bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stability of 21 Antihypertensive Drugs in Serum Collected in Standard (Nongel) Serum Tubes Versus Tubes Containing a Gel Separator
Authors: Hegstad Solfrid , Spigset Olav , Helland Arne 
Published: October 2019

Background:
Therapeutic drug monitoring of antihypertensive drugs is being increasingly used to optimize treatment and to assess nonadherence. Separator gels are often used in blood collection tubes to facilitate serum or plasma separation from other blood constituents before analyses. Drug adsorption into the separator gel presents a possible pre-analytical cause of falsely low concentrations or false negative results.

Methods:
Drug-free blood from blood donors was spiked with therapeutic concentrations of 21 antihypertensive drugs, transferred to serum tubes with and without separator gel (Vacuette gel plastic tubes and plain serum plastic tubes, respectively), and centrifuged. Serum was collected immediately after centrifugation and after 24 and 72 hours of room temperature storage, samples were analyzed in triplicates using liquid chromatography–mass spectrometry.

Results:
Serum samples collected immediately after centrifugation or 24 hours later, had the same drug concentrations in the gel and nongel tubes. After 72 hours of room temperature storage, verapamil and lercanidipine serum concentrations were 43% and 29%, respectively, lower in gel tubes than nongel tubes. Canrenone, diltiazem, and bendroflumethiazide showed between 10% and 20% concentration loss in gel tubes, compared with nongel tubes, with the 2 latter observed as unstable also in nongel tubes.

Conclusions:
Except for verapamil, lercanidipine, and canrenone, which showed substantial concentration loss in gel tubes, gel tubes may be used for therapeutic drug monitoring purposes for the most commonly used antihypertensive drugs. Transferring serum to gel-free containers immediately after centrifugation minimizes concentration loss; however, bendroflumethiazide and diltiazem are generally unstable at room temperature.
CHOROIDAL VASCULARITY INDEX AND CHOROIDAL THICKNESS IN EYES WITH RETICULAR PSEUDODRUSEN
Authors: Velaga Swetha B. , Nittala Muneeswar G. , Vupparaboina Kiran K. , Jana Soumya , Chhablani Jay , Haines Jonathan , Pericak-Vance Margaret A. , Stambolian Dwight , Sadda Srinivas R. 
Published: October 2019

Purpose:
To evaluate choroidal vascularity index (CVI), choroidal thickness, choroidal volume, and choroidal intensity in subjects with nonneovascular age-related macular degeneration (NNVAMD) with and without reticular pseudodrusen (RPD).

Methods:
We included 60 eyes of 35 subjects with NNVAMD (including 30 eyes of 18 subjects with RPD) and 30 eyes of 17 age-matched healthy individuals from the ongoing Amish Eye study. The choroid was segmented from dense volume spectral domain optical coherence tomography scans and choroidal thickness (microns), choroidal intensity (log units), and choroidal volume (mm3) from the entire macula (6 × 6 mm) were computed. A central horizontal B-scan was binarized and the luminal and stromal portions of the choroid were segmented. Choroidal vascularity index (%) was calculated as the ratio of luminal area to total choroid area. Choroidal parameters were compared between the groups by pairwise comparisons using the Student's t-test.

Results:
The CVI was significantly lower in healthy eyes compared to those with RPD (53.43 ± 8.51 vs. 54.76 ± 4.83, P < 0.001). The CVI was also significantly lower in NNVAMD eyes without RPD compared to those with RPD (50.09 ± 7.51 vs. 54.76 ± 4.83, P = 0.006). There was no difference in CVI between healthy eyes and NNVAMD eyes without RPD (P = 0.84). Choroidal thickness and choroidal volume were significantly higher in NNVAMD without RPD (P < 0.05); and significantly lower in NNVAMD with RPD (P < 0.05) when compared with normal eyes. Choroidal intensity was significantly higher in NNVAMD with RPD when compared with normal eyes (P = 0.02) and NNVAMD eyes without RPD (P = 0.001).

Conclusion:
Multiple choroidal parameters reflecting the status of the choroidal vasculature and stroma seem to be altered in eyes with RPD compared with both normal eyes and NNVAMD eyes without RPD. These findings may provide insights into the pathophysiology of RPD.
Contrasting Perspectives of Practice Leaders and Practice Facilitators May Be Common in Quality Improvement Initiatives
Authors: McHugh Megan , Brown Tiffany , Walunas Theresa L. , Liss David T. , Persell Stephen D. 
Published: October 2019

ABSTRACT
Practice facilitation is an approach for advancing quality improvement (QI), but its success depends on effective relationships and communication among participants. Our goal was to identify patterns of contrasting perspectives on implementation issues between practice leaders and their practice facilitators, and factors that may contribute to them. We conducted individual interviews with practice leaders and the practice facilitators assigned to them as part of a program focused on preventive cardiology within primary care practices. We used summative content analysis to quantify the incidence of contrasting perspectives, and bivariate and qualitative analyses to explore relationships between contrasting perspectives and contextual factors. Among the 16 dyads, contrasting perspectives commonly related to the easiest or hardest QI interventions to implement (8 of 16 dyads) and the practice's success implementing interventions (5 of 16 dyads). There was a nonsignificant, inverse correlation (r = −0.19, p = .47) between the number of in-person QI visits from the facilitator and the total number of contrasting perspectives. Turnover of staff was frequently reported in dyads with contrasting perspectives. Although the impact of contrasting perspectives warrants additional study, planners of QI initiatives using practice facilitation should consider taking steps to minimize contrasting perspectives, or the potential adverse consequences of them, by addressing turnover challenges and encouraging opportunities to share perspectives.
Reasons for early discontinuing or switching of antiplatelet therapy in elderly patients after acute coronary syndrome
Authors: Gimbel Marieke E. , Vos Gerrit J. A. , Nguyen Thuc A. , Kelder Johannes C. , ten Berg Jurriën M. 
Published: October 2019

Objective
This study aims to determine frequency and reasons for prematurely discontinuing or switching antiplatelet therapy in elderly patients admitted with non-ST-elevation acute coronary syndrome (NSTE-ACS).

Method
Patients of 75 years or older admitted with suspected NSTE-ACS were included between 2013 and 2016. Information was extracted from the patients’ medical files.

Results
A total of 544 patients were included, 17.3% discontinued aspirin within one year, predominantly (57%) within 30 days. The most common reason was the start of a (non-vitamin-K) oral anticoagulant [(N)OAC], either combined with a P2Y12-inhibitor (43%) or as monotherapy (16%). The P2Y12-inhibitor was discontinued in 31.2% of patients within one year, of which 46% within 30 days. The most common reason was undergoing coronary artery bypass grafting (CABG; 22%). Switching of clopidogrel seldom occurred; however, ticagrelor was switched in 50/179 patients mainly due to dyspnoea (42%). Independent predictors for prematurely discontinuing antiplatelet therapy were undergoing CABG [odds ratio (OR) 3.257 (95% confidence interval [CI] 1.836–5.779)], need for (N)OAC [OR 2.167 (95% CI 1.423–3.300)] and type II ACS as final diagnosis [OR 3.793 (95% CI 1.721–8.361)]. Undergoing percutaneous coronary intervention [OR 0.393 (95% CI 0.243–0.634)] and use of clopidogrel [OR 0.441(95% CI 0.293–0.662)] were independent predictors of continuing antiplatelet therapy.

Conclusion
In elderly patients of at least 75 years with NSTE-ACS, antiplatelet therapy is frequently discontinued prematurely, most often within 30 days. Main reasons for discontinuing are need for (N)OAC, undergoing CABG or type II ACS as final diagnosis and suffering from dyspnoea while on ticagrelor.
Technetium-99m-dimercaptosuccinic acid renal scintigraphy and single photon emission computed tomography/computed tomography in patients with sickle cell disease
Authors: Ramos Celso Dario , Onusic Daniel Massaro , Brunetto Sergio Querino , Amorim Bárbara Juarez , Souza Thiago Ferreira , Saad Sara Teresinha Olalla , Lima Mariana da Cunha Lopes 
Published: October 2019

Purpose
Sickle cell disease (SCD) is a common hematologic hereditary disorder characterized by vaso-occlusive episodes affecting multiple organs, and substantially alters renal structure and function. We aimed to evaluate the utility of renal scintigraphy and single photon emission computed tomography/computed tomography (SPECT/CT) with technetium-99m-dimercaptosuccinic acid (99mTc-DMSA) in adult patients with SCD and no clinical evidence of renal insufficiency.

Materials and methods
Twenty-six patients (16 female) aged 23–58 years with SCD and no clinical evidence of renal insufficiency were prospectively studied. Planar and SPECT/CT images were, respectively, obtained after 3 and 4 hours of the injection of 110–180 MBq of 99mTc-DMSA. The relative radiopharmaceutical uptake and renal length were, respectively, determined using SPECT and CT images. Planar and SPECT/CT images were visually analyzed to identify focal areas of 99mTc-DMSA reduced uptake and anatomical deformities of the kidneys.

Results
Focal areas of reduced 99mTc-DMSA uptake with an image aspect of renal scars or inflammation were present in 21/26 patients (81%). In 11/21 (52%) of these patients, the cortical lesions were clearly identified only on SPECT images. Prominent renal columns were observed in 17/26 (65%) patients. The left kidney tended to be more affected than the right kidney. Most patients had enlarged kidneys.

Conclusion

99mTc-DMSA scintigraphy and SPECT/CT identify renal lesions possible related to renal infarcts or infections in most adult patients with SCD and no clinical evidence of renal insufficiency. Prominent renal columns and increased renal size tend to occur in most of these patients.
Comparison of glomerular filtration rates determined using two- and single-blood sample methods with a three-blood sample technique for 2922 paediatric studies
Authors: Bibbo Giovanni , Munn Catherine , Kirkwood Ian 
Published: October 2019

Objective
Several different methods for measuring glomerular filtration rates (GFRs) have been developed in search of a more accurate and simplified technique. Currently, the main methods used are the slope-intercept and distribution volume techniques. In this work, 2922 GFR studies have been retrospectively reanalysed as two- and single-blood sample methods and compared with the three-blood sample data.

Patients and Methods
Paediatric GFR data from 1/1/1993 to 4/12/2018 using the three-blood sample technique have been reanalysed as two- and single-blood sample methods. The timing of blood sampling was also reviewed.

Results
Both the two- and the single-sample methods provide accurate estimates of GFR in children for all levels of renal function provided that the blood samples are collected at the appropriate times post administration of the tracer. For the highest accuracy, blood for the two-blood samples method should be collected at 2 and 4 h and at 2 h for the single-blood sample method. The relationship between renal clearance and the 2-h volume of distribution (V120) is linear with a line of best fit: GFR (ml/min) = 3.108 × V
120 − 2.557.

Conclusion
Both the two- and the single-sample techniques can be used to measure GFR in children with the same accuracy as the three-blood sample. With the collection of only a single-blood sample, there are benefits to all involved: patients, families, and nuclear medicine personnel. In addition, institutions have a choice as to which technique to use and for which patients.
Current Practices and Novel Techniques in the Diagnosis and Management of Neuroendocrine Tumors of Unknown Primary
Authors: Hendifar Andrew E. , Ramirez Robert A. , Anthony Lowell B. , Liu Eric 
Published: October 2019

Abstract
Neuroendocrine tumors (NETs) comprise a heterogeneous group of neoplasms in which tumor staging/prognosis and response to treatments depend heavily on accurate and timely identification of the anatomic primary site or NET subtype. Despite recent technological advancements and use of multiple diagnostic modalities, 10% to 14% of newly diagnosed NETs are not fully characterized based on subtype or anatomic primary site. Inability to fully characterize NETs of unknown primary may cause delays in surgical intervention and limit potential treatment options. To address this unmet need, clinical validity and utility are being demonstrated for novel approaches that improve NET subtype or anatomic primary site identification. Functional imaging using 68Ga-radiolabeled DOTATATE positron emission tomography/computed tomography has been shown to overcome some false-positive and resolution issues associated with octreotide scanning and computed tomography/magnetic resonance imaging. Using a genomic approach, molecular tumor classification based on differential gene expression has demonstrated high diagnostic accuracy in blinded validation studies of different NET types and subtypes. Given the widespread availability of these technologies, we propose an algorithm for the workup of NETs of unknown primary that integrates these approaches. Including these technologies in the standard workup will lead to better NET subtype identification and improved treatment optimization for patients.
Combined Antiangiogenic Therapy and Immunotherapy Is Effective for Pancreatic Cancer With Mismatch Repair Proficiency but High Tumor Mutation Burden
Authors: Chen Mengni , Yang Shengli , Fan Li , Wu Lu , Chen Renwang , Chang Jian , Hu Jianli 
Published: October 2019

Abstract
Immunotherapy has been recommended as a second-line treatment only for high microsatellite instability or DNA mismatch repair deficiency advanced pancreatic cancer in National Comprehensive Cancer Network guidelines. Here, we report a case with a good response to immunotherapy in pancreatic cancer with mismatch repair proficiency. A 55-year-old woman diagnosed with pancreatic cancer cT4N1M1 (liver, lung) who harbored ERBB2 mutations with high tumor mutation burden (TMB) underwent multiple therapies and survived 19 months. A partial response in pancreatic cancer was observed when the patient was treated with combined antiangiogenic therapy and immunotherapy after a series of ineffective treatments. Neutrophil-to-lymphocyte ratio (NLR), a predictive marker of efficacy of immunotherapy, confirmed that immunotherapy resulted in the partial response in pancreatic cancer. To our knowledge, this is the first to report advanced pancreatic cancer with mismatch repair proficiency had a good response to immunotherapy, and this is the first to report an association between high blood-based TMB or NLR and improved clinical outcomes in pancreatic cancer. Therefore, TMB may also be a biomarker for immunotherapy of pancreatic cancer, and NLR may be a prospective predictive marker for efficacy of immunotherapy in pancreatic cancer.
Vasoactive Intestinal Peptide–Secreting Tumors
Authors: Siddappa Pradeep Kumar , Vege Santhi Swaroop 
Published: October 2019

Abstract
Vasoactive intestinal peptide–secreting tumors (VIPomas) are a group of rare neuroendocrine tumors, which cause a typical syndrome of watery diarrhea. Most of these tumors are found in the pancreas and are usually detected at a later stage. Although curative resection is not possible in most of these tumors, both symptom and tumor control can be achieved by a multidimensional approach, to enable a long survival of most patients. There are no clear-cut guidelines for the management of VIPomas because of the rarity of this neoplasm and lack of prospective data. In this review, we discuss the available evidence on the clinical features and management of these rare tumors.
Health and Disability Among Young Black Men
Authors: Ricks Tiffany N. , Frederick Angela , Harrison Tracie 
Published: October 2019

Background
Black men experience the highest rate of disability compared to White, Asian, and Hispanic men. Yet, we know little about how Black men with disabilities experience the embodiment of their gender, race, social class, and disability positionalities and how they draw from their cultural backgrounds as they engage in health-seeking behaviors.

Objectives
The purpose of this study was to explore how young Black men experienced the onset of chronic disabling conditions while negotiating health-promoting activities in the context of gender, race, social class, disability positionalities, and culture.

Methods
This descriptive study used hermeneutic phenomenology to achieve study objectives. This study’s research questions were answered using audiotaped, one-on-one qualitative interviews, along with detailed field notes. Each participant was interviewed twice at a mutually decided upon location to ensure their privacy and comfort.

Results
In relation to their embodied interactions of self in the context of disability, these men described their health-related decisions using four themes: maintaining manhood, economic constraints, the “risk” of healthcare, and health promotion.

Conclusions
By examining the experiences of young adult Black men living with disabilities, knowledge of their perspectives and experiences at earlier stages in their life course contributes to the understanding of their personal challenges, health needs, and their perspectives of health-promoting strategies.
Frequency and Identification of Risk Factors of Uveitis in Juvenile Idiopathic Arthritis
Authors: Conti Giovanni , Chirico Valeria , Porcaro Federica , Fede Claudia , Vitale Agata , Fede Antonio , Castagna Irene , Fede Carmelo 
Published: October 2019

Background
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood. The JIA–associated uveitis represents the most common extra-articular manifestation.

Objectives
The main aim of this study was to evaluate frequency and risk factors of uveitis in a pediatric population affected by JIA.

Methods
One hundred eight Italian children with JIA were followed during a follow-up period of 13 years. Association between uveitis, antinuclear antibodies (ANAs), and subtype of arthritis has been estimated, and Kaplan-Meier curves were generated to assess the probability of ocular complications during the follow-up period.

Results
Twenty-one patients developed uveitis, after 96.5 ± 50.4 months from the enrollment. According to JIA subtypes, the oligoarthritis subtype was characterized by the highest prevalence (39%) of uveitis. The greatest risk of uveitis has been detected in oligoarthritis patients associated to ANA positivity (risk ratio, 8.6; 95% confidence interval, 2.27–32.9; χ2 = 20.4), whereas the worst evolution was revealed in patients with oligoarthritis and high levels of ANAs, with a progression time of 36 months (log-rank χ2 = 16.39; p < 0.0001; risk ratio, 18; 95% confidence interval, 7.3–44.2).

Conclusions
Patients with early-onset ANA-positive oligoarticular JIA have the highest risk of developing uveitis. A routine ophthalmological follow-up is required at regular intervals, even though the joint disease is clinically quiescent.
Nontraumatic Subperiosteal Orbital Hematoma in a Patient With Behcet Disease
Authors: Seo Ji Won , Kim Eung Hyun , Han So-Eun 
Published: October 2019

Abstract
Orbital subperiosteal hematomas are commonly caused by facial trauma. Nontraumatic subperiosteal orbital hematomas (NTSOHs) are rare but may occur in patients with underlying medical diseases. A 71-year-old woman presented to the emergency department with a 5-day history of left periorbital pain and proptosis. She was known to have Behcet disease and presented with no recent trauma. Clinical features and computed tomography findings aided in establishing the diagnosis of an NTSOH. The hematoma was evacuated via sub brow incision. After surgery, the patient's clinical symptoms resolved and did not recur during the 12-month follow-up period. On the basis of the findings of this case, the authors conclude that patients diagnosed with diseases such as bleeding disorders or autoimmune vasculitis should consider visual symptoms as a sign of an NTSOH. Patients who diagnosed with disease experience visual disturbance, periorbital pain, or periorbital swelling should undergo early surgical treatment for spontaneous NTSOH to avoid permanent visual loss.
A Rarely Seen Mass of Nasal Cavity: Seromucinous Hamartoma
Authors: Şahin Bayram , Sönmez Said , Kara Hakan , Aydemir Levent , Çomoğlu Şenol 
Published: October 2019

Abstract
Seromucinous hamartoma (SH) is a rarely seen benign polypoid mass of the sinonasal tract. Although the most common presentation symptom is nasal obstruction, most of the patients are asymptomatic. In this paper, the authors present an additional case of SH and discuss its differential diagnosis. A 34-year-old male patient presented with progressive nasal obstruction and serous nasal discharge for several months. A well-defined polypoid mass was detected in the left nasal cavity during the endoscopic assessment. Preoperative biopsy was reported as benign polypoid lesion. The mass was resected via transnasal endoscopic approach and final pathological examination was notified as SH.
The SH is an uncommon tumor, originates from nasal septum in the most cases and presents as a well-circumscribed polypoid mass. Radiological imaging modalities and biopsy should be performed to distinguish from the sinonasal malignancies. Complete surgical excision is recommended treatment and recurrence is almost never.