bluuebunny/crossref_metadata_2025_split huggingface dataset:
A study of fetomaternal outcome of hepatic disorders in pregnancy
Authors: Jain Mahima , Thaker Himani 
Published: February 2019

Background: Liver is a vital organ to maintain physiology of the body and supports every organ of the body. Its proper functioning during pregnancy is essential for a good maternal and fetal outcome. The study analyses the causes and fetomaternal outcome in pregnancies with jaundice and suggests measures to reduce morbidity and mortality.Methods: This is a one-year prospective study in a tertiary care institute during which 7165 deliveries are conducted. Total 55 cases of Jaundice with pregnancy are identified and studied for clinical, biochemical profile, etiology and maternal and fetal outcome. 8 maternal deaths are reported amongst this study group.Results: In this study 55 cases of hepatic disorders in pregnancy are studied. The age group reported is 21-29 years. Majority 72% cases belong to rural areas and 85% in lower socioeconomic class. 96.3% patients were in the third trimester of pregnancy. Most common etiology of hepatic disorders in pregnancy is acute viral hepatitis followed by intrahepatic cholestasis of pregnancy and preeclampsia and HELLP syndrome. In acute viral hepatitis 81% patients were hepatitis E positive. Most common complication are DIC followed by hemorrhagic shock and subsequently AKI and septicemia. 77.7% babies were born alive and 30.9% NICU admission due to severe birth asphyxia and prematurity. Of these 16.6% died in neonatal period. Maternal mortality in 14.5% patients due to viral hepatits, HELLP and septicemia.Conclusions: Jaundice in pregnancy is a rare medical disorder and deadly combination affecting maternal and fetal outcome. Earl detection and timely intervention with multidisciplinary approach including obstetrician, neonatologist, intensivist and skilled nursing care can help to reduce maternal mortality and morbidity.
Pre-operative diagnosis of ovarian ectopic pregnancy: a challenge to practicing clinician
Authors: Valecha Shalini Mahana , Bashani Dolly , Gedam Jaya , . Pandeeswari 
Published: February 2019

The first case of primary ovarian ectopic pregnancy was reported by St. Maurice in 1689. Primary ovarian ectopic pregnancy is rare entity, with incidence of around 3% of all ectopic pregnancies. The aim of present case report is to study the role of different modalities like clinical findings, biochemistry, sonography, surgery and histopathology in diagnosis of primary ovarian ectopic pregnancy. Authors present a case of a 24 years old female with history of 2 months amenorrhoea, per vaginal spotting and mild intermittent abdominal pain in RIF. Examination was unremarkable and serum βHCG was 2007.5IU/ml. An ultrasound scan showed an ectopic mass in the right adnexa suggestive of a tubal ectopic pregnancy and she underwent surgical management at our institute. At laparoscopy, both fallopian tubes were noted to be normal with an ectopic mass attached to the right ovary with a pedicle. With these unusual laparoscopic findings, possibilities of tubal miscarriage, ovarian pregnancy, or abdominal pregnancy were suspected. Ectopic mass was coagulated and cut through the pedicle with bipolar cautery and specimen was sent for HPE. Our patient made an uneventful recovery and no further medical management was indicated. The diagnosis of right ovarian ectopic pregnancy was finally confirmed by histopathological evidence of the presence of chorionic villi in a background of ovarian stromal tissue, in consideration with Spigelberg’s criteria. Present case highlights the importance of considering non-tubal ectopic pregnancies when making a diagnosis based on ultrasound scan. Pre-operative diagnosis of ovarian ectopic pregnancy still remains a challenge in spite of current medical advances. Despite the benefits and reliability of ultrasound scanning, there will still be situations where the definitive diagnosis can only be made at surgery. However, histopathological examination is confirmatory and always mandatory.
Coexistence of both Brenner tumor and cystadenofibroma of ovary in a postmenopausal woman: a rare case
Authors: Kalpana B. , Panda Soumya Ranjan 
Published: February 2019

Brenner tumor, and cystadeno fibroma of ovary are rare varieties of ovarian tumor, characterized by presence of solid components. There are very rare instances where both Brenner tumor and cystadenofibroma coexist in a single patient. A 48-year P1L1, postmenopusal woman presented at Guru hospital, Madurai, with chief complaints of on and off postmenopausal bleeding for 6 months. On ultrasonography there were two simple cysts of ovary measuring 6x 6 cm on left side and 4x4 cm on right side. She was managed with total laparoscopic hysterectomy and bilateral salpingoophorectomy. Intraoperatively there was a right ovarian mass of 6x6 cm size and a left ovarian mass of 4x4 cm size. Left ovarian mass reported as benign cystadenofibroma while the right ovarian mass was reported to be brenners tumor on histopathology. As the preoperative imaging are not completely relied for diagnosing these tumors, awareness of the surgeons of these entities is particularly important. The prognosis of both of these tumors is excellent with suitable treatment. They have a very low recurrence risk on compete removal through surgery.
ANALISIS PENGARUH CAPITAL/LABOUR INTENSIVE, INVESTASI, KEPEMILIKAN MANAJERIAL, LEVERAGE OPERASI DENGAN VARIABEL MEDIASI KEBIJAKAN DIVIDEN DAN LEVERAGE KEUANGAN TERHADAP NILAI PERUSAHAAN
Authors: Nugraha Robi 
Published: February 2019

ABSTRACT
The purpose of this study was to analyze the influence of capital labour intensive, investment, managerial ownership, operating leverage, dividen and financial leverage on the firm value of Indonesia non financial sector companies, the influence of capital labour intensive, investment, managerial ownership, operating leverage variable on dividen and financial leverage of Indonesia non financial sector companies, and the influence of capital labour intensive, investment, managerial ownership, operating leverage variable on the firm value through dividen and financial leverage as intervening variable.
The research data was collected using purposive sampling method to the data of non financial sector companies listed on the Indonesian Stock Exchange during the period 2003-2012. Based on the criteria of the study obtained 310 samples were then analyzed Using the panel data regression and path analysis. The results show that the capital labour intensive, investment, managerial ownership, operating leverage, dividen and financial leverage have significant influences on the firm value of Indonesia non financial sector companies. The capital labour intensive, investment, managerial ownership, operating leverage variable do not have significant influences on dividen. The capital labour intensive, investment, managerial ownership, operating leverage variable have significant influences on financial leverage.
With path analysis, the result show the The capital labour intensive, investment, managerial ownership, operating leverage variable do not have significant influence on the firm value of Indonesia non financial sector companies with dividen and financial leverage as intervening variable.
Keywords: Capital Labour Intensive, Investment, Managerial Ownership, Operating Leverage, Dividen and Financial Leverage, Firm Value.
Pengaruh Service Quality, Customer Satisfaction, dan Brand Trust di Mediasi Oleh Customer Commitment Terhadap Customer Loyalty Penumpang Maskapai Low Cost Carrier Di Bali
Authors: Lakhsmidevy Dewa ayu alit 
Published: February 2019

Kebutuhan masyarakat Indonesia atas layanan transportasi terus meningkat sesuai dengan meningkatnya pembangunan nasional. Jenis layanan transportasi udara juga terus berkembang, salah satu adalah dengan beroperasinya model penerbangan unik yaitu melalui strategi penurunan operating cost di semua lini yang mengakibatkan harga tiket dapat ditekan. Model penerbangan ini disebut low cost carrier (LCC). Kepuasan konsumen terhadap pelayanan yang diberikan oleh maskapai penerbangan di Indonesia sangat berpengaruh terhadap seberapa besar tingkat kualitas pelayanan dari sebuah maskapai penerbangan. Berbagai pelayanan yang mempengaruhi, kepuasan konsumen adalah keramahan seluruh awak kabin, fasilitas fisik yang ada, tarif penerbangan, ketepatan waktu keberangkatan kemudahan akses dan juga keselamatan penerbangan. Berdasarkan jajak pendapat dari 2.674 orang responden mengenai apa yang diinginkan dari sebuah maskapai penerbangan didapatkan hasil sebanyak 9,6% menginginkan pelayanan ramah dari awak kabin, 16,9% penerbangan yang tepat waktu, armada yang baru 18,3%, 55,2% tarif yang murah (Indopos. 2015). Maskapai penerbangan di Indonesia sering mengalami keterlambatan waktu pada saat akan terbang atau dengan kata lain sering mengalami delay. Salah satu maskapai penerbangan di Indonesia yang sering mengalami keterlambatan dalam pemberangkatan pesawat adalah penerbangan low cost carriers. Secara garis besar tujuan penelitian ini adalah : menguji pengaruh service quality, customer satisfaction, brand trust terhadap costumer commitment serta dampaknya kepada customer loyalty pada penerbangan domestik maskapai low cost carrier di Bandara Internasional Ngurah Rai, Bali. Dengan unit observasi sebanyak 250 responden yang terdiri dari beberapa kriteria responden. Metode penelitian adalah explanatory survey. Hasil pengujian menunjukkan total indirect effect paling tinggi adalah pengaruh service quality terhadap customer loyalty dengan nilai t value sebesar 4,074, selanjutnya service quality terhadap customer commitment dengan nilai t value sebesar 3,243 di ikuti dengan sisa variabel lainnya. Hasil ini menunjukkan bahwa service quality merupakan variabel yang mendominasi pada hasil penelitian yang dilakukan. Semakin baik service quality yang diberikan maskapai kepada penumpang maka akan meninggkatkan komitmen penumpang dan selanjutnya akan menggiring penumapng untuk semakin loyal kepada maskapai.
A randomized controlled trial of the effect of supervised progressive crosscontinuum strength training in older medical patients: the STAND-Cph trial
Authors: Pedersen Mette Merete , Petersen Janne , Beyer Nina , Juul-Larsen Helle Gybel , Jensen Pia Søe , Andersen Ove , Bandholm Thomas 
Published: February 2019

Abstract
Background: During hospitalization, older adults (+65) are inactive, which puts them at risk of functional decline and loss of independence. Systematic strength training can prevent loss of functional performance. However, we lack knowledge about the effect of strength training commenced during hospitalization and continued after discharge in older medical patients. This assessor-blinded, randomized study investigated the effect of a simple, supervised strength training program for the lower extremities, combined with post-training protein supplementation during hospitalization and 4 weeks at home after discharge on change in mobility in older medical patients.
Methods: Older medical patients (≥65 yrs) admitted acutely from their home to the Emergency Department were randomized to either standard care or supervised progressive strength training and an oral protein supplement during hospitalization and at home 3 days/week for 4 weeks after discharge. The primary outcome was between-group difference in change in mobility from baseline to 4 weeks after discharge assessed by the De Morton Mobility Index. Secondary outcomes were 24-hour mobility, lower extremity strength, gait speed, grip strength and Activities of Daily Living.
Results: Eighty-five patients were randomized to the intervention (N=43) or control group (N=42). In the intervention group, 43% were highly compliant with the intervention. Our intention to treat analysis revealed no between-group difference in mobility (difference baseline to 4 weeks: -4.17 (IQR -11.09;2.74; p=0.24) nor in any of the secondary outcomes. The per protocol analysis showed that the intervention group increased significantly more in the daily number of steps taken compared to the control group (difference in change from baseline to 4 weeks: 1024.7 steps (IQR 0.7;2048.6); p<0.05; adjusted for mobility at baseline).
Conclusions: Simple supervised strength training for the lower extremities, combined with protein supplementation initiated during hospitalization and continued at home for 4 weeks after discharge was not superior to usual care on change in mobility at 4 weeks in older medical patients. For the secondary outcome, daily number of steps, high compliance with the intervention resulted in a higher daily number of steps. Less than half of the patients were compliant with the intervention indicating that a simpler intervention might be needed.
Trial registration: NCT01964482, https://clinicaltrials.gov/ct2/show/NCT01964482, registration date: October 14, 2013, trial protocol: PubMed ID (PMID): 27039381.
1-1-8 one-step sevoflurane-nitrous oxide wash-in scheme for low-flow anesthesia: simple, rapid, and predictable induction
Authors: Tribuddharat Sirirat , Sathitkarnmanee Thepakorn , Vattanasiriporn Naruemon , Thananun Maneerat , Nonlhaopol Duangthida , Somdee Wilawan 
Published: February 2019

Abstract
Background

Sevoflurane is suitable for low-flow anesthesia (LFA). LFA needs a wash-in phase. The reported sevoflurane wash-in schemes lack simplicity, target coverage, and applicability. We proposed a one-step 1-1-8 wash-in scheme for sevoflurane-nitrous oxide (N2O) LFA. The objective of our study was to identify times to achieve every alveolar concentration of sevoflurane (FAS) from 1% to 3.5%.

Methods

We recruited 102 adults requiring general anesthesia with endotracheal intubation and controlled ventilation. After induction and intubation, a wash-in was started using a fresh gas flow of oxygen (O2):N2O at 1:1 L·min-1 plus sevoflurane 8%. The ventilation was controlled to maintain end-tidal carbon dioxide (CO2) of 30-35 mmHg.

Results

The rising patterns of FAS and inspired concentration of sevoflurane (FIS) are similar and parallel. The FAS/FIS ratio increased from 0.46 to 0.72 within 260 sec. The respective times to achieve FAS of 1%, 1.5%, 2%, 2.5%, 3% and 3.5% were 1, 1.5, 2, 3, 3.5, and 4.5 min. The heart rate and blood pressure significantly increased initially then gradually decreased as FAS increased.

Conclusions

The 1-1-8 wash-in scheme for sevoflurane has many advantages, including simplicity, coverage, swiftness, safety, and economy. A respective FAS of 1%, 1.5%, 2%, 2.5%, 3%, and 3.5% can be expected at 1, 1.5, 2, 3, 3.5, and 4.5 min. This scheme may be applied for LFA in the situation where anesthetic gas analyzer is not available.
The effect of oxygenation by continuous low-pressure oxygen flow through thyrocricocentesis cannulation on asphyxia-induced injury in canine.
Authors: Huang Fengyi , Chen Feng , Zheng Xiaochun , Gao Fei 
Published: February 2019

Abstract
Background

To observe the oxygenation efficacy using a continuous low-pressure oxygen flow through thyrocricoid emergency airway by venous catheter needle in canine model of asphyxia.

Methods

Eighteen healthy male canine were randomly assigned to three group A (control), group B (continuous low-pressure oxygen flow insufflation), and group C (continuous low-pressure oxygen flow insufflation with chest compressions). After thyrocricocentesis cannulation and intubation achieved, ventilation was stopped for 40 minutes to establish asphyxia model. Electrocardiogram (ECG), arterial blood pressure (ABP), oxygen saturation (SpO2), heart rate (HR), arterial blood gas analysis was recorded in duration. Concentration of S100β protein, cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB) and moisture in brain tissue were measured at before asphyxia, 2h and 4h after resuscitation.

Results

Compared with the control group, the pace of decline in SpO2, PaO2, pH value and the raise of PaCO2, LAC were slower in the other two groups. Similarly, a delay in increase of concentration of S100β, cTnI was observed, moreover, cerebral edema in group B and group C was significantly alleviated. Compared with Group B, the level of serum S100β, cTnI and brain tissue moisture content was lower in Group C (p<0.05).

Conclusions

The implication of continuous low-pressure oxygen insufflation through venous catheter needle after thyrocricoid puncture with assisted chest compression can ameliorate oxygenation in vivo, slow the increasing of PaCO2 and reduce the accumulation of H+. Consequently, it could attenuate the injury of vital organs, and finally improve prognosis. So it can be a promising approach for rescuing patients with asphyxia in clinic.
Postoperative Care of the Patient With Pulmonary Hypertension
Authors: Dezube Rebecca , Housten Traci , Mathai Stephen C. 
Published: February 2019

CASE: SH is a 46-year-old woman with idiopathic pulmonary arterial hypertension (IPAH) (World Health Organization [WHO] Group 1), New York Heart Association functional class (NYHA FC) I, treated with bosentan and sildenafil as well as with anticoagulation. She was diagnosed with IPAH 10 years prior and her most recent right heart catheterization (RHC) showed a right atrial pressure of 7 mm Hg, mean pulmonary artery pressure (mPAP) of 48 mm Hg, cardiac output of 5.3 L/min, and pulmonary vascular resistance (PVR) of 7.1 Wood units. She was transferred to our intensive care unit with vaginal bleeding significant enough to cause systemic hypotension associated with a cardiac troponin leak and requiring multiple units of transfusions. Uterine artery embolization was attempted by interventional radiology at our institution, but the patient continued to have significant bleeding postprocedure. The patient ultimately was urgently taken to the operating room and underwent dilation and curettage while receiving general anesthesia. The patient tolerated the procedure well, was extubated, and transferred to the intensive care unit on 100% oxygen delivered by face mask.
The surgical team requests consultation regarding postoperative management. What advice would you give?
Diagnosis and Preoperative Evaluation of Chronic Thromboembolic Pulmonary Hypertension
Authors: van Kan Coen , Bresser Paul 
Published: February 2019

Chronic thromboembolic pulmonary hypertension (CTEPH) can be defined as precapillary pulmonary hypertension (PH) as assessed by right heart catheterization, and results from incomplete resolution of the vascular obstruction associated with acute pulmonary embolism (PE). Pulmonary thromboendarterectomy (PTE) is the therapy of choice for CTEPH patients with surgically accessible thrombi.
Although associated with potential risks, PTE has been found to improve, and in many cases normalize pulmonary hemodynamics, functional status, and long-term survival. It is critical to undergo careful diagnosis and preoperative selection of patients who will most likely benefit from surgery. We have used published literature along with our personal experiences to review diagnosis of CTEPH and evaluation in advance of the PTE procedure.
In patients with PH or suspected PH, a complete diagnostic workup should be performed to identify the underlying etiology of the disease. Pulmonary angiography and right heart catheterization are the preferred assessment tools to diagnose CTEPH. PTE remains the treatment of choice, and for further evaluation of operability and preoperative risk patients should be referred to a CTEPH expert center.
Medical Therapy for Chronic Thromboembolic Pulmonary Hypertension
Authors: Rodriguez-Lopez Josanna , Channick Richard N. 
Published: February 2019

Chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary hypertension (PH) secondary to chronic emboli, obstructing the pulmonary arteries. This results in increased pulmonary vascular resistance and right ventricular failure. CTEPH is the only form of PH that is potentially curable, through a surgical procedure that removes the chronic emboli: pulmonary thromboendarterectomy (PTE). The first step in managing patients diagnosed with CTEPH is to determine if they are operable. The use of medical therapy should never delay referral for surgery, which should be done at a specialized center with expertise in CTEPH. Since a significant proportion of CTEPH patients are not surgical candidates, or are among the 10% to 15% of patients that have persistent or recurrent PH after surgery, there is a need for effective medical therapy.
The use of several pulmonary arterial hypertension (PAH)-targeted agents have been studied, mostly in small uncontrolled trials. A recent Phase 3 clinical trial found riociguat, a stimulator of soluble guanylate cyclase (sGC), to be effective for inoperable CTEPH.
A Treatment Algorithm for Pulmonary Arterial Hypertension
Authors: Galiè Nazzareno 
Published: February 2019

The treatment algorithm for pulmonary arterial hypertension (PAH) represents graphically a sequence of operations that are needed for the management of patients. The treatment algorithm includes different types of recommendations with varying degrees of scientific evidence. The recommendations are based on information derived from different areas including clinical, hemodynamic, medical, interventional, pharmacological, and regulatory domains.
The current treatment algorithm is divided into 3 main sections: I) general measures, supportive therapy, referral strategy, acute vasoreactivity testing, and chronic treatment with calcium channel blockers; II) initial therapy with approved PAH drugs; III) clinical response to the initial therapy, combination therapy, balloon atrial septostomy, and lung transplantation. The European Society of Cardiology grades of recommendation and levels of evidence are adopted to rank the proposed treatments.
Research Reviews
Authors: Shlobin Oksana A. , Rich Jonathan D. 
Published: February 2019

In this issue of Advances, section editors Oksana Shlobin, MD, and Jonathan Rich, MD, review findings from 2 recently published studies focused on outcomes and implications of the REVEAL registry.
Farber HW, Miller DP, Poms AD, et al. Five-year Outcomes of Patients Enrolled in the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension (PAH) Disease Management (REVEAL). Chest. 2015 Jun 11. [Epub ahead of print]
Benza RL, Miller DP, Foreman AJ, et al. Prognostic implications of serial risk score assessments in patients with pulmonary arterial hypertension: a Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease (REVEAL) analysis. J Heart Lung Transplant. 2015;34(3):356–361.