bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Decade of Improvement in Door-to-Needle Time Among Acute Ischemic Stroke Patients, 2008 to 2017
Authors: Tong Xin , Wiltz Jennifer L. , George Mary G. , Odom Erika C. , Coleman King Sallyann M. , Chang Tiffany , Yin Xiaoping ,   Paul Coverdell National Acute Stroke Program team, Merritt Robert K. 
Published: December 2018

Background:
The clinical benefit of intravenous (IV) alteplase in acute ischemic stroke is time dependent. We assessed the overall temporal changes in door-to-needle (DTN) time and examine the factors associated with DTN time ≤60 and ≤45 minutes.

Methods and Results:

A total of 496 336 acute ischemic stroke admissions were identified in the Paul Coverdell National Acute Stroke Program from 2008 to 2017. We used generalized estimating equations models to examine the factors associated with DTN time ≤60 and ≤45 minutes, and calculated adjusted odds ratios and 95% CI. Between 2008 and 2017, the percentage of acute ischemic stroke patients who received IV alteplase including those transferred, increased from 6.4% to 15.3%. After excluding those who received IV alteplase at an outside hospital, a total of 39 737 (8%) acute ischemic stroke patients received IV alteplase within 4.5 hours of the time the patient last known to be well. Significant increases were seen in DTN time ≤60 minutes (26.4% in 2008 to 66.2% in 2017,
P
<0.001), as well as DTN time ≤45 minutes (10.7% in 2008 to 40.5% in 2017,
P
<0.001). Patients aged 55 to 84 years were more likely to receive IV alteplase within 60 minutes, while those aged 55 to 74 years were more likely to receive IV alteplase within 45 minutes, as compared with those aged 18 to 54 years. Arrival by emergency medical service, and patients with severe stroke were more likely to receive IV alteplase within 60 and 45 minutes. Conversely, women, black patients as compared with white, and patients with a medical history of diseases associated with stroke were less likely to receive DTN time ≤60 or 45 minutes.

Conclusions:
Rapid improvements in DTN time were observed in the Paul Coverdell National Acute Stroke Program; however, opportunities to reduce disparities remain.
Effects of Liraglutide Versus Placebo on Cardiovascular Events in Patients With Type 2 Diabetes Mellitus and Chronic Kidney Disease
Authors: Mann Johannes F. E. , Fonseca Vivian , Mosenzon Ofri , Raz Itamar , Goldman Bryan , Idorn Thomas , von Scholten Bernt Johan , Poulter Neil R. ,   The LEADER Publication Committee on behalf of the LEADER Trial Investigators
Published: December 2018

Background:
LEADER trial (Liraglutide Effect and Action in Diabetes: Evaluation of CV Outcome Results) results demonstrated cardiovascular benefits for patients with type 2 diabetes mellitus at high cardiovascular risk on standard of care randomized to liraglutide versus placebo. The effect of glucagon-like peptide-1 receptor agonist liraglutide on cardiovascular events and all-cause mortality in patients with type 2 diabetes mellitus and chronic kidney disease is unknown. Liraglutide’s treatment effects in patients with and without kidney disease were analyzed post hoc.

Methods:

Patients were randomized (1:1) to liraglutide or placebo, both in addition to standard of care. These analyses assessed outcomes stratified by baseline estimated glomerular filtration rate (eGFR; <60 versus ≥60 mL/min/1.73 m
2
) and baseline albuminuria. The primary outcome (composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) and secondary outcomes, including all-cause mortality and individual components of the primary composite outcome, were analyzed using Cox regression.

Results:

Overall, 2158 and 7182 patients had baseline eGFR <60 or ≥60 mL/min/1.73 m
2
, respectively. In patients with eGFR <60 mL/min/1.73 m
2
, risk reduction for the primary composite cardiovascular outcome with liraglutide was greater (hazard ratio [HR], 0.69; 95% CI, 0.57–0.85) versus those with eGFR ≥60 mL/min/1.73 m
2
(HR, 0.94; 95% CI, 0.83–1.07; interaction
P
=0.01). There was no consistent effect modification with liraglutide across finer eGFR subgroups (interaction
P
=0.13) and when analyzing eGFR as a continuous variable (interaction
P
=0.61). Risk reductions in those with eGFR <60 versus ≥60 mL/min/1.73 m
2
were as follows: for nonfatal myocardial infarction, HR, 0.74; 95% CI, 0.55–0.99 versus HR, 0.93; 95% CI, 0.77–1.13; for nonfatal stroke, HR, 0.51; 95% CI, 0.33–0.80 versus HR, 1.07; 95% CI, 0.84–1.37; for cardiovascular death, HR, 0.67; 95% CI, 0.50–0.90 versus HR, 0.84; 95% CI, 0.67–1.05; for all-cause mortality, HR, 0.74; 95% CI, 0.60–0.92 versus HR, 0.90; 95% CI, 0.75–1.07. Risk reduction for the primary composite cardiovascular outcome was not different for those with versus without baseline albuminuria (HR, 0.83; 95% CI, 0.71–0.97; and HR, 0.92; 95% CI, 0.79–1.07, respectively; interaction
P
=0.36).

Conclusions:
Liraglutide added to standard of care reduced the risk for major cardiovascular events and all-cause mortality in patients with type 2 diabetes mellitus and chronic kidney disease. These results appear to apply across the chronic kidney disease spectrum enrolled.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov/
. Unique identifier: NCT01179048.
Intralesional Cidofovir for Treatment of Acyclovir-Resistant Laryngeal Herpes Manifesting as Supraglottic Mass
Authors: Yang Charles Q. , Mathur Anisha , Kumar Princy N. , Dhillon Vaninder K. 
Published: December 2018

Introduction: Laryngopharyngeal herpes simplex virus infection is rare and presents typically in the supraglottis. Findings on presentation can range from small mucosal lesions to fungating obstructive masses mimicking neoplasm. Laryngopharyngeal herpes is a medically treated disease. Objectives: Identify potential treatment in cases that are refractory to antiviral medications. Methods: Individual case with treatment adapted from other case report. Case Presentation: We report a case of bulky, obstructive supraglottic and glottic herpes virus laryngitis that presented with dysphonia, dysphagia, and airway complaints resistant to acyclovir analogues that was treated effectively with intralesional cidofovir injection. Conclusions: Our promising initial response suggests a potential novel treatment for this unusual condition.
Effectiveness of custom-made foot orthoses in patients with rheumatoid arthritis: a randomized controlled trial
Authors: Reina-Bueno María , Vázquez-Bautista María del Carmen , Pérez-García Sergio , Rosende-Bautista Carolina , Sáez-Díaz Antonia , Munuera-Martínez Pedro V 
Published: December 2018

Objective: To determine the effect of custom-made foot orthoses versus placebo insoles on pain, disability, foot functionality, and quality of life. Design: Double-blinded randomized controlled trial. Setting: University Podiatric Clinical Area. Subjects: Patients with rheumatoid arthritis. Interventions: Patients were randomly assigned to either group A, which received custom-made foot orthoses, or group B, which received placebo, flat cushioning insoles, for three months. Main measures: The primary outcome was foot pain, measured by visual analog scale. Foot functionality, foot-related disability, and quality of life were measured using the Foot Function Index, the Manchester Foot Pain and Disability Index, and 12-Item Short Form Health Survey (SF-12) questionnaires, respectively, at the beginning and at days 30, 60, and 90. Results: A total of 53 patients, aged 59.21 ± 11.38 years, received either the custom-made foot orthoses ( N = 28) or the placebo ( N = 25). For the analysis of the data, only participants who had been measured at the four time points (0, 30, 60, and 90 days) were included. In group A, all variables showed statistically significant differences when comparing the initial and final measurements. Pain showed 6.61 ± 2.33 and 4.11 ± 2.66 in group A, at baseline and at 90 days, respectively, and Group B showed 6.16 ± 1.77 and 5.60 ± 2.71 at baseline and at 90 days, respectively. This was the only variable that showed statistically significant difference between groups ( P = 0.048). Conclusion: The custom-made foot orthoses significantly reduced the participants’ foot pain, although they did not have positive effects on disability, foot functionality, and quality of life compared with only cushioning.
Treatment of tumor-like lesions in the femoral neck using free nonvascularized fibular autografts in pediatric patients before epiphyseal closure
Authors: Luo Shanchao , Jiang Tongmeng , Yang Xiaoping , Yang Yingnian , Zhao Jinmin 
Published: December 2018

Objectives Surgical resection of benign bone tumors and tumor-like lesions at the femoral neck presents a difficult reconstructive challenge. However, the safety and efficacy of free nonvascularized fibular autografts (FNFAs) in the treatment of femoral neck tumor-like lesions before epiphyseal closure in young patients remain unknown. Methods Sixteen pediatric patients who had not yet undergone epiphyseal closure were treated with FNFAs after resection of tumor-like lesions in the femoral neck from August 2012 to September 2016. All patients underwent supplementary skeletal traction through the supracondylar femur for 4 to 6 weeks after resection. Demographic data were recorded and clinical and radiological outcomes were evaluated during the follow-up. Results All patients could walk with partial weight bearing 4 weeks postoperative, and full weight bearing was permitted after a mean of 8 weeks. Graft union was attained in all 16 patients at a mean of 2 months. The donor site of the fibular cortical strut showed good regeneration in all patients. The Harris hip score significantly improved from 65% to 95%. Conclusions Application of an FNFA is a feasible method in the treatment of tumor-like lesions in the femoral neck before epiphyseal closure in pediatric patients. Level of Evidence Level IV.
Innovative operational strategies for biogas plant including temperature and stirring management
Authors: Önen Senem , Nsair Abdullah , Kuchta Kerstin 
Published: December 2018

Finding the optimum operational conditions (mainly temperature and stirring) inside the fermenters is crucial in the field of anaerobic digestion. This study was conducted to contribute to the research area of anaerobic digestion process optimization and is an example for other biogas plants to improve efficiency. The research aimed at finding the optimum operational conditions in a large-scale biogas plant located in Lower Saxony, Germany, which started operation in 2011. The optimization activities were performed by operating the fermenters under different operational conditions: the temperature inside the fermenters ranged between 40°C and 43°C, while applying several stirring scenarios. These changes led to an increase in specific electricity yield of 11.7% and a decrease in internal energy consumption of 10.4%. The total internal energy consumption of the biogas plant was in the range of 6.3–7.2% (the average monthly internal energy consumption was 6.7% in 2013 and 6.0% in 2014) from their own production, and 28% of this energy consumption was used by the stirrers before optimization. Therefore, finding the optimum operational conditions leads to high energy harvesting and lower internal energy consumption.
Another Side of the Coin: Exchange Rate Movements and the Manufacturing Sector in Nigeria
Authors: Orji Anthony , Ogbuabor Jonathan E. , Okeke Chiamaka , Anthony-Orji Onyinye I. 
Published: December 2018

This study estimated the impact of exchange rate (EXCH) movements on the manufacturing sector in Nigeria over the period 1981–2016. Time series data and ordinary least square (OLS) estimation technique were employed in this study to address the specified objective. The variables analysed were EXCH, manufacturing GDP (MGDP), government capital expenditure, foreign direct investment (FDI), credit to private sector and value of imports. From the result, it is apparent that EXCH movements play a significant role in the manufacturing sector’s performance in Nigeria. Specifically, the findings showed that EXCH, government capital expenditure (GCEXP), imports and FDI were positively related to MGDP, while credit to private sector was negatively related. Among others, the study recommends that the apex bank keep a closer watch on EXCH developments in order to keep formulating up-to-date policies that will ultimately enhance EXCH stability. This will largely contribute to the development of the manufacturing sector in the short and long run. JEL Classification: D51, F31, Q24
Applying Mindfulness to Benefit Economically Disadvantaged Families: A Randomized Controlled Trial
Authors: Lo Herman H. M. , Wong Janet Y. H. , Wong Simpson W. L. , Wong Samuel Y. S. , Choi C. W. , Ho Rainbow T. H. , Fong Ricci W. T. , Snel Eline 
Published: December 2018

Objective: To evaluate the effects of family-based mindfulness intervention (FBMI) to promote the stress management and early development of economically disadvantaged families. Method: Families receiving social security allowance and full textbook allowance and with children aged 5–7 were recruited. Participants were randomized to an FBMI with parallel programs for parents and children ( n = 51) and to a wait-list control condition ( n = 51). Results: Intent-to-treat analyses showed more significant improvements in child attention, self-regulation, and in parenting stress, in the intervention group than in the control group. At-risk group analyses showed that the high stress group benefited in small to moderate effect sizes in parenting stress and depression, and in moderate to large effect sizes in child behavioral problem and self-regulation. Conclusions: The results provide preliminary support that FBMI can alleviate the impact of economic disadvantage. FBMI should be applied in social work practice to support disadvantaged families.
Cost-Utility Study of the Economics of Bunion Correction Surgery
Authors: Sutherland Jason M. , Mok Janice , Liu Guiping , Crump Trafford , Wing Kevin , Younger Alastair , Penner Murray , Veljkovic Andrea 
Published: December 2018

Background: Bunion correction surgery is a very common procedure to improve patients’ pain and physical function attributable to a misaligned first metatarsophalangeal joint. The objective of this study was to apply a health utility framework to estimate the cost utility of bunion correction surgery. Methods: Patients were prospectively recruited from the population of patients seen in a lower-extremity orthopedic clinic and scheduled for isolated bunion surgery. Participants completed EuroQoL’s EQ-5D(3L) to measure patients’ current general health preoperatively and 6 months postoperatively. Participants’ change in quality-adjusted life years (QALYs) were calculated by comparing the difference between postoperative utility values and preoperative utility values. The study had 95 patients representing 53% of eligible patients. Results: The mean preoperative utility value was 0.6816 and the mean postoperative value was 0.7451, a statistically significant difference denoting an improvement in self-reported health. The cost per QALY, assuming gains in health accrued for 15 years, was $4911 (the 95% confidence interval ranged from $4736 to $5088). The cost per QALY was highest among the oldest patients. Assuming gains in health accrued for 20 years, the cost per QALY was $3922. Conclusion: This study demonstrated that bunion correction surgery was inexpensive relative to its gains in health compared with commonly applied thresholds for women and men in all age groups, though the gains were not uniformly distributed across age categories. Future research should examine the impact of recurrence on the robustness of these findings. Level of Evidence: Level III, comparative study.
Antibody response to feline panleukopenia virus vaccination in cats with asymptomatic retrovirus infections: a pilot study
Authors: Bergmann Michèle , Schwertler Stephanie , Speck Stephanie , Truyen Uwe , Hartmann Katrin 
Published: December 2018

Objectives Currently, there are only a few studies on how immunocompromised cats, such as cats infected with feline leukaemia virus (FeLV) and feline immunodeficiency virus (FIV), respond to vaccination. Therefore, this study measured feline panleukopenia virus (FPV) antibodies in retrovirus-infected cats within a period of 28 days after FPV vaccination, and compared the immune response to that of non-infected cats. Methods Eight asymptomatic retrovirus-infected cats (four FeLV, four FIV), and non-infected age-matched control cats (n = 67) were vaccinated with a commercial FPV modified live virus (MLV). Pre- and post-vaccination antibody titres were measured by haemagglutination inhibition (HI) on days 0, 7 and 28. An HI titre ⩾1:40 was defined as protective. An adequate response to vaccination was defined as a four-fold titre increase or higher. Comparison of the immune response of retrovirus-infected and non-infected cats was performed. Results Pre-vaccination FPV antibody titres ⩾1:40 were present in 100% (n = 8/8; 95% confidence interval [CI] 62.8–100) of retrovirus-infected and in 77.6% (n = 52/67; 95% CI 66.2–86.0) of non-infected cats. An adequate response to vaccination (titre increase ⩾four-fold) was seen in 1/8 retrovirus-infected cats (12.5%; 95% CI 0.1–49.2) compared with 22/67 non-infected cats (32.8%; 95% CI 22.8–44.8). In cats with high pre-vaccination titres (⩾1:160), a four-fold titre increase or higher was observed in 1/8 retrovirus infected cats (12.5%; 95% CI 0.1–49.2) compared with 4/42 non-infected cats (9.5%; 95% CI 3.2–22.6). None of the eight retrovirus-infected cats developed illness or vaccination side effects after vaccination with MLV against FPV within the 28 days. There were no significant differences between groups: for pre-vaccination titres; for at least four-fold titre increases following vaccination in either all cats or the cats with high pre-vaccination titres; and concerning adverse effects. Conclusions and relevance All retrovirus-infected asymptomatic cats had pre-vaccination FPV antibodies indicating protection against panleukopenia. Response of retrovirus-infected cats to vaccination was similar to the response of non-infected cats.
Margin-Controlled, Staged Surgical Excision in the Treatment of High-Risk Basal Cell Carcinomas of the Head and Neck Region
Authors: Durmus Ucar Ayse Nigar , Durmus Kocaaslan Fatma Nihal , Salman Andac , Demirkesen Cuyan , Erdem Bayram Filiz , Bayramicli Mehmet 
Published: December 2018

Background: The most common skin cancer is basal cell carcinoma (BCC), and the gold-standard treatment for high-risk tumours is Mohs surgery. However, alternative methods are needed for high-risk tumours in countries where the performance rate of Mohs surgery is low. Objectives: The objective of this article is to investigate the feasibility, efficacy, and safety of margin-controlled, staged surgical excision (MCSSE) in high-risk tumours as a possible treatment alternative. Methods: A retrospective cohort study, including patients diagnosed with high-risk BCC in the head and neck region and treated with MCSSE between 2003 and 2010, was conducted. Results: During the study period 50 tumours in 47 patients were treated, with low adverse event rates and high patient satisfaction rates. Of the 50 tumours, 1 recurred at the 12-month follow-up. Conclusions: Despite the small sample size and relatively short follow-up period, the present study shows that MCSSE might be a feasible alternative for the treatment of high-risk BCCs in institutions where Mohs surgery is not performed. Future studies on long-term recurrence rates are needed.
Outcome of Second-Ray Pathologies Following Weil Osteotomy in Patients Treated for Hallux Valgus
Authors: Young Ki Won , Lee Hong Seop , Park Ki Chol 
Published: December 2018

Background: We hypothesized that the cause of second-ray pathology with hallux valgus is excessive relative length of the second metatarsal and performed Weil osteotomy to shorten it, with correction of hallux valgus. The purpose of this study is to evaluate the outcome of second-ray pathology after distal chevron osteotomy (DCO) with Weil osteotomy to correct metatarsal parabola. Methods: We performed concomitant Weil osteotomy of the second metatarsal with DCO of the first metatarsal as part of hallux valgus with second-ray pathology correction surgery in 45 feet (40 patients). Second-ray pathologies were claw toe deformity, painful plantar callosity, second metatarsophalangeal joint (MTPJ) dislocation, and osteoarthritis (OA) of the second MTPJ. We measured projection of the second metatarsal (PSM), metatarsal protrusion index (MPI), and metatarsal protrusion distance (MPD). The second-ray surgery outcome was assessed by patient satisfaction. Results: Patient satisfaction was good in claw toe deformity and OA (satisfaction rate: 60% [23 patients] and 71% [7 patients], respectively) and fair in painful plantar callosity and second MTP joint dislocation (satisfaction rate: 44% [9 patients] and 33% [6 patients], respectively). Total patient satisfaction rate was higher when the PSM, MPI, and MPD ranged between 7 and 12 mm, −5 and 0 mm, and 0 and 4 mm, respectively. Conclusions: We concluded that simultaneous performance of hallux valgus correction and Weil osteotomy in patients with second-ray pathologies associated with hallux valgus was safe as well as effective. Correcting the metatarsal parabola within the appropriate range after surgery is associated with second-ray pathology outcome. Levels of Evidence: Therapeutic studies, Level VI: Case series
A Prospective Randomized Controlled Trial of Aspiration and Fibrin Sealant Use Versus Aspiration Alone in the Treatment of Dorsal Wrist Ganglia
Authors: Hatchell Alexandra , Meathrel Kimberly , Farrokhyar Forough , Hynes Nicolas 
Published: December 2018

Purpose: Multiple treatments for dorsal wrist ganglia (DWG) exist but have high recurrence rates. We investigated whether aspiration followed by injection of Tisseel is more effective at reducing the DWG recurrence rate than aspiration alone. Methods: Adults with untreated DWG were randomly assigned to aspiration alone (A) or aspiration followed by Tisseel injection (AT). Patients were measured at baseline, 1, 6, and 12 months. Primary outcome was the rate of recurrence. Secondary outcomes included recurrent ganglion size and maximum pain experienced from the ganglion. Continuous data were compared with Student t tests and Mann-Whitney U tests. Categorical data were compared with χ2 tests and Fisher exact tests. Treatment effect was reported as relative risk or mean differences (MD) with 95% confidence intervals. Results: Seventy-nine patients were randomized to the A (n = 39) or AT (n = 40) group. Twenty-five patients were lost to follow-up. There were no differences in recurrence risk between groups at 1, 6, or 12 months ( P > .05). Ganglia were significantly smaller for both groups at 1 month versus baseline ( P < .001). The A group demonstrated a significantly larger decrease in size at 1 month versus the AT group (MD = 0.75 cm2, 95% confidence interval: 0.07-1.43, P = .03). Both groups experienced significantly less pain at 1, 6, and 12 months ( P < .03), but this was not significantly different between groups. Conclusion: Aspiration and Tisseel injection does not decrease DWG recurrence versus aspiration alone. Both interventions produced a significant decrease in pain. Although aspiration alone carries a high recurrence risk, it may provide sufficient symptomatic relief for patients with DWG.