disease. We compared the number of patients undergoing colonoscopy with recorded detection of polyps, adenomas, advanced adenomas, sessile serrated polyps (SSPs), right colonic adenomas, right colonic polyps, or right colonic SSPs.

RESULTS:
Twenty-eight trials fulfilled the inclusion criteria (8,842 participants). Of the seven trials comparing split-dose vs day-before bowel preparation regimens, there was an increased detection rate of adenomas (risk ratio (RR) 1.26, 95% confidence intervals (CIs): 1.10–1.44; 4 trials; 1,258 participants), advanced adenomas (RR 1.53, 95% CI: 1.22–1.92; 3 trials; 1,155 participants), and SSPs (RR 2.48, 95% CI: 1.21–5.09; 2 trials; 1,045 participants). Pooled estimates from 8 trials (1,587 participants) evaluating split-dose vs same-day bowel preparations yielded no evidence of statistical difference. For various split-dose vs split-dose trials, 14 fulfilled the criteria (5,496 participants) and no superior split-regimen was identified.

CONCLUSIONS:
Compared with day-before bowel preparation regimens, split-dose bowel preparations regimens increase the detection of adenomas, advanced adenomas, and have the greatest benefit in SSP detection.
Physical Activity, Fatty Liver, and Glucose Metabolism Over the Life Course: The Lifelines Cohort
Authors: Byambasukh Oyuntugs , Zelle Dorien , Corpeleijn Eva 
Published: March 2019

OBJECTIVES:
We examined the dose-dependent association of habitual moderate-to-vigorous physical activity (MVPA) with the biochemical markers for nonalcoholic fatty liver disease (NAFLD) and whether this association changes with age and degree of impaired glucose metabolism. We also investigated whether the associations depend on the domain of MVPA.

METHODS:
In this study, using data from the population-based Lifelines cohort (N = 42,661), MVPA was self-reported on the short questionnaire to assess health-enhancing physical activity. NAFLD was defined as a fatty liver index value of >60, based on body mass index, waist circumference, plasma triglycerides, and gamma-glutamyltransferase. Glucose metabolism was defined as normal (NGM), impaired (IGM), and type 2 diabetes mellitus (T2DM). Exclusion criteria were previously diagnosed hepatitis or cirrhosis and excessive alcohol use. All analyses were adjusted for age, sex, and education.

RESULTS:
Higher MVPA was dose dependently associated with a lower risk of having NAFLD: compared with “No MVPA,” the odds ratios (ORs) (95% confidence intervals) for MVPA quintiles were 0.78 (0.71–0.86), 0.64 (0.58–0.70), 0.53 (0.48–0.59), 0.51 (0.46–0.56), and 0.45 (0.41–0.50) for the highest level of MVPA. The association between MVPA and NAFLD was stronger for more impaired glucose status (ORNGM = 0.49 (0.42–0.57), ORIGM = 0.46 (0.40–0.54), ORT2DM = 0.42 (0.27–0.66)) and for older age (OR20-40 years = 0.51 (0.42–0.62), OR60-80 years = 0.37 (0.29–0.48)) with the highest level of MVPA, relative to No MVPA. No favorable association was observed for occupational MVPA. With regard to MVPA and fibrosis, associations with fibrosis markers showed contradictory results.

CONCLUSIONS:
Higher MVPA levels are dose dependently associated with a lower NAFLD risk. This association is stronger in people with diabetes and older adults.