bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of vaginal estradiol tablets and moisturizer on menopause-specific quality of life and mood in healthy postmenopausal women with vaginal symptoms: a randomized clinical trial
Authors: Diem Susan J. , Guthrie Katherine A. , Mitchell Caroline M. , Reed Susan D. , Larson Joseph C. , Ensrud Kristine E. , LaCroix Andrea Z. 
Published: May 2018

Abstract

Objective:
Compare the effects of a vaginal estradiol tablet and a vaginal moisturizer, each to placebo, on menopause-related quality of life and mood in postmenopausal women with moderate–severe vulvovaginal symptoms.

Methods:
A total of 302 postmenopausal women enrolled in a 12-week, double-blind, placebo-controlled randomized trial were assigned to vaginal 10 μg estradiol tablet plus placebo gel (n = 102), vaginal moisturizer plus placebo tablet (n = 100), or dual placebo (n = 100). We measured change from randomization to 12 weeks in total score of the Menopause-Specific Quality of Life (MENQOL) questionnaire. We also evaluated the four MENQOL domains, depressive symptoms as measured by the Patient Health Questionnaire 8, and anxiety symptoms as measured by the Generalized Anxiety Disorder (GAD-7) questionnaire.

Results:
Treatment with vaginal estradiol resulted in significantly greater improvement in total MENQOL scores compared to dual placebo (mean difference between arms −0.3 at 12 weeks (95% confidence interval [CI] −0.5, 0.0; P = 0.01). A statistically significant group mean difference favoring vaginal estradiol was observed for the MENQOL sexual function domain (−0.4 at 12 weeks; 95% CI −1.0, 0.1; P = 0.005), but not for any of the other domains. Treatment with vaginal moisturizer did not provide greater improvement compared to placebo in total MENQOL scores (mean difference 0.2 at 12 weeks; 95% CI −0.1, 0.4; P = 0.38) or in any of the MENQOL domains. Neither treatment group showed improvement compared with placebo in the Patient Health Questionnaire 8 or Generalized Anxiety Disorder Questionnaire .

Conclusions:
Treatment with low-dose vaginal estradiol, but not vaginal moisturizer, modestly improved menopause-related quality of life and sexual function domain scores in postmenopausal women with moderate–severe vulvovaginal symptoms.
Validation of a Self-Report Clinical Decision-Making Tool Using Rasch Analysis
Authors: Macauley Kelly , Brudvig Tracy , Barry Amanda , Lufkin Olivia , McEnroy Kevin , Milinazzo Andrew 
Published: May 2018

Introduction.
No objective tools exist that assess the level and progression of clinical decision-making (CDM) skills in Doctor of Physical Therapy (DPT) students. Tools in other health professions exist but are not applicable or transferable to DPT education. The purpose of the current study is to validate an objective tool to assess DPT students' perceptions of their CDM skills across a curriculum.

Methods.
This is a cross-sectional, observational design study, using a convenience sample of DPT students enrolled in a DPT program. Four phases of data collection, representing four iterations of the CDM tool, are included. A self-report tool assessing CDM using a Likert scale was sent to the participants through email. Data were analyzed using Rasch analysis after each phase of data collection, which led to survey revisions and further data collection.

Results.
The tool demonstrated high internal consistency throughout the four phases of data collection. The tool measures one construct, CDM. The Likert scale levels discriminated well between the different ability levels on all items. The scores on the CDM tool provided known groups validation of the tool. The tool has a ceiling effect, floor effect, and is unable to differentiate CDM skills for DPT graduates who have been practicing for >1 year.

Discussion.
Clinical decision making is a complex, highly individualized construct. This CDM tool distinguishes the students' perceived level of CDM ability across the different class years of a DPT curriculum. The sample was one of convenience. Further research increasing the heterogeneity of the sample will assist with increasing the generalizability of the tool.
Tympanic Membrane Perforation Repair Using Porcine Small Intestinal Submucosal Grafting
Authors: Yawn Robert J. , Dedmon Matthew M. , O’Connell Brendan P. , Virgin Frank W. , Rivas Alejandro 
Published: May 2018

Objective:
To evaluate the use of porcine small intestinal submucosal grafts for tympanic membrane repair.

Patients:
Adult and pediatric patients with tympanic membrane perforations with and without chronic otitits media, and perforations after removal of cholesteatoma.

Intervention:
Endoscopic or microscopic tympanic membrane repair using porcine small intestinal submucosal grafts (Biodesign).

Main Outcome Measure(s):
Perforation closure, bone and air pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS) were recorded as outcome measures.

Results:
Thirty-seven patients were included with a mean age of 25.4 years (range, 6–75), 57% men. Twenty-six cases (70%) were performed endoscopically and 34 (92%) had concomitant cartilage grafting. Three patients (8%) had postoperative pinpoint (<1% surface area) perforation, and two patients (5%) had postoperative perforation, with an overall success rate of 86.5%. The mean improvement in air-bone gap was 7.6 dB and (p = 0.006). There were no statistically significant differences in closure rates when comparing primary versus revision cases, endoscopic versus microscopic cases, size of perforation, cholesteatoma, concomitant mastoidectomy, age, tobacco exposure, or comorbid diabetes mellitus. Patients with concomitant cartilage graft were more likely to be successful when compared with those without cartilage graft (p = 0.04).

Conclusions:
Porcine small intestinal submucosal grafts are effective in the repair of the tympanic membrane. These grafts are an excellent choice in total endoscopic cases as it avoids incisions necessary for allograft harvest.
Imaging in the Diagnosis and Management of Necrotizing Otitis Externa: A Survey of Practice Patterns
Authors: Cooper Timothy , Hildrew Douglas , McAfee Jacob S. , McCall Andrew A. , Branstetter Barton F. , Hirsch Barry E. 
Published: May 2018

Objective:
To survey neurotologists and head and neck radiologists regarding use of imaging in the diagnosis and management of necrotizing otitis externa (NOE).

Study Design:
Cross-sectional survey study.

Setting:
Online survey distributed through email to specialty society membership lists.

Participants:
Neurotologists and head and neck radiologists with membership in either the American Neurotology Society or The American Society of Head and Neck Radiology.

Main Outcome Measures:
Responses to survey consisting of two demographic and seven clinically oriented questions related to the use of imaging in the diagnosis and management of NOE.

Results:
One hundred thirty-six participants responded to the survey. The imaging modality of choice in establishing the diagnosis of NOE selected by the respondents was computed tomography (CT) (37.5%) followed by technetium scintigraphy (21.3%). Magnetic resonance imaging (MRI) was the preferred investigation by 41.9% of participants for determining extent of disease. Gallium scanning was the imaging modality preferred by 32.4% of respondents for determining when to cease medical therapy. Ninety-five percent of participants responded that CT scans were always or frequently used in the diagnosis and management of NOE compared with 72.8% for MRI, 34.5% for gallium scans, and 34.2% for technetium scans.

Conclusions:
There is considerable heterogeneity in the preferred imaging modalities used in the diagnosis and management of NOE. CT and MRI are the preferred contemporary modalities used by many physicians, demonstrating a shift away from the historic use of nuclear medicine scans.
Spleen Stiffness Differentiates Between Acute and Chronic Liver Damage and Predicts Hepatic Decompensation
Authors: Meister Phil , Dechêne Alexander , Büchter Matthias , Kälsch Julia , Gerken Guido , Canbay Ali , Jochum Christoph 
Published: May 2018

Objectives:
Spleen stiffness (SS) correlates with liver stiffness (LS) and hepatic venous pressure gradient. The latter is currently the most accurate predictor of hepatic decompensation. Our study aims to check whether SS has a similar predictive capability, while being an easy-to-perform noninvasive test in a real-life patient cohort.

Methods:
Concomitantly, 210 successive patients were examined and received liver and SS measurements and a standard laboratory. Patients were observed for 1 year in terms of clinical signs of decompensation.

Results:
One hundred fifty-nine of the initial 210 patients had a valid LS and SS measurement and were evaluable for clinical follow-up. Twelve patients developed a hepatic decompensation; with a SS >39 kPa (P=0.0005). Especially in a group with elevated LS, patients with a high risk of decompensation could be identified using SS. Patients with comparable LS who suffered from acute liver damage had significantly lower SS than respective patients with chronic liver damage (30.97 vs. 46.03 kPa; P=0.04). Acute liver failure was associated with elevated LS (16.47 kPa) but not with elevated SS (30.97 kPa).

Conclusions:
The risk of a hepatic decompensation can easily be assessed using SS measurement. Therefore SS measurement might be a powerful screening tool identifying patients who need closer monitoring. Moreover, SS is able to differentiate between acute and chronic or acute on chronic liver damage.
Automated low-flow ascites pump in a real-world setting: complications and outcomes
Authors: Solbach Philipp , Höner zu Siederdissen Christoph , Wellhöner Freya , Richter Nicolas , Heidrich Benjamin , Lenzen Henrike , Kerstin Port , Hueper Katja , Manns Michael P. , Wedemeyer Heiner , Jaeckel Elmar 
Published: May 2018

Background and aims
The aim of this study was to investigate the Alfapump, an automated low-flow pump system for the treatment of refractory ascites (RA) as an alternative for repeated large-volume paracentesis in patients with contraindication for placement of a transjugular intrahepatic portosystemic shunt (TIPS) or liver transplantation.

Materials and methods
In 21 consecutive patients with RA and contraindication for a placement of a TIPS, the Alfapump was implanted at Hannover Medical School between December 2012 and May 2016. Repeated laboratory, clinical, and microbiology data were collected and analyzed to assess the outcome of patients with an Alfapump. Half of the patients received a modified peritoneal catheter.

Results
Twenty-one patients with RA in end-stage liver disease and with a contraindication to TIPS placement received the Alfapump. Diuretic dosages were significantly reduced, and the number of paracentesis declined from 2.3±2.7 to 0 per week. Using the Alfapump, kidney function and serum sodium remained stable. Likewise, serum albumin remained stable in the absence of albumin infusions. Thirty-three complications (dislocation and/or blockade of the catheter, infection, pump dysfunction) related to the Alfapump were observed in 15 of 21 patients (71.4%), and 21 surgical interventions were needed in 15 patients (71.4%, 1–3 interventions per patient). A new peritoneal catheter system could significantly reduce blockage of the peritoneal catheter.

Conclusion
The Alfapump is an effective treatment in patients with RA. However, a high rate of complications were observed, which could be reduced with a modified peritoneal catheter.
The Use of a Honeycomb Technique Combined with Ultrasonic Aspirators and Indocyanine Green Fluorescence Angiography for a Superthin Anterolateral Thigh Flap: A Pilot Study
Authors: Fan Song , Zhang Han-qing , Li Qun-xing , Tian Tian , Chen Wei-xiong , Pan Guo-kai , Ho-Young Ahn Michael , Sun Sheng , Wu Bing-hao , Li Jin-song 
Published: May 2018

Background:
Harvesting an optimally thinned anterolateral thigh flaps is a challenge in overweight individuals and in the Western population. The authors describe a novel honeycomb technique to achieve a superthin anterolateral thigh flap in overweight patients.

Methods:
Forty patients with a body mass index greater than 25 kg/m2 who required a thinned anterolateral thigh flap for reconstruction were assigned randomly to a honeycomb technique group or a microdissection technique group. The honeycomb technique group underwent flap thinning with the Cavitron Ultrasonic Surgical Aspirator, and flap thinning was performed with a conventional microdissection technique in the microdissection technique group. Perfusion of all flaps was measured by indocyanine green fluorescence angiography before and after thinning. Hypoperfusion was defined as 30 percent.

Results:
The mean body mass index was 28.6 ± 2.0 kg/m2 and 27.3 ± 1.9 kg/m2 in the honeycomb group and the microdissection group, respectively. Flap size, perforator, type of dissection, and initial perfusion were comparable between the two groups. However, significantly more patients (nine of 21) experienced final hypoperfusion in the microdissection group than in the honeycomb group (two of 19) (p = 0.034). In addition, blood loss and final flap thickness were significantly lower in the honeycomb group (p < 0.05), and the duration of thinning was comparable between the two groups. No flap necrosis was found in either group.

Conclusion:
The honeycomb technique in combination with the Cavitron Ultrasonic Surgical Aspirator and indocyanine green angiography was able to remove adipose tissue but protect the integrity of the subcutaneous vascular plexus to reduce potential risk of jeopardizing flap perfusion while obtaining a superthin anterolateral thigh flap in an overweight population.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Chronotropic Incompetence and Reduced Heart Rate Recovery in Rheumatoid Arthritis
Authors: Peçanha Tiago , Rodrigues Reynaldo , Pinto Ana Jéssica , Sá-Pinto Ana Lúcia , Guedes Lissiane , Bonfiglioli Karina , Gualano Bruno , Roschel Hamilton 
Published: May 2018

Background/Objective
Recent studies have indicated that cardiac autonomic dysfunction is an early sign of cardiovascular impairment in rheumatoid arthritis (RA). Previous studies have mainly focused on resting assessments; however, analysis of heart rate (HR) responses to exercise might provide additional information on cardiac autonomic dysfunction in this disease. Thus, we aimed to assess the HR responses during and after a maximal graded exercise test in patients with RA and healthy controls (CONs).

Methods
This was a cross-sectional study in which 27 female RA patients and 14 female CONs frequency matched by physical activity, age, and body mass index were compared for HR responses during and after a maximal graded exercise test.

Results
Rheumatoid arthritis patients showed reduced chronotropic response (94.3% ± 16.3% vs. 106.1% ± 10.3%, p = 0.02) and lower HR recovery (HRR) at 30 seconds (8.6 ± 6.7 vs. 13.4 ± 5.2 beats/min [bpm], p = 0.02), 60 seconds (16.5 ± 7.8 vs. 24.0 ± 9.9 bpm, p = 0.01), 120 seconds (32.6 ± 9.9 vs. 40.7 ± 12.3 bpm, p = 0.03), and 180 seconds (46.5 ± 12.6 vs. 55.5 ± 13.4 bpm, p = 0.05) post-maximal exercise test when compared with CONs. Moreover, the prevalence of chronotropic incompetence (i.e., failure to reach 80% of the HR-predicted response) and abnormal HRR (i.e., HRR ≤12 bpm) were, respectively, 22.2% and 37.1% in RA patients.

Conclusions
Patients with RA showed reduced chronotropic response to exercise and slower postexercise HRR. These abnormal autonomic responses to exercise indicate the presence of cardiac autonomic dysfunction and increased cardiovascular risk in this population.
Development of Human Face Literature Database Using Text Mining Approach: Phase I
Authors: Kaur Paramjit , Krishan Kewal , Sharma Suresh K. 
Published: May 2018

Abstract
The face is an important part of the human body by which an individual communicates in the society. Its importance can be highlighted by the fact that a person deprived of face cannot sustain in the living world. The amount of experiments being performed and the number of research papers being published under the domain of human face have surged in the past few decades. Several scientific disciplines, which are conducting research on human face include: Medical Science, Anthropology, Information Technology (Biometrics, Robotics, and Artificial Intelligence, etc.), Psychology, Forensic Science, Neuroscience, etc. This alarms the need of collecting and managing the data concerning human face so that the public and free access of it can be provided to the scientific community. This can be attained by developing databases and tools on human face using bioinformatics approach. The current research emphasizes on creating a database concerning literature data of human face. The database can be accessed on the basis of specific keywords, journal name, date of publication, author's name, etc. The collected research papers will be stored in the form of a database. Hence, the database will be beneficial to the research community as the comprehensive information dedicated to the human face could be found at one place. The information related to facial morphologic features, facial disorders, facial asymmetry, facial abnormalities, and many other parameters can be extracted from this database. The front end has been developed using Hyper Text Mark-up Language and Cascading Style Sheets. The back end has been developed using hypertext preprocessor (PHP). The JAVA Script has used as scripting language. MySQL (Structured Query Language) is used for database development as it is most widely used Relational Database Management System. XAMPP (X (cross platform), Apache, MySQL, PHP, Perl) open source web application software has been used as the server.
The database is still under the developmental phase and discusses the initial steps of its creation. The current paper throws light on the work done till date.
Comparison of Piezosurgery and Hammer-Chisel in Endoscopic Dacryocystorhinostomy
Authors: Çukurova Ibrahim , Bulğurcu Suphi , Arslan Ilker Burak , Dikilitaş Bünyamin 
Published: May 2018

Background:
In this study, we compared the advantages and disadvantages of piezosurgery and hammer-chisel used in endoscopic dacryocystorhinostomy (EDCR).

Material and Methods:
Between January 2012 and January 2016, 10 women and 8 men in whom piezosurgery was used (group 1) and 11 women and 7 men in whom hammer-chisel was used (group 2) during EDCR operations were compared retrospectively. Recurrence, operation time, postoperative bleeding, and operative cost were evaluated in patients who were followed for an average of 11.8 months. In addition, visual analogue scale (VAS) was used to assess pain at 6 hours postoperatively.

Results:
No recurrence was observed in group 1, but recurrence was observed in 2 patients in group 2 (P = 0.685). There was no postoperative bleeding in both groups. The mean duration of operation was 30.6 ± 8.2 minutes in group 1 and 46.8 ± 9.5 minutes in group 2 (P = 0.038). The VAS score in group 1 was 2.7 ± 1.4 and the VAS score in group 2 was 5.8 ± 2.2 (P = 0.01). Piezosurgery costs an additional $325 for each patient while the use of the hammer-chisel does not incur additional costs.

Conclusion:
Piezosurgery causes shorter operation time, less recurrence, and less pain when compared with hammer-chisel.
Pure Retroperitoneal Optical Access Trocar for Lumbar Diseases in Adults: A Step-by-Step Technique
Authors: Nunes-Silva Igor , Hidaka Alexandre , Barrios Carol , Azevedo Eduardo , Ferreira Faria Eliney , Zampoli Hamilton , Bertrand Guillonneau , Tobias-Machado Marcos 
Published: May 2018

Purposes:
The primary end point of this study was to describe step by step the technique of the pure retroperitoneal optical access trocar (PROAT) in adults. The secondary end point was to access between-group differences in perioperative outcomes.

Materials and Methods:
Forty-five patients underwent retroperitoneoscopic surgery using the PROAT technique to enter the retroperitoneal space (PROAT group). Thirty-nine patients underwent retroperitoneoscopic surgery using the conventional open-Hasson technique with manufactured Hasson-trocar and space-maker balloon to enter and create the retroperitoneal space (conventional group). PROAT technique was described. Data were prospectively collected and analyzed.

Results:
Mean time for first-entry trocar insertion was lower in the PROAT group (9.76±3.17 vs. 23±7.2 s; P<0.001). Mean time to develop the retroperitoneal space until all-trocar placement was higher in the PROAT group (12.7±3.3 vs. 6.4±2.2 min; P<0.001). Carbon dioxide gas leakage was not observed.

Conclusions:
The PROAT technique is feasible and safe. This approach can potentially avoid carbon dioxide leakage when manufactured Hasson trocars are not available and allow a reduced-cost procedure.
Robotic-assisted Laparoscopic Repair of Scrotal Inguinal Hernias
Authors: Yheulon Christopher G. , Maxwell Daniel W. , Balla Fadi M. , Patel Ankit D. , Lin Edward , Stetler Jamil L. , Davis Steven S. 
Published: May 2018

Background:
Scrotal inguinal hernias represent a challenging surgical pathology. Although some advanced laparoscopists can repair these hernias through a minimally invasive approach, open repair is considered the technique of choice for most surgeons. The purpose of this study is to show our results of robotic-assisted laparoscopic repair of scrotal inguinal hernias.

Patients and Methods:
We reviewed the charts of 14 patients with inguinoscrotal hernias who underwent robotic-assisted transabdominal preperitoneal (TAPP) hernia repair. Mean follow-up was 7 months. The European Registry for Abdominal Wall Hernia Quality of Life score, a 90-point scale, was utilized to quantify patient reported outcomes.

Results:
Robotic TAPP repair was successful in all 14 patients. Average case duration was 100 minutes (78 to 140 min) for unilateral hernias and 208 minutes (166 to 238 min) for bilateral hernias. Trainees were involved in 93% (13/14) of cases. There were no recurrences. Three patients developed postoperative seromas. The mean European Registry for Abdominal Wall Hernia Quality of Life score was 3.7 (0 to 10).

Conclusions:
Scrotal hernias can be safely repaired using robotic-assisted TAPP methods with low morbidity and favorable patient reported outcomes.
Application of a triblock copolymer additive modified polyvinylidene fluoride membrane for effective oil/water separation
Authors: Shen S. S. , Liu K. P. , Yang J. J. , Li Y. , Bai R. B. , Zhou X. J. 
Published: May 2018

A hollow fibre membrane was fabricated by blending polyvinylidene fluoride (PVDF) with a triblock copolymer additive polymer that has both hydrophilic and oleophobic surface properties. The novel membrane was characterized and examined for oil/water separation under various system conditions, including different cross-flow rate, feed temperature, trans-membrane pressure, and its rejection and cleaning efficiency, etc. By applying the membrane into the filtration of synthesized oil/water emulsion, the membrane constantly achieved an oil rejection rate of above 99%, with a relatively constant permeate flux varied in the range of 68.9–59.0 l m
−2
h
−1
. More importantly, the fouling of the used membrane can be easily removed by simple water flushing. The membrane also demonstrated a wide adaptability for different types of real oily wastewater, even at very high feed oil concentration (approx. 115 000 mg l
−1
in terms of chemical oxygen demand (COM)). Hence, the novel triblock copolymer additive-modified PVDF membrane can have a great prospect in the continuing effort to expand the engineering application of polymeric membranes for oily wastewater treatment.