bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic Review of Surgical Treatment and Outcomes After Local Surgery of Primary Cutaneous Melanomas of the Penis and Scrotum
Authors: Bittar Julie M. , Bittar Peter G. , Wan Marilyn T. , Kovell Robert C. , Guzzo Thomas J. , Shin Thuzar M. , Etzkorn Jeremy R. , Sobanko Joseph F. , Miller Christopher J. 
Published: July 2018

BACKGROUND
Few data exist to guide surgical management and counseling about local recurrence after surgery of primary male genital melanoma.

OBJECTIVE
To compile all available data on local recurrence rates after surgery of primary cutaneous melanoma of the penis and scrotum.

MATERIALS AND METHODS
A systematic review of PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Excerpta Medica database (EMBASE), and Web of Science identified all surgically treated penile and scrotal melanomas that reported local recurrence status and follow-up time.

RESULTS
One hundred twenty-seven melanomas from 74 manuscripts were included. Eighty-six percent of melanomas were located on the penis, and 14% were located on the scrotum. Average follow-up time was 35.7 months. Scrotal melanomas were predominantly treated with organ-sparing surgeries (16/18, 88.9%), whereas penile melanomas were treated more often with amputation (61/109, 56.0%). Overall, local recurrence rate was 15.7% (20/127). Local recurrence rates for penile cases were 18.8% (9/48) after organ-sparing surgery versus 13.1% (8/61) for amputative surgery. Local recurrence rates were 66.7% (4/6) after positive surgical margins versus 10.2% (5/49) after negative surgical margins.

CONCLUSION
Local recurrence rates are high after both organ-sparing and amputative surgery of primary cutaneous melanoma of the penis and scrotum. There is a need to standardize reporting for this rare tumor, as more complete data are necessary to develop consensus guidelines for surgical management of male genital melanoma.
Residential exposure to fine particulate matter air pollution and incident breast cancer in a cohort of Canadian women
Authors: Villeneuve Paul J. , Goldberg Mark S. , Crouse Dan L. , To Teresa , Weichenthal Scott A. , Wall Claus , Miller Anthony B. 
Published: July 2018

Background:
Air pollution has been classified as a human carcinogen based largely on epidemiological studies of lung cancer. Recent research suggests that exposure to ambient air pollution increases the risk of breast cancer.

Methods:
Our aim was to characterize associations between residential exposure to ambient fine particulate matter (PM2.5) and the incidence of breast cancer in a cohort of 89,247 women enrolled in the Canadian National Breast Screening Study between 1980 and 1985. Vital status and incident cancers were determined through record linkage to the national registry data through 2005. Individual-level estimates of exposures to PM2.5 at baseline were derived from satellite observations. Six thousand five hundred three incident breast cancers were identified during follow-up. We classified menopausal status using self-reported information collected at baseline and by attained age (50, 52, and 54 years) as women were followed-up. We computed hazard ratios (HRs) and their 95% confidence intervals (CI) using age as the time axis. Models were adjusted for several individual risk factors, including reproductive history, as well as census-based neighborhood-level characteristics.

Results:
The median residential concentration of PM2.5 was 9.1 μg/m3. In models adjusted for personal and contextual risk factors, a 10-μg/m3 increase in PM2.5 was associated with an elevated risk of premenopausal (HR = 1.26; 95% CI = 0.99, 1.61) but not postmenopausal breast cancer (HR = 1.01; 95% CI = 0.94, 1.10). The elevated risk of premenopausal breast cancer from PM2.5 was only evident among those randomized to the screening arm of the study.

Conclusions:
Our findings support the hypothesis that exposure to low concentrations of PM2.5 increase the risk of premenopausal breast cancer.
Residential exposure to air pollution and incidence of Parkinson’s disease in a large metropolitan cohort
Authors: Cerza Francesco , Renzi Matteo , Agabiti Nera , Marino Claudia , Gariazzo Claudio , Davoli Marina , Michelozzi Paola , Forastiere Francesco , Cesaroni Giulia 
Published: July 2018

Background:
The literature on air pollution exposure and Parkinson’s disease (PD) reported controversial results. The aim of this study is to analyze the association of exposure to particulate matter (PM10, PM2.5, PM2.5–10, PM2.5 absorbance), nitrogen oxides (NO2, NOx), and ozone (O3) with incidence of PD in a large administrative cohort.

Methods:
We followed 1,008,253 patients who are 50+-year-old residents in Rome (free from PD) from January 2008 to December 2013. We identified new cases of PD using data from several sources including drug prescriptions and hospital discharges. We estimated exposure at residence using land use regression models for particulate matter and nitrogen oxides, and a chemical dispersion model for summer ozone. We used Cox models (hazard ratio [HR]) to estimate the association between air pollution exposure and incidence of PD, adjusting for individual and contextual variables.

Results:
There were 13,104 new cases of PD during the follow-up. There was no evidence of a positive association between particulate matter exposure and PD. There was a negative association between PM absorbance, nitrogen oxides exposure, and incidence of PD with HR = 0.97 (95% confidence interval [CI] = 0.96, 0.99) per 10 μg/m3 increase in NO2 and HR = 0.97 (95% CI = 0.96, 0.98) per 20 μg/m3 increase in NOx. Long-term exposure to ozone was positively associated with incidence of PD, HR = 1.02 (95% CI = 1.00, 1.05) per 10 μg/m3 increase in summer ozone.

Conclusions:
Incidence of PD was not related to PM exposure in this study and a negative association was found for nitrogen oxides. The association found with ozone is new and should be further investigated.
Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Thrombocytopenia
Authors: Janion-Sadowska Agnieszka , Papuga-Szela Elżbieta , Łukaszuk Robert , Chrapek Magdalena , Undas Anetta 
Published: July 2018

Aims:
Thrombocytopenia was one of the exclusion criteria in randomized trials in which non–vitamin K antagonist oral anticoagulants (NOACs) were tested. The safety of NOACs in patients with atrial fibrillation (AF) and thrombocytopenia remains unclear.

Methods:
We studied 62 patients with AF aged from 53 to 85 (mean 70.5) years with platelet count from 50 to 100 × 109/L who were treated with rivaroxaban 15 mg once daily (33.9%), dabigatran 110 mg twice daily (bid) (54.8%), or apixaban 2.5 mg bid (11.3%). Age- and sex-matched AF patients with normal platelet count and similar CHA2DS2-VASc scores who were treated with the recommended doses of NOACs served as a reference group.

Results:
Patients were followed for a mean of 55 months (range, 23–64 months). In the thrombocytopenia group bleeding risk was higher (mean HAS-BLED score 2.0, vs. 1.0, P < 0.0001). During follow-up in thrombocytopenic and normocytopenic patients, we observed similar rates of major bleeding (1.8%/year vs. 2.7%/year, P = 0.49), clinically relevant nonmajor bleeding (CRNMB) (1.5%/year vs. 1.1%/year, P = 0.74), ischemic stroke and transient ischemic attacks (1.8%/year vs. 1.5%/year, P = 0.8), and death (1.06%/year vs. 1.11%/year, P = 0.96). The risk of bleeding and stroke was unaffected by the type of the NOAC used in both groups. Major bleedings and clinically relevant nonmajor bleeding in thrombocytopenic patients on NOACs were predicted only by age (hazard ratio 1.1, 95% confidence interval 1.0–1.3, P = 0.04).

Conclusions:
Our findings indicate that in AF patients with mild thrombocytopenia, anticoagulation with NOAC at reduced doses seems to be safe and effective.
Pediatric Thyroid Eye Disease: Clinical Characteristics and Orbital Decompression Outcomes
Authors: Chua Michael R. , Tomlinson Lauren A. , Binenbaum Gil , Katowitz William R. 
Published: July 2018

Purpose:
To review the clinical presentation, disease severity, and surgical interventions of children with thyroid eye disease (TED) at a single institution over a 7-year period.

Methods:
Retrospective cohort study of children 0 to 18 years of age with a diagnosis of TED, seen at the Children’s Hospital of Philadelphia from 2009 to 2016. Ophthalmic examination findings, neuroimaging study results, and ophthalmological management were recorded. t-Tests were used to test for statistical significance. Institutional Review Board approval was obtained for the study.

Results:
Sixty-seven subjects with pediatric TED were studied: 59 female and 8 male. The mean age at diagnosis was 11.6 years (SD 4.2, range 2.3–17.9). All subjects had proptosis (67, 100%). Other clinical findings were eyelid retraction in 46 (69%), chemosis in 7 (10%), punctate epithelial erosions in 8 (12%), and strabismus in 1 (1.5%). No subjects had evidence of optic neuropathy. Five subjects with static-phase TED received orbital decompression surgery for exposure keratopathy and disfigurement. All had significant cosmetic improvement and resolution of exposure keratopathy.

Discussion:
In this series, children with TED generally exhibit mild ocular signs, which is in agreement with past studies. Our study presented a high incidence of proptosis compared with other studies; however, this may represent a referral bias to our quaternary care center.

Conclusion:
Pediatric TED patients exhibit mild symptoms, such as proptosis and eyelid retraction without strabismus, vision loss, or optic neuropathy. Some children with TED have severe disfigurement and corneal exposure due to the disease and benefit from orbital decompression.
Vasopressor Infusion After Subarachnoid Hemorrhage Does Not Increase Regional Cerebral Tissue Oxygenation
Authors: Yousef Khalil M. , Crago Elizabeth , Chang Yuefang , Lagattuta Theodore F. , Mahmoud Khadejah , Shutter Lori , Balzer Jeffrey R. , Pinsky Michael R. , Friedlander Robert M. , Hravnak Marilyn 
Published: July 2018

ABSTRACT

Introduction: Vasopressors are commonly used after aneurysmal subarachnoid hemorrhage (aSAH) to sustain cerebral pressure gradients. Yet, the relationship between vasopressors and the degree of cerebral microcirculatory support achieved remains unclear. This study aimed to explore the changes in cerebral and peripheral regional tissue oxygen saturation (rSO2) as well as blood pressure (BP) before and after vasopressor infusion in patients with aSAH. Methods: Continuous noninvasive cerebral and peripheral rSO2 was obtained using near-infrared spectroscopy for up to 14 days after aSAH. Within-subject differences in rSO2 before and after the commencement of vasopressor infusion were analyzed controlling for Hunt and Hess grade and vasospasm. Results: Of 45 patients with continuous rSO2 monitoring, 19 (42%) received vasopressor infusion (all 19 on norepinephrine, plus epinephrine in 2 patients, phenylephrine in 4 patients, and vasopressin in 2 patients). In these 19 patients, their vasopressor infusion times were associated with higher BP (systolic [b = 15.1], diastolic [b = 7.3], and mean [b = 10.1]; P = .001) but lower cerebral rSO2 (left cerebral rSO2 decreased by 4.4% [b = −4.4, P < .0001]; right cerebral rSO2 decreased by 5.5% [b = −5.5, P = .0002]). Conclusions: Despite elevation in systemic BP during vasopressor infusion times, cerebral rSO2 was concurrently diminished. These findings warrant further investigation for the effect of induced hypertension on cerebral microcirculation.
Stroke Education Video Does Not Affect Patient Satisfaction Scores: A System Analysis
Authors: Meighan Melissa M. 
Published: July 2018

ABSTRACT
With limited time and resources in the acute care hospital, the most effective methods of stroke education are crucial. A combination of methods of one-on-one counseling or teaching, print, and video has been shown to have the greatest effect. Video education is a component of a combination educational approach. This evaluation from a large integrated system comprising 21 medical facilities compared patient satisfaction data with stroke education from 5 facilities that have video educational services and print materials and 17 facilities that provide print materials only. All 21 facilities provided additional teaching by the nurse. From this evaluation, it seems that there may be no relationship between video or kiosk equipment on patient satisfaction scores for this integrated system.
A review article on gastric varices with focus on the emerging role of endoscopic ultrasound-guided angiotherapy
Authors: Khoury Tawfik , Nadella Divya , Wiles Alex , Marshall Caitlin , Kumar Manoj , Shapira Gilad , Ludvik Nicholas , Schumann Alan , Mahamid Mahmud , Mizrahi Meir 
Published: July 2018

Background
Gastric varices (GV) manifest in almost one-fifth of the patients with portal hypertension. Although primary pharmacological prevention of esophageal varices has been identified, there are limited therapeutic options that are optimal for GV bleeding. Recently, the use of endoscopic ultrasound (EUS)-guided angiotherapy [cyanoacrylate (CA) and coils] was introduced for the treatment of GV. Although CA injection is the recommended first-line therapeutic modality, it is associated with systemic, life-threatening embolization as well as technical instrumental challenges. Recently, EUS-guided coiling for GV was used with high safety profile.

Methods
This is a review of the current literature on the treatment of GV, focusing on the role of EUS-guided angiotherapy in the treatment of GV. We performed a Medline/PubMed search, and 37 relevant studies were extracted and examined.

Results
EUS-guided angiotherapy has shown a consistent favorable result among the several reports throughout the literature, with better safety and efficacy profile toward EUS-guided coiling; however, a combination treatment with EUS-guided coiling followed by glue injection has shown as well to reduce the embolization adverse events associated with glue injection.

Conclusion
EUS-guided angiotherapy and specifically EUS-guided coiling is an emerging promising technique and should be considered as a first-line therapeutic option for bleeding GV.
The Significant Value of Preoperative Prognostic Nutritional Index for Survival in Pancreatic Cancers
Authors: Liu Jiandong , Jiang Shanshan , Yang Xinghua , Li Xiaoqiang , Wang Ning 
Published: July 2018

Abstract
Nutritional status plays a significant value in the incidence of postoperative complications and survival rate after resection of cancers. The preoperative prognostic nutritional index (PNI) has recently been reported to be a simple, sensitive, and effective prognostic parameter in various cancers. We conducted a meta-analysis to explore the significant value of PNI in pancreatic cancers. We systematically searched electronic databases of PubMed, Embase, Cochrane Library, Web of Science, Wanfang Data, and Chinese National Knowledge Infrastructure. Then, relevant studies were selected to perform this meta-analysis. Eleven studies with a total of 2123 patients met the inclusion criteria of this meta-analysis. The pooled results revealed that a lower PNI was significantly correlated with poorer overall survival (hazard ratio, 1.57; 95% confidence interval, 1.40–1.77; P < 0.001). Preoperative PNI might be an efficient predictor of survival with pancreatic cancers.
Association of Admission Functional Status and Assistive Device Provision for Veterans Poststroke
Authors: Winkler Sandra L. , Kairalla John A. , Feng Hua 
Published: July 2018

Objectives
The aims of the study were (a) to provide knowledge about the provision of assistive devices in practice and (b) to describe the challenges of standardizing device provision.

Design
This is a retrospective study using Department of Veteran Affairs National Prosthetic Patient Database and other administrative databases. The cohort included all veterans treated by the Veterans Health Administration for stroke during fiscal years 2007–2008. Descriptive methods were used to analyze data with emphasis on inspecting relationships between device provision and motor and cognitive function using Functional Independence Measure scores.

Results
A total of 8374 veterans treated for stroke and receiving at least one assistive device are included. Individuals who received standard or caregiver controlled wheelchairs tended to be older, and those who received ultralight or caregiver controlled wheelchairs had a higher proportion of Hispanics than the overall cohort. Veterans who received any type of wheelchair had lower motor, cognitive, and total functioning scores than the cohort as a whole. Veterans who received canes had the highest functioning. Veteran patients who received patient lifts and beds had lower cognitive scores compared with the overall cohort.

Conclusions
Functional status can provide some objectivity to the largely subjective assistive device provision decision-making process; however, many other factors must be considered simultaneously, complicating efforts to standardize provision.
Changes in Patient Safety Culture in Palestinian Public Hospitals: Impact of Quality and Patient Safety Initiatives and Programs
Authors: Hamdan Motasem , Saleem Abed Alra'oof 
Published: July 2018

Objectives
To assess the changes in the patient safety culture between 2011 and 2016 after the implementation of patient safety initiative in Palestinian public hospitals.

Methods
A cross-sectional quantitative design employed using the Hospital Survey on Patient Safety Culture to collect data. Participants were 1,229 clinical and nonclinical employees from all public hospitals in the West Bank.

Results
Significant improvements were observed in patient safety culture with positive responses to 10 (83.3%) composite categories and 36 (86.0%) items of the Hospital Survey on Patient Safety Culture since the baseline survey in 2011 (P < 0.05). The increase in the percent of positive responses to the survey composites ranged from 9.1% (P < 0.001) to “Frequency of events reported” to 3.8% for “Teamwork across hospital units” (P < 0.001). Significant decrease in positive responses to “Staffing” (11.4%) was observed (P < 0.05); no significant change was observed in “Organizational learning—continuous improvement” (P > 0.05). Most participants (70.5%) rated patient safety level in their units/hospital as ‘Excellent/Very good’, with an increase of 6.3% from the baseline (P < 0.001); no significant increase in the number of reported events in the past 12 months was observed (P < 0.05).

Conclusions
Compared with the baseline survey results, patients’ safety initiatives and quality improvement programs had positive effect on the safety culture in public Palestinian hospitals.
Multimodal Imaging Study of Gadolinium Presence in Rat Cerebellum
Authors: Rasschaert Marlène , Schroeder Josef A. , Wu Ting-Di , Marco Sergio , Emerit Andréa , Siegmund Heiko , Fischer Claudia , Fretellier Nathalie , Idée Jean-Marc , Corot Claire , Brochhausen Christoph , Guerquin-Kern Jean-Luc 
Published: July 2018

Purpose
The aim of this study was to investigate, based on in-depth multimodal imaging, the presence of Gd deposits, their ultrastructure, location, and co-location with endogenous elements, in the cerebellum, after repeated administrations of gadolinium-based contrast agents (GBCAs).

Methods
Rats sensitized by subtotal nephrectomy received 20 daily intravenous injections of 0.6 mmol Gd/kg for 5 weeks of commercial forms of either gadoterate, gadobenate or gadodiamide, or saline (n = 2/group). The study was randomized and blinded. Magnetic resonance imaging examination was performed weekly. One month after the last injection, electron microscopy analysis of the deep cerebellar nuclei, the granular layer of cerebellar cortex, and the choroid plexus was performed. Elemental analysis of deposits was carried out by electron energy loss spectroscopy. Secondary ion mass spectroscopy was used for complementary chemical mapping.

Results
A T1 hypersignal was evidenced in the deep cerebellar nuclei of rats treated with linear GBCAs, and Gd deposits were identified in all the studied cerebellar structures with gadobenate and gadodiamide (except in the granular layer in gadobenate-treated rats). No such effect was found with the macrocyclic GBCA gadoterate. Most of the Gd deposits revealed a characteristic spheroid “sea urchin-like” morphology, rich in phosphorus, and were localized in the basal lamina of microvessels, in the perivascular Virchow-Robin space, and in the interstitium. Gd was also identified in the glial cells, associated with lipofuscin pigments, for these same groups.

Conclusions
Transmission electron microscopy analysis of cerebellums of renally impaired rats repeatedly injected with gadobenate and gadodiamide revealed the presence of Gd. Spheroid Gd depositions consisting of a filamentous meshwork were observed in the wall of microvessels, in perivascular Virchow-Robin space, and in the interstitium. Gd was also found in choroid plexus and was associated with pigments (likely lipofuscin) in glial cells. This is consistent with the involvement of the glymphatic distribution pathway for GBCAs. No insoluble Gd deposits were detected in rats injected with the macrocyclic GBCA gadoterate and controls.
Cognitive Impairment Level and Elderly Hip Fracture: Implications in Rehabilitation Nursing
Authors: Jiménez Mola Sonia , Calvo-Lobo César , Idoate Gil Javier , Seco Calvo Jesús 
Published: July 2018

Abstract

Purpose
The aim of the study was to determine the cognitive impairment level influence in descriptive characteristics, comorbidities, complications, and pharmacological features of older adults with hip fracture.

Design
Cross-sectional study.

Method
Five hundred fifty-seven older adults with hip fracture were recruited and divided into cognitive impairment levels (severe/moderate, mild, no impairment). Descriptive characteristics, comorbidities, complications, and pharmacological data were collected.

Findings
Significant differences (p < .05, R
2 = .012–.475) between cognitive impairment levels were shown. Shorter presurgery hospital length of stay and lower depression and Parkinson comorbidities; delirium complication; and antidepressants, antiparkinsonians, and neuroleptics use were shown for the no-impairment group. With regard to the cognitive impairment groups, lower presence of cardiopathy and hypertension; higher presence of dementia; antihypertensives, antiplatelets, and antidementia medication; infection/respiratory insufficiency complications; and lower constipation complications were shown.

Conclusion
Cognitive impairment levels may determine the characteristics, comorbidities, pharmacology, and complications of older adults with hip fracture.

Clinical Relevance
Cognitive impairment level may impact rehabilitation nursing practice, education, and care coordination.