bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and Outcomes of Sepsis in Korea: A Nationwide Cohort Study From 2007 to 2016
Authors: Oh Seung-Young , Cho Songhee , Kim Ga Hee , Jang Eun Jin , Choi Seongmi , Lee Hannah , Ryu Ho Geol 
Published: September 2019

Objectives:
This study aimed to estimate the incidence and clinical outcomes of sepsis in Korea from 2007 to 2016.

Design:
Retrospective observational study.

Setting:
Nationwide study with population-based healthcare reimbursement claims database.

Patients:
Using data from the National Health Insurance Service of Korea, patients who were hospitalized with a diagnosis of sepsis from 2007 to 2016 were analyzed. The incidence of sepsis was calculated using mid-year census population and analyzed according to year, age, and sex. The Elixhauser Comorbidity Index score was calculated to adjust for the impact of comorbidities on clinical outcome. In-hospital mortality, hospital length of stay, ICU admission rates, and risk factors for in-hospital mortality were also analyzed.

Interventions:
None.

Measurements and Main Results:
The incidence of sepsis increased from 173.8 per 100,000 population in 2007 to 233.6 per 100,000 population in 2016. In-hospital mortality decreased from 30.9% in 2007 to 22.6% in 2016 (p < 0.0001). From 2007 to 2016, hospital length of stay and ICU admission rates associated with sepsis decreased from 26.0 ± 33.5 days to 21.3 ± 24.4 days (p < 0.0001) and from 16.2% to 12.7% (p < 0.0001), respectively. Male sex, age greater than 50 years, Elixhauser Comorbidity Index greater than 10, and mechanical ventilation were identified as risk factors for in-hospital mortality after adjusting for baseline characteristics.

Conclusions:
The incidence of sepsis in Korea increased from 2007 to 2016, while the associated in-hospital mortality, hospital length of stay, and ICU admission rates decreased.
The Prognostic Role of Pretreatment Neutrophil to Lymphocyte Ratio (NLR) in Malignant Adrenal Lesions Treated With Stereotactic Body Radiation Therapy (SBRT)
Authors: Mills Matthew N. , Reddy Abhinav V. , Richardson Logan , Richardson K. Martin , Kersh Charles R. 
Published: September 2019

Objective:The objective of this study was to evaluate a single institution’s experience with stereotactic body radiotherapy (SBRT) in treating malignant adrenal lesions, as well as the prognostic value of systemic inflammation biomarkers.Materials and Methods:From November 2007 to February 2018, 27 patients with malignant adrenal lesions received 31 SBRT treatments. Outcomes, measured from the date of SBRT, included overall survival (OS), local control (LC), and freedom from progression. Cox proportional hazard model was utilized to identify potential prognostic factors. Tumor response was assessed with PET Response Evaluation Criteria In Solid Tumors (PERCIST)/Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Acute toxicity was evaluated with the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.03 criteria.Results:Median follow-up for all patients was 8 months. The complete response, partial response, stable disease, and progressive disease rates were 59%, 9%, 32%, and 0%, respectively. One-year LC, OS, and freedom from progression were 77.7%, 38.0%, and 10.0%, respectively. There was a trend toward significance upon multivariate analysis for pretreatment neutrophil to lymphocyte ratio >4.1 to predict inferior OS (adjusted hazard ratio=3.29,P=0.09, 1-year OS: 11% vs. 80%). There were 3 cases (10%) complicated by grade 2 acute toxicity, including nausea and fatigue. There was 1 grade 5 toxicity, as 1 case was complicated by a fatal gastric ulcer occurring 3 months after SBRT to the left adrenal gland (112.5 BED10).Conclusions:These results support the limited existing literature, demonstrating that SBRT provides adequate LC for adrenal lesions with minimal toxicity. Pretreatment neutrophil to lymphocyte ratio may serve as a prognostic factor in these patients.
Tube Shunt Revision With Excision of Fibrotic Capsule Using Mitomycin C With and Without Ologen—a Collagen Matrix Implant: A 3-Year Follow-up Study
Authors: Salimi Ali , Kovalyuk Natalya , Harasymowycz Paul J. 
Published: September 2019

Precis:
Tube revision with capsule excision in failed glaucoma drainage devices (GDDs) has good medium-term success effectively reducing the intraocular pressure (IOP) and medication burden. Implantation of Ologen may limit the complications, particularly erosion.

Purpose:
To evaluate the 36-month outcomes of tube shunt revision with capsule excision using Mitomycin C (MMC) versus MMC with Ologen—a collagen matrix implant.

Materials and Methods:
Twenty-three eyes with failed GDD underwent tube revision with fibrotic capsule excision. 12 of them received a MMC application whereas the other 11 also received an Ologen implant. Qualified success, changes in IOP, medication burden, and complication rates were evaluated and compared.

Results:
Three years post-revision, qualified success for the whole cohort was 58% with no significant difference between the MMC group (52%) and MMC+Ologen group (67%; P=0.606). Mean survival time for each group was 27.4 and 29.8 months, respectively. With no intergroup differences through 3 years, capsule excision leads to a significant decrease in IOP from 28.6±6.5 to 15.1±4.3 mm Hg (47% reduction) and in antiglaucoma medications, from 3.6±1.2 to 2.5±1.3 mm Hg (30% reduction; P<0.001). Complication rates were significantly lower in the MMC+Ologen group (27%) compared with the MMC group (75%; P=0.022). Plate erosion happened in 25% of the eyes in the MMC group which required excision of the tube and plate, but no such complication was observed in the MMC+Ologen group.

Conclusions:
Revision of a failed tube shunt by excision of the encapsulated bleb offers good medium-term outcomes by reducing the IOP and glaucoma medications. Although the addition of Ologen did not affect the medium-term success, IOP, or medication burden, its implantation yielded significantly lower complication rates.
The Chinese Glaucoma Study Consortium for Patients With Glaucoma: Design, Rationale and Baseline Patient Characteristics
Authors: Zhang Hui , Jia Hongyan , Duan Xiaoming , Li Liang , Wang Hui , Wu Jian , Hu Jianping , Cao Kai , Zhao Aiping , Liang Jing , Song Jing , Qiao Chunyan , Wang Ningli 
Published: September 2019

Precis:
Chinese Glaucoma Study Consortium (CGSC) as the first nationwide glaucoma registry in China, we describe its design, rationale, the geographic distribution of the hospitals, and baseline patient characteristics.

Aim:
As a leading cause of blindness in China, glaucoma affects 2% to 4% of adults over the age of 40 and will become increasingly prevalent as the population ages. At the national level, there are few reports on the current medical practice for glaucoma patients. CGSC will be considered as the first nationwide glaucoma registry in China. Here we describe its design, rationale, the geographic distribution of the hospitals, and baseline patient characteristics.

Methods:
From December 21, 2015 to September 9, 2018, CGSC recruited patients with the diagnoses of primary angle-closure suspect, primary angle-closure, primary angle-closure glaucoma, acute primary angle closure, primary open-angle glaucoma (POAG), pigmentary glaucoma (PG), and pseudoexfoliative glaucoma (PXG) from 111 hospitals covering 67 cities from 22 provinces, 4 municipalities, and 5 autonomous regions in mainland China. Clinical data were collected using an Electronic Data Capture System designed by Tongren hospital and Gauss informed Ltd. Blood samples were collected from every patient for further genetic analysis.

Results:
Medical records of 10,892 patients were collected, of which 5762 patients have complete information. The average age of those with complete information (n=5762) was 62.05±11.26 years old, and 35.25% were males. Primary angle-closure disease, including primary angle-closure suspect/primary angle-closure/primary angle-closure glaucoma/acute primary angle closure, was predominant (4588, 79.63%), and the distribution for others is as follows: POAG (1116, 19.37%), PXG (41, 0.71%) and PG (17, 0.30%). A total of 16,684 blood samples were collected, of which 9917 (82.68%) were primary angle-closure disease, 1987 (16.57%) were POAG, 69 (0.58%) were PXG, 22 (0.18%) were PG, and 4689 were normal controls.

Conclusions:
The CGSC is the first national-level glaucoma registry study in China. Clinical data and blood samples will provide the opportunity to study the epidemiology of glaucoma in Chinese hospitals, to evaluate the level of medical diagnosis and treatment of glaucoma in China, and to identify the susceptibility loci for glaucoma.
Identification of Norovirus and Human Parechovirus in Patients With Hand, Foot and Mouth Disease Syndrome
Authors: Li Kun , Lin Xian-Dan , Chen Yi-Ping , Liu Qi , Wang Wen , Plyusnin Alexander , Zhang Yong-Zhen 
Published: September 2019

Background:
Hand, foot and mouth disease (HFMD) is caused mostly by enteroviruses. However, other viral agents also can cause similar syndromes, and hence, the infections they cause are often misdiagnosed clinically. To determine non-enterovirus etiologic agents in HFMD-like cases, we screened enterovirus-negative samples collected from the patients who were clinically diagnosed as HFMD in China.

Methods:
Two hundred enterovirus-negative samples were collected previously in Wenzhou city of Zhejiang province, China. Both high throughput sequencing and RT-PCR were used to screen viral agents. In addition, their clinical features were analyzed.

Results:
Norovirus (NoV) and human parechovirus (HPeV) were identified from 22 (11.00%) and 9 (4.50%) samples, respectively. In addition, the complete genome sequences were recovered from 4 NoV-positive samples, and the VP1/3Dpol gene sequences were recovered from 5 HPeV-positive samples. Phylogenetic analyses of the NoV sequences revealed that they were closely related to those circulated in other regions of China. Notably, 4 genotypes of HPeVs, including HPeV-1, HPeV-4, HPeV-5 and HPeV-14, were found, indicating high genetic diversity of the virus. Frequent recombination between various genotypes was also observed in the HPeVs. Although most of the patients presented with the clinical features of HFMD, 4 patients infected with NoV GII.4 and 3 patients infected with HPeV-1 (1) and HPeV-4 (2) were characterized with diarrhea. Finally, tonsillitis, convulsion and granulocytopenia were observed in 1 NoV GII.4 patient, while liver dysfunction was found in 1 NoV GII.17 patient.

Conclusions:
These data reveal the variety of agents in the cases clinically diagnosed as HFMD.
Prevalence, Clinical Features and Antibiotic Susceptibility of Group A Streptococcal Skin Infections in School Children in Urban Western and Northern Uganda
Authors: Chang Aileen Y. , Scheel Amy , Dewyer Alyssa , Hovis Ian W. , Sarnacki Rachel , Aliku Twalib , Okello Emmy , Bwanga Freddie , Sable Craig , Maurer Toby A. , Beaton Andrea Z. 
Published: September 2019

Background:
Group A Streptococcus (GAS) skin infections can lead to invasive sepsis, poststreptococcal glomerulonephritis, and potentially rheumatic heart disease (RHD). Within a study to identify predisposing factors of RHD in Ugandan schoolchildren, we determined the prevalence of skin infections and assessed the clinical features and antibiotic susceptibility of GAS skin infection.

Methods:
Cross-sectional study conducted at 3 urban primary schools in Western and Northern Uganda in March 2017. A dermatologist rendered clinical diagnoses and obtained a skin swab specimen from lesions with signs of bacterial infection. Beta-hemolytic colonies underwent Lancefield grouping, species identification by polymerase chain reaction and antimicrobial susceptibility testing.

Results:
From 3265 schoolchildren, we observed 32% with ≥1 fungal, 1.8% with ≥1 bacterial, 0.9% with ≥1 viral, and 0.2% with ≥1 ectoparasitic infection. Of 79, 25 (32%) specimens were GAS-positive, of which one-third demonstrated tetracycline resistance. Of 17 impetigo cases, 13 (76%) were located on the leg/foot and 3 (18%) on the head/neck. Prevalence of GAS skin infection was 0.8% (25 of 3265). In Northern Uganda, where subclinical definite RHD prevalence is 1.1%, GAS skin infection prevalence was 1.2% (4 of 343) and 0.9% (3 of 352).

Conclusion:
This study identifies tetracycline-resistant GAS in Ugandan communities, suggests modified skin examination of exposed anatomic locations may be appropriate for population-based GAS skin infection studies, and underscores need for clear case definitions of GAS skin infection. Future studies are needed to evaluate the role of GAS skin infection in development of RHD in Ugandan communities.
Serum Vitamin D Deficiency Is an Independent Risk Factor for Thyroid Eye Disease
Authors: Heisel Curtis J. , Riddering Alixandra L. , Andrews Christopher A. , Kahana Alon 
Published: September 2019

Thyroid eye disease is an inflammatory orbitopathy associated with Graves disease. Vitamin D is a known immune system regulator. The authors show that vitamin D deficiency is associated with the development of thyroid eye disease.

Purpose:
Thyroid eye disease (TED) is an inflammatory orbitopathy with significant impact on visual function and quality of life. Although studies have shown that patients who are deficient in vitamin D are more likely to develop autoimmune conditions, there are no studies demonstrating a definitive correlation between serum 25-hydroxyvitamin D (25(OH)D) deficiency and an increased risk of TED.

Methods:
This retrospective case–control study compared serum 25(OH)D levels among 4 groups: 1) Graves disease (GD) patients with TED (n = 89); 2) GD patients without TED (n = 89); and healthy control patients matched to 3) the TED group (n = 356); and 4) the GD group (n = 356). The authors compared 25(OH)D level in the TED group measured within 1 year of TED diagnosis to the most recently measured 25(OH)D level in the GD group using Student t test of the log transformation of serum levels. Linear regression was used to control for other risk factors. Thyroid eye disease patients and GD patients were compared separately to their matched healthy control patients with linear mixed models.

Results:
Thyroid eye disease patients displayed significantly lower serum 25(OH)D levels than GD patients (24.8 ± 13.2 ng/ml vs. 29.4 ± 13.3 ng/ml; p = 0.006). Controlling for smoking status and previous radioactive iodine treatment did not affect this statistically significant difference.

Conclusions:
Low serum vitamin D is associated with TED diagnosis. Assessing and supplementing vitamin D levels may be an important addition to the early management of GD patients. Future research should include longitudinal studies and prospective clinical trials to further explore the mechanism responsible for the observed association.
Development and Evaluation of a Simulation-Based Acute Care Course in a Physical Therapist Education Program
Authors: Silberman Nicki , Litwin Bini , Fernandez-Fernandez Alicia , Dornbaum Martin , Ng Grace 
Published: September 2019

Introduction.
Delivery of acute care content in physical therapist (PT) education programs varies greatly. A new course included a series of 6 progressively complex, high fidelity, immersive acute care simulation-based learning experiences (SBLEs) using standardized patients. The primary purpose of this study was to examine the students' perceived value of the SBLEs in relationship to their acute care clinical experiences (CEs). Self-efficacy and clinical performance were also measured to further evaluate course outcomes.

Participants.
Students completing acute care CEs were recruited from 3 consecutive cohorts of a Doctor of Physical Therapy (DPT) program. The control group completed the curriculum before implementing the new course. The experimental groups participated in the first and second years of the course, respectively.

Methods.
A total of 60 students across the 3 cohorts completed the study. Experimental groups completed the course before their acute care CE. Focus groups were conducted to explore student perspectives with both experimental groups on completion of their respective CEs. Self-efficacy was assessed using the Acute Care Confidence Survey before the course, after course completion, and midterm of the CE. Clinical performance was evaluated using the PT Clinical Performance Instrument rating scale at both midterm and final of the CE.

Results.
Qualitative analysis revealed 2 main themes: (1) SBLEs foster self-efficacy in application of the 3 domains of learning and (2) students develop a wider perspective of the dynamic professional roles of the acute care PT. Self-efficacy significantly increased, and there was an upward trend, although no significant difference, in clinical performance for students who completed the course.

Conclusions.
Student performance in the acute care setting was positively influenced by a series of SBLEs. A simulation-based acute care course can be effectively incorporated into a DPT curriculum to foster student's professional identity in multiple domains.
Use of technology to increase physical activity in female veterans and soldiers aged 19–64 years
Authors: Riordan Joan K. , Alexander Susan , Montgomery Ida S. 
Published: September 2019

Background and purpose:
Heart disease is the leading cause of mortality for American women, claiming 289,753 lives annually. Research has show that female veterans are more sedentary after separating from service and that mobile apps can assist in increasing physical activity. The purposes of this study were to: 1) implement a mobile application to increase physical activity, 2) compare the exercise data, and 3) determine the sustainability of using a mobile application in female active duty soldiers, military retirees, and veterans with prior service.

Methods:
A convenience sample of 30 participants, aged 19–64 years, was recruited from the Womack Army Medical Center, Fort Bragg, North Carolina. Active duty soldiers, retired military, and family members are eligible for care at Womack. Six of the participants with prior military service are spouses of active duty and retired military and were included in the sample. The participants documented the type of physical activity and amount of time exercised over 12 weeks using the closed discussion group. Clinically significant differences were demonstrated in individual averages of minutes exercised per week in the group of veterans (n = 4; Z = −0.944, p = .345, r = 0.3) and active duty group (n = 5; Z = −1.826, p = .068, r = 0.65).

Conclusions:
The study did not demonstrate a statistically significant increase in physical activity using technology.

Implications for practice:
Mobile technology provides nurse practitioners with tools to empower patients. The use of technology to increase physical activity is relatively new and continues to evolve.
Post-hysterectomy rare collision vulva tumor with long-term human papilloma virus infection composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland
Authors: Yang Fan , Li HongYi , Qi Xiaorong , Bian Ce 
Published: September 2019

Abstract

Rationale:
Post-hysterectomy collision tumors of the vulva has rarely been reported. Though long-term HPV infection may induce vulva tumor, but the relationship between HPV infection and collision vulva tumor is not clear. And there are no clear rules of the post-hysterectomy cancer surveillance for human papilloma virus (HPV) long-term infections. So here we first report a case of post-hysterectomy rare collision vulva tumor with long-term HPV infection composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland and hope to bring new direction to our future research.

Patient concerns:
A 48-year-old woman with long-term HPV infection, 3 years after hysterectomy, gravida 3, para 2, was admitted to our hospital with complaints of a 4-month history of an itching vulva ulceration. An anabrosis was located on the surface of the solid mass of the bartholin gland at the posterior part of the right labium and the right inguinal lymph nodes were palpable. Result of the incisional biopsy of the ulcer area at local hospital was atypical squamous cells couldn’t exclude high-grade squamous intraepithelial lesion (ASC-H). Subsequently more authoritative pathological consultation results suggested squamous cell carcinoma of the vulva.

Diagnoses:
Post-hysterectomy collision vulva tumor with long-term HPV infection composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland.

Interventions:
The extensive excision of the vulva, bilateral inguinal lymph nodes dissection, and local skin flap transposition surgeon was done to this patient. The final certificate diagnosis was: vulvar tumor T1bM0N0 composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland; HPV infection; post hysterectomy, and bilateral salpingectomy.

Outcomes:
The patient recovered well after surgery, and consequently received 6 courses of TC (paclitaxel + carboplatin) chemotherapy, and 9 months and 13 days followed up. So far patient recorded as complete response (CR).

Lessons:
Collision vulva tumor occurred post-hysterectomy is extremely rare. It is most likely related to long-term HPV infection, which suggests us should to modify the manner of the post-hysterectomy cancer surveillance for HPV long-term infections. For patients with high-risk HPV infection, even if the cytology results are negative, we may should perform colposcopy and vulva biopsy more positively to prevent the disease from progressing into cancer. And the pathogenesis of relationship between HPV infection and collision vulva tumor is still need further investigation.
Phacoemulsification in bilateral anterior lenticonus in Alport syndrome
Authors: Sedaghat Mohammad-Reza , Momeni-Moghaddam Hamed , Haghighi Batool , Moshirfar Majid 
Published: September 2019

Abstract

Rationale:
To report the visual status and results of phacoemulsification cataract surgery in a young patient with Alport syndrome associated with bilateral anterior lenticonus. The milestone of this report is the use of anterior segment optical coherence tomography (AS-OCT) to confirm the central protrusion of the anterior surface of the crystalline lens.

Patient concerns:
A 23-year-old young woman presented with severe progressive visual loss in both eyes, which started several years ago.

Diagnoses:
Refractive status was indicative of high myopia with astigmatism and vision was not improved with optimal correction to better than 0.1 in the right eye and 0.2 in the left eye (visual acuities given in decimal notation). Slit-lamp examination showed transparent cornea, anterior lenticonus and posterior sub-capsular cataract in both eyes. The classical appearance of oil droplet was evident using retro-illumination on the slit lamp.

Interventions:
The natural lenses were replaced with intraocular lens (IOL).

Outcomes:
An excellent refractive status achieved associated with an uncorrected distance visual acuity 0.9 and 0.8 in the right and left eye, respectively.

Lessons:
AS-OCT is a valuable device for confirming the budging of the anterior crystalline lens surface.