bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increasing Serum Albumin Level Shortly After Gastrostomy Tube Insertion Predicts Longer Survival in Elderly Patients With Dementia
Authors: Gingold-Belfer Rachel , Weiss Avraham , Geller Alex , Sapoznikov Boris , Beloosesky Yichayaou , Morag-Koren Nira , Niv Yaron , Boltin Doron , Issa Nidal , Schmilovitz-Weiss Hemda 
Published: August 2016

Goal:
To identify factors influencing survival after percutaneous endoscopic gastrostomy (PEG) tube insertion in elderly patients with severe dementia.

Background:
Use of PEG in patients with dementia raises medical and ethical questions.

Study:
The cohort included 189 patients aged ≥64 years with severe dementia who underwent PEG tube insertion in 2002 to 2011 at a tertiary hospital and were followed through 2014. Data were collected on background diseases, laboratory tests conducted 14 (±10) days before and 90 (±10) days after PEG, and date of death. Multivariate Cox regression analysis was performed and cumulative survival curves plotted.

Results:
Mean baseline serum albumin level was significantly lower in patients who died ≤30 days after PEG (n=32, 16.9%) than patients who survived longer (2.9±0.5 vs. 3.3±0.5 g/dL, P<0.001), and significantly higher in patients who survived 1 year after PEG (n=96, 50.8%) than patients who died earlier (3.4±0.5 vs. 3.1±0.5 g/dL, P=0.002). No significant differences were found for the other laboratory parameters. After adjustment for background diseases, serum albumin level above the median (3.3 g/dL) was the only predictor of survival (hazard ratio 0.51; 95% confidence interval, 0.37-0.72; P<0.001). Patients with stable/increased serum albumin levels at 90 days after PEG (n=80, 42.3%) survived longer than patients with decreased levels. The only predictor of survival after adjustment for age and background diseases was a stable/increased albumin level at 90 days (hazard ratio 0.59; 95% confidence interval, 0.42-0.85; P=0.004).

Conclusions:
Survival after PEG tube insertion is associated with a higher serum albumin level at baseline and a stable/increased serum albumin level during follow-up.
Longitudinal Evaluation of Noninvasive Biomarkers for Eosinophilic Esophagitis
Authors: Min Steve B. , Nylund Cade M. , Baker Thomas P. , Ally Mazer , Reinhardt Brian , Chen Yen-Ju , Nazareno Luz , Moawad Fouad J. 
Published: August 2016

Background:
The diagnosis and management of eosinophilic esophagitis (EoE) often requires multiple endoscopies. Serum biomarkers can be elevated in EoE patients, but their clinical utility in diagnosis and assessing response to treatment is not well established.

Goals:
To evaluate serum biomarkers in EoE subjects compared with controls and assess longitudinally in response to treatment.

Study:
We conducted a prospective cohort study of children and adults undergoing esophagogastroduodenoscopy for suspected EoE. After completing an 8-week course of proton-pump inhibitor therapy, esophageal mucosal biopsies were obtained, as well as, serum analysis of absolute eosinophil count (AEC), eotaxin-3, eosinophil-derived neurotoxin (EDN), eosinophil cationic protein (ECP) and interleukin-5. Subjects with normal endoscopic and histologic findings constituted controls. Those meeting criteria for EoE underwent repeat esophagogastroduodenoscopy and biomarker measurements following treatment with topical steroids for 8 weeks.

Results:
Median levels of AEC (263.50 vs. 102 cu/mm, P<0.001), ECP (26.98 vs. 5.20 ng/mL, P<0.001) and EDN (31.70 vs. 14.18 ng/mL, P=0.004) were significantly elevated in EoE subjects compared with controls and correlated with esophageal eosinophilia. Levels of AEC (odds ratio, 1.79; 95% confidence interval, 1.28-2.64) and ECP (odds ratio, 1.61; 95% confidence interval, 1.23-2.36) were associated with a diagnosis of EoE. Among the 5 biomarkers evaluated, only AEC significantly predicted esophageal eosinophilia following topical steroid therapy in EoE subjects (P=0.006).

Conclusions:
AEC, ECP, and EDN were higher in EoE subjects compared with controls and correlated with degree of esophageal eosinophilia. Furthermore, AEC predicted post-treatment eosinophilia, suggesting a potential role in monitoring EoE disease activity.
Measuring gaze patterns during colonoscopy: a useful tool to evaluate colon inspection?
Authors: Dik Vincent K. , Hooge Ignace T.C. , van Oijen Martijn G.H. , Siersema Peter D. 
Published: August 2016

Background and objective
Considerable variation in adenoma detection has been shown between endoscopists, which may be explained by differences in colon inspection. Eye-tracking technology is an objective tool that detects differences in viewing patterns. We investigated the feasibility of eye-tracking technology during real-time, self-performed colonoscopies.

Methods
In this pilot study, 10 endoscopists performed two colonoscopies each. A mobile eye-tracking system to register the right eye position was used to determine the gaze across four areas of interest of the endoscopy monitor (upper, lower, left, and right quadrant). The measured gaze across the endoscopy monitor was correlated with the gaze across the endoscopically visualized colonic surface.

Results
Gaze patterns were measured successfully in 18 of 20 procedures. Significant differences in the time spent per area of interest were observed between endoscopists. The measured total gaze time per area of interest correlated strongly with the time spent on the corresponding area of the colonic surface (Pearson correlation coefficients ranging between 0.91 and 0.97). Endoscopists with more years of colonoscopy experience showed significantly higher percentages of overlap between the measured gaze position in the different areas of interest and the actual inspected area of the colonic surface (r=0.65, P=0.02). More experienced endoscopists had nonsignificantly longer mean gaze times per area of interest (r=0.52, P=0.06).

Conclusion
Eye-tracking technology to measure gaze patterns of endoscopists during real-time, self-performed colonoscopies is feasible and may be used to evaluate and compare viewing behavior across the colonic surface of experienced endoscopists.
Therapeutic outcomes of endoscopic submucosal dissection for early gastric cancer: single-center study
Authors: Sohn Se Hoon , Lee Si Hyung , Kim Kyeong Ok , Jang Byung Ik , Kim Tae Nyeun 
Published: August 2016

Objectives
Endoscopic submucosal dissection (ESD) has been widely accepted for selected patients with early gastric cancer (EGC). The aim of this study was to assess the therapeutic outcomes after ESD according to the pathological extent.

Patients and methods
From January 2005 to December 2014, a total of 599 patients with 611 lesions were enrolled in this study. The tumors were categorized according to pathological results on the basis of absolute criteria (AC), expanded criteria (EC), EC with undifferentiated histology [(EC-U), mucosal cancer, ulcer (−), ≤20 mm], or beyond EC (BEC). The therapeutic outcomes among the four groups were analyzed retrospectively.

Results
The number of patients in the AC, EC, EC-U, and BEC groups was 447, 91, 19, and 54. The complete resection rates of EGC were 97.8, 84.6, 94.4, and 45.5% (P=0.001) and en bloc resection rates in the AC, EC, EC-U, and BEC groups were 99.1, 98.9, 100, and 98.1% (P=0.833), respectively. The 5-year disease-free survival rate in the AC, EC, EC-U, and BEC groups was 90.6, 88.7, 75.0, and 83.3% (P=0.394). In multivariate analysis, undifferentiated histology (P=0.001) and tumor size (>30 mm, P=0.017) were risk factors related to local recurrence.

Conclusion
The efficacy of ESD for EGCs in EC is almost equal to that in AC when complete resection was achieved. However, the indication for ESD should be decided conservatively because the complete resection rate of EGC in the EC group was significantly lower than that in the AC group. Undifferentiated histology and tumor size over 30 mm were risk factors related to local recurrence.
A Statewide Effort to Implement Collaborative Care for Depression
Authors: Rossom Rebecca C. , Solberg Leif I. , Parker Emily D. , Crain A. Lauren , Whitebird Robin , Maciosek Michael , Molitor Beth , Trangle Michael , Unützer Jürgen 
Published: August 2016

Background:
Little is known about the reach and impact of collaborative care for depression outside of clinical trials.

Objective:
The objective of this study was to examine the effect of a collaborative care intervention for depression on the rates of depression diagnosis, use of specific depression codes, and treatment intensification.

Research Design:
Evaluation of a staggered, multiple baseline implementation initiative.

Subjects:
Patients receiving depression care in primary care clinics throughout Minnesota from February 2008 through March 2011.

Measures:
Data regarding depression diagnosis rates and codes, and measures of antidepressant intensification were provided by health insurers.

Results:
Depression Improvement Across Minnesota: Offering a New Direction (DIAMOND) affected neither rates of depression recognition nor use of depression diagnostic codes, and the overall reach of DIAMOND was disappointingly small. Patients in DIAMOND had more episodes of treatment intensification than non-DIAMOND patients, but we were unable to account for depression severity in our analysis.

Conclusions:
DIAMOND did not affect depression recognition or diagnostic coding, but may have affected treatment intensification. Our results suggest that even strongly evidence-based interventions may have little contamination effects on patients not enrolled in the new care model.
The ACA’s Zero Cost-Sharing Mandate and Trends in Out-of-Pocket Expenditures on Well-Child and Screening Mammography Visits
Authors: Kirby James B. , Davidoff Amy J. , Basu Jayasree 
Published: August 2016

Background:
Starting in September of 2010, the Patient Protection and Affordable Care Act required most health insurance policies to cover evidence-based preventive care with no cost-sharing (no copays, coinsurance, or deductibles). It is unknown, however, whether declines in out-of-pocket costs for preventive services are large enough to prompt increases in utilization, the ultimate goal of the policy.

Methods:
In this study, we use a nationally representative sample of ambulatory care visits to estimate the impact of the zero cost-sharing mandate on out-of-pocket expenditures on well-child and screening mammography visits. Estimates are made using 2-part interrupted time-series models, with well-woman visits serving as the control group because they were not covered under the zero cost-sharing mandate until after our study period.

Results:
Results indicate a substantial reduction in out-of-pocket costs attributable to the Affordable Care Act. Between January 2011 and September 2012, the zero cost-sharing mandate reduced per-visit out-of-pocket costs for well-child visits from $18.46 to $8.08 (56%) and out-of-pocket costs for screening mammography visits from $25.43 to $6.50 (74%). No reduction was apparent for well-woman visits.

Conclusions:
The Affordable Care Act’s zero cost-sharing mandate for preventive care has had a large impact on out-of-pocket expenditures for well-child and mammography visits. To increase preventive service use, research is needed to better understand barriers to obtaining preventive care that are not directly related to cost.
Meaningful Engagement of ACOs With Communities
Authors: Hefner Jennifer L , Hilligoss Brian , Sieck Cynthia , Walker Daniel M. , Sova Lindsey , Song Paula H. , McAlearney Ann Scheck 
Published: August 2016

Objectives:
Population health management (PHM) activities within health care organizations have traditionally focused on coordinating services for populations who present for care in physicians’ offices. With the recent proliferation of Accountable Care Organizations (ACOs), however, the reach of PHM has expanded. We aimed to study ACOs’ evolving definitions of their patient populations, and how these definitions might be linked to different types of PHM activities pursued by ACOs.

Methods:
Over a 2-year period, we conducted in-depth case studies of 4 ACOs operating in the private sector, including 149 interviews with 89 informants. Although the main study focused on the ACO implementation process, our use of both inductive and deductive qualitative methods enabled us to study emergent topics such as we report here about PHM.

Results:
Interviewees across sites described their ACO populations using terms indicating both panel management and community/neighborhood involvement in the context of PHM. Further, all 4 sites reported conducting PHM activities that extended beyond traditional provider-based PHM; these ranged from wellness registries to school-based clinics. Executives at all 4 ACOs also discussed providing, or planning to provide, health care services to all community members in local settings.

Conclusions:
Administrators and physicians in private sector ACOs were proponents of ACO-led programs delivered in community settings that provided health care to all members of the community, and reported their ACOs engaged in multisector collaborations designed to improve neighborhood health. These community engagement activities point to a distinction from 90s era managed and integrated care organizations and may contribute to the sustainability of the ACO model.
The central role of arterial retention of cholesterol-rich apolipoprotein-B-containing lipoproteins in the pathogenesis of atherosclerosis: a triumph of simplicity
Authors: Borén Jan , Williams Kevin Jon 
Published: August 2016

Purpose of reviewToday, it is no longer a hypothesis, but an established fact, that increased plasma concentrations of cholesterol-rich apolipoprotein-B (apoB)-containing lipoproteins are causatively linked to atherosclerotic cardiovascular disease (ASCVD) and that lowering plasma LDL concentrations reduces cardiovascular events in humans. Here, we review evidence behind this assertion, with an emphasis on recent studies supporting the ‘response-to-retention’ model – namely, that the key initiating event in atherogenesis is the retention, or trapping, of cholesterol-rich apoB-containing lipoproteins within the arterial wall.Recent findingsNew clinical trials have shown that ezetimibe and anti-PCSK9 antibodies – both nonstatins – lower ASCVD events, and they do so to the same extent as would be expected from comparable plasma LDL lowering by a statin. These studies demonstrate beyond any doubt the causal role of apoB-containing lipoproteins in atherogenesis. In addition, recent laboratory experimentation and human Mendelian randomization studies have revealed novel information about the critical role of apoB-containing lipoproteins in atherogenesis. New information has also emerged on mechanisms for the accumulation in plasma of harmful cholesterol-rich and triglyceride-rich apoB-containing remnant lipoproteins in states of overnutrition. Like LDL, these harmful cholesterol-rich and triglyceride-rich apoB-containing remnant lipoprotein remnants become retained and modified within the arterial wall, causing atherosclerosis.SummaryLDL and other cholesterol-rich, apoB-containing lipoproteins, once they become retained and modified within the arterial wall, cause atherosclerosis. This simple, robust pathophysiologic understanding may finally allow us to eradicate ASCVD, the leading killer in the world.
Effect of inflammation on HDL structure and function
Authors: Feingold Kenneth R. , Grunfeld Carl 
Published: August 2016

Purpose of review
Studies have shown that chronic inflammatory disorders, such as rheumatoid arthritis, systemic lupus erythematosus, and psoriasis are associated with an increased risk of atherosclerotic cardiovascular disease. The mechanism by which inflammation increases cardiovascular disease is likely multifactorial but changes in HDL structure and function that occur during inflammation could play a role.

Recent findings
HDL levels decrease with inflammation and there are marked changes in HDL-associated proteins. Serum amyloid A markedly increases whereas apolipoprotein A-I, lecithin:cholesterol acyltransferase, cholesterol ester transfer protein, paraoxonase 1, and apolipoprotein M decrease. The exact mechanism by which inflammation decreases HDL levels is not defined but decreases in apolipoprotein A-I production, increases in serum amyloid A, increases in endothelial lipase and secretory phospholipase A2 activity, and decreases in lecithin:cholesterol acyltransferase activity could all contribute. The changes in HDL induced by inflammation reduce the ability of HDL to participate in reverse cholesterol transport and protect LDL from oxidation.

Summary
During inflammation multiple changes in HDL structure occur leading to alterations in HDL function. In the short term, these changes may be beneficial resulting in an increase in cholesterol in peripheral cells to improve host defense and repair but over the long term these changes may increase the risk of atherosclerosis.
Duodenal Disaccharidase Activities During and After Weaning off Parenteral Nutrition in Pediatric Intestinal Failure
Authors: Sanaksenaho Galina , Mutanen Annika , Koivusalo Antti I. , Merras‐Salmio Laura , Pakarinen Mikko P. 
Published: August 2016

ABSTRACTObjectives:Data on factors affecting absorptive function in children with intestinal failure (IF) are sparse. We evaluated duodenal disaccharidase activities and inflammation in relation to parenteral nutrition (PN) and intestinal resection in pediatric onset IF.Methods:Disaccharidase (maltase, sucrase, and lactase) activities and histologic inflammation were evaluated from duodenal biopsies in 58 patients during PN (n = 23) or full enteral nutrition (n = 40) and in 43 matched controls. The first and the last postresection biopsies were analyzed separately after 4.3 (1.2–9.7) years and 6.5 (2.3–12.4) years, respectively.Results:During PN, maltase and sucrase activities were 1.6‐fold lower and mucosal inflammation more frequent (22% vs 3%) when compared to matched controls (P < 0.05 for both). In patients on full enteral nutrition, activities of maltase and sucrase were significantly higher than that in patients receiving PN and comparable to those of matched controls. Postresection time correlated positively (r = 0.448 and r = 0.369) and percentage length of the remaining small intestine inversely (r = –0.337 and r = –0.407) with maltase and sucrase activity in patients on full enteral nutrition (P < 0.05 for all), whereas proportional length of remaining colon correlated positively with maltase and lactase activity (r = 0.424–0.544, P < 0.05) in patients receiving PN.Conclusions:In children with IF, PN dependency associated with decreased duodenal maltase and sucrase activities and mucosal inflammation, which may disturb intestinal absorptive function. Localization and extent of intestinal resection and post‐resection time correlated with duodenal disaccharidase activities.
Prevalence, Clinical Profile, and Outcome of Ascitic Fluid Infection in Children With Liver Disease
Authors: Srivastava Anshu , Malik Rohan , Bolia Rishi , Yachha Surender K. , Poddar Ujjal 
Published: August 2016

ABSTRACTObjectives:Pediatric literature on spontaneous bacterial peritonitis (SBP) is limited. We evaluated the prevalence, subtypes, clinical profile, and effect on outcome of ascitic fluid infection (AFI) in children with liver disease.Methods:Children with liver disease‐related ascites and subjected to paracentesis were classified as no‐AFI and AFI (SBP, culture‐negative neutrocytic ascites [CNNA], and monomicrobial non‐neutrocytic bacterascites). Clinical and laboratory parameters, in‐hospital mortality, and outcome in follow‐up were noted.Results:Two hundred sixty‐two children (163 boys; age 84 [1–240] months, chronic liver disease [CLD, n = 173], non‐CLD [n = 89]) were enrolled. A total of 28.6% (n = 75) had SBP/CNNA, more common in CLD than non‐CLD (55/173 [31.7%] vs 20/89 [22.4%]; P = 0.1). A total of 50.6% SBP/CNNA cases were symptomatic for AFI. Gram‐negative bacilli were isolated from 70% SBP cases. Twenty‐five percent (18/72) CLD children with AFI had a poor hospital outcome, with INR, Child‐Pugh score and gastrointestinal bleeding predicting outcome on multivariate analysis. Patients with CLD with SBP had higher in‐hospital mortality (10/20 vs 5/35; P = 0.01) than those with CNNA, but similar Child‐Pugh score (12[7–15] vs 11[7–14]; P = 0.1), recurrence of AFI (3/9 vs 6/24; P = 0.6) and mortality in follow‐up (22.2% vs 25%; P = 0.1). Patients with CLD with SBP/CNNA had higher mortality over 1 year follow‐up than no‐AFI (24.2% [8/33] vs 12.2% [7/57]; P = 0.1) but the difference was not significant.Conclusions:A total of 28.6% children with liver disease‐related ascites have SBP/CNNA; 50% are symptomatic. Patients with CLD with SBP/CNNA have a mortality of 24% over 1year follow‐up. CLD with SBP is similar to CNNA except for higher in‐hospital mortality.
Specialized Imaging and Procedures in Pediatric Pancreatology
Authors: Lin Tom K. , Troendle David M. , Wallihan Daniel B. , Barth Bradley , Fox Victor L. , Fishman Douglas S. , Morinville Veronique D. 
Published: August 2016

ABSTRACTObjectives:An increasing number of children are being diagnosed with pancreatitis and other pancreatic abnormalities. Dissemination of the information regarding existing imaging techniques and endoscopic modalities to diagnose and manage pancreatic disorders in children is sorely needed.Methods:We conducted a review of the medical literature on the use of the following imaging and procedural modalities in pediatric pancreatology: transabdominal ultrasonography (TUS), computed tomography (CT), magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP). Recommendations for current use and future research were identified.Results:TUS offers noninvasive images of the pancreas but has limitations to details of parenchyma and ductal structures. CT offers improved detail of pancreatic parenchyma, solid masses, and traumatic injuries, but requires relatively high levels of ionizing radiation and does not adequately assess ductal anatomy. MRI/MRCP offers detailed intrinsic tissue assessment and pancreatic ductal characterization, but requires longer image acquisition time and is relatively poor at imaging calcifications. EUS provides excellent evaluation of pancreatic parenchyma and ductal anatomy, but can be subjective and operator dependent and requires sedation or anesthesia. EUS offers the capacity to obtain tissue samples and drain fluid collections and ERCP offers the ability to improve drainage by performing sphincterotomy or placing pancreatic stents across duct injuries and strictures.Conclusions:Various imaging modalities may be used in pediatric pancreatology, but TUS and MRI/MRCP are favored. Interventional therapeutic maneuvers primarily involve use of ERCP and EUS. Future research is necessary to optimize equipment, expertise, and appropriate indications.
Levels of Serum Brain-Derived Neurotrophic Factor in Schizophrenia
Authors: Lee Jimmy , Nurjono Milawaty , Lee Tih-Shih 
Published: August 2016

Abstract
Recent meta-analyses of serum brain-derived neurotrophic factor (BDNF) have reported lower levels in patients with schizophrenia. However, most studies did not consider the potential confounding effects of time of collection, age, sex, smoking, and obesity. Here, we sought to examine differences in serum BDNF between medicated patients with schizophrenia compared with control subjects, taking into consideration the potential confounders of serum BDNF. Serum was obtained from a sample of fasted blood collected from all participants, and BDNF was assayed on a commercially available kit. After adjusting for potential confounders, there was no statistically significant difference between cases and control subjects (p = 0.261). In the model, body mass index emerged as the most significant predictor of serum BDNF (β = 0.22, p = 0.009). The present study did not support a role for serum BDNF as a biomarker in schizophrenia. This could be due to the nonspecific nature of serum BDNF and its association with both mental and physical conditions.