bluuebunny/crossref_metadata_2025 huggingface dataset:
The Association Between β-Blocker Use and Cardiorespiratory Fitness: The Maastricht Study
Authors: Nielen Johannes T. H. , de Vries Frank , van der Velde Jeroen. H. P. M. , Savelberg Hans H. C. M. , Schaper Nicolaas C. , Dagnelie Pieter C. , Henry Ronald M. A. , Schram Miranda , Stehouwer Coen D. A. , Boonen Annelies , Koster Annemarie , van den Bemt Bart J. F.
Published: May 2018

Purpose:

β-Blockers (BBs) have been associated with a reduced cardiorespiratory fitness (CRF). This is possibly caused by inhibition of β2-receptors in the airways. However, there are limited data available on β-receptor selectivity and CRF. We therefore aimed to assess the association between BB use and CRF and to assess the association between β-receptor selectivity and CRF.

Methods:

Participants in the Maastricht Study were aged between 40 and 75 years. Exposure to BB use was determined by use of pharmacy records. General linear models were used to obtain adjusted means of 2 proxies for CRF: covered distance during the 6-minute walk test (6MWT) and estimated maximum power output adjusted for body mass ( Wmax kg−1) during the submaximal cycle ergometer test. Adjusted means were compared between current, past, and never BB users. Current users were subsequently stratified by β-receptor selectivity and dose.

Results:

Compared to never use, current use was associated with a lower CRF, based on the 6MWT (current use: 569.7 m; never use: 580.4 m [ P = .010]), but not based on the cycling test (current use: 2.14 W kg−1; never use: 2.13 W kg−1 [ P = .690]). There was no difference between current selective and current nonselective BB use.

Conclusion:

β-Blockers use was associated with CRF based on the 6MWT but not the cycling test. There was no difference between current selective and nonselective BB users, possibly due to the small number of nonselective BB users, differential underlying diseases, other pharmacological properties, and limitations related to the proxies of the outcome.
Effects of director rotation relaxation on viscoelastic wave dispersion in nematic elastomer beams
Authors: Zhao Dong , Liu Ying
Published: May 2018

In this paper, the transverse wave dispersion in a nematic elastomer (NE) Timoshenko beam is studied by considering anisotropy and viscoelasticity of NEs in the low frequency limit. Firstly, the characteristic equations of wave motion in an NE beam are derived, and then numerically solved to obtain the corresponding phase velocities and attenuation factors. The influences of anisotropic parameter, director rotation and rubber relaxation times on the wave dispersion in an NE beam are discussed. Results show that unlike the situation in general isotropic viscoelastic beam, non-classical viscoelastic wave dispersion is found in NE beams. Geometric dispersion is restrained with the vanishing of cut-off frequencies for shear waves due to director rotation relaxation of NEs. This unique property promises prospective applications of NE beams in optic or acoustic design.
Cooking loss, tenderness, and sensory evaluation of chicken meat roasted after wrapping with edible films
Authors: Küçüközet Ahmet Oktay , Uslu Mustafa Kemal
Published: May 2018

In this study, edible films were produced from sodium caseinate and a sodium caseinate–starch mixture and with or without oleoresins (cumin and oregano oleoresin mixture). Chicken meat was wrapped in the respective films, stored at 4 ℃ for four days, and roasted at 200 ℃ for 30 min. The cooking loss, color changes, instrumental tenderness (shear force and energy) were measured. In addition, sensory evaluation was performed. All films effectively reduced cooking loss from chicken meat. The sodium caseinate–starch-based films were the most successful in preventing cooking loss. The average shear force and shear energy values of the wrapped samples were about 40% and 30% less than those of control samples, respectively. In sensory evaluation, chicken meat roasted after wrapping with the films was considered more tender and delicious than the control. Particularly, chicken meat wrapped with the films containing oleoresin mixture was assessed as the most delicious among the samples. It was shown that the cooking quality of the chicken meat could be significantly improved by pre-wrapping the meat with edible films.
Three-dimensional solutions for free vibration of variable stiffness laminated sandwich plates with curvilinear fibers
Authors: Houmat A
Published: May 2018

This paper is concerned with the free vibration of variable stiffness laminated sandwich plates with curvilinear fibers. The three-dimensional elasticity theory and the p-version of the finite element method are adopted for the analysis. The skin is composed of one or more plies with curvilinear fibers. The fiber path orientation angle in a ply is assumed to vary linearly with the x coordinate. The plies may be stacked symmetrically or anti-symmetrically with respect to the middle surface of the plate. Each layer is modeled as one brick p-element. The principle of virtual displacements is used to derive the element stiffness and mass matrices. The generalized displacements at vertices, edges, and faces shared by elements are matched to ensure inter-element compatibility. Since no solutions are available for the free vibration of such variable stiffness laminated sandwich plates, the validity, convergence, and accuracy of the present three-dimensional method are established by comparing with existing three-dimensional frequencies for constant stiffness laminated sandwich plates with rectilinear fibers. The study reveals that inter-layer modal bending stresses are discontinuous; modal transverse shearing stresses are constant in the core; the sign of modal transverse shearing stresses can change through the thickness of the skin; and the shape of modal cross-sectional warping is influenced by the mode number and stacking sequence of plies. Three-dimensional frequencies are presented for different fiber orientation angles, boundary conditions, aspect ratios, thickness ratios, core/skin thickness ratios, and stacking sequences of plies. The accurate results presented here will serve as a benchmark for future investigations.
Personalised telehealth intervention for chronic disease management: A pilot randomised controlled trial
Authors: Bohingamu Mudiyanselage Shalika , Stevens Jo , Watts Jennifer J , Toscano Julian , Kotowicz Mark A , Steinfort Christopher L , Bell Jennifer , Byrnes Janette , Bruce Stephanie , Carter Sarah , Hunter Claire , Barrand Chris , Hayles Robyn
Published: May 2018

Introduction

The aim of this study was to assess the impact of home-based telehealth monitoring on health outcomes, quality of life and costs over 12 months for patients with diabetes and/or chronic obstructive pulmonary disease (COPD) who were identified as being at high risk of readmission to hospital.

Methods

This pilot study was a randomised controlled trial combined with an economic analysis to examine the outcomes of standard care versus home-based telehealth for people with diabetes and/or COPD who were at risk of hospital readmission within one year. The primary outcomes were (i) hospital admission and length of stay (LOS); and (ii) health-related quality of life (HRQOL); and the secondary outcomes were (i) health-related clinical outcomes; (ii) anxiety and depression scores; and (iii) health literacy. The costs of the intervention and hospitalisations were included.

Results

A total of 86 and 85 participants were randomised to the intervention and control groups respectively. The difference between groups in hospital LOS was –3.89 (95% confidence interval (CI): –9.40, 1.62) days, and for HRQOL, 0.09 (95% CI: 0.05, 0.14) in favour of the telehealth monitoring group. There was a saving of AUD$6553 (95% CI: –12145, –961) in the cost of hospitalisation over 12 months, which offset the increased cost of tele-monitoring. The intervention group showed an improvement in anxiety, depression and health literacy at 12 months, and in the diabetes group, a reduction in microalbuminuria.

Discussion

The telehealth monitoring intervention improved patient's health outcomes and quality of life at no additional cost.
Impact of patient-centred home telehealth programme on outcomes in heart failure
Authors: Srivastava Anshul , Do Jacquelyn-My , Sales Virna L , Ly Samantha , Joseph Jacob
Published: May 2018

Background

Telehealth is a promising intervention to reduce readmissions and healthcare-associated costs in patients with heart failure.

Methods

We performed a retrospective analysis of the impact of telehealth on 197 heart failure patients who had successfully completed one year of home telehealth monitoring following a heart failure admission as part of a clinically mandated programme at a Veterans Affairs Medical Center. Outcomes were compared both within the group (one year before and one year after home telehealth monitoring), and to a contemporary control cohort of 870 heart failure patients who were admitted but not enrolled in home telehealth. The following outcomes were analysed: admissions for any cause, heart failure admissions, total hospital days per patient, average length of stay per admission, urgent care and emergency room visits, and primary care visits.

Results

Both the home telehealth and control cohorts consisted of older male patients. Total hospital days per patient was significantly reduced by home telehealth monitoring in the home telehealth group (2.4 ± 3.5) in comparison to the previous year without monitoring (4.1 ± 4.6, p < 0.0001) and to the control group (3.8 ± 5.3, p < 0.001). A significantly lower admission rate (1.1 ± 1.6) and length of stay (5.7 ± 11.3 days) were observed during home telehealth monitoring within the home telehealth group compared to the prior year (1.6 ± 1.7, p < 0.05 and 9.5 ± 14 days, p < 0.01 respectively) but not in comparison with the control group (1.4 ± 2.0, p < 0.07). The home telehealth group also had a significantly lower length of stay when compared to the control group (5.7 ± 11.3 vs 9.0 ± 14.9, p < 0.01). The number of urgent care and emergency room visits, or primary care visits, was not significantly different during home telehealth monitoring as compared to the prior year.

Conclusions

Personalised and patient-centred home telehealth monitoring in heart failure patients was successful in reducing outcomes without an increase in outpatient and urgent care visits.
A computational fluid dynamics study on the solid mineral particles-laden flow in a novel offshore agitated vessel
Authors: Yang D , Lv XQ , Xiong YL
Published: May 2018

Most seabeds are unexplored and rich in mineral deposits, making offshore mining a promising activity. However, offshore operation brings in great challenges from technical equipment to physical space. For instance, an offshore agitated vessel is supposed to stabilize the solids concentration from the underwater mining and make little impact on the stability of the platform or ship. For this reason, we proposed a novel offshore agitated vessel. The whole system based on the arrangement of the mineral processing platform and the slurry mix flow rate is obtained from the previous design stage. Large-scale unsteady computational fluid dynamics simulations are performed to calculate its effectiveness. The simulation model equipped with two pitched blade turbines and inlets/outlets is investigated. A classical Eulerian multiphase model and a modification of the standard k-ε eddy-viscosity turbulence model are adopted to simulate the dense solid–liquid suspension dynamics. Computational fluid dynamics results were found to be in satisfactory agreement with the theoretical predictions. The agitated system obtained was found to be effective to stabilize the solid particle concentration. In order to achieve a higher concentration at outlets and lower power consumption, further improvement was made and validated by computational fluid dynamics simulations. The proposed offshore mechanical agitated vessel could be equipped on offshore mining.
Reduced graphene oxide/TiO2 nanocomposites coating of cotton fabrics with antibacterial and self-cleaning properties
Authors: Stan Miruna S , Nica Ionela C , Popa Marcela , Chifiriuc Mariana C , Iordache Ovidiu , Dumitrescu Iuliana , Diamandescu Lucian , Dinischiotu Anca
Published: May 2018

Textile materials can be easily used as a support for the nano-decoration with active particles in order to gain new features such as self-cleaning, antimicrobial efficiency, water repellency, mechanical strength, color change and protection against ultraviolet radiations. In this context, our present research reports the fabrication and characterization (physico-chemical analysis and surface morphology) of cotton fabrics treated with reduced graphene oxide decorated with two types of TiO2 nanoparticles co-doped with 1% iron and nitrogen atoms (TiO2/rGO NPs) and synthesized in different hydrothermal conditions by a simultaneous precipitation of Ti3+ and Fe3+ ions to achieve their uniform distribution or after a sequential precipitation of these two cations for obtaining a higher concentration of iron on the surface of Ti4+ oxyhydroxide. Further, the antimicrobial efficiency of these TiO2/rGO-treated textiles and their influence on human cells were assessed. We demonstrated the successful development of TiO2/rGO coating of cotton fabrics which are harmless for human skin cells and inhibit the growth of Staphylococcus aureus and Enterococcus faecalis. These findings confirm their great potential as novel graphene-based materials for biomedical and photocatalytic applications and this approach could be used for the large-scale fabrication of innovative self-cleaning and antimicrobial textiles.
A Comparison of Ultrasound and MRI Measurements of the Cross-Sectional Area of the Median Nerve at the Wrist
Authors: Hersh Beverly , D’Auria Jennifer , Scott Michael , Fowler John R.
Published: May 2018

Background: Ultrasound (US) measurement of cross-sectional area (CSA) of the median nerve has emerged as a viable alternative to electromyography/nerve conduction studies (EMG/NCS) for diagnosis of carpal tunnel syndrome (CTS). The purpose of this study is to compare CSA of the median nerve between US and MRI using current MRI and US technology. The null hypothesis is there is no difference between US and MRI CSA measurements. Methods: The study design was an observational cohort, enrolling patients presenting to clinic with MRI of the wrist. Participants with clinical signs and symptoms of CTS were excluded. The CSA measurements of the median nerve on MRI T1-weighted axial images were performed by a hand fellow blinded to results of US measurements, and US measurement of median nerve CSA was performed by a hand fellowship trained surgeon blinded to results of the MRI measurements. Results were analyzed via percent error, Pearson correlation, and t tests. Results: Twenty participants were enrolled with mean age of 29.4 years. Four left wrists and 16 right wrists were measured. The US mean CSA of the median nerve was 6.8 mm2 (±2.330 mm2). The MRI mean CSA of the median nerve was 6.8 mm2 (±2.153 mm2), P = .442. Pearson correlation between modalities was 0.93, suggesting near-perfect correlation. Mean percent error was 8.8%. Conclusions: Results of this study suggest that US is an accurate method to measure CSA of the median nerve at the carpal tunnel inlet. The mean difference between US and MRI was unlikely to be clinically significant.
Arthroscopic Abrasion Arthroplasty Is Not Superior to Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Arthritis
Authors: Rog Dominik , Ozyurekoglu Tuna , Karuppiah Kumar K.
Published: May 2018

Background: A few arthroscopic options have been proposed for the treatment of early stages of the arthritis of the thumb carpometacarpal (CMC) joint. The purpose of this study was to compare the results of arthroscopic abrasion arthroplasty with ligament reconstruction and tendon interposition (LRTI). Methods: In this retrospective cohort study, 11 patients who underwent thumb CMC joint arthroscopic abrasion arthroplasty were compared with 15 patients who were randomly selected from a group of 80 LRTI arthroplasty patients during the same study period, with a minimum 1 year follow-up. Preoperative and postoperative evaluations included radiographs and measurements of grip strength, visual analog scale (VAS) pain scores, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: The mean preoperative VAS score in both groups was 6.8. Mean preoperative DASH scores were 61.1 in the arthroscopy group and 67.4 in the LRTI group. Postoperative VAS score at final follow-up was 4.8 in the arthroscopy group and 1.2 in the LRTI group ( P < .05). Postoperative DASH scores 9 months after surgery were 23 for the LRTI group and 55.2 for the arthroscopy group ( P < .05). Eight patients in the arthroscopy group had a second surgery due to persistent pain. Conclusions: Patients undergoing arthroscopic abrasion arthroplasty had high revision rates, higher postoperative pain, and lower patient-rated outcomes than patients undergoing LRTI procedure. The poor results in the arthroscopy group may be secondary to the inherent instability of the CMC joint and lack of use of any biological or artificial interposition material.
Long non-coding RNA SNHG6 promotes glioma tumorigenesis by sponging miR-101-3p
Authors: Meng Qiang , Yang Bao-Ying , Liu Bei , Yang Ji-Xue , Sun Yang
Published: May 2018

Introduction:

Glioma is the most common primary brain tumor. The small nucleolar RNA host gene (SNHG) SNHG6 is a potential oncogene in the development of several types of cancers.

Methods:

In this study, we investigated the functional role of long non-coding RNA (lncRNA) SNHG6 in the malignancy of glioma in cell lines and transplanted nude mice.

Results:

We found that the expression of lncRNA SNHG6 was higher in glioma tissues and cells than in normal brain tissues and cells. The expression of lncRNA SNHG6 was positively correlated with the malignancy and poor prognosis of glioma patients. microRNA (miR)-101-3p expression was decreased in glioma tissues and cells and was negatively correlated with the malignancy and poor prognosis of glioma patients. In glioma tissues, the expression of lncRNA SNHG6 was negatively correlated with the expression of miR-101-3p. SNHG6 contained a binding site of miR-101-3p. Knockdown of SNHG6 expression resulted in a significant increase of miR-101-3p expression. miR-101-3p mimic markedly decreased the luciferase activity of SNHG6. Knockdown of SNHG6 inhibited glioma cell proliferation, migration, and epithelial-mesenchymal transition (EMT), and increased apoptosis. miR-101-3p mimic enhanced knockdown of SNHG6-induced inhibition of cell proliferation, migration, and EMT, and an increase of apoptosis. Anti-miR-101-3p reversed the the effects of si-SNHG6 on cell malignancy. Knockdown of SNHG6 remarkably reduced the increase of tumor volumes in xenograft mouse models. In tumor tissues, knockdown of SNHG6 increased the expression of miR-101-3p and reduced EMT biomarker expression.

Conclusions:

Our study provides novel insights into the functions of lncRNA SNHG6/miR-101-3p axis in the tumorigenesis of glioma.
Deciphering the potential value of 5-fluorouracil metabolic enzymes in predicting prognosis and treatment response of colorectal cancer patients
Authors: Gajjar Kinjal K. , Vora Hemangini H. , Kobawala Toral P. , Trivedi Trupti I. , Ghosh Nandita R.
Published: May 2018

Introduction:

5-flourouracil (5-FU) is one of the standard chemotherapeutic drugs used today in the treatment of colorectal cancer patients. Disruption of 5-FU metabolic pathway may contribute to altered effectiveness towards 5-FU-based therapy. Hence, the study of 5-FU metabolizing enzymes might have the potential efficacy to predict survival and response to treatment in colorectal cancer patients.

Materials and methods:

Immunohistochemical localization of 5-FU metabolic enzymes (TS, MTHFR, DPYD, and TP) was evaluated in 143 untreated patients with colorectal cancer; their prognostic and predictive values were also evaluated.

Results:

Immuno-positivity for TS, MTHFR, DPYD, and TP was observed in 77%, 75%, 88%, and 96% of colorectal cancer patients, respectively. Univariate survival analysis in total patients showed that low DPYD expression significantly predicted adverse overall survival ( P=0.042). Moreover, subgroup of colon cancer patients with low TS expression was associated with unfavorable prognosis. TP expression also emerged as a prognosticator in the subgroup of early and advanced stage patients. Additionally, when effect of co-expression of 5-FU metabolic enzymes was evaluated in total patients, low coexpression of all four proteins was predictive of poor overall survival than for individuals expressing high coexpression of these proteins ( P=0.045). In contrast, none of the 5-FU metabolic enzymes—either singly or on coexpression—emerged as a useful biomarker of potential therapeutic value when evaluated in the subgroup of patients treated with 5-FU alone or 5-FU plus oxaliplatin.

Conclusion:

The above findings suggest that coexpression of 5-FU metabolic enzymes possess significant prognostic value and could be useful biomarkers in colorectal cancer patients.
The role of selected chemokines and their specific receptors in pancreatic cancer
Authors: Łukaszewicz-Zając Marta , Gryko Mariusz , Mroczko Barbara
Published: May 2018

Pancreatic carcinoma is a highly malignant disease associated with an extremely poor prognosis, which is caused by late presentation, aggressive invasion and metastases, as well as the detection of pancreatic carcinoma in its advanced stages. Thus, better understanding of the tumour biology of this malignancy is sorely needed to improve the clinical outcome. A great challenge for the medical practice is finding a new biomarker of pancreatic carcinoma that will be helpful in diagnosis, in prognosis and in making clinical decisions, including the assessment of patients’ response to therapy. It is suggested that selected chemokines and their specific receptors play an important role in tumour progression, such as tumour growth, angiogenesis, proliferation and development of metastasis. In the present review, general characteristics of chemokines and their specific receptors as well as the significance of these molecules in tumour development are described. The crucial issue of this review is to summarise the importance of various chemokines and their specific receptors in pancreatic carcinoma. Understanding the role of chemokines in the pathogenesis of pancreatic carcinoma is extremely important since these proteins may be used as a potential tool in the diagnosis and prognosis of pancreatic carcinoma patients.
Design of active disturbance rejection controller for compass-like biped walking
Authors: Song Sumian , Tang Chong , Wang Zidong , Wang Yinan , Yan Gangfeng
Published: May 2018

This article proposes an active disturbance rejection controller design scheme to stabilize the unstable limit cycle of a compass-like biped robot. The idea of transverse coordinate transformation is applied to form the control system based on angular momentum. With the linearization approximation, the limit cycle stabilization problem is simplified into the stabilization of an linear time-invariant system, which is known as transverse coordinate control. In order to solve the problem of poor adaptability caused by linearization approximation, we design an active disturbance rejection controller in the form of a serial system. With the active disturbance rejection controller, the system error can be estimated by extended state observer and compensated by nonlinear state error feedback, and the unstable limit cycle can be stabilized. The numerical simulations show that the control law enhances the performance of transverse coordinate control.
Optical properties of traditional clay tiles for ventilated roofs and implication on roof thermal performance
Authors: Di Giuseppe Elisa , Sabbatini Simona , Cozzolino Nikita , Stipa Pierluigi , D’Orazio Marco
Published: May 2018

A remarkable advantage of clay tiles roof coverings in hot climates is the realization of a ventilated air layer between them and the roofing underlay that allows a natural and forced convection through the tiles joints and the channel from eaves to ridge, thus cooling the roof materials. However recently, in many countries, regulatory developments on buildings energy efficiency or buildings sustainability certification protocols are increasingly encouraging the use of alternative strategies, with the aim of reducing the urban heat island (UHI) effect and the buildings’ cooling consumptions. Among them, the use of ‘cool’ materials for roof covering. These mandatory or voluntary measures de facto push the construction products market towards specific directions, risking penalizing traditional components such as clay tiles. This article reports the results of experimental and numerical activities carried out in order to extensively characterize the optical properties of clay tile materials and investigate their impact, also coupled with above sheathing ventilation, on the thermal performance of a ventilated roof under warm-temperate climate. In the first phase of the research, the main optical properties of over 30 different clay products have been experimentally characterized in order to get a clear and extensive picture of such properties for the materials spread in the market. In a second phase, starting from the thermal data collected on an experimental real-scale building, a dynamic energy analysis tool was calibrated and used to perform simulations by varying the optical properties of the roof covering thus assessing the impact on the roof temperatures, also in comparison to a clay tiles roof. The results underline that the use of the above sheathing ventilation obtained through clay tiles is an effective strategy to reduce roof temperatures, even if covering materials are not qualified as ‘cool’, thus impacting on both UHI and indoor comfort.
Restraint of adults with intellectual disabilities: A critical review of the prevalence and characteristics associated with its use
Authors: Fitton Lucy , Jones Dominic Ryan
Published: May 2018

Background:

As part of their care, adults with intellectual disabilities are often subject to restrictive interventions including restraint.

Method:

A review examining the prevalence of restraint use with people with intellectual disabilities and the characteristics associated with its use.

Results:

The seven papers identified used quantitative methodologies and had cross-sectional designs. Prevalence rates of restraint ranged from 11% to 78%, multiple forms of restraint were common. Most studies focused on characteristics within the person with an intellectual disability, three considered external factors. Challenging behaviour was the most consistent characteristic associated with the use of restraint, but how this was defined varied.

Conclusions:

The review highlights a need for more consistent means of defining and measuring restraint and its associated characteristics. Future research into this area may also want to focus on the context of restraint such as whether it is the least restrictive option used.
Tourette’s syndrome and tic disorders
Authors: Poulter Caroline , Mills Jonathan
Published: May 2018

Tourette’s syndrome and tic disorders affect around 1% of the population. The presentation can range from relatively innocuous stereotyped movements and noises, through to more severe symptoms resulting in significant social and psychological disability. Although the majority of tic disorders present in childhood, a third of those affected experience tics into adulthood. The prevalence suggests that most GPs will have patients with tic disorders in their practice.
Statins for primary prevention and rhabdomyolysis: A nationwide cohort study in France
Authors: Coste Joël , Billionnet Cécile , Rudnichi Annie , Pouchot Jacques , Dray-Spira Rosemary , Giral Philippe , Zureik Mahmoud
Published: May 2018

Aims

The purpose of this study was to investigate the risk of rhabdomyolysis in subjects initiating statin therapy for primary prevention of cardiovascular disease, focusing on the type of statin, dose and time since initiation.

Methods and results

A nationwide cohort study using French hospital discharge and claims databases was performed, studying subjects from the general population 40–75 years in 2009, with no history of cardiovascular disease and no lipid-lowering drugs during the preceding three-year period, followed for up to seven years. The primary outcome was hospitalization for rhabdomyolysis. Event-free survival analysis and case-time-control analysis were both performed, separately by gender. The cohort included 8,236,667 subjects, 969,460 of whom initiated a lipid-lowering drug for cardiovascular disease primary prevention. During 18,407,391 person-months exposed to statins, 168 events were observed, corresponding to an incidence of rhabdomyolysis of 1.10 per 10,000 person-years (1.54 in men vs 0.81 in women); 10/168 cases were fatal, and 18/168 and 57/168 cases occurred during the first month and first trimester of treatment, respectively. Survival analysis did not reveal any increased overall risk (hazard ratio = 1.02 (0.83–1.25) in men and 0.76 (0.60–0.96) in women). However, exposure to high-potency statins was associated with an increased risk in men (hazard ratio = 1.93 (1.27–2.94)). Rosuvastatin 20 mg (in men and women) and simvastatin 40 mg (in men) were associated with hazard ratios > 5. Case-time-control analyses showed similar patterns of risk. Drug interactions did not appear to significantly contribute to rhabdomyolysis events in this study.

Conclusion

Although the overall risk of statin-associated rhabdomyolysis in the context of primary prevention was not increased, the first months of treatment and the use of high-potency statins represent at-risk situations, which require appropriate monitoring, especially in men.
von Willebrand factor is a useful biomarker for liver fibrosis and prediction of hepatocellular carcinoma development in patients with hepatitis B and C
Authors: Takaya Hiroaki , Kawaratani Hideto , Tsuji Yuki , Nakanishi Keisuke , Saikawa Soichiro , Sato Shinya , Sawada Yasuhiko , Kaji Kosuke , Okura Yasushi , Shimozato Naotaka , Kitade Mitsuteru , Akahane Takemi , Moriya Kei , Namisaki Tadashi , Mitoro Akira , Matsumoto Masanori , Fukui Hiroshi , Yoshiji Hitoshi
Published: May 2018

Background

Several noninvasive biomarkers are available for diagnosing liver fibrosis stage and predicting hepatocellular carcinoma (HCC) development in patients with chronic hepatitis and liver cirrhosis. However, these biomarkers are not sufficiently accurate. Recently, von Willebrand factor (VWF) has been related to angiogenesis and apoptosis. Furthermore, VWF is associated with hepatic spare ability and HCC.

Objective

We aimed to determine whether VWF is a potential biomarker for liver fibrosis and HCC development.

Methods

Two hundred and twelve patients with chronic hepatitis B and C were recruited. VWF antigen (VWF: Ag) levels in each patient were determined via enzyme‐linked immunosorbent assay. Univariable and multivariable analyses were used to determine the risk factor of HCC.

Results

The VWF: Ag levels were higher in patients with severe liver fibrosis stage and/or HCC development than in those without. The area under the curve of VWF: Ag for diagnosis of severe liver fibrosis stage was 0.721. Multivariable analysis showed that only VWF: Ag was a predictive biomarker for HCC development.

Conclusions

VWF: Ag is related to liver fibrosis and may be useful for predicting HCC development. VWF is a potentially useful biomarker to diagnose severe liver fibrosis and predict HCC development.
Thrombotic storm in a 4-year-old boy with a thrombus in the right atrium
Authors: Ma Jing-Yao , Zhang Xin , Li Xiao-Feng , He Le-Jian , Ma Ning , Wei Yun-Yun , Wu Run-Hui , Wang Fang-Yun
Published: May 2018

Thrombotic storm (TS) is a rare disease, especially with thrombus in the heart of pediatric patient. We present a case of a 4-year-old boy, who was diagnosed with TS during his first hospitalization due to lower extremity deep venous thrombosis, pulmonary embolism, and thrombosis of the inferior vena cava, cerebral, left internal jugular, portal, renal, and iliac veins. He was eventually prescribed with rivaroxaban to control thrombosis after 30 days of successive use of low-molecular-weight heparin, unfractionated heparin, and warfarin, which were demonstrating little effect on preventing thrombosis, and the patient was intolerant to argatroban. While his lupus anticoagulant ratio was slightly above the normal range and no other potential causes such as congenital thrombophilia, severe infection, malignancy, and trauma were confirmed, we suspected antiphospholipid antibody syndrome and prescribed glucocorticoid and rituximab to control the disease. After 36 days of admission, ultrasonography showed recanalization of the former thrombus. One month after discharge, a tumor embolus resembling a mass emerged in his right atrium under effective anticoagulant therapy. During his second admission, he underwent surgical thrombectomy, and pathological examination confirmed the mass to be a platelet-rich thrombus rather than tumor embolus or infection. Considering the suspected antiphospholipid antibody syndrome as the cause of the TS, we prescribed aspirin combined with rivaroxaban to prevent thrombosis. In this case, surgery and pathology shed light on the type of thrombus that emerged from the inferior vena cava and traveled to the heart, which is the possible potential cause of TS. It also changed our therapeutic strategy to antiplatelet therapy combined with anticoagulant therapy to control the disease.
Rapid titration of opiate doses via patient-controlled intravenous analgesia for patients with severe cancer pain
Authors: Tian Suming , Liu Minjun , Qiao Shina , Wu Yue
Published: May 2018

This study was to investigate the feasibility and safety of patient-controlled intravenous analgesia for opiate titration in patients with severe cancer. Eligible patients with cancer pain were randomly divided into two groups, which were titrated with a subcutaneous injection of morphine and patient-controlled intravenous analgesia, respectively. The time required for patients to begin titration to reach visual analog scale score ⩽ 3, the adverse reactions during titration, the time spent by nurses in titrating each patient, and the time to complete the titration with a delayed-release dosage form analgesic effect and adverse reaction. The mean titration time of patient-controlled intravenous analgesia group (1.09 ± 0.82 vs 2.97 ± 1.98) and morphine dosage (18.78 ± 12.32 vs 13.23 ± 8.07) were significantly lower than those in the subcutaneous group ( P < 0.05). The incidences of nausea, vomiting, pruritus, urinary retention, and sedation in the subcutaneous injection group were significantly lower than those in the subcutaneous injection group ( P < 0.05). The assessment times of the two groups (10.19 ± 3.72 vs 10.25 ± 4.88) were similar ( P > 0.05). However, the time required for subcutaneous injection in patients under patient-controlled intravenous analgesia was significantly lower than that in the subcutaneous injection group (36.36 ± 12.15 vs 132.36 ± 32.79), which was statistically significant ( P < 0.05). After the titration, the controlled release opioid was used to treat cancer pain. The visual analog scale score of the patient-controlled intravenous analgesia group was significantly lower than that of the subcutaneous group (2.44 ± 1.37 vs 2.73 ± 0.91) at 7 days after treatment in the subcutaneous group (1.05 ± 0.30 vs 2.45 ± 1.29; P < 0.05). Patient-controlled intravenous analgesia technique can effectively and quickly complete the titration of cancer pain treatment with less occupational care resources and is better than the subcutaneous injection titration.
Repair of Sinus Venosus Defect and Anomalous Pulmonary Veins Associated With Vein of Galen Malformation
Authors: Anderson Heather N. , Said Sameh M. , Cetta Frank
Published: May 2018

Sinus venosus defect (SVD) is a deficiency in the sinus venosus portion of the atrium, often associated with partial anomalous pulmonary venous connections. In patients with vein of Galen malformation (VGAM), SVD provides a unique challenge with respect to embolization treatment. In our case, the child had percutaneous device closure of the SVD prior to VGAM embolization. Nine years later, he required surgical removal of the SVD device and Warden procedure due to progressive right-sided cardiac enlargement.
Understanding Entrepreneurial Team Decisions: Measuring Team Members’ Influences With The Metricized Limit Conjoint Analysis
Authors: Baierl Ronny
Published: May 2018

Contextualizing research on entrepreneurial team decisions (ETDs) is closely related to elaborating the influence of several team members (TMs) on group decisions. Therefore, this study shows how the metricized limit conjoint analysis (MLCA) provides a method to more accurately determine TMs’ influences. For doing so, this study introduces a new approach as a suitable alternative to directly ask for TMs’ influences by utilizing a detailed step-by-step instruction for further research. Moreover, this study theoretically underlines the usability and preferableness of this new approach and validates it with a simulation of 45,000 assessments nested within 5,000 artificial respondents. The results indicate a diverse application potential for researching ETDs in several contexts. In addition, an illustrative example shows how this conjoint approach can be of value in subsequent research projects. Therefore, the MLCA is of increased interest for both researchers and practitioners when focusing on ETDs in several contexts.
Surgical treatment of cervical subaxial intraspinal extradural cysts using a full-endoscopic uniportal posterior approach
Authors: Ruetten Sebastian , Hahn Patrick , Oezdemir Semih , Baraliakos Xenophon , Godolias Georgios , Komp Martin
Published: May 2018

Purpose:

Symptomatic intraspinal extradural cysts of the cervical subaxial spine are rare, but usually require surgery. Conventional posterior decompression is the gold standard. However, there is increasing experience with endoscopic surgical techniques. The purpose of the study is to evaluate the technical implementation and outcomes of a full-endoscopic uniportal technique via the posterior approach in patients with symptomatic intraspinal extradural cysts of the cervical subaxial spine.

Methods:

Seven consecutive patients with a subaxial location of symptomatic intraspinal extradural cysts were decompressed in a full-endoscopic uniportal technique via the posterior approach between 2009 and 2015. Imaging and clinical data were collected in follow-up examinations for 18 months.

Results:

In all cases, the cyst was completely removed and adequate decompression was achieved using the full-endoscopic uniportal technique. One patient developed a dural leak that was sutured and covered intraoperatively. No other complications requiring treatment were observed. All patients had a good clinical outcome with stable regression of the radicular and central nerve pain or neurological deficits. The imaging follow-up showed sufficient decompression in all cases. No evidence was found of increasing instability during the follow-up period.

Conclusion:

The full-endoscopic uniportal operation with a posterior approach allows the resection of the cyst and can minimize trauma and destabilization and has technical benefits and a low complication rate. It is an alternative surgical method that can offer advantages and is considered by the authors to be the surgical technique of choice for cervical subaxial intraspinal extradural cysts.
IGF-1 facilitates thrombopoiesis primarily through Akt activation
Authors: Chen Shilei , Hu Mengjia , Shen Mingqiang , Wang Song , Wang Cheng , Chen Fang , Tang Yong , Wang Xinmiao , Zeng Hao , Chen Mo , Gao Jining , Wang Fengchao , Su Yongping , Xu Yang , Wang Junping
Published: May 2018

Key Points

IGF-1 has the ability to promote megakaryocyte differentiation, PPF, and platelet release. The effect of IGF-1 on thrombopoiesis is mediated primarily by AKT activation with the assistance of SRC-3.
Successful ventilation through a Rüsch intubation guide catheter in severe laryngotracheal stenosis
Authors: Van Regemorter Victoria , Potié Arnaud , Schmitz Sandra , Scholtes Jean-Louis , Veevaete Laurent , Van Boven Michel
Published: May 2018

Background

Providing adequate ventilation may remain complex in patients with severe proximal laryngotracheal stenosis, especially when the airway is shared with the surgeon during tracheal resection surgery. We describe an effective alternative to standard endotracheal intubation using a Rüsch flexible intubation guide catheter.

Methods

In two patients undergoing tracheal repair surgery, we failed to insert a 5.0 inner diameter endotracheal tube (6.9 mm outer diameter) or a 6.0 mm outer diameter endoscope through the laryngotracheal stenosis. However, using indirect laryngoscopy, a 6.0 outer diameter Rüsch flexible intubation guide catheter was passed successfully through the vocal cords and then through the stenosis. Controlled ventilation was achieved by means of the Rüsch guide, provided with its two large Murphy's eyes. When the trachea was opened, the Rüsch guide was removed just enough for the surgeons to place a Montandon tracheal tube, at that point taking over ventilation. A 7.0 inner diameter endotracheal cuffed tube had been inserted onto the Rüsch guide and left pending upstream from the vocal cords. Once the posterior tracheal wall was sutured, this endotracheal cuffed tube was slid along the Rüsch guide through the vocal cords with the cuff placed beyond the tracheal sutures.

Results

Controlled ventilation through the Rüsch flexible intubation guide catheter showed satisfying and stable ventilatory parameters in both patients. Inspiratory pressures of 25–30 mmHg were enough to reach adequate tidal volumes around 450 ml. End tidal CO2 was kept between 35 and 40 mmHg (PaCO2 showed similar values). Standard endotracheal intubation at the end of the tracheal resection was easy and safe thanks to the Rüsch guide still in place between the vocal cords.

Conclusions

We suggest an effective and reliable method using a Rüsch flexible intubation guide catheter for airway management in patients suffering from laryngotracheal stenosis in the setting of tracheal repair surgery.
Improved Adherence Rates and Clinical Outcomes of an Integrated, Closed-Loop, Pharmacist-Led Oral Chemotherapy Management Program
Authors: Muluneh Benyam , Schneider Molly , Faso Aimee , Amerine Lindsey , Daniels Rowell , Crisp Brett , Valgus John , Savage Scott
Published: May 2018

Purpose:

To address the growing use of oral anticancer therapy, an integrated, closed-loop, pharmacist-led oral chemotherapy management program was created within an academic medical center.

Methods:

An integrated, closed-loop, pharmacy-led oral chemotherapy management program was established. From September 2014 until June 2015, demographic information, rates of adherence, patient understanding of treatment, pharmacist interventions, patient and provider satisfaction, and molecular response rates in patients with chronic myeloid leukemia (CML) were collected.

Results:

After full implementation, 107 patients were enrolled in our oral chemotherapy management program from September 2014 until June 2015. All patients were educated before starting oral chemotherapy, and using pre- and postassessment tests, comprehension of oral chemotherapy treatment increased from 43% to 95%. Patient-reported adherence was 86% and 94.7% for the GI/breast and malignant hematology patient populations, respectively, and these were validated with medication possession ratio, revealing adherence rates of 85% and 93.9% for the GI/breast and malignant hematology patient populations, respectively. A total of 350 encounters with a clinical pharmacist and 318 adverse effects were reported, which led to 235 interventions. This program led to a higher major molecular response rate (83%) in our CML population compared with published clinical trials (average major molecular response rates, 40% and 60% with 1- and 2-year follow-up, respectively).

Conclusion:

An innovative model was developed and resulted in improved patient knowledge regarding oral chemotherapy, improved adherence rates that exceeded nationally established thresholds, and superior major molecular response outcomes for patients with CML compared with published literature. As a result, this model has produced the gold standard in managing patients receiving oral chemotherapy.
Long-Term Testosterone Supplementation in Older Men Attenuates Age-Related Decline in Aerobic Capacity
Authors: Traustadóttir Tinna , Harman S Mitchell , Tsitouras Panayiotis , Pencina Karol M , Li Zhuoying , Travison Thomas G , Eder Richard , Miciek Renee , McKinnon Jennifer , Woodbury Erin , Basaria Shehzad , Bhasin Shalender , Storer Thomas W
Published: May 2018

Context

Testosterone increases skeletal muscle mass and strength, but long-term effects of testosterone supplementation on aerobic capacity, or peak oxygen uptake (V̇O2peak), in healthy older men with low testosterone have not been evaluated.

Objective

To determine the effects of testosterone supplementation on V̇O2peak during incremental cycle ergometry.

Design

A double-blind, randomized, placebo-controlled, parallel-group trial (Testosterone’s Effects on Atherosclerosis Progression in Aging Men).

Setting

Exercise physiology laboratory.

Participants

Healthy men aged ≥ 60 years with total testosterone levels of 100 to 400 ng/dL (3.5 to 13.9 nmol/L) or free testosterone levels < 50 pg/mL (174 pmol/L).

Interventions

Randomization to 1% transdermal testosterone gel adjusted to achieve serum levels of 500 to 950 ng/dL or placebo applied daily for 3 years.

Main Outcome Measures

Change in V̇O2peak.

Results

Mean (±SD) baseline V̇O2peak was 24.2 ± 5.2 and 23.6 ± 5.6 mL/kg/min for testosterone and placebo, respectively. V̇O2peak did not change in men treated with testosterone but fell significantly in men receiving placebo (average 3-year decrease, 0.88 mL/kg/min; 95% CI, −1.39 to 0.38 mL/kg/min; P = 0.035); the difference in change in V̇O2peak between groups was significant (average 3-year difference, 0.91 mL/kg/min; 95% CI, 0.010 to 0.122 mL/kg/min; P = 0.008). The 1-g/dL mean increase in hemoglobin (P < 0.001) was significantly associated with changes in V̇O2peak in testosterone-treated men.

Conclusion

The mean 3-year change in V̇O2peak was significantly smaller in men treated with testosterone than in men receiving placebo and was associated with increases in hemoglobin. The difference in V̇O2peak change between groups may indicate attenuation of its expected age-related decline; the clinical meaningfulness of the modest treatment effect remains to be determined.