bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the Mechanism of Detecting and Measuring Holes in Ad hoc Wireless Sensor Network
Authors: Bayoumi Mohamed A , Salem Tarek M , Koriem Samir M
Published: May 2019

Area detection and measuring is one of the most important problems in wireless sensor network because it mainly relates to the continuity and functionality of most routing protocols applied to the region of interest (ROI). Electronics failure, random deployment of nodes, software errors or some phenomena such as fire spreading or water flood could lead to wide death of sensor nodes. The damage on ROI can be controlled by detecting and calculating the area of the holes, resulting from the damaged sensor networks. In this paper, a new mathematical algorithm, wireless sensor hole detection algorithm (WHD), is developed to detect and calculate the holes area in ROI where the sensor nodes are spread randomly. WHD is developed for achieving quality of service in terms of power consumption and average hole detection time. The dynamic behavior of the proposed WHD depends on executing the following steps. Firstly, WHD algorithm divides down the ROI into many cells using the advantage of the grid construction to physically partition the ROI into many small individual cells. Secondly, WHD algorithm works on each cell individually by allocating the nearest three sensor nodes to each of the cell’s coordinates by comparing their positions, WHD connects each cell’s coordinate points with the selected sensor nodes by lines that construct a group of triangles, then WHD calculates the area of upcoming triangles. Repeating the previous step on all the cells, WHD can calculate and locate each hole in the ROI. The performance evaluation depends on the NS-2 simulator as a simulation technique to study and analyze the performance of WHD algorithm. Results show that WHD outperforms, in terms of average energy consumption and average hole discovery time, path density algorithm, novel coverage hole discovery algorithm and distriputed coverage hole Detection.
Finding ‘the Most Highly Qualified Publicists’: Lessons from the International Court of Justice
Authors: Helmersen Sondre Torp
Published: May 2019

Article 38(1) of the Statute of the International Court of Justice (ICJ Statute) instructs the Court to ‘apply … the teachings of the most highly qualified publicists’. This raises the question of how to decide who these ‘publicists’ are and how to rank them. This article suggests four factors that the Court’s judges apparently use when assessing the weight of ‘teachings’: the quality of the work, the expertise and official positions of the author(s) and agreement between multiple authors. Judges may invoke these factors because it can make their opinions more authoritative and saves time, and in order to conform with Article 38 of the ICJ Statute. Counting the authors and teachings that judges have highlighted as having high quality, being experts and holding prestigious official positions provides a list that is different from the lists of writers who are cited most often and by the most judges. While this gives a rough idea of who ‘the most highly qualified publicists’ may be, it also shows that a final, conclusive ranking cannot be given.
Moduli Spaces of Point Configurations and Plane Curve Counts
Authors: Reineke Markus , Weist Thorsten
Published: May 2019

We identify certain Gromov–Witten invariants counting rational curves with given incidence and tangency conditions with the Euler characteristics of moduli spaces of point configurations in projective spaces. On the Gromov–Witten side, S. Fomin and G. Mikhalkin established a recurrence relation via tropicalization, which is realized on the moduli space side using Donaldson–Thomas invariants of subspace quivers.
Treatment on Trial: Tanzania’s National Tuberculosis Program, the International Union against Tuberculosis and Lung Disease, and the Road to DOTS, 1977-1991
Authors: Gradmann Christoph
Published: May 2019

Tanzania's national tuberculosis control program, created in 1977, is credited with having been the main inspiration for the World Health Organization's Directly Observed Treatment, Short-Course (DOTS) strategy for the control of tuberculosis, which was implemented from 1994. The text focuses on what previously took place in Tanzanian tuberculosis control between 1977 and the early 1990s. What was it that the International Union against Tuberculosis and Lung Disease, which was central in the effort, assisted in creating? In what sense was the program innovative? How could a country whose health system was destroyed by a deepening economic crisis in the 1980s become a lighthouse of tuberculosis control? How much consideration was given to the rise of HIV/AIDS that occurred in parallel? The paper proposes answers to these questions, and suggests that we should see the creation of the Tanzanian program as a laboratory of nascent global health.
Emerging strategies for the identification of protein–metabolite interactions
Authors: Luzarowski Marcin , Skirycz Aleksandra
Published: May 2019

Interactions between biological molecules enable life. The significance of a cell-wide understanding of molecular complexes is thus obvious. In comparison to protein–protein interactions, protein–metabolite interactions remain under-studied. However, this has been gradually changing due to technological progress. Here, we focus on the interactions between ligands and receptors, the triggers of signalling events. While the number of small molecules with proven or proposed signalling roles is rapidly growing, most of their protein receptors remain unknown. Conversely, there are numerous signalling proteins with predicted ligand-binding domains for which the identities of the metabolite counterparts remain elusive. Here, we discuss the current biochemical strategies for identifying protein–metabolite interactions and how they can be used to characterize known metabolite regulators and identify novel ones.
Novel and conserved functions of S-nitrosoglutathione reductase in tomato
Authors: Hussain Adil , Yun Byung-Wook , Kim Ji Hyun , Gupta Kapuganti Jagadis , Hyung Nam-In , Loake Gary J
Published: May 2019

Novel functions of GSNOR have been uncovered in tomato.
Recalculating growth and defense strategies under competition: key roles of photoreceptors and jasmonates
Authors: Ballaré Carlos L , Austin Amy T
Published: May 2019

The growth–defense trade-off in plant biology has gained enormous traction in the last two decades, highlighting the importance of understanding how plants deal with two of the greatest challenges for their survival and reproduction. It has been well established that in response to competition signals perceived by informational photoreceptors, shade-intolerant plants typically activate the shade-avoidance syndrome (SAS). In turn, in response to signals of biotic attack, plants activate a suite of defense responses, many of which are directed to minimize the loss of plant tissue to the attacking agent (broadly defined, the defense syndrome, DS). We argue that components of the SAS, including increased elongation, apical dominance, reduced leaf mass per area (LMA), and allocation to roots, are in direct conflict with configurational changes that plants require to maximize defense. We hypothesize that these configurational trade-offs provide a functional explanation for the suppression of components of the DS in response to competition cues. Based on this premise, we discuss recent advances in the understanding of the mechanisms by which informational photoreceptors, by interacting with jasmonic acid (JA) signaling, help the plant to make intelligent allocation and developmental decisions that optimize its configuration in complex biotic contexts.
Clinical Accuracy of Holographic Navigation Using Point-Based Registration on Augmented-Reality Glasses
Authors: van Doormaal Tristan P C , van Doormaal Jesse A M , Mensink Tom
Published: May 2019

BACKGROUND

As current augmented-reality (AR) smart glasses are self-contained, powerful computers that project 3-dimensional holograms that can maintain their position in physical space, they could theoretically be used as a low-cost, stand-alone neuronavigation system.

OBJECTIVE

To determine feasibility and accuracy of holographic neuronavigation (HN) using AR smart glasses.

METHODS

We programmed a fully functioning neuronavigation system on commercially available smart glasses (HoloLens®, Microsoft, Redmond, Washington) and tested its accuracy and feasibility in the operating room. The fiducial registration error (FRE) was measured for both HN and conventional neuronavigation (CN) (Brainlab, Munich, Germany) by using point-based registration on a plastic head model. Subsequently, we measured HN and CN FRE on 3 patients.

RESULTS

A stereoscopic view of the holograms was successfully achieved in all experiments. In plastic head measurements, the mean HN FRE was 7.2 ± 1.8 mm compared to the mean CN FRE of 1.9 ± 0.45 (mean difference: –5.3 mm; 95% confidence interval [CI]: –6.7 to –3.9). In the 3 patients, the mean HN FRE was 4.4 ± 2.5 mm compared to the mean CN FRE of 3.6 ± 0.5 (mean difference: –0.8 mm; 95% CI: –3.0 to 4.6).

CONCLUSION

Owing to the potential benefits and promising results, we believe that HN could eventually find application in operating rooms. However, several improvements will have to be made before the device can be used in clinical practice.
The effects of pretransportation or arrival meloxicam administration to calves entering the feedlot on morbidity, biomarkers, performance, and carcass characteristics
Authors: Van Engen Nicholas K , Engelken Terry J , Lockard Caleb G , Lakritz Jeffery , Cernicchiaro Natalia , Wilson Blake K , Krehbiel Clint R , Coetzee Johann F
Published: May 2019

The objective of this trial was to investigate the effects of using meloxicam as a pretransport or on arrival therapeutic on disease outcomes of bovine respiratory disease (BRD), biomarker outcomes associated with BRD, performance characteristics over the first 42 d on feed, and carcass traits at harvest in cross bred beef cattle. Multisourced, crossbred steer calves (n = 168) consisting of mainly British and British-Continental breeds were purchased from an auction market in central Missouri. Calves were processed prior to transportation and again upon feedlot arrival. Animals were randomized to 3 separate treatments: pretransport meloxicam (PMEL), arrival meloxicam (AMEL), and a control group receiving inactive excipient (CONT). Dosing at 1 mg/kg on weighted averaged administered per os. Animals were weighed and blood was collected pre- and post-transport. Haptoglobin (Hp)-matrix metaloproteinase (MMP)-9 complex, cortisol, and substance P were quantified. Weights were taken again at 42 d and at harvest. Clinical signs of BRD were monitored using indicators of depression, appetite, respiration, and temperature that qualified the animals for treatment. Harvest parameters were collected using a standardized United States Department of Agriculture grading system for quality grade and yield grade. Meloxicam did not have a significant effect on BRD morbidity over the course of the study and there was no significant effect on performance characteristics at 42 d (P > 0.10). Of the calves that did succumb to BRD, no significant differences were found in severity of disease (P > 0.10). Concentrations of substance P and Hp- MMP-9, were increased on arrival (P ≤ 0.05) however no significant treatment effect or interaction were found between AMEL, PMEL, CONT, or across different levels of biomarkers (P > 0.10). Meloxicam use prior to or on arrival does not mitigate disease or improve performance during the feeding period.
A Clinical Reference Guide on Sexual Devices for Obstetrician–Gynecologists
Authors: Rubin Elizabeth S. , Deshpande Neha A. , Vasquez Peter J. , Kellogg Spadt Susan
Published: May 2019

In the United States, more than half of all women have used a vibrator, nearly one third of women have used a dildo, and more than three quarters of women who have sex with women have used a vibrator. Sexual devices can be used by patients with decreased libido, anorgasmia, conditions inhibiting vaginal penetration, partner erectile dysfunction, and motor or sensory disabilities. Basic knowledge of sexual devices can help obstetrician–gynecologists counsel patients about device safety, sharing, cleaning, disinfection, and material selection. Common sexual devices include vibrators, penetrative devices, anal-specific devices, and air pulsation devices. Collision dyspareunia aids can assist patients who experience difficulty with deep penetration owing to pain and structural limitations. Although rare, the most common risks of sexual devices are traumatic injury and infection. Barrier use over sexual devices and proper disinfection can help reduce, but not eliminate, the risk of transmission of common viral and bacterial sexually transmitted infections. Sexual devices made of nonporous materials are the safest and easiest to clean and disinfect. Porous materials should be avoided given inability to disinfect and risk of material breakdown. Sexual devices can benefit specific patient populations, including women who are pregnant or postpartum, those with disorders of sexual function or pelvic floor, menopausal patients, cancer patients undergoing treatment, and women with disability and chronic illness.
Recorded Diagnoses of Depression During Delivery Hospitalizations in the United States, 2000–2015
Authors: Haight Sarah C. , Byatt Nancy , Moore Simas Tiffany A. , Robbins Cheryl L. , Ko Jean Y.
Published: May 2019

OBJECTIVE:

To describe national, state-specific, and sociodemographic trends in diagnoses of depressive disorders recorded during delivery hospitalizations.

METHODS:

Data were analyzed from the National Inpatient Sample (2000–2015) and 31 publicly available State Inpatient Databases (2000–2015) of the Healthcare Cost and Utilization Project. Delivery hospitalizations were identified by using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic and procedure codes for obstetric delivery. Depressive disorders were identified from ICD-9-CM diagnoses codes classified as depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (291.89, 292.84, 293.83, 296.2–296.26, 296.3–296.36, 300.4, and 311). Prevalence rates and average annual rate change were calculated nationally and across 28 states with at least 3 years of data and age, payer source, and race or ethnicity.

RESULTS:

The U.S. rate of depressive disorders recorded during delivery hospitalizations increased from 4.1 diagnoses per 1,000 hospitalizations in 2000 to 28.7 in 2015. Rates significantly increased in 27 of the 28 states. Recent (2014–2015) rates were lowest in Hawaii and Nevada (less than 14/1,000) and highest in Vermont, Minnesota, Oregon, and Wisconsin (greater than 49/1,000). Rates in 2015 were highest among those aged 35 years or older, public insurance recipients, and non-Hispanic white women (greater than 31/1,000). The highest annual rate increases were in Vermont and Maine (3.8/1,000 or greater). Non-Hispanic white women, those 35 years of age or older, and public insurance recipients showed the highest annual rate increases during 2000–2015 (1.7/1,000 or greater).

CONCLUSION:

During 2000–2015, rates of depressive disorders recorded during delivery hospitalizations increased nationally, in 27 states with available data, and across all sociodemographic categories.
Treat-to-target in axial spondyloarthritis: gold standard or fools’ gold?
Authors: Machado Pedro M. , Deodhar Atul
Published: May 2019

Purpose of review

Treat-to-target (T2T) is an emerging management strategy in axial spondyloarthritis (axSpA). The concept was originally based on evidence from other chronic conditions, such as hypertension, diabetes and hypothyroidism, as well as some rheumatic diseases, such as rheumatoid arthritis and gout. The purpose of this review is to discuss the arguments against and in favour of adopting a T2T strategy in the management of axSpA.

Recent findings

International groups have recommended a T2T strategy in axSpA. Inactive disease according to the Ankylosing Spondylitis Disease Activity Score (ASDAS) has been suggested as a potential target. Achievement of ASDAS inactive disease has been associated with less progression of radiographic damage in several studies. Evidence for the benefit of a T2T approach has been published in psoriatic arthritis, a form of spondyloarthritis.

Observational evidence suggests that a T2T approach might be beneficial in axSpA. However, data from a prospective randomized study proving the efficacy of a T2T strategy compared to routine care are still lacking. Moreover, the cost-effectiveness of such strategy in clinical practice also needs to be tested. The target will need to be useful and feasible in both clinical practice and clinical trials.
Optimizing the Host in Fracture Surgery
Authors: Bergin Patrick F. , Tarkin Ivan S. , Kempton Lawrence B. , Sagi H. Claude , Hsu Joseph , Archdeacon Michael T.
Published: May 2019

Multiple factors impact fracture healing; thus, endocrine optimization and nutritional optimization warrant investigation in the acute fracture and nonunion patient. This article presents current evidence regarding the role of the endocrinologists and the dietician in the fracture patient as well as the most recent data assessing the vitamin D axis in these populations. Similarly, the most recent information regarding the use and risks of NSAIDs in fracture healing are presented. The fracture surgeon must consider each individual patient and weigh the benefits versus the costs of host optimization.
The Trauma Service Line: Revenue From Subsequent Injury- and Noninjury-Related Care
Authors: Flanagan Christopher D. , Rascoe Alexander S. , Wang David M. , Vallier Heather A.
Published: May 2019

Objective:

To calculate the revenue generated for injury- and noninjury-related services after the initial injury event in an orthopaedic trauma population.

Design:

Retrospective cohort study.

Setting:

Single Level 1 trauma center.

Participants:

Four hundred forty adult trauma patients treated operatively for spine, pelvis, and/or upper or lower extremity fractures with ≥1 night stay.

Intervention:

Operative fracture management.

Main Outcome Measurement:

Revenue for follow-up care and for noninjury-related indications for 24 months.

Results:

Most patients returned for follow-up (92.3%), generating 6704 visits with professional and technical collections of $8,135,022 and $37,292,722, respectively, per 1000 unique patients. The greatest revenue was from rehabilitation services. Patients were less likely to return if they resided outside adjacent counties [odds ratio (OR) = 0.16], experienced a complication (OR = 0.38), or were older (OR per 10-year increase: 0.66) (all P < 0.0001). More than 70% of trauma patients were new to our system, accounting for 33% of all subsequent noninjury-related visits, most for primary care (25.6%). Male patients [OR = 3.28, 95% confidence interval (CI), 1.08–9.93], nonwhites (OR = 3.41; 95% CI, 1.41–8.28), and patients residing near the trauma center (OR = 16.1, 95% CI, 2.13–121) were more likely to return (P < 0.0001). Realized noninjury-related professional and technical revenue was $506 per operative orthopaedic trauma case.

Conclusions:

Demographics and outcomes predict likelihood of follow-up. Rehabilitation services account for the greatest revenue per patient. The greatest number of return visits was for primary care services; awareness of such services, especially in men and in those residing near the hospital system, could improve retention.
Tacrolimus Trough Level at the First Month May Predict Renal Transplantation Outcomes Among Living Chinese Kidney Transplant Patients: A Propensity Score–Matched Analysis
Authors: Yin Saifu , Song Turun , Jiang Yamei , Li Xingxing , Fan Yu , Lin Tao
Published: May 2019

Background:

Monitoring and maintaining a stable tacrolimus trough level is essential because of its narrow therapeutic window and considerable fluctuation in the early phase after kidney transplantation. However, optimal tacrolimus exposure early after transplantation remains unclear among Chinese patients.

Methods:

In this propensity score–matched cohort study, we thoroughly investigated the association between tacrolimus trough level at the first month and acute rejection (AR) as well as infection within the first year after kidney transplantation.

Results:

In a first step, a total of 1415 patients were divided into 3 groups according to the receiver operating characteristic curve: low-level group (410 patients with a tacrolimus trough level <5.35 ng/mL at the first month), median-level group (466 patients with a tacrolimus trough level from 5.35 to 7.15 ng/mL), and high-level group (539 patients with a tacrolimus trough level >7.15 ng/mL). Ultimately, 363 and 459 pairs of cases were enrolled by using 2 propensity score matches between low- and median-level groups and between high- and median-level groups, respectively. Compared with patients in the low-level group, patients in the median-level group had lower risk of AR without increased incidence of infection (AR, 12.4% versus 5.7%, P = 0.02; infection, 13.2% versus 13.2%, P = 1.00 for low- and median-level groups, respectively) within the first year. Compared with patients in the high-level group, patients in the median-level group had lower incidence of infection without the growing risk of AR (infection, 17.6% versus 12.2%, P = 0.021; AR, 4.6% versus 5.4%, P = 0.545 for high- and median-level groups, respectively) within the first year. Multilogistic analysis showed that tacrolimus trough levels were an independent factor for AR (odds ratio, 0.749, 95% confidence interval, 0.632–0.888, P = 0.001). Tacrolimus trough levels were also associated with infection (odds ratio 1.110, 95% confidence interval, 1.013–1.218, P = 0.001). Serum creatinine levels were similar among groups. No difference was found in 1-, 3-, and 5-year graft survival and patient survival among groups.

Conclusions:

The tacrolimus trough level maintained between 5.35 and 7.15 ng/mL at the first posttransplant month may prevent AR without increasing the incidence of infection within the first year after living kidney transplantation among Chinese patients.
Hydrogen gas protects against ovariectomy-induced osteoporosis by inhibiting NF-κB activation
Authors: Wu Gang , Pan Lei , Sun Jing , Chen Guimin , Wang Shaohai
Published: May 2019

Objectives:

Osteoporosis is a prevalent condition among postmenopausal women, and lacks satisfactory therapeutic options. Hydrogen (H2) has been shown to be effective in alleviating many diseases. This study aimed to investigate the effects of H2on inhibiting osteoclastogenesis and bone loss in ovariectomized mice.

Methods:

Osteoclast differentiation from Raw264.7 cells was induced with receptor activator NF-κB ligand (RANKL) with or without 60% H2. The number and resorption activity of osteocalsts were assessed by tartrate-resistant acid phosphatase staining and pit formation assay, respectively. The expression of osteoclast markers and NF-κB phosphorylation were detected by western blot. NF-κB nuclear translocation was assessed by immunofluorescence. NF-κB transcriptional activity was analyzed by luciferase assay. Bone loss in mice was induced by ovariectomy (OVX). OVX mice were given either regular air or 60% H2. Bone structure was analyzed by micro-computed tomography and hematoxylin and eosin staining. Cytokine levels were measured by enzyme-linked immunosorbent assay. The data were analyzed with one-way or two-way ANOVA followed by Bonferroni post hoc tests.

Results:

H2did not have any measurable effect on the proliferation of Raw264.7 cells. The number of osteoclasts and size of resorption pits of RANKL+H2-treated cells were 3 to 4 times less than RANKL treated cells. The expression of osteoclast marker genes of RANKL+H2-treated cells was 30% to 60% lower than RANKL-treated cells (P< 0.05). H2markedly inhibited RANKL-induced activation, nuclear translocation, and transcriptional activity of NF-κB (P < 0.05, RANKL+H2vs RANKL). The amount and density of trabecular bone and bone mineral density of ovariectomized mice were significantly less than sham-operated mice (P < 0.05 OVX vs sham). The amount of trabecular bone and bone mineral density of OVX mice that inhaled H2were more than 40% higher, whereas the levels of serum proinflammatory cytokine interleukin 1β, IL-6, and tumor necrosis factor-α were more than 50% lower than those of OVX mice (P < 0.05).

Conclusions:

These results demonstrated that H2could be an effective therapeutic agent of postmenopausal osteoporosis.
Shared Medical Appointments in Preoperative Joint Replacement: Assessing Patient and Healthcare Member Satisfaction
Authors: Powell Robert L. , Biernacki Pamela J.
Published: May 2019

Background:

Shared medical appointments (SMAs) have proven to be effective in improving patient access and education while augmenting productivity. In shifting from a traditional visit model, patient and interdisciplinary healthcare team (IHCT) member satisfaction is imperative. Predominantly seen in primary care, SMA use in orthopedics is limited. After identification of access and productivity concerns, the SMA was implemented as a quality improvement project in a rural clinic. The lower extremity joint replacement (LEJR) population was chosen because of multiple preoperative appointments and costs on the healthcare system.

Purpose:

To assess patients' and IHCT members' satisfaction levels in using an SMA for the preparation of LEJR.

Relevance to Healthcare Quality:

The SMA is an effective model offering an efficient, cost-effective methodology aligning with the Institute for Healthcare Improvement's Triple Aim.

Results:

Twenty SMAs were conducted. Sixty-three patients and 14 ICHT members participated. Mean (M) satisfaction rating for SMA patients (M = 4.90, SD 0.26) was significantly higher than mean for traditional patients (M = 4.03, SD 0.39). Interdisciplinary healthcare team members' attitudes toward SMAs revealed a mean score of 4.58. Incidentally, cycle times improved as did lengths of stay.

Conclusions:

Lower extremity joint replacement patients and IHCT members reported high satisfaction with SMAs.
Impact of contrast ultrasound diagnosis for patients with liver cancer
Authors: Guo Hong-bin , Wang Jun-hu
Published: May 2019

Background:

Numerous studies have reported that contrast ultrasound (CU) can be utilized for diagnosis in patients with liver cancer (LC) accurately. However, no systematic review has addressed to assess its diagnostic impact on patients with LC. Thus, this systematic review will investigate the accurate of CU diagnosis on LC.

Methods:

A comprehensive literature search for relevant studies will be performed in the Cochrane Library, EMBASE, MEDILINE, Web of Science, PSYCINFO, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inceptions to the March 10, 2019. All case-controlled studies investigating the impacts of CU diagnosis on LC will be included in this study. Two researchers will independently carry out study selection, quality assessment, and data extraction. The quality will be assessed by using Quality Assessment of Diagnostic Accuracy Studies tool. Statistical analysis will be conducted by RevMan V.5.3 (Cochrane Community, London, UK) and Stata V.12.0 software (Stata Corp, College Station).

Results:

This study will present the accuracy of CU diagnosis for patients with LC through the assessment of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CU.

Conclusion:

The findings of this study will summarize the current evidence for accuracy of CU diagnosis in patients with LC.

Systematic review registration:

PROSPERO CRD42019127108.
Usefulness of hyperintense acute reperfusion marker sign in patients with transient neurologic symptom
Authors: Kang Jihoon , Kwon Hyuksool , Jung Cheol Kyu , Bae Hee-Joon , Han Moon-Ku , Kim Beom Joon , Jo You Hwan
Published: May 2019

It aimed to investigate the incidence and final diagnosis of hyperintense acute reperfusion marker (HARM) signs in patients initially suspected of having a transient ischemic attack (TIA).

In retrospective manner, a series of consecutive series of patients who arrived at the emergency department and was initially assessed as TIA within 12 hours of symptom onset between July 2015 and December 2016 were enrolled. Conventional magnetic resonance imaging protocol including diffusion-weighted imaging (DWI) and pre- and post-contrast fluid attenuation inversion recovery imaging (FLAIR) was conducted to evaluate the ischemic lesion and prognosis. Through the review of medical records and imaging studies, their final diagnosis and its association with HARM signs on post-contrast FLAIR were investigated.

A total of 174 subjects were enrolled (mean age, 64.0 ± 12.9 years old; male, 54.6%; DWI lesion, 17.8%). HARM signs were observed in 18 (10%) patients, and their final diagnoses were classified as true TIA (n = 11, 61%), seizure (2, 11%), posterior reversible encephalopathy (2, 11%), reversible cerebral vascular constriction (1, 6%) and unclassified encephalopathy (2, 11%). The co-occurrence of HARM and DWI lesions were observed in 7 subjects which were 6 subjects of true TIA (ischemic stroke) and 1 subject with RCVS related ischemic stroke.

The observation of HARM sign would be helpful to confirm the ischemic insult and distinguish the other disease.
Ultrasound-guided intra-articular injection of hyaluronic acid and ketorolac for osteoarthritis of the carpometacarpal joint of the thumb
Authors: Koh Sung Hoon , Lee Sang Chul , Lee Woo Yong , Kim Jongwoo , Park Yongbum
Published: May 2019

Intra-articular hyaluronic acid (HA) is widely used to treat symptomatic osteoarthritis (OA) in the carpometacarpal joint (CMCJ) of the thumb. However, although apparently effective and relatively safe, intra-articular HA injections act relatively slowly. Therefore, a nonsteroidal anti-inflammatory drug could be added for more prompt pain relief. The aim of this study was to compare the efficacy and safety of ultrasound (US)-guided intra-articular injection of HA and ketorolac with that of HA alone in patients with OA of the CMCJ of the thumb.

Seventy-four patients identified by chart review to have a diagnosis of OA of the CMCJ of the thumb received either a US-guided intra-articular injection of 0.5 mL of sodium hyaluronate and 0.5 mL of ketorolac (n = 38) or 0.5 mL of sodium hyaluronate and 0.5 mL of saline (n = 36). Disabilities of the arm, shoulder, and hand (DASH) and verbal numeric scale (VNS) pain scores were recorded before and 1, 3, and 6 months after injection. Univariable analyses (using the chi-squared test) and multiple logistic regression analysis were performed to evaluate the relationship between potential predictors of the outcome (treatment allocation, patient age and sex, duration of pain, and Eaton–Littler classification) and therapeutic effects.

The DASH and VNS scores were improved at 1, 3, and 6 months postinjection in both groups. The onset of pain relief was significantly more rapid (at 1 month) after the injection containing HA and ketorolac than after the injection containing HA alone. In 55.3% of cases, pain and function were improved postinjection compared with baseline and remained so for up to 6 months. The success rate was not significantly different between the assessments at 1, 3, and 6 months, and the univariable analyses did not identify any statistically significant potential predictors of the outcome. Multiple logistic regression analysis did not identify any independent predictors of a successful outcome at midterm follow-up.

The onset of analgesic action was more rapid after an injection containing HA and ketorolac than after 1 containing HA alone in patients with OA of the CMCJ of the thumb. There were no serious complications.
A cohort study of both human menopausal gonadotropin (HMG) and recombinant luteinizing hormone addition at early follicular stage in in vitro fertilization outcome
Authors: Xia Xi , Shi Yu , Geng Lan , Liu Dan , Hou Zhenhui , Lin Hongbo , Li Rong , Wang Haiyan , Tao Liyuan , Meng Fanhua , Da Jian , Chen Yun , Qiao Jie , Qian Weiping , Li Hongzhen
Published: May 2019

At present, the precise role of human menopausal gonadotropin (HMG) and recombinant luteinizing hormone (rLH) supplementation at an early time of follicular phase on in vitro fertilization (IVF)/intra cytoplasmatic sperm injection (ICSI) outcomes remains uncertain.

Here infertile women of normal ovarian function undergoing their first cycle of IVF/ICSI were studied and were randomly allocated into 3 groups. Group 1, ovarian stimulation with 150IU recombinant follicle-stimulating hormone (FSH) alone. Group 2, patients received 75IU rFSH and 75IU HMG. Group 3 patients were given 150IU rFSH and 75IU rLH.

There were no significant differences in the clinical characteristics, ovarian response, the biochemical, clinical and ongoing pregnancy rates among the 3 groups. No significant differences were found in biochemical, clinical and ongoing pregnancy rates between the patients whose LH levels were lower than 0.75 mIU/ml and those above this threshold in group 1. Furthermore, there were also no significant differences in biochemical, clinical and ongoing pregnancy rates among the 3 group patients whose LH level lower than 0.75 mIU/ml.

The results showed that either the addition of HMG or rLH supplementation at an early time of follicular phase produce no significant benefit on IVF outcome in patients with normal ovarian function.
Evaluation of a strategy to shorten the time to surgery in patients on antiplatelet therapy with a proximal femur fracture (AFFEcT Study)
Authors: Rafael Anaya , Mireia Rodriguez , José María Gil , Victoria Moral , Angélica Millan , Noèlia Vilalta , Erica Claudia , Rosa María Antonijoan , Francesca Reguant , Patricia Guilabert , Domingo Blanco , José Mateo , Angela Merchán-Galvis , Maria Jose Martinez-Zapata
Published: May 2019

Introduction:

Patients with femur fracture benefit from early surgery. Recent reports suggest that regional anesthesia may be superior to general anesthesia in these patients. Early surgery under spinal anesthesia could be performed safely by determining platelet function in patients receiving antiplatelet agents.

Methods:

Multicenter, randomized, open-label, parallel clinical trial expected to include 156 patients ≥ 18 years of age under chronic treatment with antiplatelet agents who develop a proximal femur fracture. Exclusion criteria: presence of multiple or pathological fractures, current treatment with vitamin K antagonists or new oral anticoagulants, and congenital or acquired coagulopathy.

Patients will be randomized to either

The primary endpoint is time (hours) from admission to surgery. Secondary endpoints include: platelet function; postoperative bleeding; medical-surgical complications; perioperative and 1-year mortality; quality of life; length of hospital stay; cost-effectiveness; and cost-utility. Follow-up assessments will be performed during hospital admission and at 1, 6, and 12 months after surgery.

Potential impact of the study:

The determination of platelet function at admission to the emergency department in patients with femoral fracture receiving antiplatelet therapy may permit earlier surgery under spinal anesthesia, thus shortening the hospital stay and reducing the risk of complications. These advantages associated with early surgery could positively impact patient well-being and also reduce treatment-related healthcare costs.

Ethics and dissemination:

The study has been approved by the ethics committees at all participating centers. Their results will be disseminated in congresses and published in peer reviewed journals.
Short- and long-term impacts of adenoidectomy with/without tonsillectomy on immune function of young children <3 years of age
Authors: Yan Yuyan , Song Yingluan , Liu Yingying , Su Jinzhu , Cui Li , Wang Juan , Geng Jiangqiao , Liu Xiaofeng , Shi Yanan , Quan Shan , Hang Aiping , Zuo Lujie
Published: May 2019

To investigate the short- and long-term impacts of adenoidectomy with/without tonsillectomy on the immune functions of young children < 3 years of age.

This longitudinal prospective study included 40 pediatric patients (age <3 y) undergoing adenoidectomy with/without tonsillectomy for snoring and sleep apnea. Serum immunoglobulin IgA, IgG, IgM, complement C3, and C4 levels were measured for the status of humoral immunity; CD3+, CD4+, CD8+, CD4+/CD8+, CD19+, CD56+, CD3+CD4-CD8-, and CD3+CD4+CD8+ T cells were measured for the status of cellular immunity. Blood samples were taken at 3 time points: before surgery, 1 month after surgery (short-term), and 3 months after surgery (long-term). All patients were assessed for short-term outcome at 1-month postoperation, but only 30 patients were followed at 3 months after surgery. The incidence of recurrent respiratory tract infections and other immune-related conditions were recorded at each follow-up.

The levels of IgA significantly decreased from the preoperative level at 1-month follow-up (P < .05), but still within normal range. No significant changes were found in the levels of IgA, IgG, IgM, C3, C4, CD3+, CD4+, CD8+, CD4+/CD8+, CD19+, CD56+, CD3+CD4-CD8-, and CD3+CD4+CD8+ T cell at 3-month follow-up in comparison with preoperative levels. There was also no episode of recurrent respiratory tract infection and other immune-deficiency conditions.

Adenoidectomy with/without tonsillectomy may result in a reduction in individual antibodies in children <3 years of age, but did not show negative impacts on their immune functions. Also, the surgery does not lead to the increased risk of upper respiratory tract infection in these children.
Relationship between esophageal motility and severity of gastroesophageal reflux disease according to the Los Angeles classification
Authors: Liu Lan , Li Shuai , Zhu Kongxi , Yu Weihua , Wang Hongjuan , Guo Jianqiang , Gao Hongwei
Published: May 2019

The current study aimed to investigate the relationship between the severity of gastroesophageal reflux disease (GERD) according to the Los Angeles (LA) classification and esophageal motility using high-resolution manometry (HRM) and 24-hour esophageal pH monitoring.

We examined 124 patients with GERD from January 2016 to June 2018. The LA classification of each patient was determined by endoscopy. HRM was performed by the intraluminal water infusion method. HRM and 24-hour esophageal pH monitoring parameters of the patients were studied and statistically compared.

On HRM examination, GERD symptoms were found to be associated with worsened distal contractile integral (DCI), ineffective esophageal motility (IEM), peristalsis break (PB), lower esophageal sphincter (LES) pressure, and the 4-second integrated relaxation pressure (IRP4s) of LES pressure along with the grade of LA classification, especially in patients having grade C and D GERD who had transverse mucosal breaks. The 24-hour pH monitoring study revealed that patients classified as having grade C or D GERD had an esophageal pH < 4.0 for a longer time than those with grade O, A, or B GERD. Similar results were found regarding the duration of the longest reflux event, the number of reflux episodes longer than 5 minutes, and the number of reflux episodes. Patients with higher grade esophagitis had higher De Meester scores, which suggested greater esophageal acid exposure. Hiatal hernia (HH) was more closely related to LES pressure, IRP4s, and acid exposure, whereas DCI, IEM, and PB were not statistically different between patients with GERD with and without HH.

Patients with severe esophagitis may have motor dysfunction not only in the LES but also in the esophageal body, with resulting increased esophageal acid exposure, which causes esophagitis. Low LES pressure might be the main reason that patients with HH develop esophagitis. GERD without HH may be due to a variety of motor dysfunctions.
The prognostic values of insulin-like growth factor binding protein in breast cancer
Authors: Wang Jiao , Luo Xin-Xin , Tang Yun-Liang , Xu Ji-Xion , Zeng Zhen-Guo
Published: May 2019

Insulin-like growth factor binding proteins (IGFBPs) are a family of proteins binding to insulin-like growth factors, generally consisting 6 high-affinity IGFBPs, namely IGFBP1 through IGFBP6. IGFBP family members have been indicated to be involved in the development and progression of tumors and may be useful prognostic biomarkers in various malignancies. However, the prognostic role of individual IGFBPs, especially at the mRNA level in breast cancer patients remains elusive.

We accessed the prognostic roles of IGFBPs family (IGFBP1-6) in breast cancer through the “Kaplan–Meier plotter” online database and OncoLnc database.

Our results showed that the high expression of IGFBP1 mRNA was associated with favorable relapsed free survival (RFS) in all breast cancer patients. The high expression of IGFBP2 mRNA was associated with favorable overall survival (OS) and RFS in all breast cancer patients. The high expression of IGFBP3 mRNA was significantly correlated to worsen RFS in all breast cancer patients. The high expression of IGFBP4 mRNA was associated with favorable OS, RFS, distant metastasis-free survival, and post-progression survival in all breast cancer patients.

Our results indicated that expression of IGFBPs mRNA may have prognostic values in breast cancer patients, and have a benefit for developing tools to predict the prognosis more accurately.
Prediction of intestinal failure from necrotizing enterocolitis following surgery
Authors: Wang Huan , Wang Yan , Deng Chun , Li Lei , Guo Chunbao
Published: May 2019

The aim of the present study was to identify risk factors for intestinal failure (IF) in infants who received surgery for necrotizing enterocolitis (NEC).

A retrospective multicenter case-series study was conducted in a sample of 91 infants admitted to Children's Hospital of Chongqing Medical University between January 2010 and December 2017. The occurrence of IF was defined as the dependence on parenteral nutrition for ≥90 days. Logistic regression was used to investigate the predictors of IF.

Of 179 patients reviewed, excluding those with intestinal malformation and inadequate information, 91 were included in the study, and of these cases, 32 (35.2%) developed IF. Controlling for other factors, multivariate analysis showed that birth weight (OR = 0.999; 95% CI, 0.998–1.000; P = .010), the length of the bowel resected (OR = 1.109; 95% CI, 1.048–1.173; P = .000), and the percentage of small bowel resected (OR = 1.305; 95% CI, 1.133–1.504; P = .000) were factors that increased the chances of IF occurrence.

Our data demonstrated that variables characteristic of severe NEC, including lower birth weight, greater extent of bowel resection, and larger percentage of small bowel resection were associated with the incidence of IF.
The effects of intradialytic resistance training on muscle strength, psychological well-being, clinical outcomes and circulatory micro-ribonucleic acid profiles in haemodialysis patients
Authors: Zelko Aurel , Skoumalova Ivana , Kolarcik Peter , Rosenberger Jaroslav , Rabajdova Miroslava , Marekova Maria , Geckova Andrea Madarasova , van Dijk Jitse P. , Reijneveld Sijmen A.
Published: May 2019

Background:

Intradialytic resistance training (IRT) protects patients’ muscle mass and functions against protein-energy wasting, malnutrition and cachexia. However, the evidence of the effects of such an intervention in haemodialysis patients is limited and not conclusive. To improve the applicability of such interventions, we need a better understanding of molecular, functional and psycho-social adaptation in dialysed patients following a physical training. Therefore, the aim of this study is to investigate the effects of IRT on lower extremity muscle functions, quality of life, and anxiety and depression, clinical outcomes and circulatory micro-ribonucleic acid (miRNA) profiles in patients on chronic haemodialysis therapy.

Methods:

We will perform a quasi-experimental study in 3 dialysis centres. Patients will be recruited via their nephrologists and will be allocated to an experimental and a control group based on the location of the patients’ dialysis centre. Patients allocated to the experimental group will undergo a 12-week IRT, while the control group will remain physically inactive during dialysis. The primary outcome is the change in the maximal force produced during an isometric contraction of lower extremity muscles. Secondary outcomes regard quality of life, anxiety and depression, clinical outcomes and circulatory miRNA profiles. Patients’ level of health literacy defined as the ability to get and understand health information will be also measured in the study as a potential modifier of effects.

Discussion:

This quasi-experimental study can add in an important way to our understanding of the effects of resistance training on dialysis patients’ muscle strength, quality of life and disease-specific outcomes.
The impact of natural disasters on medicare costs in U.S. gulf coast states
Authors: Horney Jennifer , Rosenheim Nathanael , Zhao Hongwei , Radcliff Tiffany
Published: May 2019

Medicare utilization and costs for residents of the U.S. Gulf Coast, who are highly vulnerable to natural disasters, may be impacted by their disaster exposure.

To estimate differences in healthcare utilization by disaster exposure, we calculated Medicare expenditures among residents of U.S. Gulf States and compared them with expenditures among residents of other regions of the U.S.

Panel models were used to calculate changes in overall Medicare expenditures, inpatient expenditures, and home health expenditures for 32,819 Medicare beneficiaries. Individual demographic characteristics were included as predictors of change in expenditures.

Medicare beneficiaries with National Health Interview Survey participation were identified and Part A claims were linked. Federal Emergency Management Agency (FEMA) data was used to determine counties that experienced no, some, high, and extreme hazard exposure. FEMA data was merged with Medicare claims data to create a panel dataset from 2001 to 2007.

Medicare Part A claims for the years 2001 to 2007 were merged with FEMA data related to disasters in each U.S. County. Overall Medicare costs, as well as costs for inpatient and home health care for residents of states located along the U.S. Gulf Coast (Texas, Louisiana, Mississippi, Alabama, and Florida) were compared to costs for residents of the rest of the U.S.

Expenditures among residents of U.S. Gulf States decreased with increased hazard exposure. Decreases in inpatient expenditures persisted in the years following a disaster.

The use of beneficiary-level data highlights the potential for natural hazards to impact health care costs. This study demonstrates the possibility that exposure to more severe disasters may limit access to health care and therefore reduce expenditures. Additional research is needed to determine if there is a substitution of services (e.g., inpatient rehabilitation for home health) in disaster-affected areas during the post-disaster period.