bluuebunny/crossref_metadata_2025 huggingface dataset:
Markers of Oxidant-Antioxidant Equilibrium in Patients with Sudden Sensorineural Hearing Loss Treated with Hyperbaric Oxygen Therapy
Authors: Paprocki Jarosław , Sutkowy Paweł , Piechocki Jacek , Woźniak Alina
Published: February 2019

The concentration of thiobarbituric acid reactive substances (TBARSs) in plasma and erythrocytes, the activity of selected antioxidant enzymes in erythrocytes: catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx), and the levels of hemoglobin (HGB) and haematocrit (HCT) were determined in 40 patients with sudden sensorineural hearing loss (SSNHL) subjected to 14 treatment sessions in a Haux Starmed 2200 hyperbaric chamber. Hyperbaric oxygen (HBO) therapy involved breathing 100% oxygen at 0.25 MPa. Blood for analysis was collected from the basilic vein at three time points: before the first HBO session, approximately 5 min after the first session, and after the 14th session. The control group included 20 healthy individuals never before treated with HBO therapy. Compared to the pre-HBO values, a 10% increase (P<0.05) in the TBARS concentration in erythrocytes, a 28% increase in the GPx activity (P<0.05), and a 7% decrease in the SOD activity (P<0.05) were observed after 14 HBO sessions. The CAT activity decreased by 6% (P<0.05) after the first session. The TBARS concentration in plasma was 13% higher (P<0.01), while that in erythrocytes was 24% lower (P<0.001) in the SSNHL patients before the first HBO session compared to the control group. The CAT activity in the SSNHL patients before HBO therapy was 26% higher (P<0.001) than that in the control group. A statistically significant reduction in HGB and HCT after 14 HBO sessions (P<0.01) compared to the pre-HBO values was demonstrated. SSNHL is accompanied by disturbance in the oxidant-antioxidant equilibrium. Repeated stimulation with hyperbaric oxygen modulates the activity of antioxidant enzymes. It seems that the increased generation of hydrogen peroxide is responsible for the changes in the activity of antioxidant barrier enzymes observed after HBO sessions.
Bridging the Gap between Advancements in the Evolution of Diagnosis and Treatment towards Better Outcomes in Achalasia
Authors: Chuah Seng-Kee , Lim Chee-Sang , Liang Chih-Ming , Lu Hung-I , Wu Keng-Liang , Changchien Chi-Sin , Tai Wei-Chen
Published: February 2019

Over the past few decades, there was an encouraging breakthrough in bridging the gap between advancements in the evolution of diagnosis and treatment towards a better outcome in achalasia. The purpose of this review is to provide updated knowledge on how the current evidence has bridged the gap between advancements in the evolution of diagnosis and treatment of esophageal achalasia. The advent of high-resolution manometry and standardization based on the Chicago classification has increased early recognition of the disease. These 3 clinical subtypes of achalasia can predict the outcomes of patients, and the introduction of POEM has revolutionized the choice of treatment. Previous evidence has shown that laparoscopic Heller myotomy (LHM) and anterior fundoplication were considered the most durable treatments for achalasia. Based on the current evidence, POEM has been evolving as a promising strategy and is effective against all 3 types of achalasia, but the efficacy of POEM is based on short- and medium-term outcome studies from a limited number of centers. Types I and II achalasia respond well to POEM, LHM, and PD, while most studies have shown that type III achalasia responds better to POEM than to LHM and PD. In general, among the 3 subtypes of achalasia, type II achalasia has the most favorable outcomes after medical or surgical therapies. The long-term efficacy of POEM is still unknown. The novel ENDOFLIP measures the changes in intraoperative esophagogastric junction dispensability, which enables a quantitative assessment of luminal patency and sphincter distension; however, this technology is in its infancy with little data to date supporting its intraoperative use. In the future, identifying immunomodulatory drugs and the advent of stem cell therapeutic treatments, including theoretically transplanting neuronal stem cells, may achieve a functional cure. In summary,it is important to identify the clinical subtype of achalasia to initiate target therapy for these patients.
Effects of on-Board Unit on Driving Behavior in Connected Vehicle Traffic Flow
Authors: Chang Xin , Li Haijian , Rong Jian , Huang Zhufei , Chen Xiaoxuan , Zhang Yunlong
Published: February 2019

Connected vehicle technology has potentials to increase traffic safety, reduce traffic pollution, and ease traffic congestion. In the connected vehicle environment, the information interaction among people, cars, roads, and the environment is significantly enhanced, and driver behavior will change accordingly due to increased external stimulation. This paper designed a Vehicle-to-Vehicle (V2V) on-board unit (OBU) based on driving demand. In addition, a simulation platform for the interconnection and communication between the OBU and simulator was built. Thirty-one test drivers were investigated to drive an instrumented vehicle in four scenarios, with and without the OBU under two different traffic states. Collected trajectory data of the subject vehicle and the vehicle in front, as well as sociodemographic characteristics of the test drivers were used to evaluate the potential impact of such OBUs on driving behavior and traffic safety. Car-following behavior is an essential component of microsimulation models. This paper also investigated the impacts of the V2V OBU on car-following behaviors. Considering the car-following related indicators, the k-Means algorithm was used to categorize different car-following modes. The results show that the OBU has a positive impact on drivers in terms of speed, front distance, and the time to stable regime. Furthermore, drivers’ opinions show that the system is acceptable and useful in general.
Memory NK Cell Features Exploitable in Anticancer Immunotherapy
Authors: Capuano Cristina , Pighi Chiara , Battella Simone , Santoni Angela , Palmieri Gabriella , Galandrini Ricciarda
Published: February 2019

Besides their innate ability to rapidly produce effector cytokines and kill virus-infected or transformed cells, natural killer (NK) cells display a strong capability to adapt to environmental modifications and to differentiate into long-lived, hyperfunctional populations, dubbed memory or memory-like NK cells. Despite significant progress in the field of NK cell-based immunotherapies, some factors including their short life span and the occurrence of a tumor-dependent functional exhaustion have limited their clinical efficacy so that strategies aimed at overcoming these limitations represent one of the main current challenges in the field. In this scenario, the exploitation of NK cell memory may have a considerable potential. This article summarizes recent evidence in the literature on the peculiar features that render memory NK cells an attractive tool for antitumor immunotherapy, including their long-term survival andin vivopersistence, the resistance to tumor-dependent immunosuppressive microenvironment, the amplified functional responses to IgG-opsonized tumor cells, andin vitroexpansion capability. Along with highlighting these issues, we speculate that memory NK cell-based adoptive immunotherapy settings would greatly take advantage from the combination with tumor-targeting therapeutic antibodies (mAbs), as a strategy to fully unleash their clinical efficacy.
Crashworthiness Design and Multiobjective Optimization for Hexagon Honeycomb Structure with Functionally Graded Thickness
Authors: Qin Ruixian , Zhou Junxian , Chen Bingzhi
Published: February 2019

Higher energy absorption efficiency and better crashworthiness performance are always the key objectives for different energy absorbing structures applied in numerous industries including aerospace, rail equipment transportation, and automotive. In this study, a functionally graded thickness (FGT) design method is introduced in the design of a hexagon honeycomb structure to improve energy absorbing efficiency on the basis of a traditional honeycomb with uniform thickness (UT). The validation of a numerical analysis model for a UT honeycomb under axial loading is implemented by a nonlinear finite element code LS-DYNA (V971). Furthermore, the multiobjective crashworthiness optimization of an FGT honeycomb subjected to axial quasi-static compression is conducted to maximize specific energy absorption (SEA) and minimize peak crashing force (PCF). In addition, three surrogate models, including radial basis function (RBF), response surface method (RSM), and kriging (KRG), are compared in the accuracy of predicting SEA and PCF and capacity for optimization design of FGT honeycomb structure; the Nondominated Sorting Genetic Algorithm (NSGA-II) is applied to obtain the Pareto optimal solutions for the maximum thickness, minimum thickness, and thickness variation gradient exponent of a honeycomb wall. The optimal points obtained by different surrogate models subjected to an SEA value of 18.5 kJ/kg, 20 kJ/kg, 22 kJ/kg, and 24 kJ/kg are validated, and corresponding optimal parameters are compared; RBF and RSM are more suitable in crashworthiness optimization design of the FGT honeycomb structure. It is indicated that the FGT honeycomb with optimal geometrical parameters presents remarkable enhancement and energy absorbing potential compared to the traditional honeycomb structure.
Sensitivity of CO2 and CH4 Annual Cycles to Different Meteorological Variables at a Rural Site in Northern Spain
Authors: Pérez Isidro A. , Sánchez M. Luisa , García M. Ángeles , Pardo Nuria
Published: February 2019

The focus of the current paper is to explore the influence of meteorological variables on atmospheric CO2 and CH4 mean annual cycles at a rural site. Four variables were investigated: boundary layer height, recirculation factor, trajectory direction, and wind speed modelled at the altitude of the site. Boundary layer height and wind speed were provided by the METeorological data EXplorer (METEX) model. Recirculation factor and trajectory direction were obtained from calculations based on this trajectory model, and a nonparametric procedure was used to obtain a smooth evolution. The main results are higher concentrations obtained during the night, attributed to lower dispersion in this period. The smoothed values of the boundary layer height reached nearly 1200 m AGL during the day in August, and its low values caused high concentrations in spring. During the night, the recirculation factor and wind speed showed a sharp contrast between summer and winter. The average recirculation factor was low, 0.10, and average wind speed was 5.1 m·s−1. Trajectories were directionally distributed in four quadrants. Different tests were performed by selecting values of meteorological variables above or below certain thresholds. The influence of these variables reached values around 6.3 and 0.023 ppm for CO2 and CH4 average concentrations, respectively, during the day when the boundary layer was below 400 m. The main conclusion of this study is that the influence of meteorological variables should not be ignored. In particular, extremely low boundary layer heights may have noticeable effects on both gases.
Yiqi-Huoxue Granule (YQHX) Downregulates Prothrombotic Factors by Modulating KLF2 and NF-κB in HUVECs following LPS Stimulation
Authors: Wu Hong , Wang Xinzhou , Gao Shuibo , Dai Liping , Tong Haibin , Gao Haixia , Lei Zhen , Han Yongjun , Wang Zhentao , Han Lihua , Qi Dake
Published: February 2019

The Yiqi-Huoxue granule (YQHX) is a traditional Chinese medication widely used in the therapy of the traditional Chinese medicine diagnosis “Qi deficiency” or “blood stasis” in China. Both these symptoms are related to inflammation, but the mechanisms of YQHX against inflammation are largely unknown. Thus, our present study investigated the effects of YQHX on regulating inflammatory responses induced by lipopolysaccharides (LPS) in HUVECs. Our data found that YQHX remarkably inhibits the production of prothrombotic factors, plasminogen activator inhibitor-1 (PAI-1) and tissue factor (TF), while it upregulates the protein expression of Kruppel-like factor 2 (KLF2). The increase in PAI-1 and TF was significantly attenuated through a transgenic knockdown in KLF2 with a Lenti-shKLF2 vector. YQHX also decreases the phosphorylation of nuclear factor-κB (NF-κB) p65 and IκB following LPS stimulation, and it effectively suppresses PAI-1 and TF via a NF-κB-dependent mechanism. Taken together, our results suggest that YQHX provides a notable antithrombotic activity via regulating the KLF2 expression and NF-κB signaling pathway in HUVECs. The KLF2 and NF-κB may be potential therapeutic targets for interventions of inflammation associated with atherosclerosis.
In Vitro Safety Evaluation and In Vivo Imaging Studies of Superparamagnetic Iron Oxide Nanoparticles through Biomimetic Modification
Authors: Song Xinfeng , Zhang Yancong , Sun Hanwen , Dong Pingxuan , Zhang Zhongyu , Liu Jing
Published: February 2019

Magnetic resonance imaging (MRI) is an advanced medical imaging diagnostic technique that utilizes different resonance signals generated by the signal strength of water content and the relaxation time of protons in water molecules under the influence of an external magnetic field. This technique requires contrast agents, such as Gd-DTPA and Gd-DOTA, which could increase the risk of renal fibrosis in patients with severe renal insufficiency. The magnetic moment or susceptibility of superparamagnetic iron oxide nanoparticle (SPION) is higher than that of other paramagnetic substances and could significantly reduce the dosage of the contrast agent required. In our previous work, the novel magnetic composite nanoparticles (abbreviated as c(RGDyK)-PDA-SPION) had been successfully synthesized by a facile and simple approach. Further evaluation had demonstrated that it had an average particle size of about 50 nm and uniform distribution, superparamagnetic properties, and good dispersion stability in water solution. Animal acute toxicity test also had proved that it had high safety in vivo. In this work, c(RGDyK)-PDA-SPION was further studied for the cell toxicity and effect on HepG2 cells in vitro, and the MRI imaging of this contrast agent in HepG2 tumor-bearing mice was also studied. It is an extension of the published work. The results showed that it possessed high safety and enrichment phenomenon on HepG2 cells in vitro. Animal experimental data preliminarily prove that the contrast agent could enhance the MRI T2-weighted imaging capability of HepG2 carcinoma in tumor-bearing mice and could be a potential T2 contrast agent.
Immune-Checkpoint Blockade Opposes CD8+ T-cell Suppression in Human and Murine Cancer
Authors: Pfannenstiel Lukas W. , Diaz-Montero C. Marcela , Tian Ye F. , Scharpf Joseph , Ko Jennifer S. , Gastman Brian R.
Published: February 2019

Immune-checkpoint blockade enhances antitumor responses against cancers. One cancer type that is sensitive to checkpoint blockade is squamous cell carcinoma of the head and neck (SCCHN), which we use here to study limitations of this treatment modality. We observed that CD8+ tumor-infiltrating lymphocytes (TILs) in SCCHN and melanoma express excess immune checkpoints components PD-1 and Tim-3 and are also CD27−/CD28−, a phenotype we previously associated with immune dysfunction and suppression. In ex vivo experiments, patients' CD8+ TILs with this phenotype suppressed proliferation of autologous peripheral blood T cells. Similar phenotype and function of TILs was observed in the TC-1 mouse tumor model. Treatment of TC-1 tumors with anti–PD-1 or anti–Tim-3 slowed tumor growth in vivo and reversed the suppressive function of multi-checkpoint+ CD8+ TIL. Similarly, treatment of both human and mouse PD-1+ Tim-3+ CD8+ TILs with anticheckpoint antibodies ex vivo reversed their suppressive function. These suppressive CD8+ TILs from mice and humans expressed ligands for PD-1 and Tim-3 and exerted their suppressive function via IL10 and close contact. To model therapeutic strategies, we combined anti–PD-1 blockade with IL7 cytokine therapy or with transfer of antigen-specific T cells. Both strategies resulted in synergistic antitumor effects and reduced suppressor cell function. These findings enhance our understanding of checkpoint blockade in cancer treatment and identify strategies to promote synergistic activities in the context of other immunotherapies.
Risk Factors for Mortality in Pneumocystis jirovecii Pneumonia in Patients with Inflammatory Bowel Disease
Authors: Yoshida Atsushi , Kamata Noriko , Yamada Akihiro , Yokoyama Yoko , Omori Teppei , Fujii Toshimitsu , Hayashi Ryohei , Kinjo Tetsu , Matsui Akira , Fukata Norimasa , Takahashi Sakuma , Sakemi Ryosuke , Ogata Noriyuki , Ashizuka Shinya , Bamba Shigeki , Ooi Makoto , Kanmura Shuji , Endo Katsuya , Yoshino Takuya , Tanaka Hiroki , Morizane Toshio , Shinzaki Shinichiro , Kobayashi Taku
Published: February 2019

Background: Pneumocystis jirovecii pneumonia (PJP) is highly fatal once infection is established. In this study, we investigated the risk of PJP mortality in patients with inflammatory bowel disease (IBD). Methods: We conducted a retrospective observational study of case data from IBD patients who developed PJP, compiled from 17 collaborating institutions. Parameters such as age, sex, medications used, and blood test results were analyzed to identify risk factors for mortality. Results: The mortality rate among the 28 IBD patients who developed PJP was 17.9%. A low serum albumin level at the start of IBD treatment was identified as a risk factor for mortality and showed the following association with probability of death (P): P = 1/[1 + exp(–5.5 + 2.4 × Alb). The probability of death exceeded 0.5 when serum albumin was 2.2 g/dL or lower. Conclusion: Patients with IBD who develop PJP have a high mortality rate and often cannot continue treatment with medication alone. Therefore, it is necessary to pay attention to albumin levels at the start of immunosuppressive therapy when creating a treatment plan.
Efficacy and Safety of a Weekly Cyclophosphamide-Bortezomib-Dexamethasone Regimen as Induction Therapy Prior to Autologous Stem Cell Transplantation in Japanese Patients with Newly Diagnosed Multiple Myeloma: A Phase 2 Multicenter Trial
Authors: Tanaka Keisuke , Toyota Shigeo , Akiyama Megumi , Wakimoto Naoki , Nakamura Yuichi , Najima Yuho , Doki Noriko , Kakihana Kazuhiko , Igarashi Aiko , Kobayashi Takeshi , Ohashi Kazuteru , Kudo Daisuke , Shinagawa Atsushi , Takano Hina , Fujio Takayuki , Okoshi Yasushi , Hori Mitsuo , Kumagai Takashi , Saito Tatsuya , Mukae Junichi , Yamamoto Koh , Tsutsumi Ikuyo , Komeno Takuya , Yoshida Chikashi , Yamamoto Masahide , Kojima Hiroshi ,   on behalf of the Ochanomizu Hematology Study Group
Published: February 2019

We assessed the efficacy and safety of weekly cyclophosphamide-bortezomib-dexamethasone (CBD) induction prior to autologous stem cell transplantation (ASCT) in newly diagnosed Japanese patients with multiple myeloma (MM). This regimen consisted of four 28-day cycles of once-weekly oral cyclophosphamide (300 mg/m2), subcutaneous bortezomib (1.3 mg/m2), and oral dexamethasone (40 mg). Responding patients underwent stem cell collection followed by ASCT. The primary endpoint was the postinduction rate of achieving a near complete response (nCR) or better. Among the 38 enrolled patients, a complete response (CR), an nCR, a very good partial response (VGPR), and a partial response (PR) were achieved in 10.5, 2.6, 23.7, and 36.8% of cases, respectively. A grade 4 hematological adverse event (AE) was observed in 1 patient. Grade 3–4 infection, including febrile neutropenia, was observed in 4 patients (10.5%). Although 2 patients dropped out due to AE, 94.7% of the patients completed the induction phase. However, because of a poor response to induction chemotherapy (<PR in 6 patients), poor stem cell mobilization (4 patients), and a protocol violation (1 patient), only 24 patients (63.2%) proceeded to ASCT. The 2-year progression-free and overall survivals were 55.3 and 82.7%, respectively. We thus believe that the therapeutic power of weekly CBD is not strong enough as a 3-drug induction regimen despite its feasibility for most Japanese patients.
Low Volume Circulation in Normotensive Women Pregnant with Neonates Small for Gestational Age
Authors: Vonck Sharona , Staelens Anneleen Simone , Lanssens Dorien , Tomsin Kathleen , Oben Jolien , Dreesen Pauline , Bruckers Liesbeth , Gyselaers Wilfried
Published: February 2019

Background: Pregnancies complicated with small for gestational age (SGA) neonates are reported with maternal circulatory maladaptations. Objectives: We aimed to understand the pathophysiology of the maternal circulation in normotensive SGA pregnancies and to point out the trimestral differences from those with appropriate-to-large (non-SGA [NGA]) neonates. Methods: An observational study was conducted in 3 trimestral cohorts of normotensive pregnancies, categorized after birth according to neonatal birth weight percentile (BW%) as SGA (BW% ≤10, n = 158) or NGA (BW% > 10, n = 1,038). Standardized electrocardiogram-Doppler ultrasound, impedance cardiography, and bio-impedance were used to assess the maternal heart, arteries, veins, and fluid. Results: Diastolic blood pressure and mean arterial pressure were not significantly different, unless in the third trimester. In SGA compared to NGA pregnancies, total peripheral resistance (TPR) was higher and total arterial compliance, cardiac output (CO), and total body water (TBW) were lower throughout pregnancy. Venous return-enhancing functions were activated. In NGA but not SGA pregnancies, a positive correlation was found between BW% and CO + TBW and a negative correlation between BW% and TPR. Conclusions: SGA pregnancies are characterized by lower maternal body fluid volume and CO, while normal blood pressures are maintained via increased TPR already from the first trimester onwards. Pregnancy-induced hemodynamic changes are superimposed on these characteristics.
Effect of Mode of Delivery on Early Oral Colonization and Childhood Dental Caries: A Systematic Review
Authors: Antão Celeste , Teixeira Cristina , Gomes Maria José
Published: February 2019

This review investigated whether mode of delivery influences the colonization of infant’s oral cavity and the risk of early childhood caries (ECC). The search strategy included systematic searching of electronic databases (Web of Science and PubMed) for articles published (1995–2015) and hand searching of references lists. Outcomes of interest were the presence of oral caries-related microorganisms, oral species considered protective against caries, and dental caries. Other outcomes included severity of dental caries, dental claims, and age at first dental visit. Study quality was assessed using the EPHPP tool. For each study, we present odds ratios and respective 95% confidence intervals for the association between these outcomes and the mode of delivery. Fourteen studies were identified. In 5 out of 8 studies addressing oral colonization, children born by cesarean section were less likely to harbor caries-related microorganisms as well as protective bacteria against caries and acquired caries-related microorganisms earlier, when compared with vaginally delivered children. No consistent results were obtained for the association between mode of delivery and dental caries. Although there were differences in oral colonization by mode of delivery, it seems that other determinants rather than mode of delivery could be major contributors to the development of ECC.
Meal and Snack Patterns of Infants and Toddlers in the United Arab Emirates: The UAE Feeding Infants and Toddlers Study
Authors: Abdulrazzaq Yousef M. , Abdulla Shahraban , Belhaj Ghazala
Published: February 2019

Aim: To describe meal and snack patterns and practices of infants and toddlers in the UAE. Method: A random sample of 1,000 infants and toddlers, aged 5 months to 2 years and attending Public Health clinics for immunization, was recruited. One face-to-face interview in which caregivers reported the feeding pattern of their infants and toddlers in the preceding 24-h period was conducted. For statistics, we used percentages (proportions) by age group (5–11.9 and 12–24 months). Result: The rate of breastfeeding decreased with age from 60% at 5 months to 37% at 12 months. At the age of 5–6 months, 90% of infants had been introduced to complementary foods. Juice was consumed by 7% of the infants before the American Academy of Pediatrics-recommended age of 6 months. At the age of 9–11 months, 90–100% of infants consumed cows’ milk on a daily basis. Moreover, French fries and/or sweetened beverages were consumed by 10% of infants and toddlers. Chicken was the most commonly fed meat (19.6% of infants and 57.2% of toddlers). Conclusion: The study results provide important evidence of improper feeding in some children and would help in providing guidance to parents and caregivers about the introduction of appropriate solid foods at an appropriate time.
Analysis of the Associations between Obesity Indices and Left Ventricular Mass
Authors: Feng Panpan , Huang Yi , Wang Sihang , Yu Guiquan , Li Ge , Lei Han , Qin Shu , Huang Wei
Published: February 2019

The aims of this study were to investigate the association between different obesity indices and left ventricular mass (LVM) and to develop interventions for obese hypertensive patients to delay the progression of left ventricular hypertrophy (LVH). The association between the visceral adiposity index (VAI) and LVM was explored using multiple regression analysis in all subjects (n = 1,035), the subgroups of patients aged < 65 (n = 713) and ≥65 years (n = 322), and perimenopausal women (n = 319). The VAI was the only obesity index associated with LVH (OR = 1.134; 95% CI 1.025–1.254, p = 0.015). In the subgroup of patients aged < 65 years, both systolic blood pressure and VAI were risk factors for LVH. However, in the subgroup aged ≥65 years, only systolic blood pressure was a risk factor, and there was no association between VAI and LVH (p = 0.13). Perimenopause was an independent risk factor (OR = 1.786; 95% CI 1.125–2.837, p = 0.014). Reducing the VAI rather than the BMI or waist circumference may prevent LVH complications in obese hypertensive patients. For patients aged < 65 years strict control of blood pressure and obesity may be important, and for those aged ≥65 years blood pressure control should be the priority. Estrogen replacement may be useful in postmenopausal women to prevent LVH.
NT-proBNP in the Prognosis of Death or Need for Renal Replacement Therapy in Patients with Stage 3–5 Chronic Kidney Disease
Authors: Gromadziński Leszek , Januszko-Giergielewicz Beata , Czarnacka Kamila , Pruszczyk Piotr
Published: February 2019

Background: The risk of cardiovascular (CV) complications is much greater in patients with chronic kidney disease (CKD). The aim of this study was to assess predictors of mortality, renal failure progression, and the need for dialysis in patients with CKD. Methods: The study group consisted of 70 patients with stage 3–5 CKD, followed up on average for 33.4 ± 15.6 months. Laboratory tests and echocardiography were performed on all patients. Composite endpoints were defined as (1) all-cause mortality and (2) mortality or renal replacement therapy (RRT), defined as the initiation of dialysis therapy. Results: During the observation period, 13 patients died and 11 began dialysis therapy. NT-proBNP was found to be a significant predictor in receiver operating characteristic curve analysis for all study endpoints. The optimal cutoff value for NT-proBNP as a predictor of mortality was 569.8 pg/mL, with a sensitivity of 53.8% and a specificity of 89.1%. For mortality or RRT, the cutoff value for NT-proBNP was 384.9 pg/mL, with a sensitivity and specificity of 70.8 and 72.7%, respectively. In a multivariate regression analysis, NT-proBNP was an independent predictor of mortality with an OR = 7.5 (95% CI: 1.05–53.87; p = 0.044) and of mortality or RRT with an OR = 4.7 (95% CI: 1.01–22.66; p = 0.048). Conclusions: NT-proBNP is an independent predictor of mortality in patients with CKD and can also be useful for CV risk stratification in this patient population.
Using the Region of Interest from Time-of-Flight Magnetic Resonance Angiography to Differentiate Between Intracranial Arterial Dissection and True Atherosclerotic Stenosis
Authors: Hwang Jung Won , Jung Jin-Man , Cha Jae Hyung , Jung Il Eok , Park Moon Ho , Kwon Do-Young , Kim Jiyeon , Kim Yool Hee  , Lee Sang Hun
Published: February 2019

Background: Noncontrast three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is commonly used to examine intracranial arterial stenosis, although it can be difficult to identify the etiology of the stenosis. Our aim was to determine the effectiveness of 3D TOF MRA in differentiating an intracranial arterial dissection from atherosclerosis. Methods: During 2015–2017, 356 patients had confirmed intracranial arterial stenosis based on high resolution-magnetic resonance imaging. This study ultimately included 51 patients with severe focal stenosis that was caused by dissection and atherosclerosis. We compared the dissection group with the atherosclerotic narrowing group by measuring the region-of-interest (ROI) values 3 mm proximal and 3 mm distal from sites of severe focal stenosis. Results: A significant difference was observed between the median ROI difference values in the dissection group (n = 18) and the atherosclerosis group (n = 33; 35.6 [20.9–78.4] vs. 165.5 [99.8–328.5]; p < 0.001). A receiver operating characteristic curve was prepared to distinguish between dissection and atherosclerosis using the ROI difference values. The area under the curve was 0.919 (sensitivity 75.8%, specificity 94.4%). The optimal cutoff value for using ROI to distinguish between dissection and atherosclerosis was found to be 99.0 based on the Youden’s index. Conclusion: The ROI difference value from 3D TOF MRA could help distinguish between dissection and atherosclerosis. If the ROI difference value from 3D TOF MRA is small (< 99.0), detailed testing should be performed to identify dissection.
Dynamic Thiol/Disulphide Homeostasis in Children with Nephrotic Syndrome
Authors: Yazılıtaş Fatma  , Oztek-Celebi Fatma Zehra , Erel Özcan , Çakıcı Evrim Kargın , Alışık Murat , Bülbül Mehmet
Published: February 2019

Background: There is a growing body of evidence showing that there is an association between oxidative damage and kidney injury in patients with nephrotic syndrome (NS). Dynamic thiol/disulphide homeostasis (DTDH) is an important antioxidant system. The aim of this study was to determine if DTDH could be used as a biomarker of antioxidant status in pediatric NS patients using a novel automated method. Methods: The study included 39 patients with NS and 40 healthy controls. The DTDH level was measured using a calorimetric and automated method developed by Erel and Neselioglu. In the NS group, DTDH was measured during first-attack episode, relapse, and remission. Results: The native thiol, total thiol, and disulphide levels were significantly lower, the native thiol/total thiol ratio was significantly lower, and the disulphide/native thiol and disulphide/total thiol ratios were significantly higher in the NS patients during relapse and first-attack episode than during remission and in the controls. In addition, the native thiol and total thiol levels, and the native thiol/total thiol ratio were significantly lower, and the disulphide/native thiol and disulphide/total thiol ratios were significantly higher in the NS group during remission than those in the control group. Conclusions: The present findings show that DTDH shifted toward disulphide formation in the NS patients, even during remission. A clearer understanding of the mechanism of this disruption to homeostasis in NS patients might lead to the development of novel therapeutic strategies.
Gender- and Age-Specific Associations between Visceral Obesity and Renal Function Impairment
Authors: Tsao Yu-Chung , Chen Jau-Yuan , Yeh Wei-Chung , Li Wen-Cheng
Published: February 2019

Objective: Although obesity is associated with an increased risk of chronic kidney disease, this trend becomes nonsignificant following adjustment for cardiovascular risk factors. The present study aims to investigate whether visceral obesity is independently associated with renal function impairment. Method: The medical records of 14,529 male and 10,561 female Chinese adults undergoing health check-ups during 2013–2015 were retrospectively collected. The baseline characteristics, including the degree of visceral fat and the percentage of body fat, were compared. The association between study groups and renal function impairment was investigated using regression models adjusted for confounding factors. Results: All variables differed significantly among non-obese, peripheral, and central type obese subjects, both younger and older, and of both genders, except for hsCRP in older male subjects (p = 0.053) and eGFR in older female subjects (p = 0.098). Unadjusted univariate analysis showed that central obesity contributed significantly to renal function impairment in all age groups and in both genders. After adjusting for possible confounding factors, only central obesity was found to be an independent factor of renal function impairment in all groups, except for men under 45 years of age. Conclusion: Visceral obesity is independently associated with renal function impairment in all ages and both genders, except for males younger than 45 years.
Maxillary Zoster and Neurotrophic Keratitis following Trigeminal Block
Authors: Cho Yang Kyung , Kwon JinWoo , Pugazhendhi Sangeetha , Ambati Balamurali K.
Published: February 2019

Herpes zoster ophthalmicus is commonly used to describe viral reactivation from the trigeminal ganglia with ocular involvement. The ophthalmic branch is the most commonly involved, whereas the maxillary and mandibular dermatomes are less commonly affected. Neurotrophic ulcer may occur secondary to intentional or inadvertent damage to the trigeminal nucleus, root, ganglion, or any segment of the ophthalmic branch of this cranial nerve. We report a case of reactivated maxillary herpes zoster combined with neurotrophic keratitis due to percutaneous 2nd and 3rd branch of trigeminal nerve block with alcohol to treat trigeminal neuralgia. A 57-year-old female came to the ophthalmology department complaining of decreased visual acuity and skin vesicle over the right lower lid and cheek. She had undergone right trigeminal nerve block for treatment of trigeminal neuralgia. Clinical examination revealed neurotrophic keratitis and maxillary herpes zoster. She was treated with oral and topical antivirals and vigorous lubrication with eye drops. Her neurotrophic keratitis showed a slow recovery. Although a few cases of herpes zoster following nerve block have been described, it would appear that a case of simultaneous maxillary herpes zoster and neurotrophic keratitis following trigeminal block has not yet been documented. It is possible that trigeminal nerve block may cause reactivation of latent virus and refractory neurotrophic keratitis.
Comparison of Subjective and Objective Assessments of Neurosensory Function after Lingual Nerve Repair
Authors: Shintani Yukari , Nakanishi Takashi , Ueda Masamichi , Mizobata Naoki , Tojyo Itaru , Fujita Shigeyuki
Published: February 2019

Objective: Mandibular third molar extractions are important in oral maxillofacial surgery. Damage to the lingual nerves, although rare, is a possible complication. There are reports of postoperative recovery after lingual nerve repair, but few reports have compared subjective and objective assessments of neurosensory function. Therefore, this study aims to compare subjective and objective assessments of neurosensory function after lingual nerve repair. Subjects and Methods: This retrospective cohort study comprised 52 patients with lingual nerve anesthesia after third molar extraction at the Department of Oral and Maxillofacial Surgery, Wakayama Medical University Hospital, Wakayama, Japan, between December 2008 and December 2015. We recorded pre- and postoperative (6 months and 12 months) neurosensory examinations. Results: Patient’s subjective assessments of neurosensory function suggested improvement between the preoperative period and 12 months postoperation, although this difference was not significant. Objective assessment based on examination and testing, on the other hand, showed a significant difference in improvement (p < 0.05). Conclusions: There was no evidence that improvement of subjective preoperative and postoperative assessments was significantly associated with improvement of objective neurosensory assessments after lingual nerve repair. Overall physical condition and background were thought to affect subjective evaluation. Subjective assessment is important in conjunction with objective evaluation because it may reveal dysesthesia that would otherwise be missed. In the future, we will examine those cases in whom subjective assessments showed no improvement although objective assessments showed improvement.
Pigment Epithelium-Derived Factor Affects Angiogenesis in Celiac Disease
Authors: Akpinar Muhammet Yener , Kahramanoglu Aksoy Evrim , Pirincci Sapmaz Ferdane , Ceylan Dogan Ozlem , Uzman Metin , Nazligul Yasar
Published: February 2019

Objective: Recent studies have demonstrated that angiogenesis is impaired in patients with celiac disease (CD). In this study, we evaluated the levels of the novel antiangiogenic factor pigment epithelium-derived factor (PEDF) in CD patients. Methods: Eighty-four patients were included in the study; 71 patients with CD and 13 healthy controls. In the CD patient cohort, there were 21 newly diagnosed patients, 19 with adherence to a gluten-free diet and 31 practicing no adherence to this diet. The PEDF levels were measured using enzyme-linked immunosorbent assays. Results: The data revealed that celiac patients had higher levels of PEDF than did healthy controls. PEDF levels were not significantly different among the three CD groups. Additionally, the PEDF levels were not correlated with tissue transglutaminase IgA or IgG. Conclusions: Our data indicate that PEDF levels are significantly higher in CD patients than those in the healthy controls. This result suggests that PEDF negatively affects angiogenesis in CD. Although we did not observe any differences of PEDF levels among celiac patients, additional studies including more patients could clarify this issue.
INSULIN RESISTANCE IN PATIENTS WITH NEWLY DIAGNOSED PULMONARY TUBERCULOSIS WITH DIFFERENT TREATMENT OUTCOME
Authors: Yasinskyi R. N.
Published: February 2019

The aim of the study – to evaluate fasting glucose, insulin levels and homeostasis model assessment (HOMA-IR) index in patients with newly diagnosed pulmonary tuberculosis treatment failure (TFT) compared to data of patients who have successfully completed course of treatment (NDT).

Materials and methods. 49 newly diagnosed pulmonary tuberculosis patients were examined. Patients were divided into 2 groups. Group 1 included 28 patients with TFT. Group 2 (comparison group) included 21 NDT patients. Blood sampling in the patients was done before treatment, after 3 months of the treatment start and after 2–3 months of treatment of patients in the group 1. Fasting plasma glucose level was determined by the hexokinase method by using Beckman Coulter AU640 biochemical analyzer, Japan. Fasting serum insulin level was determined by electrochemiluminescence method on Cobas e411 analyzer, Switzerland. Insulin resistance index was calculated by HOMA-IR by Matthews et al., 1985.

Results. Fasting glucose levels were normal and almost similar in both groups before and after treatment, p˃0.05. Fasting insulin levels were also normal, but they were higher in patients of the group 1 than in the group 2, p˂0.05. It means there was a relative slight hyperinsulinemia in TFT patients. HOMA-IR index was also significantly greater among patients in the group 1, p˂0.05. Fasting glucose levels increase was in 10.7 % of patients in the group 1 and in 4.8 % patient in the group 2. Decrease of glucose levels was in 4.8 % of patients from the group 2. Fasting insulin levels increase was determined in 1 case among the group 1 patients and there were not cases with increased insulin levels among the patients of the group 2; fasting insulin levels reduction was identified in 14.3 % of patients from the group 1 only, p˃0.05. There was HOMA-IR index increase among patients of the group 1 mostly: 9 cases (33.3 %) versus 1 case (4.8 %) in the group 2, p˂0.05. Thus, a relative slight hyperinsulinemia in normal glucose levels and HOMA-IR index increase could be a signs of preclinical disorders of carbohydrate metabolism in patients with TFT.

Conclusion. It may indicate negative impact of virulent mycobacteria and more severe clinical and radiological changes on carbohydrate metabolism or/and negative impact of such disorders to prognosis of tuberculosis.
Primary care and healthcare utilization among older Brazilians (ELSI-Brazil)
Authors: Macinko James , Andrade Fabíola Bof de , Souza Junior Paulo Roberto Borges de , Lima-Costa Maria Fernanda
Published: February 2019

OBJECTIVE: To characterize healthcare access and utilization among older Brazilians. METHODS: Data are from the baseline wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative, population-based cohort study of persons aged 50 years and older conducted in 2015/2016 (n = 9,412). The prevalence of barriers to primary care and number and type of doctor visits in the past 12 months are compared by three main sources of healthcare (private, Family Health Strategy, traditional public clinics). Two-part multivariable hurdle analyses assess the relation between healthcare utilization, primary care problems, and source of healthcare, while controlling for healthcare determinants. RESULTS: Females comprised 54% of the sample, with a mean age of 63 years. There were no demographic differences by source of healthcare. Nearly 83% had at least one doctor visit in the past 12 months, with higher use among private health plan holders. Private health plan holders most frequently visited specialists, while those using the public system were more likely to visit a general practitioner. Primary care barriers averaged 3.5 out of 12 and were the highest among those using traditional health posts. A greater number of primary care problems was negatively associated with all types of healthcare utilization. CONCLUSIONS: By international standards, access to basic healthcare among older Brazilians is relatively high. Nevertheless, different levels of primary care problems between the public and private sectors and resulting utilization patterns suggest the need to continue working to close remaining gaps.
Falls among Brazilian older adults living in urban areas
Authors: Pimentel Wendel Rodrigo Teixeira , Pagotto Valéria , Stopa Sheila Rizzato , Hoffmann Maria Cristina Corrêa Lopes , Andrade Fabíola Bof de , Souza Junior Paulo Roberto De , Lima-Costa Maria Fernanda , Menezes Ruth Losada de
Published: February 2019

OBJECTIVE: To assess the prevalence and factors associated with falls in a nationally representative sample of older Brazilians residing in urban areas. METHODS: Data from 4,174 participants (60 years or older) from the baseline of ELSI-Brazil, conducted between 2015 and 2016, were used. The outcome variable was the reporting of one or more falls in the last 12 months. The exploratory variables were sociodemographic characteristics, factors related to the urban environment, and health conditions. Statistical analysis was performed using Poisson regression. RESULTS: The prevalence of falls was 25.1%. Of these, 1.8% resulted in a hip or femur fracture and, among them, 31.8% required surgery for prosthesis placement. Statistically significant associations (p < 0.05) with falls were observed for females [prevalence ratio (PR) = 1.26], age group of 75 years or older (PR = 1.21), fear of falling due to defective sidewalks (PR = 1.47), fear of crossing streets (PR = 1.22), diabetes (PR = 1.17), arthritis or rheumatism (PR = 1.29), and depression (PR = 1.53). No significant associations were found for educational level, marital status, hypertension, and perception of violence in the neighborhood. CONCLUSIONS: The factors associated with falls among older adults are multidimensional, comprising individual characteristics and the urban environment, which indicates the need for intra and intersectoral actions to prevent falls in this population.
Multimorbidity
Authors: Nunes Bruno Pereira , Batista Sandro Rogério Rodrigues , Andrade Fabíola Bof de , Souza Junior Paulo Roberto Borges de , Lima-Costa Maria Fernanda , Facchini Luiz Augusto
Published: February 2019

OBJECTIVE: To evaluate the occurrence and factors associated with multimorbidity among Brazilians aged 50 years and over. METHODS: This is a cross-sectional study in a nation-based cohort of the non-institutionalized population in Brazil. Data were collected between 2015 and 2016. Multimorbidity was assessed from a list of 19 morbidities, which were categorized into ≥ 2 and ≥ 3 diseases. The analysis included the calculation of frequencies and the most frequent 10 pairs and triplets of combinations of diseases. The crude and adjusted analyses evaluated the demographic, socioeconomic, behavioral, and contextual variables (area of residence, geopolitical region, and coverage of the Family Health Strategy) using Poisson regression. RESULTS: From the total of 9,412 individuals, 67.8% (95%CI 65.6–69.9) and 47.1% (95%CI 44.8–49.4) showed ≥ 2 and ≥ 3 diseases, respectively. In the adjusted analysis, women, older persons, and those who did not consume alcohol had increased multimorbidity. There were no associations with race, area of residence, geopolitical region, and coverage of the Family Health Strategy. The 10 pairs (frequencies observed between 11.6% and 23.2%) and the 10 triplets (frequencies observed between 4.9% and 9.5%) of the most frequent diseases mostly included back problems (15 times) and systemic arterial hypertension (11 times). All combinations were statistically higher than expected by chance. CONCLUSIONS: The occurrence of multimorbidity was high even among younger individuals (50 to 59 years). Approximately two in three (≥ 2 diseases) and one in two (≥ 3 diseases) individuals aged 50 years and over presented multimorbidity, which represents 26 and 18 million persons in Brazil, respectively. We observed high frequencies of combinations of morbidities.