bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Prenatal Depression: Effectiveness of an Online Training Module Across Health Care Disciplines
Authors: A. Leiferman Jenn , Farewell Charlotte V. , E. Lee-Winn Angela , Jewell Jennifer , Ulrickson Claire , Huberty Jennifer , Paulson James 
Published: August 2019

Introduction:
Maternal depression is associated with numerous deleterious maternal and child health outcomes. Although there are several treatment options for prenatal depression, many depressed women remain untreated. This study tested the effects of a low-intensity online training module on providers' attitudes, beliefs, and management practices of prenatal depression across a diverse group of providers.

Methods:
Health care providers who were providing care to pregnant women completed a 64-item survey consisting of items from the Management of Maternal Depression Inventory. Upon completion of the survey, providers were randomized into the intervention or the active control arm (wait-listed). The intervention consisted of an online training, which targeted knowledge and skills related to providing guidance on prenatal mood disorders. Approximately 6 to 8 weeks after randomization, all providers completed the survey again, and a general linear model framework was used to test change from baseline.

Results:
The final sample was comprised 74 compliant providers (intervention arm: n = 41; control arm: n = 33). Providers in the intervention arm reported significant increases in the sense of responsibility and self-efficacy when compared with their counterparts in the active control arm (all P < .001). Providers in the intervention arm also reported an increase in satisfaction related to communication with mental health specialists when compared with their counterparts in the active control arm (P = .05).

Discussion:
Our findings suggest that a brief, online training improved the attitudes, confidence, and communication of diverse providers related to the management of prenatal depression. Provider online training may help encourage patient–provider dialogue and in turn, enhance the management of prenatal depression.
Caring for Daughters Without Mothers
Authors: Gunn Jennie , Rikabi Gulenia , Huebner Carroll 
Published: August 2019

ABSTRACT:
The death of one's mother during childhood is the severing of one of the most important human bonds. The child may suffer periods of grief that continue into adulthood and throughout life. The nurse has a vital role in assisting women traumatized by loss of a mother at a young age. This article discusses the experience of maternal loss and notes care needs of the motherless child-adult woman. Identification of women in this situation should be made as early as possible.
Two Unusual Cases of Discoid Lupus Erythematosus Associated With Xanthomatized Macrophages
Authors: Weiss Amy , Kwon Eun Ji , Kreidel Marit , Mann Ranon , Cohen Jason A. , Hui Yiang , Jacobson Mark I. 
Published: August 2019

Abstract:
We present 2 patients with chronic discoid lupus erythematosus (LE) associated with xanthomatized macrophages on light microscopic findings. Skin biopsies revealed hyperkeratotic and atrophic epidermis, vacuolar degeneration of the dermal–epidermal junction, thickened basement membrane, follicular plugging, and perivascular and perifollicular lymphohistiocytic infiltrate. Notably, large collections of lipid-laden histiocytes were observed within the subjacent dermis. The patients denied history of intralesional steroid treatment. The patients did not demonstrate any clinical or laboratory signs of hyperlipidemia, cholestasis, and diabetes mellitus and insipidus. Accumulation of lipid-laden foam cells in cutaneous LE is a rare phenomenon that has been reported in discoid LE and lupus panniculitis, each only once in the literature. It has also been described within lesions of various other dermatoses in patients without lipid, hepatic, or endocrine abnormalities. Its mechanism remains unclear, but it has been hypothesized that intracellular lipids released from degenerating cells contribute to lipidization of mononuclear scavengers. Xanthomatous infiltration in cutaneous LE is an unusual feature, and its presence may not necessarily signify an underlying metabolic disorder.
Comparative Efficacy of a 35% Glycolic Acid Peel Alone or in Combination With a 10% and 20% Trichloroacetic Acid Spot Peel for Melasma: A Randomized Control Trial
Authors: Garg Shimona , Thami Gurvinder Pal , Bhalla Mala , Kaur Jasleen , Kumar Anand 
Published: August 2019

BACKGROUND
To study and compare the therapeutic efficacy and side effects of a 35% glycolic acid (GA) full face peel alone or in combination with a 10% or 20% trichloroacetic acid (TCA) spot peel for facial melasma.

METHODS
Thirty patients with facial melasma were randomly divided into 3 equal Groups A, B, and C. Group A was treated with a 35% GA full-face peel, Group B and C with 35% GA full-face peel followed by a 10% and 20% TCA spot peel respectively once every 15 days. Four peels were performed once every 15 days. The response to the treatment was evaluated by the percentage reduction in melasma area severity index (MASI) scoring.

RESULTS
All 3 groups had significant reduction of MASI, but there was no significant difference between the groups. Group A had minimum side effects.

CONCLUSION
Chemical peels with GA alone or in combination with TCA do result in a significant improvement in melasma, but the combination of the peels in the same sitting does not seem to have any additive or synergistic effect while they may increase the side effects.
Quantitative Association Between Serum/Dietary Magnesium and Cardiovascular Disease/Coronary Heart Disease Risk: A Dose–Response Meta-analysis of Prospective Cohort Studies
Authors: Zhao Lingyun , Hu Meng , Yang Lei , Xu Haoming , Song Wenyan , Qian Yazhi , Zhao Meimi 
Published: August 2019

Background:
The quantitative association between serum/dietary magnesium and cardiovascular disease (CVD) remains unclear. We conducted a dose–response meta-analysis to evaluate the quantitative association between serum/dietary magnesium and CVD, including coronary heart disease (CHD).

Methods:
PubMed, China National Knowledge Infrastructure, and Web of Science were searched for publications. STATA 12.0 was used to analyze data. We used the random-effects model to reduce heterogeneity.

Results:
Eighteen prospective cohort studies with 544,581 participants and 22,658 CVD cases were included. The follow-up duration was 1–28 years. The pooled relative risk (RR) of CVD for the relatively normal versus lowest serum and dietary magnesium level was 0.64 {[95% confidence interval (CI): 0.51–0.80] and 0.90 [95% CI: 0.84–0.96]}. The pooled RR of CHD for the relatively normal versus lowest serum and dietary magnesium level was 0.70 (95% CI: 0.57–0.85) and 0.86 (95% CI: 0.77–0.94). We noted a significant association between increasing serum magnesium levels (per 0.1-mg/dL increase) and risk of CVD (RR: 0.93, 95% CI: 0.88–0.97) and CHD (RR: 0.90, 95% CI: 0.84–0.96) and between dietary magnesium levels (per 100-mg/d increase) and risk of CVD (RR: 0.90, 95% CI: 0.83–0.96) and CHD (RR: 0.92, 95% CI: 0.82–0.98). Serum/dietary Mg level comparisons presented a 7%–10% decrease in CVD/CHD risk. The dose–response meta-analyses showed linear relationships between serum magnesium and CVD (Pnonlinearity = 0.833) or CHD (Pnonlinearity = 0.193) and dietary magnesium and CVD (Pnonlinearity = 0.463) or CHD (Pnonlinearity = 0.440).

Conclusions:
Increasing dietary magnesium or serum magnesium level is linearly and inversely associated with the risk of total CVD and CHD events.
In Vitro Anticoagulant Activity of Mikania laevigata: Deepening the Study of the Possible Interaction Between Guaco and Anticoagulants
Authors: Leite Paula Mendonça , Miranda Ana Paula Nader , Amorim Juliana Mendes , Duarte Rita Carolina Figueiredo , Bertolucci Suzan Kelly Vilela , Carvalho Maria das Graças , Castilho Rachel Oliveira 
Published: August 2019

Abstract:

Mikania laevigata, popularly known in Brazil as guaco, is widely used for respiratory disorders. As this plant is rich in coumarins, there is evidence of indications that it may cause bleeding and therefore should not be used concomitantly with anticoagulants. The basis of this information is very theoretical, with no clinical evidence of such contraindication. Thus, the aim of this study was to evaluate the in vitro effect of M. laevigata extract on blood coagulation through prothrombin time (PT) and activated partial thromboplastin time (aPTT) tests, fibrinogen plasma concentration, and the new thrombin generation test, which investigate, with high sensibility, hemostatic changes (CAAE 60904316.6.0000.5149), besides evaluating its qualitative micromolecular composition, providing scientific evidence to support the management of patients taking warfarin. Ethanolic extracts of guaco leaves were incubated with a plasma pool of healthy individuals at concentrations of 1.67, 2.26, and 2.86 mg/mL. The presence of flavonoids, tannins, coumarins, and triterpenes was demonstrated by selective reagents in thin layer chromatography. Benzoylgrandifloric acid, cinnamoylgrandifloric acid, o-coumaric acid, coumarin, and quercetin-3-β-glucoside were identified by coinjection in ultraperformance liquid chromatography. The extract at all concentrations prolonged TP and aPPT and reduced the potential for endogenous thrombin potential by the thrombin generation test. The control plasma had endogenous thrombin potential = 1465 nM/min, and after the addition of M. laevigata extract (2.26 mg/mL), this value was reduced to 1087 nM/min, indicating a lower generation of thrombin. Related to fibrinogen plasma concentration, concentrations of 2.26 and 2.86 mg/mL were effective in reducing plasma fibrinogen levels. These results allow us to conclude that the guaco extract demonstrated an anticoagulant effect in vitro, possibly interfering with intrinsic, extrinsic, and common coagulation pathways. A discussion on the contribution of the identified substances to the activity is also present.
cGMP Signaling and Modulation in Heart Failure
Authors: Blanton Robert M. 
Published: August 2019

Abstract:
Cyclic GMP (cGMP) represents a classic intracellular second messenger molecule. Over the past 2 decades, important discoveries have identified that cGMP signaling becomes deranged in heart failure (HF) and that cGMP and its main kinase effector, protein kinase G, generally oppose the biological abnormalities contributing to HF, in experimental studies. These findings have influenced the design of clinical trials of cGMP-augmenting drugs in HF patients. At present, the trial results of cGMP-augmenting therapies in HF remain mixed. As detailed in this review, strong evidence now exists that protein kinase G opposes pathologic cardiac remodeling through regulation of diverse biological processes and myocardial substrates. Potential reasons for the failures of cGMP-augmenting drugs in HF may be related to biological mechanisms opposing cGMP or because of certain features of clinical trials, all of which are discussed.
Dyspnea During In-Hospital Rehabilitation as a Predictor of Rehospitalization and Mortality in Patients With Acute Heart Failure
Authors: Yoshimura Kae , Hiraoka Arudo , Saito Kazuya , Urabe Yukio , Maeda Noriaki , Yoshida Toshinobu , Hayashida Akihiro 
Published: August 2019

Purpose:
Consensus articles that explore rehabilitation exercise for heart failure (HF) mainly focus on stable patients with chronic HF. Results from investigations that focus on the relationship between clinical outcomes and exercise during rehabilitation of patients with acute heart failure (AHF) have produced insufficient data. The aim of this study was to evaluate the correlation between clinical outcomes and dyspnea during in-hospital early rehabilitation in patients with AHF.

Methods:
Dyspnea was measured using a 5-point Likert scale (5PLS) during rest and at the initiation of upright sitting and standing. Dyspnea was defined as 5PLS ≥2. The primary endpoint was combined all-cause death or rehospitalization for HF.

Results:
A total of 221 patients were included in this study; 81 patients (37%) died or were hospitalized during the follow-up period. In patients with dyspnea during upright sitting and standing, the event-free ratio was significantly lower compared with patients without dyspnea (P = .008 and P < .001, respectively). Body mass index (hazard ratio [HR] = 0.91, P = .011), noninvasive positive pressure ventilation usage (HR = 1.96, P = .042), and 5PLS ≥2 at the initiation of standing (HR = 2.63, P = .008) were detected as predictors of primary endpoint. New York Heart Association class IV at admission (OR = 3.17, P = .0114) and pre-admission Katz ADL index <6 (OR = 3.76, P = .0007) were isolated as risk factors for dyspnea when standing.

Conclusions:
Dyspnea during standing was associated with unfavorable events in patients with AHF as a comprehensive indicator.
Predictive value of the combination of age, creatinine, and ejection fraction score and diabetes in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention
Authors: Gao Side , Liu Qingbo , Ding Xiaosong , Chen Hui , Zhao Xueqiao , Li Hongwei 
Published: August 2019

Background:
This study investigated whether the age, creatinine, and ejection fraction (ACEF) score [age (years) /ejection fraction (%) +1 (if creatinine>176μmol/L)] could predict 1-year outcomes following ST-segment elevation myocardial infarction after percutaneous coronary intervention, and whether accuracy could be improved by establishing novel ACEF-derived risk models.

Methods:
A total of 1146 patients were included. The study endpoint was 1-year major adverse cardio-cerebrovascular events, including all-cause death, nonfatal myocardial infarction, unplanned revascularization, and nonfatal stroke. Accuracy was defined with area under the curve by receiver-operating characteristic curve analysis.

Results:
The incidence of 1-year major adverse cardio-cerebrovascular event increased with the rising age, creatinine, and ejection fraction score tertiles (4.8%, 8.4%, and 15.2%, P < 0.001 for all). Higher ACEF score was significantly associated with an increased risk of the endpoint in overall (odds ratio = 3.75, 95% confidence interval, 2.44–5.77, P < 0.001) and in subgroups (all P < 0.05). The accuracy of the ACEF score was equivalent to the other complex risk scores. The combination of ACEF, and diabetes (ACEF-diabetes score) yielded a superior discriminatory ability than the original ACEF score (increase in C-statistic from 0.67 to 0.71, P = 0.048; continuous net reclassification improvement = 51.9%, 95% confidence interval, 33.4–70.5%, P < 0.001; integrated discrimination improvement = 0.020, 95% confidence interval, 0.011–0.030, P < 0.001).

Conclusions:
The simplified ACEF score performed well in predicting 1-year outcomes in ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention. The novel ACEF-diabetes score provided a better predictive value and thus may help stratify high-risk patients and potentially facilitate decision making.
Strategies to effect change in the ICU
Authors: Wallace David J. 
Published: August 2019

Purpose of review
To provide an update on implementation efforts in the care of critically ill patients, with a focus on work published in the last 2 years.

Recent findings
Only half of surveyed members of the multidisciplinary care team in the ICU were aware of the Choosing Wisely campaign, and of those that were, approximately one-third reported no implementation of the recommendations. Barriers to implementation of the ABCDE bundle extend to beyond patient-level domains, and include clinician-related, protocol-related, and other domains. Prospective audit and feedback approaches have demonstrated moderate success for improving the quality of antibiotic prescription practices in the ICU.

Summary
Clinical research in intensive care has moved beyond simple discovery and dissemination. Best practices must be applied to effect change in ICU care, requiring the application of principles from implementation science. Future work should move beyond simple before-after evaluations to provide a stronger case for causal inference following implementation efforts.
A CARE-compliant article: ipsilateral progressive idiopathic lipid keratopathy
Authors: Pang Yilin , Zhang Qin , Bao Yongzhen 
Published: August 2019

Abstract

Rationale:
Lipid deposition on the cornea without previous infection, inflammation, vascularization, or trauma is idiopathic lipid keratopathy. In vivo laser confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) are 2 noninvasive methods that can help identify the structures and morphological characteristics of the focus.

Patient concerns:
A 63-year-old woman with ipsilateral corneal lipid deposits developing from a small white spot into a yellow-white superotemporal elliptic shape within a year. AS-OCT showed peripheral deep stromal deposits. IVCM showed hyper-reflective material with typical crystalline-like or needle-like structures in the superotemporal area.

Diagnosis:
Idiopathic lipid degeneration.

Interventions:
Topical steroids eye drops 3 times a day for a month and further consultation every 3 months.

Outcomes:
This patient of idiopathic lipid keratopathy was observed every 3 months and till now we have reviewed this patient twice. Topical steroids eye drops were only used during the first month. No further development was observed about the lesion and the patient's visual acuity remained good.

Conclusion:
IVCM and AS-OCT can help identify the characteristic crystalline-like or needle-like hyper-reflective material that could help diagnosis of idiopathic lipid degeneration.
A preliminary prospective study of patients who underwent vacuum-assisted and mesh-mediated fascial traction techniques for open abdomen management with negative fluid therapy
Authors: Tian Weiliang , Huang Qian , Yao Zheng , Huang Ming , Yang Fan , Zhao Yunzhao , Li Jieshou 
Published: August 2019

Abstract
It is unclear whether strategies targeting negative fluid balance are associated with facilitated early fascial closure. The present study investigated the effects of fluid removal therapy on early facial closure of open abdomen patients.
A prospective study was conducted in patients who underwent open abdomen management with vacuum-assisted and mesh-mediated fascial traction technique. Therapeutic diuresis with torasemide was applied to cause negative fluid balance in the treatment group. The study and follow-up periods were 7 and 180 days, respectively. The observational indices included the intra-abdominal pressure, the number of days to closure, the type of closure, the septic complications, the duration of ventilation support, the duration of initial hospital stay, and the duration of intensive care unit (ICU) stay.
A total of 27 patients were divided into the treatment (16 patients) and control (11 patients) groups. The median intra-abdominal pressure (IAP) of the patients of the control and the treatment groups was significantly lower at day 7 compared with the baseline value (P < .0001). IAP was lower in the treatment group compared with that noted in the control group, following day 4 of the fluid removal therapy (P < .05). The percentage weight loss in the treatment group was between 4.80% and 10.88%. The early closure rates were significantly higher in the treatment group compared with those in the control group (75.0% vs 18.2%, P = .0063).
Fluid removal therapy combined with vacuum-assisted and mesh-mediated fascial traction provided a high early fascial closure rate for open abdomen patients.
Gut microbiota shifts in patients with gastric cancer in perioperative period
Authors: Liang Weiren , Yang Yan , Wang Haiyong , Wang Haohao , Yu Xiongfei , Lu Yimin , Shen Shengrong , Teng Lisong 
Published: August 2019

Abstract
Gastric cancer (GC) is one of the common malignant tumors in China, with a high morbidity and mortality. With the development and application of high-throughput sequencing technologies and metagenomics, a great quantity of studies have shown that gastrointestinal microbiota is closely related to digestive system diseases. Although some studies have reported the effect of long-term follow-up after subtotal gastrectomy on intestinal flora changes in patients with GC. However, the features of gut microbiota and their shifts in patients with GC in perioperative period remain unclear.
This study was designed to characterize fecal microbiota shifts of the patients with GC before and after the radical distal gastrectomy (RDG) during their hospital staying periods. Furthermore, fecal microbiota was also compared between the GC patients and healthy individuals.
Patients who were diagnosed with advanced gastric adenocarcinoma at distal stomach were enrolled in the study. The bacterial burden within fecal samples was determined using quantitative polymerase chain reaction. To analyze the diversity and composition of gut microbiota from fecal DNA of 20 GC patients and 22 healthy controls, amplicons of the 16S rRNA gene from all subjects were pyrosequenced. To study gut microbiota shifts, the fecal microbiota from 6 GC patients before and after RDG was detected and subsequently analyzed. Short-chain fatty acids were also detected by chromatography spectrometer in these 6 GC patients.
RDG had a moderate effect on bacterial richness and evenness, but had pronounced effects on the composition of postoperative gut microbiota compared with preoperative group. The relative abundances of genera Akkermansia, Esherichia/Shigella, Lactobacillus, and Dialister were significant changed in perioperative period. Remarkably, higher abundances of Escherichia/Shigella, Veillonella, and Clostridium XVIII and lower abundances of Bacteroides were observed in gut microbiota of overall GC patients compared to healthy controls.
This study is the first study to characterize the altered gut microbiota within fecal samples from GC patients during perioperative period, and provide a new insights on such microbial perturbations as a potential effector of perioperative period phenotype. Further research must validate these discoveries and may evaluate targeted microbiota shifts to improve outcomes in GC patients.
Safety issues related to the electronic cross-matching of blood in mainland China
Authors: Wang Yuan-Jie , Liu Jia-Rui , Liu Yong 
Published: August 2019

Abstract
Although the electronic cross-matching of blood has been widely applied in some developed countries and regions, concern over the risk of undetected red blood cell (RBC) antibodies has limited its application in mainland China.
This study was performed to explore the missed detection rate of RBC antibodies in a Chinese population from 2011 to 2016. If the results of 2 consecutive tests of ABO/RhD blood group identification were consistent and antibody screening results were negative, electronic cross-matching of the blood was performed. In addition, traditional serological cross-matching of blood (polybrene method) and a parallel experiment for electronic cross-matching of blood were performed to analyze the missed detection of unexpected RBC antibodies in blood donors and recipients.
Using the polybrene method, 40,228 blood samples were tested by parallel traditional serological cross-matching of blood; among these samples, blood compatibility was found in 40,222 cases, primary incompatibility (incompatibility of the donor's erythrocytes with the recipient's serum) was found in 6 cases, and no secondary incompatibility was found. Identification of antibody specificity was performed using panel cells, and all unexpected RBC antibodies were confirmed as anti-Mur alloantibodies in the MNS system.
Further improvements in the erythrocyte antigenic spectrum, especially the Mur antigen in Asian populations, are expected to ensure the safety of implementing electronic cross-matching in China.