bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and Outcomes for Patients With Cirrhosis Admitted to the United Kingdom Critical Care Units*
Authors: McPhail Mark J. W. , Parrott Francesca , Wendon Julia A. , Harrison David A. , Rowan Kathy A. , Bernal William 
Published: January 2018

Objective:
To assess the epidemiology and outcome of patients with cirrhosis following critical care unit admission.

Design:
Retrospective cohort study.

Setting:
Critical care units in England, Wales, and Northern Ireland participating in the U.K. Intensive Care National Audit and Research Centre Case Mix Programme.

Patients:
Thirty-one thousand three hundred sixty-three patients with cirrhosis identified of 1,168,650 total critical care unit admissions (2.7%) admitted to U.K. critical care units between 1998 and 2012.

Interventions:
None.

Measurements and Main Results:
Ten thousand nine hundred thirty-six patients had alcohol-related liver disease (35%). In total, 1.6% of critical care unit admissions in 1998 had cirrhosis rising to 3.1% in 2012. The crude critical care unit mortality of patients with cirrhosis was 41% in 1998 falling to 31% in 2012 (p < 0.001). Crude hospital mortality fell from 58% to 46% over the study period (p < 0.001). Mean(sd) Acute Physiology and Chronic Health Evaluation II score in 1998 was 20.3 (8.5) and 19.5 (7.1) in 2012. Mean Acute Physiology and Chronic Health Evaluation II score for patients with alcohol-related liver disease in 2012 was 20.6 (7.0) and 19.0 (7.2) for non–alcohol-related liver disease (p < 0.001). In adjusted analysis, alcohol-related liver disease was associated with increased risk of death (odds ratio, 1.51 [95% CI, 1.42–1.62; p < 0.001]) with a year-on-year reduction in hospital mortality (adjusted odds ratio, 0.95/yr, [0.94–0.96, p < 0.001]).

Conclusions:
More patients with cirrhosis are being admitted to critical care units but with increasing survival rates. Patients with alcohol-related liver disease have reduced survival rates partly explained by higher levels of organ failure at admission. Patients with cirrhosis and organ failure warrant a trial of organ support and universal prognostic pessimism is not justified.
REPEATABILITY OF CHOROIDAL THICKNESS MEASUREMENTS ASSESSED WITH SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY IN HEALTHY AND DIABETIC INDIVIDUALS
Authors: Abadía Beatriz , Calvo Pilar , Bartol-Puyal Francisco , Verdes Guayente , Suñén Inés , Ferreras Antonio 
Published: January 2018

Purpose:
To assess the intrasession repeatability of choroidal thickness measurements obtained using swept-source optical coherence tomography in Type 2 diabetic (T2D) patients and healthy controls.

Methods:
This was a single-center, prospective, observational, cross-sectional study with consecutive inclusion of 33 healthy subjects and 43 T2D patients. Subjects underwent three consecutive swept-source optical coherence tomography scans in a single session. After automatic delineation of the choroid, subfoveal choroidal thickness, and thickness at 500-μm intervals up to 2,500 μm nasal and temporal from the fovea were measured using the software caliper by the same operator. Intraclass correlation coefficients (ICCs), coefficients of variation, and test-retest variability were calculated.

Results:
Mean subfoveal choroidal thickness in healthy subjects and in T2D patients was 229.97 ± 79.9 and 192.67 ± 74.3 μm, respectively (P = 0.013). All intrasession intraclass correlation coefficients were higher than 0.95 and 0.99, respectively. Coefficients of variations were less than 4.4% and 1.8%, respectively. Test-retest variability ranged from 0.76 μm to 11.12 μm and 0.64 μm to 6.29 μm, respectively. No significant differences were found in the intrasession repeatability of any choroidal measurement between healthy subjects and T2D patients.

Conclusion:
Swept-source optical coherence tomography provided excellent intrasession repeatability of choroidal thickness measurements in healthy subjects and T2D patients.
Maternal Serum Eye Drops in the Management of Pediatric Persistent Corneal Epithelial Defects: A Case Series
Authors: Kalhorn Ashton J. , Tawse Kirstin L. , Shah Avni A. , Jung Jennifer L. , Gregory Darren G. , McCourt Emily A. 
Published: January 2018

Purpose:
We report our experience with the use of maternally derived serum eye drops as adjunctive treatment in the management of pediatric persistent corneal epithelial defects.

Methods:
Five eyes of 4 patients were identified in a retrospective review of pediatric patients with persistent corneal epithelial defects who received maternal serum drops. Diagnoses associated with the defects comprised pontine tegmental cap dysplasia with bilateral cranial nerve V1, V2, V3, and VII palsies; pontine tegmental cap dysplasia with left cranial nerve V1, VII, and VIII palsies; traumatic left cranial nerve II, V1, V2, and VI palsies due to a basilar skull fracture; and Stevens–Johnson syndrome with ocular involvement. We evaluated the feasibility of using maternally derived serum drops; thus, we looked at the ability to prepare and tolerate the drops as well as any complications that could have been associated with treatment. Other data collected included visual acuity, corneal examination, and current and previous treatments.

Results:
Both the duration of therapy and time of follow-up ranged from 5 to 28 months. All patients experienced improvement or resolution of their corneal epithelial defects within 3 weeks of initiating serum eye drops. Furthermore, there were no adverse effects from the use of allogeneic serum drops.

Conclusions:
Maternal serum eye drops are a well-tolerated and potentially beneficial addition to the management of pediatric persistent corneal epithelial defects.
Discordance between lipoprotein particle number and cholesterol content: an update
Authors: Cantey Eric P. , Wilkins John T. 
Published: January 2018

Purpose of review
The cholesterol content within atherogenic apolipoprotein-B (apoB) containing lipid particles is the center of consensus guidelines and clinicians’ focus whenever evaluating a patient's risk for atherosclerotic cardiovascular disease. The pathobiology of atherosclerosis requires the retention of lipoprotein particles within the vascular intima over time followed by maladaptive inflammation resulting in plaque formation and rupture in some. The cholesterol content is widely variable within each particle creating either cholesterol-deplete or cholesterol-enriched particles. This variance in particle cholesterol content varies within and between individuals. Discordance analysis exploits this difference in cholesterol content of particles to demonstrate the differential significance of LDL-cholesterol (LDL-C) and non-HDL-C from measures of lipoprotein particle number in terms of assessing atherosclerotic cardiovascular disease risks.

Recent findings
Three studies have added to the growing body of literature of discordance analysis. Despite wide variability of discordance cutoffs, baseline risk of atherosclerotic disease, and populations sampled, the conclusion remains the same: risk of atherosclerotic disease follows apoB lipid particle concentration rather than cholesterol content of lipid particles.

Summary
In addition to traditional lipid fractions, assessments of atherogenic particle number should be strongly considered whenever assessing CVD risk in nontreated and treated individuals. There is a need for clinical trials that focus not only on the reduction in LDL-C but apoB, as well.
Electronic Health Record Implementation Findings at a Large, Suburban Health and Human Services Department
Authors: Crowley Kenyon , Mishra Anubhuti , Cruz-Cano Raul , Gold Robert , Kleinman Dushanka , Agarwal Ritu 
Published: January 2018

Objective:
Evaluate an electronic health record (EHR) implementation across a large public health department to better understand and improve implementation effectiveness of EHRs in public health departments.

Design:
A survey based on Consolidated Framework for Implementation Research constructs was administered to staff before and after implementation of an EHR.

Setting:
Large suburban county department of health and human services that provides clinical, behavioral, social, and oral health services.

Participants:
Staff across 4 program areas completed the survey prior to EHR implementation (n = 331, June 2014) and 3 months post-EHR final implementation (n = 229, December 2015).

Intervention:
Electronic health record

Main Outcome Measures:
Constructs were validated using confirmatory factor analysis and included information strengths and information gaps in the current environment; EHR impacts; ease of use; future use intentions; usefulness; knowledge of system; and training. Paired t tests and Wilcoxon signed rank tests of a matched sample were performed to compare the pre-/postrespondent scores.

Results:
A majority of user perceptions and expectations showed a significant (P < .05) decline 3 months postimplementation as compared with the baseline with variation by service area and construct. Staff perceived the EHR to be less useful and more complex, provide fewer benefits, and reduce information access shortly after implementation.

Conclusions:
Electronic health records can benefit public health practices in many ways; however, public health departments will face significant challenges incorporating EHRs, which are typically designed for non–public health settings, into the public health workflow. Electronic health record implementation recommendations for health departments are provided. When implementing an EHR in a public health setting, health departments should provide extensive preimplementation training opportunities, including EHR training tailored to job roles, competencies, and tasks; assess usability and specific capabilities at a more granular level as part of procurement processes and consider using contracting language to facilitate usability, patient safety, and related evaluations to enhance effectiveness and efficiencies and make results public; apply standard terminologies, processes, and data structures across different health department service areas using common public health terminologies; and craft workforce communication campaigns that balance potential expected benefits with realistic expectations.
Automated Mechanical Peripheral Stimulation Improves Gait Parameters in Subjects With Parkinson Disease and Freezing of Gait
Authors: Pinto Camila , Pagnussat Aline Souza , Rozin Kleiner Ana Francisca , Marchese Ritchele Redivo , Salazar Ana Paula , Rieder Carlos R.M. , Galli Manuela 
Published: January 2018

Objective
This study aimed to assess spatiotemporal gait parameters and range of motion of lower limbs in subjects with Parkinson disease (PD) and freezing of gait, treated with automated mechanical peripheral stimulation (AMPS) or AMPS SHAM (placebo).

Design
This randomized clinical trial included 30 subjects allocated into two groups: AMPS (15 subjects with PD) and AMPS SHAM (15 subjects with PD). Fourteen age-matched healthy subjects were also included as a reference group. Both PD groups received the treatment twice a week during 4 weeks. Automated mechanical peripheral stimulation was applied using a commercial medical device (Gondola) and consisted of mechanical pressure in four areas of feet. For AMPS SHAM group, a subliminal stimulus was delivered. Gait analysis were measured before, after the first, after the fourth, and after the eighth sessions.

Results
We did not find significant differences between AMPS and AMPS SHAM groups either for spatiotemporal gait parameters or for range of motion of lower limbs. However, within-group analysis showed that AMPS group significantly improved spatiotemporal gait parameters and hip rotation range of motion throughout the treatment period. The AMPS SHAM group did not show any improvement.

Conclusions
Automated mechanical peripheral stimulation therapy induces improvements in spatiotemporal parameters and hip rotation range of motion of subjects with PD and freezing of gait.

To Claim CME Credits
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives
Upon completion of this article, the reader should be able to: (1) Understand the impact of reduced plantar sensitivity on gait in individuals with Parkinson disease; (2) Identify the improvements on spatiotemporal gait parameters in subjects with Parkinson disease and freezing of gait after automated mechanical peripheral stimulation therapy; and (3) Recommend the use of new strategies of plantar stimulus for gait disorders of subjects with Parkinson disease.

Level
Advanced

Accreditation
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Mechanical Traction for Lumbar Radicular Pain
Authors: Bilgilisoy Filiz Meral , Kiliç Zeynep , Uçkun Alper , Çakir Tuncay , Koldaş Doğan Şebnem , Toraman Naciye Füsun 
Published: January 2018

Objective
The aim of the study was to compare the effects of mechanical lumbar traction either in the supine or in the prone position with conventional physical therapy (PT) in patients with chronic low back pain and lumbosacral nerve root involvement in terms of disability, pain, and mobility.

Design
Participants (N = 125) were randomly assigned to receive 15 sessions of PT with additional mechanical lumbar traction either in the supine position (supine traction group) or in the prone position (prone traction group) or only PT without traction (PT only group). Patients were assessed at baseline and at the end of the PT sessions in terms of disability, pain, and mobility. Disability was assessed using the modified Oswesty Disability Index; pain was assessed using a visual analog scale, and lumbar mobility was assessed using the modified lumbar Schober test.

Results
One hundred eighteen patients completed the trial. All groups improved significantly in the Oswesty Disability Index, visual analog scale, and modified lumbar Schober test (P < 0.05). In the between-group analysis, improvements of Oswesty Disability Index and visual analog scale were found significantly better in the prone traction group compared with the PT only group (adjusted P = 0.031 and 0.006, respectively).

Conclusions
Addition of traction in the prone position to other modalities resulted in larger immediate improvements in terms of pain and disability, and the results suggest that when using traction, prone traction might be first choice. Further research is needed to confirm the benefits of lumbar traction in the prone position.
Clinical Findings of a Cantilever Iliac Bone Graft for Secondary Correction of Cleft Lip–Nose Deformities
Authors: Sugiyama Madoka , Nakatsuka Takashi , Saijo Hideto , Fujihara Yuko , Kanno Yuki , Hikita Atsuhiko , Takato Tsuyoshi , Hoshi Kazuto 
Published: January 2018

Abstract
The authors performed a cantilever iliac bone graft for the secondary correction of severe cleft lip–nose deformities after the completion of growth. For the purpose of clarifying effects of the cantilever iliac bone grafts and the adverse events with regard to their time course changes after this procedure, the authors retrospectively surveyed long-term morphologic changes in 65 cleft lip, alveolus, and palate patients in whom cleft lip–nose deformities were treated with a cantilever iliac bone graft (age at surgery: 14–45 years old). All postsurgical documents of facial photographs and radiologic images were reviewed to evaluate the effects and adverse events. The main adverse events were deviations of the apex of the nose, excess resorption of the grafted iliac bone, protruding deformations of the grafted iliac bone at the root of the nose, and fracture of the grafted iliac bone. Additional surgery was necessary in 10.7% of patients. Postsurgical changes in facial profiles became favorable, measured on lateral view of cephalometric radiography, achieving morphologic improvements. A cantilever iliac bone graft was effective for improving nasal deformities in cleft lip, alveolus, and palate patients, although the counter measures should be taken to these adverse events.
Diagnosis and Treatment of Gorham-Stout Disease in Maxillofacial Regions
Authors: Qu Luyao , Cai Xieyi , Wang Baoli 
Published: January 2018

Purpose:
This study was aimed to investigate the clinical features, imaging examination, and treatment of the patients with Gorham-Stout disease (GSD) in maxillofacial region, so as to improve the understanding of GSD.

Methods:
The medical records of the patients with GSD who were referred to Shanghai Ninth People's Hospital from January 2010 to May 2016 were reviewed. Their ages, lesion location, imaging results, laboratory examination results, treatment, and therapeutic effects were analyzed.

Results:
A total of 4 cases were included (males 2, females 2). The average onset age was 40 years. GSD attacked the mandible in 2 cases; mandible and temporal bone in 1 case; and mandible, temporal bone, and zygoma in 1 case. All cases were examined by computed tomography (CT), which showed bone resorption and atrophy of soft tissue in involved region. Four patients were given alendronate for treatment. All of them had no significant signs of progress after treatment.

Conclusions:
GSD can affect one single bone or multiple bones in maxillofacial region. The diagnosis mainly depends on the imaging examinations. Enhanced CT or magnetic resonance imaging is advocated for differential diagnosis of this disease. Alendronate was used with apparent good effect in these patients.
Unit Advancement Flap for Lower Lip Reconstruction
Authors: Ogino Akihiro , Onishi Kiyoshi , Okada Emi , Nakamichi Miho 
Published: January 2018

Background:
Lower lip reconstruction requires consideration of esthetic and functional outcome in selecting a surgical procedure, and reconstruction with local tissue is useful. The authors reconstructed full-thickness defects with a unit advancement flap.

Methods:
Reconstruction was performed using this method in 4 patients with lower lip squamous cell carcinoma in whom tumor resection with preservation of the mouth angle was possible. The lower lip resection width was 30 to 45 mm, accounting for 50% to 68% of the entire width of the lower lip. The flap was prepared by lateral extension from above the mental unit and matched with the potential wrinkle line of the lower lip in order to design a unit morphology surrounded by the anterior margin of the depressor labii inferioris muscle. It was elevated as a full-thickness flap composed of the orbicularis oris muscle, skin, and mucosa of the residual lower lip from the bilateral sides, and advanced to the defect. Flap transfer was adjusted by small triangular resection of the skin on the lateral side of the mental unit.

Results:
The postoperative scar was inconspicuous in all patients and there was no impairment of the mouth opening–closing or articulation functions.

Conclusions:
This was a relatively simple surgical procedure. A blood supply of the flap was stable, and continuity of the orbicularis oris muscle was reconstructed by transferred the residual lower lip advancement flap from the bilateral sides. The postoperative mouth opening–closing function was sufficient, and dentures could be placed from an early phase in elderly patients. The postoperative scar was consistent with the lip unit morphology, being esthetically superior. This procedure may be applicable for reconstruction of defects approximately 1/3 to 2/3 the width of the lower lip where the mouth angle is preserved.
Treatment of Severe Maxillary Hypoplasia With Combined Orthodontics and Distraction Osteogenesis
Authors: Lucchese Alessandra , Manuelli Maurizio , Albertini Paolo , Asperio Paolo , Gastaldi Giorgio 
Published: January 2018

Abstract
Distraction osteogenesis (DO) is a technique that allows the generation of new bone in a gap between 2 vascularized bone surfaces in response to the application of graduated tensile stress across the bone gap.
Distraction osteogenesis has become a routine treatment of choice to correct skeletal deformities and severe bone defects in the craniofacial complex over the past decade. Distraction osteogenesis has been successfully chosen in lengthening the maxilla and the mandible; in the maxilla and recently in the mandible, the jawbones have been distracted and widened transversely to relieve severe anterior dental crowding and transverse discrepancies between the dental arches.
Distraction osteogenesis for maxillary advancement started in 1993 and is now widely used, especially in patients with skeletal Class III malocclusion caused by maxillary hypoplasia.
The aim of this study was to present the efficiency of combined orthodontic and DO in the severe maxillary hypoplasia.
A 35-year-old Italian man presented to our clinical practice with the chief complaint of esthetic and functionally problems because of skeletal Class III malocclusion with anterior crossbite.
Considering that the severity of the skeletal discrepancy is remarkable but compensated by the DO potential, the combined orthodontic and DO treatment was considered adequate, like less invasive and equally effective.
It was obtained a good alignment with the upper and lower arch dental alveolar maxillary advancement that allowed to correct the sagittal relationships.
The patient was satisfied for the treatment results and had considerable improvement in his self-esteem.
Comparison of Tongue-in-Groove and Columellar Strut on Rotation and Projection in Droopy Nasal Tip: Contribution of a Cap Graft
Authors: Demir Uygar Levent 
Published: January 2018

Abstract
Underrotation of the nasal tip with narrow nasolabial angle is a common nasal deformity that leads to a long nose appearance, named drooping nose. In these patients, there are various techniques described to correct droopy tip and to achieve a desirable nasal tip rotation such as lateral crural steal, lateral crural overlay, tongue-ingroove, columellar strut graft, tip rotation sutures, cephalic trimming, and others. In this study, the effects of tongue-in-groove (TIG) and columellar strut graft (CS) and the contribution of cap graft on nasal tip rotation and projection were evaluated. Twenty-eight consecutive patients who underwent open approach rhinoplasty by the same senior author (ULD) between January 2015 and December 2016 with the diagnosis of septonasal deformity and droopy nasal tip were included. In 9 of these patients nasal tip was constructed with strut graft, in 6 patients with both strut and cap grafts, in 6 patients with TIG technique and in 7 patients with both TIG and cap graft. Standardized right lateral images were taken preoperatively and 6 months postoperatively to use for further assessments. The nasal tip rotation was evaluated by measuring nasolabial angle (NLA) and the nasal projection (NP) was evaluated by using the Goode method. Finally, the postoperative values of NLA and NP at the 6th month were compared with preoperative recorded values in between groups. Each group showed increase at nasal projection; however, significance was present only in CS graft and TIG groups (P=0.011 and P=0.027 relatively). Each 4 groups showed significant increase in nasal tip rotation. In addition, the comparison of percent changes between preoperative and postoperative NP and NLA revealed no difference (P=0.56 and P=0.431 relatively). In conclusion, the authors argued that TIG and CS graft techniques are both reliable methods to correct droopy nasal tip and using additional cap graft over dome area when required is safe and useful.