bluuebunny/crossref_metadata_2025 huggingface dataset:
Rückgang der Spermienqualität: Umweltmedizinische Ursachen
Authors: Mutter Joachim , Hensinger Peter
Published: January 2019

Die abnehmende Spermienqualität der letzten Jahrzehnte hat dazu geführt, dass die Normwerte für das Spermiogramm herabgesetzt wurden. Die inzwischen recht umfangreiche Forschung legt den Schluss nahe, dass diverse Umweltfaktoren zur abnehmenden Spermienqualität zumindest beitragen. Dazu zählen u. a. Schwermetall- und Arsenbelastungen, der Einsatz von Glyphosat und Pestiziden in der Landwirtschaft, die Verwendung von Bisphenyl A in Verpackungen. Aber auch elektromagnetische Felder niederer Intensität, denen praktisch jeder ausgesetzt ist, z. B. durch Mobilfunk, Laptop- und WLAN-Nutzung werden diskutiert.

Im Beitrag wird die aktuelle Datenlage zu den aufgrund der weiten Verbreitung wichtigsten umweltmedizinischen Faktoren für Spermienschäden zusammengefasst.
Rebuilding the Standing Prescription Renewal Orders
Authors: Nelson Scott , Rector Hayley , Brashear Daniel , Mathe Janos , Wen Haomin , English Stacey , Hedges William , Lehmann Christoph , Ozdas-Weitkamp Asli , Stenner Shane
Published: January 2019

Background Managing prescription renewal requests is a labor-intensive challenge in ambulatory care. In 2009, Vanderbilt University Medical Center developed clinic-specific standing prescription renewal orders that allowed nurses, under specific conditions, to authorize renewal requests. Formulary and authorization changes made maintaining these documents very challenging.

Objective This article aims to review, standardize, and restructure legacy standing prescription renewal orders into a modular, scalable, and easier to manage format for conversion and use in a new electronic health record (EHR).

Methods We created an enterprise-wide renewal domain model using modular subgroups within the main institutional standing renewal order policy by extracting metadata, medication group names, medication ingredient names, and renewal criteria from approved legacy standing renewal orders. Instance-based matching compared medication groups in a pairwise manner to calculate a similarity score between medication groups. We grouped and standardized medication groups with high similarity by mapping them to medication classes from a medication terminology vendor and filtering them by intended route (e.g., oral, subcutaneous, inhalation). After standardizing the renewal criteria to a short list of reusable criteria, the Pharmacy and Therapeutics (P&T) committee reviewed and approved candidate medication groups and corresponding renewal criteria.

Results Seventy-eight legacy standing prescription renewal orders covered 135 clinics (some applied to multiple clinics). Several standing orders were perfectly congruent, listing identical medications for renewal. We consolidated 870 distinct medication classes to 164 subgroups and assigned renewal criteria. We consolidated 379 distinct legacy renewal criteria to 21 criteria. After approval by the P&T committee, we built subgroups in a structured and consistent format in the new EHR, where they facilitated chart review and standing order adherence by nurses. Additionally, clinicians could search an autogenerated document of the standing order content from the EHR data warehouse.

Conclusion We describe a methodology for standardizing and scaling standing prescription renewal orders at an enterprise level while transitioning to a new EHR.
Hip Hype: FAI Syndrome, Amara's Law, and the Hype Cycle
Authors: Kassarjian Ara
Published: January 2019

Femoroacetabular impingement (FAI) has taken us on a roller-coaster ride of innovation, heightened expectations, disillusionment, and confusing diagnostic and treatment pathways. This article reviews and analyzes the phases of FAI diagnosis and treatment over the past 15 years and discusses its parallels to Amara's law and Gartner's hype cycle.
Pharmacomechanical Catheter-Directed Thrombolysis in Acute Femoral–Popliteal Deep Vein Thrombosis: Analysis from a Stratified Randomized Trial
Authors: Kearon Clive , Gu Chu-Shu , Julian Jim , Goldhaber Samuel , Comerota Anthony , Gornik Heather , Murphy Timothy , Lewis Laurence , Kahn Susan , Kindzelski Andrei , Slater Dennis , Geary Randolph , Winokur Ronald , Natarajan Kannan , Dietzek Alan , Leung Daniel , Kim Stanley , Vedantham Suresh
Published: January 2019

Background and Objectives The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial reported that pharmacomechanical catheter-directed thrombolysis (PCDT) did not reduce post-thrombotic syndrome (PTS), but reduced moderate-to-severe PTS and the severity of PTS symptoms. In this analysis, we examine the effect of PCDT in patients with femoral–popliteal deep vein thrombosis (DVT) (without involvement of more proximal veins).

Patients and Methods Within the ATTRACT trial, 300 patients had DVT involving the femoral vein without involvement of the common femoral or iliac veins and were randomized to receive PCDT with anticoagulation or anticoagulation alone (no PCDT). Patients were followed for 24 months.

Results From 6 to 24 months, between the PCDT versus no PCDT arms, there was: no difference in any PTS (Villalta scale ≥ 5: risk ratio [RR] = 0.97; 95% confidence interval [CI], 0.75–1.24); moderate-or-severe PTS (Villalta scale ≥ 10: RR = 0.93; 95% CI, 0.57–1.52); severity of PTS scores; or general or disease-specific quality of life (p > 0.5 for all comparisons). From baseline to both 10 and 30 days, there was no difference in improvement of leg pain or swelling between treatment arms. From baseline to 10 days, major bleeding occurred in three versus none (p = 0.06) and any bleeding occurred in eight versus two (p = 0.032) PCDT versus no PCDT patients. Over 24 months, recurrent venous thromboembolism occurred in 16 PCDT and 12 no PCDT patients (p = 0.24).

Conclusion In patients with femoral–popliteal DVT, PCDT did not improve short- or long-term efficacy outcomes, but it increased bleeding. Therefore, PCDT should not be used as initial treatment of femoral–popliteal DVT. (NCT00790335).
Mathematical modeling and analysis of two-variable system with noninteger-order derivative
Authors: Owolabi Kolade M. , Hammouch Zakia
Published: January 2019

The aim of this paper is to apply the newly trending Atangana-Baluanu derivative operator to model some symbiosis systems describing commmensalism and predator-prey processes. The choice of using this derivative is due to the fact that it combines nonlocal and nonsingular properties in its formulation, which are the essential ingredients when dealing with models of real-life applications. In addition, it is only the Atangana-Baleanu derivative that has both Markovian and non-Markovian properties. Also, its waiting time takes into account the power, exponential, and Mittag-Leffler laws in its formulation. Mathematical analysis of these dynamical models is considered to guide in the correct use of parameters therein, with chaotic and spatiotemporal results reported for some instances of fractional power α.
SNARE machinery is optimized for ultrafast fusion
Authors: Manca Fabio , Pincet Frederic , Truskinovsky Lev , Rothman James E. , Foret Lionel , Caruel Matthieu
Published: January 2019

Significance

We propose a mechanistic description of fusion of a synaptic vesicle with a target membrane executed by a team of zippering SNARE complexes (SNAREpins). In the context of neurotransmitters release, this process naturally decomposes in two steps with rates that depend on the number of SNAREpins

N

. The first step is synchronized escape from the metastable half-zippered state, which gets exponentially more sluggish as

N

increases. The second step is fusion of two closely tethered membranes, which is accelerated exponentially by an increase of

N

. The tradeoff between these two antagonist trends results in a sharply optimal number of SNAREpins

N
=
3
−
6

, which ensures fusion at the physiological submillisecond timescale.
Patient Characteristics Associated with Treatment Initiation and Engagement among Individuals Diagnosed with Alcohol and Other Drug use Disorders in Emergency Department and Primary Care Settings
Authors: Kline-Simon Andrea H. , Stumbo Scott P. , Campbell Cynthia I. , Binswanger Ingrid A. , Weisner Constance , Haller Irina V. , Hechter Rulin C. , Ahmedani Brian K. , Lapham Gwen T. , Loree Amy M. , Sterling Stacy A. , Yarborough Bobbi Jo H.
Published: January 2019

Background

Treatment initiation and engagement rates for alcohol and other drug (AOD) use disorders differ depending on where the AOD use disorder was identified. Emergency department (ED) and primary care (PC) are 2 common settings where patients are identified; however, it is unknown whether characteristics of patients who initiate and engage in treatment differ between these settings.

Methods

Patients identified with an AOD disorder in ED or PC settings were drawn from a larger study that examined Healthcare Effectiveness Data and Information Set (HEDIS) AOD treatment initiation and engagement measures across 7 health systems using electronic health record data ( n = 54,321). Multivariable generalized linear models, with a logit link, clustered on health system, were used to model patient factors associated with initiation and engagement in treatment, between and within each setting.

Results

Patients identified in the ED had higher odds of initiating treatment than those identified in PC (adjusted odds ratio [aOR] = 1.89, 95% confidence interval [CI] = 1.73–2.07), with no difference in engagement between the settings. Among those identified in the ED, compared with patients aged 18–29, older patients had higher odds of treatment initiation (age 30–49: aOR = 1.25, 95% CI = 1.12–1.40; age 50–64: aOR = 1.42, 95% CI = 1.26–1.60; age 65+: aOR = 1.27, 95% CI = 1.08–1.49). However, among those identified in PC, compared with patients aged 18–29, older patients were less likely to initiate (age 30–49: aOR = 0.81, 95% CI = 0.71–0.94; age 50–64: aOR = 0.68, 95% CI = 0.58–0.78; age 65+: aOR = 0.47, 95% CI = 0.40–0.56). Women identified in ED had lower odds of initiating treatment (aOR = 0.80, 95% CI = 0.72–0.88), whereas sex was not associated with treatment initiation in PC. In both settings, patients aged 65+ had lower odds of engaging compared with patients aged 18–29 (ED: aOR = 0.61, 95% CI = 0.38–0.98; PC: aOR = 0.42, 95% CI = 0.26–0.68).

Conclusion

Initiation and engagement in treatment differed by sex and age depending on identification setting. This information could inform tailoring of future AOD interventions.
GLAD: GLycan Array Dashboard, a visual analytics tool for glycan microarrays
Authors: Mehta Akul Y , Cummings Richard D
Published: January 2019

Motivation

Traditional glycan microarray data is typically presented as excel files with limited visualization and interactivity. Thus, comparisons and analysis of glycan array data have been difficult, and there is need for a tool to facilitate data mining of glycan array data.

Results

GLAD (GLycan Array Dashboard) is a web-based tool to visualize, analyze, present and mine glycan microarray data. GLAD allows users to input multiple data files to create comparisons. GLAD extends the capability of the microarray data to produce more comparative visualizations in the form of grouped bar charts, heatmaps, calendar heatmaps, force graphs and correlation maps in order to analyze broad sets of samples. Additionally, it allows users to filter, sort and normalize the data and view glycan structures in an interactive manner, to facilitate faster visual data mining.

Availability and implementation

GLAD is freely available for use on the Web at https://glycotoolkit.com/Tools/GLAD/ with all major modern browsers (Edge, Firefox, Chrome, Safari).

Supplementary information

Full documentation and video tutorials for GLAD can be found on https://glycotoolkit.com/GLAD.
State Payments to Victims of Violent Crime: Discretion and Bias in Awards for Sexual Offences
Authors: Daly Kathleen , Holder Robyn L
Published: January 2019

State monetary schemes for victims of violent crime began in the 1960s and operate in 35 countries today, yet knowledge is lacking on who is applying, how decisions are reached, variation in awards and why amounts may differ. Analysing 291 sexual offence cases in Queensland, we ask whether awards differ by victim sex/gender and by societal constructs of ideal, real rape, and credible victims. We found that male child victims received higher awards than female child victims for more serious sexual offences and that awards to females aged 12 and older were affected by elements associated with real rape and credible victims. We call upon researchers and governments to pursue and expand this new area of research.
Clinical Features of Mycobacterium canettii Infection: A Retrospective Study of 20 Cases Among French Soldiers and Relatives
Authors: Briquet Anaïs , Vong Rithy , Roseau Jean-Baptiste , Javelle Emilie , Cazes Nicolas , Rivière Fréderic , Aletti Marc , Otto Marie-Pierre , Ficko Cécile , Duron Sandrine , Fabre Michel , Pourcel Christine , Simon Fabrice , Soler Charles
Published: January 2019

Background

Mycobacterium canettii forms part of the Mycobacterium tuberculosis complex. Mycobacterium canettii infections are mainly described in the Horn of Africa. The permanent presence of French soldiers in Djibouti raises the question of the risk of being infected with M. canettii. Here, we describe M. canettii infections among French military and their families between 1998 and 2015.

Methods

This retrospective study relied on 3 sources of data: the reference center for mycobacteria in the Biology Department at Percy Military Hospital in Paris, the French Military Center for Epidemiology and Public Health, and the scientific literature. After an exhaustive census of the strains, we studied the epidemiological data on 20 cases among French soldiers and their families.

Results

Twenty cases of M. canettii infections are reported, including 5 unpublished cases. Adenitis predominates (n = 15), especially in the cervico facial area and among children; 1 case was observed 1 month after dental care in Djibouti. The pulmonary forms were less frequent (n = 6), and 3 atypical forms are described. All patients had stayed in Djibouti.

Conclusions

Cases of M. canettii infection among the French military consisted mainly of adenitis; disseminated forms were possible with immunodeficiency. Their evolution under specific treatments was comparable to that of tuberculosis. The presumed origin of the infection seemed to be environmental, possibly a water reservoir, and not due to human-to-human contagion.
Tests of ocean-tide models by analysis of satellite-to-satellite range measurements: an update
Authors: Ray R D , Loomis B D , Luthcke S B , Rachlin K E
Published: January 2019

Seven years of GRACE intersatellite range-rate measurements are used to test the new ocean tide model FES2014 and to compare against similar results obtained with earlier models. These qualitative assessments show that FES2014 represents a marked improvement in accuracy over its earlier incarnation, FES2012, with especially notable improvements in the Arctic Ocean for constituents K1 and S2. Degradation appears to have occurred in two anomalous regions: the Ross Sea for the O1 constituent and the Weddell Sea for M2.
On the Dynamics of Zero-Speed Solutions for Camassa–Holm-Type Equations
Authors: Alejo Miguel A , Cortez Manuel Fernando , Kwak Chulkwang , Muñoz Claudio
Published: January 2019

In this paper, we consider globally defined solutions of Camassa–Holm (CH)-type equations outside the well-known nonzero-speed, peakon region. These equations include the standard CH and Degasperis–Procesi (DP) equations, as well as nonintegrable generalizations such as the $b$-family, elastic rod, and Benjamin-Bona-Mahony (BBM) equations. Having globally defined solutions for these models, we introduce the notion of zero-speed and breather solutions, i.e., solutions that do not decay to zero as $t\to +\infty $ on compact intervals of space. We prove that, under suitable decay assumptions, such solutions do not exist because the identically zero solution is the global attractor of the dynamics, at least in a spatial interval of size $|x|\lesssim t^{1/2-}$ as $t\to +\infty $. As a consequence, we also show scattering and decay in CH-type equations with long-range nonlinearities. Our proof relies in the introduction of suitable virial functionals à la Martel–Merle in the spirit of the works of [74, 75] and [50] adapted to CH-, DP-, and BBM-type dynamics, one of them placed in $L^1_x$ and the 2nd one in the energy space $H^1_x$. Both functionals combined lead to local-in-space decay to zero in $|x|\lesssim t^{1/2-}$ as $t\to +\infty $. Our methods do not rely on the integrable character of the equation, applying to other nonintegrable families of CH-type equations as well.
FcγRIIIA-mediated activation of NK cells by IgG heavy chain complexed with MHC class II molecules
Authors: Shimizu Yuta , Kohyama Masako , Yorifuji Hideki , Jin Hui , Arase Noriko , Suenaga Tadahiro , Arase Hisashi
Published: January 2019

Natural killer (NK) cells are a major FcγRIIIA-expressing lymphocyte population that mediate antibody-dependent cellular cytotoxicity. Although NK cells are critical for immunity against viruses and tumors, they are also activated in the joints of patients with rheumatoid arthritis (RA) and may be involved in disease progression. We previously found that human leukocyte antigen (HLA) class II molecules transport misfolded cellular proteins, such as IgG heavy chain (IgGH), to the cell surface via association with their peptide-binding grooves. Furthermore, we found that IgGHs bound to HLA class II molecules encoded by RA susceptibility alleles are specific targets for rheumatoid factor, an auto-antibody involved in RA. Here, we report that IgGHs bound to HLA class II molecules preferentially stimulate FcγRIIIA-expressing but not FcγRI-expressing cells. A significant correlation was observed between the reactivity of FcγRIIIA-expressing cells to IgGH complexed with a specific HLA-DR allele and the odds ratio for HLA-DR allele’s association with RA. Moreover, primary human NK cells expressing FcγRIIIA demonstrated IFN-γ production and cytotoxicity against cells expressing IgGH complexed with HLA class II molecules. Our findings suggest that IgGH complexed with HLA class II molecules are involved in the activation of FcγRIIIA-expressing NK cells observed within arthritic joints.
Social Ecological System Tools for Improving Crop Pest Management
Authors: Magarey Roger D , Chappell Thomas M , Trexler Christina M , Pallipparambil Godshen R , Hain Ernie F
Published: January 2019

Integrated pest management (IPM) is a valuable tool for reducing pesticide use and for pesticide resistance management. Despite the success of IPM over the last 50 yr, significant challenges remain to improving IPM delivery and adoption. We believe that insights can be obtained from the field of Social Ecological Systems (SES). We first describe the complexity of crop pest management and how various social actors influence grower decision making, including adoption of IPM. Second, we discuss how crop pest management fits the definition of an SES, including such factors as scale, dynamic complexities, critical resources, and important social–ecological interactions. Third, we describe heuristics and simulation models as tools to understand complex SES and develop new strategies. Finally, we conclude with a brief discussion of how social processes and SES techniques could improve crop pest management in the future, including the delivery of IPM, while reducing negative social and environmental impacts.
Acceleration and escape processes of high-energy particles in turbulence inside hot accretion flows
Authors: Kimura Shigeo S , Tomida Kengo , Murase Kohta
Published: January 2019

We investigate acceleration and propagation processes of high-energy particles inside hot accretion flows. The magnetorotational instability (MRI) creates turbulence inside accretion flows, which triggers magnetic reconnection and may produce non-thermal particles. They can be further accelerated stochastically by the turbulence. To probe the properties of such relativistic particles, we perform magnetohydrodynamic simulations to obtain the turbulent fields generated by the MRI, and calculate orbits of the high-energy particles using snapshot data of the MRI turbulence. We find that the particle acceleration is described by a diffusion phenomenon in energy space with a diffusion coefficient of the hard-sphere type: Dε ∝ ε2, where ε is the particle energy. Eddies in the largest scale of the turbulence play a dominant role in the acceleration process. On the other hand, the stochastic behaviour in configuration space is not usual diffusion but superdiffusion: the radial displacement increases with time faster than that in the normal diffusion. Also, the magnetic field configuration in the hot accretion flow creates outward bulk motion of high-energy particles. This bulk motion is more effective than the diffusive motion for higher energy particles. Our results imply that typical active galactic nuclei that host hot accretion flows can accelerate CRs up to ε ∼ 0.1−10 PeV.
Receptor for advanced glycation end products: a key molecule in the genesis of chronic kidney disease vascular calcification and a potential modulator of sodium phosphate co-transporter PIT-1 expression
Authors: Belmokhtar Karim , Ortillon Jeremy , Jaisson Stéphane , Massy Ziad A , Boulagnon Rombi Camille , Doué Manon , Maurice Pascal , Fritz Günter , Gillery Philippe , Schmidt Ann Marie , Rieu Philippe , Touré Fatouma
Published: January 2019

Background

Chronic kidney disease (CKD) is associated with increased cardiovascular mortality, frequent vascular calcification (VC) and accumulation of uraemic toxins. Advanced glycation end products and S100 proteins interact with the receptor for advanced glycation end products (RAGE). In the present work, we aimed to investigate the role(s) of RAGE in the CKD–VC process.

Methods

Apoe−/− or Apoe−/−Ager (RAGE)−/− male mice were assigned to CKD or sham-operated groups. A high-phosphate diet was given to a subgroup of Apoe−/−and Apoe−/−Ager−/− CKD mice. Primary cultures of Ager+/+ and Ager−/− vascular smooth muscle cells (VSMCs) were established and stimulated with either vehicle, inorganic phosphate (Pi) or RAGE ligands (S100A12; 20 µM).

Results

After 12 weeks of CKD we observed a significant increase in RAGE ligand (AGE and S100 proteins) concentrations in the serum of CKD Apoe−/− mice. Ager messenger RNA (mRNA) levels were 4-fold higher in CKD vessels of Apoe−/− mice. CKD Apoe−/− but not CKD Apoe−/− or Ager−/− mice displayed a marked increase in the VC surface area. Similar trends were found in the high-phosphate diet condition. mRNA levels of Runx2 significantly increased in the Apoe−/− CKD group. In vitro, stimulation of Ager+/+VSMCs with Pi or S100A12 induced mineralization and osteoblast transformation, and this was inhibited by phosphonoformic acid (Pi co-transporters inhibitor) and Ager deletion. In vivo and in vitro RAGE was necessary for regulation of the expression of Pit-1, at least in part through production of reactive oxygen species.

Conclusion

RAGE, through the modulation of Pit-1 expression, is a key molecule in the genesis of VC.
Posterior Interhemispheric Precuneal Approach: Fundamental Principles and Case Illustration: 3-Dimensional Operative Video
Authors: Patra Devi Prasad , Savardekar Amey Rajan , Dossani Rimal H , Mohammed Nasser , Narayan Vinayak , Georgescu Maria-Magdalena , Nanda Anil
Published: January 2019

Peritrigonal lesions are deeply seated and are surrounded by critical neurovascular structures. Traditional transcortical approaches carry the risk of damage to important surrounding white matter tracts. In this regard, a posterior interhemispheric approach gives a more direct and less invasive route and therefore is a reasonable alternative to transcortical approaches. The 3-dimensional video includes illustrations and animations showing the anatomy of the white matter tracts around the trigone and explains the physiological basis of posterior interhemispheric precuneal approach to this complex region. This also includes a 3-dimensional operative video of the same approach in a 50-yr-old male patient with left periatrial lesion describing surgical techniques and nuances.

An informed written consent has been obtained from the patient.
Ramsay Sedation Scale and Richmond Agitation Sedation Scale
Authors: Rasheed Akram M. , Amirah Mohammad F. , Abdallah Mohammad , P.J. Parameaswari , Issa Marwan , Alharthy Abdulrhman
Published: January 2019

Background

Many sedation scales and tools have been developed and compared for validity in critically ill patients. However, selection and use of sedation scales vary among intensive care units.

Objective

The aim of this study is to compare the reliability of 2 sedation scales—Ramsay Sedation Scale and Richmond Agitation-Sedation Scale (RASS)—in the adult intensive care unit.

Method

Four hundred twenty-five patients were recruited in the study. Informed consent had been obtained from each patient guardian/relative. However, only 290 patients (68.24%) completed the study and were independently assessed for sedation effect by investigator and bedside nurses simultaneously using Ramsay scale and RASS.

Results

Agreement between the nurse and investigator scores on Ramsay scale (weighted κ = 0.449, P < .001) indicated weak level of agreement. Agreement between the nurse and investigator on RASS (weighted κ = 0.879, P < .001) indicated a strong level of agreement. Cronbach α analysis showed that 10 items of RASS had an excellent level of internal consistency (α = .989) compared with good level of internal consistency of Ramsay scale (α = .828).

Discussion

Richmond Agitation-Sedation Scale showed excellent interrater agreement compared with weak interrater agreement of Ramsay scale. The results also support that RASS has consistent agreement with clinical observation and practice among different observers. The results suggest that use of RASS is linked to a more reliable assessment of sedation levels in the intensive care unit.
Determinants of quality of life in patients with hemorrhagic stroke
Authors: Zhu Wei , Jiang Yan
Published: January 2019

Identifying the determinants of health-related quality of life (HRQOL) improved assessment and decision-making in clinical practice. A few studies have focused on the determinants of HRQOL and their interrelationships in patients with hemorrhagic stroke. The aim of this study was to identify the factors contributing to HRQOL and exam their interrelationships.

A total of 202 patients with hemorrhagic stroke who were discharged from the neurological unit participated in this study. Stroke-specific quality of life was used to assess HRQOL. The Hamilton Rating Scale for Anxiety, the Hamilton Rating Scale for Depression, the Scandinavian Stroke Scale and the Barthel Index were collected as potential predictors as well as social-demographic data. A path analysis was used to explore the potential interrelationships between various factors based on the International Classification of Functioning model.

The final model reasonably fitted the data. The activities of daily living, neurological function and anxiety had direct effects on quality of life. Age, comorbidities, hemorrhage type, financial status, anxiety, and neurological function also had indirect influences on quality of life. All these factors explained 82.0% of all variance in quality of life.

HRQOL in patients with stroke can be predicted by anxiety, neurological function, activities of daily living and other personal and environmental factors. These identified predictors and their interrelationships may assist clinical professions focusing their assessments and developing strategies for modifiable factors to improve HRQOL.
Impact of educational levels on survival rate
Authors: Cho Seong-Sik , Ju Young-Su , Park Hanwool , Kim Young-Kug , Hwang Shin , Choi Seong-Soo
Published: January 2019

Among living donor liver transplantation recipients, the impact of educational levels on survival has rarely explored. Thus, the purpose of study is to analyze the survival rate differences across educational levels among recipients who underwent living donor liver transplantation.

We retrospectively analyzed 2007 adult recipients who underwent living donor liver transplantation in a single large center. The educational level was divided into three categories: middle school or lower, high school, and college or higher. The primary outcome was all-cause mortality after living donor liver transplantation. Stratified log-rank test and Cox proportional hazard model were employed for statistical analysis.

The incidence rates of all-cause mortality were 23.85, 20.19, and 18.75 per 1000 person-year in recipients with middle school or lower, high school, and college or higher education groups, respectively. However, the gender-stratified log-rank test has not shown a statistically significant difference (P = .3107). In the unadjusted model, hazard ratio (HR) was 1.02 [95% confidence interval (CI) = 0.79–1.33] in high school and 1.23 (95% CI = 0.93–1.64) and in middle school or lower educational level, respectively; In the full adjusted model, the HR of high school was 0.98 (95% CI = 0.75–1.28) and the HR of middle school or lower was 1.01 (95% CI = 0.74–1.37).

Although study population of this study is large, we could not find significant survival rate differences by the levels of education. Social selection and high compliance rate might contribute to this result.
FKBP51 is associated with early postoperative cognitive dysfunction in elderly patients undergoing hip fracture surgery
Authors: Wang Li-Wei , Zhu Mei-Jun , Li Yan , Wang Sheng-Tao , Zhou Mei-Yan , Yu You-Jia , Ma Zheng-Liang
Published: January 2019

Enhanced inflammation response was increasingly reported in association with postoperative cognitive dysfunction (POCD). Glucocorticoid receptor (GR) signal plays a key role in suppression of inflammation. This prospective cohort study aimed to evaluate GR signaling in elderly patients undergoing selective operation.

One hundred twenty-six elderly patients were scheduled for hip fracture surgery with general anesthesia. Plasma cortisol levels and the expression levels of GR and FK506 binding protein 51 (FKBP51) in leukocytes were determined at 1 day preoperatively and 7 days. Postoperatively postoperative pain was assessed following surgery using visual analog pain scale (VAS). Neuropsychological tests were performed before surgery and 1 week postoperation. A decline of 1 or more standard deviations in 2 or more tests was considered to reflect POCD.

POCD incidence in participants was 28.3% at 1 week after surgery. POCD patients presented significantly higher cortisol and FKBP51 levels compared with non-POCD patients (P < .05). Compared with non-POCD patients, VAS scores at 12 hours after surgery were higher in POCD patients (P < .05). No significant difference in expression levels of GR was found between groups POCD and non-POCD patients.

High expression of FKBP51 in leukocytes and glucocorticoid resistance were associated with POCD in aged patients following hip fracture surgery.
Prognostic value of angiopoietin-2 for patients with coronary heart disease after elective PCI
Authors: Jian Wen , Li Lang , Wei Xiao-Min , Wu Cheng-Qiang , Gui Chun
Published: January 2019

Patients with coronary heart disease (CHD) frequently have cardiovascular complications after undergoing PCI. Angiopoietin-2 (Ang-2) is an important proangiogenic factor that also plays an important role in atherosclerosis. This study aimed to evaluate the value of Ang-2 in predicting cardiovascular events after elective PCI.

This prospective study enrolled 97 patients with CHD who underwent elective PCI from 2013 to 2014. Blood samples were collected in the first morning after admission and within 24 to 48 h after PCI. The primary endpoint was cardiovascular events, defined as a composite of cardiac death, nonfatal myocardial infarction/repeat revascularization, readmission for severe deterioration of angina and readmission for new onset heart failure. Based on the median level of pre-PCI or post-PCI Ang-2, the patients were divided into a low level group and a high level group.

During the whole follow-up period (mean, 53 ± 13 months), Kaplan–Meier curves of cardiovascular events showed that there was no significant difference between the two pre-PCI groups (χ
2 = 2.22, P = .137, and log-rank test) or the two post-PCI groups (χ
2 = 2.83, P = .093, and log-rank test). However, in a multivariable Cox regression model, landmark analysis showed that the patients in high level group of post-PCI, not pre-PCI, were associated with remarkable higher risks of cardiovascular events compared to the low level group during the first 1.5 years of follow-up (adjusted HR = 9.99, 95%CI = 1.99–50.13, P = .005). However, that was of no significance from 1.5 years to maximum follow-up years (adjusted HR = 0.82, 95%CI = 0.26–2.59, P = .733).

High Ang-2 levels of post-PCI can predict the occurrence of cardiovascular events in the short to medium term.
Association between hepatitis B virus infection and chronic kidney disease
Authors: Du Ye , Zhang Shikun , Hu Mei , Wang Qiaomei , Liu Na , Shen Haiping , Zhang Yiping , Yan Donghai , Zhang Man
Published: January 2019

Hepatitis B virus (HBV) infection can lead to different types of chronic kidney diseases (CKD) in clinical practice. However, HBV infection has been observed to have no significant association with CKD indicators in some epidemiological surveys. This research aims to estimate CKD prevalence in HBV infection population and clarify the relationship between HBV infection status and CKD.

The participants aged 20 to 49 years were selected by multistage random sampling from January 1, 2010 to December 31, 2012 across 31 provinces and regions in rural China. The data was collected by standard questionnaire and physical check-up. Status of HBV infection was diagnosed as immune tolerant phase, hepatitis B envelope antigen -positive chronic HBV infection, inactive HBV carrier, hepatitis B envelope antigen -negative chronic HBV infection and resolved HBV infection based on serological markers, and the level of hepatic function, respectively.

In total, 2,969,502 subjects were included in the study. In population aged 20 to 49 years in rural China, prevalence of HBV infection was 12.17%. Prevalence of proteinuria, hematuria, estimated glomerular filtration rate less than 60 mL/min/1.73m2 and CKD was 0.94%(95% CI = 0.91–0.97%) vs. 0.65%(95% CI = 0.64–0.66%), 1.92%(95% CI = 1.87–1.96%) vs. 1.19% (95% CI = 1.18–1.21%), 1.02%(95% CI = 0.99–1.06%) vs. 0.77% (95% CI = 0.76–0.78%), and 3.85%(95% CI = 3.78–3.91%) vs. 2.60%(95% CI = 2.58–2.62%) in population with HBV infection and without infection, respectively. Prevalence of CKD and indicators was higher in population in every status of HBV infection than in population without infection, respectively (all P < 0·0001). Every HBV infection status was a risk factor for CKD.

CKD prevalence was higher in population in every status of HBV infection than without infection. HBV infection was a risk factor for CKD in population aged 20 to 49 years in rural China.
Comparison of radiological outcomes and complications between single-level and multilevel anterior cervical discectomy and fusion (ACDF) by using a polyetheretherketone (PEEK) cage–plate fusion system
Authors: Lee Han-Chung , Chen Chao-Hsuan , Wu Chih-Ying , Guo Jeng-Hung , Chen Yueh-Sheng
Published: January 2019

This study aimed to compare the differences in radiological outcomes and complications between single- and multilevel anterior cervical discectomy and fusion (ACDF) by using a polyetheretherketone (PEEK) cage–plate fusion system.

Fifty-seven patients who underwent ACDF via the PEEK cage–plate fusion system were enrolled and subjected to ≥6 months of follow-up. The patients were divided into 4 groups according to different cage–plate implantation levels: 1-level group (n = 17), 2-level group (n = 24), 3-level group (n = 12), and 4-level group (n = 4). Fusion time, changes in segment and global lordotic angle, subsidence rate, and changes in disc and adjacent segmental disc height were subjected to radiological evaluation.

The fusion period of multilevel ACDF was longer than that of single-level ACDF. The fusion period of the 3-level (4.09 ± 0.94, P = .004) and 4-level (5.25 ± 0.89, P = .004) group was also significantly longer than that of the 1-level group. The mean lordotic angle in all of the groups was changed in the immediate postoperative period and in the final follow-up. The cage subsidence rates were 11.76% (2/17) in the 1-level group, 20.83% (5/24) in the 2-level group, and 2/12 (16.67%) in the 3-level group. No subsidence occurred in the 4-level groups. Changes in the lower adjacent segmental disc height were significantly increased in multilevel ACDF compared with those in single-level ACDF.

Despite the longer fusion time, the outcomes of the proposed system were even better with the greater number of treatment levels by using PEEK cage–plate fusion system. Changes in the lower adjacent segmental disc height should also prolong follow-up duration to investigate the symptomatic adjacent segment degeneration in multilevel ACDF.
Risk factors for developing Mycobacterium kansasii lung disease
Authors: Kim Jin Hyoung , Seo Kwang Won , Shin Yongjoon , Oh Ji Seon , Jun Jae-Bum , Jeong Joseph , Sim Chang Sun , Baek Seunghee , Lee Taehoon , Ahn Jong Joon
Published: January 2019

Previous studies have suggested that development of Mycobacterium kansasii lung disease (MKLD) was associated with COPD, pneumoconiosis, aging, male, immunosuppression, alcohol, malignancy, and certain occupations such as mining and sandblasting. However, previous studies were outdated and used non-comparative statistical methods. We aimed to determine the current risk factors for developing MKLD in Korea by using appropriate statistical techniques.

Eighty-six MKLD patients were identified through a search of the Ulsan University Hospital database between January 2010 and December 2014. These cases were matched with 172 controls who had normal respiratory systems in a health examination during the same period (matching variables, age and sex; case: control ratio of 1:2). Clinical and demographic characteristics were gathered by reviewing the medical record and telephone survey. Multivariate logistic regression analyses were performed to evaluate risk factors for developing MKLD.

Multivariate analysis showed that occupation in heavy industries (adjusted odds ratio (aOR) 6.41, 95% confidence interval (CI) 2.19−18.74, P = .001) and low body mass index (BMI) (aOR [per kg/m2] 0.73, 95% CI 0.63−0.85, P < .001) were independent risk factors for development of MKLD. Educational attainment more than high school was associated with a lower risk of MKLD development (aOR 0.22, 95% CI 0.08−0.63, P 
= .005).

Employees in heavy industry and low BMI are independent risk factors for development of MKLD in Korea.
Sclerosing pneumocytoma mixed with a typical carcinoid tumor
Authors: Wang Zhao , Yang Mai-Qing , Huang Wen-Jing , Zhang Di , Xu Hong-Tao
Published: January 2019

Rationale:

Sclerosing pneumocytoma accompanied with other type of tumor in one patient is very rare. Here, we report a case of a sclerosing pneumocytoma mixed with a typical carcinoid tumor in a same neoplasm.

Patient concerns:

A 55-year-old woman incidentally detected a space-occupying lesion of right lung in routine health examination. The patient was asymptomatic and there were no positive findings in routine laboratory examination, physical examination, and pulmonary function test. Computed tomography revealed a solitary round mass in the middle lobe of the right lung.

Diagnosis:

The lesion was diagnosed as a sclerosing pneumocytoma accompanied with a typical carcinoid tumor of the right lung.

Intervention:

The patient underwent thoracoscopic lobectomy in our hospital.

Outcomes:

The postoperative course was uneventful.

Lessons:

This case is rare and noteworthy for a lesion containing two different types of neoplasms, which may cause diagnostic difficulties.
Efficacy and safety of norepinephrine versus phenylephrine for the management of maternal hypotension during cesarean delivery with spinal anesthesia
Authors: Xu Shiqin , Shen Xiaofeng , Liu Shijiang , Yang Jianjun , Wang Xian
Published: January 2019

Background:

Phenylephrine is the current “gold standard" vasopressor used to treat maternal hypotension in women undergoing cesarean delivery with spinal anesthesia. Since 2015, various studies have explored the use of norepinephrine to manage maternal hypotension. We conducted this systematic review and meta-analysis of available randomized controlled trials (RCTs) to compare the efficacy and safety of norepinephrine and phenylephrine for the prevention and treatment of maternal hypotension.

Methods:

A systematic literature search was conducted using electronic databases, including PubMed, MEDLINE, Embase (Embase.com), and the Cochrane CENTRAL register of controlled trials. Parturients underwent cesarean delivery with spinal anesthesia and received norepinephrine to prevent or treat hypotension were considered. Maternal outcomes, including incidences of hypotension, hypertension, bradycardia, intraoperative nausea and vomiting (IONV), maternal cardiac output (CO), and blood pressure (BP) control precision, as well as neonatal Apgar scores and umbilical cord blood analyses, were compared between groups.

Results:

Three RCTs in 4 reports published between 2015 and 2018 were finally identified with a total of 294 parturients. We found there was no difference in effectiveness between norepinephrine and phenylephrine for the treatment of maternal hypotension (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.37–1.10, P = .11), and there was no difference in the occurrence of hypertension (OR 0.74; 95% CI 0.33–1.62, P = .45). Of note, compared to the phenylephrine group, parturients in the norepinephrine group were less likely to experience bradycardia (OR 0.29; 95% CI 0.12–0.68, P = .005) and IONV (OR 0.54; 95% CI, 0.29–0.99, P = .04). Further, we did not observe a difference between the two vasopressors in the incidence of neonatal Apgar scores < 7 at 1  and 5 minutes or in umbilical vein (UV) blood gas. However, evidence is insufficient to draw conclusions regarding the greater maternal CO and better BP control precision with the use of norepinephrine.

Conclusion:

This systematic review and meta-analysis shows norepinephrine provides similar efficacy to manage maternal hypotension compared to phenylephrine; additionally, showing advantage regarding certain side effects like bradycardia and IONV reduction. Accordingly, norepinephrine is a promising alternative to phenylephrine. However, before routine clinical application, more studies are warranted.
Anxiolytic treatment but not anxiety itself causes hyponatremia among anxious patients
Authors: Gilboa Mayan , Koren Gideon , Katz Racheli , Melzer-Cohen Cheli , Shalev Varda , Grossman Ehud
Published: January 2019

The aim of the study was to define whether anxiety itself or only the treatment with anxiolytic medication is risk factor for hyponatremia and overhydration.

A case–control study of patients with a diagnosis of anxiety who received a selective serotonin reuptake inhibitor (SSRI). Serum sodium, urea to creatinine ratio, and odds ratio (OR) of hyponatremia and overhydration before initiation of treatment were compared to those of a control group of participants. Laboratory tests were also examined for changes following treatment with an SSRI. All blood tests were conducted from January 1, 2001 until December 31, 2017. Subjects were selected from a large electronic database, insuring 2 million Israelis. A total of 7211 patients with a diagnosis of anxiety who have received a prescription for an SSRI were identified; 3634 were excluded mostly due to other conditions that could cause hyponatremia, and 3520 participants were included in the case group. The control group consisted of 6985 age and gender matched participants who did not have a diagnosis of anxiety or any other exclusion criteria.

Mean serum sodium levels were elevated in cases before the initiation of SSRIs; sodium: case 139.3 (137.3–141.3), control 139.2 (137.06–141.26) mmol/L (P = .01). The OR of hyponatremia was 0.89 for the case group (P = .004). Treatment with SSRIs decreased mean serum sodium (139.3–139.1 mmol/L; P = .0001) and increased by 50% the rate of hyponatremia (2.6–3.9% P = .024).

It is the use of SSRIs and not anxiety itself that causes hyponatremia among anxious patients.
Does Involuntary Admission With Bipolar Disorder Differ From Involuntary Admission With Schizophrenia and Related Disorders? A Report From the Dublin Involuntary Admission Study (DIAS)
Authors: KELLY BRENDAN D. , UMAMA-AGADA EMMANUEL , CURLEY AOIFE , DUFFY RICHARD M. , ASGHAR MUHAMMAD , GILHOOLEY JANE
Published: January 2019

Background:

While involuntary psychiatric admission and treatment are common, little is known about what impact different diagnoses have on specific features of involuntary admission and on how involuntary status is terminated (eg, by psychiatrists or tribunals, which are independent, court-like bodies reviewing involuntary admissions).

Methods:

We studied 2940 admissions, 423 (14.4%) of which were involuntary, at 3 psychiatry units covering a population of 552,019 individuals in Dublin, Ireland.

Results:

Involuntary patients were more likely than voluntary patients to be male and unmarried. The median length of stay for involuntary patients was 27 days compared with 10 days for voluntary patients (P<0.001). Schizophrenia (and related disorders, including schizoaffective disorder) and bipolar disorder accounted for 58.6% and 17.3% of involuntary admissions, respectively, compared with 20.1% and 12.4% of voluntary admissions (P<0.001). Psychiatrists revoked the majority of involuntary orders for both patients with bipolar disorder (85.3%) and those with schizophrenia (and related disorders) (86.6%); in contrast, tribunals did not revoke any involuntary admission orders for patients with bipolar disorder and revoked orders for 3.8% of patients with schizophrenia (and related disorders) (P=0.034). On the basis of multivariable testing, increased age among patients with bipolar disorder was the only characteristic among those studied (sex, age, marital status, occupation, involuntary admission criteria, length of stay, method of involuntary order revocation, location) that independently distinguished involuntary patients with bipolar disorder from those with schizophrenia (and related disorders) (P=0.028).

Conclusions:

Involuntary admission of patients with bipolar disorder is similar in most respects to that of patients with schizophrenia (and related disorders). Consequently, it is important that measures aimed at reducing the need for involuntary admission (eg, patient advance statements/advance directives) are implemented equally across all diagnostic groups associated with involuntary care.