bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adolescents in Scotland: Challenges and Opportunities for Sexual Risk Reduction
Authors: Morrison-Beedy Dianne , Martin Caroline Hollins , Pow Janette , Elliott Lawrie 
Published: May 2019

Abstract
Sexually transmitted infections, HIV, and unplanned pregnancy challenge the health of Scottish teens. We conducted focus groups with teens (ages 16–19 years) recruited from an urban youth cafe in Edinburgh and assessed sexual risk-taking and protective behaviors. A trained facilitator, using a semi-structured interview guide, led the groups. We taped and transcribed data verbatim for coding and theming. The teens revealed similar concerns despite differences in gender and/or sexual histories. Despite school-based sex education, sex was rarely discussed with peers or adults outside classrooms; the ability to practice communication and negotiation skills was minimal. Much risky behavior occurred in public spaces and was often linked to drug or alcohol intake. There was a glaring lack of teen planning for, or contemplating, future adult lives. Findings highlight the challenges these teens faced in practicing safer sex and limited opportunities to tailor intervention strategies to address the cultural realities of their lives.
Glasgow Coma Scale: Generating Clinical Standards
Authors: Enriquez Catherine M. , Chisholm Karen H. , Madden Lori Kennedy , Larsen Amy D. , de Longpré Tuesday , Stannard Daphne 
Published: May 2019

ABSTRACT

Background: The Glasgow Coma Scale (GCS) is a tool used to aid in objectively measuring the neurological status of a patient. This study aimed to evaluate the limitations and discrepancies in GCS use among nurses in an academic medical center neurological intensive care unit and compile evidence for development of a standardized GCS educational program. Methods: Twenty nurse participants completed a survey before attending an educational intervention. Participants then attended a 90-minute educational intervention. In follow-up, participants were asked to complete a postsurvey. Results: The standardized GCS educational program significantly improved nurse knowledge of the GCS as measured by presurvey and postsurvey general GCS question scores. Educational programming improved application of the GCS as measured by presurvey and postsurvey GCS verbal component, motor component, and sum scores. GCS motor score performance was the least accurate component. Conclusion: Participants reported that the education has informed the unit culture and emboldened clinical nurses to speak to their practice with more authority. Educational interventions should be aimed toward applied transfer of knowledge to the case-based scenarios in the clinical setting.
Intraoperative Intracochlear Electrocochleography and Residual Hearing Preservation Outcomes When Using Two Types of Slim Electrode Arrays in Cochlear Implantation
Authors: Ramos-Macias Angel , O’Leary Stephen , Ramos-deMiguel Angel , Bester Christo , Falcon-González Juan C. 
Published: May 2019

Objectives:
To report residual hearing preservation outcomes in patients with low frequency hearing, after cochlear implant (CI) electrode insertion with two types of electrode arrays: one straight and other perimodiolar, when using intraoperative intracochlear electrocochleography (ECochG) during (CI) electrode insertion.

Study Design:
Prospective, randomized study.

Setting:
Tertiary referral otology center.

Patients:
Fifteen patients ranging from 33 to 54 years old (mean 51.19). They had been diagnosed with a bilateral, profound sensorineural hearing loss and treated with a unilateral cochlear implant: eight of them with the CI532 and seven of them with the CI522 (Cochlear Ltd, Sydney, Australia).

Intervention:
Pure-tone audiometry was performed preoperatively and at 1 and 6 months postoperatively. Interoperatively, intracochlear ECochG was performed using the apical-most electrode. The amplitude of the first harmonic was plotted and monitored in real time by the audiologist-surgeon team during their CI electrode insertion. The different ECoch patterns of the insertion track were recorded and analyzed.

Results:
In 12 cases ECochG responses were successfully recorded. In three cases no ECochG responses could be recorded with no residual hearing observed postoperatively in two of them. With respect to the first harmonic amplitude changes, we found: four cases with an overall increase in amplitude measured from the beginning of insertion until completion, all of them showed residual hearing (<15 dB HL) at 6 months postoperation. Three cases with an increasing amplitude at the beginning of insertion, with a decrease in amplitude as insertion progressed to completion, in two cases dropping of residual hearing (15–30 dB HL) were observed after 6 months postoperation and, in one case, complete residual hearing was observed at 6 months postoperatively. And finally five cases presented amplitudes at the start of insertion with modifications of amplitude during the insertion dynamic, with increasing and descending in amplitude range during the whole insertion, two of them showed residual hearing at 6 months postoperation and three cases a drop of residual hearing (15–30 dB HL) was observed after 6 months postoperation. No statistical differences between CI532 and CI522 electrodes were found. Data of the ECochG responses are also presented (p value ≥ 0.05).

Conclusion:
ECochG is a useful tool to evaluate the residual hearing in CI patients with straight and perimodiolar cochlear implant. More studies are needed to fully understand the relationship between ECochG and the presence of residual hearing, cochlear trauma, and functional outcomes.
Extended Retrolabyrinthine Approach: Results of Hearing Preservation Surgery Using a New System for Continuous Near Real-time Neuromonitoring in Patients With Growing Vestibular Schwannomas
Authors: Sass Hjalte C.R. , Miyazaki Hidemi , West Niels , Hansen Søren , Møller Martin N. , Cayé-Thomasen Per 
Published: May 2019

Objective:
To report hearing preservation results after retrolabyrinthine vestibular schwannoma surgery, using a new system for continuous near real-time monitoring of cochlear nerve function.

Study Design:
Retrospective chart review.

Setting:
Tertiary referral center, University Hospital.

Patients:
Thirty-one consecutive patients with growing vestibular schwannomas and opting for hearing preservation surgery.

Interventions:
Tumor removal by a modified, extended retrolabyrinthine approach, using a new system for continuous near real-time monitoring of cochlear nerve function.

Main Outcome Measures:
Pure-tone average and speech discrimination (SD) 1-year postoperative. Preservation of word recognition score class. Preservation of serviceable hearing (SD>50%).

Results:
Any hearing was preserved in 83 and 69% had preserved word recognition score class or better. Serviceable hearing was preserved in 77%. SD was unchanged in 48%, improved in 21%, and poorer in 31%. Of 18 patients with potential for improvement (SD 90% or worse preoperatively), 33% improved (SD increase 10% or more).

Conclusion:
The hearing preservation rate is favorable using the modified, extended retrolabyrinthine approach and a new system for continuous near real-time monitoring of cochlear nerve function for removal of growing vestibular schwannomas, as 77% preserved serviceable hearing 1 year after surgery. Hearing improved after surgery in 33%. Using the new neuromonitoring system, serviceable hearing preservation rate improved from 53 to 77% at our center.
Changes in Lower Gastrointestinal Bleeding Presentation, Management, and Outcomes Over a 10-Year Span
Authors: Kim Kyeong Ok , Kozarek Richard , Gluck Michael , Ross Andrew , Lin Otto S. 
Published: May 2019

Background:
There are only limited data available on changes in the etiology, management, and clinical outcomes in patients with lower gastrointestinal bleeding over the past decade.

Study:
We compared 2 groups of consecutive patients hospitalized with lower gastrointestinal bleeding during 2 time periods: 2005 to 2007 (301 patients) and 2015 to 2017 (249 patients).

Results:
Compared with the 2005 to 2007 group, the mean Charlson comorbidity index in the 2015 to 2017 group was higher (5.0±2.6 vs. 6.0±3.0, P=0.028), whereas the use of computerized tomographic angiography and small bowel capsule endoscopy was more common (12.9% vs. 58.1%, P<0.001, and 28.8% vs. 69.0%, P=0.031, respectively). In 2005 to 2007, ischemic colitis (12.0%) was the most common confirmed etiology of bleeding and diverticular bleeding the second most common (8.6%), whereas in 2015 to 2017, diverticular bleeding was the most common etiology (10.4%), followed by angiodysplasia (8.4%). Small bowel bleeding sources were confirmed more often in the 2015 to 2017 group (P=0.017). Endoscopic treatment was attempted in 16.6% of patients in 2005 to 2007 versus 25.3% in 2015 to 2017 (P=0.015). Higher rebleeding rates, longer hospitalization durations (4.6±4.3 vs. 5.5±3.4 d, P=0.019), and a higher proportion of patients needing a transfusion (62.0% vs. 78.4%, P=0.016) were noted in 2015 to 2017.

Conclusions:
Over a 10-year span, there were several notable changes: (1) more comorbidities in patients hospitalized for lower gastrointestinal bleeding; (2) marked increase in the use of computerized tomographic angiography and capsule endoscopy for diagnostic evaluation; and (3) longer hospitalization durations and greater need for blood transfusion, possibly reflecting the selection of sicker patients for in-patient management in 2015 to 2017.
Antifungal Drug Use for Onychomycosis
Authors: Thomas Jackson , Peterson Gregory M. , Christenson Julia K. , Kosari Sam , Baby Kavya E. 
Published: May 2019

Background:
Onychomycoses are fungal nail infections affecting predominantly toenails, and mainly caused by dermatophyte fungi, molds and some Candida species. Nail infections can be mild with purely cosmetic implications, but they can also negatively influence quality of life. The deep-seated nature of fungi within the nail plate, prolonged treatment, poor patient adherence, frequent recurrences, and development of resistance to various antimicrobial agents make onychomycosis difficult to successfully treat.

Areas of Uncertainty:
When and how should clinicians prescribe systemic and topical antifungal drugs for onychomycosis?

Data Sources:
A narrative review was undertaken of the current literature identified in Medline, Scopus, CINAHL, the Cochrane library, and Google Scholar.

Results:
Treatment is often lengthy and requires persistence and patient education. Definitive mycological diagnosis, and an individualized evaluation of risks and benefits of different treatments are imperative before initiating therapy. The choice of treatment can be influenced by the age and general health of the patient, the causative organism, the number of affected nails, and the extent of nail involvement. Oral antifungals offer greater likelihood of a cure than topicals, but oral therapy carries greater risks and requires closer monitoring. Oral terbinafine is the treatment of choice, followed by itraconazole pulse regimen. The newly approved topical agents, efinaconazole and tavaborole, were superior to placebo in clinical trials and appear to produce slightly improved mycological cure rates compared to previous topicals, but further direct comparisons are needed.

Conclusions:
The treatment of onychomycosis can be challenging, as most therapeutic options are lengthy, expensive and potentially unsuccessful.
Management of congenital adrenal hyperplasia: beyond conventional glucocorticoid therapy
Authors: Khattab Ahmed , Marshall Ian 
Published: May 2019

Purpose of review
The most common enzyme defect associated with congenital adrenal hyperplasia (CAH) is 21-hydroxylase deficiency (21OHD). Glucocorticoid therapy aiming to suppress adrenocorticotrophic hormone (ACTH)-mediated hyperandrogenemia and to replace glucocorticoid deficiency, if indicated, remains the first line of management in CAH with or without mineralocorticoid replacement therapy and salt supplementation. We review interventions that may address unmet needs in the management of CAH. Although the objective of this review is to highlight some potential benefits of supplemental therapies, the authors do not recommend for or against the use of the reviewed therapies. In the review, the terms ‘male’ and ‘female’ refer to ‘genetic male (46,XY)’ and ‘genetic female (46,XX)’ respectively.

Recent findings
Supplemental therapies, some of which appear to be promising, attempt to address CAH-associated morbidity but long-term efficacy and safety data are still lacking.

Summary
We highlight main ideas behind the use of interventions that target an improvement in physiological glucocorticoid replacement, adult height outcome, and management of female genital virilization in CAH.
Use of the microbiome in the management of children with type 2 diabetes mellitus
Authors: Brar Preneet Cheema , Kohn Brenda 
Published: May 2019

Purpose of review
The purpose of this review is to present recent data that defines our current understanding of the role of the gut microbiome in the development of T2DM.

Recent findings
Recent studies focus on the physiology and molecular pathways of the gut microbiome–host interaction. Short-chain fatty acids (SCFAs) derived from the fermentation of plant-based nonsoluble fiber bind to G-protein-coupled receptors (GPR) GPR 41 and GPR 43 to induce enteroendocrine molecules that control appetite, and to upregulate intestinal gluconeogenesis gene expression that controls glucose regulation. “Metabolic endotexemia” reflects a state of low-grade systemic inflammation that results from lipopolysaccharide (LPS) release from the gut into the systemic circulation in response to a high-fat diet. Inflammatory pathways induced by LPS, activation of toll-like receptor-4 (TLR-4), and other inflammatory signaling pathways are mediators of systemic inflammation, insulin resistance and type II diabetes mellitus.

Summary
Recent scientific data support that derangements in the composition of the microbiota, termed “microbiome dysbiosis” is a factor in the development of “metabolic endotoxemia” and T2DM. Therapeutic options that target the gut microbiome in the treatment of T2DM are explored.
Diagnostic Efficacy of Liquid-Based Cytology in Endoscopic Ultrasound–Guided Fine Needle Aspiration for Pancreatic Mass Lesions During the Learning Curve
Authors: Mitoro Akira , Nishikawa Takeshi , Yoshida Motoyuki , Sawai Masayoshi , Okura Yasushi , Kitagawa Koh , Seki Kenichiro , Furukawa Masanori , Ozutsumi Takahiro , Takeuchi Mao , Morita Kohei , Ohbayashi Chiho , Yamao Junichi , Yoshiji Hitoshi 
Published: May 2019

Objectives
The diagnostic yield of endoscopic ultrasound–guided fine needle aspiration (EUS-FNA) cytology widely varies depending on the treatment method used. Liquid-based cytology (LBC) has gained popularity in the gynecological field because of its efficacy in collection of target cells and simplicity in the manipulation of specimens. Since the introduction of EUS-FNA at our institution, we have used LBC for the diagnosis of pancreatic mass lesions. This study aims to investigate the diagnostic efficacy of EUS-FNA with LBC in patients with pancreatic mass lesions during the learning curve for EUS-FNA.

Methods
In this study, we retrospectively enrolled 222 patients with pancreatic mass lesions who were diagnosed using EUS-FNA with LBC between 2011 and 2016. The diagnostic yields for EUS-FNA with LBC for pancreatic mass lesions were evaluated.

Results
The diagnostic sensitivity, specificity, and accuracy for malignancy were found to be 93.9%, 95.1%, and 94.1%, respectively.

Conclusions
This study suggests that EUS-FNA with LBC for specimens provides good diagnostic efficacy in patients with pancreatic mass lesions even during the learning curve for EUS-FNA.
Impact of Mesenteric Mass in Patients With Midgut Neuroendocrine Tumors
Authors: Malik Preeti , Pinto Candida , Naparst Monica S. , Ward Stephen C. , Aronson Anne , Aalberg Jeffrey J. , Divino Celia M. , Kim Michelle K. 
Published: May 2019

Objectives
In this study, we used the institutional pathological and clinical databases from The Mount Sinai Hospital to investigate the impact of mesenteric mass on clinical and staging features in small intestinal neuroendocrine tumors.

Methods
Demographic, clinical, and staging data were collected. Tumor-node-metastasis stage was assigned according to the American Joint Committee on Cancer eighth edition staging manual. We used a χ2-square test to evaluate the association between mesenteric mass and presenting symptoms, as well as the association between mesenteric mass and tumor characteristics, type of surgical resection, and use of somatostatin analogues.

Results
Presence of mesenteric mass was strongly associated with highly symptomatic clinical presentation (P < 0.0001). Patients with a mesenteric mass were more likely to have more advanced tumor status (T3 and T4; P = 0.005). The presence of a mesenteric mass was also more strongly associated with metastatic disease (P = 0.002). Patients with a mesenteric mass were more likely to undergo extensive surgical resection (P < 0.0001) and be treated with somatostatin analogues (P < 0.003).

Conclusions
The data confirm our clinical observations that mesenteric involvement represents more extensive disease and is also associated with more aggressive treatment.
Epidural Analgesia Improves Postoperative Pain Control but Impedes Early Discharge in Patients Undergoing Pancreatic Surgery
Authors: Kim Stephanie S. , Niu Xiaojuan , Elliott Irmina A. , Jiang Jerry P. , Dann Amanda M. , Damato Lauren M. , Chung Hallie , Girgis Mark D. , King Jonathan C. , Hines O. Joe , Rahman Siamak , Donahue Timothy R. 
Published: May 2019

Objectives
The aim of this study was to evaluate the impact of epidural analgesia (EA) on postoperative length of stay (LOS), expeditious discharge, and pain relief after pancreaticoduodenectomy (PD) and distal pancreatectomy (DP).

Methods
Retrospective reviews of 2014–2015 American College of Surgeons National Surgical Quality Improvement Program databases and our institutional pancreatic surgery database were conducted.

Results
On univariate analysis, EA was associated with statistically significant longer lengths of stay for both PD and DP. On comparative analysis at mode LOS, discharged before versus after 7 days for PD and 6 days for DP, EA was a significant predictor for the longer groups for both procedures on multivariable analysis (PD, odds ratio of 1.465, P < 0.001; DP, odds ratio of 1.471, P = 0.004). On review of our institution's pancreatic surgery database, patient-reported pain scores were significantly lower in the EA groups than intravenous narcotics groups on the day of surgery only for both PD and DP.

Conclusions
Epidural analgesia was associated with longer LOS with a most pronounced effect on early discharge after surgery for patients undergoing open PD and DP. It only resulted in superior pain control on the day of surgery.
Glucose Counter-regulation After Acute Pancreatitis
Authors: Bharmal Sakina H. , Pendharkar Sayali , Singh Ruma G. , Cho Jaelim , Petrov Maxim S. 
Published: May 2019

Objectives
Persistent hyperglycemia is a common sequela of acute pancreatitis (AP). The role of counter-regulatory hormones in maintaining glucose homeostasis has been largely studied during the course of AP, but not after clinical resolution of the disease. The objectives of this study were to investigate the associations between circulating levels of glucagon, cortisol, and human growth hormone and glucose homeostasis after AP as well as their associations with a comprehensive panel of pancreatic hormones, gut peptides, and proinflammatory cytokines.

Methods
Participants with no history of pre-existing prediabetes or diabetes were categorized into hyperglycemia and normoglycemia after AP groups. Binary logistic regression and linear regression analyses were conducted.

Results
Eighty-three individuals were included, of whom 19 had hyperglycemia. Glucagon, cortisol, and human growth hormone did not differ significantly between the groups. Glucagon explained up to 86% of the variance in glucagon-like peptide 1, whereas cortisol explained up to 89% of the variance in interleukin 6 in hyperglycemia after AP.

Conclusions
Counter-regulatory hormones do not appear to play a direct role in the mechanisms underlying hyperglycemia after AP. However, significant associations between glucagon and glucagon-like peptide 1, as well as between cortisol and interleukin 6, suggest that that these hormones may be involved indirectly in the pathophysiology of hyperglycemia after AP.
Plasma Chromogranin A as a Prognostic Marker in Pancreatic Ductal Adenocarcinoma
Authors: Lee Sang Hoon , Jo Jung Hyun , Kim Yeong Jin , Lee Hee Seung , Chung Moon Jae , Park Jeong Youp , Bang Seungmin , Park Seung Woo , Song Si Young 
Published: May 2019

Objectives
Neuroendocrine differentiation in pancreatic ductal adenocarcinoma (PDAC) is known, but its clinical significance still remains uncertain. The clinical role of chromogranin A (CgA), a marker of neuroendocrine tumor, was evaluated in patients with PDAC.

Methods
We retrospectively analyzed 350 patients with PDAC. All patients had plasma CgA levels at diagnosis. Patients were classified as normal and high CgA groups according to the upper limit of plasma CgA.

Results
There were 202 patients (57.7%) in the normal CgA group and 148 patients (42.3%) in the high CgA group. High CgA group presented higher rate of metastatic disease (61.5% vs 45.0%; P = 0.002) and shorter median overall survival (OS) (8.2 vs 11.6 months; P = 0.015). Upon grouping patients based on clinical stages, OS was significantly different between the CgA groups only in metastatic disease (6.6 vs 7.2 months; P = 0.022). Multivariate analysis showed no association between high CgA and OS (hazard ratio, 1.22; 95% confidence interval, 0.97–1.54; P = 0.090). However, high CgA was associated with poor OS in patients with metastatic disease (hazard ratio, 1.37; 95% confidence interval, 1.01–1.87; P = 0.047).

Conclusions
High CgA levels may predict poor prognosis in patients with pancreatic cancer, especially during metastatic stages.
Inhibition of LONP1 Suppresses Pancreatic Cancer Progression Via c-Jun N-Terminal Kinase Pathway–Meditated Epithelial-Mesenchymal Transition
Authors: Liu Can , Wang Hai , Li Hao , Chen Xiong , Wu Xiang , Lu Bin , Zhang Wenling , Zhou Yong , Xiao Gary Guishan , Gao Ge 
Published: May 2019

Objective
The aim of this study was to investigate the role of LONP1 in the progression of pancreatic cancer.

Methods
Lentivirus was used to silence LONP1 in PANC-1 cells. Colony formation assay, cell counting kit (CCK8) assay, cell scratch-wound assay, and transwell assay were used to assess the effects of our strategy on inhibiting cancer growth, migration, and invasion. Protein expression was detected by Western blot analysis.

Results
The expression of LONP1 in pancreatic carcinoma tissues was higher than that in adjacent normal pancreatic tissues. Downregulation of LONP1 suppressed the proliferation, migration, and invasion of PANC-1 cells. Knockdown of LONP1 in PANC-1 cells inhibited epithelial-mesenchymal transition and matrix metalloprotein (MMP) 2/9 by downregulation of vimentin, snail, slug, MMP2, and MMP9 and upregulation of claudin-1. The c-Jun N-terminal kinase pathway was inactivated in LONP1 knockdown PANC-1 cells. Activation of the c-Jun N-terminal kinase pathway by anisomycin treatment significantly reversed the changes in epithelial-mesenchymal transition markers and MMP2/9 induced by ablation of LONP1 in PANC-1 cells.

Conclusions
LONP1 plays a vital role in the proliferation and metastasis of pancreatic cancer, which provides a potential therapeutic target for the treatment of pancreatic cancer.