bluuebunny/crossref_metadata_2025 huggingface dataset:
Search for exoplanetary transits in the Galactic bulge
Authors: Cortés C C , Minniti D , Villanova S
Published: November 2018

A search for extrasolar planetary transits using extended Kepler mission (K2) campaigns 9 and 11 revealed five new candidates towards the Galactic bulge. The stars EPIC 224439122, 224560837, 227560005, 230778501 and 231635524 are found to have low-amplitude transits consistent with extrasolar planets, with periods P = 35.1695, 3.6390, 12.4224, 17.9856 and 5.8824 days, respectively. The K2 data and existing optical photometry are combined with multi-band near-IR photometry of the Vista Variables in the Via Lactea (VVV) survey and Two-Micron All-Sky Survey (2MASS) in order to measure accurate physical parameters for the host stars. We then measure the radii of the new planet candidates from the K2 transit light curves and also estimate their masses using mass–radius relations, concluding that two of these candidates could be low-mass planets and three could be giant gaseous planets.
Art and Emotion
Authors: Contesi Filippo
Published: November 2018

The study of the arts in philosophy has often concentrated on the role that emotions (and affective responses more generally) play in art’s creation and value. Philosophical theories of art have sometimes even defined art in terms of its capacity to elicit or express emotions. Philosophers have debated such questions as what it is to express an emotion in art; whether emotions form part of the value of an artwork; whether the emotions involved in art appreciation are of the same kind as those that we experience in real life, or of a different, even sui generis kind (i.e., aesthetic emotions); whether it is rational or appropriate to experience emotions in response to art; and what value, if any, there is in art that evokes unpleasant emotions. Although the focus here will be on what, to a first approximation, can be characterized as the “Western mainstream philosophical tradition,” discussion of the role of emotions in art can also be found in different approaches and traditions of thought: from Indian philosophy to cognitive science, to so-called Continental philosophy.
Nātha Sampradāya
Authors: Muñoz Adrián
Published: November 2018

The religious order of yogis commonly associated with the legendary figure of Yogī Gorakhnāth (Gorakṣanātha in Sanskrit) is known as the Nātha Sampradāya, or Nāth Panth, meaning the “lineage,” “sect,” or “order” of the Nāths. The Sanskrit nātha means “lord,” “protector,” or “master,” and does not always refer to a member of the Nātha Sampradāya. Because this religious group is widely present in vernacular contexts, the Hindi form nāth will be often used here, instead of the Sanskrit nātha, except when dealing with Sanskrit titles or contexts. The origins of the order have been dubiously thought to go back as far as the twelfth or thirteenth century, when Gorakhnāth is believed to have founded the sampradāya, a matter of academic debate. Traditionally, it is believed that he has been born in each of the four different cosmic ages, or yugas. Nowadays, the Nāth Yogis can be easily distinguished from other ascetic groups by the visible earrings they wear in the cartilage of both ears, for which reason they are sometimes also known as “Kānphaṭa” yogis, an appellation that is sometimes seen as derogatory, since they prefer the term “Darśanī.” Some specialists identify two broad bodies of Nāths: an ascetic order and a householder order. The ascetic group is a renouncer troupe and can in turn be divided into wandering yogis (ramtā) or yogis residing in a monastery (maṭhdhārī). Although strongly based in some places in North India, they have been historically present in many other parts of South Asia as well, especially (but not limited to) Kathmandu, the Greater Punjab, parts of Afghanistan, Uttar Pradesh, Bengal, Rajasthan, Maharashtra, and Karnataka. Formally, the followers of the Nātha Sampradāya worship the Hindu god Śiva, the primeval and divine yogi, so that through the practice of yoga they seek to acquire immunity to bodily decay, immortality, perfection, and extraordinary powers. Sometimes, the worship is directed specifically to Bhairava, a fearsome form of Śiva. Throughout premodern India, the Nātha Sampradāya was known to practice hatha yoga, was often considered to be the founder of this practice, and was also conversant with other religious groups, such as Sufis, Buddhists, Vaiṣṇavas, and Sikhs. There is a large amount of textual production ascribed to Nāth figures (Matsyendra, Gorakh, Cauraṅgi, Bhartharī, Carpaṭa, for example). Interestingly, these texts were composed in both Sanskrit and vernacular languages (such as braj bhāṣā, avadhī, or khaṛī bolī), a somewhat uncommon phenomenon in South Asian religious traditions. This also accounts for the yogis’ immense geographic, social, and cultural intercourse with different groups, as well as their varied and complex identities.
ESTIMATE OF UAE COMMERCIAL AIRCREW EFFECTIVE DOSES USING CARI-6, EPCARD AND SIEVERT CODES
Authors: Dalah Entesar Z , Elmahdi Hussein M , Al Humaidan Khalid S , Semerjian Lucy
Published: November 2018

The aim of this study is to calculate total cruising route effective doses using three commonly used algorithm codes CARI-6, EPCARD and SIEVERT. Further, the impact of flight cruising duration, altitude and latitude on the estimated effective doses will also be investigated. A total of 24 commercial UAE flight data were collected and retrospectively analysed. CARI-6, EPCARD and SIEVERT codes were used to estimate the total route effective doses per single trip of different destinations including USA, Europe, South Africa, Asia and Australia. Aircraft crew effective doses were shown to significantly increase with flying altitude. A strong significant correlation (0.6469; p < 0.05) was obtained between flight duration and the estimated effective doses, while a moderate insignificant correlation (0.3899; p > 0.05) was obtained with flying altitude for all 24 flights using CARI-6. For flights with the same latitude and duration, all codes gave total effective doses within experimental uncertainties.
Not-So-Secret Weapons: Lebanese Women’s Rights Activists and Extended Family Networks
Authors: Stephan Rita
Published: November 2018

This study asks one crucial question: How do Lebanese women apply available social capital and informal social networks to engage in political activism for women’s rights? Building on social- and women’s-movement theories, I argue that Lebanese feminists do not exclusively operate in the public sphere in their fight for political goals, nor do they privilege only the extra-family space. On the contrary, they engage in political activities by using extended family networks as a form of weak social ties. I construct this argument on the basis of interviews, observations, and analysis of Lebanese feminists’ writings. This paper introduces the concept of mahsoubieh as a form of weak social ties generated within connective family networks. Specifically, I examine how elite, intellectual, and middle-class Lebanese women activists use the positive social capital generated by mahsoubieh to gain credibility, diffuse their political stances, and develop countervailing power. Aspects such as the size, reputation, and respectability of their kinship networks aided the Lebanese women in their fight to change the legal structure concerning women’s rights and political representation.
Chagas disease
Authors: Tzizik Dan M. , Borchardt Roy A.
Published: November 2018

Chagas disease is a parasite infection primarily transmitted to humans via the bite of triatomine insect vectors. Up to 8 million people are estimated to be infected with Chagas disease in the Americas. Patients who do not receive treatment can develop severe cardiac debility, gastrointestinal organ dysfunction, and may die. The changing demographics of the United States, a consequence of changing immigration patterns, means that healthcare providers are more likely to encounter patients with Chagas disease, and must understand its cause, pathogenesis, diagnosis, and treatment.
Analgesic Potentials of Preoperative Oral Pregabalin, Intravenous Magnesium Sulfate, and their Combination in Acute Postthoracotomy Pain
Authors: Salah Abdelgalil Ahmed , Shoukry Aktham A. , Kamel Mahmoud A. , Heikal Ashraf M.Y. , Ahmed Naglaa A.
Published: November 2018

Objectives:

The objective of this study was to investigate the effects of the preoperative combination of oral Pregabalin and intravenous (IV) magnesium sulfate as analgesic adjuvants in postthoracotomy pain.

Patients and Methods:

One hundred twenty patients with American Society of Anesthesiologists physical status II were allocated randomly into 1 of 4 groups. Group MP received 300 mg pregabalin orally and an IV infusion of magnesium sulfate 50 mg/kg mixed with 200 mL normal saline (NS); group P received 300 mg pregabalin orally and 200 mL NS infusion; group M received an IV infusion of magnesium sulfate 50 mg/kg mixed with 200 mL NS and a placebo capsule; and group C received placebo capsule and an IV infusion of 200 mL NS. All medications were given 1 hour before surgery in all groups. In the first 24 hours postoperatively, total morphine consumption, the Visual Analog Scale (0 to 10)—used as a pain measurement tool—and postoperative nausea and vomiting were assessed.

Results:

The total morphine consumption in the first 24 hours postoperatively decreased significantly in group MP (28.47±5.76 mg) compared with group P (33.97±6.34 mg), group M (40.87±4.4 mg), and group C (42.2±6.1 mg), respectively. VAS scores were in the accepted range (≤4) in the 4 groups throughout the first 24 hours, as all patients were on patient-controlled analgesia. However, there was a statistically significant difference at 0 and 4 hours postoperatively in favor of groups MP and P. Postoperative nausea and vomiting decreased significantly in groups MP, P, and M in comparison with group C (P<0.001).

Conclusions:

The combined preoperative single dose of pregabalin and magnesium sulfate is an effective method for attenuating postoperative pain and total morphine consumption in patients undergoing thoracotomy.
Cognitive Biases Toward Pain
Authors: Rusu Adina C. , Gajsar Hannah , Schlüter Michael-Christian , Bremer Yara-Inken
Published: November 2018

Objectives:

Information-processing biases such as attentional, interpretation, and memory biases are supposed to play a role in the exacerbation and maintenance of chronic pain. Current research in the area of cognitive biases shows that all these biases seem to have an influence on attention to, interpretation of, and recall of pain and can lead to maladaptive strategies and the exacerbation of pain.

Methods:

We conducted a narrative literature review, considering evidence extracted from various databases including PubMed, MEDLINE, Science Direct, and ProQuest. Search terms included cognitive biases, neurocognitive processing, chronic pain, and depression.

Results:

The literature on attentional, interpretative, and memory biases in experimental and chronic pain, as well as their neuronal underpinnings, suggests that the depression of chronic pain patients may differ from the depression of patients without pain. Depressed pain patients show a recall bias for illness-related and health-related stimuli, whereas depressed patients without pain show a bias for depression-related stimuli. In addition, research has shown that catastrophizing, helplessness/hopelessness, and thought suppression as psychological responses to pain are mediators of the relationship between chronic pain and depression.

Conclusions:

Current research supports the importance of individual diagnosis of chronic pain patients and their response patterns of pain, psychological processing, and information processing. This leads to the conclusion that depressed pain patients need other clinical interventions when compared with depressed patients without pain. Previous research showed that a combination of a cognitive-behavioral therapy with mindfulness meditation seems to be a promising approach.
Efficacy and Safety of Pregabalin in Neuropathic Pain Followed Spinal Cord Injury
Authors: Yu Xiaobing , Liu Tao , Zhao Dewei , Yang Ke , Zhang Xiuzhi , Zhang Meng , Zhang Shuo , Huang Wei , Wu Baolin , Li Junlei
Published: November 2018

Objective:

Pregabalin has been approved for the treatment of the neuropathic pain following spinal cord injury (SCI). We performed a systemic review and meta-analysis of randomized, controlled, multicenter trials to evaluate the efficacy and safety of pregabalin for SCI-induced neuropathic pain.

Materials and Methods:

Research searching was performed in PubMed and EMBASE databases and the Cochrane library in May 2018. Clinical controlled trials using pregabalin for the pain treatment following SCI in adults (18 y old and above) were included. Pain and safety-related adverse events were considered as outcomes. Meta-analysis was conducted using Revman 5.0 software.

Results:

Five publications (pregabalin, patients=261, placebo, patients=216) were included in our study. After at least 4-week’s treatment with pregabalin (flexible dose, 150 to 600 mg/d), pregabalin-treated patients showed reduced pain −1.54, 95% confidence interval (CI) (−2.33, −0.75), P=0.0001; improved >30% 1.83, 95% CI (1.37, 2.46), P<0.0001 and >50% pain relief 2.40, 95% CI (1.53, 3.77), P=0.0001; increased adverse events 1.36, 95% CI (1.18, 1.577), P<0.0001; and reduced Hospital Anxiety and Depression Scale - anxiety −1.50, 95% CI (−2.99, −0.00), P=0.05 and - depression −0.34, 95% CI (−0.55, −0.12), P=0.002 scores compared with placebo-treated patients. Stratified meta-analysis showed there was no difference in primary adverse events (drowsiness, dizziness, peripheral edema, and dry mouth) between pregabalin and placebo groups (P≥0.05).

Conclusions:

Our results showed pregabalin was efficacious and might be safe treatment for chronic pain followed SCI.
Sleep and Intensive Care Unit–Acquired Weakness in Critically Ill Older Adults
Authors: Elías Maya N. , Munro Cindy L. , Liang Zhan , Calero Karel , Ji Ming
Published: November 2018

Background

Older adults in the intensive care unit (ICU) often experience sleep disturbances, which may stem from life-threatening illness, the ICU environment, medications/sedation, or psychological stress. Two complementary endocrinological responses occur as a result of compromised sleep and consequently could exacerbate ICU-acquired weakness: a decrease in anabolic hormones leading to decreased protein synthesis and an increase in catabolic hormones leading to increased protein degradation. Age-associated decreases in anabolic hormones, such as insulin-like growth factor 1, testosterone, and growth hormone, may inhibit protein synthesis. Likewise, age-associated increases in insulin resistance, glucocorticoids, and myostatin can stimulate muscle atrophy and further reduce protein synthesis. Thus, perhaps, sleep promotion in the ICU may attenuate muscle atrophy among critically ill older adults who are at risk for ICU-acquired weakness and subsequent functional decline.

Objectives

The aim of this study was to discuss the hypothesized theoretical underpinnings of the relationship between sleep disturbances and ICU-acquired weakness among critically ill older adults.

Methods

A search of research literature published from 1970 to 2018 and indexed in MEDLINE, Embase, CINAHL, and Ovid was undertaken, and relevant sources were selected to build an informed discussion.

Results

Nurses must be mindful of secondary sleep disturbances that occur throughout the acute phase of critical illness and their probable links to ICU-acquired weakness. Targeted interventions to promote functional outcomes in elderly patients should consider this relationship.

Discussion

Improved sleep may have the potential to decrease the severity of muscle atrophy and ICU-acquired weakness. Future research must explore this hypothesis and the underlying mechanisms of the association between sleep disturbances and ICU-acquired weakness in critically ill older adults.
Influence of Anastomotic Leak After Elective Colorectal Cancer Resection on Survival and Local Recurrence: A Propensity Score Analysis
Authors: Zimmermann Markus S. , Wellner Ulrich , Laubert Tilman , Ellebrecht David B. , Bruch Hans-Peter , Keck Tobias , Schlöricke Erik , Benecke Claudia R.
Published: November 2018

BACKGROUND:

The occurrence of anastomotic leakage is still a life-threatening complication for patients after colorectal surgery. In literature not only an impact on the short-term outcome but also on long-term survival and local recurrence of colorectal cancer patients is discussed.

OBJECTIVE:

This study aimed to investigate the impact of anastomotic leakage on long-term survival and local recurrence.

DESIGN:

A total of 1122 patients with resections for colorectal cancer were analyzed. In 94 patients (8.4%) there was clinical proof of anastomotic leakage. A reference group was defined as the 1028 patients without anastomotic leakage using 1:1 propensity score-matching according to the following criteria: age, sex, International Union Against Cancer stage, Karnofsky index, tumor site, and grading, as well as adjuvant chemotherapy. A calculation of overall survival, disease-free survival, and local recurrence rate was performed for both groups.

SETTINGS:

The study was conducted using a retrospective matched-pairs analysis, based on a prospectively maintained institutional colorectal cancer database.

PATIENTS:

Ninety-four patients with anastomotic leakage and 94 matched control subjects from a total of 1122 patients with resections for colorectal cancer were studied.

MAIN OUTCOME MEASURES:

Overall survival, disease-free survival, and local recurrence rate for patients with colorectal cancer with and without anastomotic leakage were measured.

RESULTS:

The propensity score matching successfully created 2 groups with no significant differences in the matching criteria. Survival analysis disclosed no significant differences between the groups in terms of overall survival, disease-free survival, and local recurrence rate. Univariate analysis identified age, Karnofsky index, International Union Against Cancer stage, and lymph node metastasis as significant prognostic factors. Multivariable analysis of these variates revealed age and positive lymph nodes as independent predictors of overall survival and disease-free survival.

LIMITATIONS:

The study was limited by nature of being a retrospective analysis and monocentric study.

CONCLUSIONS:

This matched-pairs analysis, comparing patients with colorectal cancer with and without anastomotic leakage, revealed no significant differences in overall survival, disease-free survival, and local recurrence rate. Contrary results in the literature might be caused by nonbalanced settings in nonmatched collectives. See Video Abstract at http://links.lww.com/DCR/A811.
The Association Between Income and Psychotropic Drug Purchases: Individual Fixed Effects Analysis of Annual Longitudinal Data in 2003–2013
Authors: Junna Liina , Moustgaard Heta , Tarkiainen Lasse , Martikainen Pekka
Published: November 2018

Background:

Previous cross-sectional studies show that low income is associated with poor mental health. However, longitudinal research has produced varying results. We assess whether low income is associated with increased psychotropic drug use after accounting for confounding by observed time-varying, and unobserved stable individual differences.

Methods:

The longitudinal register-based data comprises an 11% nationally representative random sample of Finnish residents aged 30–62 years between the years 2003 and 2013. The analytic sample includes 337,456 individuals (2,825,589 person–years). We estimate the association between annual income and psychotropic purchasing using ordinary-least-squares and fixed effects models, the latter controlling for all unobserved time-invariant individual characteristics.

Results:

The annual prevalence of psychotropic purchasing was 15%; 13% among men and 18% among women. Adjusted for age squared, sex and calendar year, the doubling of income decreased the probability of purchases by 4 percentage points (95% confidence interval: 4,4) in the ordinary-least-squares model. We observed no association after further adjusting for observed sociodemographic characteristics and unobserved individual differences in the fixed effects specification.

Conclusions:

Following adjustment for an extensive set of confounders, no contemporaneous association between variations in annual individual income and psychotropic drug purchasing was observed. Similar results were obtained irrespective of baseline income level and sex. The results imply that indirect selection based on preexisting individual characteristics plays a major role in explaining the association between variations in income measured over the short term, and psychotropic drug purchases. The association appears largely attributable to unobserved, stable individual characteristics. See video abstract at, http://links.lww.com/EDE/B463.
Advances in osteoporosis from 1970 to 2018
Authors: Gallagher J. Christopher
Published: November 2018

In 1970, there were no drugs under study for osteoporosis. Estrogen was used, but little was known about the correct dose for preventing bone loss. At that time, fractures were not even recognized as a disease, but regarded as part of normal aging. From 1970 to this year (2018), there have been extensive advances in the osteoporosis field ranging from fracture epidemiology to the remarkable invention of bone density measurements. There have been major advances in therapeutic options available for patients for prevention and treatment of osteoporosis. In parallel, the advances in the laboratory helped elucidate the process of bone remodeling, not only at the macroscopic level but also at the cellular level. This led to rapid advances in translational research from cellular biology to new therapies exemplified by the development of monoclonal antibodies for osteoporosis. Further understanding of the signaling pathways in bone cells will lead to new small molecules made for osteoporosis treatment, perhaps causing less adverse events. University-based research throughout the world has been a leader in most of these advances, and Pharma support for phase 1 to 4 studies helped bring these discoveries to patients. In the osteoporosis field alone, one sees the tremendous value of grant support for university research by National funding agencies such as the National Institute of Health in this country and similar agencies in other countries. There are clinical challenges that have to be solved with long-term compliance with osteoporosis medication if we want to reduce fracture incidence in the long term.
Electrical Stun Gun and Modern Implantable Cardiac Stimulators
Authors: Mattei Eugenio , Censi Federica , Calcagnini Giovanni
Published: November 2018

The aim of the study is to investigate systematically the possible interactions between two types of stun guns and last-generation pacemakers and implantable defibrillators. Experimental measurements were performed on pacemakers and implantable defibrillators from five leading manufacturers, considering the effect of stun gun dart positioning, sensing modality, stun gun shock duration, and defibrillation energy level. More than 300 measurements were collected. No damage or permanent malfunction was observed in either pacemakers or implantable defibrillators. During the stun gun shock, most of the pacemakers entered into the noise reversion mode. However, complete inhibition of the pacing activity was also observed in some of the pacemakers and in all the implantable defibrillators. In implantable defibrillators, standard stun gun shock (duration 5 s) caused the detection of a shockable rhythm and the start of a charging cycle. Prolonged stun gun shocks (10–15 s) triggered the inappropriate delivery of defibrillation therapy in all the implantable defibrillators tested. Also in this case, no damage or permanent malfunction was observed. For pacemakers, in most cases, the stun guns caused them either to switch to the noise reversion mode or to exhibit partial or total pacing inhibition. For implantable defibrillators, in all cases, the stun guns triggered a ventricular fibrillation event detection. No risks resulted when the stun gun was used by a person wearing a pacemaker or an implantable defibrillator. This work provides novel and up-to-date evidence useful for the evaluation of risks to pacemaker/implantable defibrillator wearers due to stun guns.
A Purely Poisson-based Approach to Estimating Audible Scan Survey Sensitivities
Authors: Justus Alan L.
Published: November 2018

Several attempts have been made over the years to estimate the sensitivity of audible scan surveys. Some estimates involved certain factors of the background count rate, while others involved calculations utilizing parameters pulled from the normal (Gaussian) distribution, regardless of background count rate. This paper discusses the results of a purely Poisson-based calculational method for the determination of appropriate decision levels and affiliated detection limits associated with health physics audible scan surveys. Comparisons are made to the other approaches and to empirical tests, where available. Although agreement with previous estimates can be had over limited ranges of background count rate, order-of-magnitude differences are possible outside of those ranges. The previous estimates are generally conservative at the higher count rates but quite nonconservative at the lowest count rates. Several real-life operational examples are provided that illustrate the approach.
Radiation Field Strengths Near Cylindrical Volume Sources Via Point-source Correction Factors
Authors: Steward Palmer G.
Published: November 2018

Due to the ease with which the radiation field strength is determined for a point source, the field strength emanating from radiopharmaceutical therapy patients is sometimes estimated by using the point source approximation with a correction factor. It is inevitable that the correction factor will occasionally be used under conditions that do not precisely match those for which the factor was originally derived. The difficulty is that the boundary of the correction factor’s domain of acceptability is usually unclear. The purpose of this paper is to address this issue. The patient is modeled as a cylinder containing the radionuclide administered to the patient. From first principles, the expression for converting the radiation field strength of an unshielded point source to that of the extended cylindrical volume source is derived. This expression is analytically separated into the component depicting geometric dispersion of the source material into the volume and the component depicting self-absorption (absorption characteristics of 131I in water are used). These components, along with their composite, are presented showing their dependence on patient size, distance from the patient, and various dispersion patterns of the source material within the patient. Correlation of theory and measurement is demonstrated, and a conceptual grasp is conveyed regarding field strength variations around volume sources with changes in shape, size, distance, and other parameters. Using data presented, the radiation field strength emanating from a radiopharmaceutical therapy patient can be estimated from the point source approximation and customized for patient size and presumed internal radionuclide distribution.
A Comparison of High‐Dose Cytarabine During Induction Versus Consolidation Therapy in Newly Diagnosed AML
Authors: Schwarer Anthony P. , Butler Jason , Jackson Kathryn , Beligaswatte Ashanka , Martin Louisa , Kennedy Glen , Daniela Zantomio , Lewis Ian , Hiwase Devendra , Wight Joel , He Simon , Grigg Andrew , Morris Kirk , Mollee Peter , Marlton Paula
Published: November 2018

The proportion of patients with acute myeloid leukemia (AML) cured is increased by administering high‐dose cytarabine (HiDAC). It remains uncertain whether to administer HiDAC as induction or consolidation, and whether ≥1 cycle of HiDAC is required. Our retrospective study of 416 adult AML patients, excluding good risk cytogenetics, compared a single cycle of HiDAC‐based therapy followed by 2 cycles of standard‐dose cytarabine (SDAC) (HiDAC induction cohort) with SDAC‐based chemotherapy followed by 2 cycles of HiDAC‐based chemotherapy (HiDAC consolidation cohort). Complete remission (CR) rate was greater in the HiDAC induction cohort (90% vs 78%, P < 0.01) which did not lead to an improved overall survival (48% vs 43%, P = 0.18) or disease‐free survival (DFS) (39% vs 45%, P = 0.95). We noted that, after censoring for allogeneic hematopoetic stem cell transplant (alloHSCT) in CR1, the cumulative incidence of relapse was lower in the HiDAC consolidation cohort in patients with intermediate risk cytogenetics (68% vs 44%, P = 0.01), which lead to a greater DFS (30% vs 47%, P = 0.095). In the patients with adverse risk cytogenetics, the RR was numerically greater in the HiDAC consolidation cohort (52% vs 80%, P = 0.60) which lead to a lower DFS (27% vs 4%, P = 0.11). Our data show that, although the HiDAC induction cohort (1 cycle of HiDAC) achieved a greater CR rate, there were no overall survival differences between the 2 cohorts, and that the HiDAC consolidation cohort (2 cycles of HiDAC) had a lower RR and greater DFS in those patients with intermediate risk cytogenetics who did not undergo alloHSCT in CR1.
Integrated Safety Profile of a New Approved, Fully Liquid DTaP5-HB-IPV-Hib Vaccine
Authors: Xu Jin , Stek Jon E. , Ziani Eddy , Liu G. Frank , Lee Andrew W.
Published: November 2018

Background:

DTaP5-HB-IPV-Hib is a fully liquid, hexavalent vaccine containing a 5-antigen pertussis component, approved since 2016 in Europe [Vaxelis; DTaP5-HB-IPV-Hib vaccine: Diphtheria, tetanus, pertussis (5 acellular components: pertussis toxoid [PT], filamentous haemagglutinin [FHA], pertactin (PRN), and fimbriae Types 2 and 3 [FIM]), hepatitis B (recombinant DNA: rDNA), poliomyelitis (inactivated) and Haemophilus influenzae type b conjugate vaccine (adsorbed); MCM Vaccine B.V., The Netherlands] for primary and booster vaccination in infants and toddlers against diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis and invasive diseases caused by Haemophilus influenzae type b. The comparator vaccine (control) was INFANRIX hexa (GlaxoSmithKline Biologics S.A., Rixensart, Belgium) (DTaP3-IPV-HepB/Hib) in European studies and PENTACEL (DTaP5-IPV/Hib) (Sanofi Pasteur, Swiftwater, PA) in US studies.

Methods:

Data from 6 studies were integrated and analyzed to provide a comprehensive safety profile. Numbers and proportions of subjects with adverse events (AEs) were summarized by treatment group. Group differences in proportion of AEs were calculated.

Results:

Among the DTaP5-HB-IPV-Hib (N = 5223) and 2295 control (N = 2295) groups, solicited injection-site and systemic AEs were very common. Serious AEs were reported by 3.9% of DTaP5-HB-IPV-Hib and 3.7% of control subjects. Vaccine-related serious AEs occurred infrequently, 0.2% for both groups. Most AEs were mild-to-moderate and did not lead to subject withdrawal. Group differences for solicited systemic AEs were small (<3%) and not statistically significant, except for pyrexia (estimated difference 9.4% [95% CI: 6.7%–12%]). The difference was driven by the 2 US studies where the PENTACEL control group had a lower fever rate. Among European studies, there was no significant difference in rates of pyrexia between DTaP5-HB-IPV-Hib and INFANRIX hexa.

Conclusions:

The safety of DTaP5-HB-IPV-Hib is consistent with the safety profile of its components and similar to comparator vaccines, including INFANRIX hexa. The vaccine provides a new, fully liquid and convenient hexavalent vaccination option for use with various vaccination schedules in Europe.
Factors Influencing Acceptance Into Part C Early Intervention Among Low-Risk Graduates of Neonatal Intensive Care Units
Authors: Miller Kerry , Marvin Christine , Lambert Matthew
Published: November 2018

Low-risk infants discharged from a neonatal intensive care unit (NICU) can include infants whose stay was due to late-term prematurity, suspicion of sepsis, breathing issues, and/or feeding challenges. This study aimed to identify the degree to which sociodemographic and medical factors contribute to low-risk NICU graduates being accepted into Part C early intervention services. Family sociodemographic and child medical factors were examined for 3,826 low-risk graduates of NICUs in 1 Midwestern state. These NICU graduates were compared with the general population of children birth to age 3 years in the state for rates of enrollment in Part C programs. Low-risk NICU graduates had significantly higher early intervention acceptance rates than children in the general population. Neonatal intensive care unit graduates residing in an urban area were more likely to be accepted into early intervention services than those residing in a rural area. The length of NICU stay also predicted acceptance into services; the likelihood of acceptance into early intervention programs increased for each additional day a child stayed in the NICU. Low-risk NICU graduates should be monitored routinely after discharge for developmental delays and the need for referral to Part C early intervention programs any time in the children's first 3 years of life.
Clinical Workflows and the Associated Tasks and Behaviors to Support Delivery of Integrated Behavioral Health and Primary Care
Authors: Davis Melinda M. , Gunn Rose , Cifuentes Maribel , Khatri Parinda , Hall Jennifer , Gilchrist Emma , Peek C. J. , Klowden Mindy , Lazarus Jeremy A. , Miller Benjamin F. , Cohen Deborah J.
Published: November 2018

Integrating primary care and behavioral health is an important focus of health system transformation. Cross-case comparative analysis of 19 practices in the United States describing integrated care clinical workflows. Surveys, observation visits, and key informant interviews analyzed using immersion-crystallization. Staff performed tasks and behaviors—guided by protocols or scripts—to support 4 workflow phases: (1) identifying; (2) engaging/transitioning; (3) providing treatment; and (4) monitoring/adjusting care. Shared electronic health records and accessible staffing/scheduling facilitated workflows. Stakeholders should consider these workflow phases, address structural features, and utilize a developmental approach as they operationalize integrated care delivery.
Health Status in Adults With Chronic Conditions
Authors: Selim Alfredo J. , Qian Shirley X. , Rogers William , Arya Deepa , Simmons Kimberly , Shapiro Gabriel D. , Sonis Lily A. , Kazis Lewis E.
Published: November 2018

This literature review analyzes 418 articles from 2 periods (2000-2010 and 2011-2017) to provide interpretative guidelines for the change in physical (PCS) and mental component summaries (MCS) of well-established patient-reported measures (MOS SF-36 V1, HOS SF-12, VR-36, and VR-12). The magnitude of the intervention effects was calculated using baseline and follow-up data. Results were similar across the 2 periods, although the effects of social and behavioral interventions are less consistent and are smaller for PCS. Both single interventions and multicomponent interventions met the moderate to large effect size criterion for PCS and MCS.
Evaluating Perceptions of Self-efficacy and Quality of Life in Patients Having Coronary Artery Bypass Grafting and Their Family Caregivers
Authors: Thomson Patricia , Howie Kate , Mohan A.R.M. , Chung Misook L.
Published: November 2018

Background

Self-efficacy is a critical factor for quality of life in patients who undergo coronary artery bypass grafting, as well as for their family caregivers. However, there is lack of knowledge about whether patients' self-efficacy and caregivers' perceptions of patient self-efficacy are associated with quality of life in patient and caregiver dyads.

Objectives

The aims of this study were to compare self-efficacy and quality of life between patients and family caregivers and to examine whether patients' and caregivers' perceptions of patient self-efficacy were associated with their own and their partner's quality of life in patient and caregiver dyads who were waiting for patients' coronary artery bypass grafting.

Methods

In this cross-sectional study, 84 dyads (85% male patients and 87% female caregivers) completed the Cardiac Self-efficacy Scale, which consists of self-efficacy for controlling symptoms and self-efficacy for maintaining function subscales, and the Short-Form 12 Health Survey for quality of life. Data were analyzed using the Actor-Partner Interdependence Model.

Results

Caregivers rated patient self-efficacy for maintaining function higher than did patients themselves and caregivers' perceptions were positively correlated with patients' physical health. Patients' self-efficacy for maintaining function exhibited an actor effect on their own mental health. There were no other actor or partner effects of self-efficacy on quality of life.

Conclusions

Differences between patients' and caregivers' perceptions of patient self-efficacy for maintaining function should be addressed before surgery to reduce discordance. Patients' self-efficacy for maintaining function was associated with their own quality of life. There was no partner (relationship) effect of self-efficacy on quality of life. More research is needed in this area.
Posterior temporary C1-2 fixation for 3-part fractures of the axis (odontoid dens and Hangman fractures)
Authors: Yuan Suomao , Wei Bin , Tian Yonghao , Yan Jun , Xu Wanlong , Wang Lianlei , Liu Xinyu
Published: November 2018

Case series study.

To report the clinical outcomes of posterior temporary C1-2 fixation for 3-part fracture of the axis (Type II odontoid fracture according to Grauer classification combined with Hangman fracture).

The 3-part fracture of the axis is rare and the treatment is controversy.

A total of 8 patients with 3-part fracture of the axis were included in this study. X-rays, CT, and MRI prior to surgery were used to evaluate the cervical spine injury. Grauer classification, fracture angulation, and fracture translation were used to evaluate the fracture of dens. The neck disability index (NDI) and range of neck rotary motion were used to assess the neck function.

The preoperative fracture angulation and fracture translation were 4.6 ± 1.3° and 2.4 ± 0.6 mm, respectively. The average operation time and blood loss were 109 ± 27 minutes and 49 ± 15 mL. No infection, vascular injuries or neural structure injuries was observed. All patients acquired bone healing at 5.9 ± 2.0 months. The temporary instrumentation was removed at 10.8 ± 1.3 months. The average NDI before and 2 days after removal of instrumentation were 10.1 ± 4.0 and 7.1 ± 3.0, respectively. At 1-year follow-up after instrumentation removal, the NDI was 1.8 ± 0.7, which was much better than immediate NDI after instrumentation removal. The neck rotary motion (left rotation + right rotation) before and 2-day after instrumentation removal were 70.4 ± 6.3° and 119.6 ± 13.1°, respectively. At 1-year follow-up, the average neck rotary motion was 153.1 ± 9.1°, which had significant different with rotary motion 2-day after the removal of temporary instrumentation.

With regard to the high fracture fusion rates, low complications, and excellent predictable outcomes in patients treated with posterior temporary C1-2 pedicle screw fixation, the technique may be a suitable choice for 3-part fracture of the axis.
Treatment of severe rash caused by crizotinib with both traditional Chinese medicine and Western medicine
Authors: Zheng Shu-Yue , Shen Wen , Peng Yan-Mei , Cui Hui-Juan , Duan Hua , Qiu Yu-Qin , Li Qiang , Zhang Jing-Yi , Sun Chen-Yao , Zhang Xu
Published: November 2018

Rationale:

Lung adenocarcinoma is the most common pathologic pattern of lung cancer. During the past decades, a number of targeted agents have been explored to treat advanced lung adenocarcinoma. Recently, Crizotinib, the antagonist of anaplastic lymphoma kinase (ALK), has been widely used in ALK-rearranged lung cancer treatment. Crizotinib is generally well tolerated while its most frequent adverse events include visual disorders, gastrointestinal disturbances, cardiac and endocrine abnormalities. Rash caused by crizotinib is rarely seen, and there are few case reports of severe rash caused by crizotinib.

Patient concerns and diagnoses:

Here we report cases of an 81-year-old man and a 66-year-old woman with ALK-rearranged advanced lung adenocarcinoma. When patients came to our department, they both had crizotinib-induced severe rash.

Interventions:

Crizotinib was initiated as the 1st-line treatment without other therapies. We treated severe rash with traditional Chinese medicine (TCM) therapy called Zhiyang Pingfu liquid along with Western medicine. Zhiyang Pingfu liquid consists of Scutellaria baicalensis 20 g, Portulaca oleracea 30 g, Cortex Dictamni 30 g, Sophora flavescens 30 g, and other substances. Western medicine includes Minocycline hydrochloride tablets and Aprepitant capsules.

Outcomes:

Both patients achieved a partial response when treated with crizotinib, and suffered from severe rash. With Zhiyang Pingfu liquid and Western medicine, their rash gradually disappeared with no sign of cancer progression. Also the male patient did not relieve after taking only antibiotics (standard therapy) and anti-allergic medicine.

Lessons:

Despite the dramatic benefit of crizotinib for patients with ALK rearrangement, crizotinib-induced severe rash needs to be dealt with caution. This is the 1st case in which TCM and Western medicine are used to successfully treat crizotinib-induced severe rash. The mechanism of crizotinib-induced rash deserves further attention in future research.
Effect of interventional embolization treatment for hydrosalpinx on the outcome of in vitro fertilization and embryo transfer
Authors: Hong Xin , Ding Wen-bin , Yuan Rui-fan , Ding Jia-yi , Jin Jie
Published: November 2018

To explore the effect of interventional embolization treatment for hydrosalpinx on the outcome of in vitro fertilization and embryo transfer (IVF-ET).

During the period from January 2013 to January 2015, a total of 129 patients with unilateral or bilateral hydrosalpinx were treated with IVF-ET and selected for retrospective analysis. Seventy-three patients (intervention group) with unilateral or bilateral hydrosalpinx were treated with fallopian tube embolization, which was followed by IVF-ET. During the same period, 56 patients (control group) with unilateral or bilateral hydrosalpinx directly received IVF-ET without receiving any treatment for hydrosalpinx.

The clinical pregnancy rate of the control group was significantly lower than that of the intervention group (P < .05), while the abortion rate and ectopic pregnancy rate of the control group were strikingly higher than that of the intervention group (P < .05).

Hydrosalpinx can decrease the clinical pregnancy rate of IVF-ET, and increase the incidence of abortion and ectopic pregnancy. The interventional embolization treatment for hydrosalpinx before IVF-ET can improve the clinical pregnancy rate and reduce adverse pregnancy outcome and which, with the advantages of a high success rate, convenient use, low cost, less pain, no anesthetic risk and no effect on the ovarian function it may further be developed for use in the clinic.
Primary biliary cirrhosis with refractory hypokalemia
Authors: Dong Kai-Hui , Fang Yi-Na , Wen Xiao-Yu , Jin Qing-Long
Published: November 2018

Rationale:

Renal tubular acidosis (RTA) represents a class of metabolic disorders characterized by metabolic acidosis with a normal plasma anion gap. As a rare complication of primary biliary cirrhosis (PBC), RTA is easily overlooked, likely leading to misdiagnosis.

Patient concerns:

A 32-year-old woman who had been diagnosed with PBC at our hospital was found to have hypokalemia due to repeated fatigue for 2 years, and the etiology was unknown.

Diagnoses:

Due to the laboratory test results, radiographic findings, and pathologic results, she was diagnosed with PBC associated with RTA.

Interventions:

She was then treated with ursodeoxycholic acid, potassium citrate, and calcium supplements together with activated vitamin D.

Outcomes:

Thus far, the patient showed a good response to ursodeoxycholic acid, and the clinical symptoms and liver function were significantly improved.

Lessons:

Physicians that encounter refractory hypokalemia in a patient with PBC should be aware of the presence of RTA. The early diagnosis and treatment of such patients are of paramount importance to alleviate clinical symptoms and delay disease progression.
Comparison of big funnel and individualized stents for management of stomach cancer with gastric outlet obstruction
Authors: Shi Ding , Liu Jianping , Hu Xujun , Liu Yongpan , Ji Feng , Bao Yinsu , Guo Daxin
Published: November 2018

Background:

Previous studies reported a similar rate of complications, including stent migration and obstruction, between individualized stents and the standard uncovered stents in gastric outlet obstruction (GOO) caused by distal stomach cancer. The objective of this study was to evaluate the efficacy and safety of funnel stents for management of GOO caused by distal stomach cancer.

Methods:

This study was designed as a multicenter, controlled, prospective, and randomized clinical trial involving 4 hospitals. The individualized stent group (44 cases) received cup and funnel covered stents, and the funnel group (44 cases) received only funnel covered stents for management of GOO caused by distal gastric cancer.

Results:

All patients with GOO were treated with cup and funnel stents according to their assigned groups. The rate of GOO resolution was 100% in the funnel group and 97.7% in the individualized stent group. Stent obstruction caused by tumor ingrowth was observed in 1 patient in the individualized stent group, and proximal partial stent migration was observed in 1 patient in each group. Stent obstruction caused by tumor ingrowth was observed in 1 patient in the individualized stent group. There was no statistical difference in stent migration, obstruction, and survival between groups.

Conclusion:

Big funnel stents and individualized stents resulted in similar shaping effect and prevention of stent migration and obstruction, suggesting that funnel shaped stents can be used to treat cup or funnel shaped GOO caused by distal stomach cancer.
The role of cognitive rehabilitation in limbic encephalitis
Authors: Corallo Francesco , Lo Buono Viviana , Di Cara Marcella , De Salvo Simona , Formica Caterina , Morabito Rosa , Floridia Daniela , Pastura Concetta , Rifici Carmela , D’Aleo Giangaetano , Sessa Edoardo , Bramanti Placido , Marino Silvia
Published: November 2018

Rationale:

Limbic encephalitis is a parenchymal inflammation caused by viral, bacterial, or other microbial and postinfectious agents, which is usually expressed by multifocal neurological signs and cognitive impairment.

Patient concerns:

A 50-year-old female was admitted in postacute phase, at our rehabilitative Center, to undertake neuro-motor treatment for a period of 4 months.

Diagnoses:

The patient was affected by limbic encephalitis. Clinical presentation revealed attention, memory and executive dysfunctions, as well as behavioral changes, emotional dysregulation and reduction of self-awareness.

Interventions:

The patients received an intensive cognitive and motor rehabilitation training.

Outcomes:

Neuropsychological assessment and magnetic resonance imaging were performed before and after rehabilitative training to evaluate the cognitive and cerebral changes induced by treatment. The patient showed an improvement in cognitive performances and behavioral aspects.

Lessons:

The reducing cognitive deficits, especially memory deficits, could improve quality of life by using available cognitive resources.