bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relationship between protein convertase subtilisin kexin type-9 levels and extent of coronary artery disease in patients with non-ST-elevation myocardial infarction
Authors: Dalgic Yalcin , Abaci Okay , Kocas Cuneyt , Cetinkal Gokhan , Dalgic Sadiye N. , Buyuk Ahmet , Ser Ozgur S. , Batit Servet , Arat Alev , Gurmen Aziz T. 
Published: June 2019

BackgroundCardiovascular disease is one of the leading causes of death worldwide. According to the results of various studies, protein convertase subtilisin kexin type-9 (PCSK9) was determined as a novel risk factor for stable coronary artery disease. Few studies have investigated the relationship between PCSK9 levels and the severity of coronary artery disease in patients with acute coronary syndrome; thus, we herein aimed to investigate this relationship in patients with non-ST-elevation myocardial infarction (NSTEMI) who underwent coronary angiography.Patients and methodsHerein, 168 patients with NSTEMI were prospectively enrolled, and severity of atherosclerotic lesions was determined using SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX), Gensini and Jeopardy scores. Plasma PCSK9 levels, lipid parameters and C-reactive protein levels were measured after a 12-h fasting period. The relationship of PCSK9 levels and clinical and laboratory parameters of patients with their SYNTAX, Gensini and Jeopardy scores was investigated.ResultsPearson correlation analysis showed a strong positive correlation between PCSK9 and the three scores (P < 0.001,r > 0.5 for all). In ROC analysis, a mid-high SYNTAX score of at least 25 was predicted with a sensitivity of 81% and a specificity of 63% when the PCSK9 level was higher than 52.8 ng/ml (area under a curve 0.76,P < 0.001). Multivariate linear regression analysis revealed that PCSK9, low-density lipoprotein cholesterol and creatinine levels were independent predictors of a high SYNTAX score.ConclusionTaken together, high PCSK9 levels may be a risk factor for adverse events in patients with NSTEMI. Aggressive lipid-lowering therapies may benefit this group of patients.
Autologous stem cell transplantation for patients with viral hepatitis-induced liver cirrhosis: a systematic review and meta-analysis
Authors: Chen Bin , Pang Long , Cao Hongxin , Wu Dongbo , Wang Yonghong , Tao Yachao , Wang Menglan , Chen Enqiang 
Published: June 2019

Background
Recently, stem cells have been used in the treatment of viral hepatitis-induced liver cirrhosis (LC), and stem cell therapy is showing potential therapeutic effects on liver function improvement. The consensus on effects and safety of stem cell therapy has not been reached, thus it is essential for us to conduct a systematic review and meat-analysis to investigate the efficacy and safety of stem cell therapy for viral hepatitis-induced LC.

Materials and methods
Medline, Embase, SinoMed and Cochrane Library databases were searched with appropriate keywords through 5 August 2018. We included eight trials involving 467 patients. The pooled weight mean difference (WMD) and 95% confidence interval (CI) were calculated using a fixed or random effects model. Quality assessment and publication bias were also performed. The selected studies were considered for meta-analysis using RevMan V5.3.

Results
Compared with traditional therapy group, autologous stem cell transplantation increased the level of albumin (WMD: 2.47, 95% CI: 1.05–3.90, P < 0.001), but decreased the level of total bilirubin (WMD: −2.26, 95% CI: −3.61 to −0.90, P = 0.001), alanine aminotransferase (WMD: −9.16, 95% CI: −16.47 to −1.85, P = 0.01) and prothrombin time (WMD: −3.02, 95% CI: −4.83 to −1.22, P = 0.001). Clinical symptoms such as edema, fatigue, anorexia and abdominal distention were alleviated. Model for End-Stage Liver Disease and Child–Pugh scores were decreased after stem cell therapy. Whereas, there was no statistically significant difference between two groups regarding aspartate aminotransferase, prothrombin time activity, ascites and pleural fluid. No procedure-related complications were found.

Conclusion
Autologous stem cell transplantation might have beneficial effects on patients with viral hepatitis-induced LC and is relatively safe for these patients. Further high-quality randomized controlled trials are needed.
Correlations between the serum bilirubin level and ulcerative colitis: a case–control study
Authors: Shi Haitao , Feng Yuan , Jiang Jiong , Zhao Juhui , Li Xiao , Liu Xin 
Published: June 2019

Objective
To analyze whether the bilirubin level is a protective factor in ulcerative colitis (UC) and the predictive value of the bilirubin level.

Patients and methods
We compared the bilirubin levels of 100 UC patients and 140 healthy controls as well as those of the subgroups of patients with different UC severities and then analyzed the correlation between the bilirubin level and UC and the correlations among the erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein (hs-CRP) level, UC severity, and bilirubin level. The predictive value of the bilirubin level for UC was determined by constructing a receiver operating characteristic (ROC) curve.

Results
The mean levels of the total bilirubin (TBIL) and indirect bilirubin (IBIL) in the UC were lower in comparison with the mean TBIL and IBIL levels in the control group, and the TBIL and IBIL levels were significantly higher in the mild activity subgroup than in the moderate and severe activity subgroups (P<0.05). TBIL (P<0.001, 95% confidence interval: 0.794–0.918) and especially IBIL (P<0.001, 95% confidence interval: 0.646–0.809) were independent protective factors for UC. There were also significant differences in the serum ESR and hs-CRP levels between the patients with different UC severities (ESR=χ
2: 23.975; hs-CRP=χ
2: 26.626, P<0.001), and there was a positive correlation between these two parameters (ESR=r: 0.472; hs-CRP=r: 0.495, P<0.001). However, the TBIL and IBIL levels were correlated negatively with the ESR (r
total=−0.429, r
indirect=−0.461, P<0.001) and hs-CRP (r
total=−0.289, r
indirect=−0.25, P<0.05) levels. The ROC curve showed that the threshold values of TBIL and IBIL were 8.87 and 6.735 µmol/l, the areas under the maximum ROC curve were 0.664 and 0.716, the sensitivities were 0.450 and 0.61, and the specificities were 0.800 and 0.786, respectively.

Conclusion
TBIL and especially IBIL may be independent protective factors for UC because of their antioxidant and anti-inflammatory effects. A low level of IBIL has a moderate predictive value for UC, and an IBIL level less than 6.735 µmol/l can be used as a defining index for predicting UC.
Anticipatory care of children and adolescents with inflammatory bowel disease: a primer for primary care providers
Authors: Carman Nicholas , Mack David R. , Benchimol Eric I. 
Published: June 2019

Purpose of review
About 10–20% of patients with newly diagnosed inflammatory bowel disease (IBD) are under 18 years of age, with incidence increasing in young children. Children with IBD have unique healthcare needs, which require coordination between primary care providers and pediatric gastroenterologists to provide appropriate care. This review highlights some key elements of anticipatory care in pediatric IBD, including vaccination, risk of serious infection and malignancy, psychosocial and educational needs, and cannabis use.

Recent findings
Therapies for IBD that include anti-tumor necrosis factor medications, especially when combined with corticosteroids are associated with higher risks of serious infections. Vaccination remains the best way to prevent infections. Live vaccinations should be avoided during immunosuppression, but the schedule should be otherwise completed, including vaccination for influenza, pneumococcus and meningococcus, and human papillomavirus. Malignancy risk is increased in IBD patients, both because of disease factors and resulting from immunomodulatory medications. Children with IBD are at risk for mental health disorders and negative educational outcomes, so identification of at-risk children and early intervention are important.

Summary
High-quality care in pediatric IBD requires coordination between pediatric gastroenterologists and primary care providers, with careful attention paid to the specific needs of children with IBD.
Thiol Disulfide Homeostasis and Ischemia-modified Albumin Level in Children With Beta-Thalassemia
Authors: Odaman Al Işik , Ayçiçek Ali , Ersoy Gizem , Bayram Cengiz , Neşelioğlu Salim , Erel Özcan 
Published: June 2019

Objective:
It is well known that increased oxidative stress leads to tissue damage in beta-thalassemia (β-thal) patients. Thiols are one of the most important antioxidant agents, and thiol/disulfide (SH/SS) homeostasis is a novel oxidative stress marker. This study aimed to investigate the relationship of thiol levels, SH/SS homeostasis, and ischemia-modified albumin (IMA) in patients with β-thal.

Materials and Methods:
A hundred transfusion-dependent β-thal patients and 41 healthy controls were included in the study.

Results:
Native thiol, total thiol, disulfide, catalase, and IMA levels were significantly higher in the β-thal group compared with the control group (P<0.02). There were no correlation between serum ferritin level and SH/SS homeostasis, and weak positive correlations were found between serum ferritin and IMA (r=0.242, P=0.022).

Conclusions:
Our study results suggest that antioxidant systems try to compensate for peroxidative damage in the patients’ group and serum IMA level was found increased because of increased oxidative status. To the best of our knowledge, there has been no report evaluating plasma dynamic SH/SS homeostasis in β-thal patients.
Peripheral Vestibular and Balance Function in Athletes With and Without Concussion
Authors: Christy Jennifer B. , Cochrane Graham D. , Almutairi Anwar , Busettini Claudio , Swanson Mark W. , Weise Katherine K. 
Published: June 2019

Background and Purpose:According to the most recent consensus statement on management of sport-related concussion (SRC), athletes with suspected SRC should receive a comprehensive neurological examination. However, which measures to include in such an examination are not defined. Our objectives were to (1) evaluate test-retest reliability and normative data on vestibular and balance tests in athletes without SRC; (2) compare athletes with and without SRC on the subtests; and (3) identify subtests for concussion testing protocols.Methods:Healthy athletes (n = 87, mean age 20.6 years; standard deviation = 1.8 years; 39 female and 48 male) and athletes with SRC (n = 28, mean age 20.7 years; standard deviation = 1.9 years; 11 female and 17 male) were tested using rotary chair, cervical vestibular-evoked myogenic potential (c-VEMP), and the Sensory Organization Test (SOT). A subset (n = 43) were tested twice. We analyzed reliability of the tests, and compared results between athletes with and without SRC.Results:Reliability ranged from poor to strong. There was no significant difference between athletes with and without SRC for tests of peripheral vestibular function (ie, rotary chair and c-VEMP). Athletes with SRC had significantly worse scores (P< 0.05) on vestibular-ocular reflex (VOR) cancellation gain, subjective visual vertical and horizontal variance, and all conditions of the SOT.Discussion and Conclusion:SRC did not affect medium frequency VOR or saccular function. SRC did affect the ability to use vestibular inputs for perception of vertical and postural control, as well as ability to cancel the VOR.Video Abstract availablefor more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A274).
Stroke Survivors' Perspectives on Post–Acute Rehabilitation Options, Goals, Satisfaction, and Transition to Home
Authors: Krishnan Shilpa , Hay Catherine C. , Pappadis Monique R. , Deutsch Anne , Reistetter Timothy A. 
Published: June 2019

Background and Purpose:
Patients and caregivers have not typically been involved in the selection of a post–acute care (PAC) provider. In 2015, the Centers for Medicare & Medicaid Services proposed the need to involve patients and their families during discharge planning. Engaging patients in rehabilitation decisions encourages shared decision making among patients and their clinicians. The purpose of this study was to examine stroke survivors' perspectives on their involvement in selecting a PAC provider and their goal setting and their satisfaction with the rehabilitation stay and their discharge advice for stroke survivors, prior to 2015.

Methods:
This qualitative study utilized semistructured interviews. Thematic content analysis was performed on interviews involving 18 stroke survivors (mean age = 68 years) related to their involvement in planning for their inpatient rehabilitation facility or skilled nursing facility stay, goal setting, and discharge needs.

Results:
More than half the participants were not involved in the selection of their PAC setting and believed that doctors made these decisions. Around two-fifths of stroke survivors reported that they were not involved in rehabilitation goal setting. Most patients were satisfied with their rehabilitation stay. When asked to recommend discharge topics for other stroke survivors, participants recommended additional information on health care services, interventions, and insurance coverage.

Discussion and Conclusion:
Despite recommendations to include stroke patients in PAC selection and goal setting, many former inpatient rehabilitation facility and skilled nursing facility patients report not being involved in either aspect of care.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A273).
Patterns in Forensic Decapitations
Authors: Pilloud Marin A. , Swenson Victoria M. , George Rebecca L. , Knight Laura D. 
Published: June 2019

AbstractSeparation of the head from the body can occur for a variety of reasons and in various locations across the neck. This study presents a review of the literature to identify the patterns of decapitations in forensic cases in relation to manner of death, age, and anatomical location (n = 88). The most common manner of death was suicide, followed by homicide and then accident. Ages ranged from 32 weeks prenatal to 85 years. Decapitation is reported at higher rates for individuals between 19 and 65. The majority of decapitations occurred at the midneck (second to fifth cervical vertebrae), followed by the upper neck and then the lower neck. This pattern holds true for all manners of death; however, in homicides, the percentage occurring at the midneck decreases. The findings of this study indicate some patterns in terms of manner of death, age, and location of decapitation, which could aid the medicolegal community in interpreting neck trauma. A case study is also briefly presented to illustrate findings.
Necessary Defense or Homicide?
Authors: Handlos Petr , Joukal Marek , Dokoupil Marek , Uvíra Matěj , Marecová Klára 
Published: June 2019

Abstract
Reconstruction of a criminal offense is a crucial approach in forensics and criminalistics allowing for the verification of the location, the particular method used, or the use of a specific instrument. This report describes the case of a young man who was killed by an arrow shot from a crossbow. The autopsy revealed a penetration of the head and significant damage to the brain stem. Although the cause of death was evident from the outset, it was necessary to clarify whether or not the arrow was shot as necessary self-defense. Ballistic investigation of the seized weapon and reconstruction of the crime was absolutely essential to bring forth conclusive evidence to convict the perpetrators of the murder.
Evaluation of Service Delivery Effectiveness Through Patient-Reported Outcome Measures
Authors: Faieta Julie , Schmeler Mark R. , Schiappa Vince J. , Hand Brittany N. , Schein Richard M. , Saptono Andi , Berner Theresa , DiGiovine Carmen P. 
Published: June 2019

Objective
The aims of the study were to report the demographic characteristics and functional mobility for individuals accessing an academic medical center mobility device clinic and to compare functional mobility data across demographic characteristics and mobility device type.

Design
This study used a retrospective, cross-sectional design. Demographic, mobility type, and patient-reported outcome measure data for 833 clients were analyzed. The Functional Mobility Assessment was used as the patient-reported outcome measure to determine satisfaction.

Results
The mean (SD) baseline Functional Mobility Assessment score was 0.59 (0.25) on a 0–1 scale. Significant differences with the Functional Mobility Assessment scores were found across the mobility device types, with scooter and power wheelchair groups reporting higher satisfaction scores than those in the cane/crutch/walker or manual wheelchair groups. Device type, sex, and age were each found to be significant predictors of satisfaction scores (P < 0.01).

Conclusions
Mobility device type is associated with satisfaction level. Mobility devices that offer higher levels of assistance are associated with increased satisfaction. The Functional Mobility Assessment, mobility device type, and demographic data provide baseline information for evaluating the effectiveness of an academic medical center mobility device clinic.
Thyroid Cancer Bone Metastasis
Authors: Kondraciuk Jessica D. , Rice Samuel L. , Zhou Xiaosun , Gharzeddine Karem , Knezevic Andrea , Spratt Daniel E. , Sabra Mona , Larson Steven M. , Grewal Ravinder K. , Osborne Joseph R. 
Published: June 2019

Purpose
Bone metastasis (BM) in differentiated thyroid cancer (DTC) is the second most common site of metastasis after lung. Bone metastases are associated with worse prognosis in DTC. In this study, we examined risk factors for overall survival in patients with BM and for the first time explore the pattern of genomic alterations in DTC BM.

Patients and Methods
A Health Insurance Portability and Accountability Act (HIPAA) compliant, institutional review board–approved retrospective evaluation of the medical record was performed for all patients treated at a single institution for thyroid cancer over a 16-year period. Seventy-four patients met inclusion criteria. Multiple prognostic factors including age, sex, genes, radioactive iodine, and radiation or kinase inhibitor therapies were analyzed. Univariate and multivariate analyses were performed.

Results
Treatment with external beam radiation was found to significantly increase survival (P = 0.03). The 5-year survival rate was 59% and median survival was 92 months. Patients who developed bone metastasis earlier tend to live longer (P = 0.06). The presence of TERT and BRAF mutations did not significantly worsen the prognosis (P = 0.10).

Conclusion
Patients with DTC can benefit from early treatment with external beam radiation therapy, especially those who develop bone metastasis within 3 years of primary TC diagnosis. Kinase inhibitor treatment tended to prolong survival but not in a statistically significant manner. Sex, age, and TERT or BRAF genetic mutations did not significantly affect the prognosis.
Midgut NET With Orbital, Myocardial, Testicular, Lymph Nodal and Pulmonary Metastases Presenting With Bilateral Proptosis—Role of 68Ga-DOTANOC PET/CT
Authors: Senthil Raja , Pratap Thara , Visakh R Arun , Philip Mathew 
Published: June 2019

Abstract
Neuroendocrine tumors (NET) are rare neoplasms and commonly metastasize to liver, lymph nodes and less frequently to bones and lungs. Metastases to other organs are extremely rare and we report a case of NET clinically presenting with bilateral proptosis secondary to metastases in orbits. 68Ga-DOTANOC PET/CT demonstrated somatostatin receptor overexpressing lesions in bilateral orbits, small intestine, lymph nodes, lungs, heart and testes in the absence of liver metastases.
Interlesional Heterogeneity of Metastatic Neuroendocrine Tumors Based on 18F-DOPA PET/CT
Authors: de Hosson Lotte D. , van der Loo–van der Schaaf Aline M. , Boellaard Ronald , van Snick Johannes H. , de Vries Elisabeth G. E. , Brouwers Adrienne H. , Walenkamp Annemiek M. E. 
Published: June 2019

Purpose
Neuroendocrine tumors (NETs) can produce neuroendocrine amines resulting in symptoms. Selecting the most active amine-producing tumor lesions for local treatment might be beneficial for patients with metastatic small intestinal NET. Tumor burden correlates with catecholamine pathway activity. We analyzed interlesional heterogeneity with 18F-DOPA PET scans in patients with small intestinal NET and investigated if lesions with substantially higher 18F-DOPA uptake could be identified.

Methods
In this retrospective, observational study, the 18F-DOPA uptake was calculated by dividing SUVpeak of the lesion by the SUVmean of the background organ. The magnitude of heterogeneity between lesions within a patient was calculated by dividing the lesion with the highest by the one with the lowest 18F-DOPA uptake. Lesions with a higher 18F-DOPA uptake than the upper inner or outer fence (>1.5 or 3 times the interquartile range above the third quartile) were defined as lesions with mild or extreme high 18F-DOPA uptake, respectively, and presence of these was determined in patients with 10 lesions or more.

Results

18F-DOPA was detected over 680 lesions in 38 patients, of which 35 were serotonin producing. 18F-DOPA uptake varied with a median of 8-fold up to 44-fold between lesions within a patient. In 12 of 20 evaluable patients, lesions with mild high 18F-DOPA uptake were found, and in 5, lesions with extreme high 18F-DOPA uptake.

Conclusions

18F-DOPA-PET showed considerable heterogeneity in 18F-DOPA uptake between tumor lesions and identified lesions within patients with mild or extreme high 18F-DOPA uptake.
18F-Fluciclovine PET/CT in Suspected Residual or Recurrent High-Grade Glioma
Authors: Bogsrud Trond V. , Londalen Ayca , Brandal Petter , Leske Henning , Panagopoulos Ioannis , Borghammer Per , Bach-Gansmo Tore 
Published: June 2019

Purpose
To retrospectively investigate the uptake of 18F-fluciclovine on PET/CT in patients with suspected recurrent high-grade glioma (HGG).

Methods
Twenty-one patients were included. The standard of truth was histopathologic interpretation if available. When histopathology was not available or rebiopsy did not show signs of malignancy, clinical follow-up including MRI and clinical outcome was considered the standard of truth.

Results
All 21 patients met the reference standard of either histopathologic proof of HGG recurrence (n = 10) or disease progression clinically and with tumor growth corresponding to the primary tumor sites on follow-up MRI (n = 11). Median time from PET/CT to death was 5 months (range, 1–20 months). Median time from primary diagnosis to death was 14.5 months (range, 6 to >400). Average SUVmax of the lesions was 8.3 ± 5.3 (SD) and 0.34 ± 0.13 for normal brain tissue. Median lesion-to-background ratio was 21.6 (range, 3.1–84.4). In 4 patients, 18F-fluciclovine PET/CT detected small satellite tumors that had not been reported on MR.

Conclusions
The uptake of 18F-fluciclovine in clinically and/or histopathologically confirmed recurrent HGG is high compared with the uptake reported for other amino acid PET tracers. Because of the high tumor uptake and thus high tracer contrast, small satellite tumors with a diameter below usual reported PET spatial resolution and not reported on MRI were detected in 4 patients. As no patients with confirmed treatment-related changes were included, we cannot as of yet ascertain the ability of 18F-fluciclovine PET to discriminate between recurrent HGG and treatment-related changes, for example, pseudoprogression and radionecrosis.