bluuebunny/crossref_metadata_2025 huggingface dataset:
Wide variation in severe neonatal morbidity among very preterm infants in European regions
Authors: Edstedt Bonamy Anna Karin , Zeitlin Jennifer , Piedvache Aurélie , Maier Rolf F , van Heijst Arno , Varendi Heili , Manktelow Bradley N , Fenton Alan , Mazela Jan , Cuttini Marina , Norman Mikael , Petrou Stavros , Reempts Patrick Van , Barros Henrique , Draper Elizabeth S
Published: January 2018

Objective

To investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates.

Design

Area-based cohort study of all births before 32 weeks of gestational age.

Setting

16 regions in 11 European countries in 2011/2012.

Patients

Survivors to discharge from neonatal care (n=6422).

Main outcome measures

Severe neonatal morbidity was defined as intraventricular haemorrhage grades III and IV, cystic periventricular leukomalacia, surgical necrotizing enterocolitis and retinopathy of prematurity grades ≥3. A secondary outcome included severe bronchopulmonary dysplasia (BPD), data available in 14 regions. Common definitions for neonatal morbidities were established before data abstraction from medical records. Regional severe neonatal morbidity rates were correlated with regional in-hospital mortality rates for live births after adjustment on maternal and neonatal characteristics.

Results

10.6% of survivors had a severe neonatal morbidity without severe BPD (regional range 6.4%–23.5%) and 13.8% including severe BPD (regional range 10.0%–23.5%). Adjusted inhospital mortality was 13.7% (regional range 8.4%–18.8%). Differences between regions remained significant after consideration of maternal and neonatal characteristics (P<0.001) and severe neonatal morbidity rates were not correlated with mortality rates (P=0.50).

Conclusion

Severe neonatal morbidity rates for VPT survivors varied widely across European regions and were independent of mortality rates.
Automated diabetic retinopathy detection using optical coherence tomography angiography: a pilot study
Authors: Sandhu Harpal Singh , Eladawi Nabila , Elmogy Mohammed , Keynton Robert , Helmy Omar , Schaal Shlomit , El-Baz Ayman
Published: January 2018

Background

Optical coherence tomography angiography (OCTA) is increasingly being used to evaluate diabetic retinopathy, but the interpretation of OCTA remains largely subjective. The purpose of this study was to design a computer-aided diagnostic (CAD) system to diagnose non-proliferative diabetic retinopathy (NPDR) in an automated fashion using OCTA images.

Methods

This was a two-centre, cross-sectional study. Adults with type II diabetes mellitus (DMII) were eligible for inclusion. OCTA scans of the macula were taken, and the five vascular maps generated per eye were analysed by a novel CAD system. For the purpose of classification/diagnosis, three different local features—blood vessel density, blood vessel calibre and the size of the foveal avascular zone (FAZ)—were segmented from these images and used to train a new, automated classifier.

Results

One hundred and six patients with DMII were included in the study, 23 with no DR and 83 with mild NPDR. When using features of the superficial retinal map alone, the system demonstrated an accuracy of 80.0% and area under the curve (AUC) of 76.2%. Using the features of the deep retinal map alone, accuracy was 91.4% and AUC 89.2%. When data from both maps were combined, the presented CAD system demonstrated overall accuracy of 94.3%, sensitivity of 97.9%, specificity of 87.0%, area under curve (AUC) of 92.4% and dice similarity coefficient of 95.8%.

Conclusion

Automated diagnosis of NPDR using OCTA images is feasible and accurate. Combining this system with OCT data is a plausible next step that would likely improve its robustness.
Visual pathway function and structure in Wolfram syndrome: patient age, variation and progression
Authors: Hoekel James , Narayanan Anagha , Rutlin Jerrel , Lugar Heather , Al-Lozi Amal , Hershey Tamara , Tychsen Lawrence
Published: January 2018

Background/aims

To report alterations in visual acuity and visual pathway structure over an interval of 1–3 years in a cohort of children, adolescents and young adults who have Wolfram syndrome (WFS) and to describe the range of disease severity evident in patients with WFS whose ages differed by as much as 20 years at first examination.

Methods

Annual, prospective ophthalmological examinations were performed in conjunction with retinal nerve fibre layer (RNFL) analysis. Diffusion tensor MRI-derived fractional anisotropy was used to assess the microstructural integrity of the optic radiations (OR FA).

Results

Mean age of the 23 patients with WFS in the study was 13.8 years (range 5–25 years). Mean log minimum angle resolution visual acuity was 0.66 (20/91). RNFL thickness was subnormal in even the youngest patients with WFS. Average RNFL thickness in patients with WFS was 57±8 µ or ~40% thinner than that measured in normal (94±10 µ) children and adolescents (P<0.01). Lower OR FA correlated with worse visual acuity (P=0.006). Subsequent examinations showed declines (P<0.05) in visual acuity, RNFL thickness and OR FA at follow-up intervals of 12–36 months. However, a wide range of disease severity was evident across ages: some of the youngest patients at their first examination had deficits more severe than the oldest patients.

Conclusion

The genetic mutation of WFS causes damage to both pregeniculate and postgeniculate regions of the visual pathway. The damage is progressive. The decline in visual pathway structure is accompanied by declines of visual function. Disease severity differs widely in individual patients and cannot be predicted from their age.
Impact of order set design on urine culturing practices at an academic medical centre emergency department
Authors: Munigala Satish , Jackups Ronald R , Poirier Robert F , Liang Stephen Y , Wood Helen , Jafarzadeh S Reza , Warren David K
Published: January 2018

Background

Urinalysis and urine culture are commonly ordered tests in the emergency department (ED). We evaluated the impact of removal of order sets from the ‘frequently ordered test’ in the computerised physician order entry system (CPOE) on urine testing practices.

Methods

We conducted a before (1 September to 20 October 2015) and after (21 October to 30 November 2015) study of ED patients. The intervention consisted of retaining ‘urinalysis with reflex to microscopy’ as the only urine test in a highly accessible list of frequently ordered tests in the CPOE system. All other urine tests required use of additional order screens via additional mouse clicks. The frequency of urine testing before and after the intervention was compared, adjusting for temporal trends.

Results

During the study period, 6499 (28.2%) of 22 948 ED patients had ≥1 urine test ordered. Urine testing rates for all ED patients decreased in the post intervention period for urinalysis (291.5 pre intervention vs 278.4 per 1000 ED visits post intervention, P=0.03), urine microscopy (196.5vs179.5, P=0.001) and urine culture (54.3vs29.7, P<0.001). When adjusted for temporal trends, the daily culture rate per 1000 ED visits decreased by 46.6% (−46.6%, 95% CI −66.2% to –15.6%), but urinalysis (0.4%, 95% CI −30.1 to 44.4%), microscopy (−6.5%, 95% CI −36.0% to 36.6%) and catheterised urine culture rates (17.9%, 95% CI −16.9 to 67.4) were unchanged.

Conclusions

A simple intervention of retaining only ‘urinalysis with reflex to microscopy’ and removing all other urine tests from the ‘frequently ordered’ window of the ED electronic order set decreased urine cultures ordered by 46.6% after accounting for temporal trends. Given the injudicious use of antimicrobial therapy for asymptomatic bacteriuria, findings from our study suggest that proper design of electronic order sets plays a vital role in reducing excessive ordering of urine cultures.
Beyond motor neurons: expanding the clinical spectrum in Kennedy’s disease
Authors: Manzano Raquel , Sorarú Gianni , Grunseich Christopher , Fratta Pietro , Zuccaro Emanuela , Pennuto Maria , Rinaldi Carlo
Published: January 2018

Kennedy’s disease, or spinal and bulbar muscular atrophy (SBMA), is an X-linked neuromuscular condition clinically characterised by weakness, atrophy and fasciculations of the limb and bulbar muscles, as a result of lower motor neuron degeneration. The disease is caused by an abnormally expanded triplet repeat expansions in the ubiquitously expressed androgen receptor gene, through mechanisms which are not entirely elucidated. Over the years studies from both humans and animal models have highlighted the involvement of cell populations other than motor neurons in SBMA, widening the disease phenotype. The most compelling aspect of these findings is their potential for therapeutic impact: muscle, for example, which is primarily affected in the disease, has been recently shown to represent a valid alternative target for therapy to motor neurons. In this review, we discuss the emerging study of the extra-motor neuron involvement in SBMA, which, besides increasingly pointing towards a multidisciplinary approach for affected patients, deepens our understanding of the pathogenic mechanisms and holds potential for providing new therapeutic targets for this disease.
Psychiatric symptoms in preclinical behavioural-variant frontotemporal dementia inMAPTmutation carriers
Authors: Cheran Gayathri , Silverman Hannah , Manoochehri Masood , Goldman Jill , Lee Seonjoo , Wu Liwen , Cines Sarah , Fallon Emer , Kelly Brendan Desmond , Olszewska Diana Angelika , Heidebrink Judith , Shair Sarah , Campbell Stephen , Paulson Henry , Lynch Timothy , Cosentino Stephanie , Huey Edward D
Published: January 2018

Objective

To characterise psychiatric symptoms in preclinical and early behavioural-variant frontotemporal dementia (bvFTD), a neurodegenerative disorder whose symptoms overlap with and are often mistaken for psychiatric illness.

Methods

The present study reports findings from a systematic, global, prospective evaluation of psychiatric symptoms in 12 preclinical carriers of pathogenicMAPTmutations, not yet meeting bvFTD diagnostic criteria, and 46 familial non-carrier controls. Current psychiatric symptoms, informant-reported symptoms and lifetime prevalence of psychiatric disorders were assessed with The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the Neuropsychiatric Inventory Questionnaire. Fisher exact test was used to compare carriers and non-carriers’ lifetime prevalence of six DSM-IV disorders: major depressive disorder, panic attacks, alcohol abuse, generalised anxiety disorder, panic disorder, and depressive disorder not otherwise specified. Other DSM-IV disorders had insufficient prevalence across our sample for between-group comparisons, but are reported.

Results

Non-carriers had greater prevalence of mood and anxiety disorders than has been reported for a general reference population. Preclinical carriers had lower lifetime prevalence of mood and anxiety disorders than non-carriers, except for depressive disorder not otherwise specified, an atypical syndrome comprising clinically significant depressive symptoms which fail to meet criteria for major depressive disorder.

Conclusion

Findings suggest that early psychiatric symptoms of emergent bvFTD may manifest as emotional blunting or mood changes not cleanly conforming to criteria for a DSM-defined mood disorder.
Increased blood pressure variability after endovascular thrombectomy for acute stroke is associated with worse clinical outcome
Authors: Bennett Alicia E , Wilder Michael J , McNally J Scott , Wold Jana J , Stoddard Gregory J , Majersik Jennifer J , Ansari Safdar , de Havenon Adam
Published: January 2018

Background and purpose

Blood pressure variability has been found to contribute to worse outcomes after intravenous tissue plasminogen activator, but the association has not been established after intra-arterial therapies.

Methods

We retrospectively reviewed patients with an ischemic stroke treated with intra-arterial therapies from 2005 to 2015. Blood pressure variability was measured as standard deviation (SD), coefficient of variation (CV), and successive variation (SV). Ordinal logistic regression models were fitted to the outcome of the modified Rankin Scale (mRS) with univariable predictors of systolic blood pressure variability. Multivariable ordinal logistic regression models were fitted to the outcome of mRS with covariates that showed independent predictive ability (P<0.1).

Results

There were 182 patients of mean age 63.2 years and 51.7% were female. The median admission National Institutes of Health Stroke Scalescore was 16 and 47.3% were treated with intravenous tissue plasminogen activator. In a univariable ordinal logistic regression analysis, systolic SD, CV, and SV were all significantly associated with a 1-point increase in the follow-up mRS (OR 2.30–4.38, all P<0.002). After adjusting for potential confounders, systolic SV was the best predictor of a 1-point increase in mRS at follow-up (OR 2.63–3.23, all P<0.007).

Conclusions

Increased blood pressure variability as measured by the SD, CV, and SV consistently predict worse neurologic outcomes as measured by follow-up mRS in patients with ischemic stroke treated with intra-arterial therapies. The SV is the strongest and most consistent predictor of worse outcomes at all time intervals.
Concomitant conus medullaris arteriovenous shunts and sacral dural arteriovenous fistulas: pathophysiological links related to the venous drainage of the lesions in a series of five cases
Authors: Rosi Andrea , Consoli Arturo , Condette-Auliac Stéphanie , Coskun Oguzhan , Di Maria Federico , Rodesch Georges
Published: January 2018

Background

Spinal cord arteriovenous shunts (scAVSs) are a group of lesions located in the spinal cord itself or in the surrounding structures. The most common scAVSs are spinal dural arteriovenous fistulas (sDAVFs), which are acquired lesions. The pathogenesis of sDAVFs involves thrombosis and venous hypertension as trigger factors. Intradural scAVSs such as spinal cord arteriovenous nidus type malformations (AVMs) and pial arteriovenous fistulas are less common than sDAVFs and are considered to have a so-called ‘congenital’ origin. The association between different concomitant scAVSs is very rare and the association of sDAVFs with intradural scAVSs has been described in only a few case reports.

Methods

We describe a case series of five patients presenting with a conus medullaris AVS associated with a lower lumbar or sacral DAVF.

Results

Three of our patients were <30 years old at presentation. In four of these five cases the intradural scAVS drained caudally, engorging the epidural plexus in the same location as the sDAVF. In only one case, who presented with thrombosis of the drainage of the main compartment of a conus medullaris pial AVF, was the location of the DAVF opposite to the location of the residual drainage.

Conclusion

We discuss the pathophysiological link between scAVS and sDAVF on the basis of the rarity of the DAVF, the uncommon association between scAVS and sDAVF, the presence of sDAVF in young patients, and the venous hypertension created by the venous drainage towards the sacral area responsible for angiogenesis creating the dural shunt.
What to do about fibrin rich ‘tough clots’? Comparing the Solitaire stent retriever with a novel geometric clot extractor in an in vitro stroke model
Authors: Fennell Vernard S , Setlur Nagesh Swetadri Vasan , Meess Karen M , Gutierrez Liza , James Rhys H , Springer Michael E , Siddiqui Adnan H
Published: January 2018

Background

Despite advances in revascularization tools for large vessel occlusion presenting as acute ischemic stroke, a significant subset of clots remain recalcitrant to current strategies. We assessed the effectiveness of a novel thrombectomy device that was specifically designed to retrieve resistant fibrin rich clots, the geometric clot extractor (GCE; Neuravi, Galway, Ireland), in an in vitro cerebrovascular occlusion stroke model.

Methods

After introducing fibrin rich clot analogues into the middle cerebral artery of the model, we compared the rates of recanalization between GCE and Solitaire flow restoration stent retriever (SR; Medtronic, Minneapolis, Minnesota, USA; control group) cases. A maximum of three passes of each device was allowed. If the SR failed to recanalize the vessel after three passes, one pass of the GCE was allowed (rescue cases).

Results

In a total of 26 thrombectomy cases (13 GCE, 13 SR), successful recanalization (Thrombolysis in Cerebral Infarction score of 2b or 3) was achieved 100% of the time in the GCE cases with an average of 2.13 passes per case. This rate was significantly higher compared with the Solitaire recanalization rate (7.7%, P<0.0001) with an average of three passes per case. After SR failure (in 92% of cases), successful one pass GCE rescue recanalization was achieved 66% of the time (P<0.005).

Conclusion

Application of the GCE in this experimental stroke model to retrieve typically recalcitrant fibrin rich clots resulted in higher successful recanalization rates than the SR.
The 100 most cited articles in the endovascular management of intracranial aneurysms
Authors: Maingard Julian , Phan Kevin , Ren Yifan , Kok Hong Kuan , Thijs Vincent , Hirsch Joshua A , Lee Michael J , Chandra Ronil V , Brooks Duncan Mark , Asadi Hamed
Published: January 2018

Introduction

Endovascular interventions for intracranial aneurysms have evolved substantially over the past several decades. A citation rank list is used to measure the scientific and/or clinical impact of an article. Our objective was to identify and analyze the characteristics of the 100 most cited articles in the field of endovascular therapy for intracranial aneurysms.

Methods

We performed a retrospective bibliometric analysis between July and August 2017. Articles were searched on the Science Citation Index Expanded database using Web of Science in order to identify the most cited articles in the endovascular therapy of intracranial aneurysms since 1945. Using selected key terms (‘intracranial aneurysm’, ‘aneurysm’, ‘aneurysmal subarachnoid’, ‘endovascular’, ‘coiling’, ‘stent-assisted’, ‘balloon-assisted’, ‘flow-diversion’) yielded a total of 16 314 articles. The top 100 articles were identified and analyzed to extract relevant information, including citation count, authorship, article type, subject matter, institution, country of origin, and year of publication.

Results

Citations for the top 100 articles ranged from 133 to 1832. All articles were cited an average of 27 times per year. There were 45 prospective studies, including 7 level–II randomized controlled trials. Most articles were published in the 2000s (n=53), and the majority constituted level III or level IV evidence. Half of the top 100 articles arose from the USA.

Conclusion

This study provides a comprehensive overview of the most cited articles in the endovascular management of intracranial aneurysms. It recognizes the contributions made by key authors and institutions, providing an important framework to an enhanced understanding of the evidence behind the endovascular treatment of aneurysms.
Are changes in objective working hour characteristics associated with changes in work-life conflict among hospital employees working shifts? A 7-year follow-up
Authors: Karhula Kati , Koskinen Aki , Ojajärvi Anneli , Ropponen Annina , Puttonen Sampsa , Kivimäki Mika , Härmä Mikko
Published: January 2018

Objective

To investigate whether changes in objective working hour characteristics are associated with parallel changes in work-life conflict (WLC) among hospital employees.

Methods

Survey responses from three waves of the Finnish Public Sector study (2008, 2012 and 2015) were combined with payroll data from 91 days preceding the surveys (n=2 482, 93% women). Time-dependent fixed effects regression models adjusted for marital status, number of children and stressfulness of the life situation were used to investigate whether changes in working hour characteristics were associated with parallel change in WLC. The working hour characteristics were dichotomised with cut-points in less than or greater than 10% or less than or greater than25% occurrence) and WLC to frequent versus seldom/none.

Results

Change in proportion of evening and night shifts and weekend work was significantly associated with parallel change in WLC (adjusted OR 2.19, 95% CI 1.62 to 2.96; OR 1.71, 95% CI 1.21 to 2.44; OR 1.63, 95% CI 1.194 to 2.22, respectively). Similarly, increase or decrease in proportion of quick returns (adjusted OR 1.45, 95% CI 1.10 to 1.89) and long work weeks (adjusted OR 1.26, 95% CI 1.04 to 1.52) was associated with parallel increase or decrease in WLC. Single days off and very long work weeks showed no association with WLC.

Conclusions

Changes in unsocial working hour characteristics, especially in connection with evening shifts, are consistently associated with parallel changes in WLC.
Concurrent endocrine neoplasias in dogs and cats: a retrospective study (2004–2014)
Authors: Beatrice Laura , Boretti Felicitas Schär , Sieber‐Ruckstuhl Nadja S , Mueller Claudia , Kümmerle‐Fraune Claudia , Hilbe Monika , Grest Paula , Reusch Claudia E
Published: January 2018

Multiple endocrine neoplasia (MEN) is a well‐known syndrome in human medicine, whereas only a few cases of concurrent endocrine neoplasias have been reported in dogs and cats. The aim of this study was to evaluate the prevalence of concurrent endocrine neoplasias in dogs and cats at our clinic, identify possible breed and sex predispositions and investigate similarities with MEN syndromes in humans. Postmortem reports of 951 dogs and 1155 cats that died or were euthanased at the Clinic for Small Animal Internal Medicine, University of Zurich, between 2004 and 2014 were reviewed, and animals with at least two concurrent endocrine neoplasias and/or hyperplasias were included. Twenty dogs and 15 cats met the inclusion criteria. In dogs, the adrenal glands were most commonly affected. Multiple tumours affecting the adrenal glands and the association of these tumours with pituitary adenomas were the most common tumour combinations. Only one dog had a combination resembling human MEN type 1 syndrome (pituitary adenoma and insulinoma). In cats, the thyroid glands were most commonly affected and there were no similarities to human MEN syndromes. The prevalence of concurrent endocrine neoplasia was 2.1 per cent in dogs and 1.3 per cent in cats and MEN‐like syndromes are very rare in these species.
Topological interaction of electromagnetism and torsion
Authors: Hammond Richard T.
Published: January 2018

A fully gauge-invariant topological coupling of torsion to the electromagnetic field is examined. It is shown, while the gravitational fields are unaltered, torsion may serve as a source for electromagnetism and electromagnetism may serve as a source for torsion. Unlike most couplings, this gives rise to conservation of charge, no magnetic monopoles, and is in agreement with the principle of equivalence.
Albuminuria in kidney transplant recipients is associated with increased urinary serine proteases and activation of the epithelial sodium channel
Authors: Hinrichs Gitte R. , Michelsen Jannie S. , Zachar Rikke , Friis Ulla G. , Svenningsen Per , Birn Henrik , Bistrup Claus , Jensen Boye L.
Published: January 2018

Albuminuria predicts adverse renal outcome in kidney transplant recipients. The present study addressed the hypothesis that albuminuria is associated with increased urine serine proteases with the ability to activate the epithelial sodium channel (ENaC) and with greater extracellular volume and higher blood pressure. In a cross-sectional design, kidney transplant recipients with ( n = 18) and without ( n = 19) albuminuria were included for office blood pressure measurements, estimation of volume status by bioimpedance, and collection of spot urine and plasma samples. Urine was analyzed for serine proteases and for the ability to activate ENaC current in vitro. Urine exosome protein was immunoblotted for prostasin and γ-ENaC protein. In the present study, it was found that, compared with nonalbuminuria (8.8 mg/g creatinine), albuminuric (1,722 mg/g creatinine) kidney transplant recipients had a higher systolic and diastolic blood pressure, despite receiving significantly more antihypertensives, and a greater urinary total plasminogen, active plasmin, active urokinase-type plasminogen activator, and prostasin protein abundance, which correlated significantly with u-albumin. Fluid overload correlated with systolic blood pressure, urinary albumin/creatinine, and plasminogen/creatinine. Urine from albuminuric kidney transplant recipients evoked a greater amiloride- and aprotinin-sensitive inward current in single collecting duct cells (murine cell line M1). γENaC subunits at 50 and 75 kDa showed increased abundance in urine exosomes from albuminuric kidney transplant recipients when compared with controls. These findings show that albuminuria in kidney transplant recipients is associated with hypertension, ability of urine to proteolytically activate ENaC current, and increased abundance of γENaC. ENaC activity could contribute to hypertension and adverse outcome in posttransplant proteinuria.
UE‐Initiated Cell Reselection Game for Cell Load Balancing in a Wireless Network
Authors: Park Jaesung
Published: January 2018

A user changes its serving cell if the quality of experience (QoE) provided by the current serving cell is not satisfactory. Since users reselect cells to increase their QoEs selfishly, the system resource efficiency can be deteriorated and a system can be unstable if users are not driven to cooperate appropriately. In this paper, inspired by the minority game (MG) model, we design a UE‐initiated cell reselection policy. The MG has a salient characteristic that the number of players who win the game converges to a prespecified value even though players act selfishly without knowing the actions taken by the other players. Using the MG model, we devise a rule by which each UE plays a cell reselection game. We also design a criterion that a system controller uses to determine the result of a game and public information sent by a system controller to induce implicit cooperation among UEs. The simulation results show that compared with noncooperative method the proposed method increases not only the system performance, such as cell load balance index and system utility, but also the performance of UEs in terms of a downlink data rate and an outage probability received from a system.
Measuring the Complex Construct of Macroergonomic Compatibility: A Manufacturing System Case Study
Authors: Realyvásquez Arturo , Maldonado-Macías Aide A.
Published: January 2018

Macroergonomic compatibility (MC) refers to the extent to which macroergonomic factors and elements (MFEs) interact positively with humans. It is one of the most complex constructs to measure in work systems and in ergonomics. The goal of this paper is to determine the levels of MC in a manufacturing system. As methods, we use the macroergonomic compatibility index (MCI) and the Macroergonomic Compatibility Questionnaire (MCQ). The MCQ was administered in its three versions (i.e., worker version, expert version, and medical department version) to collect data about the macroergonomic practices implemented in the manufacturing company. Regarding results, all the macroergonomic factors and most of the macroergonomic elements showed a low level of MC; that is, MCI < 0.7. Only macroergonomic elements Education, Knowledge, and Skills reached a medium level; namely, MCI = 0.709. The factor with the highest level of MC was the Person factor (MCI = 0.328). Similarly, the whole manufacturing system showed a low level of MC. In conclusion, the studied manufacturing company requires urgent macroergonomic interventions. Also, we found that the MCI can effectively measure the level of MC of MFEs and can guide the implementation of macroergonomic practices (MPs) and explain the MC construct.
Redefining the Phenotype of Dental Caries
Authors: Weber Megan , Bogstad Søvik Jenny , Mulic Aida , Deeley Kathleen , Tveit Anne B. , Forella Jessalyn , Shirey Nicholas , Vieira Alexandre R.
Published: January 2018

Dental caries is a multifactorial infectious disease and a major public health problem estimated to affect 60-90% of school children as well as a vast number of adults. The aim of this work was to define patterns of progression of the disease based on longitudinal data in contrast to using a cross-sectional assessment. dmft/DMFT scores were collected at ages 5, 12, 14, 16, 17, and 18 from 876 individuals. We tested our newly defined phenotypes for association with genetic variants in genes shown to be associated with caries. We generated genotyping data using Taqman chemistry in markers of genes involved in processes such as enamel formation and salivary contributions. Kallikrein 4 (KLK4) was found to show a significant association with the created phenotypes (p = 0.0008 in a recessive model for low caries experience in the primary dentition vs. high caries experience in the primary dentition, and p = 0.0004 in a recessive model for caries free primary dentition vs. high caries experience in the primary dentition).
A Clinical Review of Generalized Overgrowth Syndromes in the Era of Massively Parallel Sequencing
Authors: Kamien Benjamin , Ronan Anne , Poke Gemma , Sinnerbrink Ingrid , Baynam Gareth , Ward Michelle , Gibson William T. , Dudding-Byth Tracy , Scott Rodney J.
Published: January 2018

The overgrowth syndromes are important to diagnose, not just for accurate genetic counseling, but also for knowledge surrounding cancer surveillance and prognosis. There has been a recent expansion in the number of genes associated with a mendelian overgrowth phenotype, so this review updates previous classifications of overgrowth syndromes. We also describe a clinical and molecular approach to the investigation of individuals presenting with overgrowth. This review aims to assist the clinical diagnosis of generalized overgrowth syndromes by outlining the salient features of well-known overgrowth syndromes alongside the many syndromes that have been discovered and classified more recently. We provide key clinical “handles” to aid clinical diagnosis and a list of genes to aid with panel design when using next generation sequencing, which we believe is frequently needed due to the overlapping phenotypic features seen between overgrowth syndromes.
Ultra-Low Contrast Volume for Patients with Advanced Chronic Kidney Disease Undergoing Coronary Procedures
Authors: Rozenbaum Zach , Benchetrit Sydney , Rozenbaum Eliezer , Neumark Eran , Mosseri Morris , Pereg David
Published: January 2018

Background/Aims: Contrast induced nephropathy (CIN) is associated with adverse clinical outcomes in patients undergoing coronary interventions, particularly in patients with advanced chronic kidney. The study was aimed to assess the real-life feasibility and safety of ultra-low volume coronary procedures in patients with advanced chronic kidney disease. Methods: A prospective study that included patients with an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2) was conducted. Coronary procedures were performed using an ultra-low contrast volume technique. Results: The 30 patients had a mean eGFR of 31.8(±8) mL/min/1.73 m2. Indications for coronary angiography were non-ST elevation myocardial infarction (63.3%), unstable (20%), and stable angina pectoris (16.7%). Median contrast volume for diagnostic coronary angiography was 13 mL (interquartile ranges [IQR] 12–14.9), and an additional 13 mL (IQR 8.8–14.3) for percutaneous coronary intervention (PCI). In 3 patients (10%), a ≥25% increase was demonstrated in serum cystatin C levels 48 h following the procedure. None of the patients demonstrated a ≥25% increase in serum creatinine levels at 48 h. Following 6 months, no patient required renal replacement therapy or unplanned coronary intervention. Conclusions: In patients with advanced chronic kidney disease, the ultra-low contrast technique is feasible and effective and can be used safely without a significant deterioration in renal function. This technique may increase the utilization of PCI in high-risk coronary patients with chronic kidney disease.
Comparison of Single-Incision Laparoscopic Cholecystectomy versus Needlescopic Cholecystectomy: A Single Institutional Randomized Clinical Trial
Authors: Umemura Akira , Suto Takayuki , Nakamura Seika , Fujiwara Hisataka , Endo Fumitaka , Nitta Hiroyuki , Takahara Takeshi , Sasaki Akira
Published: January 2018

Background: Both single-incision laparoscopic cholecystectomy (SILC) and needlescopic cholecystectomy (NSC) are superior to conventional laparoscopic cholecystectomy in terms of cosmetic outcome and incisional pain. We conducted a prospective, randomized clinical trial to evaluate the surgical outcome, postoperative pain, and cosmetic outcome for SILC and NSC procedures. Methods: In this trial, 105 patients were enrolled (52 in the SILC group; 53 in the NSC group). A visual analogue scale (VAS) was used to evaluate the cosmetic outcome and incisional pain for patients. Logistic regression analyses were used to evaluate the operative difficulty that was present for both procedures. Results: There were no significant differences in patient characteristics or surgical outcomes, including operative time and blood loss. The mean VAS scores for cosmetic satisfaction were similar in both groups. There were significant differences in the mean VAS scores for incisional pain on postoperative day 1 (p = 0.009), and analgesics were required within 12 h of surgery (p = 0.007). Obesity (body mass index ≥25 kg/m2) was the only significant influential factor for operating time over 100 min (p = 0.031). Conclusion: NSC is superior to SILC in terms of short-term incisional pain. Experienced laparoscopic surgeons can perform both SILC and NSC without an increase in operative time.
La crítica de Friedrich Schlegel a las concepciones naturalistas de la representación artística
Authors: Galfione María Verónica
Published: January 2018

En el presente trabajo procuramos reconstruir las críticas que realiza Friedrich Schlegel a la concepción estética del joven Herder. A partir del análisis de dichas críticas se intentará demostrar que la distinción schlegeliana entre una “poesía objetiva” y otra de carácter “interesante” no se hallaba orientada a garantizar la condena radical del arte moderno sino más bien a cuestionar el compromiso de Herder con una concepción naturalista de la belleza artística. Schlegel descubría en este punto un momento de continuidad entre las dos posiciones enfrentadas en la Querelle entre los antiguos y los modernosy hacía derivar de este elemento común la incapacidad de ambas posturas para recrear un arte de carácter objetivo. Como veremos hacia el final de estas páginas, Schlegel consideraba que el restablecimiento de la objetividad poética en el marco de las nuevas condiciones que imponía la modernidad solo podía lograrse por medio de la propia radicalización delas tendencias subjetivistas; es decir, por medio de una teoría estética que asumiera de manera consecuente la necesidad de una mediación reflexiva de la totalidad de los elementos poéticos.
Inhibition of Endothelial Notch Signaling Impairs Fatty Acid Transport and Leads to Metabolic and Vascular Remodeling of the Adult Heart
Authors: Jabs Markus , Rose Adam J. , Lehmann Lorenz H. , Taylor Jacqueline , Moll Iris , Sijmonsma Tjeerd P. , Herberich Stefanie E. , Sauer Sven W. , Poschet Gernot , Federico Giuseppina , Mogler Carolin , Weis Eva-Maria , Augustin Hellmut G. , Yan Minhong , Gretz Norbert , Schmid Roland M. , Adams Ralf H. , Gröne Hermann-Joseph , Hell Rüdiger , Okun Jürgen G. , Backs Johannes , Nawroth Peter P. , Herzig Stephan , Fischer Andreas
Published: January 2018

Background:

Nutrients are transported through endothelial cells before being metabolized in muscle cells. However, little is known about the regulation of endothelial transport processes. Notch signaling is a critical regulator of metabolism and angiogenesis during development. Here, we studied how genetic and pharmacological manipulation of endothelial Notch signaling in adult mice affects endothelial fatty acid transport, cardiac angiogenesis, and heart function.

Methods:

Endothelial-specific Notch inhibition was achieved by conditional genetic inactivation of Rbp-jκ in adult mice to analyze fatty acid metabolism and heart function. Wild-type mice were treated with neutralizing antibodies against the Notch ligand Delta-like 4. Fatty acid transport was studied in cultured endothelial cells and transgenic mice.

Results:

Treatment of wild-type mice with Delta-like 4 neutralizing antibodies for 8 weeks impaired fractional shortening and ejection fraction in the majority of mice. Inhibition of Notch signaling specifically in the endothelium of adult mice by genetic ablation of Rbp-jκ caused heart hypertrophy and failure. Impaired heart function was preceded by alterations in fatty acid metabolism and an increase in cardiac blood vessel density. Endothelial Notch signaling controlled the expression of endothelial lipase, Angptl4, CD36, and Fabp4, which are all needed for fatty acid transport across the vessel wall. In endothelial-specific Rbp-jκ–mutant mice, lipase activity and transendothelial transport of long-chain fatty acids to muscle cells were impaired. In turn, lipids accumulated in the plasma and liver. The attenuated supply of cardiomyocytes with long-chain fatty acids was accompanied by higher glucose uptake, increased concentration of glycolysis intermediates, and mTOR-S6K signaling. Treatment with the mTOR inhibitor rapamycin or displacing glucose as cardiac substrate by feeding a ketogenic diet prolonged the survival of endothelial-specific Rbp-jκ–deficient mice.

Conclusions:

This study identifies Notch signaling as a novel regulator of fatty acid transport across the endothelium and as an essential repressor of angiogenesis in the adult heart. The data imply that the endothelium controls cardiomyocyte metabolism and function.
D-Dimer Predicts Long-Term Cause-Specific Mortality, Cardiovascular Events, and Cancer in Patients With Stable Coronary Heart Disease
Authors: Simes John , Robledo Kristy P. , White Harvey D. , Espinoza David , Stewart Ralph A. , Sullivan David R. , Zeller Tanja , Hague Wendy , Nestel Paul J. , Glasziou Paul P. , Keech Anthony C. , Elliott John , Blankenberg Stefan , Tonkin Andrew M. ,   For the LIPID Study Investigators
Published: January 2018

Background:

D-dimer, a degradation product of cross-linked fibrin, is a marker for hypercoagulability and thrombotic events. Moderately elevated levels of D-dimer are associated with the risk of venous and arterial events in patients with vascular disease. We assessed the role of D-dimer levels in predicting long-term vascular outcomes, cause-specific mortality, and new cancers in the LIPID trial (Long-Term Intervention with Pravastatin in Ischaemic Disease) in the context of other risk factors.

Methods:

LIPID randomized patients to placebo or pravastatin 40 mg/d 5 to 38 months after myocardial infarction or unstable angina. D-dimer levels were measured at baseline and at 1 year. Median follow-up was 6.0 years during the trial and 16 years in total.

Results:

Baseline D-dimer levels for 7863 patients were grouped by quartile (≤112, 112–173, 173–273, >273 ng/mL). Higher levels were associated with older age, female sex, history of hypertension, poor renal function, and elevated levels of B-natriuretic peptide, high-sensitivity C-reactive protein, and sensitive troponin I (each
P
<0.001). During the first 6 years, after adjustment for up to 30 additional risk factors, higher D-dimer was associated with a significantly increased risk of a major coronary event (quartile 4 versus 1: hazard ratio [HR], 1.45; 95% confidence interval, 1.21–1.74), major cardiovascular disease (CVD) event (HR, 1.45; 95% confidence interval, 1.23–1.71) and venous thromboembolism (HR, 4.03; 95% confidence interval, 2.31–7.03; each
P
<0.001). During the 16 years overall, higher D-dimer was an independent predictor of all-cause mortality (HR, 1.59), CVD mortality (HR, 1.61), cancer mortality (HR, 1.54), and non-CVD noncancer mortality (HR, 1.57; each
P
<0.001), remaining significant for deaths resulting from each cause occurring beyond 10 years of follow-up (each
P
≤0.01). Higher D-dimer also independently predicted an increase in cancer incidence (HR, 1.16;
P
=0.02).The D-dimer level increased the net reclassification index for all-cause mortality by 4.0 and venous thromboembolism by 13.6.

Conclusions:

D-dimer levels predict long-term risk of arterial and venous events, CVD mortality, and non-CVD noncancer mortality independent of other risk factors. D-dimer is also a significant predictor of cancer incidence and mortality. These results support an association of D-dimer with fatal events across multiple diseases and demonstrate that this link extends beyond 10 years’ follow-up.
Excessive Daytime Sleepiness Independently Predicts Increased Cardiovascular Risk After Myocardial Infarction
Authors: Xie Jiang , Sert Kuniyoshi Fatima H. , Covassin Naima , Singh Prachi , Gami Apoor S. , Chahal C. Anwar A. , Somers Virend K.
Published: January 2018

Background

Excessive daytime sleepiness (
EDS
), a common symptom among patients with sleep‐disordered breathing, is closely associated with the development of cardiovascular diseases, but its long‐term prognostic value is not completely understood. The aim of this study was to investigate whether
EDS
would be an independent prognostic factor after myocardial infarction.

Methods and Results

We prospectively recruited 112 post–myocardial infarction patients. The Epworth Sleepiness Scale was completed before polysomnography, and
EDS
was defined as a score ≥11. After exclusion of 8 patients who accepted treatment with continuous positive airway pressure, 104 patients were followed up for 48 months. The primary composite end point was major adverse cardiac events. Patients with
EDS
had higher rates of major adverse cardiac events (48.4% versus 27.4%, χ
2
=5.27,
P
=0.022) and reinfarction (29.0% versus 5.5%, χ
2
=13.51,
P
=0.0002) compared with those without
EDS
. In the Cox proportional hazards model, patients with
EDS
had 2.15 times (95% confidence interval, 1.08–4.18;
P
=0.030) higher crude risk of major adverse cardiac events, with prognostic significance persisting after adjusting for age, diabetes mellitus, depression, left ventricular ejection fraction, apnea–hypopnea index, and nocturnal nadir oxygen saturation (hazard ratio: 2.13, 95% confidence interval, 1.04–4.26,
P
=0.039). Furthermore, among participants with moderate to severe sleep‐disordered breathing, the presence of
EDS
was associated with higher risk of major adverse cardiac events than those without
EDS
, after adjusting for age and nadir oxygen saturation (hazard ratio: 3.17, 95% confidence interval, 1.22–7.76,
P
=0.019).

Conclusions

EDS
may be an independent prognostic factor of adverse outcome in post–myocardial infarction patients with moderate to severe sleep‐disordered breathing. Evaluation of
EDS
may shed new light on risk stratification and identify treatment responders for this patient population.
Incident Heart Failure in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study
Authors: Khalid Usman , Egeberg Alexander , Ahlehoff Ole , Lane Deirdre , Gislason Gunnar H. , Lip Gregory Y.H. , Hansen Peter R.
Published: January 2018

Background

Rheumatoid arthritis (
RA
) is a chronic inflammatory disease associated with a wide range of comorbidities, including cardiovascular disease, but its association with heart failure (
HF
) is not fully clear. We investigated the risk of incident
HF
in a nationwide cohort of patients with
RA
.

Methods and Results

The study comprised the entire Danish population aged ≥18 years followed from January 1, 2008 until first hospitalization for
HF
, emigration, December 31, 2012, or death. Information on comorbidity, medication, and socioeconomic status was identified by individual‐level linkage of administrative registers. Patients with a rheumatologist diagnosis of
RA
between 1978 and 2008 were included. The primary study outcome was incident
HF
defined as first hospital admission for
HF
. Incidence rates of
HF
per 1000 person‐years were calculated and incidence rate ratios adjusted for age, sex, calendar year, comorbidity, medications, socioeconomic status, smoking, and alcohol consumption were estimated. A total of 4 305 225 subjects with no history of
HF
were eligible for analysis at the study start. Of these subjects, 24 343 developed
RA
and 50 623 were hospitalized for
HF
. Overall incidence rates of incident
HF
were 2.43 and 6.64 for the reference population (n=49 879) and patients with
RA
(n=744), respectively. Correspondingly, the fully adjusted incidence rate ratio for incident
HF
was increased in patients with
RA
with incidence rate ratio 1.30 (95% confidence interval, 1.17–1.45).

Conclusions

In this cohort study,
RA
was associated with an increased hospitalization for
HF
. These findings add significantly to the existing evidence of
RA
as a clinically relevant risk factor for
HF
.
Effect of Dysphagia Screening Strategies on Clinical Outcomes After Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke
Authors: Smith Eric E. , Kent David M. , Bulsara Ketan R. , Leung Lester Y. , Lichtman Judith H. , Reeves Mathew J. , Towfighi Amytis , Whiteley William N. , Zahuranec Darin B.
Published: January 2018

Introduction—

Dysphagia screening protocols have been recommended to identify patients at risk for aspiration. The American Heart Association convened an evidence review committee to systematically review evidence for the effectiveness of dysphagia screening protocols to reduce the risk of pneumonia, death, or dependency after stroke.

Methods—

The Medline, Embase, and Cochrane databases were searched on November 1, 2016, to identify randomized controlled trials (RCTs) comparing dysphagia screening protocols or quality interventions with increased dysphagia screening rates and reporting outcomes of pneumonia, death, or dependency.

Results—

Three RCTs were identified. One RCT found that a combined nursing quality improvement intervention targeting fever and glucose management and dysphagia screening reduced death and dependency but without reducing the pneumonia rate. Another RCT failed to find evidence that pneumonia rates were reduced by adding the cough reflex to routine dysphagia screening. A smaller RCT randomly assigned 2 hospital wards to a stroke care pathway including dysphagia screening or regular care and found that patients on the stroke care pathway were less likely to require intubation and mechanical ventilation; however, the study was small and at risk for bias.

Conclusions—

There were insufficient RCT data to determine the effect of dysphagia screening protocols on reducing the rates of pneumonia, death, or dependency after stroke. Additional trials are needed to compare the validity, feasibility, and clinical effectiveness of different screening methods for dysphagia.