bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of a Cardiac Rehabilitation Program Versus Usual Care on Cardiopulmonary Function in Patients With Cardiac Syndrome X
Authors: Rahmani Reza , Niyazi Sepideh , Sobh-Rakhshankhah Amir , Guazzi Marco , Mazaheri Reza , Hashemi Naeimeh , Khoddami-Vishteh Hamid-Reza 
Published: June 2019

Purpose:
Because of uncertainty in the pathophysiological process, the treatment of cardiac syndrome X (CSX) is still under study. Addressing the effects of cardiac rehabilitation (CR) can help promote the prescription of this modality as an adjuvant therapy for these patients.

Methods:
This study was performed on 30 patients with effort-induced angina pectoris using a positive exercise test and/or myocardial perfusion scan in the absence of obvious stenosis or a stenosis of <50% on coronary angiography. The patients were divided into the CR and usual care (UC) groups and underwent cardiopulmonary exercise testing with gas exchange analysis before and after the study. The Duke Treadmill Score was used to compare prognosis and survival estimates of patients.

Results:
An increase in peak oxygen uptake (

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2) was significantly higher in the CR group than in the control group (P = .017). Resting

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2 was also increased in the CR group, but its difference with the UC group was not statistically significant. Resting O2 pulse was increased in the CR group, which significantly differed between groups (P = .041). Exercise test duration and the Duke Treadmill Score significantly increased in the CR group as compared with the UC group (P = .003 and P = .002, respectively). Also, recovery heart rate in the first minute was significantly improved in CR group.

Conclusion:
Adding a 4-wk course of CR to UC for patients with CSX not only increased the Duke Treadmill Score and exercise test duration but also improved the resting O2 pulse, peak

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2, and first-minute recovery heart rate.
EVALUATION OF ACCURACY AND UNIFORMITY OF THE NOMENCLATURE OF VITREORETINAL INTERFACE DISORDERS
Authors: Benyamini Shira , Loewenstein Anat , Moisseiev Elad 
Published: June 2019

Purpose:
To evaluate the accuracy and uniformity of the definitions used to diagnose vitreoretinal (VR) interface disorders and to assess it after review of its definitions.

Methods:
A case-series study, consisting of a questionnaire of 46 optical coherence tomography images of six VR interface disorders: vitreomacular adhesion, vitreomacular traction, epiretinal membrane, full-thickness macular hole, lamellar macular hole, and pseudohole. Images were presented to 41 practicing ophthalmologists (13 residents, 11 VR specialists, and 17 non-VR specialists), and a diagnosis was recorded for each image. The questionnaire was repeated after review of the International Vitreomacular Traction Study (IVTS) group classification. Rates of accuracy and uniformity for each condition were analyzed.

Results:
Overall correct identification rates according to the IVTS classification were achieved in 67.4% of cases and were highest for epiretinal membrane and full-thickness macular hole, followed by vitreomacular adhesion, vitreomacular traction, and lamellar macular hole, and were significantly lower for pseudohole (P < 0.001). Accuracy was higher among VR specialists and was associated with previous familiarity with the IVTS classification (P = 0.043) but not with length of experience in ophthalmology (P = 0.74). After review of the IVTS classification, overall correct identification rates improved to 71.7% (P = 0.004), with the significant improvement in pseudohole identification (P = 0.002).

Conclusion:
The IVTS classification is effective in standardizing the diagnosis of VR interface disorders. It is expected to become increasingly assimilated among ophthalmologists over time, leading to higher rates of accuracy and uniformity in diagnosing VR interface disorders.
Audiologic and Otologic Complications of Cryptococcal Meningoencephalitis in Non-HIV Previously Healthy Patients
Authors: King Kelly A. , Ansari Ghedak , Panackal Anil A. , Zalewski Chris , Anjum Seher , Bennett John E. , Beri Andrea , Kim Hung Jeff , Hammoud Dima , Brewer Carmen C. , Williamson Peter R. 
Published: June 2019

Objective:To identify audiologic and otologic outcomes in previously healthy non-HIV patients with cryptococcal meningoencephalitis (CM).Study Design:Retrospective case review of a subset of patients recruited in a prospective observational study following previously healthy individuals who developed CM.Setting:Tertiary referral center, National Institutes of Health Clinical Center.Patients:Previously healthy adult patients with CM without immune suppressive therapy before disease onset.Interventions:Diagnostic evaluations included audiometry, acoustic immittance, otoacoustic emissions, and auditory brainstem response studies, in addition to neurotologic assessment.Results:Twenty-nine patients (58 years) underwent audiologic evaluation between 6 months and 3.5 years after CM diagnosis; 21 patients were seen for longitudinal assessment with an average duration of follow up of 20.3 months. Nearly three-quarters (73%) of the cohort presented with hearing loss, most commonly (90%) sensorineural in origin. The most frequent degree of loss was mild and then moderate, although some patients had severe or profound impairment. Hearing loss improved (43%) or remained stable (38%) in most cases. Ears with internal auditory canal enhancement on magnetic resonance imaging (MRI) had significantly more hearing loss than those without enhancement, although a similar finding was not observed with gyral enhancement or the presence of ependymitis or ventricular volume expansion. Hearing loss was not associated with reduced cerebrospinal fluid (CSF) glucose, CSF total protein, cryptococcal antigen, or total cell count.Conclusions:Hearing loss is a common manifestation of cryptococcal meningitis in previously healthy patients and may involve a cochlear or neural site of lesion, or both. Routine surveillance of hearing in patients is recommended, regardless of symptomatology, to ensure early and appropriate intervention and care.
Standardization of the Punch Technique for the Implantation of Bone Anchored Auditory Devices: Evaluation of the MIPS Surgical Set
Authors: Kim Harold Hyon Soo , Kari Elina , Copeland Benjamin J. , Moore Gary F. , Shaia Wayne T. , Cosetti Maura K. , Wazen Jack J. , Wanna George B. , Chang Chin-Yen Joseph 
Published: June 2019

Objective:To describe and assess intraoperative and postoperative outcomes in the insertion of osseointegrated auditory implants with a newly designed surgical instrumentation set through a punch type technique.Study Design:Retrospective case series.Methods:Patients who underwent bone anchored auditory implant surgery using the Minimally Invasive Ponto Surgery (Oticon Medical, Somerset, NJ) surgical set through a punch technique at nine neurotology tertiary referral based practices were identified. Demographic data, skin thickness at implant site, implant used, duration of surgery, adverse intraoperative events, and postoperative outcomes were recorded.Results:Seventy-five patients comprised the study cohort (32 males, 43 females). Most patients (57. 3%) were aged 51 to 75 years while 30.7% of the cohort comprised those aged 18 to 50 years and 12% were over 75 years. All but two patients received 4 mm fixtured implants and 68% received the Oticon Medical BioHelix implant. Two patients received 3 mm fixture implants and 32% received the Oticon Medical Wide Ponto implant. Mean surgical time was 12.2 minutes (6–45 min, standard deviation of 6.88 min). In three instances, surgery was converted to a linear incision to control brisk bleeding. Skin condition was Holgers 0 to 1 in 91.8%, while 5.5% had Holgers 2, and 2.7% had Holgers 3 at the first postoperative visit. At second postoperative visit, 94.3% had Holgers 0 to 1, 4.3% had Holgers 2, and 1.4% had Holgers 3. All instances of adverse skin reactions were treated with topical or systemic antibiotics and/or local debridement. There were no instances of implant loss. One patient had his implant traumatically displaced to a 45-degree angle necessitating implant replacement at a second site.Conclusion:Punch technique placement of osseointegrated auditory implants using the Minimally Invasive Ponto Surgery surgical set represents a safe technique that further simplifies a progressively minimally invasive surgery.
Audiologic Improvement Following MCF Approach for Spontaneous Cerebrospinal Fluid Leaks
Authors: Alwani Mohamedkazim , Bandali Elhaam , Van Buren Lauren , Yates Charles W. , Nelson Rick F. 
Published: June 2019

Objective:
To determine the audiologic improvement after middle cranial fossa (MCF) approach to repair spontaneous cerebrospinal fluid (sCSF) leaks.

Study Design:
Retrospective cohort study.

Setting:
Tertiary referral center.

Patients:
Twenty-four consecutive patients (27 ears) with temporal bone sCSF leak over a 4-year period. Patient age, sex, ethnicity, body mass index (BMI), location of CSF leak, recurrence of CSF leak, and presence of encephalocele(s) were recorded.

Intervention:
Audiometric testing in patients undergoing MCF repair of temporal bone sCSF leak.

Main Outcome Measures:
Comparison of preoperative and postoperative pure-tone average (PTA), air-bone gap (ABG), and word recognition score (WRS) in the sCSF leak ear.

Results:
Out of 27 ears, 55% had multiple tegmen defects and 82% had more than or equal to 1 encephaloceles. There were no recurrent CSF leaks at a median follow up of 4 months. The mean (SD) preoperative PTA and ABG were 40.58 [15.67] and 16.44 [6.93] dB, respectively. There was significant improvement in mean PTA (10.28 [8.01] dB; p < 0.001; Cohen d = 0.95) and ABG (9.31 [7.16] dB; p < 0.001; Cohen d = 0.88) after sCSF repair. Mean WRS improved (by 3.07 [6.11] %; p = 0.024; Cohen d = 0.46) from a mean preoperative WRS of 93.16 [9.34]% to a mean postoperative WRS of 96.26 [6.49]%.

Conclusions:
MCF approach for repair of sCSF leaks yields significant improvement in conductive hearing loss and is highly effective in management of the entire lateral skull base where multiple bony defects are often identified.
Arterial stiffness is associated independently with liver stiffness in biopsy-proven nonalcoholic fatty liver disease: a transient elastography study
Authors: Bilgin Beyza O. , Sunbul Murat , Kani Haluk T. , Demirtas Coskun O. , Keklikkiran Caglayan , Yilmaz Yusuf 
Published: June 2019

Background
Nonalcoholic fatty liver disease (NAFLD) has been associated with an increased arterial stiffness. However, the question as to whether an association exists between the extent of vascular and liver stiffness in patients with biopsy-proven NAFLD remains open. In this study, we sought to investigate whether pulse wave velocity (PWV) and augmentation index (AIx) – two common indices of arterial stiffness – are associated with (a) liver stiffness measurement (LSM) on transient elastography (TE) and (b) histological liver fibrosis.

Patients and methods
We examined 125 patients with biopsy-proven NAFLD and 55 age-matched and sex-matched controls. Arterial stiffness of the brachial artery was measured using a Mobil-O-Graph arteriography system. LSM was assessed using TE, whereas the presence of advanced fibrosis (F ≥ 3) was determined on histology.

Results
Patients with NAFLD had higher PWV [median: 7.2 (6.3−8.2) and 6.2 (5.5−6.7) m/s, respectively, P < 0.001] and AIx (mean: 21.3 ± 13.5 and 17.2 ± 11.9%, respectively, P=0.01) compared with the controls. LSM showed positive correlations with both PWV (ρ = 0.300; P<0.01) and AIx (ρ = 0.223, P = 0.02). Both indices of arterial stiffness were higher in patients with advanced fibrosis than in those with nonadvanced fibrosis (F ≤ 2).

Conclusion
The severity of arterial and liver stiffness increases in parallel in patients with biopsy-proven NAFLD. Systematic risk assessment for reducing arterial stiffness is recommended in the presence of TE-determined advanced fibrosis.
Offset Effects of Outpatient Cost-sharing for the Poor in Korea
Authors: Ko Hansoo 
Published: June 2019

Objective:
The objective of this study was to evaluate the impacts of the implementation of patient cost-sharing for an outpatient visit and prescription drugs for poor and nonable bodied Koreans in 2007.

Data Sources/Study Settings:
Nationally-representative longitudinal data sets (Korea Welfare Panel Study and the Korean Longitudinal Study of Ageing) in 2006, 2008, and 2010.

Research Design:
Propensity score matching with difference-in-differences framework exploiting within-person variation in cost-sharing.

Results:
Decreases in the probability of outpatient visit are offset by increases in the likelihood of hospitalization after the policy change. Cost-sharing also decreases drug adherence by 20%, particularly among chronically-ill persons.

Conclusion:
Because the costs of increased hospitalization among Medical Aid enrollees accrue to the government, the introduction of outpatient cost-sharing does not achieve the goal of cost control.
Disputes of Self-reported Chronic Disease Over Time
Authors: Quiñones Ana R. , Melekin Amanuel , Cigolle Christine T. , Nagel Corey L. 
Published: June 2019

Background:
Respondents in longitudinal health interview surveys may inconsistently report their chronic diseases across interview waves. Racial/ethnic minority adults have an increased burden of chronic diseases and may dispute chronic disease reports more frequently.

Objective:
We evaluated the longitudinal association between race/ethnicity, nativity, and language of interview with disputing previously reported chronic diseases.

Methods:
We performed secondary data analysis of nationally representative longitudinal data (Health and Retirement Study, 1998–2010) of adults 51 years or older (n=23,593). We estimated multilevel mixed-effects logistic models of disputes of previously reported chronic disease (hypertension, heart disease, lung disease, diabetes, cancer, stroke, arthritis).

Results:
Approximately 22% of Health and Retirement Study respondents disputed prior chronic disease self-reports across the entire study period; 21% of non-Latino white, 20.5% of non-Latino black, and 28% of Latino respondents disputed. In subgroup comparisons of model-predicted odds using postestimation commands, Latinos interviewed in Spanish have 34% greater odds of disputing compared with non-Latino whites interviewed in English and 35% greater odds of dispute relative to non-Latino blacks interviewed in English.

Conclusions:
The odds of disputing a prior chronic disease report were substantially higher for Latinos who were interviewed in Spanish compared with non-Latino white or black counterparts interviewed in English, even after accounting for other sociodemographic factors, cognitive declines, and time-in-sample considerations. Our findings point toward leveraging of multiple sources of data to triangulate information on chronic disease status as well as investigating potential mechanisms underlying the higher probability of dispute among Spanish-speaking Latino respondents.
Heme Oxygenase-1 Polymorphism Is Associated With the Development of Necrotic Acute Pancreatitis Via Vascular Cell Adhesion Molecule-1 and the E-Selectin Expression Regulation Pathway
Authors: Gulla Aiste , Gulbinas Antanas , Dambrauskas Zilvinas , Strupas Kestutis 
Published: June 2019

Objectives
Severe acute pancreatitis can lead to systemic complications. Here, we explore the mechanisms based on our previous study associated with the deregulation of heme oxygenase-1 (HO-1) and development of severe acute pancreatitis.

Methods
Acute pancreatitis patients (n = 135) and age- and sex-matched healthy controls (n = 108) were studied. The polymerase chain reaction products were analyzed with an ABI 3130 genetic analyzer and GeneMapper software. A short allele was defined ≤27 dinucleotide (GT) repeats, whereas a long allele was defined >27 GT. Levels of 12 different cytokines in blood serum were measured by enzyme-linked immunosorbent assay. All samples in this study were consistently stored in −80°C.

Results
Patients with the long long genotype expressed E-selectin and vascular cell adhesion molecule-1 at statistically significantly higher levels in serum compared with short short genotype or short long genotypes. Vascular cell adhesion molecule-1 and E-selectin serum levels significantly correlate with the total allele length of the HO-1 promoter region.

Conclusion
Polymorphism of the GT repeats in the HO-1 promoter region may be a risk factor for developing acute necrotizing pancreatitis due to deregulation of the immune response.
Per Oral Pancreatoscopy Identification of Main-duct Intraductal Papillary Mucinous Neoplasms and Concomitant Pancreatic Duct Stones
Authors: Han Samuel , Raijman Isaac , Machicado Jorge D. , Edmundowicz Steven A. , Shah Raj J. 
Published: June 2019

Objectives
Per oral pancreatoscopy (POP) assists in the evaluation and treatment of select benign and neoplastic pancreatic disorders including main-duct intraductal papillary mucinous neoplasm (MD-IPMN). Although pancreatic duct stones are classically thought of as pathognomonic for chronic pancreatitis, its co-occurrence with MD-IPMN as identified via POP may help identify an alternative etiology for presumed idiopathic chronic pancreatitis.

Methods
This was a multicenter retrospective case series of patients found to have pancreatic duct stones with concomitant MD-IPMN by POP.

Results
Thirteen patients with presumed idiopathic chronic calcific pancreatitis were found on POP to have both pancreatic duct stones and MD-IPMN. All patients had a dilated pancreatic duct, and most (92.3%) were symptomatic.

Conclusions
Per-oral pancreatoscopy may identify MD-IPMN as an etiology for patients with presumed idiopathic chronic calcific pancreatitis and associated dilated pancreatic duct. Larger prospective studies are needed to validate these findings.
Lactation Consultation Sustains Breast Milk Intake in Infants With Cystic Fibrosis
Authors: Miller Tami , Antos Nicholas J. , Brock Lisa A. , Wade Thomas , Goday Praveen S. 
Published: June 2019

ABSTRACTGuidelines recommend breastfeeding in cystic fibrosis (CF) but breastfeeding rates decline rapidly in CF. We initiated a quality improvement project to improve breastfeeding in CF by incorporating International Board‐Certified Lactation Consultants (IBCLC) into the initial CF‐diagnosis visit to support mothers who were breastfeeding at diagnosis. In the preintervention group, only 8/14 (57%) continued to provide breast milk after the first visit, whereas postintervention, 16/17 (94%) mothers continued to do so (P = 0.03). The duration of any (or partial) breastfeeding increased to an average of 7.7 months from an average of 6.4 months preintervention (P = 0.45). The weight z score and weight‐for‐length z score at diagnosis showed no change at 6 or 12 months (all comparisons P value >0.05). We conclude that mothers who met with the IBCLC were less likely to quit breastfeeding and hypothesize that lactation support to mothers can prolong the duration of breastfeeding in infants with CF.
Clinical Nurse Specialist–Led Implementation of an Early Discharge Protocol After Cardiac Surgery
Authors: Kwak Chanyeong , Ko Young 
Published: June 2019

Purpose/Aims
Current practice in Korean medical institutions executes prolonged average length of stay post–cardiac surgery, imposing higher risks of mortality and morbidity, along with administrative issues resulting in long waiting lists for future cardiac surgery. The purpose of this article is to develop and evaluate an early discharge protocol after cardiac surgery led by clinical nurse specialist in a Korean medical institution.

Description of the Project/Program
The project of implementing early discharge protocol seeks to provide an efficient delivery system for patients who are undergoing cardiac surgery. To evaluate the efficacy of this project, a group of cohorts administered with early discharge protocol was compared against the control group for their length of hospital stay, adverse complications, and clinical outcomes such as postoperative mortality and morbidity.

Outcomes
The early discharge protocol group had a decreased hospital length of stay by 30% (P < .05) compared with the control group under the conventional discharge protocol while maintaining patient safety and minimizing exposure of patients to further risks of mortality and morbidity.

Conclusion
Clinical nurse specialist–led early discharge protocol in patients who received cardiac surgery decreases length of stay, thus minimizing exposure of patients to further risks of mortality and morbidity.
Color Vision Deficiency Among Doctors: Can We Make Useful Adaptations to the Color Codes Used in the Clinical Environment?
Authors: Thomas Peter B. M. , Nesaratnam Nisha , Chaudhuri-Vayalambrone Prannoy , Mollon John D. 
Published: June 2019

Abstract
Color vision deficiency (formerly known as color blindness) is common as a congenital and as an acquired condition. Some professions, most famously commercial aviation, require their members to demonstrate normal color vision. In the United States and United Kingdom, no restriction is placed on the ability of the color-deficient doctor to practice medicine, although there is evidence that certain clinical discriminations are harder for such doctors. Generally ignored has been the difficulty and the potential for error that arises from the use of color codes in clinical equipment. In this review, we introduce the basic concepts of color deficiency, summarize evidence for the challenges it poses to the doctor, examine global variation in policy, show the potential for confusion among clinical color codes, and suggest how the current situation could be improved to enhance both patient safety and the well-being of the color-deficient doctor.
Biologics in Acute Burn Injury
Authors: Kogan Samuel , Halsey Jordan , Agag Richard L. 
Published: June 2019

Abstract
There have been significant advances in the care of burns over the past decade. As a result of the improved survival of burn patients, attention has shifted to the optimized management of their wounds. Traditionally, autografts have been described as the gold standard treatment in cases of deep second- and third-degree burn wounds; however, they are limited especially in large surface area burns. As such, advancements have been made in the development of biologic dressings, which attempt to mimic the function of the lost epidermis and/or dermis. The ideal biologic dressing is nontoxic, lacks antigenicity, is immunologically compatible, and is sterile. Additionally, easy storage conditions, long shelf lives, and reasonable costs are key determinants of whether biologic dressings may truly be widely used in the clinical setting. Biologic dressings serve an important role as skin substitutes in the setting of acute burn injury. This review aims to summarize the multitude of available biologic dressings and their applications.

Methods
The PubMed and Google Scholar databases were searched for the following terms either alone or in combination: “burn injury,” “biologic membrane,” “skin substitutes,” “biosynthetic dressings,” and “acellular membrane.”