bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lessons from Marias: what the titleness and nameless taught me that elite medical institutions couldn’t teach me
Authors: Almeida Marcela 
Published: August 2019

Abstract
In an era of rapid advancements in healthcare and technology, sophisticated treatments and pressure for speedy recoveries, contemporary physicians are often led to neglect some of the support pillars of medicine: That science, guidelines and protocols should not come before the individual; prescriptions serve little purpose without books and literacy; medications are not a substitute for nourishment. That hearing lamenting stories and watching tears run through despondent, downcast faces are sometimes our only resort. That social justice is a powerful healing instrument. That rather than treating the sickness, we shall treat the sick--helpless, deprived, forsaken and in need.
Measuring the effect of a competency-based education conference for PAs and NPs
Authors: Laghezza Matthew , Clapper Timothy C. , Christos Paul J. , Sharma Rahul , Naik Neel 
Published: August 2019

ABSTRACT

Objective:
To evaluate the effectiveness of a competency-based continuing medical education (CME) conference model for physician assistants (PAs) and NPs.

Methods:
This mixed-method research included a pretest/post-test assessment of knowledge and procedural assessment for six clinical skills, along with an open-ended survey to assess the value of an educational conference for PAs and NPs (N = 48) in an urban academic healthcare facility.

Results:
Significant increases in knowledge scores and all six clinical skill procedures were noted from pre- to post-test. Participants said they acquired new techniques and knowledge (55%) or improved current knowledge and skills (40%).

Conclusions:
The competency-based conference model could serve as a viable method for providing evidence-based learning and informed practice as well as instilling reflective practice and a commitment to personal growth.
Reading between the lines for a solution to burnout
Authors: Bernard Kari , McMoon Michelle 
Published: August 2019

ABSTRACT
Physician assistants (PAs) have historically reported high levels of professional satisfaction, but emerging research indicates increasing levels of professional burnout. This article explores burnout interventions in the literature and their usefulness to PAs. We propose that PAs and leaders of the profession must acknowledge and assess the phenomenon of burnout through standardized measurement at the population level, be mindful of personal boundaries in order to maintain a healthy work life balance, and commit to creating an organizational culture that sustains overall clinician well-being and fosters PA engagement.
Blood level of adiponectin is positively associated with lean mass in women without type 2 diabetes
Authors: Banh Taylor H. , Puchala Sarah E. , Cole Rachel M. , Andridge Rebecca R. , Kiecolt-Glaser Janice K. , Belury Martha A. 
Published: August 2019

Abstract

Objective:
The objective of this study was to evaluate the relationship between blood levels of adiponectin and leptin with lean body and trunk adipose mass in women with and without type 2 diabetes mellitus (T2DM).

Methods:
This cross-sectional study analyzed baseline data from five previous clinical studies involving postmenopausal women (n = 95). Body composition was assessed by dual-energy x-ray absorptiometry, and appendicular lean mass was calculated based on body mass index (ALMBMI). Adipokines and cytokines were measured by enzyme-linked immunosorbent assay. Linear mixed-effect models with a random study effect were used to investigate the relationship between predictors (eg, adiponectin, leptin), outcomes (eg, ALMBMI, trunk adipose mass), and co-variables (T2DM status, age, interleukin-6, and C-reactive protein).

Results:
Postmenopausal women with T2DM had lower ALMBMI than those without T2DM. There was a positive association between blood adiponectin and ALMBMI in postmenopausal women without T2DM, but no association in those with T2DM. Blood leptin was negatively associated with ALMBMI for women regardless of T2DM diagnosis. Blood adiponectin was negatively associated, whereas blood leptin was positively associated with trunk adipose mass for the entire cohort.

Conclusions:
T2DM status moderated the relationship between blood adiponectin and ALMBMI, where blood adiponectin was positively associated with ALMBMI in postmenopausal women without T2DM, but not those with T2DM. Dysregulated metabolism in T2DM may contribute to lower muscle mass in women with T2DM, but future research is required to elucidate this mechanistic link. The negative association between blood leptin and ALMBMI was a novel finding. Future studies will need to more clearly define the relationship between these variables.
Relationship between BMI and aortic stiffness: influence of anthropometric indices in hypertensive men and women
Authors: Vallée Alexandre , Olié Valérie , Lelong H.é.lène , Kretz Sandrine , Safar Michel E. , Blacher Jacques 
Published: August 2019

Background:
Increased aortic stiffness could be one of the mechanisms by which obesity increases cardiovascular risk independently of traditional risk factors. Studies have suggested that anthropometric indices may be predictors of cardiovascular risk but few studies have investigated their relations with aortic stiffness in high cardiovascular risk population. We investigated the strength of correlation between different anthropometric indices with aortic stiffness in hypertensive and diabetic patients.

Methods:
A cross-sectional study was performed in 474 hypertensive patients. Anthropometric indices were calculated: BMI, waist circumference, waist–hip ratio, and waist–height ratio (WHtR). Aortic stiffness was assessed by measurement of carotid-femoral pulse wave velocity (PWV). Correlations between indices and PWV were investigated by linear regression analyses and hierarchical analyses after adjusting for cardiovascular risk factors.

Results:
Regional anthropometric indices were more strongly correlated with PWV than BMI in both sexes. In linear regression analyses, WHtR presented the highest correlation with PWV than other indices in our study population. In adjusted hierarchical regression used, WHtR had the highest additive value on top of BMI while there no additive value of BMI on top of WHtR. These differences remained after adjustment on cardiovascular events. In men WHtR was more closely correlated with PWV than others. In women, waist–hip ratio and WHtR were equally correlated with PWV compared with BMI.

Conclusion:
Regional anthropometric indices are more closely correlated with PWV than BMI in hypertensive patients. WHtR presents the highest correlation with PWV beyond BMI.

Registration:
The study was registered in the French National Agency for Medicines and Health Products Safety (No. 2013-A00227-38) and was approved by the Advisory Committee for Protection of Persons in Biomedical Research.
Association Between Flexibility and Low Back Pain in Female Adolescent Gymnasts
Authors: Sweeney Emily A. , Daoud Ariel Kiyomi , Potter Morgan N. , Ritchie Lauren , Howell David R. 
Published: August 2019

Objective:
To determine the relationship between low back pain (LBP), flexibility, and individual demographic characteristics in competitive adolescent female gymnasts.

Design:
Cross-sectional observational study.

Setting:
Gymnastics facilities in Colorado.

Participants:
Six- to 18-year-old gymnasts who participate in the USA Gymnastics Women's Artistic Junior Olympic Program levels 3 to 10.

Independent Variables:
Demographic data included height, weight, menstrual status, gymnastics level, and participation hours per week. Flexibility measurements were obtained on the gymnasts. Gymnasts also completed a questionnaire documenting LBP in the past 12 months. Univariable (t test and χ2) analyses were used to assess between-group differences; multivariable logistic regression model was used to assess the association between LBP, flexibility, and demographics/injury history.

Main Outcome Measures:
Low back pain within the past 12 months.

Results:
Thirty (45%) of 67 gymnasts reported LBP within the past year. Those who reported LBP were older (11.7 vs 13.7 years, P = 0.005), heavier (37.5 vs 43.4 kg, P = 0.049), and participated in gymnastics more often (19.1 vs 22.4 h/wk, P = 0.017). A greater proportion of gymnasts with LBP had experienced menarche compared with those without LBP (47% vs 16%; P = 0.008). On multivariable analysis, gymnasts with LBP were less likely to have left Iliotibial (IT) band tightness compared with those without LBP [adjusted odds ratio (aOR) = 0.186; 95% confidence interval (CI), 0.04-0.82] and more likely to have experienced menarche (aOR = 8.0; 95% CI, 1.2-50.9).

Conclusions:
Low back pain is more common in gymnasts who experienced menarche, whereas limited joint flexibility does not seem to be associated with LBP in this population.
The use of cochlear implantation in the elderly
Authors: Lally John W. , Adams Jason K. , Wilkerson Brent J. 
Published: August 2019

Purpose of review
To evaluate the impact of cochlear implantation on hearing outcomes, quality of life, complications, and cognitive function in elderly patients.

Recent findings
Nine articles published between 2014 and 2019 pertain to cochlear implantation in the elderly population. The findings conclude that cochlear implantation improves autonomy and overall quality of life in the elderly.

Summary
Design: a pubmed search was employed with title search terms ‘cochlear implant,’ AND ‘elderly’ or ‘aged.’ Twenty-one articles were generated. Of the 21, articles without evidence-based findings were excluded and those published more than 5 years ago were excluded, yielding a final number of nine articles for review. Results: nine articles published on the use of cochlear implantation in the elderly were identified through the literature search between the years 2014–2019. Outcomes included quality of life, speech recognition improvement, improvement in cognitive function as defined by geriatric validated scales, outcomes of hearing rehabilitation, improvement in verbal comprehension, surgical complications, and the ability to manage the external components of the device. Conclusion: cochlear implantation improves autonomy and the quality of life in the elderly. Age should not be a factor limiting surgical decision-making, and cochlear implantation can be utilized as a well tolerated, efficient treatment option for severe-to-profound hearing loss in the elderly population.
Safety and Adjuncts in Face Lifting
Authors: Wan Dinah , Dayan Erez , Rohrich Rod J. 
Published: August 2019

Learning Objectives:
After studying this article, the participant should be able to: 1. Classify the commonly performed types of face-lift procedures based on the extent of skin incision and face and neck dissection, and superficial musculoaponeurotic system treatment and perform the appropriate amount of skin undermining in variations of superficial musculoaponeurotic system techniques. 2. Select the optimal placement of skin incisions and list the danger zones encountered in face-lift dissection and their relationship to the fat compartments and retaining ligaments. 3. Use fat grafting as an adjunctive procedure to face lift and apply safe skin resurfacing techniques at the time of rhytidectomy. 4. Institute a preprocedure and postprocedure skin care regimen and use an antihypertensive protocol for postoperative hematoma prevention. 5. List the commonly injured sensory and motor nerves in rhytidectomy, including prevention and treatment strategies.

Summary:
Today’s face lifts can be classified as “traditional,” “short-scar,” or “mini.” Placement of skin incision, extent of dissection in the face and neck, and methods of superficial musculoaponeurotic system treatment are standard components of face-lift techniques. Proper knowledge of facial anatomy and danger zones is crucial for patient safety. Adjunctive fat grafting and skin resurfacing procedures can create superior results without adding to patient morbidity. Management options for more serious yet potentially preventable surgical complications are discussed, including hematoma and sensory and motor nerve injuries.
Cell-Enriched Fat Grafting Improves Graft Retention in a Porcine Model: A Dose-Response Study of Adipose-Derived Stem Cells versus Stromal Vascular Fraction
Authors: Rasmussen Bo S. , Sørensen Celine L. , Kurbegovic Sorel , Ørholt Mathias , Talman Maj-Lis M. , Herly Mikkel , Pipper Christian B. , Kølle Stig-Frederik T. , Rangatchew Filip , Holmgaard Rikke , Vester-Glowinski Peter V. , Fischer-Nielsen Anne , Drzewiecki Krzysztof T. 
Published: August 2019

Background:
Cell-enrichment of fat grafts has produced encouraging results, but the optimal concentrations and types of added cells are unknown. The authors investigated the effects of enrichment with various concentrations of ex vivo–expanded adipose-derived stem/stromal cells and stromal vascular fraction on graft retention in a porcine model.

Methods:
Adipose-derived stem/stromal cells were culture-expanded, and six fat grafts (30 ml) were prepared for each minipig (n = 13). The authors investigated grafts enriched with 2.5 × 106 to 20 × 106 adipose-derived stem cells/ml and stromal vascular fraction and nonenriched control grafts. Each pig served as its own control. Magnetic resonance imaging was performed immediately after grafting and 120 days postoperatively before the pigs were euthanized, and histologic samples were collected.

Results:
The authors recorded an enhanced relative graft retention rate of 41 percent in a pool of all cell-enriched grafts compared to the nonenriched control (13.0 percent versus 9.2 percent; p = 0.0045). A comparison of all individual groups showed significantly higher graft retention in the 10 × 106–adipose-derived stem/stromal cells per milliliter group compared with the control group (p = 0.022). No significant differences were observed between the cell-enriched groups (p = 0.66). All fat grafts showed a significantly better resemblance to normal fat tissue in the periphery than in the center (p < 0.009), but no differences in overall graft morphology were observed between groups (p > 0.17).

Conclusions:
Cell-enriched fat grafting improved graft retention and was feasible in this porcine model. No significant differences in graft retention were observed among the various adipose-derived stem/stromal cell concentrations or between adipose-derived stem/stromal cell and stromal vascular fraction enrichment. Future studies using this model can help improve understanding of the role of adipose-derived stem/stromal cells in cell-enriched fat grafting.
The Greater Occipital Nerve and Obliquus Capitis Inferior Muscle: Anatomical Interactions and Implications for Occipital Pain Syndromes
Authors: Scherer Saja S. , Schiraldi Luigi , Sapino Gianluca , Cambiaso-Daniel Janos , Gualdi Alessandro , Peled Ziv M. , Hagan Robert , Pietramaggiori Giorgio 
Published: August 2019

Background:
The compression/injury of the greater occipital nerve has been identified as a trigger of occipital headaches. Several compression points have been described, but the morphology of the myofascial unit between the greater occipital nerve and the obliquus capitis inferior muscle has not been studied yet.

Methods:
Twenty fresh cadaveric heads were dissected, and the greater occipital nerve was tracked from its emergence to its passage around the obliquus capitis inferior. The intersection point between the greater occipital nerve and the obliquus capitis inferior, and the length and thickness of the obliquus capitis inferior, were measured. In addition, the nature of the interaction and whether the nerve passed through the muscle were also noted.

Results:
All nerves passed either around the muscle loosely (type I), incorporated in the dense superficial muscle fascia (type II), or directly through a myofascial sleeve within the muscle (type III). The obliquus capitis inferior length was 5.60 ± 0.46 cm. The intersection point between the obliquus capitis inferior and the greater occipital nerve was 6.80 ± 0.68 cm caudal to the occiput and 3.56 ± 0.36 cm lateral to the midline. The thickness of the muscle at its intersection with the greater occipital nerve was 1.20 ± 0.25 cm. Loose, tight, and intramuscular connections were found in seven, 31, and two specimens, respectively.

Conclusions:
The obliquus capitis inferior remains relatively immobile during traumatic events, like whiplash injuries, placing strain as a tethering point on the greater occipital nerve. Better understanding of the anatomical relationship between the greater occipital nerve and the obliquus capitis inferior can be clinically useful in cases of posttraumatic occipital headaches for diagnostic and operative planning purposes.
Evaluating the Economic Impact of Plastic and Reconstructive Surgical Efforts in the Developing World: The ReSurge Experience
Authors: Nasser Jacob S. , Billig Jessica I. , Sue Gloria R. , Chang James , Gosain Arun K. , Chung Kevin C. 
Published: August 2019

Background:
As the global burden of disease continues to rise, it becomes increasingly important to determine the sustainability of specialty surgery in the developing world. The authors aim to (1) evaluate the cost-effectiveness of plastic and reconstructive surgery in the developing world and (2) quantify the economic benefit.

Methods:
In this study, the authors performed a retrospective analysis of surgical trips performed by ReSurge International from 2014 to 2017. The organization gathered data on trip information, cost, and clinical characteristics. The authors measured the cost-effectiveness of the interventions using cost per disability-adjusted life-years and defined cost-effectiveness using World Health Organization Choosing Interventions That Are Cost-Effective thresholds. The authors also performed a cost-to-benefit analysis using the human capital approach.

Results:
A total of 22 surgical trips from eight different developing countries were included in this study. The authors analyzed a total of 756 surgical interventions. The cost-effectiveness of the surgical trips ranged from $52 to $11,410 per disability-adjusted life-year averted. The economic benefit for the 22 surgical trips was $9,795,384. According to World Health Organization Choosing Interventions That Are Cost-Effective thresholds, 21 of the surgical trips were considered very cost-effective or cost-effective.

Conclusions:
Plastic and reconstructive operations performed during short-term surgical trips performed by this organization are economically sustainable. High-volume trips and those treating complex surgical conditions prove to be the most cost-effective. To continue to receive monetary funding, providing fiscally sustainable surgical care to low- and middle-income countries is imperative.
Parenchymal Sparing Anatomical Liver Resections With Full Laparoscopic Approach
Authors: Berardi Giammauro , Igarashi Kazuharu , Li Chao Jen , Ozaki Takahiro , Mishima Kohei , Nakajima Kosuke , Honda Masayuki , Wakabayashi Go 
Published: August 2019

Objective:
The aim of this study was to describe laparoscopic anatomical parenchymal sparing liver resections for hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) and report the short-term outcomes.

Background:
Anatomical resections (ARs) have better oncological outcomes compared to partial resections in patients with HCC, and some suggest should be performed also for CRLM as micrometastasis occurs through the intrahepatic structures. Furthermore, remnant liver ischemia after partial resections has been associated with worse oncological outcomes. Few experiences on laparoscopic anatomical resections have been reported and no data on limited AR exist.

Methods:
We performed a retrospective analysis of 86 patients undergoing full laparoscopic anatomical parenchymal sparing resections with preoperative surgical simulation and standardized procedures.

Results:
A total of 55 patients had HCC, whereas 31 had CRLM with a median of 1 lesion and a size of 30 mm. During preoperative three-dimensional (3D) simulation, a median resection volume of 120 mL was planned. Sixteen anatomical subsegmentectomies, 56 segmentectomies, and 14 sectionectomies were performed. Concordance between preoperative 3D simulation and intraoperative resection was 98.7%. Two patients were converted, and 7 patients experienced complications. Subsegmentectomies had comparable blood loss (166 mL, P = 0.59), but longer operative time (426 min, P = 0.01) than segmentectomies (blood loss 222 mL; operative time 355 min) and sectionectomies (blood loss 120 mL; operative time 295 min). R0 resection and margin width remained comparable among groups.

Conclusions:
A precise preoperative planning and a standardized surgical technique allow to pursue the oncological quality of AR enhancing the safety of the parenchyma sparing principle, reducing surgical stress through a laparoscopic approach.
Subtractive Genomic Analysis for Identification of Novel Drug Targets and Vaccine Candidates against Bartonella bacilliformis subsp. Ver097
Authors: Khan Md. Tahsin , Mahmud Araf , Iqbal Md. Asif , Hasan Mahmudul 
Published: August 2019

AbstractBartonella bacilliformis is the causative agent of Carrión’s disease, one of the truly neglected tropical diseases found in Peru, Colombia and Ecuador. Recent evidence predicts that Bartonella bacilliformis subsp. ver097 can emerge as an antibacterial resistant strain and hence identification of novel drug targets is a crying need. Subtractive genome analysis of B. bacilliformis subsp. ver097 was successfully done in order to address the challenges. Various computational tools and online based servers were used to screen out human homologous proteins of pathogen and proteins involved in common metabolic pathways of host and pathogen. Only 7 proteins involved in pathogen specific pathways were further analyzed to identify membrane proteins. ‘Flagellar biosynthesis protein FlhA’ and ‘ABC transporter permease’ were found to be novel as targets according to DrugBank database. To avoid side effects in human while administering drugs, human ‘anti-targets’ analysis was performed to confirm non-homology of selected novel drug targets. Both predicted proteins also showed probability of antigenicity prediction through VaxiJen, however, ‘Flagellar biosynthesis protein FlhA’ showed broad spectrum conservancy with Bartonella strains. Therefore, Flagellar biosynthesis protein FlhAcould facilitate the development of novel drugs and therapeutic compounds along with vaccines for efficient treatment of infections caused by Bartonella bacilliformis subsp. ver097.
Overlapping Genetic Architecture between Parkinson Disease and Melanoma
Authors: Dube Umber , Ibanez Laura , Budde John P , Benitez Bruno A , Davis Albert A , Harari Oscar , Iles Mark M , Law Matthew H , Brown Kevin M ,   23andMe Research Team,   Melanoma-Meta-analysis Consortium, Cruchaga Carlos 
Published: August 2019

AbstractEpidemiologic studies have reported inconsistent results regarding an association between Parkinson disease (PD) and cutaneous melanoma (melanoma). Identifying shared genetic architecture between these diseases can support epidemiologic findings and identify common risk genes and biological pathways. Here we apply polygenic, linkage disequilibrium-informed methods to the largest available case-control, genome-wide association study summary statistic data for melanoma and PD. We identify positive and significant genetic correlation (correlation: 0.17, 95% CI 0.10 to 0.24;P= 4.09 × 10-06) between melanoma and PD. We further demonstrate melanoma and PD-inferred gene expression to overlap across tissues (correlation: 0.14, 95% CI 0.06 to 0.22;P= 7.87 × 10-04), and highlight seven genes includingPIEZO1, TRAPPC2L, andSOX6as potential mediators of the genetic correlation between melanoma and PD. These findings demonstrate specific, shared genetic architecture between PD and melanoma that manifests at the level of gene expression.