bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chief Resident Immersion Training in the Care of Older Adults: A Successful National Replication of an Interspecialty Educational Intervention
Authors: Levine Sharon A. , Chao Serena H. , Caruso Lisa B. , Jackson Angela H. , Russell Matthew L. , Young Megan E. , Brett Belle 
Published: June 2018

Purpose
Nongeriatricians must acquire skills and knowledge in geriatric medicine to ensure coordinated care of older adults’ complex conditions by interspecialty and interprofessional teams. Chief residents (CRs) are an ideal target for an educational intervention. This study examined whether the Boston Medical Center Chief Resident Immersion Training (CRIT) in the Care of Older Adults was replicable at diverse medical institutions.

Method
Between 2008 and 2010, 12 institutions in 11 states received funding, technical support, and a common program model. Each implemented 2.5-day CRITs, consisting of a patient case, geriatrics-related lectures, CR leadership sessions, action project planning, and networking time. Site faculty conducted 21 CRITs for 295 CRs representing 28 specialties. CRs completed knowledge pre- and posttests, and self-report baseline and six-month follow-up surveys. Outcome measures were change in pre- and posttest score, and change from baseline to six months in self-reported surveys.

Results
Response rate for CRs was 99% (n = 293) for the pre–post tests and 78% (n = 231) for matchable baseline and follow-up surveys. Participants’ knowledge increased from 6.32 to 8.39 (P < .001) averaged from 12 questions. CRs’ self-reported ability to apply clinical problem-solving skills to older patients (P < .001), number of geriatrics topics taught (P < .001), frequency of geriatrician consultations (P = .017), confidence in leadership skills (P < .001), and confidence to conduct CR work (P < .001) increased from baseline to follow-up.

Conclusions
CRIT is an innovative way to give nongeriatricians knowledge and skills to treat complex older patients.
Drug-induced lupus erythematosus: an update on drugs and mechanisms
Authors: He Ye , Sawalha Amr H. 
Published: June 2018

Purpose of reviewRapid introduction of newly developed drugs in the absence of clear understanding of the pathophysiologic mechanisms behind drug-induced lupus erythematosus (DILE) can sometimes make DILE difficult to recognize in clinical practice. The purpose of this review is to summarize drugs most recently reported to be involved in DILE and discuss the current landscape of diverse mechanisms involved.Recent findingsA large number of proton pump inhibitor (PPI)-induced subacute cutaneous lupus erythematosus cases have been reported, suggesting a shift over time in the spectrum of drugs implicated in DILE. Twenty-two articles comprising 29 DILE case reports published within the last 2 years are summarized in this review, including 12 (41.4%) systemic DILE. Antitumor necrosis factor (anti-TNF) drugs were the most frequently (41.7%) reported to introduce systemic DILE in these cases. Chemotherapeutic drugs were the most common drug class (54.5%) involved in subacute cutaneous lupus erythematosus, with an observed higher incidence in female patients. Enhanced neutrophil extracellular trap (NET) formation induced by procainamide and hydralazine could be a new mechanism contributing to the pathogenesis of DILE.SummaryThe list of drugs implicated in triggering DILE is expanding as new drugs with novel mechanisms of action are being developed. It is important to recognize culprit drugs that may induce lupus erythematosus, as discontinuation usually results in improvement of drug-induced manifestations. Characterizing the mechanisms involved might help better understand the cause of idiopathic autoimmunity.
Comparison of Decompression, Decompression Plus Fusion, and Decompression Plus Stabilization for Degenerative Spondylolisthesis
Authors: Inose Hiroyuki , Kato Tsuyoshi , Yuasa Masato , Yamada Tsuyoshi , Maehara Hidetsugu , Hirai Takashi , Yoshii Toshitaka , Kawabata Shigenori , Okawa Atsushi 
Published: June 2018

Study Design:
This is a prospective, randomized controlled trial.

Objective:
To prospectively assess the long-term clinical results of decompression alone, decompression plus fusion, and decompression plus stabilization for degenerative spondylolisthesis.

Summary of Background Data:
Symptoms of lumbar spinal stenosis due to degenerative spondylolisthesis originate from compression of the dural sac or nerve root. Essentially, this condition is treated by performing a decompression of neural structures. Posterolateral lumbar fusion and posterior pedicle-based dynamic stabilization are additional techniques performed to ensure improved prognosis. However, to date, the selection of a surgical procedure for lumbar spinal stenosis due to degenerative spondylolisthesis remains debatable, especially in terms of the addition of instrumentation because of the few available prospective, randomized studies.

Materials and Methods:
We randomly assigned patients who had 1 level lumbar spinal stenosis due to degenerative spondylolisthesis at the L4/5 level to undergo either decompression alone (decompression group), decompression plus fusion (fusion group), or decompression plus stabilization (stabilization group). Outcomes were assessed using the Japanese Orthopaedic Association and Visual Analogue Scale scores.

Results:
In total, 85 patients underwent randomization. The follow-up rate at 5 years was 86.4%. The fusion and stabilization groups showed higher blood loss and a longer operative time than the decompression group. The fusion group showed longer postoperative hospital stay than the decompression group. In terms of clinical outcomes, all scores significantly improved postoperatively, and these outcomes were maintained at 5 years postoperatively in each group. There were no significant differences among the groups at 1 and 5 years postoperatively.

Conclusions:
Additional instrumentation operation for low-grade (<30%) degenerative spondylolisthesis did not result in superior results to decompression alone at 1 and 5 years postoperatively.

Level of Evidence:
Level II.
Estimating the Impact of Changes to Occupational Standards for Silica Exposure on Lung Cancer Mortality
Authors: Keil Alexander P. , Richardson David B. , Westreich Daniel , Steenland Kyle 
Published: June 2018

Background:
Respiratory exposure to silica is associated with the risk of death owing to malignant and nonmalignant disease. 2.3 million US workers are exposed to silica. Occupational exposure limits for silica are derived from a number of lines of evidence, including observational studies. Observational studies may be subject to healthy worker survivor bias, which could result in underestimates of silica’s impact on worker mortality and, in turn, bias risk estimates for occupational exposure limits.

Methods:
Using data on 65,999 workers pooled across multiple industries, we estimate the impacts of several hypothetical occupational exposure limits on silica exposure on lung cancer and all-cause mortality. We use the parametric g-formula, which can account for healthy worker survivor bias.

Results:
Assuming we could eliminate occupational exposure, we estimate that there would be 20.7 fewer deaths per 1,000 workers in our pooled study by age 80 (95% confidence interval = 14.5, 26.8), including 3.91 fewer deaths owing to lung cancer (95% CI = 1.53, 6.30). Less restrictive interventions demonstrated smaller but still substantial risk reductions.

Conclusions:
Our results suggest that occupational exposure limits for silica can be further strengthened to reduce silica-associated mortality and illustrate how current risk analysis for occupational limits can be improved.
Ambient Particulate Matter Concentrations and Hospital Admissions in 26 of China’s Largest Cities: A Case–Crossover Study
Authors: Liu Hui , Tian Yaohua , Xiang Xiao , Juan Juan , Song Jing , Cao Yaying , Huang Chao , Li Man , Hu Yonghua 
Published: June 2018

Background:
Few studies have evaluated the short-term impacts of ambient particulate matter (PM) pollution on morbidity in China. The aims of this study were to examine the short-term association between hospital admissions and ambient PM and also to explore whether PM2.5 at levels below current regulatory limits also increases the risk of hospitalizations in 26 Chinese cities.

Methods:
We identified 14,569,622 all-cause, 2,008,786 cardiovascular, and 916,388 respiratory admissions during 2014–2015. We employed conditional logistic regression to estimate the association between hospital admissions and ambient PM.

Results:
A 10 μg/m3 increase in PM2.5 at lag 0 day corresponded to increases of 0.19% (95% confidence interval [CI] = 0.18%, 0.20%) in all-cause, 0.23% (95% CI = 0.20%, 0.26%) in cardiovascular, and 0.26% (95% CI = 0.22%, 0.31%) in respiratory admissions. For PM10, the values were 0.12% (95% CI = 0.11%, 0.13%) for all-cause, 0.15% (95% CI = 0.13%, 0.17%) for cardiovascular, and 0.21% (95% CI = 0.17%, 0.24%) for respiratory admissions. The associations held at PM2.5 levels below the current Chinese and European/WHO standards. Among individuals with exposure levels below 25 μg/m3, increasing PM2.5 levels from below 15 μg/m3 to above 15 μg/m3 was associated with increases of 1.8% (odds ratio, 1.018; 95% CI = 1.015, 1.022) in all-cause admissions and 2.5% (odds ratio, 1.025; 95% CI = 1.017, 1.034) in cardiovascular admissions.

Conclusions:
Short-term PM exposures were associated with increased hospitalizations, even for exposure levels not exceeding the current regulatory limits.
The role of androgens in the treatment of genitourinary syndrome of menopause (GSM): International Society for the Study of Women's Sexual Health (ISSWSH) expert consensus panel review
Authors: Simon James A. , Goldstein Irwin , Kim Noel N. , Davis Susan R. , Kellogg-Spadt Susan , Lowenstein Lior , Pinkerton JoAnn V. , Stuenkel Cynthia A. , Traish Abdulmaged M. , Archer David F. , Bachmann Gloria , Goldstein Andrew T. , Nappi Rossella E. , Vignozzi Linda 
Published: June 2018

Abstract

Objective:
The objective of this consensus document is to broaden the perspective on clinical management of genitourinary syndrome of menopause to include androgens.

Methods:
A modified Delphi method was used to reach consensus among the 14 international panelists representing multiple disciplines and societies.

Results:
Menopause-related genitourinary symptoms affect over 50% of midlife and older women. These symptoms have a marked impact on sexual functioning, daily activities, emotional well-being, body image, and interpersonal relations. Tissues in the genitourinary system are both androgen and estrogen-dependent. The clitoris, vestibule, including minor and major vestibular glands, urethra, anterior vaginal wall, periurethral tissue, and pelvic floor are androgen-responsive. Historically, treatment of postmenopausal genitourinary symptoms involved both androgens and estrogens. This subsequently gave rise to predominantly estrogen-based therapies. More recently, double-blind, placebo-controlled clinical trials have demonstrated that local vaginal dehydroepiandrosterone improves symptoms in postmenopausal women, including moderate to severe dyspareunia. Limited data suggest that systemic testosterone treatment may improve vaginal epithelial health and blood flow. Open-label studies that have used high doses of intravaginal testosterone in the presence of aromatase inhibitor therapy for breast cancer have resulted in supraphysiological serum testosterone levels, and have been reported to lower vaginal pH, improve the vaginal maturation index, and reduce dyspareunia.

Conclusions:
Vaginal dehydroepiandrosterone, hypothesized to enhance local production of both androgen and estrogen, is effective for the management of dyspareunia in menopause. Vaginal testosterone offers potential as a treatment for genitourinary syndrome of menopause, but more studies are needed.
Provider Agreement in the Assessment of Glaucoma Progression Within a Team Model
Authors: Shah Saumya M. , Choo Clara , Odden Jamie , Zhao Bingying , Fang Chengbo , Schornack Muriel , Stalboerger Gina , Bennett Jeffrey R. , Khanna Cheryl L. 
Published: June 2018

Purpose:
Glaucoma specialists and optometrists who work in a team model at a single institution utilize a common definition of glaucoma progression and treatment algorithm. The purpose of this study was to assess the consistency of agreement in identifying glaucoma progression among glaucoma specialists and optometrists of 1 team.

Methods:
In total, 399 eyes of 200 patients age 18 or older with glaucoma were enrolled over 2 years. Clinical data, disc photographs, optical coherence tomography (OCT), and visual fields were independently reviewed by 2 masked optometrists and 2 masked fellowship-trained glaucoma specialists. Each eye was judged as progression or no progression of glaucomatous disease. The following were assessed: (1) agreement among optometrists; (2) agreement among glaucoma specialists; and (3) agreement among optometrists and glaucoma specialists. The frequency of use of testing modality to determine progression was also studied. κ statistics were used to evaluate agreements.

Results:
Optometrists agreed with each other for 74.2% of the eyes assessed (κ=0.42), whereas glaucoma specialists agreed with each other for 78.7% of eyes (κ=0.39). All 4 providers agreed with each other for 54.4% of the eyes evaluated (κ=0.37). Providers had the highest agreement when the progression decision was based on disc hemorrhage (92%) and the lowest agreement when based on OCT progression analysis (36%). Compared with optometrists, glaucoma specialists used OCT (P≤0.01) more frequently to determine disease progression.

Conclusions:
Fair to moderate agreement levels were found among providers in their assessment of glaucoma progression, suggesting that a team approach to glaucoma management may be effective. Further work is needed to investigate ways to optimize consistency within the glaucoma team.
Retinal Arteriolar Narrowing in Young Adults With Glaucomatous Optic Disc
Authors: Adiarti Rossada , Ekantini Retno , Agni Angela N. , Wong Tien Y. , Sasongko Muhammad B. 
Published: June 2018

Purpose:
Glaucomatous optic disc (GOD) might represent various subclinical processes. However, whether the presence of GOD is related to vascular processes is less clear. This study aimed to assess the retinal vessel diameter, as surrogate markers of vascular regulation, in healthy young adults with GOD compared with normal.

Materials and Methods:
This was a clinic-based case-control study of 54 participants, aged between 18 and 30 years. We included patients with GOD (confirmed with slit-lamp and optical coherence tomography examination having cup-to-disc ratio ≥0.5), intraocular pressure ≤21 mm Hg, no history of hypertension, cardiovascular and kidney disease, anemia, diabetes mellitus, and spherical correction of ≤−1.5 D. Controls were healthy subjects with similar criteria but no sign of GOD. Retinal vessel diameters were measured using semiautomated program [Singapore I Vessel Assessment (SIVA) version 4.0] and expressed as central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent.

Results:
The mean CRAE was significantly narrower in patients with GOD than controls (110.6±12.16 vs. 118.6±12.17; P=0.019). Central retinal venular equivalent was not significantly different. A CRAE narrower than 107.1 μm was significantly associated with GOD (odds ratio, 8.59; 95% confidence interval, 1.68-43.9; P<0.001) compared with controls.

Conclusions:
Retinal arterioles were narrower in young adults with GOD compared with normal, suggesting that the presence of GOD might be associated with subclinical changes in retinal vascularization even in the absence of increased intraocular pressure. However, the clinical significance of these findings deserves further studies.
Scleral Patch Graft Melt After Tube Shunt Surgery: Grading and Identification of Risk Factors
Authors: Xia Tian , Khouri Albert S. 
Published: June 2018

Purpose:
To identify scleral patch graft (SG) melting trends in patients after tube shunt surgery and validate a grading scale for SG health.

Methods:
Patients with glaucoma who underwent tube shunt surgery with a SG were enrolled consecutively at Rutgers New Jersey Medical School from September, 2016 to June, 2017. SG images that were acquired through slit-lamp photography were graded independently by 3 researchers for surface area remaining, thickness and vascularity of the conjunctiva. Interobserver correlation coefficient (kappa) was performed for these scores using our grading system. A chart review of patient records was conducted to investigate comorbid conditions and the student t test was performed with significance P<0.05 to identify associations with SG melt.

Results:
In total, 67 eyes (mean age 60±20 y, 65% female, 35% male) were enrolled. In total, 124 SG images were acquired, but the 67 best captured images were evaluated by 3 graders. Mean percentage of surface area remaining area were 46.2±44.1 (kappa=0.82). The average measured surface area remaining was 6.8 mm2 from reference of 16 mm2. For the 3 graders, mean thickness scores were 1.0±0.9 (kappa=0.79), and mean vascularity scores were 1.1±0.6 (kappa=0.83). Time from surgery at which SG were evaluated was: 17 eyes (25%) <3 months, 11 (16%) 3 to 12 months, 8 (12%) 12 to 24 months, 16 (24%) 2 to 5 years, and 15 (23%) >5 years. At those time point: average percentage SG remaining were 72.9, 60, 31.3, 30.7, and 33.3%, respectively (P<0.05 comparing <1 to >1 y) and SG thickness score 1.6, 1.2, 0.6, 0.6, and 0.7, respectively (P<0.05 comparing <3 mo to 12 to 24 mo). The rate of SG melt (measured by surface area remaining) over time was higher in patients with ocular surface disease (P<0.01).

Conclusions:
SG melts gradually after tube shunt surgery with the most dramatic melt occurring after 12 months postoperatively. This simple and consistent SG grading scale has high interrater agreement and can be may be used to assess and follow graft health over time.
Anatomic Considerations in Thyroid Eye Disease
Authors: Dutton Jonathan J. 
Published: June 2018

Purpose:
To review and summarize the clinical findings in thyroid eye disease (TED) related to the unique anatomical structures of the eyelids and orbit.

Methods:
A PubMed search was performed searching for anatomical relationships between eyelid and orbital anatomy and the clinical findings of TED.

Results:
The major clinical findings associated with TED are varied. They typically involve both the eyelid and the orbit. In the eyelid, usual findings include upper eyelid retraction, contour abnormalities, eyelid edema, prolapsed orbital fat, conjunctival injection and chemosis, caruncular edema, and meibomian gland dysfunction. The exact causes of these changes remain a matter of controversy, but numerous hypotheses have been proposed, most with limited experimental support. In the orbit, inflammation and congestion characterize the acute active phase, with tissue expansion and fibrosis persisting into the chronic inactive phase. All of these findings result, at least in part, from the unique anatomy of the eyelids and orbit and their interaction with the immunologic processes underlying TED. Here we review these major characteristics of TED, with special reference to their anatomic relationships.

Conclusions:
The major findings characterizing TED are related to unique anatomic features in the eyelid, including Müller muscle, the levator palpebrae superioris muscle, and suspensory ligaments of the conjunctiva. In the orbit, Graves-related remolding results from the special physiologic features of the extraocular muscles, the structure of the orbital walls and their relations to adjacent paranasal sinuses, and the reaction of orbital fat to immunologic challenges.
Role of Retrobulbar Hyaluronidase in Filler-Associated Blindness: Evaluation of Fundus Perfusion and Electroretinogram Readings in an Animal Model
Authors: Hwang Catherine J. , Mustak Hamzah , Gupta Adit A. , Ramos Regina M. , Goldberg Robert A. , Duckwiler Gary R. 
Published: June 2018

Purpose:
Hyaluronic acid gel filler-associated blindness is an uncommon but devastating complication. Hyaluronidase can potentially dissolve intravascular filler and improve perfusion; however, its role in filler-associated blindness has yet to be determined. The purpose of this study is to determine the effect of retrobulbar hyaluronidase on hyaluronic acid gel-induced ophthalmic artery occlusion in a rabbit model.

Methods:
New Zealand red rabbits were used to simulate hyaluronic acid gel filler-associated vascular occlusive blindness. Ophthalmic artery occlusion and subsequent ischemia were confirmed by both retinal fundus photography and electroretinogram changes. Retrobulbar hyaluronidase 1,000 IU was injected 30 minutes after occlusion. Fundus photography and electroretinogram changes were recorded at 30, 60, 90, and 120 after administration of retrobulbar hyaluronidase.

Results:
A total of 6 rabbits were used, for a total of 12 eyes. Four eyes were used as controls. Of the 8 experimental eyes, 2 eyes had recorded partial occlusion and 6 eyes had fully occluded ophthalmic arteries by angiographic evaluation. One of the partially occluded eyes demonstrated some improvement in perfusion 60 minutes after injection of retrobulbar hyaluronidase; however, electroretinogram readings remained flat over the 120-minute period of observation. Six eyes with completely occluded ophthalmic arteries showed no improvement in retinal perfusion with corresponding flat electroretinogram readings at 120 minutes following retrobulbar hyaluronidase injection.

Conclusions:
In this rabbit model, 1,000 IU of retrobulbar hyaluronidase administered 30 minutes after occlusion failed to reverse obstruction or restore function following hyaluronic acid gel occlusion of the ophthalmic artery.
Role of glucagon in protein catabolism
Authors: Thiessen Steven E. , Gunst Jan , Van den Berghe Greet 
Published: June 2018

Purpose of review
Glucagon is known as a key hormone in the control of glucose and amino acid metabolism. Critical illness is hallmarked by a profound alteration in glucose and amino acid metabolism, accompanied by muscle wasting and hypoaminoacidemia. Here we review novel insights in glucagon (patho)physiology and discuss the recently discovered role of glucagon in controlling amino acid metabolism during critical illness.

Recent findings
The role of glucagon in glucose metabolism is much more complex than originally anticipated, and glucagon has shown to be a key player in amino acid metabolism. During critical illness, the contribution of glucagon in bringing about hyperglycemia appeared to be quite limited, whereas increased glucagon availability seems to contribute importantly to the typical hypoaminoacidemia via stimulating hepatic amino acid breakdown, without affecting muscle wasting. Providing amino acids further increases hepatic amino acid breakdown, mediated by a further increase in glucagon.

Summary
Glucagon plays a crucial role in amino acid metabolism during critical illness, with an apparent feedback loop between glucagon and circulating amino acids. Indeed, elevated glucagon may, to a large extent, be responsible for the hypoaminoacidemia in the critically ill and infusing amino acids increases glucagon-driven amino acid breakdown in the liver. These novel insights further question the rationale for amino acid administration during critical illness.