bluuebunny/crossref_metadata_2025_split huggingface dataset:
Liver stiffness measurement changes following hepatocellular carcinoma treatment with percutaneous microwave ablation or transarterial chemoembolization: a cohort study
Authors: Abdelaziz Ashraf O. , Abdelhalim Hanan , Elsharkawy Aisha , Shousha Hend I. , Abdelmaksoud Ahmed H. , Soliman Zeinab A. , Seif Mohamed I. , Sayed Dina B. , Farouk Mohamed H. , Elbaz Tamer M. , Nabeel Mohamed M. 
Published: January 2019

Background
Liver stiffness increases after the development of hepatocellular carcinoma (HCC). Transient elastography for liver stiffness measurement (LSM) using fibroscan is a simple noninvasive method of proven efficacy. This study aims to assess the changes in LSM following HCC treatment.

Patients and methods
This study included 150 patients with hepatitis C virus related HCC attending the multidisciplinary HCC clinic, Kasr Al-Ainy Hospital between March 2014 and October 2015 who underwent either transarterial chemoembolization (TACE) or microwave ablation (MWA). Baseline LSM was carried out 3 and 6 months after treatment. The response rate was calculated according to the modified Response Evaluation Criteria in Solid Tumors criteria; overall survival and LSM changes were then compared between the two procedures.

Results
MWA showed higher rates of complete ablation (77.4%) than did TACE (31.7%) (P=0.004). Increase in LSM 3 and 6 months after treatment was statistically significant in the TACE group (P<0.001) but not in the MWA group (P=0.4). Patients who showed complete ablation had statistically significant lower baseline LSM than those with incomplete ablation, and their 6 months increase in LSM was also significantly lower. Logistic regression revealed that with each unit increase in baseline stiffness, 3% reduction in the odds of complete ablation is expected, and this did not change after controlling for the type of treatment. Child–Pugh class, number, and size of HCCs were our independent prognostic factors by Cox proportional analysis.

Conclusion
The increase in LSM is significant after TACE than after MWA. Moreover, lower pre-ablation LSM is a predictor of complete ablation.
Prophylactic efficacy of a novel method against postendoscopic papillary balloon dilation pancreatitis
Authors: Natsui Masaaki , Aoki Yohei , Oka Hiromitsu , Tsuboi Kiyotaka , Tsubata Shunsuke , Yoko Kazumi , Sato Toshifumi 
Published: January 2019

Objective
This study aimed to investigate whether a novel method including prophylactic pancreatic stent (PS) placement prevents postendoscopic papillary balloon dilation pancreatitis.

Patients and methods
This study enrolled 200 consecutive patients with bile duct stones measuring up to 8 mm in diameter and retrospectively recruited 113 patients undergoing ordinary endoscopic papillary balloon dilation (EPBD) without PS placement from our previous study. In the novel method, EPBD and PS placement was attempted with a guidewire left in the main pancreatic duct for patients in whom stable guidewire placement in the main pancreatic duct was possible. EST was performed for patients in whom stable guidewire placement was impossible. The incidence rate of pancreatitis was compared between the novel method and ordinary EPBD, and risk factors for pancreatitis were analyzed.

Results
Of 194 patients undergoing the novel method, EPBD and EST were performed in 180 and 14 patients, respectively. Following EPBD, PS placement was successful in 177/180 (98.3%) of patients. Pancreatitis occurred in 7/194 (3.6%) of patients after the novel method and 9/113 (8.0%) of patients after ordinary EPBD. There was a trend toward lower incidence rate of pancreatitis in the novel method. Stent dislodgement by the first postoperative morning and no previous endoscopic nasobiliary drainage (ENBD) were identified as risk factors for pancreatitis after EPBD with PS placement. No previous ENBD was also identified as a risk factor for pancreatitis after ordinary EPBD.

Conclusion
Our novel method is likely to be superior to ordinary EPBD in preventing pancreatitis. Previous ENBD may prevent post-EPBD pancreatitis regardless of PS placement.
Attitudes About Consumer Strategies Among Americans in High-deductible Health Plans
Authors: Cliff Betsy Q. , Krenz Christopher , West Brady T. , Levy Helen , Fendrick A. Mark , Winkelman Tyler N.A. , So Jonathan , Fagerlin Angela , Kullgren Jeffrey T. 
Published: January 2019

Background:
More than 70 million Americans are enrolled in a high-deductible health plan (HDHP), with high upfront cost-sharing to encourage strategies such as price shopping to mitigate out-of-pocket spending. Recent research suggests HDHP enrollees are reluctant to engage in these consumer strategies, but there is little information on why.

Objectives:
To describe associations between HDHP enrollees’ attitudes about and intent to engage in consumer strategies.

Research Design:
We conducted a nationally representative web survey of 1637 HDHP enrollees that included 2 hypothetical scenarios amenable to consumer strategies. For each scenario, we asked participants whether they would compare price or quality information, discuss cost with a provider, or try to negotiate a service price. We measured participants’ ratings of the difficulty of each strategy, its effectiveness at reducing cost or increasing the likelihood of getting care, and how likely participants would be to actually engage in each strategy.

Results:
Fewer than half of HDHP enrollees intended to engage in any of the surveyed strategies. Enrollees who viewed a consumer strategy as helpful were more likely to engage in that strategy; no associations were found with perceived difficulty of a strategy and intent to engage in it.

Conclusions:
HDHP enrollees may not pursue consumer strategies because they believe they are not helpful for getting care or lowering costs. Providers and payers should ensure these strategies are actually helpful to HDHP enrollees and that enrollees understand how they could use these strategies to reduce their out-of-pocket costs.
Measuring and Analyzing Length of Stay in Critical Care Trials
Authors: Harhay Michael O. , Ratcliffe Sarah J. , Small Dylan S. , Suttner Leah H. , Crowther Michael J. , Halpern Scott D. 
Published: January 2019

Background:
In randomized clinical trials among critically ill patients, it is uncertain how choices regarding the measurement and analysis of nonmortal outcomes measured in terms of duration, such as intensive care unit (ICU) length of stay (LOS), affect studies’ conclusions.

Objectives:
Assess the definitions and analytic methods used for ICU LOS analyses in published randomized clinical trials.

Research Design:
This is a systematic review and statistical simulation study.

Results:
Among the 80 of 150 trials providing sufficient information regarding the chosen definition of ICU LOS, 3 different start times (ICU admission, trial enrollment/randomization, receipt of intervention) and 2 end times (discharge readiness, actual discharge) were used. In roughly three quarters of these studies, ICU LOS was compared using approaches that did not explicitly account for death, either by ignoring it entirely or stratifying the analyses by survival status. The remaining studies used time-to-event (discharge) models censoring at death or applied a fixed LOS value to patients who died. In statistical simulations, we showed that each analytic approach tested a different question regarding ICU LOS, and that approaches that do not explicitly account for death often produce misleading or ambiguous conclusions when treatments produce small effects on mortality, even if those are not detected as significant in the trial.

Conclusions:
There is considerable variability in how ICU LOS is measured and analyzed which impairs the ability to compare results across trials and can produce spurious conclusions. Analyses of duration-based outcomes such as LOS should jointly assess the impact of the intervention on mortality to yield correct interpretations.
Pathways of smooth muscle foam cell formation in atherosclerosis
Authors: Pryma Collin S. , Ortega Carleena , Dubland Joshua A. , Francis Gordon A. 
Published: January 2019

Purpose of review
Smooth muscle cells (SMCs) are the major cell type in human atherosclerosis-prone arteries and take up excess lipids, thereby contributing to luminal occlusion. Here we provide a focused review on pathways by which smooth muscle cells (SMCs) can become foam cells in atherosclerosis.

Recent findings
A synthesis of recent and older investigations provides key mechanistic insights into SMC foam cell formation. LDL and other apoB-containing lipoproteins are modified by a diverse array of oxidative, enzymatic, and nonenzymatic processes present in the arterial intima. These modifications of LDL all promote the aggregation of LDL (agLDL), a key finding from analysis of arterial lesion particles. Scavenger receptor and phagocytic capacity of SMCs can vary greatly, perhaps related to differences in SMC phenotype or in-vitro cell culture environments, and can be increased with exposure to cytokines, growth factors, and cholesterol. Macrophages promote the formation of SMC foam cells in direct or indirect co-culture models.

Summary
SMCs contribute significantly to the foam cell population in atherosclerosis. Further investigation and identification of key mechanisms of SMC foam cell formation will help drive new therapeutics to reduce cardiovascular disease.
Progress in finding pathogenic DNA copy number variations in dyslipidemia
Authors: Iacocca Michael A. , Dron Jacqueline S. , Hegele Robert A. 
Published: January 2019

Purpose of review
DNA copy number variations (CNVs) are large-scale mutations that include deletions and duplications larger than 50 bp in size. In the era when single-nucleotide variations were the major focus of genetic technology and research, CNVs were largely overlooked. However, CNVs clearly underlie a substantial proportion of clinical disorders. Here, we update recent progress in identifying CNVs in dyslipidemias.

Recent findings
Until last year, only the LDLR and LPA genes were appreciated as loci within which clinically relevant CNVs contributed to familial hypercholesterolemia and variation in Lp(a) levels, respectively. Since 2017, next-generation sequencing panels have identified pathogenic CNVs in at least five more genes underlying dyslipidemias, including a PCSK9 whole-gene duplication in familial hypercholesterolemia; LPL, GPIHBP1, and APOC2 deletions in hypertriglyceridemia; and ABCA1 deletions in hypoalphalipoproteinemia.

Summary
CNVs are an important class of mutation that contribute to the molecular genetic heterogeneity underlying dyslipidemias. Clinical applications of next-generation sequencing technologies need to consider CNVs concurrently with familiar small-scale genetic variation, given the likely implications for improved diagnosis and treatment.
Unaccounted risk of cardiovascular disease: the role of the microbiome in lipid metabolism
Authors: Joris Benjamin R. , Gloor Gregory B. 
Published: January 2019

Purpose of review
Not all of the risk of cardiovascular disease can be explained by diet and genetics, and the human microbiome, which lies at the interface of these two factors, may help explain some of the unaccounted risk. This review examines some of the well established links between the microbiome and cardiovascular health, and proposes relatively unexplored associations.

Recent findings
Byproducts of microbial metabolism are associated with health and disease: Trimethylamine N oxide is associated with atherosclerosis; whereas short-chain fatty acids are associated with decreased inflammation and increased energy expenditure. More broadly, a large number of association studies have been conducted to explore the connections between bacterial taxa and metabolic syndrome. In contrast, the relationship between the microbiome and triglycerides levels remains poorly understood.

Summary
We suggest that deeper understanding of the molecular mechanisms that drive linkages between the microbiome and disease can be determined by replacing 16S rRNA gene sequencing with shotgun metagenomic sequencing or other functional approaches. Furthermore, to ensure translatability and reproducibility of research findings, a combination of multiple different complementary ‘-omic’ approaches should be employed.
Management of the marginal mandibular nerve during and after neck dissection
Authors: Murthy Samskruthi P. , Paderno Alberto , Balasubramanian Deepak 
Published: January 2019

Purpose of review
Marginal mandibular nerve palsy (MMNP) is often an understated complication after neck dissection. This article reviews literature regarding anatomic landmarks that help define marginal mandibular nerve (MMN) during neck dissection, oncologic safety of surgical maneuvers, implications of MMNP, and reconstructive options.

Recent findings
A thorough knowledge of anatomy of the nerve can aid in its preservation. Course, branching pattern and communications of MMN are extremely variable. The Hayes Martin method classically described to preserve the nerve may not be oncologically safe in patients with prefacial nodal involvement. MMNP significantly affects quality of life after neck dissection. Cause, timing, and degree of neural damage play an important role in determining diagnostic and therapeutic options to correct the deformity resulting from MMNP. Owing to treatment-related factors, functionality of local structures may be compromised, which limits available reconstructive options for the surgeon. This should favor a shift of management option toward more conservative procedures in patients treated for head and neck cancer.

Summary
When oncologically safe, the MMN must always be preserved. The patient perceived deformity resulting from MMNP is significantly higher than clinician-detected rate. In select patients who are affected by significant smile asymmetry, multiple dynamic and static corrective procedures can be offered.
Arguments for routine administration of probiotics for NEC prevention
Authors: Underwood Mark A. 
Published: January 2019

Purpose of review
Probiotic administration to premature infants for the purpose of prevention of necrotizing enterocolitis is common in many parts of the world but uncommon in the United States. The present review will emphasize recent findings in support of routine administration of probiotics to this highly vulnerable population.

Recent findings
Additional evidence from animal models describing mechanisms of protection of probiotics in the immature gut and updated meta-analyses of randomized placebo-controlled trials and observational cohorts are presented (now including more than 40 000 premature infants from countries across the globe).

Summary
The preponderance of evidence suggests that probiotic administration to premature infants is well tolerated and decreases the risk of death, necrotizing enterocolitis, and sepsis. Further comparisons of probiotic administration to placebo are not likely to alter these conclusions. Rather, future work should focus on assurance of high-quality products with demonstrated purity and viability of probiotic microbes, and future clinical trials should focus on comparisons between high-quality products and doses.
Use of earth observations for temperature exposure assessment in epidemiological studies
Authors: Kloog Itai 
Published: January 2019

Purpose of review
Low, high, extreme, and variable temperatures have been linked to multiple adverse health outcomes, particularly among the elderly and children. Recent models incorporating satellite remote sensing data have mitigated several limitations of previous studies, improving exposure assessment. This review focuses on these new temperature exposure models and their application in epidemiological studies.

Recent findings
Satellite observations of land surface temperature have been used to model air temperature across large spatial areas at high spatiotemporal resolutions. These models enable exposure assessment of entire populations and have been shown to reduce error in exposure estimates, thus mitigating downward bias in health effect estimates.

Summary
Satellite-based models improve our understanding of spatiotemporal variation in temperature and the associated health effects. Further research should focus on improving the resolution of these models, especially in urban areas, and increasing their use in epidemiological studies of direct temperature exposure and vector-borne diseases.
Insights Into Pediatric Autoimmune Gastritis
Authors: Moreira‐Silva Helena , Silva Gisela , Costa Emília , Guerra Isabel , Santos‐Silva Ermelinda , Tavares Marta , Cleto Esmeralda , Lima Rosa 
Published: January 2019

ABSTRACTObjectives:Autoimmune gastritis (AIG) is a chronic inflammatory condition of the gastric mucosa, mainly described in adults presenting with pernicious anemia. It results from antibody‐mediated destruction of parietal cells, but the precise initiating event is unknown. The pathogenicity of Helicobacter pylori (H pylori) has been suggested but not established. This study aimed to better characterize AIG in pediatric patients and to address the possible role of H pylori infection.Methods:Descriptive single‐center study, retrospectively describing 20 patients with a diagnosis of AIG based on positivity for anti‐parietal cell autoantibodies, in addition to analytical and/or histological findings of oxyntic mucosa atrophy.Results:In the majority (18/20), AIG diagnosis was suggested during investigation of refractory iron‐deficient anemia. One patient had dyspepsia and none of the others had gastrointestinal symptoms. Fifty‐five percent (11/20) were H pylori positive, but there were no significant differences regarding mean hemoglobin values at presentation (10.6 ± 2.5 vs 9.5 ± 1.0 g/dL, P > 0.05), analytical indicators of gastric atrophy (gastrin, 564.4 ± 184 vs 721.2 ± 220.6 pg/mL, P > 0.05), or in the presence or the grade of oxyntic mucosa atrophy.Conclusions:Our findings highlight that AIG may have an age‐dependent presentation; thus, we can consider a pediatric phenotype that in contrast to adults, is manifested by refractory iron‐deficient anemia and associated with parietal cell autoantibody positivity, but not intrinsic factor autoantibodies. A correlation between H pylori and AIG was not evident in the current study and it is still unclear whether H pylori is a trigger for AIG.
Racial Disparities in Cervical Cancer Screening: Implications for Relieving Cervical Cancer Burden in Asian American Pacific Islander Women
Authors: Lee Hee Yun , Beltran Raiza , Kim Nam Keol , Lee Do Kyung 
Published: January 2019

Background
While cervical cancer is considered preventable and the overall Papanicolaou (Pap) test utilization rate has gradually increased in the United States, certain Asian American Pacific Islander (AAPI) women consistently rate lower in Pap test receipt compared with non-Latina whites (NLWs), leading to a higher cervical cancer mortality rate for various AAPI women. Few studies, however, have focused on female AAPI college students' cervical cancer screening behavior in comparison with NLW students.

Objective
This study aimed to investigate cervical cancer screening behaviors among college-aged females by (1) determining AAPIs' and NLWs' screening rates, (2) assessing their knowledge about Pap tests, and (3) discovering factors associated with Pap test receipt. Andersen's Health Behavioral Model was used as a theoretical framework.

Methods
Using a simple random sampling strategy, 2270 female students (15% AAPIs, 85% NLWs) completed an online health survey.

Results
Results indicate AAPI students had significantly lower Pap test knowledge and Pap test receipt rate compared with NLW students. Age, nativity, human papillomavirus vaccination completion, frequency of obstetrician/gynecologist (OB/GYN) visits, and the number of sexual partners were associated with AAPI students' lower rate of Pap test receipt, whereas the Pap test receipt rate for NLW students was influenced by the same factors with the addition of having increased prior knowledge about Pap tests.

Conclusion
Results show the importance of OB/GYN visits in obtaining Pap tests for AAPI and NLW students.

Implication for Practice
Health practitioners should pay attention to students' race/ethnicity in their practice and provide corresponding ethnic group–specific preventive care.
Interdisciplinary Rounds on a Hospitalist Service
Authors: Smith Catherine V. , Maduro Ralitsa S. , Morgan Merri K. , Ver Schneider Patricia , Rutledge Carolyn M. , Zimbro Kathie S. 
Published: January 2019

Background:
Despite growth in service availability, palliative care (PC) referrals are often underutilized or delayed, which may compromise patient outcomes.

Local Problem:
Underutilized or delayed PC referrals among hospitalized adults prompted this project aimed at improving PC measures, quality, and utilization outcomes.

Methods:
Data extracted from the electronic medical record were used to identify needed improvements in PC.

Intervention:
Interdisciplinary rounds (IDRs) were implemented on the hospitalist service in a nonintensive care setting.

Results:
Following implementation, median time to PC referral decreased by 2 days. Length of stay (LOS), direct cost, and 30-day mortality also decreased. Postintervention patients were more likely to transition home compared with another facility.

Conclusions:
Results support IDRs as a mechanism to improve time to PC referral, decrease LOS, direct cost, and 30-day mortality among hospitalized adults. A more objective method of identifying patients with unmet PC needs may be warranted.
Bacteria on the Soles of Patient-Issued Nonskid Slipper Socks
Authors: Welle Mary K. , Bliha Madeline , DeLuca Jenna , Frauhiger Alayna , Lamichhane-Khadka Reena 
Published: January 2019

BACKGROUND:
This is the first study to determine whether nonskid slipper socks in contact with the hospital floor and worn into bed contaminate bed linen.

PURPOSE:
The main purpose of the study was to determine whether contamination of hospital linen occurred with bacteria transferred from the soles of nonskid slipper socks that have touched the floor.

METHODS:
This study mimicked real patients walking on a hospital floor wearing slipper socks and getting back into bed with the slipper socks on. Swab samples were collected from the surfaces of the hospital floor, nonskid slipper sock bottoms, and bed linen in 2 Midwestern hospitals. From the samples, bacterial isolates were identified and tested for antibiotic resistance.

RESULTS:
Isolates obtained from the samples were identified on all 3 surfaces at both hospitals, indicating spread of the bacteria from floor to the bed linen via the nonskid slipper socks. Antibiotic sensitivity test revealed that a significant number of isolates collected were resistant to at least 2 antibiotics tested.

CONCLUSION:
This study demonstrates cross-contamination of bed linen with potentially pathogenic bacteria present on the hospital floor via contact with patient-worn nonskid slipper socks. A simple practice change regarding the wearing of slipper socks could play an important role in preventing pathogen transfer to the bed linen. Awareness of the likelihood of hand contamination after touching the sock bottoms that have come in contact with the hospital floor should also be considered.