bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pregnancy in Women With a Fontan Circulation
Authors: Garcia Ropero Alvaro , Baskar Shankar , Roos Hesselink Jolien W. , Girnius Andrea , Zentner Dominica , Swan Lorna , Ladouceur Magalie , Brown Nicole , Veldtman Gruschen R. 
Published: May 2018

Background:
The Fontan operation has provided life-saving palliation and adult survival for individuals born with single ventricle physiology. Many now seek advice about safe pregnancy. Little data are, however, available, consisting mainly of anecdotal experience and small series. This article seeks to review the published literature and identify lessons learnt from this collective experience.

Methods and Results:
We conducted a systematic review to evaluate maternal and fetal outcomes of pregnancy in women with a Fontan circulation. Among 1150 studies that were screened, 6 studies had sufficient longitudinal data points to qualify for meaningful inclusion, yielding 255 pregnancies in 133 women after Fontan procedure resulting in 115 live births (45%; including reports from 1986 to 2015). There was a total of 137 pregnancy losses (69%), with 115 miscarriages (45%), 19 elective terminations of pregnancy (7%), 2 stillbirths (1%), and 1 ectopic pregnancy (1%).The most common cardiovascular adverse events were supraventricular arrhythmia affecting 8.4% (range, 3%–37%) and heart failure affecting 3.9% (range, 3%–11%) of pregnancies. These complications were successfully managed with conventional approaches. No maternal deaths were reported. Postpartum hemorrhage was the predominant obstetric complication affecting 14% of the patients. Most patients were on antiplatelet agents (27%) or anticoagulants (50%) whereas only a minority (11%) were on neither. Among the 115 live births, 68 were premature (59%), 17 were small for gestational age (20%), and neonatal death occurred in 6 patients (5%).

Conclusions:
The most commonly reported cardiovascular complications in patients with Fontan physiology–associated pregnancy were arrhythmia and heart failure. Miscarriages were highly prevalent as was prematurity and intrauterine growth restriction. Postpartum hemorrhage seems to be the most common obstetric complication. Large-scale data sets are needed to confirm these early observations and address the late sequelae of pregnancy in women with a Fontan circulation.
Device-Related Thrombus After Left Atrial Appendage Closure
Authors: Dukkipati Srinivas R. , Kar Saibal , Holmes David R. , Doshi Shephal K. , Swarup Vijendra , Gibson Douglas N. , Maini Brijeshwar , Gordon Nicole T. , Main Michael L. , Reddy Vivek Y. 
Published: May 2018

Background:
In patients with atrial fibrillation, left atrial appendage closure with the Watchman device prevents thromboembolism from the left atrial appendage; however, thrombus may form on the left atrial face of the device, and then potentially embolize. Herein, we studied the incidence, predictors, and clinical outcome of device-related thrombus (DRT) using a large series of clinical trial cohorts of patients undergoing Watchman implantation.

Methods:

We studied the device arms of 4 prospective Food and Drug Administration trials: PROTECT-AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) (n=463); PREVAIL (Evaluation of the Watchman LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy) (n=269); CAP (Continued Access to PROTECT AF registry) (n=566); and CAP2 (Continued Access to PREVAIL registry) (n=578). Surveillance transesophageal echocardiographs were performed at 45 days and 12 months in all patients, and also at 6 months in the randomized control trials. We assessed both the incidence of DRT during these transesophageal echocardiographs (and other unscheduled transesophageal echocardiographs), and clinical outcomes of postprocedure stroke or systemic embolism (SSE) and adjusted for CHA
2
DS
2
-VASC and HAS-BLED scores.

Results:

Of 1739 patients who received an implant (7159 patient-years follow-up; CHA
2
DS
2
-VASc=4.0), DRT was seen in 65 patients (3.74%). The rates of SSE with and without DRT were 7.46 and 1.78 per 100 patient-years (adjusted rate ratio, 3.55; 95% confidence interval [CI], 2.18–5.79;
P
<0.001), and ischemic SSE rates were 6.28 and 1.65 per 100 patient-years (adjusted rate ratio, 3.22; 95% CI, 1.90–5.45,
P
<0.001). On multivariable modeling analysis, the predictors of DRT were as follows: history of transient ischemic attack or stroke (odds ratio [OR], 2.31; 95% CI, 1.26–4.25;
P
=0.007), permanent atrial fibrillation (OR, 2.24; 95% CI, 1.19–4.20;
P
=0.012); vascular disease (OR, 2.06; 95% CI, 1.08–3.91;
P
=0.028); left atrial appendage diameter (OR, 1.06 per mm increase; 95% CI, 1.01–1.12;
P
=0.019); left ventricular ejection fraction (OR, 0.96 per 1% increase; 95% CI, 0.94–0.99;
P
=0.009). DRT and SSE both occurred in 17 of 65 patients (26.2%). Of the 19 SSE events in these patients with DRT, 9 of 19 (47.4%) and 12 of 19 (63.2%) occurred within 1 and 6 months of DRT detection. Conversely, after left atrial appendage closure, most SSEs (123/142, 86.62%) occurred in patients without DRT.

Conclusions:
After left atrial appendage closure with Watchman, DRT (≈3.7%) is not frequent but, when present, is associated with a higher rate of stroke and systemic embolism.
Gastrodia elatoides (Orchidaceae: Epidendroideae: Gastrodieae), a new holomycoheterotrophic orchid from Madagascar
Authors: HUANG WEI-CHANG , WANG ZHEN-WEI , WEI NENG , ZHU JIAO , LAN SI-REN , HU GUANG-WAN , WANG QING-FENG 
Published: May 2018

Gastrodia Brown (1810: 330; Gastrodieae, Epidendroideae) is a genus of holomycoheterotrophic orchids distributed from India and eastern Asia through Malaysia to Australia, as well as in tropical Afro-Madagascar (Pearce & Cribb 2002, Kores & Molvray 2005, Chen et al. 2009, Cribb et al. 2010). In this genus, 85 species have been accepted based on the combined information from Govaerts et al. (2018) and recently published new records of Gastrodia species (Jin & Kyaw 2017, Metusala & Supriatna 2017, Suetsugu 2017, Aung & Jin 2018). Consequently, it is now the largest holomycoheterotrophic genus among vascular plants (Hsu et al. 2016, Suetsugu 2017). Gastrodia is characterised by a fleshy tuber or coralloid rhizome, fusion of sepals and petals, a spurless lip and two sectile pollinia (Pearce & Cribb 2002, Kores & Molvray 2005, Chen et al. 2009). One species, G. elata Blume (1856: 174), is a highly valued plant in traditional Chinese medicine (TCM) for the treatment of convulsive disorders such as epilepsy (Cribb et al. 2010, Chen et al. 2009).
Using HIV Surveillance Data to Link People to HIV Medical Care, 5 US States, 2012-2015
Authors: Beltrami John , Dubose Odessa , Carson Reginald , Cleveland Janet C. 
Published: May 2018

Introduction: From 2012 through 2015, the Centers for Disease Control and Prevention (CDC) provided funding to 5 health departments for demonstration projects using HIV surveillance data to link people with newly diagnosed HIV to care. We assessed how well these health departments established linkage to care, how the demonstration projects helped them with this work, and if they sustained these activities after CDC funding ended. Materials and Methods: We obtained quantitative and qualitative data on linkage-to-care activities from health department communications and progress reports submitted to CDC. We calculated and combined linkage-to-care results for the 5 health departments, and we compared these results with the combined linkage-to-care results for 61 health departments that received CDC funding for routine HIV prevention activities (eg, HIV testing, linkage to and reengagement in HIV care, HIV partner services) and for the same 5 health departments when they used only routine HIV prevention activities for linkage to care. Results: Of 1269 people with a new HIV diagnosis at the 5 health departments, 1124 (89%) were linked to care, a result that exceeded the 2010-2015 National HIV/AIDS Strategy goal (85%), the CDC Funding Opportunity Announcement performance standard (80%), and combined results for the 61 health departments (63%) and the same 5 health departments (66%) using routine HIV prevention activities. Benefits of the projects were improved collaboration and coordination and more accurate, up-to-date surveillance data. All health departments continued linkage-to-care activities after funding ended. Practice Implications: Using HIV surveillance data to link people with HIV to care resulted in substantial clinical and public health benefits. Our observations underscore the importance of collaboration among medical providers, public health staff members, community-based organizations, and people with HIV to ensure the best possible clinical and public health outcomes.
Multidetector-row CT imaging evaluation of superior and inferior vena cava normal anatomy and caval variants: Report of our cases and literature review with embryologic correlation
Authors: Iezzi Roberto , Posa Alessandro , Carchesio Francesca , Manfredi Riccardo 
Published: May 2018

Objective To assess the potential of multidetector-row computed tomography imaging and its reformations in the evaluation of the superior and inferior vena cava normal anatomy and their anatomical variants, and to make a brief review of caval embryogenesis and developmental errors. Methods We retrospectively reviewed a total of 1000 whole-body computed tomography scans performed between January 2010 and December 2016 to assess the normal superior and inferior vena cava anatomy and their variants. Results The normal superior and inferior vena cava anatomy was found in 88.9% of patients, whereas multiple variants were found, ranging from the superior or inferior vena cava duplication, to the azygos continuation of the inferior vena cava. Conclusions Computed tomography is a powerful tool to analyse superior and inferior vena cava anatomical variants. The knowledge and assessment of normal caval anatomy and of its anatomical variants is mandatory in the correct pre-operative planning in surgical and radiological interventions. Knowledge of caval variants is helpful in the differential diagnosis of abdominal or mediastinal masses, to avoid misdiagnosis, as well as in the screening of associated congenital pathologic conditions.
Antithrombotic therapy in pediatric ventricular assist devices: Multicenter survey of the European EXCOR Pediatric Investigator Group
Authors: Miera Oliver , Schmitt Katharina L , Akintuerk Hakan , Boet Angele , Cesnjevar Robert , Chila Teresa , Fleck Thilo , Goldwasser Ranny , Guereta Luis G , Heineking Beatrice , Hoerer Juergen , Horke Alexander , Hsia Tain Y , Huebler Michael , Kansy Andrzej , Karimova Ann , Maruszewski Bohdan , Medrano Constancio , Pawlak Szymon , Reinhardt Zdenka , Romlin Birgitta , Sandica Eugen , Schmidt Florian , Schramm René , Schweiger Martin , Śliwka Joanna , Stiller Brigitte , Thul Josef , Amodeo Antonio 
Published: May 2018

Objectives: Mechanical circulatory support for pediatric heart failure patients with the Berlin Heart EXCOR ventricular assist system is the only approved and established bridging strategy for recovery or heart transplantation. In recent years, the burden of thromboembolic events has led to modifications of the recommended antithrombotic therapy. Therefore, we aimed to assess modifications of antithrombotic practice among the European EXCOR Pediatric Investigator Group members. Methods: We sent a questionnaire assessing seven aspects of antithrombotic therapy to 18 European hospitals using the EXCOR device for children. Returned questionnaires were analyzed and identified antithrombotic strategies were descriptively compared to “Edmonton protocol” recommendations developed for the US EXCOR pediatric approval study. Results: Analysis of 18 received surveys revealed substantial deviations from the Edmonton protocol, including earlier start of heparin therapy at 6–12 h postoperatively and in 50% of surveyed centers, monitoring of heparin effectiveness with aPTT assay, administering vitamin K antagonists before 12 months of age. About 39% of centers use higher international normalized ratio targets, and platelet inhibition is changed in 56% including the use of clopidogrel instead of dipyridamole. Significant inter-center variability with multiple deviations from the Edmonton protocol was discovered with only one center following the Edmonton protocol completely. Conclusion: Current antithrombotic practice among European EXCOR users representing the treatment of more than 600 pediatric patients has changed over time with a trend toward a more aggressive therapy. There is a need for systematic evidence-based evaluation and harmonization of developmentally adjusted antithrombotic management practices in prospective studies toward revised recommendations.
Impact and Effectiveness of a Stand-Alone NRT Starter Kit in a Statewide Tobacco Cessation Program
Authors: Kerr Amy N. , Schillo Barbara A. , Keller Paula A. , Lachter Randi B. , Lien Rebecca K. , Zook Heather G. 
Published: May 2018

Purpose: To examine 2-week nicotine replacement therapy (NRT) starter kit quit outcomes and predictors and the impact of adding this new service on treatment reach. Design: Observational study of a 1-year cohort of QUITPLAN Services enrollees using registration and utilization data and follow-up outcome survey data of a subset of enrollees who received NRT starter kits. Setting: ClearWay Minnesota’s QUITPLAN Services provides a quit line that is available to uninsured and underinsured Minnesotans and NRT starter kits (a free 2-week supply of patches, gum, or lozenges) that are available to all Minnesota tobacco users. Participants: A total of 15 536 adult QUITPLAN Services enrollees and 818 seven-month follow-up survey NRT starter kit respondents. Measures: Treatment reach for all services and tobacco quit outcomes and predictors for starter kit recipients. Analysis: Descriptive analyses, χ2 analyses, and logistic regression. Results: Treatment reach increased 3-fold after adding the 2-week NRT starter kit service option to QUITPLAN Services compared to the prior year (1.86% vs 0.59%). Among all participants enrolling in QUITPLAN services during a 1-year period, 83.8% (13 026/15 536) registered for a starter kit. Among starter kit respondents, 25.6% reported being quit for 30 days at the 7-month follow-up. After controlling for other factors, using all NRT and selecting more cessation services predicted quitting. Conclusion: An NRT starter kit brought more tobacco users to QUITPLAN services, demonstrating interest in cessation services separate from phone counseling. The starter kit produced high quit rates, comparable to the quit line in the same time period. Cessation service providers may want to consider introducing starter kits to reach more tobacco users and ultimately improve population health.
Knowledge of Health Conditions Associated With Sugar-Sweetened Beverage Intake Is Low Among US Hispanic Adults
Authors: Park Sohyun , Ayala Guadalupe X. , Sharkey Joseph R. , Blanck Heidi M. 
Published: May 2018

Purpose: To examine associations between knowledge of health conditions and sugar-sweetened beverage (SSB) intake among Hispanic adults. Design: Quantitative, cross-sectional study. Setting: The 2015 Estilos survey data. Participants: One thousand US Hispanic adults (≥18 years). Measures: The outcome variable was frequency of SSB intake (regular soda, fruit drink, sports/energy drink, and sweetened coffee/tea drink). Exposure variables were knowledge of 6 SSB-related health conditions (weight gain, diabetes, dental caries, high cholesterol, heart disease, and hypertension). Analysis: Six multinomial logistic regression models were used to estimate adjusted odds ratios for consuming SSBs ≥3 times/day (high intake), in relation to knowledge of SSB-related health conditions. Results: Overall, 58% of Hispanic adults consumed SSBs ≥2 times/day and 36% consumed SSBs ≥3 times/day. Although most identified that weight gain (75%) and diabetes (76%) were related to drinking SSBs, only half identified this relation with dental caries (57%) and hypertension (41%). Even fewer identified high cholesterol (32%) and heart disease (32%) as related. In crude analyses, SSB intake was significantly associated with knowledge of the associations between SSBs and weight gain, dental caries, and heart disease; however, after adjusting for sociodemographics and acculturation, associations were no longer significant. Conclusions: Although SSB intake was very high, knowledge of SSB-related health conditions was low and was not related to high SSB intake among US Hispanic adults. Education efforts alone may not be adequate for Hispanic adults to change their behaviors.
Attempted suicide by poisoning of self‐prepared arsenic trioxide solution
Authors: Poon KM , Lam SK , Lai CH , Fung HT 
Published: May 2018

Introduction:Arsenic is a traditional poison that has a history extending back to ancient times.Case presentation:A 43‐year‐old male presented to our Emergency Department 50 min after ingestion of 300 mL self‐prepared arsenic trioxide solution (砒霜). He produced the solution from heating xionghuang (雄黃), an arsenic sulfide mineral (As4S4) which is a Chinese herb, for academic purposes a few years ago.Discussion:Supportive care including fluid replacement and decontamination with gastric lavage and chelation therapy with intravenous dimercaptopropanesulphonate sodium was given to patient. Spot urine arsenic to creatinine ratio significantly decreased from 343,124 nmol/mmol (day 3) to 7116 nmol/mmol (day 5). He had an uneventful course without any neurological deficit.Conclusions:Treatment of acute arsenic poisoning includes supportive care, decontamination, and chelation therapy. DMPS is an antidote for arsenic poisoning and its use should be directed by clinical status and urinary arsenic excretion.
Outcome Measures in UCLP: The Modified 5-Year-Olds’-Index—Development and Reliability
Authors: Mittal Tarun K. , Ireland Anthony J. , Atack Nikki E. , Leary Sam D. , Russell Joyce I. , Deacon Scott A. , Ness Andy R. , Sandy Jonathan R. 
Published: May 2018

Objective: Can we reliably discriminate severity within the existing categories of the 5-Year-Olds’ Index? Design: Retrospective method comparison and development study. Setting: School of Oral and Dental Science, University of Bristol. Methods: Dental study models of 5-year-olds with unilateral cleft lip and palate (UCLP) were collected from the archives of 2 national cleft surveys (n = 351). One hundred randomly selected models were ranked to construct the modified 5-Year-Olds’ Index and also scored using a visual analogue scale (VAS). Reliability testing was performed on 51 study models. Visual analogue scale scores were used to aid statistical analysis and investigate the reliability of a VAS for outcome measurement. The modified 5-Year-Olds’ Index was then applied to 198 study models of 5-year-olds with UCLP. Results: The modified 5-Year-Olds’ Index showed excellent intra and interexaminer agreement (intraclass correlation > 0.94) and good discrimination of severity. When applied to the Cleft Care UK participants (n = 198), the modified 5-Year-Olds’ Index showed good discrimination of severity within the better categories (groups 1-3) of the 5-Year-Olds’ Index. Visual analogue Scale scores resulted in unacceptable variation between measurements. Conclusions: The new modified 5-Year-Olds’ Index is a reliable method of assessing outcomes at 5 years of age and showed improved discriminatory power between the “better” outcome categories than the original 5-Year-Olds’ Index. A VAS was found to be unsuitable for assessing outcome at 5 years of age for children with UCLP.
Could Autism Be Associated With Nutritional Status in the Palestinian population? The Outcomes of the Palestinian Micronutrient Survey
Authors: Altamimi Mohammad 
Published: May 2018

Background: Autism spectrum disorder is a neurodevelopmental disorder. It is believed that the cause of autism is multifactorial, where genetic predispositions interact with environmental factors. In this context, micronutrients play a crucial role. Objective: To present evidence on current micronutrient status in Palestine and highlight its possible role in increasing problems of neurodevelopment disorders in general and autism in particular. Method: Analytical review of results. Results And Conclusions: The Palestinian Micronutrient Survey was conducted to assess micronutrient status in most vulnerable groups and also micronutrient deficiencies. The data from Palestinian population showed severe anaemia due to iron, Zn, B12, and folic acid deficiencies. One in every 3 Palestinian pregnant women is anaemic. Moreover, 78.2% and 87.1% of lactating mothers from the West Bank and Gaza Strip are Zn deficient. For children from 6 to 59 months old, 1 in every 4 boys and 1 in every 5 girls are considered anaemic. Similar trend was found with respect to vitamins E, D, A, and folic acid. We reviewed the literature that linked micronutrient deficiencies to neurodevelopmental disorders and expected the number of neurodevelopmental disorder cases, including autism, to increase.
Providing care for a person with late-stage dementia at home: What are carers’ experiences?
Authors: Dempsey Laura , Dowling Maura , Larkin Philip , Murphy Kathy 
Published: May 2018

Background It is widely reported that carers who provide care for a family member with dementia endure physical and psychological burdens. Not only do they fulfil an important role for the person with dementia but also for the wider society. This study aims to explore the experiences of carers who provide end-of-life care for a person with late-stage dementia at home. Method Semi-structured interviews were conducted with 17 current carers and 6 past carers of a family member with late-stage dementia. Data was analysed using interpretative phenomenological analysis. Results Four super-ordinate themes were identified which described the challenges faced by carers at different stages of their care giving journey: (1) The experience of dementia grief; (2) Parenting the parent; (3) Seeking support; (4) Death, dying and life after death. Conclusion Dementia grief was experienced by carers as a result of a relationship change and an inability to recognise the person with dementia as their mother, father or spouse. A role transition ensued resulting in the carer adopting the role of parent. Carers expressed a desire to provide care for the person with dementia at home until the time of death; however, support is required in this area at both individual and community level. Family carers require education to help identify the dying phase which will assist to minimise the shock of death. Strong evidence suggests that the burden of care may leave family carers poorly equipped to adapt to life after the death of the person with dementia. Greater pre-death support is required to facilitate a better post bereavement adjustment.