bluuebunny/crossref_metadata_2025_split huggingface dataset:
Qualitative and Quantitative Analysis of Patients' Perceptions of the Patient Portal Experience with OpenNotes
Authors: Mishra Vimal , Hoyt Robert , Wolver Susan , Yoshihashi Ann , Banas Colin 
Published: January 2019

Background Access to medical encounter notes (OpenNotes) is believed to empower patients and improve the quality and safety of care. The impact of such access is not well understood beyond select health care systems and notes from primary care providers.
Objectives This article analyzes patients' perceptions about the patient portal experience with access to primary care and specialist's notes and evaluates free-text comments as an improvement opportunity.
Materials and Methods Patients at an academic health care system who accessed the patient portal from February 2016 to May 2016 were provided a link to complete a 15-item online survey. Those who had viewed at least one note were asked about patient characteristics, frequency of note access, note usefulness, note understanding, and if any action was taken after accessing the note. Free-text comments were associated with nine questions which were analyzed using qualitative methods.
Results A total of 23% (1,487/6,439) of patients who viewed the survey in the portal, participated. Seventy-six percent (1,126/1,487) knew that the notes were available on the portal, and of those, 957 had viewed at least one note to continue the survey. Ninety percent of those were older than 30 years of age, and 90% had some college education. The majority (83%) thought OpenNotes helped them take better care of themselves, without increasing worry (94%) or contacting the physician after reading the note (91%). The qualitative analysis of free-text responses demonstrated multiple positive and negative themes, and they were analyzed for potential improvement opportunities.
Conclusion Our survey confirms that patients who choose to access their primary care and specialists' online medical records perceive benefits of OpenNotes. Additionally, the qualitative analysis of comments revealed positive benefits and several potential patient portal improvement opportunities which could inform implementation of OpenNotes at other health systems.
Distribution of the Force in the Knee Joint during Daily Activities after Open Wedge High Tibial Osteotomy: A Rationale for the Proper Postoperative Management
Authors: Seo Hansol , Lim Dohyung , Jang Young Woong , Kang Kwan-su , Lee Myung Chul , Lee O-Sung , Im Byeong-Eun , Lee Yong Seuk 
Published: January 2019

AbstractThe present study was conducted to evaluate the force distribution in knee joint during daily activities after open-wedge high tibial osteotomy (OWHTO). A three-dimensional proximal tibial finite element model (FEM) was created using Mimics software to evaluate computed tomography (CT) scans of the tibia after OWHTO. The anterior and posterior gaps were 7.0 and 12.1 mm, respectively, and the target opening angle was 12 degrees. The loading ratio of the medial and lateral tibial plateaus was 6:4. To evaluate force distribution in the knee joint during activities of daily living (ADLs) after OWHTO, peak von Mises stresses (PVMSs) were analyzed at the plate and posterolateral edge region of osteotomized tibia. ADLs associated with greater knee flexion (sitting 90 degrees, standing 90 degrees, bending 90 degrees, stepping up stairs 60 degrees, and stepping downstairs 30 and 60 degrees) yielded PVMSs ranging from 195.2 to 221.5 MPa at the posterolateral edge region. In particular, stepping downstairs with knee flexion to 60 degrees produced the highest PVMS (221.5 MPa), greater than the yield strength (100–200 MPa). The highest plate PVMS was greater than 300 MPa during ADLs associated with flexion angles of approximately 90 degrees. However, these values did not exceed the yield stress (760.0 MPa). Conclusively, higher force was generated during higher flexion associated with weight-bearing and stepping downstairs produced a high force (even at lower flexion) on the posterolateral area of the tibial plateau. Therefore, a caution should be exercised when engaging in knee flexion of approximately 90 degrees and stepping downstairs in the early postoperative period when patients follow a weight-bearing rehabilitation protocol. However, this study is based on modeling; further translational studies are needed prior to clinical application.
Macrophage Polarization is Deregulated in Haemophilia
Authors: Knowles Lynn , Kagiri Daniela , Bernard Martin , Schwarz Eva , Eichler Hermann , Pilch Jan 
Published: January 2019

AbstractMacrophages make important contributions to inflammation and wound healing. We show here that macrophage polarization is deregulated in haemophilia in response to macrophage colony-stimulating factor (M-CSF) and partially in response to granulocyte-macrophage colony-stimulating factor (GM-CSF). As a result, haemophilia macrophages exhibit a specific impairment of M-CSF-mediated functions involved in wound healing such as clot invasion and phagocytosis. Haemophilia monocytes express reduced amounts of the receptors for M-CSF and GM-CSF, which correlates with a failure to express tumour necrosis factor α (TNFα) and CD163 in M-CSF-treated haemophilia macrophages and reduced expression of TNFα and CD206 after treatment with GM-CSF. Protein expression in response to M-CSF was regained with respect to CD163 and CD206 after embedding haemophilia monocytes in clotted plasma suggesting that a functioning coagulation system has positive effects on macrophage M2 polarization. Mimicking the functional deficits of haemophilia macrophages in normal macrophages was possible by adding leptin, which we found to be elevated in the blood of haemophilia patients, to a monocyte cell line. The increase of leptin occurred in conjunction with C-reactive protein in a body mass index-controlled cohort suggesting that haemophilia patients harbour chronic low-grade inflammation. Together, our data indicate that impaired clotting in haemophilia patients leads to increased inflammation and a deregulation in macrophage differentiation, which may explain the commonly observed deficits in wound healing and tissue regeneration.
Results of a Phase II Study to Determine the Efficacy and Safety of Genetically Engineered Allogeneic Human Chondrocytes Expressing TGF-β1
Authors: Lee Bumsup , Parvizi Javad , Bramlet Dale , Romness David W. , Guermazi Ali , Noh Moon , Sodhi Nipun , Khlopas Anton , Mont Michael A. 
Published: January 2019

AbstractGenetically engineered chondrocytes virally transduced with a transforming growth factor (TGF)-β1 (TG-C [TissueGene-C]) expression vector have been shown to have potential benefits in the nonoperative management of knee osteoarthritis. Previous literature has reported on safe dosages of TG-C. Therefore, the purpose of this study was to evaluate the Phase II results and a 24-month efficacy of this injectable mixture compared with placebo in patients with Kellgren–Lawrence (K–L) grade III knee osteoarthritis. Specifically, we assessed (1) functional outcomes, (2) pain scores, (3) adverse events (AEs), and (4) magnetic resonance imaging (MRIs) findings. We performed a multicenter, double-blinded, placebo-controlled, and randomized study of adults who had K–L grade III knee osteoarthritis. A total of 102 patients were 2:1 randomized to TG-C at a dose of 3.0 × 107 cells, or placebo injections between May 1, 2011 and October 31, 2012. Outcomes analyzed were knee joint function, pain, quality of life, adverse events, and MRI findings using the whole-organ magnetic resonance imaging score (WORMS) system. There were significant improvements in the International Knee Documentation Committee (IKDC) and visual analogue scale (VAS) scores in the TG-C cohort, when compared with the placebo cohort at weeks 12, 52, 72, and 104 (p < 0.05). No severe AEs were observed. Common AEs were arthralgia, joint inflammation, and joint effusion which were similar between both cohorts. Whole-knee MRIs at 12 months showed less progression of cartilage damage, infrapatellar fat pad-synovitis, and effusion-synovitis in the TG-C cohort. Patients who received TG-C had significant improvements in IKDC and VAS scores. These patients also reported less severe and frequent pain. Additionally, fewer patients treated with TG-C showed progression of cartilage damage, as well as less progression of infrapatellar fat pad synovitis and effusion-synovitis. Furthermore, treatment with TG-C was generally well tolerated with minor AEs. Therefore, based on these results, TG-C appears to be a safe and effective modality for the management of K–L grade III osteoarthritis.
Chest X-Ray Not Routinely Indicated Prior to the YEARS Algorithm in the Diagnostic Management of Suspected Pulmonary Embolism
Authors: van der Pol Liselotte , Tromeur Cecile , Faber Laura , van der Hulle Tom , Kroft Lucia , Mairuhu Albert , de Roos Albert , Huisman Menno , Klok Frederikus 
Published: January 2019

Background The YEARS algorithm was designed to simplify the diagnostic process of suspected pulmonary embolism (PE) and to reduce the number of required computed tomography pulmonary angiography (CTPA) scans. Chest X-ray (CXR) is often used as initial imaging test in patients suspected for PE.
Aim To determine if CXR results differ between patients with confirmed PE and with PE ruled out, and to investigate whether CXR provides incremental diagnostic value to the YEARS criteria that is used for selecting patients with CTPA indication.
Methods This post-hoc analysis concerned 1,473 consecutive patients with suspected PE who were managed according to YEARS and were subjected to CXR as part of routine care. The prevalence and likelihood ratios of seven main CXR findings for a final diagnosis of PE were calculated.
Results A total of 214 patients were diagnosed with PE at baseline (15%). Abnormal CXR occurred more often in patients with confirmed PE (36%, 77/214) than in patients without PE (26%; 327/1,259), for an odds ratio of 1.60 (95% confidence interval: 1.18–2.18). Only the unexpected finding of a (rib)fracture or pneumothorax, present in as few as six patients (0.4%), significantly lowered the post-test probability of PE to an extent that CTPA could have been avoided.
Conclusion The incremental diagnostic value of CXR to the YEARS algorithm to rule out PE was limited. CXR was more frequently abnormal in patients with PE than in those in whom PE was ruled out. These data do not support to perform CXR routinely in all patients with suspected PE, prior to CTPA imaging.
Hypertrophic Cardiomyopathy in Patients with Atrial Fibrillation: Prevalence and Associated Stroke Risks in a Nationwide Cohort Study
Authors: Jung Hyunjean , Yang Pil-Sung , Sung Jung-Hoon , Jang Eunsun , Yu Hee , Kim Tae-Hoon , Uhm Jae-Sun , Kim Jong-Youn , Pak Hui-Nam , Lee Moon-Hyoung , Lip Gregory , Joung Boyoung 
Published: January 2019

Background There have been no prior nationwide reports on the prevalence of hypertrophic cardiomyopathy (HCM) among patients suffering from atrial fibrillation (AF). It is also unclear how much stroke risk is attributable to HCM compared with other stroke risks in patients with AF. This study assessed the prevalence of HCM among non-valvular AF (NVAF) patients and to assess the magnitude of increase in stroke risk in NVAF patients with HCM, compared with those without HCM.
Patients and Methods From the Korean National Health Insurance Service database from January 1, 2005 to December 31, 2016, we analysed 979,784 patients with prevalent NVAF aged 18 years or older.
Results The overall HCM prevalence in NVAF patients was 1.1%. Although HCM in these patients is an absolute indication for oral anticoagulant (OAC) prescription, only 1,622 (15.3%) patients were receiving OAC at the time of AF diagnosis. Among OAC-naïve patients with NVAF, compared with those without HCM, those with HCM had the increased risk of ischaemic stroke/systemic embolism with clinical variable adjusted hazard ratio of 1.55 (95% confidential interval, 1.48–1.63; p < 0.001). Ischaemic stroke/systemic embolism rate of NVAF patients with HCM without any non-gender CHA2DS2-VASc stroke risk factors was 4.02 per 100 person-years, and approached to that of NVAF patients without HCM with CHA2DS2-VASc score of 3 (4.07 per 100 person-years).
Conclusion Among all NVAF patients, 1.1% of patient has HCM. The risk of stroke in NVAF with HCM without any CHA2DS2-VASc stroke risk factors was similar to that of those patients without HCM with CHA2DS2-VASc score of 3. Despite this, the actual use of OACs among NVAF patients with HCM was sub-optimal, relative to their high stroke risk.
Microvascular Thrombosis and Ischaemic Limb Losses in Critically Ill Patients
Authors: Warkentin Theodore 
Published: January 2019

AbstractRelatively little scientific attention has been given to the small subset of critically ill patients with circulatory shock who develop ischaemic limb losses (symmetrical peripheral gangrene [SPG]). The clinical picture consists of acral (distal extremity) tissue necrosis involving lower limbs in a largely symmetrical fashion and with detectable arterial pulses; in one-third of patients the upper extremities are also affected (potential for four-limb amputations). The laboratory picture includes thrombocytopenia, coagulopathy, and normoblastemia (circulating nucleated red blood cells). The explanation for limb losses is microvascular thrombosis caused by disseminated intravascular coagulation usually secondary to cardiogenic or septic shock. A common myth is that vasopressors cause the ischaemic limb injury. However, the more likely explanation is failure of the natural anticoagulant systems (protein C and antithrombin) to downregulate thrombin generation in the microvasculature. This is because more than 90% of patients with SPG have preceding ‘shock liver’, which occurs 2 to 5 days (median, 3 days) prior to ischaemic limb injury, with impaired hepatic production of protein C and antithrombin.
Benign Paroxysmal Vertigo of Childhood
Authors: Pawar Vishal 
Published: January 2019

AbstractThe aim of the article is to describe a case of benign paroxysmal vertigo (BPV) in childhood. It emphasizes the fact that every dizziness is not vertigo and every vertigo is not benign paroxysmal positional vertigo. BPV in childhood often goes unrecognized. This case report aims at creating awareness about this benign and self-limiting disorder.
Osteopetrose
Authors: Kornak U. , Schulz A. 
Published: January 2019

ZusammenfassungUnter der Diagnose Osteopetrose wird eine heterogene Gruppe von seltenen monogenetischen Knochenerkrankungen zusammengefasst, die sich durch eine reduzierte Osteoklasten-Aktivität, eine gesteigerte Knochenmasse und eine gesteigerte Knochenbrüchigkeit auszeichnet. Die Osteopetrosen werden verursacht durch Mutationen in verschiedenen Genen, die in der Osteoklastogenese oder Osteoklasten-Funktion involviert sind. Durch den Verlust der Knochenresorption werden Knochenumbau und -neubildung beeinträchtigt, wodurch sich die Qualität und Architektur des Knochengewebes verschlechtert. Häufige klinische Zeichen sind Osteosklerose, Knochendeformitäten, hämatologische Insuffizienzen durch Verengung der Knochenmarkräume, Sehstörungen durch Verengung der Foramina nervi optici und andere neurologische Störungen. Bis auf eine X-chromosomale Form sind alle infantilen schweren Osteopetrosen autosomal rezessiv vererbt. Die rezessiven Formen verlaufen gewöhnlich ohne Behandlung tödlich im Säuglings- oder Kindesalter, wobei allerdings selten mildere klinische Verläufe als sog. Intermediäre Osteopetrose vorkommen. Die dominante Form ist assoziiert mit Mutationen im CLCN7-Gen und verläuft in der Regel milder. Die meisten schweren Osteopetrosen können durch eine allogene hämatopoetische Stammzelltransplantation (HSZT) behandelt werden, sofern sie Osteoklasten-autonome Ursachen haben und nicht mit einer primären neurologischen Komponente verbunden sind.
A Prospective Comparative Study between Dry and Wet Tympanoplasty
Authors: Pothala Hepsiba , Shukla Sunita , Khan Wasim , Ramalingam Ravi , Ramalingam Kombupalayam 
Published: January 2019

Abstract
Background Tympanoplasty is the well-established procedure for closure of perforations of tympanic membrane.
Study Design This study was a prospective comparative study.
Objective The objective of this study was to compare the hearing improvement and graft uptake rate between dry and wet tympanoplasty performed on tubotympanic type of chronic suppurative otitis media.
Materials and Methods One hundred forty patients with tubotympanic type of chronic otitis media were selected and categorized into dry and wet ears. Tympanoplasty was performed using temporalis fascia by underlay technique in all cases. Postoperatively, graft uptake rate and hearing improvement were analyzed.
Results The graft uptake rate was equal in both dry and wet ears, which was statistically insignificant. There was no statistically significant difference in the hearing improvement between the dry ears and wet ears (χ – 2.39, p = 0.122).
Conclusion Factors such as age, sex, and status of the contralateral ear and wet ear did not have any impact on the postoperative graft uptake of tympanoplasty. There was no difference in the graft uptake between the dry and wet ears and there was no statistically significant difference between hearing improvement in both and wet ears.
SMOFlipid Protects Preterm Neonates against Perinatal Nutrition–Associated Cholestasis
Authors: Kasirer Yair , Bin-Nun Alona , Raveh Ateret , Schorrs Irina , Mimouni Francis B. , Hammerman Cathy 
Published: January 2019

Objective Intravenous lipid infusions improve both short- and long-term outcomes of premature neonates. However, prolonged infusion of lipids has been implicated in the development of parenteral nutrition-associated cholestasis (PNAC). We speculated that the multicomponent SMOFlipid would be hepatoprotective against PNAC.
Study Design This is a retrospective review comparing the incidence and severity of direct hyperbilirubinemia in preterm infants <1,500 g who were hospitalized for a minimum of 2 weeks during a 20-month period in which all preterm infants on total parenteral nutrition (TPN) received fat as Lipofundin with the following 20-month period in which all preterm infants on TPN received SMOFlipid.
Results Infants in the SMOFlipid period had a lower incidence of PNAC (6 vs. 13%; p = 0.022), lower peak direct bilirubin levels (3.2 vs. 7.1 mg/dL; p = 0.018), and a shorter length of stay (51 vs. 60 days; p = 0.019). The relative risk of developing direct hyperbilirubinemia during the Lipofundin period was 2.22 (1.1–4.3) as compared with period 1; p = 0.018; NNT-14.
Conclusion SMOFlipid was hepatoprotective in our population of preterm neonates <1,500 g receiving long-term TPN as compared with those receiving Lipofundin, despite similar levels of exposure to both intravenous lipid load and duration in the two groups.
Deep Vein Thrombosis is Modulated by Inflammation Regulated via Sirtuin 1/NF-κB Signalling Pathway in a Rat Model
Authors: Yao Xiaolan , Chen Wenpei , Liu Jin , Liu Han , Zhan Janis , Guan Shixia , Lu Ziqi , Tang Ping , Li Peng , Lin Baoqin 
Published: January 2019

Background Inflammation plays an important role in thrombus formation, and Sirtuin 1 (SIRT1) negatively regulates inflammation via deacetylating nuclear factor-kappa B. However, the relationship between SIRT1-regulated inflammation and deep vein thrombosis (DVT) is still unknown.
Objective The aim of this study was to investigate whether SIRT1 plays a critical role in inferior vena cava (IVC) stenosis-induced DVT.
Materials and Methods Thrombus weight and histopathologic analysis of IVC were evaluated at different time points after IVC stenosis in rats. Serum levels of inflammatory cytokines and protein expressions of SIRT1, acetylated p65 (Ace-p65), phosphorylated p65 (p-p65) and tissue factor (TF) in thrombosed IVC were assessed. Besides, the effects of resveratrol (RES, a SIRT1 agonist) and EX527 (a selective SIRT1 inhibitor) on DVT were evaluated.
Results Thrombus weight was increased from 1 to 3 days after IVC stenosis, and then was decreased afterwards. Leukocytes infiltration appeared and serum levels of cytokines were significantly increased in rats of IVC stenosis. SIRT1 protein expression was significantly down-regulated at 1 hour and 1 day after stenosis, while p-p65, Ace-p65 and TF protein expressions appeared a contrary trend. RES reduced thrombus weight, leukocytes infiltration, levels of tumour necrosis factor-α and interleukin-1β and protein expressions of Ace-p65 and TF as well. Moreover, RES significantly increased the protein and messenger ribonucleic acid expressions of SIRT1, while EX527 abolished the protective effects of RES.
Conclusion SIRT1 activation attenuated IVC stenosis-induced DVT via anti-inflammation in rats. Therefore, SIRT1 may be a potential therapeutic target that could ameliorate DVT.
The “Dual-Plane” DIEP Flap: Measuring the Effects of Superficial Arterial and Venous Flow Augmentation on Clinical Outcomes
Authors: Sbitany Hani , Lentz Rachel , Piper Merisa 
Published: January 2019

Background Deep inferior epigastric perforator (DIEP) flaps are routinely elevated on a single dominant perforator from the deep epigastric vascular system. However, the single perforator may not always perfuse an entire flap adequately, particularly suprascarpal tissue. We often perform “dual-plane” single perforator DIEP flaps by rerouting the superficial (SIEA/V) system directly into a branch of the deep (DIEA/V) vascular system pedicle, thus allowing both systems to contribute and enhance flap perfusion.
Methods A prospectively collected database of patients undergoing microvascular breast reconstruction was reviewed for patients undergoing “dual-plane” DIEP flaps. These were matched to a similar cohort of patients undergoing “traditional” single perforator DIEP free flaps over the same time period. Treatment demographics and flap-specific morbidity outcomes were assessed, including performance in the setting of radiation.
Results Over 2 years, 23 “dual-plane” DIEP flaps were performed (15 patients), compared with 35 single-perforator “traditional” DIEP flaps (23 patients). Rates of delayed healing were similar between both cohorts (2.9 vs. 4.3%, p = 0.28). Rates of palpable fat necrosis were significantly lower in “dual-plane” DIEP flaps compared with “traditional” flaps (0 vs. 14.3%, p = 0.03). Rates of clinically palpable fat necrosis following radiation were significantly lower in the “dual-plane” flaps (4.3 vs. 40%, p = 0.02).
Conclusion The “dual-plane” DIEP flap is one we routinely consider in our algorithm, as it allows for full preservation of functional abdominal musculature, and offers enhanced flap perfusion by incorporating both the deep and superficial (dominant) vascular systems. This results in lower fat necrosis rates, particularly in the setting of post-reconstruction radiation.