bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Lifestyle Intervention on Physiological Outcomes in Chinese Adults With, or at High Risk of, Metabolic Syndrome
Authors: Lo Sally Wai Sze , Chair Sek Ying , Lee Iris Fung Kam 
Published: January 2017

Background:
Metabolic syndrome (MS) increases the risk of cardiovascular events and the development of diabetes. This article reports the effects of lifestyle intervention on the physiological outcomes of people with or at high risk of MS in the community setting of Hong Kong.

Methods:
Chinese adults with 2 or more MS components were recruited from 13 community centers, which were cluster-randomized to the intervention or control group. The intervention group received a low-intensity lifestyle intervention program for people with MS consisting of group sessions, individual counseling, and telephone follow-ups over 3 months. The control group received standard care plus an attention placebo. The primary outcomes were body weight and waist circumference, whereas the secondary outcomes included blood pressure, lipids, glucose, and number of MS components. Linear mixed-effects models were used to compare the effects of the program between the 2 groups.

Results:
The final sample consisted of 183 adults (19.1% male) with a mean (SD) age of 54.0 (7.8) years. At 3 months, overall MS prevalence was reduced to 13.8%. Compared with the control group, subjects in the intervention group exhibited a reduced waist circumference (β = −.146, P = .008) when the interaction effects of time and group were considered simultaneously. However, no significant differences were found for changes in the other measured outcomes.

Conclusion:
A low-intensity lifestyle intervention program for people with MS can reduce central obesity among people with or at high risk for MS. Further research is necessary to confirm the long-term physiological effects of the intervention.
The Impact of Self-management Knowledge and Support on the Relationships Among Self-efficacy, Patient Activation, and Self-management in Rural Patients With Heart Failure
Authors: Young Lufei , Kupzyk Kevin , Barnason Susan 
Published: January 2017

Background:
Self-management (SM) is an essential component of heart failure (HF) management. The mechanisms to improve SM behaviors are unclear.

Objective:
The objective of this study is to examine whether patient activation mediates the effect of self-efficacy on SM behaviors in rural HF patients.

Methods:
A secondary analysis was conducted using data collected from a randomized controlled trial aimed to improve SM behaviors. The main variables included were SM knowledge, self-efficacy, patient activation, and SM behaviors.

Results:
Mediation analysis showed patient activation mediated the effect of self-efficacy on SM. Both self-efficacy and patient activation were significantly related to SM behaviors, respectively (r = 0.46, P < .001; β = .48, P = .001). However, self-efficacy was no longer directly related to SM behaviors when patient activation was entered into the final model (β = .17, P = .248). Self-management knowledge and support were significant moderators. In patients with high levels of SM knowledge, patient activation did not mediate the effect of self-efficacy on SM behaviors (β = .15, P = .47). When SM support was entered in the path model, patient activation was not a significant mediator between self-efficacy and SM behavior at high (β = .27, P = .27) or low (β = .27, P = .25) levels of SM support.

Conclusions:
Study findings suggest that targeted SM support for high-risk HF patients with low SM knowledge and support may be useful. In addition, strategies to increase patient activation may improve HF patients’ SM confidence.
Lack of Evidence to Support the Beneficial Role of Intratympanic Dexamethasone Injection in Acute Peripheral Facial Palsy
Authors: Kim Su Jin , Lee Jun , Lee Ho Yun 
Published: January 2017

Objectives:
Adjunctive intratympanic dexamethasone injection (IT-DEX) has been used for the treatment of acute peripheral facial palsy (APFP). However, there are controversies regarding the validity of this treatment. In this study, we aimed to verify the feasibility of IT-DEX treatment for APFP.

Study Design:
Retrospective cohort study.

Setting:
Local university hospital.

Patients and Methods:
Data of patients treated for APFP between 2015 and 2018, and whose follow-up records for more than 3 months were available, were collected and analyzed based on whether adjuvant IT-DEX was administered.

Main Outcome Measures:
House–Brackmann grading at the initial visit, and at 2, 6, and 10 to 16 weeks after discharge. Patients with House–Brackmann I at any time point were regarded as having complete recovery (CR).

Results:
A total of 108 patients [57 men, 51 women; mean age, 48 ± 15.67 yr (range: 18–85 yr)] were enrolled in the study. Adjunctive IT-DEX was administered to 41.7% (n = 45) of patients during hospitalization. CR was observed in 71.7% of IT-DEX-treated patients; however, it was not significantly different from the conventional treatment group (79.4%) (p > 0.05). Multiple regression analysis revealed that better facial grade at week 2 [EXP(B) = 7.407, 95% CI = 1.828–30.303, p = 0.005] was significantly associated with CR. However, the number of IT-DEX treatment sessions was not a significant prognostic factor for predicting CR.

Conclusion:
Additional beneficial treatment effect was not observed with adjuvant IT-DEX. Thus, the use of IT-DEX for APFP should be reconsidered until scientific evidence for the basis of its use is established.
Delayed Vestibular Schwannoma Regrowth Following Shrinkage After Stereotactic Radiosurgery: Implication for Life-Long Surveillance
Authors: Stapleton Emma , Crowther John A. , Locke Richard , Kontorinis Georgios 
Published: January 2017

Objective:
To enhance understanding of the behavior of vestibular schwannomas (VS) after stereotactic radiosurgery (SRS), including the potential for late tumor regrowth, and the need for lifelong radiological and clinical surveillance.

Patients:
From a total of 540 patients with VS and out of 95 patients receiving SRS for their growing VS, the cases of two women patients aged 58 and 59 years with medium sized, growing VS are presented.

Intervention:
Both patients were treated with SRS. Following treatment, both patients had close clinical follow-up and serial magnetic resonance imaging (MRI).

Main Outcome Measures:
Post-SRS clinical assessment and serial MRI to determine VS size and respond to treatment.

Results:
Close clinical follow-up after SRS identified no change in symptoms in one patient; the other developed ipsilateral facial nerve twitching without weakness. Serial MRI identified that in both patients, VS that had initially decreased in size following SRS, exhibited significant late regrowth after a 3-year period, reaching the pretreatment size.

Conclusions:
This is the first report of late vestibular schwannoma regrowth following a period of significant shrinkage after SRS. Potential reason may be the presence of living cells within the tumor; the possibility of malignant transformation should also be taken into account. Following SRS, patients with VS warrant lifelong radiological and clinical surveillance, even following good response, as there seems to be a small chance of initial regression followed by further growth. Microsurgery for tumor removal and histological diagnosis is indicated in such cases.
First Report: Linear Incision for Placement of a Magnetically Coupled Bone-Anchored Hearing Implant
Authors: Barry Jonnae Y. , Reghunathan Saranya , Jacob Abraham 
Published: January 2017

Objectives:
Discuss use of a linear incision for placement of a magnetically coupled bone anchored hearing implant.

Methods:
Case series.

Results:
Two patients underwent placement of magnetically coupled bone-anchored hearing implants (BAHI) through linear incisions. The first, a 40-year-old female with congenital single-sided deafness, previously had successful implantation of a percutaneous bone anchored hearing implant through a linear incision; unfortunately, she developed pain and intermittent drainage at her abutment site with time, resulting in a request for removal of her device. As an alternative to complete removal, we offered to replace the percutaneous implant with a magnetically coupled BAHI, employing the same linear incision previously. The second patient, a 53-year-old obese female with limited neck mobility and mixed hearing loss, underwent primary placement of a magnetically coupled BAHI through a linear incision. Limitations in neck mobility and patient body habitus precluded use of a traditional C-shaped incision. Both patients underwent surgery successfully, healed without incident, had their devices activated 6 weeks after their procedures, and are able to wear their implants more than 8 hours per day without discomfort.

Conclusion:
Surgical techniques for bone-anchored implants continue to evolve. Though manufacturers of magnetically coupled devices recommend using C-shaped incisions with large skin flaps, our first reported cases suggest that a small linear incision immediately overlying the implant magnet may be an acceptable alternative. Potential benefits include a smaller incision, less hair removal, smaller flap, decreased surgical time, and less postoperative pain.
Cochlear Nerve Deficiency and Brain Abnormalities in Pediatric Patients
Authors: Morlet Thierry , Pazuniak Markian , O’Reilly Robert C. , Kandula Vinay , Choudhary Arabinda K. 
Published: January 2017

Hypothesis:
To investigate the intracranial abnormalities present in children with cochlear nerve deficiency (CND), including abnormalities of other cranial nerves, and to describe their auditory abilities.

Background:
The prevalence of CND has increased with the development of high resolution magnetic resonance imaging (MRI). There are varying degrees of CND from true aplasia to hypoplasia. The etiology of CND remains unclear and it may be associated with intracranial abnormalities in some instances. CND needs to be identified as early as possible to ensure prompt and adequate management of hearing loss since hearing aids and cochlear implants may not be an option.

Methods:
A retrospective chart review of 56 ears of pediatric patients with CND was conducted between August 2006 and November 2014 at a tertiary care pediatric hospital.

Results:
27.6% of children had cochlear abnormalities and 48.9.8% had concomitant vestibular anomalies. Five patients had absent or abnormal facial nerves and two patients had aplastic bilateral olfactory nerves. In the 27 ears with an absent nerve that were functionally tested, eight (29.6%) had partial hearing which indicates the presence of an extremely small nerve whose size is below the limits of spatial resolution of the MRI.

Conclusion:
MRI is becoming the initial imaging choice for children with sensorineural hearing loss to identify CND and other brain anomalies. Concomitant vestibular and cochlear abnormalities were observed in respectively half and one-third of the pediatric patients with CND. The incidence of vestibular malformation suggests that balance testing should be recommended for most if not all CND patients.
Endoscopic Management of Middle Ear Paragangliomas: A Case Series
Authors: Killeen Daniel E. , Wick Cameron C. , Hunter Jacob B. , Rivas Alejandro , Wanna George B. , Nogueira João Flávio , Kutz Joe Walter , Isaacson Brandon 
Published: January 2017

Objective:
To investigate the efficacy and safety of endoscopic middle ear paraganglioma (glomus tympanicum) resection.

Study Design:
Case series with chart review.

Setting:
Multi-institutional tertiary university medical centers.

Patients:
Adult patients with middle ear paragangliomas treated via a transcanal endoscopic approach from 1/2012 to 11/2015.

Intervention:
All tumors were initially approached via a transcanal endoscopic technique. An operating microscope was used only if the tumor could not be adequately visualized or resected with endoscopic techniques alone.

Main Outcome Measures:
The main outcome was completeness of tumor resection via the endoscopic technique. Secondary measures were resolution of pulsatile tinnitus, audiometric outcomes, surgical duration, and surgical complications.

Results:
Endoscopic resection was attempted on 14 middle ear paragangliomas. Thirteen patients (93%) were women with a mean age of 61.6 years. The mean tumor size was 6.2 mm (SD, 3.3). Eleven cases (79%) had complete resection via an exclusive endoscopic approach. The mean surgical duration was 108.1 minutes (SD, 55.6). One case required use of an operating microscope via a transcanal route and two cases required postauricular incisions with mastoidectomy. There were no significant postoperative complications. Two patients (14%) had tympanic membrane perforations repaired intraoperatively without residual perforation on follow-up. All patients had normal postoperative facial nerve function. Pulsatile tinnitus resolved after surgery in all 13 patients who presented with this symptom preoperatively. The mean pure-tone average improved by 5.9 dB (SD, 4.6) after surgery.

Conclusions:
Endoscopic management of middle ear paraganglioma is safe, feasible, and effective.
Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease
Authors: Suskind David L. , Cohen Stanley A. , Brittnacher Mitchell J. , Wahbeh Ghassan , Lee Dale , Shaffer Michele L. , Braly Kimberly , Hayden Hillary S. , Klein Jani , Gold Benjamin , Giefer Matthew , Stallworth Angela , Miller Samuel I. 
Published: January 2017

Goal:
To determine the effect of the specific carbohydrate diet (SCD) on active inflammatory bowel disease (IBD).

Background:
IBD is a chronic idiopathic inflammatory intestinal disorder associated with fecal dysbiosis. Diet is a potential therapeutic option for IBD based on the hypothesis that changing the fecal dysbiosis could decrease intestinal inflammation.

Study:
Pediatric patients with mild to moderate IBD defined by pediatric Crohn’s disease activity index (PCDAI 10-45) or pediatric ulcerative colitis activity index (PUCAI 10-65) were enrolled into a prospective study of the SCD. Patients started SCD with follow-up evaluations at 2, 4, 8, and 12 weeks. PCDAI/PUCAI, laboratory studies were assessed.

Results:
Twelve patients, ages 10 to 17 years, were enrolled. Mean PCDAI decreased from 28.1±8.8 to 4.6±10.3 at 12 weeks. Mean PUCAI decreased from 28.3±23.1 to 6.7±11.6 at 12 weeks. Dietary therapy was ineffective for 2 patients while 2 individuals were unable to maintain the diet. Mean C-reactive protein decreased from 24.1±22.3 to 7.1±0.4 mg/L at 12 weeks in Seattle Cohort (nL<8.0 mg/L) and decreased from 20.7±10.9 to 4.8±4.5 mg/L at 12 weeks in Atlanta Cohort (nL<4.9 mg/L). Stool microbiome analysis showed a distinctive dysbiosis for each individual in most prediet microbiomes with significant changes in microbial composition after dietary change.

Conclusions:
SCD therapy in IBD is associated with clinical and laboratory improvements as well as concomitant changes in the fecal microbiome. Further prospective studies are required to fully assess the safety and efficacy of dietary therapy in patients with IBD.
Depression but Not Symptom Severity is Associated With Work and School Absenteeism in Refractory Chronic Constipation
Authors: Staller Kyle , Barshop Kenneth , Kuo Braden , Ananthakrishnan Ashwin N. 
Published: January 2017

Goals:
We sought to determine the patient characteristics associated with increased absenteeism and Emergency Department (ED) utilization among patients with constipation.

Background:
Chronic constipation is associated with significant direct and indirect economic costs. There has been limited study of the predictors of direct and indirect costs in a population with refractory constipation.

Study:
We conducted a cross-sectional cohort study of patients with chronic constipation who presented to a tertiary care center for anorectal manometry. We used standardized instruments to assess disease severity, quality of life, somatization, and psychiatric comorbidities. We used multivariable logistic regression to determine the predictors of work and school absenteeism as well as ED visits for constipation.

Results:
There were 148 consecutive patients enrolled (87% female, mean age 43) of whom 32 (21.6%) had high absenteeism and 36 (24.3%) visited the ED for constipation in the past year. Patients with high absenteeism and ED visits were more likely to be depressed (56.3% vs. 18.5%, P<0.0001 for high absenteeism; 47.2% vs. 19.6%, P<0.01 for ED visits). After multivariable adjustment and sensitivity analyses, only depression (OR, 4.41; P<0.01) was associated with increased absenteeism while there was a trend toward an association between depression and ED visits (OR, 2.57; P=0.067). Symptom severity was not associated with high absenteeism or ED utilization.

Conclusions:
Among patients with chronic constipation, depression is a stronger predictor of absenteeism than symptom severity. Depression may drive a portion of the indirect costs of chronic constipation.
Endoscopic Stenting for Colorectal Cancer
Authors: Fiori Enrico , Lamazza Antonietta , Sterpetti Antonio V. , Schillaci Alberto 
Published: January 2017

Goal:
The aim of our prospective study was to analyze the results of endoscopic stenting to treat obstruction due to colorectal cancer and complications after colorectal resection for cancer.

Background:
Endoscopic stenting for obstructing colorectal cancer has become a common place in clinical practice. However, there is a 2% to 5% risk of bowel perforation, and a percentage of technical failure of 2% to 10%.

Materials and Methods:
In a 15-year period (August, 1999 to December, 2013), 153 patients with colorectal cancer had endoscopic placement of a self-expandable metal stent for treatment of an obstructing colorectal cancer (133 patients) or for treatment of complications after colorectal resection for cancer (20 patients). They were prospectively evaluated in a database and they form the basis of this report.

Results:
There was no case of mortality or major morbidity. Overall technical success was 94.8%. After introducing the use of a pediatric nasogastroscope to pass the obstruction (71 patients), technical success was 100%. Complications in patients in whom the stent was left in place during the follow-up were frequent, requiring a close observation. We had 20 patients with fecal obstruction, 4 cases of stent dislodgment, and 8 cases of obstruction from ingrowth of the tumor. All patients were treated successfully endoscopically.

Conclusions:
Placement of self-expandable metal stents represents a valid technique. A proper training is required.
Acoustic radiation force impulse elastography: comparison and combination with other noninvasive tests for the diagnosis of compensated liver cirrhosis
Authors: Pfeifer Lukas , Adler Werner , Zopf Steffen , Siebler Jürgen , Wildner Dane , Goertz Ruediger S. , Schellhaas Barbara , Neurath Markus F. , Strobel Deike 
Published: January 2017

Background and aims
The aim of this study was to compare acoustic radiation force impulse (ARFI) elastography with other noninvasive tests and to develop a new score for the assessment of liver fibrosis/cirrhosis.

Materials and methods
B-mode ultrasound (including high-frequency liver surface evaluation), routine blood tests, ARFI quantification, and mini-laparoscopic liver evaluation were obtained in compensated patients scheduled for mini-laparoscopic biopsy. Our new cirrhosis score (CS) for the assessment of liver cirrhosis, based on a linear combination of ARFI, platelet (PLT), liver surface, and prothrombin index (PI), was calculated by linear discriminant analysis. Its performance was compared with ARFI-elastography, APRI, FIB-4, alanine aminotransferase (ALT)/aspartate aminotransferase (AST)-ratio, PLT, and PI. For the diagnosis of cirrhosis, a combined gold standard (cirrhosis at histology and/or at macroscopic liver evaluation) was used.

Results
In total, 171 patients, of whom 38 had compensated cirrhosis, were included. The CS was significantly better for the diagnosis of cirrhosis compared with ARFI (P=0.028), APRI (P=0.012), PLTs (P=0.013), PI (P=0.025), and ALT/AST ratio (P=0.001), but not the FIB-4 score (P=0.207), with an area under the receiver operating characteristic curve of 0.92 [95% confidence interval (CI): 0.87–0.97], 0.86 (95% CI:0.79–0.93), 0.80 (95% CI: 0.72–0.87), 0.79 (95% CI: 0.7–0.87), 0.81 (95% CI: 0.73–0.89), 0.72 (95% CI:0.64–0.81), and 0.86 (95% CI: 0.8–0.93), respectively. Sensitivity, specificity, positive predictive value, and negative predictive value for CS were 87%, 86%, 63%, and 96%, respectively. The FIB-4 score was significantly superior to the APRI score (P=0.041) and the ALT/AST ratio (P=0.011), with no significant difference from ARFI elastography (P=0.88) for the diagnosis of cirrhosis.

Conclusion
Combining ARFI elastography with other noninvasive tests that are used routinely in the workup of patients with suspected liver disease can improve diagnostic accuracy for compensated liver cirrhosis as compared with ARFI elastography alone. The FIB-4 score showed an overall comparable diagnostic accuracy to ARFI-elastography for compensated cirrhosis.
ATP-citrate lyase: genetics, molecular biology and therapeutic target for dyslipidemia
Authors: Burke Amy C. , Huff Murray W. 
Published: January 2017

Purpose of review
ATP-citrate lyase (ACLY) has re-emerged as a drug target for LDL cholesterol (LDL-C) lowering. We review ACLY as a therapeutic strategy, its genetics, its molecular and cellular biology, and also its inhibition.

Recent findings
ACLY is a critical enzyme linking glucose catabolism to lipogenesis by providing acetyl-CoA from mitochondrial citrate for fatty acid and cholesterol biosynthesis. Human genetic variants have been associated with enhanced growth and survival of several cancers, and with attenuated plasma triglyceride responses to dietary fish oil. In mice, liver-specific Acly deficiency protects from hepatic steatosis and dyslipidemia, whereas adipose tissue-specific Acly deletion has no phenotype, supporting therapeutic inhibition of ACLY. A lipid-regulating compound, bempedoic acid, was discovered to potently inhibit ACLY, and in animal models, it prevents dyslipidemia and attenuates atherosclerosis. Phase 2 clinical trials revealed that bempedoic acid effectively lowers LDL-C as monotherapy, combined with ezetimibe, added to statin therapy and in statin-intolerant hypercholesterolemic patients.

Summary
The efficacy of bempedoic acid as an LDL-C-lowering agent has validated ACLY inhibition as a therapeutic strategy. Positive results of phase 3 patient studies, together with long-term cardiovascular disease outcome trials, are required to establish ACLY as a major new target in cardiovascular medicine.