bluuebunny/crossref_metadata_2025 huggingface dataset:
Ausgaben der gesetzlichen Krankenversicherung für Gesundheitsförderung und Prävention 2012–2017: Positive Effekte durch das Präventionsgesetz?
Authors: Bödeker Wolfgang , Moebus Susanne
Published: March 2019

Hintergrund Das Präventionsgesetz zielt auf die Stärkung der Gesundheitsförderung und Prävention in Deutschland. Durch das Gesetz werden Änderungen bei den sogenannten „§20-Maßnahmen“ des Sozialgesetzbuch V vorgenommen. Für die durch die Krankenkassen zu erbringenden Leistungen in diesem Bereich wurden Richtwerte erhöht bzw. neu vorgegeben. Zielsetzung dieses Beitrags ist es zu untersuchen, wie sich die Präventionsausgaben der Gesetzlichen Krankenversicherung (GKV) im Zeitraum von 2012 bis 2017 entwickelt haben und ob die Vorgaben des Präventionsgesetzes erreicht wurden.

Methode Die Rechnungsergebnisse der GKV wurden ausgewertet. Die Leistungsausgaben pro Versicherte wurden berechnet und die Ausgabenveränderungen sowohl nach Einzelkonten als auch nach Präventionsbereichen zusammengefasst analysiert. Der Einfluss des Präventionsgesetzes wurde durch die Betrachtung der Zeiträume 2012–2017, 2012–2014 und 2014–2017 herausgestellt.

Ergebnisse Im Jahr 2017 entfielen 2,5% der Leistungsausgaben der GKV, ca. 5 Mrd. Euro, auf die ausgewiesenen Präventionsbereiche. Nahezu 60% dieser Präventionsausgaben wurden für (Krebs)-Früherkennung und Schutzimpfungen aufgewendet. Die Ausgaben für „§20-Maßnahmen“ beliefen sich auf € 7,17/Versicherte und erreichten damit den gesetzlichen Richtwert, machten aber weniger als 10% aller Präventionsausgaben aus. Die Präventionsausgaben pro Versicherte nahmen in Zeitraum zwar zu, der Anteil der GKV-Präventionsausgaben an den Leistungsausgaben hat sich aber seit 2015 insgesamt verringert. Ausgaben für Präventionsmaßnahmen, die sich direkt an die Versicherten richten (Individualansatz, Bonusprogramme) und des Setting-Ansatzes (nicht betriebliche Settings, betriebliche Gesundheitsförderung) sind nach Inkrafttreten des Präventionsgesetzes zusammen kaum gestiegen. Dies ergibt sich, weil trotz der Zunahme bei den Ausgaben für die betrieblichen und nicht betrieblichen Settings eine ebenso starke Abnahme bei den Versichertenboni für gesundheitsbewusstes Verhalten eingetreten ist.

Schlussfolgerungen Relativ zu den Gesamtausgaben der GKV nehmen die Präventionsausgaben weiterhin ab. Die durch das Präventionsgesetz vorgegeben Richtwerte wurden aber erreicht. Richtwerte haben sich als probates Instrument zur Lenkung von Präventionsausgaben erwiesen und zu einer Erhöhung der Ausgaben für den Setting-Ansatz geführt. Insgesamt zeigt sich aber kein Ausgabeneffekt im Bereich der Prävention seit dem Präventionsgesetz, da eine Kompensation zu Lasten der nicht mit Richtwerten versehenen Individuen bezogenen Maßnahmen (Bonusprogramme) erfolgte.
Quantitation of Ivosidenib, A Novel Mutant IDH1 Inhibitoron Mice DBS: Application to a Pharmacokinetic Study
Authors: Dittakavi Sreekanth , Jat Rakesh Kumar , Mullangi Ramesh
Published: March 2019

Ivosidenib is an approved drug for relapsed or refractory IDH1 mutant AML patients. The goal of the present work is to develop and validate an LC-MS/MS method for the quantitation of ivosidenib in mice dried blood spots (DBS) as per regulatory guideline in the linearity range of 1.10–3293 ng/mL. To date there is no bioanalytical method reported for quantitation of ivosidenib. The chromatographic resolution of ivosidenib and internal standard (warfarin) was achieved on a C18 column with an isocratic mobile phase. All validation parameters met the acceptance criteria. The intra- and inter-day precision was in the range of 2.79–10.5 and 5.76–9.02%, respectively. Ivosidenib was stable for 3 freeze/thaw cycles, up to 7 days at room temperature and for one month at −80°C. The applicability of the validated method is shown in a mice pharmacokinetic study. Ivosidenib was quantifiable up to 24 and 36 h following intravenous and oral administration to mice, respectively. The oral bioavailability was 48%. Comparison of DBS vs. plasma concentrations of ivosidenib showed excellent correlation, indicating DBS can be used as an alternative for plasma for pharmacokinetic analysis.
Intradural Extramedullary Spinal Metastasis of a Kidney Cancer: Case Report
Authors: Sarmento Marina , Haas Leandro , Tutida Letícia , Marques Natália , Scramocin Thaize , Omar Omar , Giustina Evelyn , Sartori Felipe , Camilo Liz , Borille Thaís , Bernardes Celso , Boer Vitor , Lara Danielle , Cabral Filipe , Mello Luís
Published: March 2019

Objective To report a case of intradural extramedullary metastasis originated from a kidney neoplasm. Metastases in this topography occur in a low frequency, especially considering that the primary tumor was located along the urinary system.

Case Report A male adult begins to present with pain in the lower limbs and develops flaccid paraparesis of the pelvic limbs, also attacking the control of the sphincter. The patient had a previous history of right nephrectomy due to a kidney neoplasm. After investigation with imaging exams, a metastatic lesion was found to be the source of the symptoms. The patient was surgically treated by the neurosurgery team of the hospital.

Conclusion Cases like this are not common, and considering the low incidence of these cases and the nonspecific symptoms, such as pain, we do not always come up with the hypothesis of a metastasis in this topography. The surgical treatment, although it is a palliative feature, has an important part in maintaining the performance and the quality of life of the patient.
Cementless versus Cemented Fixation in Total Knee Arthroplasty
Authors: Papas Paraskevi Vivian , Congiusta Dominick , Cushner Fred D.
Published: March 2019

Despite the success of total knee arthroplasty (TKA), more than 20,000 revision TKA procedures are performed annually. In an effort to decrease failures due to loosening in the past, cementless fixation of TKA was suggested. The preliminary results of cementless fixation for TKA proved to be discouraging, with midterm results linking the use of uncemented components to early aseptic loosening. While cemented TKA has remained the gold standard fixation technique, the changing demographics of the average TKA patient have led some surgeons to revisit cementless fixation as an option.
Effects of Supraphysiological Doses of Anabolic Androgenic Steroids on the Left Ventricles of Male and Female Mice Submitted to Swimming
Authors: Jerônimo Laís , Franco Priscila , Marques Petrus , Guerra Flávia , Rossi Junior Wagner , Esteves Alessandra
Published: March 2019

The use of anabolic androgenic steroids (AAS) has grown into a worldwide substance abuse problem over the last decades, with the doses taken by illegal users being 10 to 100 times higher than the therapeutic ones. In the present experiment, 60 mice were divided into 3 groups of 20 animals. Group 1 received testosterone cypionate (Deposteron [EMS, São Bernardo do Campo, SP, Brazil]); group 2 received stanozolol (Stanozolol Depot, Landerlan, Lambaré, Paraguay), and group 3 received saline solution), each one composed by 10 males and 10 females, treated once a week and put to swimming thrice a week for 2 months. After euthanasia, their chests were opened, the hearts removed and processed histologically for morphometric analyses. The specimens were cut into 6 different sections and each one was measured with the help of an optical microscope with a 40-fold magnification. For such analyses, the Axiovision Rel. 4.8.2 (Carl Zeiss Microscopy LLC, Peabody, MA, USA) and Axiovision 4 Module Interactive Measurement (Carl Zeiss Microscopy LLC) software were used. The results showed that there was an increase in the diameter of the left ventricles in the male mice treated with Deposteron while in the female animals treated with Winstrol, there was a decrease in the left ventricular diameter in relation to the other two groups. Thus, one can conclude that the use of supraphysiological doses of the given AAS significantly alters the ventricular diameter in both male and female animals, which can cause a considerable change in both heart rate and blood pressure, and potentially induce disorders that are very relevant to the organism.
Assembling responsive microgels at responsive lipid membranes
Authors: Wang Meina , Mihut Adriana M. , Rieloff Ellen , Dabkowska Aleksandra P. , Månsson Linda K. , Immink Jasper N. , Sparr Emma , Crassous Jérôme J.
Published: March 2019

Significance

Soft microgel-based colloids consisting of a responsive polymer network offer an ideal platform for exploring the interactions between nanomaterials and artificial model membranes. Here, we report a modality to pattern and assemble responsive colloids as microgels or lipogels—i.e., microgels associated with small lipid vesicles—to desired locations on phospholipid giant unilamellar vesicles. The tunable properties of the microgels—for example, softness, deformability, hydrophobicity, and thermosensitivity—are used to manipulate and guide the adsorption and assembly behavior. This study reveals that phospholipid bilayers are versatile molecular templates for defined and highly ordered interfacial assemblies, 2D colloidal crystals, and selective patterning as imposed by the fluidity of the membrane.
Age-Associated Differences in Central Artery Responsiveness to Sympathoexcitatory Stimuli
Authors: Bock Joshua M , Hughes William E , Casey Darren P
Published: March 2019

BACKGROUND

Age-associated arterial stiffening may be the result of greater tonic sympathetic nerve activity. However, age-associated changes in central artery responsiveness to sympathoexcitatory stimuli are understudied. Therefore, we examined changes in central artery stiffness and wave reflection in response to sympathoexcitatory stimuli in young and older adults.

METHODS

Fourteen young (25 ± 4 years) and 15 older (68 ± 4 years) subjects completed 3 minutes of the cold pressor test (CPT) and lower-body negative pressure (LBNP) separated by 15 minutes. Carotid–femoral pulse wave velocity (cfPWV), central augmentation pressure (cAP), and augmentation index (AIx) were measured in duplicate during rest and the final minute of each perturbation.

RESULTS

Young subjects had lower baseline cfPWV, cAP, and AIx than older subjects (P < 0.05 for all). During the CPT mean arterial pressure (MAP), cfPWV, cAP, and AIx increased in both groups (P < 0.05 for all); however, changes (Δ) in MAP (18 ± 7 vs. 9 ± 5 mm Hg), cfPWV (1.3 ± 0.7 vs. 0.6 ± 0.9 m/s), cAP (4 ± 2 vs. 6 ± 3 mm Hg), and AIx (18 ± 9% vs. 7 ± 4%) were greater in young vs. older subjects, respectively (P < 0.05 for all). With MAP as a covariate, cfPWV, cAP, and AIx responses to the CPT were no longer significantly different between groups. During LBNP, changes in MAP (–1 ± 3 vs. –3 ± 5 mm Hg), cfPWV (0.5 ± 0.3 vs. 0.5 ± 0.7 m/s), cAP (–2 ± 2 vs. –2 ± 3 mm Hg), and AIx (–7 ± 7% vs. –3 ± 6%) were similar between young and older groups, respectively (P > 0.05 for all).

CONCLUSIONS

Collectively, our data suggest the sympathetic nervous system may directly modulate central hemodynamics and that age-associated differences in central artery responsiveness to sympathoexcitatory stimuli are largely attributable to differential blood pressure responses.
The Limits of Critique and the Affordances of Form: Literary Studies after the Hermeneutics of Suspicion
Authors: Fluck Winfried
Published: March 2019

How are we going to read literature in the future? What is the direction literary studies should take? The question has gained urgency in view of a growing dissatisfaction with the mode of reading that has dominated the field over the last decades, a method of critical unmasking that is based, in one way or another, on a hermeneutics of suspicion and its key premise of the all-determining power of an absent cause. Concepts like reparative reading, surface reading, distant reading, new formalism and postcritique signal a search for alternatives. This essay focuses on two books that have been especially influential in this search, Rita Felski’s The Limits of Critique (2015), seen by many as a wake-up call to move beyond a stifling routine of suspicious readings, and Caroline Levine’s Forms: Whole, Rhythm, Hierarchy, Network (2015), an original reconsideration of the matter of form and its possible political functions. Both of these books want to escape narratives of determination in which singularity and difference are lost, but both approach the challenge in strikingly different ways. Both tell stories of a liberation from determinations that are based on very different founding assumptions. This suggests to discuss them in the larger context of other narratives of liberation in literary studies, as this essay does in its conclusion.
Comparison of haplotype-based tests for detecting gene–environment interactions with rare variants
Authors: Papachristou Charalampos , Biswas Swati
Published: March 2019

Dissecting the genetic mechanism underlying a complex disease hinges on discovering gene–environment interactions (GXE). However, detecting GXE is a challenging problem especially when the genetic variants under study are rare. Haplotype-based tests have several advantages over the so-called collapsing tests for detecting rare variants as highlighted in recent literature. Thus, it is of practical interest to compare haplotype-based tests for detecting GXE including the recent ones developed specifically for rare haplotypes. We compare the following methods: haplo.glm, hapassoc, HapReg, Bayesian hierarchical generalized linear model (BhGLM) and logistic Bayesian LASSO (LBL). We simulate data under different types of association scenarios and levels of gene–environment dependence. We find that when the type I error rates are controlled to be the same for all methods, LBL is the most powerful method for detecting GXE. We applied the methods to a lung cancer data set, in particular, in region 15q25.1 as it has been suggested in the literature that it interacts with smoking to affect the lung cancer susceptibility and that it is associated with smoking behavior. LBL and BhGLM were able to detect a rare haplotype–smoking interaction in this region. We also analyzed the sequence data from the Dallas Heart Study, a population-based multi-ethnic study. Specifically, we considered haplotype blocks in the gene ANGPTL4 for association with trait serum triglyceride and used ethnicity as a covariate. Only LBL found interactions of haplotypes with race (Hispanic). Thus, in general, LBL seems to be the best method for detecting GXE among the ones we studied here. Nonetheless, it requires the most computation time.
Despite Predominance of Uropathogenic/Extraintestinal Pathotypes Among Travel-acquired Extended-spectrum β-Lactamase–producing Escherichia coli, the Most Commonly Associated Clinical Manifestation Is Travelers’ Diarrhea
Authors: Kantele Anu , Lääveri Tinja , Mero Sointu , Häkkinen Inka M K , Kirveskari Juha , Johnston Brian D , Johnson James R
Published: March 2019

Background

One-third of the 100 million travelers to the tropics annually acquire extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae (ESBL-PE), with undefined clinical consequences.

Methods

Symptoms suggesting Enterobacteriaceae infections were recorded prospectively among 430 Finnish travelers, 90 (21%) of whom acquired ESBL-PE abroad. ESBL-PE isolates underwent polymerase chain reaction–based detection of diarrheagenic Escherichia coli (DEC) pathotypes (enteroaggregative E. coli [EAEC], enteropathogenic E. coli [EPEC], enterotoxigenic E. coli [ETEC], enteroinvasive E. coli, and Shiga toxin–producing E. coli), and extraintestinal pathogenic/uropathogenic E. coli (ExPEC/UPEC). Laboratory-confirmed ESBL-PE infections were surveyed 5 years before and after travel.

Results

Among the 90 ESBL-PE carriers, manifestations of Enterobacteriaceae infection included travelers’ diarrhea (TD) (75/90 subjects) and urinary tract infection (UTI) (3/90). The carriers had 96 ESBL-producing E. coli isolates, 51% exhibiting a molecular pathotype: 13 (14%) were DEC (10 EAEC, 2 EPEC, 1 ETEC) (12 associated with TD) and 39 (41%) ExPEC/UPEC (none associated with UTI). Of ESBL-PE, 3 (3%) were ExPEC/UPEC-EAEC hybrids (2 associated with diarrhea, none with UTI). Potential ESBL-PE infections were detected in 15 of 90 subjects (17%). The 10-year medical record survey identified 4 laboratory-confirmed ESBL-PE infections among the 430 travelers, all in subjects who screened ESBL-PE negative after returning home from their index journeys but had traveled abroad before their infection episodes.

Conclusions

Half of all travel-acquired ESBL-producing E. coli strains qualified molecularly as pathogens. Extraintestinal and uropathogenic pathotypes outnumbered enteric pathotypes (41% vs 14%), yet the latter correlated more closely with symptomatic infection (0% vs 92%). Despite more ESBL-PE strains qualifying as ExPEC/UPEC than DEC, travel-acquired ESBL-PE are more often associated with TD than UTI.
Clinical features and outcomes in a cohort of patients with immunoglobulin G4-related disease at a university hospital in Spain
Authors: Quero Maria , Draibe Juliana , Solanich Xavier , Rama Inés , Gomà Montserrat , Martínez-Valenzuela Laura , Fulladosa Xavier , Cruzado Josep M , Torras Joan
Published: March 2019

Background

Immunoglobulin G4-related disease (IgG4-RD) is a fibro-inflammatory, immune-mediated disorder, which characteristically affects the glandular tissue but has the potential to affect any organ.

Methods

We retrospectively reviewed clinical, laboratory, histological characteristics and treatment response during 12 months of follow-up of a cohort of patients with IgG4-RD diagnosed at a tertiary public hospital. Disease activity was assessed by means of the IgG4-RD responder index (IgG4-RD RI).

Results

In all, 15 patients have been diagnosed at our Institution and herein studied (80% men), with a median age of 60.7 years and a mean affectation of 2.8 organs per patient. We identified six patients with definitive diagnosis and nine with possible IgG4-RD, according to the Japanese diagnostic algorithm. IgG4-RD RI decreased from a median of 11.3 at baseline to 4.0 after 6 months and 6.2 after 12 months. Relapse occurred in five patients and was associated with lower cumulative steroid doses. Five patients (33.3%) required additional immunosuppressive (IS) drugs. Five adverse events were seen during follow-up: three infections, one deep vein thrombosis and one gastrointestinal bleeding. One patient died of pneumonia.

Conclusions

IgG4-RD is an inflammatory disease that can affect any organ. Glucocorticoids were an effective first line of treatment; however, this treatment is associated with important adverse events and relapses occurred in patients with low cumulative doses. As an alternative, IS treatment with rituximab could be an interesting option in those patients.
The Oxysterol Synthesising Enzyme CH25H Contributes to the Development of Intestinal Fibrosis
Authors: Raselli T , Wyss A , Gonzalez Alvarado M N , Weder B , Mamie C , Spalinger M R , Van Haaften W T , Dijkstra G , Sailer A W , Imenez Silva P H , Wagner C A , Tosevski V , Leibl Sebastian , Scharl M , Rogler G , Hausmann M , Misselwitz B
Published: March 2019

Intestinal fibrosis and stenosis are common complications of Crohn’s disease [CD], frequently requiring surgery. Anti-inflammatory strategies can only partially prevent fibrosis; hence, anti-fibrotic therapies remain an unmet clinical need. Oxysterols are oxidised cholesterol derivatives with important roles in various biological processes. The enzyme cholesterol 25-hydroxylase [CH25H] converts cholesterol to 25-hydroxycholesterol [25-HC], which modulates immune responses and oxidative stress. In human intestinal samples from CD patients, we found a strong correlation of CH25H mRNA expression with the expression of fibrosis markers. We demonstrate reduced intestinal fibrosis in mice deficient for the CH25H enzyme, using the sodium dextran sulphate [DSS]-induced chronic colitis model. Additionally, using a heterotopic transplantation model of intestinal fibrosis, we demonstrate reduced collagen deposition and lower concentrations of hydroxyproline in CH25H knockouts. In the heterotopic transplant model, CH25H was expressed in fibroblasts. Taken together, our findings indicate an involvement of oxysterol synthesis in the pathogenesis of intestinal fibrosis.
The association between the public reporting of individual operator outcomes with patient profiles, procedural management, and mortality after percutaneous coronary intervention: an observational study from the Pan-London PCI (BCIS) Registry using an interrupted time series analysis
Authors: Jones Daniel A , Rathod Krishnaraj S , Koganti Sudheer , Lim Pitt , Firoozi Sam , Bogle Richard , Jain Ajay K , MacCarthy Philip A , Dalby Miles C , Malik Iqbal S , Mathur Anthony , DeSilva Ranil , Rakhit Roby , Kalra Sundeep Singh , Redwood Simon , Ludman Peter , Wragg Andrew
Published: March 2019

Aims

The public reporting of healthcare outcomes has a number of potential benefits; however, unintended consequences may limit its effectiveness as a quality improvement process. We aimed to assess whether the introduction of individual operator specific outcome reporting after percutaneous coronary intervention (PCI) in the UK was associated with a change in patient risk factor profiles, procedural management, or 30-day mortality outcomes in a large cohort of consecutive patients.

Methods and results

This was an observational cohort study of 123 780 consecutive PCI procedures from the Pan-London (UK) PCI registry, from January 2005 to December 2015. Outcomes were compared pre- (2005–11) and post- (2011–15) public reporting including the use of an interrupted time series analysis. Patients treated after public reporting was introduced were older and had more complex medical problems. Despite this, reported in-hospital major adverse cardiovascular and cerebrovascular events rates were significantly lower after the introduction of public reporting (2.3 vs. 2.7%, P < 0.0001). Interrupted time series analysis demonstrated evidence of a reduction in 30-day mortality rates after the introduction of public reporting, which was over and above the existing trend in mortality before the introduction of public outcome reporting (35% decrease relative risk 0.64, 95% confidence interval 0.55–0.77; P < 0.0001).

Conclusion

The introduction of public reporting has been associated with an improvement in outcomes after PCI in this data set, without evidence of risk-averse behaviour. However, the lower reported complication rates might suggest a change in operator behaviour and decision-making confirming the need for continued surveillance of the impact of public reporting on outcomes and operator behaviour.
Air Pollution Alters Caenorhabditis elegans Development and Lifespan: Responses to Traffic-Related Nanoparticulate Matter
Authors: Haghani Amin , Dalton Hans M , Safi Nikoo , Shirmohammadi Farimah , Sioutas Constantinos , Morgan Todd E , Finch Caleb E , Curran Sean P
Published: March 2019

Air pollution is a heterogeneous environmental toxicant that impacts humans throughout their life. We introduce Caenorhabditis elegans as a valuable air pollution model with its short lifespan, medium-throughput capabilities, and highly conserved biological pathways that impact healthspan. We exposed developmental and adult life stages of C. elegans to airborne nano-sized particulate matter (nPM) produced by traffic emissions and measured biological and molecular endpoints that changed in response. Acute nPM did not cause lethality in C. elegans, but short-term exposure during larval stage 1 caused delayed development. Gene expression responses to nPM exposure overlapped with responses of mouse and cell culture models of nPM exposure in previous studies. We showed further that the skn-1/Nrf2 antioxidant response has a role in the development and hormetic effects of nPM. This study introduces the worm as a new resource and complementary model for mouse and cultured cell systems to study air pollution toxicity across the lifespan.
Alternatives to Aging Alone?: “Kinlessness” and the Importance of Friends Across European Contexts
Authors: Mair Christine A
Published: March 2019

Objectives

Increasing numbers of older adults cross-nationally are without children or partners in later life and therefore likely have greater reliance on nonkin (e.g., friends). This pattern may be particularly pronounced in country contexts that emphasize friendship. This article hypothesizes that those who lack kin (e.g., children, partners) and/or who live in countries with a stronger emphasis on friendship have more friends in their networks. Although these hypothesized patterns are consistent with interdisciplinary literatures, they have not been tested empirically and therefore remain overlooked in current “aging alone” narratives.

Method

This study combines individual-level data from the Survey of Health, Ageing, and Retirement in Europe (Wave 6) with nation-level data from the European Values Survey to estimate multilevel negative binomial models exploring number of friends among those aged more than 50 years who lack kin across 17 countries.

Results

Older adults who lack kin or whose kin are unavailable report more friends in their networks, particularly in countries with a higher percentage of people who believe that friends are “very important” in life.

Discussion

This article challenges dominating assumptions about “aging alone” that rely heavily on lack of family as an indicator of “alone.” Future studies of “kinlessness” should consider the extent to which friendship is correlated with lack of kin, particularly in more socioeconomically developed countries. Previous research on “aging alone” may have overestimated risk in more privileged countries that already emphasize friendship, but underestimated risk in family-centered countries where “kinlessness” and alternative sources of support are less common.
Clinical Factors Associated with Mortality in Cirrhotic Patients Presenting with Upper Gastrointestinal Bleeding
Authors: Bishay Kirles , Tandon Parul , Fisher Stacey , Yelle Dominique , Carrigan Ian , Wooller Krista , Kelly Erin
Published: March 2019

Background

Whether certain clinical or laboratory characteristics are able to differentiate cirrhotic patients with upper gastrointestinal bleeds (UGIB) at high-risk inpatient mortality is unknown. The objective of this study is to elucidate patient factors at presentation that are associated with in-hospital mortality.

Methods

A retrospective analysis of cirrhotic patients presenting with UGIB was performed. Baseline characteristics at admission including demographics, clinical and laboratory characteristics were collected. Factors associated with in-hospital mortality were evaluated with logistic regression analyses. The discriminative power of MELD score was evaluated with the use of area under the receiver operating characteristic (ROC) curve.

Results

One hundred and sixteen patients were included in this study. MELD score at presentation was higher in the death cohort (24.0 versus 14.8, P < 0.001) and remained significantly associated with mortality after multivariable adjustment (P < 0.001). ROC analysis of MELD score for death yielded an area under the curve of 0.88. At admission, the death group had lower systolic blood pressure (103 mmHg versus 123 mmHg, P=0.008 and more frequently presented with bright red blood per rectum (46.7% versus 11.9%, P = 0.003). Bilirubin and international normalized ratio were also higher, and albumin was lower in patients who died.

Conclusions

Among cirrhotic patients presenting with UGIB, the severity of symptoms and impairment in hepatic synthetic function is associated with in-hospital mortality. Admission MELD score may be useful in predicting in-hospital mortality.
Dysregulated miR-142, -33b and -423 in granulosa cells target TGFBR1 and SMAD7: a possible role in polycystic ovary syndrome
Authors: Li Yan , Xiang Yungai , Song Yuxia , Wan Lijing , Yu Guo , Tan Li
Published: March 2019

It is well established that microRNA (miRNA) expression profiles are altered in patients with polycystic ovary syndrome (PCOS). In addition, abnormal transforming growth factor beta (TGFB) signaling in granulosa cells is related to the pathological conditions of PCOS. However, the function of dysregulated miRNAs in PCOS is still unclear. In this study, we aimed to elucidate the roles of specific miRNAs in PCOS. We collected follicular fluid from 46 patients with PCOS and 32 healthy controls. Granulosa cells (GCs) were separated and the levels of six candidate miRNAs were determined by quantitative RT-PCR. The direct targets of three dysregulated miRNAs were predicted using bioinformatic tools and confirmed using a dual luciferase assay and immunoblotting. The biological function of three dysregulated miRNAs in primary GCs was determined using a cell proliferation assay and flow cytometry. We found that miR-423 expression was downregulated (P = 0.038), and the levels of miR-33b (P = 0.032) and miR-142 (P = 0.021) were upregulated in GCs from patients with PCOS, compared to controls. miR-423 directly repressed SMAD family member 7 (SMAD7) expression, while transforming growth factor beta receptor 1 (TGFBR1) was a direct target of both miR-33b and miR-142. An RNA oligonucleotide mixture containing miR-423 inhibitor, miR-33b mimic, and miR-142 mimic repressed TGFB signaling, promoted cell proliferation (P = 0.0098), repressed apoptosis (P = 0.027), and increased S phase cell numbers (P = 0.0036) in primary cultures of GCs, compared to the cells treated with a sequence scrambled control RNA oligonucleotide. This study unveiled the possible roles of three miRNAs in PCOS and might provide candidate biomarkers for PCOS diagnosis while in vivo functional studies, using transgenic or knockout mouse models, are expected to confirm the roles of dysregulated miRNAs in the pathogenesis of PCOS.
Excessive salt intake increases peritoneal solute transport rate via local tonicity-responsive enhancer binding protein in subtotal nephrectomized mice
Authors: Sun Ting , Sakata Fumiko , Ishii Takako , Tawada Mitsuhiro , Suzuki Yasuhiro , Kinashi Hiroshi , Katsuno Takayuki , Takei Yoshifumi , Maruyama Shoichi , Mizuno Masashi , Ito Yasuhiko
Published: March 2019

Background

High peritoneal transport is associated with high mortality and technical failure in peritoneal dialysis (PD). Baseline peritoneal solute transport rate (PSTR) as measured by the peritoneal equilibration test (PET) within 6 months after PD initiation varies between patients. Sodium is reported to be stored in the skin or muscle of dialysis patients. This study investigated whether excessive salt intake in uremic mice caused peritoneal alterations without exposure to PD fluid.

Methods

Sham-operated (Sham) and subtotal nephrectomized (Nx) mice were randomly given tap water or 1% sodium chloride (NaCl)-containing water for 8 weeks. PET was then performed to evaluate peritoneal function. Human mesothelial cell line Met-5A was used for in vitro studies.

Results

We observed higher PSTR in Nx mice with 1% NaCl-containing drinking water (Nx + salt) compared with those with tap water (Nx + water), along with enhanced angiogenesis and inflammation in the peritoneum. Blockade of interleukin (IL)-6 signaling rescued peritoneal transport function in Nx + salt mice. In cultured Met-5A, additional NaCl in the medium upregulated IL-6 as well as vascular endothelial growth factor-A, associated with increased expression and nuclear translocation of tonicity-responsive enhancer binding protein (TonEBP). Knockdown of TonEBP lowered the induction caused by high tonicity. Peritoneal TonEBP expression was higher in Nx + salt mice, while removal of high-salt diet lowered TonEBP level and improved peritoneal transport function.

Conclusions

Excessive dietary salt intake caused peritoneal membrane functional and structural changes under uremic status. TonEBP regulated hypertonicity-related inflammatory changes and might play a crucial role in high baseline peritoneal transport.
The revival of thermal utilization from the Sun: interfacial solar vapor generation
Authors: Zhou Lin , Li Xiuqiang , Ni George W , Zhu Shining , Zhu Jia
Published: March 2019

Since solar energy is the ultimate energy resource and a significant amount of global energy utilization goes through heat, there have been persistent efforts for centuries to develop devices and systems for solar–thermal conversion. Most recently, interfacial solar vapor generation, as an emerging concept of solar–thermal conversion, has gained significant attention for its great potentials in various fields such as desalination, sterilization, catalysis, etc. With the advances of rationally designed materials and structures and photon and thermal management at the nanoscale, interfacial solar vapor generation has demonstrated both thermodynamic and kinetical advantages over conventional strategies. In this review, we aim to illustrate the definition, mechanism and figures of merit of interfacial solar vapor generation, and to summarize the development progress of relevant materials and applications, as well as to provide a prospective view of the future.
Reduced Lower Extremity Functioning Is Associated With an Increased Rate of Being a Nondriver: The National Health and Aging Trends Study
Authors: Cisewski Jodi A , Durbin Laura L , Bond Elizabeth G , Qian Min , Guralnik Jack M , Kasper Judith , Mielenz Thelma J
Published: March 2019

Background

Driving a motor vehicle is an important aspect of mobility for older adults. Limited lower extremity functioning performance, as measured by the Short Physical Performance Battery (SPPB), has been associated with various negative health outcomes, but little is known about the association of SPPB scores with driving status.

Objective

The purpose of this study was to evaluate whether lower (poorer) SPPB scores are associated with an increased rate for being a current nondriver among a nationally representative sample of community-dwelling older adults.

Design

The National Health and Aging Trends Study is a longitudinal cohort study.

Methods

A population of 5935 participants, surveyed annually from 2011 to 2014 for the National Health and Aging Trends Study, was used to examine the relationship between SPPB and driving status. Using weighted data, multivariable Poisson regression with generalized estimating equations was used to calculate the rate ratios, adjusting for covariates and clustering due to the complex survey design.

Results

Participants with a low (poor) SPPB score (0–5) had a rate for being a current nondriver 2.01 times the rate (or 101% increase) of those with a high (good) SPPB score (10–12) (adjusted 95% confidence interval = 1.78–2.26).

Limitations

Current nondrivers were not asked whether they planned to resume driving if they had not driven in the previous year.

Conclusions

Unlike other factors, such as cognitive decline, lower SPPB scores (poorer lower extremity functioning) are significantly associated with an increased rate of being a current nondriver and are a modifiable risk factor. Further research is needed to examine whether optimum exercises and other physical therapist interventions focused on improving lower extremity strength and balance ultimately improve driving outcomes.
Physicians’ intention to provide exercise counseling to patients in Taiwan: an examination based on the Theory of Planned Behavior
Authors: Lynn An-Min , Huang Jiun-Hau
Published: March 2019

Increasingly more clinical guidelines have recommended that physicians provide exercise counseling (EC) to patients to help improve their lifestyle and enhance treatment effects. However, little is known about physicians’ EC intention and associated factors. This study aimed to systematically examine physicians’ EC intention using the Theory of Planned Behavior (TPB). Using the TPB as a theoretical and structural framework, 27 TPB items were developed and factor-analyzed to form five factors (i.e., attitudes toward positive and negative EC outcomes, subjective norms, and perceived control over EC under facilitating and constraining conditions) with satisfactory psychometric properties. Responses from 1,006 physicians (response rate 90.5%) were analyzed using multivariate logistic regression to examine the TPB-based factors associated with greater EC intention. Physicians’ favorable attitudes toward positive EC outcomes (adjusted odds ratio [AOR] 4.03) were most strongly linked to high EC intention, followed by supportive subjective norms (AOR 3.74) and high perceived control under facilitating conditions (AOR 1.64). Specifically, physicians’ EC intention was related to their attitudes toward better treatment effects and gaining respect from patients because of EC, perceived support for EC from patients and senior physicians, and perceived control over EC concerning their behavioral change skills. These findings could inform EC promotion efforts in clinical settings and medical education. EC-related training should be incorporated into medical school curriculum, residency training, and continuing medical education to enhance physicians’ EC-related knowledge and competence, including lifestyle management and behavioral change skills. Attention should also be paid to the role of patients and senior physicians in promoting EC.
Exposure to Cold Unmasks Potential Biomarkers of Fibromyalgia Syndrome Reflecting Insufficient Sympathetic Responses to Stress
Authors: Pardo José V. , Larson Robert C. , Spencer Rachel J. , Lee Joel T. , Pasley Jeffrey D. , Torkelson Carolyn J. , Larson Alice A.
Published: March 2019

Objectives:

Fibromyalgia syndrome (FMS) is a chronically painful condition whose symptoms are widely reported to be exacerbated by stress. We hypothesized that female patients with FMS differ from pain-free female controls in their sympathetic responses, a fact that may unmask important biomarkers and factors that contribute to the etiology of FMS.

Materials and Methods:

In a pilot study, blood pressure (BP), skin temperature, thermogenic activity, circulating glucose, and pain sensitivity of 13 individuals with FMS and 11 controls at room temperature (24°C) were compared with that after exposure to cold (19°C).

Results:

When measured at 24°C, BP, skin temperature, blood glucose, and brown adipose tissue (BAT) activity, measured using 18F-fluorodeoxyglucose positron-emission tomography/computed tomography, did not differ between controls and individuals with FMS. However, after cold exposure (19°C), BP and BAT activity increased in controls but not in individuals with FMS; skin temperature on the calf and arm decreased in controls more than in individiuals with FMS; and circulating glucose was lower in individiuals with FMS than in controls. Pain sensitivity did not change during the testing interval in response to cold.

Discussion:

The convergence of the effect of cold on 4 relatively simple measures of thermogenic, cardiovascular, and metabolic activity, each regulated by sympathetic activity, strongly indicate that individuals with FMS have impaired sympathetic responses to stress that are observable and highly significant even when measured in extraordinarily small sample populations. If insufficient sympathetic responses to stress are linked to FMS, stress may unmask and maximize these potential clinical biomarkers of FMS and be related to its etiology.
The long-term outcome of pelvic asymmetry during gait in children with cerebral palsy following unilateral femoral derotation osteotomy
Authors: Perotti Lucio , Church Chris , Dina Robert , Lennon Nancy , Henley John , Sees Julieanne , Miller Freeman
Published: March 2019

In this retrospective study, children with cerebral palsy underwent a unilateral femoral derotation osteotomy and had a preoperative (PO), short-term postoperative (1–3 years), and a long-term postoperative (≥5 years) gait analysis. Patients were subdivided into groups by the PO pelvic presentation and Gross Motor Function Classification System level. In children with PO pelvic external rotation, femoral derotation osteotomy decreased the hip internal rotation and decreased the pelvic external rotation. These results could influence surgical planning to achieve long-term pelvic asymmetry.
Practices concerning management of Gartland type III supracondylar humeral fractures among Italian pediatric orthopedic surgeons
Authors: Marengo Lorenza , Cravino Mattia , Origo Carlo
Published: March 2019

The purpose of this study was to investigate the current practice among Italian pediatric orthopedic surgeons concerning management of Gartland type III supracondylar humerus fractures (SHFs). A total of 17 Italian pediatric orthopedic surgeons were asked to complete a questionnaire about their attitudes and practices concerning Gartland type III SHF treatment in 2015. Overall, 67% of the fractures were treated in a delayed fashion (>6 h after patient presentation to the emergency department). Moreover, the method of fixation was lateral-only pinning (64% of the cases). Although the management of any child with a Gartland type III SHF should be individualized, this study shows that delayed surgery and lateral-only pin fixation is the preferred method for the treatment of most of these injuries.
Nonoperative treatment of stable juvenile osteochondritis dissecans of the knee: effectiveness of unloader bracing
Authors: Tepolt Frances A. , Kalish Leslie A. , Heyworth Benton E. , Kocher Mininder S.
Published: March 2019

The purpose of this study was to compare the treatment outcomes of stable juvenile osteochondritis dissecans (JOCD) of the knee in a large cohort treated nonoperatively with unloader bracing versus other nonoperative treatment modalities without unloader bracing. This retrospective study assessed the clinical course of skeletally immature patients who underwent a minimum of 3 months nonoperative treatment for stable JOCD of the femoral condyle at a single institution (2001–2014). Treatment was based on physician preference. Unloader bracing was compared with other ‘non-unloader’ modalities, with successful nonoperative treatment defined as the avoidance of subsequent surgical intervention. Two hundred ninety-eight patients were included, 219 (73%) of whom were male. The mean ± SD age at diagnosis was 11.5 ± 1.6 years. Thirty-five patients were diagnosed with bilateral OCD, resulting in 333 knees in total. One hundred eighty-seven (56%) knees were treated with unloader bracing for a minimum of 3 months, whereas 146 (44%) were treated with other nonoperative modalities. All patients were treated with activity restrictions. Weight-bearing restrictions were applied for a total of 83 (25%) cases, for durations ranging from 19 to 196 days (median: 46 days) and at similar rates across groups. Nonoperative treatment was successful in 189 (57%) knees with a median follow-up of 9.5 months (interquartile range: 5.9–15.7 months). Surgical intervention was required in 144 (43%) knees at a median time of 6.0 months (interquartile range: 4.1–10.5 months). The unloader bracing group more often required surgical intervention when compared with the nonunloader group [93/187 (50%) vs. 51/146 (35%) knees, respectively; P = 0.02]. Male sex (P = 0.05) and Hefti stage I (P = 0.05) showed possible associations with nonoperative treatment success. Nonoperative treatment for stable JOCD of the knee leads to the avoidance of subsequent surgical intervention in 57% of cases. Unloader bracing is not associated with significantly improved outcomes when compared with other nonoperative modalities. Level of Evidence: III Retrospective Comparative Case Series.
Developmental dysplasia of the hip and clubfoot treated by Pavlik and Ponseti methods
Authors: Oleas-Santillán Geovanny , Reid Nichols Louise , Rogers Kenneth J. , Richard Bowen James
Published: March 2019

Children having both typical developmental dysplasia of the hip (DDH) and clubfoot are rare, and early treatments of both conditions are recommended. The aim of this study was to evaluate the effects of the Ponseti method of clubfoot treatment on hips with DDH. After institutional review board approval, we identified children treated by the Ponseti and Pavlik methods between 2003 and 2016. During the Ponseti method treatment, the duration of manipulations, number of casts, tenotomies performed, and days in clubfoot orthosis were recorded. During DDH treatment, we registered duration for Pavlik and hip brace usage. Hips had dynamic sonography and radiographic evaluations. The cases were grouped according to the combination of DDH and clubfoot treatments: (a) concurrent, (b) sequential, and (c) hip observation. Seven cases of DDH and clubfoot were identified. The average number of Ponseti casts was 5.8 (range: 4–8 casts). The average number of days following the post-Achilles-tenotomy casting to the end of clubfoot bracing was 870 days (range: 90–1605 days). Eleven (four bilateral cases and three unilateral) clubfeet were corrected initially by the Ponseti method. The average number of days for Pavlik harness treatment was 74 (range: 10–126 days). Additionally, a hip orthosis was utilized in three children for an average of 131 days. At follow-up, all children had a high femoral neck-shaft angle averaging 152° (range: 144°–164°). One child (case 5) developed avascular necrosis of the femoral head, Kalamchi type I. Children with typical and nonsyndromic DDH and clubfoot treated by Pavlik harness and Ponseti methods are associated with abnormal hip development (coxa valga).
Multimodal Nutritional Management in Primary Lumbar Spine Surgery
Authors: Xu Bin , Xu Wei-xing , Lao Yang-jun , Ding Wei-guo , Lu Di , Sheng Hong-feng
Published: March 2019

Study Design.

A prospective randomized controlled trial.

Objective.

The purpose of this study was to evaluate the clinical effect and safety of a new multimodal nutritional management (MNM) protocol for patients receiving primary lumbar spine surgery.

Summary of Background Data.

Poor nutritional status is common in the perioperative period in primary lumbar spine surgery, and may impede recovery after surgery.

Methods.

A total of 187 patients were included in this prospective randomized controlled trial. They were randomly assigned to the MNM group or the control group. Albumin (ALB) infusion, postoperative ALB level, electrolyte disorders, postoperative electrolyte levels, transfusion rate, postoperative hemoglobin level, length of stay (LOS), and complications were compared between the groups.

Results.

Compared with the control group, the rate and the total amount of ALB infusion were lower in the MNM group, and the postoperative level of ALB in the MNM group was higher on the first postoperative day, and the third postoperative day. The incidence of hypokalemia, hyponatremia, and hypocalcemia were lower in the MNM group. In the MNM group, the postoperative levels of sodium, potassium, and calcium were higher than the control group. The transfusion rate was similar between the two groups. The hemoglobin level was similar between the two groups on first postoperative day, but was higher in the MNM group on third postoperative day. LOS in the MNM group was shorter than in the control group. The incidence of wound drainage was lower in the MNM group. No statistical differences were observed regarding surgical complications between the two groups.

Conclusion.

The MNM protocol effectively reduced ALB infusion, the incidence of electrolyte disorders, and wound drainage, increased the postoperative levels of ALB, sodium, potassium, and calcium, and reduced the LOS without increasing the rate of postoperative complications.

Level of Evidence: 2