bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anticoagulation in Acute Coronary Syndrome: Review of Major Therapeutic Advances
Authors: Pop Calin , Matei Claudia , Petris Antoniu 
Published: March 2019

Background:
In patients with acute coronary syndrome (ACS), a persistent hypercoagulable state has been demonstrated and antithrombin therapy in addition to platelet inhibition has been proposed.

Areas of Uncertainty:
Vitamin K antagonists (VKAs) were used as oral anticoagulant (OAC) therapy and produced mixed results whereas trials are still ongoing with non-vitamin K OACs (NOACs).

Data Sources:
A literature search regarding benefits and risks of different OAC therapies in ACS was conducted through MEDLINE and EMBASE (last 20 years until September 2018).

Therapeutic Advances:
Patients receiving dual antiplatelet therapy (DAPT) in combination with NOAC are to be considered at high bleeding risk. Rivaroxaban 2.5 mg BID in triple therapy with DAPT, rivaroxaban 15 mg, or dabigatran 110/150 mg BID in dual therapy with P2Y12 inhibitor (mainly clopidogrel) is safer in terms of bleeding risk than triple therapy with VKA plus DAPT. The reduction in ischemic events by NOACs was most promising when added to single antiplatelet therapy. Ongoing trials with apixaban and edoxaban could clarify whether dual therapy NOACs with P2Y12 inhibitor sufficiently protect against stent thrombosis or myocardial infarction and are safer in terms of bleeding risk than a dual therapy with a VKA and clopidogrel. In the absence of randomized trials, it is unknown whether dual therapy with NOAC and aspirin could be an alternative to NOAC and a P2Y12 inhibitor. Thus, the overall benefit of adding NOAC to antiplatelet treatment after ACS in patients without clear indication for long-term OAC is still unknown.

Conclusions:
Different OACs have been tested as antithrombotic therapy after ACS in combination with single or DAPT and led to a modest reduction in ischemic events. Further studies evaluating NOACs in combination with single antiplatelet therapy or shorter duration of triple antithrombotic therapy are warranted.
Current Perspectives in Facilitated Angioplasty
Authors: Crişan Simina , Petriş Antoniu Octavian , Petrescu Lucian , Luca Constantin Tudor 
Published: March 2019

Background:
Ischemic heart disease represents the most important cause of mortality worldwide, and the management of patients with ST-elevation myocardial infarction (STEMI) still remains a great challenge. For a great number of patients who do not have immediate access to primary percutaneous coronary intervention (PCI), facilitated angioplasty may be a reasonable therapeutic option.

Areas of Uncertainty:
The goal of reperfusion therapy is achieving repermeabilization of the infarct-related artery. However, the restoration of normal epicardial flow is not always followed by microvascular tissue perfusion and the presence of myocardial blush. Early studies assessing the benefits of facilitated angioplasty over primary PCI encountered disappointing results, with an increased number of bleeding complications. The invasive strategy following fibrinolysis mainly consists in angiography and PCI of the infarct-related artery between 2 and 24 hours after successful fibrinolysis or rescue PCI in failed fibrinolysis, hemodynamic, electrical instability, or worsening ischemia. Currently, a strategy of routine early angiography after fibrinolysis is recommended, taking into account studies that have demonstrated a reduced rate of reinfarction and recurrent ischemia, without an increased risk of stroke or major bleeding complications.

Therapeutic Advances:
After evaluating 1892 patients with STEMI within 3 hours after the onset of symptoms and revealing, beyond clear benefit of fibrinolysis, an increased risk of bleeding complications, the STREAM trial was the one that led to halving the tenecteplase dose for patients aged >75 years. A safety profile of adjusted-dose fibrinolytic therapy in elderly patients with STEMI will be further investigated by the ongoing STREAM-2 trial.

Conclusions:
With the current increased burden of acute coronary syndromes and the lack of immediate primary PCI facilities for all patients with STEMI, facilitated angioplasty seems a feasible therapeutic option. Another benefit of facilitated angioplasty may be represented by a major contribution of thrombolytic therapy in re-establishing microvascular myocardial blood flow.
New Directions in the Management of Peripheral Artery Disease
Authors: Chioncel Valentin , Brezeanu Radu , Sinescu Crina 
Published: March 2019

Background:
Peripheral artery disease represents an important chapter of cardiovascular pathology in which atherosclerosis (promoted by major risk factors—hypertension, smoking, dyslipidemia, and diabetes mellitus) is the major etiology. The severity of this pathology is not only due to local injury but also due to frequent association with atherosclerotic disease with other localizations, thus increasing cardiovascular morbidity and mortality in these patients. Diagnosis is based on clinical data, functional tests (the ankle–brachial index is very useful in these cases) and imagistic methods (Doppler ultrasonography, computed tomography angiography, magnetic resonance angiography, and digital subtraction angiography). Therapeutic options vary depending on the location and severity of the lesions but also on the chronic or acute nature of the disease. Thus, in addition to pharmacological treatment and nonpharmacological measures (related to lifestyle), revascularization therapy is a very important step.

Areas of Uncertainty:
There are still many things that need to be clarified in this pathology: importance of developing national registries (because epidemiological data are often poor), role of drug-eluting stents/drug-eluting balloons in femoropopliteal lesions, optimal duration of double antiplatelet treatment after stenting, and more. Current guidelines for the management of peripheral artery disease are built from the results of many trials and research groups regarding to the evaluation and therapy of these patients.

Therapeutic Advances:
Endovascular therapy is particularly targeted for cases with short lesions/occlusions or in patients with high surgical risk; instead, surgical revascularization (bypass) brings benefits in patients with long or distal stenoses/occlusions or where anatomy does not allow for interventional intervention. Anticoagulant and thrombolytic treatment plays an important role in acute limb ischemia.

Conclusions:
So, in the patients with peripheral artery disease (especially acute limb ischemia), early diagnosis and prompt application of therapeutic measures are the cornerstone of management in these cases.
Immunotherapy in Bladder Cancer
Authors: Konala Venu Madhav , Adapa Sreedhar , Aronow Wilbert S. 
Published: March 2019

Background:
Bladder cancer is the fifth most common cancer in the United States. Cisplatin-based chemotherapy is the current standard of care in stage IV bladder cancer. It has increased overall survival but rarely results in complete remission, with an overall survival of 14–15 months. The most significant breakthrough in cancer therapy over the last decade was the development of immunotherapy.

Data sources:
KEYNOTE-045, IMvigor211, CheckMate275, Javelin Solid Tumor, MEDI4736, and KEYNOTE-0528 clinical trials.

Areas of Uncertainty:
There are ongoing clinical trials using combination of immunotherapy and chemotherapy as first line of therapy in the setting of metastatic urothelial cancer and also to determine the duration of treatment.

Therapeutic Advances:
Immunotherapy is approved as a second-line treatment for metastatic urothelial cancer. Their use as a first-line agent is only limited to patients who are ineligible for cisplatin-based treatments. Five drugs are approved by Food and Drug Administration for metastatic urothelial cancer including 3 Programmed cell-death protein 1 (PD-1) inhibitors and 2 programmed cell-death ligand 1 (PD-L1) inhibitors in patients who have progressed during or after platinum-based therapy. Pembrolizumab, nivolumab, and atezolizumab are PD-1 inhibitors. Durvalumab and avelumab are PD-L1 inhibitors. However, only 2 drugs were approved based on phase III clinical trials—pembrolizumab and atezolizumab, of which only KEYNOTE study performed with pembrolizumab showed overall survival difference. Atezolizumab and pembrolizumab are the Food and Drug Administration–approved checkpoint inhibitors in cisplatin-ineligible patients.

Conclusion:
This review article summarizes the significance of immunotherapy in treatment of bladder cancer, its side effects, and limitations.
Current status of graft-versus-host disease after intestinal transplantation
Authors: Ganoza Armando , Mazariegos George V. , Khanna Ajai 
Published: March 2019

Purpose of review
Over the past decades, visceral transplantation has become the standard of care for patients with irreversible intestinal failure who suffer complications of total parenteral nutrition (TPN). Graft-versus-host disease (GVHD) after solid organ transplantation is a rare but often fatal complication with high mortality. GVHD after intestinal transplantation, given the large lymphoid content of the graft, is more frequent compared with other solid organs. It is a complex condition that may have varied clinical presentations. The therapy of GVHD is multifactorial and has evolved with visceral transplantation.

Recent findings
In recent large series of intestinal transplantation performed in centers around the world, GVHD remained an important cause of death (40–70%). Advances in immunology and current treatment options come from the hematopoietic stem-cell transplantation (HSCT) experience given the high prevalence of GVHD in that patient population. Therapeutic options for GVHD are based on disease classification, overall grading, organs involved, and associated symptoms.

Summary
Graft-versus-host disease (GVHD) is a serious complication that can occur after solid organ and allogenic HSCT. Intestinal or multivisceral transplantation have the highest incidence of GVHD among all solid organ transplants with very high mortality rates. Increased risk of GVHD is present after multivisceral and liver-included transplants compared with isolated intestinal transplant. Visceral transplantation is the all-encompassing term used for transplant that includes small bowel. It includes isolated small bowel transplant, small bowel/pancreas transplant, liver/small bowel/ pancreas transplant, stomach/pancreas/small bowel (modified multivisceral transplant), and stomach/liver/pancreas/small bowel (multivisceral). Each of these may or may not include the colon as part of the allograft. Steroids remain the first line of treatment along with modulation of the primary immunosuppression. Steroid-refractory patients remain a challenge and, to date, no consensus has been achieved for a single agent second-line therapy. Successful outcome depends on early diagnosis and prompt treatment.
Relationship Between Control Over Nursing Practice and Job Satisfaction and Quality of Patient Care
Authors: Al-Hamdan Zaid , Smadi Eman , Ahmad Muayyad , Bawadi Hala , Mitchell Ann M. 
Published: March 2019

Background:
Control over nursing practice (CONP) in the work setting is associated with several positive consequences such as increased job satisfaction, support of teamwork, decreased patient mortality, and improved quality of care.

Purpose:
The purpose of this study was to examine the level of perceived CONP among Jordanian registered nurses (RNs) and determine its relationship with their job satisfaction and quality of patient care.

Method:
A descriptive, cross-sectional correlational design was used. A convenience sample of 230 RNs was recruited from 4 hospitals.

Result:
The RNs had a moderate level of perceived CONP. This control was positively correlated with their work satisfaction and perception of the quality of patient care that they delivered.

Conclusion:
Nurse managers should be encouraged to take into consideration nurses' perceived CONP to improve working conditions for nurses.
Evaluation of a Rapid Syphilis Test in an Emergency Department Setting in Detroit, Michigan
Authors: Fakile Yetunde F. , Markowitz Norman , Zhu Weiming , Mumby Kimberly , Dankerlui Doreen , McCormick Josh K. , Ham David C. , Hopkins Andre , Manteuffel Jake , Sun Yongcheng , Huang Ya-lin A. , Peters Philip J. , Hoover Karen W. 
Published: March 2019

Background
Syphilis transmission can be prevented by prompt diagnosis and treatment of primary and secondary infection. We evaluated the performance of a point-of-care rapid syphilis treponemal (RST) test in an emergency department (ED) setting.

Methods
Between June 2015 and April 2016, men aged 18 to 34 years seeking services in a Detroit ED, and with no history of syphilis, were screened for syphilis with the RST test, rapid plasma reagin (RPR) test, and Treponema pallidum particle agglutination assay (TP-PA). A positive reference standard was both a reactive RPR and a reactive TP-PA. We compared test results in self-reported men who have sex with men (MSM) to non-MSM.

Results
Among 965 participants, 10.9% of RST tests were reactive in MSM and only 1.5% in non-MSM (P < 0.001). Sensitivity of the RST test was 76.9% and specificity was 99.0% (positive predictive value, 50.0%) compared with the positive reference standard. Three discordant specimens found negative with the RST test but positive with the reference standard had an RPR titer of 1:1, compared with 10 specimens with concordant positive results that had a median RPR titer of 1:16. The RST sensitivity was 50.0% (positive predictive value, 68.4%) compared to the TP-PA test alone. Among men seeking care in an ED, the RST detected 76.9% of participants with a reactive RPR and TP-PA.

Conclusions
The RST test detected all of the participants with an RPR titer ≥1:2 but less than 20% of participants with a positive TP-PA and negative RPR. The RST test was useful to detect a high proportion of participants with an active syphilis in an urban ED.
Unplanned Return Visits to a Pediatric Emergency Department
Authors: Seiler Michelle , Furrer Pascal Raffael , Staubli Georg , Albisetti Manuela 
Published: March 2019

Objectives
Unplanned return visits (URVs) to emergency departments (EDs) account internationally for 2.5% to 5.2% of all consultations. ED crowding is an increasing challenge, and URVs seem to contribute to this problem. This study aimed to assess factors for URVs at the ED of a tertiary children's hospital to analyze if they are jointly responsible for the steadily rising amount of treated patients.

Methods
All patients with an URV to a pediatric ED in Switzerland between January and December 2013 were included in the study. Data were taken retrospectively from the electronic patient files, and different variables were defined and analyzed.

Results
URVs occurred at an incidence of 4.6%, and mostly concerned infants and toddlers (46%). URVs were independent of weekdays and mostly occurred between 10 am and 10 pm. In 84.2% of the cases, the URVs were judged as unnecessary, and in 15.8%, a hospitalization was indicated, mainly for children with a worsening respiratory illness.

Conclusions
The occurrence of URVs in our ED was within the incidence reported in the literature. While URVs lead to hospitalization in some patients, the majority of URVs were unnecessary from a medical point of view. These results indicate that a correct evaluation of the child's health state by parents is often challenging and requires repeated medical attendance following a first ED visit, especially in infants with airway diseases and infections. Intensive counseling and scheduled short-term follow-up consultation at the pediatrician's office could prevent URVs to the ED.
Nonfatal Pediatric Injuries Associated With Consumer Products and Sports and Recreational Activities in the United States
Authors: Kamboj Amrit K. , Chounthirath Thitphalak , Hodges Nichole L. , Smith Gary A. 
Published: March 2019

Objective
The aim of this study was to investigate the epidemiology of nonfatal consumer product– and sports and recreational activity–related injuries among US children.

Methods
National Electronic Injury Surveillance System data regarding children younger than 18 years who were treated in US emergency departments (EDs) for nonfatal consumer product– or sports and recreational activity–related injuries were analyzed.

Results
From 1990 through 2012, an estimated 121,489,024 (95% confidence interval, 104,226,323–138,751,726) children younger than 18 years were treated in US EDs for nonfatal injuries meeting study criteria, yielding an average of 5,282,131 children annually, or 74.12 injuries per 1000 children. During 1990 to 2005, the overall annual injury rate decreased by 14.0% (P < 0.001), followed by an increase of 7.3% (P = 0.157) during 2005 to 2012. The concussion/closed head injury rate increased by 199.3% (P < 0.001) from 1996 to 2012. Injury rates were highest among children 0 to 4 years old and lowest among children 5 to 9 years old. Sports and recreational activities accounted for 46.5% of all injuries. Falls (40.2%) and “struck-by” (22.6%) were the leading mechanisms of injury, and 62.3% of all injuries were among boys. Injuries often occurred to the head/neck (37.8%) or upper extremities (31.9%), were frequently diagnosed as lacerations (29.0%) or soft tissue injuries (21.0%), and 2.7% were admitted to the hospital.

Conclusions
On average, a child was treated in a US ED for a nonfatal consumer product– or sports and recreational activity–related injury every 6 seconds. Although injury rates decreased early in the study period, there was a nonsignificant increasing trend from 2005 to 2012. Multilevel injury prevention efforts are recommended.
Longitudinal Analysis of Syndemic Psychosocial Problems Predicting HIV Risk Behavior Among a Multicity Prospective Cohort of Sexually Active Young Transgender Women in the United States
Authors: Mimiaga Matthew J. , Hughto Jaclyn M.W. , Biello Katie B. , Santostefano Christopher M. , Kuhns Lisa M. , Reisner Sari L. , Garofalo Robert 
Published: March 2019

Background:
Worldwide, young transgender women (YTW) contend with exceptionally high risks of HIV infection. Cross-sectional studies have suggested that co-occurring epidemics or “syndemics” of psychosocial problems may accelerate HIV acquisition and transmission through elevated sexual risk behavior among transgender women. We aimed to examine how a syndemic of 7 psychosocial problems potentiates HIV sexual risk behavior among a multicity, longitudinal cohort of sexually active YTW in the United States.

Methods:
Between 2012 and 2015, 233 YTW from Boston, MA, and Chicago, IL, completed behavioral surveys at baseline, 4, 8, and 12 months. We used generalized estimating equations to examine the prospective relationship of overlapping psychosocial problems and HIV sexual risk behavior (ie, condomless anal or vaginal sex) among YTW.

Results:
The prevalence of 7 psychosocial syndemic problems was substantial at baseline and remained high at each time point: 6.4% reported polydrug use in the past 4 months (excluding stimulants); 7.7% reported heavy alcohol use in the past 4 months; 10% reported a history of childhood sexual abuse; 15.9% reported stimulant use in the past 4 months; 41.7% reported experiencing lifetime intimate partner violence; 42.1% reported clinically significant depressive symptoms; and 68.6% reported lifetime transgender-specific victimization. We identified a statistically significant positive “dose–response” relationship between the number of psychosocial syndemic problems and condomless anal or vaginal sex over time.

Conclusions:
The accumulation of “syndemic” psychosocial problems predicted HIV sexual risk behavior in a prospective cohort of YTW. Given the high prevalence of psychosocial problems and HIV sexual risk behavior, as well as having the highest HIV incidence among any risk group, the HIV prevention agenda requires a shift toward improved assessment of psychosocial comorbidities and stronger integration with gender-affirming and supportive mental health, violence recovery, and addiction treatment services for this population.
The Value of 1H-MRS and MRI in Combined Methylmalonic Aciduria and Homocystinuria
Authors: Cheng Ailan , Yao Rong , Cao Wenjun , Yu Hong 
Published: March 2019

Objective
The aims of this study were to describe the brain magnetic resonance imaging (MRI) features of methylmalonic aciduria and homocystinuria and to evaluate the additional value of 1H-MRS.

Patients and Methods
Twenty-eight children with methylmalonic aciduria and homocystinuria were included in this study. The control group included 21 healthy children. All the cases underwent MRI and 1H-MRS before treatment. We measured the N-acetylaspartate (NAA), choline (Cho), creatine (Cr), and myoinositol (mI) peaks in the basal ganglia regions. The NAA/Cr, Cho/Cr, mI/Cr, and NAA/Cho ratios were calculated. We also observed whether there were lactic acid peaks.

Result
We identified that NAA/Cr and NAA/Cho significantly decreased in the basal ganglia and that 3 patients showed lactate peaks, but other metabolites were not significantly altered. Hydrocephalus and diffuse supratentorial white matter edema were the primary MR findings; 7 patients had thinning of the corpus callosum, and 2 patients had subdural hematoma. Six patients showed normal brain MRI findings.

Conclusions
Methylmalonic aciduria and homocystinuria patients with metabolite changes in the basal ganglia demonstrate compromised neuronal integrity, and anerobic metabolism occurs in acute encephalopathic episodes. 1H-MRS is a useful tool for evaluating brain damage. Hydrocephalus and diffuse supratentorial white matter edema are the main MRI features.
Removal of the Dental Implant Displaced Into the Maxillary Sinus Through the Inferior Nasal Meatus via Transnasal Endoscopy
Authors: Jin Tingting , Wang Yan , Li Shihao , Cai Qian , Huang Zhiquan 
Published: March 2019

Abstract
Worldwide, the reconstruction of the posterior edentulous maxilla with dental implants has become a common practice in clinical settings. However, the poor bone condition in this area is sometimes accompanied by complications. Dental implant displacement into the maxillary sinus is viewed as a rare complication. A case of a 72-year-old man in whom an endoscopic technique was used to remove a dental implant that had been mistakenly planted into the maxillary sinus was reported in this study. The authors approached the sinus through the inferior nasal meatus, and the dental implant was removed through the widened ostium. The endoscopic surgical approach described in this study is reliable and minimally invasive for removing residual roots displaced into the maxillary sinus. Therefore, it has been concluded that this clinical procedure is worth using.