bluuebunny/crossref_metadata_2025 huggingface dataset:
Lung cancer risk stratification using methylation profile in the oral epithelium
Authors: Harada Hiroaki , Miyamaoto Kazuaki , Kimura Masami , Ishigami Tetsuro , Taniyama Kiyomi , Okada Morihito
Published: November 2018

Background

Assuming that the entire airway is affected by the same inhaled carcinogen, similar molecular alterations may occur in the lung and oral cavity. Thus, we hypothesized that DNA methylation profiles in the oral epithelium may be a promising biomarker for lung cancer risk stratification.

Methods

A methylation-specific polymerase chain reaction was performed on oral epithelium from 16 patients with lung cancer and 32 controls without lung cancer. Genes showing aberrant methylation profiles in the oral epithelium were compared between patients and controls.

Results

The analysis revealed that HOXD11 and PCDHGB6 were methylated more frequently in patients than in controls ( p = 0.0055 and p = 0.0247, respectively). Combined analyses indicated that 8 of 16 (50%) patients and 3 of 32 (9.4%) controls showed DNA methylation in both genes ( p = 0.0016). Among the population limited to current and former smokers, 6 of 11 (54.5%) patients showed methylation in both genes, compared to 1 of 17 (5.9%) controls ( p = 0.0037). In a subgroup analysis limited to the population above 50-years old, 8 of 16 (50%) patients and 2 of 16 (12.5%) controls showed methylation in both genes ( p = 0.0221).

Conclusions

The results of this study indicate that specific gene methylation in the oral epithelium might be a promising biomarker for lung cancer risk assessment, especially among smokers. Risk stratification through the analysis of DNA methylation profiles in the oral epithelium may be a useful and less invasive first-step approach in an efficient two-step lung cancer screening strategy.
Validity assessment of a simulation module for robot-assisted thoracic lobectomy
Authors: Whittaker George , Aydin Abdullatif , Raveendran Sinthuri , Dar Faizan , Dasgupta Prokar , Ahmed Kamran
Published: November 2018

Background

Training for robot-assisted thoracic lobectomy remains an issue, prompting the development of virtual reality simulators. Our aim was to assess the construct and face validity of a new thoracic lobectomy module on the RobotiX Mentor, a robotic surgery simulator. We also aimed to determine the acceptability and feasibility of implementation into training.

Methods

This prospective, observational, and comparative study recruited novice (n = 16), intermediate (n = 9), and expert (n = 5) participants from King's College London, the 25th European Conference on General Thoracic Surgery, and the Society of Robotic Surgery conference 2018. Each participant completed two familiarization tasks followed by the Guided Robotic Lobectomy module and an evaluation questionnaire. Outcome measures were compared using Mann-Whitney U tests.

Results

Construct validity was demonstrated in 12/21 performance evaluation metrics. Significant differences between groups were found in all metrics including: time taken to complete module, vascular injury, respect for tissue, number of stapler firings, time instruments out of view, number of instrument collisions, and number of movements. Participants deemed aspects of the simulator (mean 3/5) and module (3/5) as realistic and rated the simulator as both acceptable (3.8/5) and feasible (3.8/5) for robotic surgical training.

Conclusions

Face validity, acceptability, and feasibility were established for the thoracic lobectomy module of the RobotiX Mentor simulator. Moderate evidence of construct validity was also demonstrated. With further work, this simulation module could help to reduce the initial part of the learning curve for trainees and decrease the risk of errors during live training.
Open insufflation: a novel technique for identifying the intersegmental border
Authors: Soultanis Constantine Marios , Chenchao Ma , Lei Jiang
Published: November 2018

Segmentectomy is gaining popularity for the treatment of lung cancer, especially in the early stages. Comprehensive understanding of segmental and subsegmental anatomy is required for the procedure to be successfully completed from a technical and oncological point of view. We hereby present a novel technique for delineating the intersegmental border, which can be widely reproduced because it is not time-consuming and does not require special equipment.
Tracheal diverticulum as a rare cause of dysphagia
Authors: Inam Hina , Zahid Ibrahim , Fatimi Saulat
Published: November 2018

Tracheal diverticula are rare benign entities characterized by small air-filled invaginations in the paratracheal area. They may be single or multiple, and usually present with nonspecific symptoms. Ideally, computed tomography imaging studies are used to confirm the diagnosis, followed by surgical resection as the treatment of choice. We present the case of a woman with an acquired tracheal diverticulum, with dysphagia as the only presenting symptom.
No ochronosis was seen at internal thoracic artery with alkaptonuria
Authors: Watanabe Toshitaka , Harada Ryo , Mikami Takuma , Numaguchi Ryosuke , Doi Hirosato , Kawaharada Nobuyoshi
Published: November 2018

Alkaptonuria is a rare disorder of amino acid metabolism that causes premature large joint spine arthropathy and cardiac disease. We describe a case of aortic stenosis and coronary artery disease associated with ochronosis in a 76-year-old man who underwent aortic valve replacement and coronary artery bypass grafting. Although the ochronosis was extensive, no ochronosis was seen in the internal thoracic artery which used for coronary artery bypass grafting. Ochronosis with alkaptonuria is considered to accelerate the atherosclerotic process, so the internal thoracic artery may ensure a better long-term outcome. Long-term follow-up may allow better understanding of this rare condition.
Analysis of achieving an “ideal” outcome following midline unifocalization
Authors: Mainwaring Richard D , Patrick William L , Rosenblatt Tatiana R , Nasirov Teimour , Kamra Komal , Hanley Frank L
Published: November 2018

Objective

Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries is a complex form of congenital heart disease. Midline unifocalization has been developed for the surgical treatment of this condition. There are 3 outcome measures that determine long-term success: patients are alive, patients have achieved complete repair (i.e. ventricular septal defect closure), and patients have a relatively low right ventricle-to-aortic pressure ratio (<0.45). However, to date, no studies have combined these 3 outcome measures to analyze the likelihood of achieving an ideal outcome.

Methods

This was a retrospective review of 255 patients who underwent midline unifocalization for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries. The median age at unifocalization was 4.5 months.

Results

Two hundred thirty-five (92%) patients were alive at a mean follow-up of 5.3 years. Two hundred and seventeen (85%) patients underwent single-stage complete repair, and 38 (15%) had an initial unifocalization and shunt. Twenty-four of the 38 palliated patients have subsequently undergone repair. Thus 241 (94%) patients ultimately achieved complete repair. Of the 241 patients who were repaired, 219 (86%) had a right ventricle-to-aortic peak systolic pressure ratio <0.45. Combining these outcome measures, 77% of patients achieved an ideal outcome at one month, 73% at 6 months, 76% at one year, and 80% at 4 years.

Conclusions

Most (80%) patients can achieve all 3 measures of favorable outcome at 4 years following midline unifocalization. We speculate that this will be a favorable portend for the future of these patients.
Geographical variations in the use of diagnostic imaging of musculoskeletal diseases in Norway
Authors: Gransjøen Ann Mari , Lysdahl Kristin Bakke , Hofmann Bjørn Morten
Published: November 2018

Background

There is a high prevalence of musculoskeletal disorders in the Norwegian population. A significant number of these patients are referred to diagnostic imaging. Geographical variations in the use of imaging for musculoskeletal disorders may display over- or underuse, and knowledge about these variations is required.

Purpose

To investigate geographical variations in diagnostic imaging of the musculoskeletal system and analyze variations in the use of these examinations of all musculoskeletal diagnostic imaging, the specific modalities, and specific examinations.

Material and Methods

Population rates from Statistics Norway and outpatient radiological procedures of the musculoskeletal system registered at the Norwegian Health Economics Administration (HELFO) the first half of 2016 were accessed. The HELFO data were age-adjusted; high/low ratios were calculated as rates in number of examinations per 1000 inhabitants. A high/low ratio of 1 = equal use, 1.5–1.9 = moderate variation (approximately 50% difference), and > 2 (twice as much) = high variation.

Results

Geographical variations were demonstrated at all levels, with an overall high/low ratio of 1.3. For specific modalities the highest variation was for ultrasound (3.2) and CT (2.2). For individual examinations, the highest high/low ratios were observed for MRI of the shoulder (2.4) and radiography of the lower back (1.9) and shoulder (1.8).

Conclusion

We demonstrate a moderate to high geographical variation in the use of diagnostic imaging of the musculoskeletal system. This variation can indicate over- or underuse, which may violate basic principles of equity, priority, setting and appropriate care, and needs further attention.
Efficacia del Trattamento Dell'ipertrofia Prostatica Benigna Con Finasteride: Valutazione Urodinamica pre e Post Terapia
Authors: Carbone A. , Pesce F. , Ciccariello M. , Pacchiele R. , Cerulli N.
Published: November 2018

19 patients suffering from symptomatic benign prostatic hyperplasia (BPH) underwent symptom score analysis, serum PSA level determination, trans-rectal ultrasound, flowmetry and pressure/flow (P/F) studies both before and at the end of a six month treatment period with finasteride, 5 mg a day. After six months of therapy, 89.5% of the pts had a significant symptomatic improvement, according to the decrease in symptom scores. Urodynamic evaluation showed a significant decrease in voiding pressure in 84% of the pts. 5 pts moved from the “obstructed” to the “unobstructed” section of the Abrams-Griffiths nomogram. 15/19 pts had a significant decrease in prostatic weight, as showed by means of ultrasound evaluation. This study confirms the efficacy of finasteride both in the symptomatic relief and in the functional improvement of BPH pts.
Trattamento dell'incontinenza urinaria nel paziente operato per IPB
Authors: Ceresoli A. , Zanetti G. , Seveso M. , Trinchieri A. , Baroni P.
Published: November 2018

One complication of prostatectomy is urinary incontinence. In this study we treated 21 patients who were incontinent after surgery. Bladder training, after correct evaluation of the bladder and sphincteric situation, was our method of treatment in this situation.
Carcinoma prostatico: Confronto tra tomografia assiale computerizzata e risonanza magnetica nucleare nella stadiazione locale: Prostatic carcinoma: Comparison between computed tomography and magnetic resonance in local tumour staging
Authors: Perini L. , Bidoli L. , Marcon M. , Ricciardi G. , Galetti T. Prayer , Zattoni F. , D'Arrigo L. , Cavallo A. , Zacchi C.
Published: November 2018

We evaluated 20 patients with prostatic carcinoma who subsequently underwent radical prostatectomy with pelvic lymphadenectomy. All patients were examined with CT scan (CT) and magnetic resonance (MR) and the findings compared with definitive pathological stage. The neoplasia was correctly diagnosed in 19/20 patients with MR, but in no-one with CT. Sensitivity and diagnostic accuracy of CT and MR were respectively: for capsular penetration 15%/20% and 36.8%/40%; for seminal vesicle involvement 20%/60% and 60%/80%; bladder involvement 25%/85% and 50%/90%; nodal involvement 0%/60% and 16.6%/65%. MR seems to be more reliable than CT in detecting seminal vesicle involvement. Nevertheless, neither MR nor CT gave an adequate evaluation of capsular penetration or tumour spread to lymph nodes.
Enzymatic degradation of coconut shell powder–reinforced polylactic acid biocomposites
Authors: Tanjung Faisal Amri , Arifin Yalun , Husseinsyah Salmah
Published: November 2018

This work examined the effects of filler content and chemical treatment on the biodegradation of poly(lactic acid) (PLA)/coconut shell (CS) biocomposites in a diastase enzyme-containing buffer medium. CS was treated with two distinct chemical treatments: maleic acid and silanation with 3-aminopropyltriethoxysilane (3-APE). The CS was incorporated into PLA composites and their biodegradation patterns were studied. Both of the treated PLA/CS biocomposites exhibited lower biodegradation rates than the untreated biocomposites due to their enhanced interfacial adhesion, which reduced the area exposed to enzyme hydrolysis. Scanning electron micrographs taken after 30 days of biodegradation displayed surface roughening on both of the treated biocomposites, with fewer voids compared to the untreated biocomposites. The differential scanning calorimetry indicated that the glass transition temperature and melting temperature values of the treated biocomposites increased but that crystallinity declined. The crystallization temperature peak apparently disappeared due to the polymer chain alignment and rearrangement of the shorter PLA chains caused by the degradation. Fourier transform infrared analysis revealed the structural changes in the biocomposites after biodegradation, indicating the presence of soluble lactic acid as was confirmed by ultraviolet–visible spectroscopy analysis.
Model reduction of aerothermodynamic for hypersonic aerothermoelasticity based on POD and Chebyshev method
Authors: Xiaoxuan Yan , Jinglong Han , Bing Zhang , Haiwei Yuan
Published: November 2018

Accurate modeling of aerothermodynamics with low computational cost takes on a crucial role for the optimization and control of hypersonic vehicles. This study examines three reduced-order models (ROMs) to provide a reliable and efficient alternative approach for obtaining the aerothermodynamics of a hypersonic control surface. Coupled computational fluid dynamics (CFD) and computational thermostructural dynamics (CTSD) approaches are used to generate the snapshots for ROMs considering the interactions between aerothermodynamics, structural dynamics and heat transfer. One ROM adopts a surrogate approach named Kriging. The second ROM is constructed by the combination of Proper Orthogonal Decomposition (POD) and Kriging, namely, POD-Kriging. The accuracy of Kriging-based ROM is higher than that of POD-Kriging-based ROM, but the efficiency is lower. Therefore, to address the shortcomings of the above two approaches, a new ROM is developed that is composed of POD and modified Chebyshev polynomials, namely, POD-Chebyshev. The ROM based on POD-Chebyshev has the best precision and efficiency among the three ROMs and generally has less than 2% average maximum error for the studied problem.
Relationship between socioeconomic status and risk of sexually transmitted infections in Uganda: Multilevel analysis of a nationally representative survey
Authors: Anguzu Godwin , Flynn Andrew , Musaazi Joseph , Kasirye Ronnie , Atuhaire Leonard K , Kiragga Agnes N , Kabagenyi Allen , Mujugira Andrew
Published: November 2018

Socioeconomic status (SES) appears to have positive and negative associations with sexually transmitted infection (STI) risk in resource-limited settings, but few studies have evaluated nationally representative data. We assessed multiple SES measures and their effect on STI risk. We conducted a secondary analysis of data from the Uganda Demographic and Health Survey (UDHS 2011). The primary outcome (STI risk) was self-reported STIs and/or symptoms in the prior 12 months. We examined associations between multiple SES measures and STI risk using a mixed-effects Poisson regression model. The results showed that of the 9256 sexually active individuals, 7428 women and 1828 men were included in the analysis. At an individual level, middle wealth quintile and disposable income were associated with STI risk, whereas being in the richest wealth quintile was protective. Residence in wealthier regions (adjusted incidence rate ratio [aIRR] 3.92, 3.62, and 2.75, for Central, Western, and Eastern regions; p < 0.01) was associated with increased STI risk. Regional level analysis revealed stochastic variability of STI risk across geographical region (variance 0.03; p = 0.01). The bilateral association between SES and STI risk underscores the need for multi-sectoral interventions to address the upstream effects of poverty on STI risk and downstream effects of STIs on health and economic productivity.
High burden of previously undiagnosed HIV infections and gaps in HIV care cascade for conflict-affected female sex workers in northern Uganda
Authors: Goldenberg Shira M , Muzaaya Godfrey , Akello Monica , Braschel Melissa , Birungi Josephine , Shannon Kate
Published: November 2018

Given the disproportionate HIV burden faced by female sex workers FSWs and limited data regarding their engagement in the HIV cascade of care in conflict-affected settings, we characterized the cascade of care and examined associations with new HIV diagnoses and antiretroviral therapy (ART) use in a community-based cohort of FSWs in conflict-affected Northern Uganda. Data were collected via FSW/peer-led time-location sampling and outreach, interview-administered questionnaires, and voluntary HIV testing. Of 400 FSWs, 33.5% were living with HIV, of whom 33.6% were new/previously undiagnosed infections and 32.8% were on ART. Unstable housing and heavy alcohol/drug use were independently associated with increased odds of new HIV diagnoses, whereas exposure to condom demonstrations and number of lifetime pregnancies were negatively associated. In subanalysis among known HIV-positive women, age and time since diagnosis were associated with ART use, whereas sexually transmitted infections were negatively associated. Findings suggest the need for FSW-tailored, peer-based, and integrated HIV and sexual and reproductive health programs to address gaps in HIV testing and treatment for FSWs in conflict-affected communities.
Does Gold Act as a Hedge or a Safe Haven against Equity and Currency in Asia?
Authors: Aftab Muhammad , Shah Syed Zulfiqar Ali , Ismail Izlin
Published: November 2018

In recent years, uncertainty in financial markets has stimulated the need to explore alternative avenues for safeguarding wealth and managing risk. In this strand of research, gold has been particularly important due to its potential to mitigate risk and preserve wealth. This study investigates gold behaviour against equities and currencies in three regions across Asia. We follow Engle’s (2002) dynamic conditional correlation-multivariate generalized autoregressive conditional heteroscedasticity (DCC-MGARCH) model to test the gold link with equity and currency markets. We use a weekly series of exchange rate (national currency/the US dollar), equity and gold prices in national currency over the weekly period, 1995–2013. The sample consists of 12 countries covering East Asia, South Asia and Southeast Asia. Findings suggest that gold is just a diversifier against stocks in the Asian economies except in Korea, Singapore and Thailand. However, gold acts as a hedge and safe haven against Asian currencies—except China and Hong Kong—thus still preserving its monetary role.
Poeticalization and Storying; www.mmm.com
Authors: Moe Merete , Reinertsen Anne B.
Published: November 2018

A threshold situation is a kind of crisis of, for example, deteriorating health. Fall 2014, a project was conducted, focusing on writing for well-being with a former employee and leader at an Early Childhood Education and Care, now on long-term sick leave. Here is her story and poem; her writings/Sis. Our stories and theory/practice/data/interpretive poems; our writings/Merete and Anne: Our companionship, company, and compassion: Sis/Merete/Anne.Com . We aim at Deleuze and Guattarian safespace writing. In modern working life participation, empowerment, governance, and self-leadership is considered vital for creating good psychosociological work environments. Foucault’s concept governmentality aims to elucidate how we are created as subjects, looking at how we are governed by others and by ourselves according to norms and expectations in organizations, society, and from ourselves. We think with poetry to open up, explore, and fabulate. We call it poeticalization and storying and work and worlds and words or rather work/world/word/making/melding/mattering/Sis/Merete/Anne: www.mmm.com .
People of Diverse Genders and/or Sexualities Caring For and Protecting Animal Companions in the Context of Domestic Violence
Authors: Taylor Nik , Riggs Damien W. , Donovan Catherine , Signal Tania , Fraser Heather
Published: November 2018

This article reports on a thematic analysis of open-ended questions about how humans respond to violence directed toward animals in the context of violent human relationships, derived from an Australian–U.K. survey of people of diverse genders and/or sexualities. From the 137 responses, three major themes were identified: (a) animals are an important source of support, (b) humans actively protect animal companions, and (c) witnessing animal abuse can trigger leaving violent relationships. The findings offer unique insights for practitioners into the help-seeking needs of people of diverse genders and/or sexualities who live with animal companions in the context of domestic violence.
Cornered at a Bar: How Victim Clothing, Alcohol Intake, and Relationship With Bystander Impact Intention to Help
Authors: Zelin Alexandra I. , Walker Ruth V. , Johnson Dawn M.
Published: November 2018

While a negative relationship between rape myth acceptance (RMA) and bystander behavior is established, the specific myths associated with bystander behavior are not well understood. In Study 1, we presented 260 participants with vignettes manipulating clothing and alcohol intake of a woman victim to see how it affected intention to help. In Study 2, we presented 247 participants with similar vignettes, manipulating alcohol intake and relationship with the bystander. Contrary to previous research on RMA, participants were significantly more willing to intervene if the woman was intoxicated. Intervention also depended upon the participants’ relationship to the woman: stranger or acquaintance.
Shaping the perception of African conflicts through framing: A case study of the African diasporic press in the UK
Authors: Ogunyemi Ola
Published: November 2018

Framing studies consistently conclude that the international news media represent African conflicts negatively and stereotypically. Owing to their focus on media content, however, most framing studies fail to examine the dynamic relationship between journalists’ cognitive role (what they say they do) and their practice role (what they actually do). Using parallel content analysis, this study compares what African diaspora journalists write about African conflicts with what they say about them. The analysis reveals that they show a preference for a factual style and a governing frame, and less preference for a judgmental style, which aligns with what they say, and a slight preference for background context which marginally aligns with what they say. However, low newsroom budgets and advertising revenue could undermine their attempts to de-Westernize the portrayal of African conflicts.
Color, Music, and Emotion: Bach to the Blues
Authors: Whiteford Kelly L. , Schloss Karen B. , Helwig Nathaniel E. , Palmer Stephen E.
Published: November 2018

When people make cross-modal matches from classical music to colors, they choose colors whose emotional associations fit the emotional associations of the music, supporting the emotional mediation hypothesis. We further explored this result with a large, diverse sample of 34 musical excerpts from different genres, including Blues, Salsa, Heavy metal, and many others, a broad sample of 10 emotion-related rating scales, and a large range of 15 rated music–perceptual features. We found systematic music-to-color associations between perceptual features of the music and perceptual dimensions of the colors chosen as going best/worst with the music (e.g., loud, punchy, distorted music was generally associated with darker, redder, more saturated colors). However, these associations were also consistent with emotional mediation (e.g., agitated-sounding music was associated with agitated-looking colors). Indeed, partialling out the variance due to emotional content eliminated all significant cross-modal correlations between lower level perceptual features. Parallel factor analysis (Parafac, a type of factor analysis that encompasses individual differences) revealed two latent affective factors— arousal and valence—which mediated lower level correspondences in music-to-color associations. Participants thus appear to match music to colors primarily in terms of common, mediating emotional associations.
Outcomes of medically managed patients with myocardial infarction
Authors: Kaul Padma , Savu Anamaria , Hamza Shereen , Knudtson Merril L , Bainey Kevin , Brass Neil , Armstrong Paul W , Welsh Robert C
Published: November 2018

Aims:

The purpose of this study was to compare outcomes associated with medical management of ST-elevation myocardial infarction and non-ST-elevation myocardial infarction patients presenting to hospitals with and without onsite catheterization facilities.

Methods

All patients ( n=25,921) with ST-elevation myocardial infarction ( n=10,563) or non-ST-elevation myocardial infarction ( n=15,358) in Alberta, Canada between April 2010–March 2016 were categorized according to availability of catheterization facilities at the hospital they presented to and their management strategy (medically managed without coronary angiography or medically managed after coronary angiography).

Results:

Overall, 51% presented to hospitals without catheterization facilities; and 34% were managed medically (18% without coronary angiography, and 16% after coronary angiography). Rates of medical management were higher at hospitals without versus those with catheterization facilities (43% vs. 24%, p<0.01). However, both the rate of presentation to hospitals without catheterization facilities (70% non-ST-elevation myocardial infarction, 24% ST-elevation myocardial infarction, p<0.01) and medical management (45% non-ST-elevation myocardial infarction, 18% ST-elevation myocardial infarction, p<0.01) differed by myocardial infarction type. The lack of catheterization facilities at the presenting hospital had no association with in-hospital mortality in patients medically managed without coronary angiography, but was associated with a lower risk of mortality among patients medically managed after coronary angiography. However, the latter benefit was restricted to non-ST-elevation myocardial infarction patients only (adjusted hazard ratio 0.43, 95% confidence interval: 0.25–0.76).

Conclusion:

The availability of catheterization facilities at the hospital at which non-ST-elevation myocardial infarction and ST-elevation myocardial infarction patients presented influenced their likelihood of being medically managed, but was not associated with adverse short- or long-term mortality outcomes.
Moderate Aerobic Training Decreases Blood Pressure but No Other Cardiovascular Risk Factors in Hypertensive Overweight/Obese Elderly Patients
Authors: Ramos Raphael Miranda , Coelho-Júnior Hélio José , Prado Raul Cosme Ramos do , da Silva Rodrigo Silveira , Asano Ricardo Yukio , Prestes Jonato , Medeiros Alexandre Igor Araripe , Rodrigues Bruno , Assumpção Claudio de Oliveira
Published: November 2018

Hypertension and obesity are prevalent diseases in elderly people, and their combination can cause deleterious effects on physiological system. Moderate intensity aerobic training (MIAT) seems to be a beneficial approach to control and treat these diseases separately. However, few studies have investigated the impact of MIAT on cardiovascular risk factors associated with these conditions (i.e., elevated blood pressure values, blood markers, and body composition). Therefore, the present study was designed to investigate the effects of MIAT on blood pressure, blood markers, and body composition in hypertensive overweight/obese elderly patients. Twenty-four hypertensive overweight/obese elderly patients were randomized into control group (CG) and training group (TG), submitted to 12 weeks of MIAT of 50 min, 3 days per week, at 60% of maximal HR (heart rate). There was a decrease in diastolic blood pressure (−10.1 ± 3.3; p = .01; effect size = 1.29) and mean arterial pressure (MAP; −8.2 ± 3.7; p = .04; effect size = 0.94) following 12 weeks of training in the TG as compared with baseline. There was an increase in triacylglycerol levels in the TG (+0.1 ± 0.0; p = .02). There were no significant changes in body composition for both groups. The present study revealed that 12 weeks of MIAT can decrease blood pressure in hypertensive obese elderly patients, with no significant modifications in blood markers and body composition.
Who should get long-term anticoagulant therapy for venous thromboembolism and with what?
Authors: Rodger Marc Alan , Le Gal Gregoire
Published: November 2018

After an initial 3 to 6 months of anticoagulation for venous thromboembolism (VTE), clinicians and patients face an important question: “Do we stop anticoagulants or continue them indefinitely?” The decision is easy in some scenarios (eg, stop in VTE provoked by major surgery). In most scenarios, which are faced on a day-to-day basis in routine practice, it is a challenging decision because of uncertainty in estimates in the long-term risks (principally major bleeding) and benefits (reducing recurrent VTE) and the tight trade-offs between them. Once the decision is made to continue, the next question to tackle is “Which anticoagulant?” Here again, it is a difficult decision because of the uncertainty with regard to estimates of efficacy and the safety of anticoagulant options and the tight trade-offs between choices. We conclude with the approach that we take in our clinical practice.
Timing of treatment of smoldering myeloma: early treatment
Authors: Mateos María-Victoria , González-Calle Verónica
Published: November 2018

This article has a companion Counterpoint by Kumar.
Long-term mental health outcomes after unintentional burns sustained during childhood: a retrospective cohort study
Authors: Duke Janine M. , Randall Sean M. , Vetrichevvel Thirthar P. , McGarry Sarah , Boyd James H. , Rea Suzanne , Wood Fiona M.
Published: November 2018

Background

Burns are a devastating injury that can cause physical and psychological issues. Limited data exist on long-term mental health (MH) after unintentional burns sustained during childhood. This study assessed long-term MH admissions after paediatric burns.

Methods

This retrospective cohort study included all children (< 18 years) hospitalised for a first burn (n = 11,967) in Western Australia, 1980–2012, and a frequency matched uninjured comparison cohort (n = 46,548). Linked hospital, MH and death data were examined. Multivariable negative binomial regression modelling was used to generate incidence rate ratios (IRR) and 95% confidence intervals (CI).

Results

The burn cohort had a significantly higher adjusted rate of post-burn MH admissions compared to the uninjured cohort (IRR, 95% CI: 2.55, 2.07–3.15). Post-burn MH admission rates were twice as high for those younger than 5 years at index burn (IRR, 95% CI 2.06, 1.54–2.74), three times higher for those 5–9 years and 15–18 years (IRR, 95% CI: 3.21, 1.92–5.37 and 3.37, 2.13–5.33, respectively) and almost five times higher for those aged 10–14 (IRR, 95% CI: 4.90, 3.10–7.76), when compared with respective ages of uninjured children. The burn cohort had higher admission rates for mood and anxiety disorders (IRR, 95% CI: 2.79, 2.20–3.53), psychotic disorders (IRR, 95% CI: 2.82, 1.97–4.03) and mental and behavioural conditions relating to drug and alcohol abuse (IRR, 95% CI: 4.25, 3.39–5.32).

Conclusions

Ongoing MH support is indicated for paediatric burn patients for a prolonged period after discharge to potentially prevent psychiatric morbidity and associated academic, social and psychological issues.
Young key affected population in Myanmar: are there any challenges in seeking information and care for HIV/sexually transmitted infections and reproductive health?
Authors: Htut Kyaw Min , Mon Myo Myo , Aye Zin Mar , Ni Lwin Lwin
Published: November 2018

Background: Unmet needs and barriers in seeking HIV/STI and RH information and care are present especially among young key affected population (YKAP). Therefore, the study was conducted to determine the health seeking behaviors of YKAP regarding HIV/STI and RH, and challenges in seeking health information and care.

Methods: A cross-sectional, mixed-methods study was conducted at two large cities in Myanmar. Face-to-face interviews were conducted with YKAP aged 15-24 years. In-depth interviews and key informant interviews were done with YKAP and health care providers. Descriptive statistics and bivariate analyses were done for quantitative data and thematic analysis was applied for qualitative data.

Results: A total of 119 young men who have sex with men (YMSM) and 123 young female sex workers (YFSW) included in the study. Mean age of YMSM and YFSW were 20.9±2.4 and 21.7±2.2 years. Over 30% of YMSM and 49.3% of YFSW had experience of any STI symptom. Particularly, 17% of YMSM and 10% of YFSW had genital ulcer, and majority sought health care at NGO clinics. About 37% of YMSM and 40% of YFSW visited Drop-in-center (DIC) within one to six months. Over 13% of YMSM and 14.6% of YFSW had challenges in seeking HIV/STI and RH information.  YMSM/YFSW type and age of YMSM were associated with visit to DIC. Lesser proportions of Tha-nge (43.5%), younger age YMSM (66.7%), brothel-based YFSW (47.9%) visited DIC than others (p<0.05). Challenges and unmet needs expressed by YKAP were reluctance in asking health information, worry for future fertility, consequences of anal sex and contraception. Challenges expressed by providers were limited time during outreach service and difficulty in reaching entertainment-based sex workers.

Conclusions: Special attention in provision of health information should be paid to YKAP since there is a considerable proportion of YKAP with unmet need in seeking HIV/STI/RH information and care.
Spices for Thought: Salt, Chili Pepper, and Slaves in Ethiopian Amharic Proverbs
Authors: Salamon Hagar
Published: November 2018

Even though slavery-related understandings are deeply embedded in the collective Ethiopian consciousness, they are seldom explicitly discussed. In the course of oral interviews carried out in rural northwestern Ethiopia with elderly men and women who still recall the practice of slavery, a rich corpus of Amharic proverbs related to this topic was collected. Focusing on a specific segment of this corpus, I invite the reader to visit Ethiopian folkloric crossroads of slaves and salt, spiced up with some hot chili pepper. These proverbs are revealed as a powerful channel to tap into generally submerged and rarely discussed local slavery-related perceptions.
Placebo analgesia
Authors: Tabeeva G. R.
Published: November 2018

Placebos are drugs, devices, or other treatments that are physically and pharmacologically inert. The placebo effects are therapeutic responses to the context of the treatment process. They are mediated by factors, such as training of a patient, his/her expectations associated with treatment, as well as social conditions, the features of cognitive functioning, etc. and can affect the clinical and physiological responses caused by the health status. The analgesic effects of placebo in different types of pain syndromes reach 25–80%. The formation of placebo analgesia involves the brain structures that belong to the pain matrix and are implicated in the basic processes of perception, in the mechanisms of pain modulation, and in a number of other cognitive and affective processes, as well as in the emotional reactions not caused by pain. A deeper understanding of the mechanisms of action of placebo analgesia can optimize the strategy of current pain therapy.
Peripheral nervous system involvement in systemic amyloidosis
Authors: Safiulina E. I. , Zinovyeva O. E. , Rameev V. V. , Kozlovskaya-Lysenko L. V.
Published: November 2018

Peripheral nervous system involvement may be a main manifestation of systemic amyloidosis or occur in the later stages of the disease in the presence of multiple organ pathology. Focal, multiple mononeuropathy, radiculopathy, polyneuropathy, autonomic nervous system dysfunction, and myopathy develop depending on the localization of amyloid deposits in the peripheral nervous system. The most characteristic symptom in systemic amyloidosis is sensorimotor polyneuropathy accompanied in most cases by the involvement of autonomic nerve fibers in the pathological process. In cases of systemic amyloidosis, peripheral nervous system involvement is progressive, leading to disability, which makes the early diagnosis of the disease and its neurological manifestations and subsequent pathogenetic therapy relevant.
Posthypoxic encephalopathy in patients after cardiac surgery: etiological, pathogenetic, and clinical aspects (a literature review)
Authors: Alekseeva T. M. , Portik O. A. , Topuzova M. P.
Published: November 2018

Post-hypoxic encephalopathy is a brain damage manifested by neurological, neuropsychiatric, and mental disorders, which is caused by a reduction in cerebral blood flow and by a resultant effect of an episode of hypoxia of various etiology and duration. This complication is most characteristic of patients who have undergone cardiac surgery in view of the high prevalence and severity of clinical manifestations, worse quality of life, the longer length of hospital stay, and the higher cost of treatment and rehabilitation. To determine the individual management tactics for such patients, combining both successful surgical treatment, by reducing perioperative stress, and prevention of cerebral complications, it is necessary to analyze the patterns of their development. The role of pathophysiological risk factors, including preoperative, perioperative and postoperative ones, for posthypoxic encephalopathy, is considered. Its preoperative risk factors include age, gender, concomitant diseases, education level, and cognitive functions before surgery, cardiac morphofunctional changes, and depressive disorders. There are surgery-related (type and duration of anesthesia, operating-suite temperatures, and hyperglycemia) and postoperative (pain syndrome after surgical intervention, sleep disorders, and the environment) risk factors. Emphasis is placed on the technical characteristics of on-pump operations, among which there are cerebral hypoperfusion, microembolism, non-pulsatile flow, and duration of extracorporeal circulation. Classifications of cerebral complications are presented. Different types of brain dysfunction are analyzed to assess their incidence rates, clinical features, and dynamics in the postoperative period.
Alzheimer's disease: some pharmacological and non-pharmacological approaches to correcting neuropsychiatric disorders
Authors: Mendelevich E. G.
Published: November 2018

Today, there is no reliable pharmacological correction of dementia, despite its high prevalence worldwide. The clinical presentation of Alzheimer's disease at one or another stage is accompanied by neuropsychiatric disorders (NPDs) in addition to cognitive defect. The intensity and range of NPDs are different. The possibilities of drug therapy for NPDs are demonstrated. The role of akatinol memantine in correcting a number of psychological and behavioral disorders is highlighted. Biological, psychological, social, and environmental factors are identified among those that contribute to or provoke the development of NPDs. Knowledge of the triggers of mental disorders makes it possible to prevent and thereby reduce or eliminate NPDs. Special emphasis is laid on the patient-caregiver relationship. In recent years, non-pharmacological interventions have been increasingly used as priority-line therapy for NPDs. There are data on main methods for non-pharmacological correction and on the efficiency of their application.
Non-motor disorders in cervical dystonia
Authors: Tolmacheva V. A. , Nodel M. R. , Saloukhna N. I.
Published: November 2018

Botulinum toxin injection therapy is the mainstay for managing patients with motor manifestations of dystonia. It is important to identify possible cognitive and mental disorders, sleep and perceptual disorders (non-motor disorders) in these patients. Correction of these disorders will be able to optimize treatment and to improve quality of life of patients.
Cognitive impairment in patients with migraine: causes, principles of effective prevention and treatment
Authors: Golovacheva V. A. , Pozhidaev K. A. , Golovacheva A. A.
Published: November 2018

Cognitive impairment (CI) is common in patients with migraine; its causes and pathogenesis continue to be discussed. Some authors consider that migraine proper does not lead to decreased cognitive functions, neuroimaging changes in the brain white matter are asymptomatic in migraine; and CI in patients with this condition is caused by comorbidities (depression, anxiety disorder) and/or concurrent cerebrovascular and neurodegenerative diseases. Other authors report the pathogenetic role of migraine in the development of CI and the importance of the frequency of headache attacks and neuroimaging changes in the brain matter in migraine. The paper reviews clinical trials dealing with the prevalence, causes, and pathogenesis of CI in patients with migraine. It sets forth the current principles of prevention and treatment of CI in patients with this condition.
The level of interleukin-6 in acute ischemic stroke: effect on the rate of recovery in patients and on the severity of neurological defect
Authors: Sergeeva S. P. , Savin А. А. , Breslavich I. D. , Litvitsky P. F. , Arkhipov V. V.
Published: November 2018

Interleukin 6 (IL-6) plays an important role in the pathogenesis of ischemic stroke (IS), exerting a modulating effect on a number of processes that determine the outcome of this disease. Objective: to investigate the peripheral blood levels of IL-6 in patients in the acute period of different IS pathogenetic subtypes and its effect on recovery rates. Patients and methods. The study enrolled 155 patients (74 men and 81 women; mean age, 63.8 years). A control group consisted of 28 people without IS. Pathogenetic subtype II was established in accordance with the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria on the basis of their clinical picture and the data of computed tomography or magnetic resonance imaging and ultrasonography of the main arteries of the head. The severity of a patient's condition and a focal neurological defect and the time course of clinical changes after stroke were determined using the National Institutes of Health Stroke Scale (NIHSS). An enzyme immunoassay (EIA) was used to measure IL-6 levels on days 1, 7, and 21 after onset of IS. An enzyme immunoassay (EIA) was used to measure IL-6 levels on days 1, 7, and 21 after onset of IS. Results. In the acute period of IS, there were significantly elevated levels of IL-6. The latter reached its highest values on day 7 in patients with the atherothrombotic pathogenetic subtype of IS. On day 7 of the study, the peak concentration of IL6 was typical for patients with all subtypes of IS, except for lacunar stroke. After its increase on day 1 of the study, the IL6 level in patients with lacunar stroke did not change significantly in all other periods. In acute IS, the concentration of IL-6 was significantly influenced by the following cardiovascular risk factors: hypercholesterolemia of days 1, 7 (p<0.01) and 21 (p<0.05), hypertension in day 1 (p<0.05), diabetes mellitus on days 1 and 7 (p<0.05), and coronary heart disease in all the study periods (p<0.01). The IL-6 concentration significantly correlated with the severity of neurological defect, but did not significantly affect the rate of recovery in the patient with acute IS. Conclusion. IL-6 was established to be of prognostic value for the outcome of acute IS on day 7. The rate of recovery can be used to identify targets for therapeutic intervention.
Treatment of patients with acute and subacute dorsalgia
Authors: Gerasimova O. N. , Parfenov V. A. , Kalimeeva E. Yu.
Published: November 2018

Objective: to investigate the efficiency of treatment for acute and subacute dorsalgia, by providing information to patients and by using nonsteroidal anti-inflammatory drugs (NSAIDs) without conducting physical therapy, reflexotherapy, and manual therapy. Patients and methods. A total of 140 patients (87 women and 53 men; mean age 50.7±17.6 years) with acute and subacute back pain were followed up. Out of them 127 (91%) patients were found to have nonspecific (musculoskeletal) pain; 13 (9%) had discogenic radiculopathy. All the patients were informed of the benign nature of the disease, the high probability of its rapid resolution, the feasibility of abandoning prolonged bedrest, and the lack of need for physical therapy, reflexotherapy, massage, and manual therapy. To reduce pain, the patients received meloxicam 15 mg/day orally or intramuscularly or first 15 mg/day intramuscularly and then orally. The investigators assessed pain intensity with the numerical rating scale and functional activity restrictions with the Roland-Morris disability (RMD) questionnaire. Results. After treatment, the visual analogue scale pain intensity scores decreased from an average of 6.4 to 1.0; the RMD scores dropped from 6.8 to 1.4 (p<0.001). The duration of treatment averaged 11.0±4.4 days. Comparison of different meloxicam dosage regimens showed no significant differences; a positive result was noted in all cases. No adverse events were observed during treatment. Conclusion. The investigation has shown the high efficiency of management in patients with acute and subacute dorsalgia, by providing information to patients (an education conversation), by using meloxicam, and by applying a personalized approach (treatment for concomitant diseases and conditions). Refusing physiotherapy, massage, acupuncture, and manual therapy substantially reduces the cost of treatment in patients with acute dorsalgia.
Hemorrhagic manifestations of cerebral amyloid angiopathy: from pathogenesis to clinical significance
Authors: Kulesh A. A. , Drobakha V. E. , Shestakov V. V.
Published: November 2018

The paper characterizes the neuropathological aspects of cerebral amyloid angiopathy (CAA) and its pathogenesis. It presents in detail the current neuroimaging markers of CAA and their neuropathological correlates. The phenotypic heterogeneity of the disease and its main clinical manifestations are considered; the updated Boston diagnostic criteria are formulated. The issues of intracerebral hemorrhages, cerebral microbleeding, and cortical superficial siderosis, which are associated with CAA, are elucidated in detail. CAA is noted to be of clinical significance for the determination of therapeutic policy in hemorrhagic stroke, systemic thrombolytic therapy, and cognitive impairment.