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[PMID]: 26093130
[Au] Autor:Regolisti G; Bozzoli L; Fiaccadori E
[Ti] Title:Iponatremia: dalle Linee Guida alla pratica clinica. [Hyponatremia: from guidelines to clinical practice].
[So] Source:G Ital Nefrol;32(3), 2015 May-Jun.
[Is] ISSN:1724-5990
[Cp] Country of publication:Italy
[La] Language:ita
[Ab] Abstract:The publication, within a short time interval, of a consensus statement on the pathophysiology, diagnosis and treatment of hyponatremia by a panel of experts mainly from the US and of the European Guidelines on the same topic has marked an important step towards reducing the differences in the treatment of this frequent, and potentially fatal, electrolyte disorder. Within this framework, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE), and the European Dialysis and Transplantation Association-European Renal Association, represented by the European Renal Best Practice (ERBP), have developed these Guidelines for clinical practice, that are focused mainly on the diagnosis and the treatment of hyponatremia. In fact, they are the result of a tight collaboration between the three scientific societies involving those specialists with an elective interest for this electrolyte disorder. In addition to a rigorous methodological approach, a choice was made to provide a document focused on clinically relevant outcomes and useful for everyday practice. With respect to the original paper, this version of the Guidelines has been shortened and translated with a special view to the recommendations concerning the diagnosis and treatment of hyponatremia. It is preceded by an introduction underscoring the main targets of non-pharmacological treatment in acute severely symptomatic cases, specifically as regards the rate of correction of hyponatremia; subsequently, potential explanations for the discrepancies between the European Guidelines and the consensus statement by US experts concerning the use of vaptans are briefly discussed; the rationale and practical limitations in the clinical use of urea are analyzed in more detail.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1506
[Js] Journal subset:IM
[St] Status:In-Data-Review

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[PMID]: 25879990
[Au] Autor:Holden TR; Smith MA; Bartels CM; Campbell TC; Yu M; Kind AJ
[Ad] Address:1 Department of Medicine, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin....
[Ti] Title:Hospice Enrollment, Local Hospice Utilization Patterns, and Rehospitalization in Medicare Patients.
[So] Source:J Palliat Med;18(7):601-12, 2015 Jul.
[Is] ISSN:1557-7740
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Rehospitalizations are prevalent and associated with decreased quality of life. Although hospice has been advocated to reduce rehospitalizations, it is not known how area-level hospice utilization patterns affect rehospitalization risk. OBJECTIVES: The study objective was to examine the association between hospice enrollment, local hospice utilization patterns, and 30-day rehospitalization in Medicare patients. METHODS: With a retrospective cohort design, 1,997,506 hospitalizations were assessed between 2005 and 2009 from a 5% national sample of Medicare beneficiaries. Local hospice utilization was defined using tertiles representing the percentage of all deaths occurring in hospice within each Hospital Service Area (HSA). Cox proportional hazard models were used to assess the relationship between 30-day rehospitalization, hospice enrollment, and local hospice utilization, adjusting for patient sociodemographics, medical history, and hospital characteristics. RESULTS: Rates of patients dying in hospice were 27% in the lowest hospice utilization tertile, 41% in the middle tertile, and 53% in the highest tertile. Patients enrolled in hospice had lower rates of 30-day rehospitalization than those not enrolled (2.2% versus 18.8%; adjusted hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.118-0.131). Patients residing in areas of low hospice utilization were at greater rehospitalization risk than those residing in areas of high utilization (19.1% versus 17.5%; HR, 1.05; 95% CI, 1.04-1.06), which persisted beyond that accounted for by individual hospice enrollment. CONCLUSIONS: Area-level hospice utilization is inversely proportional to rehospitalization rates. This relationship is not fully explained by direct hospice enrollment, and may reflect a spillover effect of the benefits of hospice extending to nonenrollees.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1089/jpm.2014.0395

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[PMID]: 25886702
[Au] Autor:Schmocker RK; Vang X; Cherney Stafford LM; Leverson GE; Winslow ER
[Ad] Address:Department of Surgery, University of Wisconsin School of Medicine and Public Health, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA....
[Ti] Title:Involvement of a surgical service improves patient satisfaction in patients admitted with small bowel obstruction.
[So] Source:Am J Surg;210(2):252-7, 2015 Aug.
[Is] ISSN:1879-1883
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: For patients with small bowel obstruction (SBO), surgical care has been associated with improved outcomes; however, it remains unknown how it impacts satisfaction. METHODS: Patients admitted for SBO who completed the hospital satisfaction survey were eligible. Only those with adhesions or hernias were included. Chart review extracted structural characteristics and outcomes. RESULTS: Forty-seven patients were included; 74% (n = 35) were admitted to a surgical service. Twenty-six percent of the patients (n = 12) were admitted to medicine, and 50% of those (n = 6) had surgical consultation. Patients with surgical involvement as the consulting or primary service (SURG) had higher satisfaction with the hospital than those cared for by the medical service (MED) (80% SURG, 33% MED, P = .015). SURG patients also had higher satisfaction with physicians (74% SURG, 44% MED, P = .015). CONCLUSION: Surgical involvement during SBO admissions is associated with increased patient satisfaction, and adds further weight to the recommendation that these patients be cared for by surgeons.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review

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[PMID]: 25770032
[Au] Autor:Howard VJ; Tanner RM; Anderson A; Irvin MR; Calhoun DA; Lackland DT; Oparil S; Muntner P
[Ad] Address:Department of Epidemiology, School of Public Health, University of Alabama at Birmingham. Electronic address: vjhoward@uab.edu....
[Ti] Title:Apparent Treatment-resistant Hypertension Among Individuals with History of Stroke or Transient Ischemic Attack.
[So] Source:Am J Med;128(7):707-714.e2, 2015 Jul.
[Is] ISSN:1555-7162
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Blood pressure control is a paramount goal in secondary stroke prevention; however, high prevalence of uncontrolled blood pressure and use of multiple antihypertensive medication classes in stroke patients suggest this goal is not being met. We determined the prevalence and factors associated with apparent treatment-resistant hypertension in persons with/without stroke or transient ischemic attack. METHODS: Data came from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national, population-based cohort of 30,239 black and white adults aged ≥45 years, enrolled 2003-2007, restricted to 11,719 participants with treated hypertension. Apparent treatment-resistant hypertension was defined as (1) uncontrolled blood pressure (systolic ≥140 mm Hg or diastolic ≥90 mm Hg) with ≥3 antihypertensive medication classes, or (2) use of ≥4 antihypertensive medication classes, regardless of blood pressure level. Poisson regression was used to calculate characteristics associated with apparent treatment-resistant hypertension. RESULTS: Among hypertensive participants, prevalence of apparent treatment-resistant hypertension was 24.9% (422 of 1694) and 17.0% (1708 of 10,025) in individuals with and without history of stroke or transient ischemic attack, respectively. After adjustment for cardiovascular risk factors, the prevalence ratio for apparent treatment-resistant hypertension for those with versus without stroke or transient ischemic attack was 1.14 (95% confidence interval, 1.03-1.27). Among hypertensive participants with stroke or transient attack, male sex, black race, larger waist circumference, longer duration of hypertension, and reduced kidney function were associated with apparent treatment-resistant hypertension. CONCLUSIONS: The high prevalence of apparent treatment-resistant hypertension among hypertensive persons with history of stroke or transient ischemic attack suggests the need for more individualized blood pressure monitoring and management.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review

  5 / 1899791 MEDLINE  
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[PMID]: 25770031
[Au] Autor:McNeely J; Strauss SM; Saitz R; Cleland CM; Palamar JJ; Rotrosen J; Gourevitch MN
[Ad] Address:Department of Population Health, New York University (NYU) School of Medicine, New York; Department of Medicine, New York University (NYU) School of Medicine, New York. Electronic address: jennifer.mcneely@nyumc.org....
[Ti] Title:A Brief Patient Self-administered Substance Use Screening Tool for Primary Care: Two-site Validation Study of the Substance Use Brief Screen (SUBS).
[So] Source:Am J Med;128(7):784.e9-784.e19, 2015 Jul.
[Is] ISSN:1555-7162
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Substance use screening is widely encouraged in health care settings, but the lack of a screening approach that fits easily into clinical workflows has restricted its broad implementation. The Substance Use Brief Screen (SUBS) was developed as a brief, self-administered instrument to identify unhealthy use of tobacco, alcohol, illicit drugs, and prescription drugs. We evaluated the validity and test-retest reliability of the SUBS in adult primary care patients. METHODS: Adults aged 18-65 years were enrolled from urban safety net primary care clinics to self-administer the SUBS using touch-screen tablet computers for a test-retest reliability study (n= 54) and a 2-site validation study (n= 586). In the test-retest reliability study, the SUBS was administered twice within a 2-week period. In the validation study, the SUBS was compared with reference standard measures, including self-reported measures and oral fluid drug tests. We measured test-retest reliability and diagnostic accuracy of the SUBS for detection of unhealthy use and substance use disorder for tobacco, alcohol, and drugs (illicit and prescription drug misuse). RESULTS: Test-retest reliability was good or excellent for each substance class. For detection of unhealthy use, the SUBS had sensitivity and specificity of 97.8% (95% confidence interval [CI], 93.7-99.5) and 95.7% (95% CI, 92.4-97.8), respectively, for tobacco; and 85.2% (95% CI, 79.3-89.9) and 77.0% (95% CI, 72.6-81.1) for alcohol. For unhealthy use of illicit or prescription drugs, sensitivity was 82.5% (95% CI, 75.7-88.0) and specificity 91.1% (95% CI, 87.9-93.6). With respect to identifying a substance use disorder, the SUBS had sensitivity and specificity of 100.0% (95% CI, 92.7-100.0) and 72.1% (95% CI, 67.1-76.8) for tobacco; 93.5% (95% CI, 85.5-97.9) and 64.6% (95% CI, 60.2-68.7) for alcohol; and 85.7% (95% CI, 77.2-92.0) and 82.0% (95% CI, 78.2-85.3) for drugs. Analyses of area under the receiver operating curve (AUC) indicated good discrimination (AUC 0.74-0.97) for all substance classes. Assistance in completing the SUBS was requested by 11% of participants. CONCLUSIONS: The SUBS was feasible for self-administration and generated valid results in a diverse primary care patient population. The 4-item SUBS can be recommended for primary care settings that are seeking to implement substance use screening.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review

  6 / 1899791 MEDLINE  
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[PMID]: 25660250
[Au] Autor:Tisminetzky M; McManus DD; Erskine N; Saczynski JS; Yarzebski J; Granillo E; Gore J; Goldberg RJ
[Ad] Address:Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester....
[Ti] Title:Thirty-day Hospital Readmissions in Patients with Non-ST-segment Elevation Acute Myocardial Infarction.
[So] Source:Am J Med;128(7):760-5, 2015 Jul.
[Is] ISSN:1555-7162
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Limited data exist about relatively recent trends in the magnitude and characteristics of patients who are rehospitalized shortly after admission for a non-ST-segment elevation acute myocardial infarction (NSTEMI). This observational study describes decade-long trends (1999-2009) in the magnitude and characteristics of patients readmitted to the hospital within 30 days of hospitalization for an incident (initial) episode of NSTEMI. METHODS: We reviewed the medical records of 2249 residents of the Worcester (Mass) metropolitan area who were hospitalized for an initial NSTEMI in 6 biennial periods between 1999 and 2009 at 3 central Massachusetts medical centers. RESULTS: The average age of our study population was 72 years, 90% were white, and 46% were women. The proportion of patients who were readmitted to the hospital for any cause within 30 days after discharge for an NSTEMI remained unchanged between 1999 and 2009 (approximately 15%) in both crude and multivariable adjusted analyses. Slight declines were observed for cardiovascular disease-related 30-day readmissions over the 10-year study period. Women, elderly patients, those with multiple chronic comorbidities or a prolonged index hospitalization, and patients who developed heart failure during their index hospitalization were at higher risk for being readmitted within 30 days than respective comparison groups. CONCLUSION: Thirty-day hospital readmission rates after hospital discharge for a first NSTEMI remained stable between 1999 and 2009. We identified several groups at higher risk for hospital readmission; further surveillance efforts and/or tailored educational and treatment approaches remain needed for these groups.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review

  7 / 1899791 MEDLINE  
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[PMID]: 25644319
[Au] Autor:Saczynski JS; Rosen AB; McCammon RJ; Zivin K; Andrade SE; Langa KM; Vijan S; Pirraglia PA; Briesacher BA
[Ad] Address:Department of Medicine, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, Worcester, Mass; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Electronic address: Jane.saczynski@umassmed.edu....
[Ti] Title:Antidepressant Use and Cognitive Decline: The Health and Retirement Study.
[So] Source:Am J Med;128(7):739-46, 2015 Jul.
[Is] ISSN:1555-7162
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Depression is associated with cognitive impairment and dementia, but whether treatment for depression with antidepressants reduces the risk for cognitive decline is unclear. We assessed the association between antidepressant use and cognitive decline over 6 years. METHODS: Participants were 3714 adults aged 50 years or more who were enrolled in the nationally representative Health and Retirement Study and had self-reported antidepressant use. Depressive symptoms were assessed using the 8-item Center for Epidemiologic Studies Depression Scale. Cognitive function was assessed at 4 time points (2004, 2006, 2008, 2010) using a validated 27-point scale. Change in cognitive function over the 6-year follow-up period was examined using linear growth models, adjusted for demographics, depressive symptoms, comorbidities, functional limitations, and antidepressant anticholinergic activity load. RESULTS: At baseline, cognitive function did not differ significantly between the 445 (12.1%) participants taking antidepressants and those not taking antidepressants (mean, 14.9%; 95% confidence interval, 14.3-15.4 vs mean, 15.1%; 95% confidence interval, 14.9-15.3). During the 6-year follow up period, cognition declined in both users and nonusers of antidepressants, ranging from-1.4 change in mean score in those with high depressive symptoms and taking antidepressants to-0.5 change in mean score in those with high depressive symptoms and not taking antidepressants. In adjusted models, cognition declined in people taking antidepressants at the same rate as those not taking antidepressants. Results remained consistent across different levels of baseline cognitive function, age, and duration of antidepressant use (prolonged vs short-term). CONCLUSIONS: Antidepressant use did not modify the course of 6-year cognitive change in this nationally representative sample.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review

  8 / 1899791 MEDLINE  
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[PMID]: 25595470
[Au] Autor:Testani JM; Brisco MA; Kociol RD; Jacoby D; Bellumkonda L; Parikh CR; Coca SG; Tang WH
[Ad] Address:Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn; Program of Applied Translational Research, Yale University School of Medicine, New Haven, Conn. Electronic address: jeffrey.testani@yale.edu....
[Ti] Title:Substantial Discrepancy Between Fluid and Weight Loss During Acute Decompensated HeartFailure Treatment.
[So] Source:Am J Med;128(7):776-783.e4, 2015 Jul.
[Is] ISSN:1555-7162
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Net fluid and weight loss are used ubiquitously to monitor diuretic response in acute decompensated heart failure research and patient care. However, the performance of these metrics has never been evaluated critically. The weight and volume of aqueous fluids such as urine should be correlated nearly perfectly and with very good agreement. As a result, significant discrepancy between fluid and weight loss during the treatment of acute decompensated heart failure would indicate measurement error in 1 or both of the parameters. METHODS: The correlation and agreement (Bland-Altman method) between diuretic-induced fluid and weight loss were examined in 3 acute decompensated heart failure trials and cohorts: (1) Diuretic Optimization Strategies Evaluation (DOSE) (n= 254); (2) Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) (n= 348); and (3) Penn (n= 486). RESULTS: The correlation between fluid and weight loss was modest (DOSE r= 0.55; ESCAPE r= 0.48; Penn r= 0.51; P < .001 for all), and the 95% limits of agreement were wide (DOSE-7.9 to 6.4 kg-L; ESCAPE-11.6 to 7.5 kg-L; Penn-14.5 to 11.3 kg-L). The median relative disagreement ranged from 47.0% to 63.5%. A bias toward greater fluid than weight loss was found across populations (-0.74 to-2.1 kg-L, P ≤ .002). A consistent pattern of baseline characteristics or in-hospital treatment parameters that could identify patients at risk of discordant fluid and weight loss was not found. CONCLUSIONS: Considerable discrepancy between fluid balance and weight loss is common in patients treated for acute decompensated heart failure. Awareness of the limitations inherent to these commonly used metrics and efforts to develop more reliable measures of diuresis are critical for both patient care and research in acute decompensated heart failure.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review

  9 / 1899791 MEDLINE  
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[PMID]: 25331267
[Au] Autor:Blashill AJ; Bedoya CA; Mayer KH; O'Cleirigh C; Pinkston MM; Remmert JE; Mimiaga MJ; Safren SA
[Ad] Address:Massachusetts General Hospital, Boston, MA, USA, Ablashill@mgh.harvard.edu.
[Ti] Title:Psychosocial Syndemics are Additively Associated with Worse ART Adherence in HIV-Infected Individuals.
[So] Source:AIDS Behav;19(6):981-6, 2015 Jun.
[Is] ISSN:1573-3254
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Adherence to antiretroviral therapy (ART) among HIV-infected individuals is necessary to both individual and public health, and psychosocial problems have independently been associated with poor adherence. To date, studies have not systematically examined the effect of multiple, co-occurring psychosocial problems (i.e., "syndemics") on ART adherence. Participants included 333 HIV-infected individuals who completed a comprehensive baseline evaluation, as part of a clinical trial to evaluate an intervention to treat depression and optimize medication adherence. Participants completed self-report questionnaires, and trained clinicians completed semi-structured diagnostic interviews. ART non-adherence was objectively measured via an electronic pill cap (i.e., MEMS). As individuals reported a greater number of syndemic indicators, their odds of non-adherence increased. Co-occurring psychosocial problems have an additive effect on the risk for poor ART adherence. Future behavioral medicine interventions are needed that address these problems comprehensively, and/or the core mechanisms that they share.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1007/s10461-014-0925-6

  10 / 1899791 MEDLINE  
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[PMID]: 26070612
[Au] Autor:Probst FJ; James RA; Burrage LC; Rosenfeld JA; Bohan TP; Melver CH; Magoulas P; Austin E; Franklin AI; Azamian M; Xia F; Patel A; Bi W; Bacino C; Belmont JW; Ware SM; Shaw C; Cheung SW; Lalani SR
[Ad] Address:Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, MS BCM225, Houston, TX, USA....
[Ti] Title:De novo deletions and duplications of 17q25.3 cause susceptibility to cardiovascular malformations.
[So] Source:Orphanet J Rare Dis;10(1):75, 2015.
[Is] ISSN:1750-1172
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Genomic disorders resulting from deletion or duplication of genomic segments are known to be an important cause of cardiovascular malformations (CVMs). In our previous study, we identified a unique individual with a de novo 17q25.3 deletion from a study of 714 individuals with CVM. METHODS: To understand the contribution of this locus to cardiac malformations, we reviewed the data on 60,000 samples submitted for array comparative genomic hybridization (CGH) studies to Medical Genetics Laboratories at Baylor College of Medicine, and ascertained seven individuals with segmental aneusomy of 17q25. We validated our findings by studying another individual with a de novo submicroscopic deletion of this region from Cytogenetics Laboratory at Cincinnati Children's Hospital. Using bioinformatic analyses including protein-protein interaction network, human tissue expression patterns, haploinsufficiency scores, and other annotation systems, including a training set of 251 genes known to be linked to human cardiac disease, we constructed a pathogenicity score for cardiac phenotype for each of the 57 genes within the terminal 2.0Mb of 17q25.3. RESULTS: We found relatively high penetrance of cardiovascular defects (~60%) with five deletions and three duplications, observed in eight unrelated individuals. Distinct cardiac phenotypes were present in four of these subjects with non-recurrent de novo deletions (range 0.08Mb-1.4Mb) in the subtelomeric region of 17q25.3. These included coarctation of the aorta (CoA), total anomalous pulmonary venous return (TAPVR), ventricular septal defect (VSD) and atrial septal defect (ASD). Amongst the three individuals with variable size duplications of this region, one had patent ductus arteriosus (PDA) at 8months of age. CONCLUSION: The distinct cardiac lesions observed in the affected patients and the bioinformatics analyses suggest that multiple genes may be plausible drivers of the cardiac phenotype within this gene-rich critical interval of 17q25.3.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1506
[Cu] Class update date: 150620
[Lr] Last revision date:150620
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1186/s13023-015-0291-0


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