bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vertebral bone marrow fat content in normal adults with varying bone densities at 3T magnetic resonance imaging
Authors: He Jie , Fang Hao , Li Xiaona 
Published: August 2018

Background Sex-related differences of vertebral bone marrow fat in relation to varying bone densities have not yet been evaluated although some studies have reported an inverse association of bone marrow fat and bone mineral density (BMD). Purpose To evaluate the relationship between bone marrow fat and BMD and to demonstrate the sex-related differences of the vertebral bone marrow fat in normal adults with varying bone densities. Material and Methods A total of 123 normal adult volunteers were enrolled in this study. 1H-MRS of the lumbar spine was performed. The fat fraction (FF) values of vertebral bone marrow were measured. Volumetric BMD measurement was performed by quantitative computed tomography (QCT). All participants were divided into three groups according to BMD (normal, osteopenia, osteoporosis). The differences in the FF and body mass index (BMI) values of the three groups were compared, and partial correlation analysis was used to evaluate the correlation between FF values and BMD/BMI. Results The FF values increased with decreasing BMD in both male and female participants. There were significant sex differences for the FF values in the normal bone density group ( P < 0.001). The FF values of the normal bone density group in male participants were significantly higher than those of the female participants ( P < 0.001). The FF values were significantly negative correlated with BMD for all participants (r = −0.820, P < 0.001). Conclusion The FF values of vertebral bone marrow correlated inversely with BMD. Sex-related differences of FF values was related to BMD.
Cerebral blood flow changes during intermittent acute hypoxia in patients with heart failure
Authors: Mansur Antonio P. , Alvarenga Glaura Souza , Kopel Liliane , Gutierrez Marco Antonio , Consolim-Colombo Fernanda Marciano , Abrahão Ludhmila Hajjar , Lage Silvia Gelas 
Published: August 2018

Objective Heart failure (HF) is associated with intermittent hypoxia, and the effects of this hypoxia on the cardiovascular system are not well understood. This study was performed to compare the effects of acute hypoxia (10% oxygen) between patients with and without HF. Methods Fourteen patients with chronic HF and 17 matched control subjects were enrolled. Carotid artery changes were examined during the first period of hypoxia, and brachial artery changes were examined during the second period of hypoxia. Data were collected at baseline and after 2 and 4 minutes of hypoxia. Norepinephrine, epinephrine, dopamine, and renin were measured at baseline and after 4 minutes hypoxia. Results The carotid blood flow, carotid systolic diameter, and carotid diastolic diameter increased and the carotid resistance decreased in patients with HF. Hypoxia did not change the carotid compliance, distensibility, brachial artery blood flow and diameter, or concentrations of sympathomimetic amines in patients with HF, but hypoxia increased the norepinephrine level in the control group. Hypoxia increased minute ventilation and decreased the oxygen saturation and end-tidal carbon dioxide concentration in both groups. Conclusion Hypoxia-induced changes in the carotid artery suggest an intensification of compensatory mechanisms for preservation of cerebral blood flow in patients with HF.
Phase II study of hypofractionated radiation therapy in elderly patients with newly diagnosed glioblastoma with poor prognosis
Authors: Navarria Pierina , Pessina Federico , Cozzi Luca , Tomatis Stefano , Reggiori Giacomo , Simonelli Matteo , Santoro Armando , Clerici Elena , Franzese Ciro , Carta Giulio , Conti Nibali Marco , Bello Lorenzo , Scorsetti Marta 
Published: August 2018

Objective: To evaluate hypofractionated radiation therapy (HFRT) given at therapeutic effective doses in a phase II study. Endpoints were progression-free survival (PFS) rate, overall survival (OS), and incidence of toxicity. Methods: Patients with newly diagnosed glioblastoma, age ⩾70 years, Karnofsky performance scale (KPS) score ⩽60, were enrolled. The total dose of HFRT was 52.5 Gy/15 fractions, corresponded to a biological effective dose to the tumor of 70.88 Gy. Results: Thirty patients were treated, with a median age of 75 years. Concurrent and adjuvant temozolomide chemotherapy (TMZ-CHT) was administered in 7 (23.3%) and 11 (40.7%) patients received only adjuvant TMZ-CHT. The median, 6-month PFS, and 12-month PFS were 5.0 months, 43.3%, and 20%, respectively. The median, 6-month OS, and 12-month OS were 8 months, 90%, and 30%, respectively. At the last observation time, 26 patients (86.7%) were dead and 4 (13.3%) were alive. No increase in steroid drugs was required during radiotherapy treatment and a reduction was possible in 12 (40%). Patients with KPS=60, RPA V, MGMT methylated status, neurological status stable or improved after surgery and who underwent HFRT with concurrent and adjuvant CHT, had the better outcome. Conclusion: HFRT has proven to be feasible and effective, with limited morbidity, for selected elderly and frail patients with newly diagnosed glioblastoma. The primary objective of this study was not reached in the whole cohort but only in selected patients, who need more aggressive treatment.
Establishment of a Medication Acuity Scoring Tool at a Tertiary Pediatric Teaching Hospital: A 2-Phase Process
Authors: DeRonde Kailynn , Palmer Claire , Gralla Jane , Poel Kevin 
Published: August 2018

Background: Currently, there is no validated objective rating system to address the acuity of medication orders that pharmacists review. Objective: The objective was to assess the acuity of a given medication through creating and validating an acuity scoring tool. Methods: Phase I included the development of the medication acuity scoring tool (MAST) from national safety standards and clinical experience. A survey was administered to pharmacists nationwide to establish a consensus on the individual components of the tool and their associated weighted scores. Phase II was designed to assess MAST's predictive validity by comparing a medication acuity rating generated by MAST to a rating assigned based upon clinical experience of experts. Additionally, in phase II, interrater and intrarater reliability of MAST was evaluated. Results: In phase I, most of MAST’s components and their associated scores achieved >75% agreement for inclusion in the final tool. In phase II, without MAST, approximately 50% of pharmacist-assigned acuity ratings were statistically consistent with tool-generated acuity ratings, and there was fair agreement between respondents (k=0.31). With the use of MAST, agreement in acuity ratings improved to substantial (k=0.69), and intrarater reliability was almost perfect (k=0.88). Conclusion: MAST is a validated rating system that captures the acuity of medications.
Breast Reconstruction and Radiation Therapy
Authors: Yun Johanna H. , Diaz Roberto , Orman Amber G. 
Published: August 2018

Purpose: The optimal approach to the integration of postmastectomy reconstruction and radiation therapy is not well-established. This review will summarize current literature pertaining to the most common types of reconstruction in the setting of postmastectomy radiation therapy (PMRT). Data Sources: Literature from PubMed was reviewed from 2000 to 2016. Study Selection: Studies were selected with relevance to “postmastectomy breast reconstruction,” “breast reconstruction,” and “breast reconstructive methods and PMRT.” Surgical outcomes, patient satisfaction, and cost-effectiveness were examined. Data Extraction: Data from publications was extracted, summarized, and converted to a table. Results of Data Synthesis: Implant-based techniques are on the rise, in the setting of PMRT. Implant-based methods are more affordable in the short term and result in immediate breast-mound formation compared to autologous methods. When compared to implant-based reconstruction with PMRT, autologous reconstruction with PMRT results in better quality of life (QoL) and sensory recovery as well as fewer complications and failures. Among autologous flaps, deep inferior epigastric perforator flaps are considered superior to transverse rectus abdominal muscle (TRAM) pedicled flaps and may be more suitable for PMRT. Latissimus dorsi and muscle-sparing free TRAM flaps are also viable options. In delayed autologous, which may be advantageous for high-risk patients, the optimal timing to delay surgery after radiation therapy is unknown. Reconstruction with a 2-stage tissue expander-implant technique offers good to excellent cosmetic outcomes in the setting of PMRT, although there may be complications in this 2-stage process. Conclusion: Surgical, cosmetic, quality of life, and life expectancy must be taken into account when selecting the way to integrate breast reconstruction and PMRT.
Comparison of clinical and imaging findings in cats with single and mixed lungworm infection
Authors: Febo Elettra , Crisi Paolo Emidio , Traversa Donato , Luciani Alessia , Di Tommaso Morena , Pantaleo Stefania , Santori Domenico , Di Cesare Angela , Boari Andrea , Terragni Rossella , Vignoli Massimo 
Published: August 2018

Objectives This study has compared clinical and imaging features in 52 cats naturally infected by respiratory nematodes Aelurostrongylus abstrusus, Troglostrongylus brevior and Capillaria aerophila, and in both monospecific and mixed infections. Methods Medical records of cats with a lungworm disease were retrospectively reviewed. Cats with clinical examination findings, haematobiochemical analysis and thoracic radiography were included in the study and clinical and radiographic scores were assigned. For eight cats CT of the thorax was also available and analysed. A statistical analysis was performed to investigate the potential correlation between clinical and radiographic score, and to evaluate the effect of age, sex and infection on clinical and radiographic severity. Results Monospecific infections by A abstrusus (32/52), T brevior (6/52) and C aerophila (5/52) and coinfections by T brevior/ A abstrusus (7/52), T brevior/ C aerophila (1/52) and A abstrusus/ C aerophila (1/52) were diagnosed. Cats with mixed infections showed higher clinical scores compared with cats with monospecific parasitoses ( P <0.05), while no differences were observed for radiographic scores. No correlation between clinical and radiographic scores was found (rs = 0.50), and these scores were not affected by patient age or sex. CT, performed on cats infected with A abstrusus, T brevior or A abstrusus/T brevior, provided additional information in cats with mild radiographic signs. Conclusions and relevance This study indicates that clinical parameters may be more severe in mixed infections than in monospecific parasitoses. A significant correlation between clinical and radiographic score was not detected, while several subclinically infected cats showed radiographic changes. In cats with mild-to-moderate lung patterns, the ventrodorsal/dorsoventral projection showed lesions that are not visible in the lateral projections, especially in the caudal lobes.
Change in mental health symptoms in families with nonresponding children referred to inpatient family units
Authors: Rimehaug Tormod 
Published: August 2018

Aims: To examine changes in child mental health symptoms following inpatient family unit treatment after long-term unsuccessful treatment in community and child psychiatry outpatient services. Follow-up from referral and admission to 3 and 12 months. Methods: Standardized questionnaires measuring the child mental health symptoms and parental anxiety and depression converted to standardized scores and compared to each child’s clinical diagnosis. Results: Significant group mean improvement on almost all problem scales at the 3-month follow-up (T2) remaining through 12-month follow-up (T3) relative to admission (T1). Aggression showed the highest levels and largest improvements. Statistically significant improvements were widespread, whereas clinically significant improvements were found for some diagnostic groups on diagnosis-related problems and secondary problems. Improvement in child symptoms were partly correlated with improvement in parental anxiety symptoms. Implications: Even previously nonresponding children may benefit from broad tailored interventions including parents and the wider system. Development of systematic component approaches is needed.
Impaired vasocontractile responses to adenosine in chorionic vessels of human term placenta from pregnant women with pre-existing and gestational diabetes
Authors: Razak Azlina A , Leach Lopa , Ralevic Vera 
Published: August 2018

Background: There is clinical and experimental evidence for altered adenosine signalling in the fetoplacental circulation in pregnancies complicated by diabetes, leading to adenosine accumulation in the placenta. However, the consequence for fetoplacental vasocontractility is unclear. This study examined contractility to adenosine of chorionic vessels from type 1 diabetes mellitus, gestational diabetes mellitus and normal pregnancies. Methods: Chorionic arteries and veins were isolated from human placenta from normal, gestational diabetes mellitus and type 1 diabetes mellitus pregnancies. Isometric tension recording measured responses to adenosine and the thromboxane A2 analogue U46619 (thromboxane A2 mediates fetoplacental vasoconstriction to adenosine). Adenosine and thromboxane prostanoid receptor protein expression was determined by immunoblotting. Results: Adenosine elicited contractions in chorionic arteries and veins which were impaired in both gestational diabetes mellitus and type 1 diabetes mellitus. Contractions to potassium chloride were unchanged. Adenosine A2A and A2B receptor protein levels were not different in gestational diabetes mellitus and normal pregnancies. Contractions to U46619 were unaltered in gestational diabetes mellitus arteries and increased in type 1 diabetes mellitus arteries. Overnight storage of vessels restored contractility to adenosine in gestational diabetes mellitus arteries and normalized contraction to U46619 in type 1 diabetes mellitus arteries. Conclusion: These data are consistent with the concept of aberrant adenosine signalling in diabetes; they show for the first time that this involves impaired adenosine contractility of the fetoplacental vasculature.
Fiscal Accountability in Gubernatorial Elections
Authors: Cummins Jeff , Holyoke Thomas T. 
Published: August 2018

AbstractAlthough significant research has been conducted on economic voting in gubernatorial elections, very few explore the impact of state fiscal conditions in these elections. The little that has been done yields conflicting results regarding the effects of state spending and found that governors are not held responsible for a state's overall fiscal health. Our study examines the impact of spending and fiscal health on gubernatorial elections from 1982 to 2013. We find evidence that voters reward incumbent parties for fiscal health and spending growth and that unified government and stronger executive budget powers enhance fiscal accountability for these outcomes. These findings contradict previous research that suggests voters punish one or both parties for higher spending. We conclude by discussing the implications of this research for the debate about the balance of powers between the executive and legislative branches.
Carotid revascularization and medical management for asymptomatic carotid stenosis – Hemodynamics (CREST-H): Study design and rationale
Authors: Marshall Randolph S , Lazar Ronald M , Liebeskind David S , Connolly E Sander , Howard George , Lal Brajesh K , Huston John , Meschia James F , Brott Thomas G 
Published: August 2018

Rationale For patients with asymptomatic high-grade carotid stenosis, clinical investigations have focused on preventing cerebral infarction, yet stenosis that reduces cerebral blood flow may independently impair cognition. Whether revascularization of a hemodynamically significant carotid stenosis can alter the course of cognitive decline has never been investigated in the context of a randomized clinical trial. Hypothesis Among patients randomized in the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis (CREST-2) trials, the magnitude of treatment differences (revascularization versus medical management alone) with regard to cognition will differ between those with flow impairment compared to those without flow impairment. Sample size We will enroll approximately 500 patients from CREST-2, of which we anticipate 100 will have hemodynamic impairment. We estimate 93% power to detect a clinically meaningful treatment difference of 0.5 SD. Methods and design We will use perfusion-weighted magnetic resonance imaging to stratify by hemodynamic status. Linear regression will compare treatment differences, controlling for baseline cognitive status, age, depression, prior cerebral infarcts, silent infarction, white matter hyperintensity volume, and cerebral microbleeds. Study outcomes The primary outcome is change in cognition at one year. Secondary outcomes include silent infarction, change in white matter hyperintensity volume, number of cerebral microbleeds, and cortical thickness over one year. Discussion If cognitive impairment can be shown to be reversible by revascularization, then we can redefine “symptomatic carotid stenosis” to include cognitive impairment and identify a new population of patients likely to benefit from revascularization. Trial Registration US National Institutes of Health (NIH) clinicaltrials.gov NCT03121209
From Wary Wearers to d-Embracers: Personas of Readiness to Use Diabetes Devices
Authors: Tanenbaum Molly L. , Adams Rebecca N. , Iturralde Esti , Hanes Sarah J. , Barley Regan C. , Naranjo Diana , Hood Korey K. 
Published: August 2018

Background: Diabetes devices such as insulin pumps and continuous glucose monitoring (CGM) are associated with improved health and quality of life in adults with type 1 diabetes (T1D). However, uptake remains low. The aim of this study was to develop different “personas” of adults with T1D in relation to readiness to adopt new diabetes technology. Methods: Participants were 1498 T1D Exchange participants who completed surveys on barriers to uptake, technology attitudes, and other psychosocial variables. HbA1c data was available from the T1D Exchange for 30% of the sample. K-means cluster analyses grouped the sample by device barriers and attitudes. The authors assigned descriptive labels based on cluster characteristics. ANOVAs and chi-square tests assessed group differences by demographic and psychosocial variables (eg, diabetes duration, diabetes distress). Results: Analyses yielded five distinct personas. The d-Embracers (54% of participants) endorsed few barriers to device use and had the highest rates of device use, lowest HbA1c, and were the least distressed. The Free Rangers (23%) had the most negative technology attitudes. The Data Minimalists (10%) used pumps but had lower CGM use and did not want more diabetes information. The Wary Wearers (11%) had lower overall device use, were younger, more distressed, endorsed many barriers, and had higher HbA1c. The High Distress (3%) group members were the youngest, had the shortest diabetes duration, reported the most barriers, and were the most distressed. Conclusion: These clinically meaningful personas of device readiness can inform tailored interventions targeting barriers and psychosocial needs to increase device uptake.
Are We Ready to Treat Our Diabetes Patients Using Social Media? Yes, We Are
Authors: Petrovski Goran , Zivkovic Marija 
Published: August 2018

Aims: The aim of the study was to evaluate Facebook group as possible communication tool to improve glucose control in adolescents and young people with type 1 diabetes (T1D). Methods: This retrospective and cross-sectional study included 728 T1D patients (age 11-25) on continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) treated at the center for insulin pump and glucose sensor in Skopje from January 2012 to December 2017. Data were collected through the electronic medical record system and cross-sectional analysis (telephone, social media (Facebook and Viber) or email). Patients were analyzed in two groups: (a) non-Internet group, with 398 patients treated using standard medical protocol with regular clinic visits; (b) Internet group, with 330 patients who, besides standard medical protocol, were active members of a national closed Facebook group on diabetes. Both the non-Internet and Internet groups had regular visits every 2-3 months. Patients from the Internet group were members of the closed Facebook group “Diabetes Macedonia” and had an opportunity to interact with questions, answers, and comments on diabetes care. An additional analysis was performed of the Internet group on combined use of Facebook and Viber. Average HbA1c levels were compared in both groups. Results: Each patient from the Facebook group had 1.5 ± 3.5 posts per day. Hba1c was significantly lower in patients from the Internet group (7.1 ± 3.2%; 54 ± 35 mmol/mol) compared to patients from the non-Internet group (7.6 ± 2.8%; 60 ± 31 mmol/mol). Conclusions: Social media like Facebook and Viber can be additional communication tool in adolescents and young people with T1D and can significantly lower HbA1c compared to patients without social media use. CSII patients are more likely to use both social media (Facebook and Viber) compared with MDI patients (Facebook only).
Hemiarthroplasty Versus Total Joint Arthroplasty for Hallux Rigidus: A Systematic Review and Meta-analysis
Authors: Stibolt Robert D. , Patel Harshadkumar A. , Lehtonen Eva J. , DeBell Henry A. , Moon Andrew S. , Naranje Sameer , Shah Ashish 
Published: August 2018

Background: When surgery is indicated for hallux rigidus, toe arthroplasty is an alternative procedure to arthrodesis for patients who wish to preserve toe range of motion. Our study investigated midterm outcomes of first metatarsophalangeal joint (MTPJ) arthroplasty in an effort to discern whether or not partial or total joint replacement confers benefit in these patients. Methods: A systematic review of MTPJ arthroplasty was performed for the years 2000 to 2017. A Forest plot was created comparing preoperative and postoperative American Orthopedic Foot and Ankle Score (AOFAS), Visual Analogue Scale (VAS), and range of motion (ROM) results for both hemitoe and total-toe arthroplasty. Statistical analysis was performed. Results: Mean postoperative AOFAS scores in patients undergoing hemiarthroplasty improved by 50.7 points (95% CI = 48.5, 52.8), whereas the mean AOFAS score improvement in total joint arthroplasty patients was 40.6 points (95% CI = 38.5, 42.8). VAS outcomes were comparable. Mean postoperative MTPJ ROM improved by 43.0° (95% CI = 39.3°, 46.6°) in hemitoe patients, which exceeded the mean ROM improvement of 32.5° (95% CI = 29.9°, 35.1°) found in total joint arthroplasty cases. A meta-analysis revealed no significant difference. Conclusion: Hemisurface implants in MTPJ arthroplasty may improve postoperative AOFAS and ROM results to a greater extent than total-toe devices. Level of Evidence: Level IV: Systematic review