bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards a fully automated car parking system
Authors: Mahmood Zahid , Haneef Ossama , Muhammad Nazeer , Khattak Shahid
Published: October 2018

Currently, payment at most car parking‐lots is carried out in the following manner: a ticket machine at entrance prints a ticket with a bar‐code for each car entering the parking‐lot. This ticket is later scanned at a payment terminal to determine the amount to be paid. The procedure can be automated using face detection and recognition technology. This automation can help with the issue of ticket loss/car theft. This study describes an automated car parking system. The proposed system consists of a camera installed at the entrance/exit of the parking‐lot. Frames are continuously acquired by the camera. If there is a detected face, it is registered in the database. When a driver is leaving, the face image is captured again at the exit of parking‐lot and compared in the database to conclude the identity. The system at the parking entrance/exit is composed of the following processing modules: (i) image acquisition, (ii) vehicle and face detection, and (iii) feature extraction that also includes a feature comparison/classification module for face recognition. The authors propose suitable algorithms for each module and carry out ad‐hoc experiments to check the feasibility of the proposed system.
Direct‐yaw‐moment control of four‐wheel‐drive electrical vehicle based on lateral tyre–road forces and sideslip angle observer
Authors: Song Yitong , Shu Hongyu , Chen Xianbao , Luo Shuang
Published: October 2018

Considering some technical and economic reasons, it is not easy to directly measure the vehicular moving parameters (such as tyre–road forces and vehicle sideslip angle) in electronic stability programme systems. This study proposes a method to estimate lateral tyre–road forces and vehicle sideslip angle by utilising real‐time measurements, based on the unscented Kalman filter. Direct‐yaw‐moment control can effectively guarantee the stability of vehicle while steering at a high speed. This study proposed a hierarchical control strategy as the solution to the problem of the yaw‐moment distribution. The overloop controller is designed to calculate the desired yaw moment based on the estimated lateral tyre–road forces and sideslip angle, using the sliding mode control. The servo‐loop controller is designed to optimise the torque distribution using weighted‐least‐squares method based on the desired yaw moment obtained from the overloop controller. MATLAB/Simulink with Carsim is applied for the simulation experiment, the results demonstrate the effectiveness of the lateral tyre–road force and sideslip angle observer, and the optimal allocation controller could improve the handling stability and energy efficiency dramatically.
Cost effective green synthesis of NiO nanostructures as highly efficient photocatalysts for degradation of organic dyes
Authors: Ullah Hameed , Mushtaq Lubna , Ullah Zia , Bangesh Masroor Ahmad , Nawaz Mohsan
Published: October 2018

Here, the cost effective green synthesis of nickel oxide (NiO) nanostructures has been reported. The organic capping and/or reducing agents were obtained by extraction from wastes of three different vegetables (cauliflower, potatoes and peas). The extracts of cauliflower and peas peels gave nanowhiskers while the extract of potato peels gave nanorods of NiO, as confirmed by scanning electron microscopy. X‐ray diffraction analyses demonstrated the nanocrystalline cubic phase of NiO in all the samples. However, crystallite size varied with the extract of vegetable waste used. Fourier transform infrared analysis helps in identifying different vibrations, particularly Ni–O stretching vibrations, and diffuse reflectance spectra analyses led to the establishment of bandgap energies. The resulting NiO nanostructures were tested for their efficiencies as photocatalysts for Methylene blue degradation. All the three samples have shown significant photocatalytic activities. The exploration in this study clearly demonstrates the very high photocatalytic activities of the synthesised NiO nanostructures, which can be used as competent agents for treatment of wastewater to remove toxic dyes.
Update Diabetische Nephropathie 2018
Authors: Böger Carsten , Krämer Bernhard
Published: October 2018

Was ist neu?

Epidemiologie der diabetischen Nephropathie (DNP) Die Prävalenz der erhöhten Albuminurie bei Diabetikern nimmt ab, die der reduzierten eGFR (geschätzte glomeruläre Filtrationsrate) nimmt zu – möglicherweise bedingt durch strengere Blutdruck- und Blutglukosekontrolle.

Risiko für Nierenersatztherapie, kardiovaskuläre Ereignisse und Tod Online sind gut validierte Risikoscore-Rechner verfügbar.

Klassifikation und Prognoseeinschätzung der DNP Klinische Variablen eignen sich derzeit noch besser als die Histologie zur Risikoprädiktion für die terminale Nierenerkrankung. Extrakapilläre Hyperzellularität, segmentale Sklerosen und exsudative Läsionen könnten einen eigenen Risikophänotyp darstellen.

Substanzklassenspezifische Therapiehinweise zur blutzuckersenkenden Medikation SGLT-2-Inhibitoren (Natrium-Glukose-Kotransporter-2-Inhibitoren) und GLP-1-Analoga (Glukagon-Like-Peptide-1-Analoga) zeigen signifikante Reduktionen harter mikro- und makrovaskulärer Endpunkte. SGLT-2-Inhibitoren sind bei eGFR > 60 ml/min/1,73 m2 zugelassen; GLP-1-Analoga und Metformin bei eGFR > 30 ml/min/1,73 m2.

Im Wandel: Definition der arteriellen Hypertonie, Blutdruckziel für Diabetiker Die ACC/AHA-Leitlinie von 2017 definiert arterielle Hypertonie bei RR ≥ 130/80 mmHg. Die ESC/ESH-Leitlinie von 2018 belässt die Schwelle zur arteriellen Hypertonie jedoch bei 140/90 mmHg. Das Blutdruckziel für Diabetiker laut ACC/AHA und ESC/ESH ist < 130/80 mmHg – gute Verträglichkeit vorausgesetzt. Die ESC/ESH empfehlen, den Blutdruck nicht < 120/70 mmHg zu senken. Für Menschen ≥ 65 Jahre wird ein systolischer Blutdruckkorridor von 130 bis < 140 mmHg empfohlen.
Sinnvolle genetische Untersuchungen in der Gastroenterologie
Authors: Hohmann Margarete , Schmelz Renate , Hampe Jochen , Zeißig Sebastian
Published: October 2018

Was ist neu?

Hereditäre Pankreatitis In den letzten Jahren konnten mehrere Genmutationen nachgewiesen werden, die ursächlich für die Ausbildung einer hereditären Pankreatitis sind. Sie spielen auch bei der Entstehung einer chronischen Pankreatitis anderer Ätiologie eine wichtige Rolle, wobei Lebensstilfaktoren hierbei in den Vordergrund treten.

Chronisch entzündliche Darmerkrankungen Das Wissen um die komplexe und multifaktorielle Ätiologie des Morbus Crohn und der Colitis ulcerosa wurde in den letzten Jahren durch die Identifikation von bislang über 200 Risikogenvarianten erweitert. Diese tragen zur Krankheitsentstehung bei, wobei Umweltfaktoren weiterhin eine entscheidende Rolle zukommt. Darüber hinaus wurden seltene mono- bzw. oligogene CED-Formen nachgewiesen, die sich durch ein frühes Erkrankungsalter auszeichnen und die die Möglichkeit spezifischer Therapieansätze bieten.

Fettlebererkrankungen und hepatozelluläres Karzinom  Genetische Varianten u. a. in den Genen PNPLA3, TM6SF2 und MBOAT7 tragen zu Entstehung und Progression einer Fettlebererkrankung auf dem Boden eines metabolischen Syndroms bzw. von Alkoholkonsum bei. Darüber hinaus erhöhen sie das Risiko für die Entwicklung eines hepatozellulären Karzinoms. Eine genetische Testung aller Patienten mit Fettleber wird derzeit (noch) nicht empfohlen.
Negative Indikatoren im psychotherapeutischen Prozess: Häufigkeit und Zusammenhang mit Bindungsmerkmalen und Therapieerfolg bei Patienten mit sozialer Angststörung
Authors: Strauß Bernhard , Grass Nadja , Ritter Viktoria , Stangier Ulrich , Nolting Björn , Herpertz Stephan , Dymel Wibke , Willutzki Ulrike , Nodop Steffi
Published: October 2018

Im Rahmen des SOPHO-Net-Projektes, dessen Kernstudie eine randomisiert-kontrollierte Vergleichsstudie zur kognitiven bzw. psychodynamischen Kurzzeittherapie bei sozialer Angst war, wurde an einer Teilstichprobe von 88 Patienten aus 3 der 5 Zentren untersucht, ob der Behandlungserfolg, zu Therapiebeginn im Interview erhobene Bindungsmerkmale und negative Indikationen im Psychotherapieprozess in Zusammenhang stehen. Die negativen Indikatoren wurden mithilfe von Fremdratings mit der Vanderbilt Negative Indicators Scale (VNIS) erfasst, wobei jeweils eine frühe (dritte), eine mittlere (neunte) und eine späte Therapiesitzung (zweiundzwanzigste) im Hinblick auf negative Indikatoren untersucht wurden. Die Studie zeigte, dass negative Indikatoren insgesamt eher selten vorkommen, häufiger in der psychodynamischen Therapie, für die sich auch ein Zusammenhang zwischen negativen Indikatoren und Therapieergebnis zeigte. Entgegen der Erwartung waren die bei Therapiebeginn erhobenen Bindungsmerkmale nicht auf negative Indikatoren bezogen.
Zahneruption und Zahnbewegung bei kongenitaler Retention mit Mutation des PTH1-Rezeptor-Gens
Authors: Danz Jan
Published: October 2018

Die primäre kongenitale Retention von Zähnen des Typs heterozygote Mutation von Parathyroid hormone receptor type 1 (PTH1R) mit autosomal dominanter Vererbung ist eine Regulationsstörung des Knochenumbaus, welche die Zahneruption und die Zahnbewegungen stark behindert oder verhindert. Bei beginnender Zahneruption und bei Zahnbewegung wird PTHrP (Parathyroid hormone-related protein) ausgeschüttet, welches durch Osteozyten den Knochenumbau Richtung Knochenresorption entkoppelt. Bei PTH1R-Mutation mit Funktionsverlust dieses Rezeptors fehlt einerseits die Verringerung der Osteoprotegerin (OPG)- und der Sclerostin-Ausschüttung durch Osteozyten und andererseits die erhöhte Expression und Ausschüttung von Soluble receptor activator of nuclear factor κB (sRANKL) durch Osteozyten und Osteoblasten, was zu einer ausbleibenden Osteoklastenaktivierung führt. Ohne Knochenresorption durch Osteoklasten sind sowohl die Zahneruption als auch die Zahnbewegung gestört. Durch das als kompetitiver Antagonist des wnt-Rezeptor-Komplexes (kanonischer-wnt-Signalweg) und der BMP-I/BMP-II-Rezeptoren wirkende Sclerostin modulieren Osteozyten auch die Osteoblastenaktivität. Bei Verdacht auf kongenitale Retention ist eine humangenetische Abklärung zum Test einer PTH1-Rezeptor-Mutation ein wichtiges diagnostisches Mittel, um nicht erfolgsversprechende kieferorthopädische Therapien zu vermeiden und Behandlungsalternativen planen zu können.
Phytotherapie in der Dermatologie: Übersicht zur Heilpflanzenverwendung in der Dermatologie und zu ihrer Verfügbarkeit als Fertigarzneimittel
Authors: Hagemann T. , Beer A.-M.
Published: October 2018

Obwohl Erkrankungen aus dem dermatologischen Spektrum häufig in der allgemeinmedizinischen und auch naturheilkundlichen Sprechstunde vorkommen, gibt es nur wenig zugelassene Fertigpräparate für Hauterkrankungen. In den Bewertungen der HMPC-Monografien wird häufig nur ein sog. „traditional use“ als Einschätzung vergeben. Nur selten werden Präparate aus dem dermatologischen Einsatzgebiet als „well-established“ eingestuft.

Um die Zahl an wissenschaftlich getesteten, zugelassenen Phytotherapeutika zu erhöhen, bedarf es einer vermehrten Forschungstätigkeit auf diesem Gebiet. Neben den von Pharmafirmen initiierten und finanzierten Studien sollte auch auf universitärer Ebene von pharmakologischer und dermatologischer Seite ein Interesse an der Förderung von phytotherapeutisch-dermatologischen Forschungen bestehen. Nur so könnte die Anzahl der unter wissenschaftlichen Gesichtspunkten getesteten Phytopharmaka für das Gebiet der Dermatologie erhöht werden.
Zahnärztliche Schlafmedizin: eine Möglichkeit, das Leben von Menschen zu verändern
Authors: Johal Ama
Published: October 2018

Ziel dieser Abhandlung ist es, die Bedeutung der Zahnmedizin bei der Behandlung von schlafbezogenen Atmungsstörungen (SBAS) mit Unterkieferprotrusionsschienen (UPS) hervorzuheben. Ihr Schwerpunkt liegt auf der Anwendung der UPS-Therapie bei SBAS hinsichtlich bestehender Leitlinien für die klinische Praxis und Auswahlkriterien. Außerdem werden die relativen Vor- und Nachteile dieser Therapieform aufgezeigt.
Sandbox-Dermatitis als unterdiagnostizierte Differenzialdiagnose bei juckenden Papeln an den Streckseiten der Extremitäten bei Kindern
Authors: Gebauer K. , Malisiewicz B. , Kaufmann R. , Meissner M.
Published: October 2018

Die Sandbox-Dermatitis ist eine weitestgehend unbekannte Erkrankung im Kindesalter, deren Prävalenz wahrscheinlich häufiger ist als angenommen. Wir berichten über den Fall eines 6-jährigen Jungen, der sich mit juckenden, stecknadelkopfgroßen, hypopigmentierten Papeln an den Streckseiten der Extremitäten, die seit den Sommermonaten bestünden, vorstellte. Da der Juckreiz für den Jungen sehr quälend war und die Eltern sich sehr besorgt zeigten, erfolgte die Vorstellung durch den Kinderarzt. Zur Diagnosefindung wurden Differenzialdiagnosen nach ihrer Lokalisation, Morphologie und nach saisonalem Auftreten bewertet. Anhand der typischen Klinik konnte die Diagnose der Sandbox-Dermatitis gestellt werden und dem kleinen Patienten weitere schmerzhafte Diagnostik erspart bleiben. Aufgrund der Einordnung war es nun möglich, eine adäquate Therapie einzuleiten und den Eltern die Sorge zu nehmen, da nun über die Harmlosigkeit, die Triggerfaktoren und den variablen Verlauf der Erkrankung aufgeklärt werden konnte.
Evidenz zur Mikrowellenbehandlung bei Hyperhidrose
Authors: Jokisch R. , Schieber A. , Bonczkowitz M.
Published: October 2018

Lokalisierte Hyperhidrose bedeutet für Betroffene eine erhebliche Einschränkung ihrer alltäglichen Lebensqualität. Insbesondere die axilläre und die palmare Hyperhidrose belasten Kontakte im sozialen Umfeld permanent. Die Reduktion der Schweißbildung auf ein als normal empfundenes Maß geht deshalb mit einem befreiten, neuen Lebensgefühl einher. Die Mikrowellenthermotherapie (MTT) ist in der Dermatologie ein neues Behandlungsprinzip. Mikrowellen erzeugen durch Anregung von Wasserdipolen Gewebstemperaturen von über 60 °C. Daher kann die Wellenlänge von 5,8 GHz zur selektiven Schädigung von Schweißdrüsen genutzt werden. Seit Ende 2014 ist in Deutschland ein mikrowellenbasiertes System (Miradry®) zur thermischen Destruktion axillärer Schweißdrüsen verfügbar. Es ist das erste nichtoperative Verfahren zur dauerhaften Besserung der Hyperhidrose. Mit diesem Mikrowellensystem sind palmare Behandlungen nicht möglich. Off-label-Anwendungen am Körperstamm, Oberschenkel und inguinal verliefen erfolgversprechend.
Akutes postoperatives Pyoderma gangraenosum
Authors: Ufimtseva M. , Bochkarev Y. , Stolin A. , Chernyadyev S. , Golubkov N. , Antonova S.
Published: October 2018

Der Artikel beschreibt eine Patientin mit Pyoderma gangraenosum nach Kaiserschnitt. Diese Diagnose macht differenzialdiagnostische Überlegungen besonders notwendig auch zu akuten Hautinfektionen. Es wurde daher eine Literaturübersicht zum Pyoderma gangraenosum mithilfe von Suchmaschinen RINZ (Russischer wissenschaftlicher Zitierungsindex), PubMed, Scholar und Medline erstellt. Das Pyoderma gangraenosum ist eine extrem seltene Krankheit und die Diagnose stellt eine Ausschlussdiagnose dar. Bei ausgedehnter Wundoberfläche, die auf Antibiotika und chirurgische Behandlung nicht anspricht, ist eine Behandlung mit Glukokortikoiden und Immunsuppressiva notwendig. In unserem Fall hat sich das Pyoderma gangraenosum als interdisziplinäres Problem dargestellt, das eine gemeinsame Patientenführung von chirurgisch tätigen Kollegen und Dermatologen fordert.
Naturheilkunde und Komplementärmedizin bei Herz-Kreislauf-Erkrankungen Teil 1: Bluthochdruck
Authors: Andreas Michalsen , Stange Rainer
Published: October 2018

Am klinischen Zentrum für Naturheilkunde in Berlin werden kardiovaskuläre Erkrankungen seit Jahren erfolgreich mit einem multimodalen Konzept behandelt. Schwerpunkte bilden die Ernährungs- und Fastentherapie, Phyto-, Ordnungs-, Hydro-, Thermo- und Bewegungstherapie sowie ausleitende Verfahren.

Der Artikel gibt einen Überblick zu den auf Erfahrungen beruhenden Empfehlungen sowie Studienresultaten naturheilkundlicher und integrativer Therapiemöglichkeiten bei Hypertonie.
Ghrelin Levels in Basal Conditions and During Glucose Tolerance Test in Prediabetic and Diabetic Patients
Authors: Bounias Ioannis , Pouliliou Stamatia , Tripsianis Gregory , Antonoglou Cristos , Papazoglou Anna , Maltezos Efstratios , Papazoglou Dimitrios
Published: October 2018

Ghrelin is associated with glucose homeostasis but its’ possible relevance with glucose levels in physiological and pathological conditions has so far been poorly investigated. The aim of the present study was to evaluate circulating ghrelin levels in prediabetic and diabetic patients in basal conditions and in response to oral glucose tolerance test (OGTT). A total of 90 male adults aged 40 – 73 years old were enrolled in our study. Fasting and postprandial plasma ghrelin, insulin and glucose levels were measured at 0, 60, 120 and 180 min following an OGTT in 40 patients with type 2 diabetes mellitus (T2DM), 20 with impaired glucose tolerance (IGT) and 30 controls. Incremental and total area under response curve were determined and calculated for glucose, insulin and ghrelin. Fasting plasma ghrelin concentrations were significantly lower in the T2DM group than IGT and control group patients (p<0.01) but not between healthy subjects and IGT group (p=0.746). In the diabetics’ group ghrelin levels showed a statistically significant negative correlation with insulin and a positive correlation with HbA1c and glucose. At all time points after the OGTT ghrelin concentrations were significantly lower in the T2DM group compared to IGT group and controls. Plasma ghrelin concentrations are lower in male diabetic patients at the fasting state and remain lower at all time points after an OGTT while minor differences were found between normal and IGT subjects. Ghrelin might play a role in insulin and glucose metabolism in diabetic patients but not in patients with IGT.
Regular Physical Activity and Risk of Venous Thromboembolism
Authors: Brækkan Sigrid , Hansen John-Bjarne , Evensen Line
Published: October 2018

Venous thromboembolism (VTE) is a complex multifactorial disease that represents a growing public health concern. Identification of modifiable risk factors at the population level may provide a measure to reduce the burden of VTE. In this review, we summarize current knowledge of the role of physical activity on the risk of VTE and VTE-related complications. We also discuss methodological challenges related to research on physical activity, and put forward plausible mechanisms for an association between physical activity and VTE. Up to now, published studies have reported diverging results on the relationship between physical activity and VTE, and a complex picture has emerged. However, the available evidence appears to be balanced toward a small beneficial effect of physical activity on the risk of incident VTE, but not in a dose-dependent manner. Still, the lack of an operational definition and standardized assessment method for physical activity, as well as several sources of bias, impairs the interpretation of the available literature. Additional work is necessary to understand the role and how to apply physical activity in the VTE setting. Future research should utilize objective assessment strategies of physical activity and physical fitness, account for the fluctuating nature in habitual activity levels, and explore the role of physical activity in the areas of secondary prevention and VTE-related complications.
Ärztliche Kompetenzentwicklung im Kinderschutz durch E-Learning
Authors: Maier A. , Hoffmann U. , Plener P. L. , Fegert J. M.
Published: October 2018

Gegenstand und Ziel: Kindesmisshandlung stellt eine individuelle und gesellschaftliche Belastung dar. Gesundheitsfachkräfte sind hierbei wichtige Akteure, haben aber häufig unzureichende Kompetenzen. Deshalb fördert das Bundesministerium für Gesundheit die Entwicklung eines Online-Kurses zu Kinderschutz in der Medizin. Diese Arbeit stellt erste Ergebnisse der Kursevaluation für die ärztlichen Teilnehmenden vor. Material und Methoden: Vor und nach Bearbeitung des Kurses wurde Bedarf, Qualität und Kompetenzvermittlung des Online-Kurses mittels Fragebögen evaluiert. An der Befragung beteiligten sich 178 ärztliche Absolventen. Ergebnisse: 74,2% der Befragten empfanden die Inhalte des Kurses als genau angemessen. Wissen und Handlungskompetenz nahmen durch Bearbeitung des Kurses signifikant zu (Cohen’s d = 1,28 und 1,06). Der häufigste Grund für den Abbruch des Kurses waren mangelnde zeitliche Ressourcen (68,4%). Schlussfolgerungen: Der Online-Kurs stellt eine gute Möglichkeit dar, notwendige Kenntnisse zu Kinderschutz in der Medizin zu erwerben oder diese auszubauen. Klinische Relevanz: Es müssen Möglichkeiten geschaffen werden, um die Verbreitung der Kursinhalte noch weiter voranzutreiben.
Dual-pulse laser ignition model
Authors: Mahamud Rajib , Tropina Albina A. , Shneider Mikhail N. , Miles Richard B.
Published: October 2018

A two-dimensional mathematical model of dual-pulse laser ignition that self-consistently integrates Navier-Stokes, translational and vibrational energy, and neutral and charged species equations has been presented. The results showed that the ignition kernel dynamics depends on the shape and initial energy distribution in the energy spot created by the first ultraviolet laser pulse. The results also suggest that the ignition delay time and the flame kernel development depend on the laser intensity, vibrational-nonequilibrium, and initial electron number density. For the high initial degree of ionization, we have obtained ignition of the lean methane–air mixture with the equivalence ratio of 0.6. Vibrational-nonequilibrium taken into account by the Landau-Teller model leads to the slower ignition kernel growth and the significant increase in the ignition delay time. For the case modeled, a change in the overlap of the second laser with the focal point of the first laser pulse leads to the early split up of the kernel and the flame extinguishment.
Measurement and modelling of residual stress in wire-feed additively manufactured titanium
Authors: Ahmad Bilal , van der Veen Sjoerd O. , Fitzpatrick Michael E. , Guo Hua
Published: October 2018

Residual stresses were characterised in a wire-feed additively manufactured titanium alloy component. A numerical simulation based on the inherent strain method was used to model residual stresses arising from the manufacturing process. The contour method was used to experimentally determine the residual stress field. High tensile residual stresses were seen at and around the interface of the substrate and the deposited metal. Compressive residual stresses were present in the substrate and at the top of the deposit. The satisfactory correlation was achieved between the results from the numerical simulation and the contour method, except for the location of the root of the deposit. The effect of pre-heating the sample substrate on the residual stress distribution is also discussed.
The Correlation Argument for Reductionism
Authors: Clarke Christopher
Published: October 2018

Reductionists say things like all mental properties are physical properties; all normative properties are natural properties. I argue that the only way to resist reductionism is to deny that causation is difference making (thus making the epistemology of causation a mystery) or to deny that properties are individuated by their causal powers (thus making properties a mystery); that is to say, unless one is happy to deny supervenience or to trivialize the debate over reductionism. To show this, I argue that if properties are individuated by their causal powers, then, surprisingly, properties are individuated by necessary coexemplification.
A novel calibration framework for survival analysis when a binary covariate is measured at sparse time points
Authors: Nevo Daniel , Hamada Tsuyoshi , Ogino Shuji , Wang Molin
Published: October 2018

The goals in clinical and cohort studies often include evaluation of the association of a time-dependent binary treatment or exposure with a survival outcome. Recently, several impactful studies targeted the association between initiation of aspirin and survival following colorectal cancer (CRC) diagnosis. The value of this exposure is zero at baseline and may change its value to one at some time point. Estimating this association is complicated by having only intermittent measurements on aspirin-taking. Commonly used methods can lead to substantial bias. We present a class of calibration models for the distribution of the time of status change of the binary covariate. Estimates obtained from these models are then incorporated into the proportional hazard partial likelihood in a natural way. We develop non-parametric, semiparametric, and parametric calibration models, and derive asymptotic theory for the methods that we implement in the aspirin and CRC study. We further develop a risk-set calibration approach that is more useful in settings in which the association between the binary covariate and survival is strong.
Strength Endurance Training but Not Intensive Strength Training Reduces Senescence-Prone T Cells in Peripheral Blood in Community-Dwelling Elderly Women
Authors: Cao Dinh Hung , Njemini Rose , Onyema Oscar Okwudiri , Beyer Ingo , Liberman Keliane , De Dobbeleer Liza , Renmans Wim , Vander Meeren Sam , Jochmans Kristin , Delaere Andreas , Knoop Veerle , Bautmans Ivan
Published: October 2018

Aging is characterized by a progressive decline in immune function known as immunosenescence. Although the causes of immunosenescence are likely to be multifactorial, an age-associated accumulation of senescent T cells and decreased naive T-cell repertoire are key contributors to the phenomenon. On the other hand, there is a growing consensus that physical exercise may improve immune response in aging. However, the optimum training modality required to obtain beneficial adaptations in older subjects is lacking. Therefore, we aimed to investigate the effects of exercise modality on T-cell phenotypes in older women. A total of 100 women (aged ≥ 65 years) were randomized to either intensive strength training (80% of one-repetition maximum ), strength endurance training (40% one-repetition maximum), or control (stretching exercise) for 2–3 times per week during 6 weeks. The T-cell percentages and absolute counts were determined using flow cytometry and a hematology analyzer. C-reactive protein was measured using immunonephelometry. We report for the first time that 6 weeks of strength endurance training significantly decreased the basal percentage and absolute counts of senescence-prone T cells, which was positively related to the number of training sessions performed. Conceivably, training protocols with many repetitions—at a sufficiently high external resistance—might assist the reduction of senescence-prone T cells in older women.
Stochastic Dominance and Weak Concentration for Sums of Independent Symmetric Random Vectors
Authors: Bednorz Witold , Tkocz Tomasz
Published: October 2018

Kwapień and Woyczyński asked in their monograph (1992) whether their notion of superstrong domination is inherited when taking sums of independent symmetric random vectors (one vector dominates another if, essentially, tail probabilities of any norm of the two vectors compare up to some scaling constants). We answer this question positively. As a by-product of our methods, we establish that a certain notion of weak concentration is also preserved by taking sums of independent symmetric random vectors.
Proposed diagnostic and treatment paradigm for high-grade neurological complications of immune checkpoint inhibitors
Authors: Anderson Dustin , Beecher Grayson , Nathoo Nabeela , Smylie Michael , McCombe Jennifer A , Walker John , Jassal Rajive
Published: October 2018

Immune checkpoint inhibitors such as antibodies to cytotoxic lymphocyte-associated protein 4 (ipilimumab) and programmed cell-death 1 (pembrolizumab, nivolumab) molecules have been used in non-small cell lung cancer, metastatic melanoma, and renal-cell carcinoma, among others. With these agents, immune-related adverse events (irAEs) can occur, including those affecting the neurological axis. In this review, high-grade neurological irAEs associated with immune checkpoint inhibitors including cases of Guillain-Barré syndrome (GBS) and myasthenia gravis (MG) are analyzed. Based on current literature and experience at our institution with 4 cases of high-grade neurological irAEs associated with immune checkpoint inhibitors (2 cases of GBS, 1 case of meningo-radiculitis, and 1 case of myelitis), we propose an algorithm for the investigation and treatment of high-grade neurological irAEs. Our algorithm incorporates both peripheral nervous system (meningo-radiculitis, GBS, MG) and central nervous system presentations (myelitis, encephalopathy). It is anticipated that our algorithm will be useful both to oncologists and neurologists who are likely to encounter neurological irAEs more frequently in the future as immune checkpoint inhibitors become more widely used.
Cost of Public Health Response and Outbreak Control With a Third Dose of Measles-Mumps-Rubella Vaccine During a University Mumps Outbreak—Iowa, 2015–2016
Authors: Marin Mona , Kitzmann Tricia L , James Lisa , Quinlisk Patricia , Aldous Wade K , Zhang John , Cardemil Cristina V , Galeazzi Chris , Patel Manisha , Ortega-Sanchez Ismael R
Published: October 2018

Background

The United States is experiencing mumps outbreaks in settings with high 2-dose measles-mumps-rubella (MMR) vaccine coverage, mainly universities. The economic impact of mumps outbreaks on public health systems is largely unknown. During a 2015–2016 mumps outbreak at the University of Iowa, we estimated the cost of public health response that included a third dose of MMR vaccine.

Methods

Data on activities performed, personnel hours spent, MMR vaccine doses administered, miles traveled, hourly earnings, and unitary costs were collected using a customized data tool. These data were then used to calculate associated costs.

Results

Approximately 6300 hours of personnel time were required from state and local public health institutions and the university, including for vaccination and laboratory work. Among activities demanding time were case/contact investigation (36%), response planning/coordination (20%), and specimen testing and report preparation (13% each). A total of 4736 MMR doses were administered and 1920 miles traveled. The total cost was >$649 000, roughly equally distributed between standard outbreak control activities and third-dose MMR vaccination (55% and 45%, respectively).

Conclusions

Public health response to the mumps outbreak at the University of Iowa required important amounts of personnel time and other resources. Associated costs were sizable enough to affect other public health activities.
Percutaneous reduction and fixation of intraarticular calcaneal fractures: a series with 2-year follow-up
Authors: Fathi Hossam , Samir Fahmy Fahmy , Abd Elwahab Ahmed
Published: October 2018

Background:

Fractures of the calcaneus may occur with high-energy trauma. The gold standard management of fractures extending to the posterior facet is open reduction and plate fixation, but soft-tissue complications are frequent. The aim of this study was to evaluate the results of percutaneous reduction and fixation of intraarticular calcaneal fractures. Our hypothesis was that percutaneous fixation of Sanders type ΙΙ or ΙΙΙ articular calcaneal fractures provides good functional results with few complications.

Methods:

Between January 2014 and June 2017, 20 patients with intraarticular fractures of the calcaneus (30 feet) were treated with closed reduction and percutaneous fixation. The mean age of the patients was 30 yr (range 18–50 yr). All patients were assessed by radiographs and CT before and after surgery. Clinical and functional outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Hind Foot Score. A P-value <0.05 was considered statistically significant.

Results:

The mean follow-up period was 24.4±7.1 mo (18–30 mo). The postoperative mean AOFAS score was 88±4.7 points. There were statistically significant improvements in the postoperative means of both the Böhler and Gissane angles. Persistent postoperative pain was encountered in one patient, and another had a completely resolved mild superficial infection without major skin complications or deep infection.

Conclusions:

Percutaneous reduction and fixation of Sanders type ΙΙ and ΙΙΙ intra-articular calcaneal fractures had satisfactory clinical and radiographic results with minimal infection and soft-tissue morbidity.
Closed reduction of dislocated hip arthroplasty: a teaching institution’s experience
Authors: Coskey Andrew Z. , Vance Nicholas G. , Lindsey Ronald W.
Published: October 2018

Background:

Dislocation is a common complication of hip arthroplasty and is typically treated initially by closed reduction under sedation in the emergency department (ED). Although closed reduction has a very high success rate, information on the risk factors for difficult or failed procedures is scarce.

Methods:

The authors retrospectively reviewed the 5-year experience of treating patients for dislocated hip arthroplasty at a single center to determine the specific variables related to difficult or failed closed reductions.

Results:

Of 112 hip arthroplasty dislocations studied, 25 (22%) closed reductions were difficult, 20 attempted closed reductions (18%) failed, and six (6%) patients had complications (two skin lacerations, two periprosthetic fractures, one incongruent reduction, and one component loosening). Significant predictors for a difficult reduction were age, prior dislocation, time to reduction, and time from surgery. The level of anesthesia approached significance. Among the 20 hip arthroplasty dislocations in which initial closed reduction attempts in the ED failed, 12 (60%) were subsequently successful under deeper levels of sedation outside of the ED, six (30%) required an open reduction, and two (10%) required revision hip arthroplasty because of complications. Hip arthroplasty dislocations in older patients typically occurred shortly after the last surgery and were at increased risk for a difficult closed reduction or complications if dislocated for longer than 24 hr.

Conclusions:

In older patients, patients in the early postoperative period, first-time hip arthroplasty dislocations, or hip arthroplasty dislocations >24 hr old, clinicians should consider performing closed-hip arthroplasty reduction in an environment that offers more flexibility than the ED.
A systematic review of the treatment of knee osteoarthritis with intraarticular injection of mesenchymal stem cells
Authors: Davidson Philip A. , Bland Daniel S. , Henderson MacIntyre
Published: October 2018

Background:

A wide array of treatment, both surgical and nonsurgical, exists for osteoarthritis (OA) of the knee. Injectable stem-cell therapy represents a minimally invasive and potentially efficacious treatment; however, there have been no level I studies conducted on this specific application of stem-cell therapy. The purpose of our review was to analyze, report, and summarize current topical data.

Methods:

A systematic review of the treatment of human knee OA with mesenchymal stem cells (MSCs) was performed by searching PubMed/Medline and Google Scholar. Non-human studies and studies involving additional procedures were excluded. Authors reviewed the studies individually, with the primary author deciding on inclusion.

Results:

Our search ultimately returned 10 studies that met the inclusion criteria. Nine of the ten studies used cultured autologous MSCs, five from bone marrow, three from subcutaneous fat, and one from peripheral blood. The remaining study used allogenic bone marrow MSCs. Radiographic analysis of cartilage quality via MRI T2 mapping showed increased type II collagen production in five studies. Outcome scores consistently showed pain reduction and improved function. No study reported significant adverse events related to stem-cell therapy.

Conclusions:

Current human studies evaluating the use of injected MSCs for knee OA demonstrated consistent improvement across several outcome scores, with no significant adverse findings.

Level of Evidence:

Level IV, systematic review of Level II-IV trials and studies.
Changes in Provider Treatment Patterns for Dupuytren’s Contracture: Analysis of Trends in Medicare Beneficiaries
Authors: Thayer Mary Kate , Somerson Jeremy S. , Huang Jerry I.
Published: October 2018

Background:

Collagenase Clostridium histolyticum (CCH) injection has been shown to be a safe and effective treatment option for Dupuytren’s contracture. We hypothesize that the gaining popularity of CCH has resulted in a change in treatment patterns among providers, with increased utilization of CCH injections in the management of Dupuytren’s contracture from 2012 to 2014.

Methods:

The Medicare Provider Utilization and Payment Data Public Use Files were used to identify all surgeons who submitted claims for surgical fasciectomy, needle aponeurotomy (NA), and CCH injection. The data were analyzed for number of providers performing the procedures, number of procedures per provider, and location of practice.

Results:

From 2012 to 2014, the number of providers performing more than 10 open fasciectomies decreased from 141 to 131. In the same time, the number of providers performing more than 10 NAs increased from 63 to 70 with mean procedures per provider decreasing from 35 to 21. In contrast, the number of providers performing more than 10 CCH injections increased from 72 to 112, with mean injections per provider going from 24 to 20. The total number of injections performed increased from 1,734 to 2,220 from 2012 to 2014. The largest increase in number of injections and number of providers performing injections occurred in the South.

Conclusions:

The introduction of collagenase has changed treatment patterns with more providers treating Dupuytren’s contractures with CCH injections and a statistically significant decline in the number of NA procedures per provider.
Atherosclerotic cardiovascular disease risk assessment in familial hypercholesterolemia: does one size fit all?
Authors: Mata Pedro , Alonso Rodrigo , Pérez de Isla Leopoldo
Published: October 2018

Purpose of review

Familial hypercholesterolemia is a frequent genetic disease associated with lifelong elevation of LDL-cholesterol and premature atherosclerotic cardiovascular disease (ASCVD). Statins are the cornerstone of treatment. However, with the introduction of novel LDL-cholesterol-lowering therapies, it is necessary to identify familial hypercholesterolemia patients presenting a significantly high residual ASCVD risk. The aim of this review is to provide an update on the recent literature concerning cardiovascular risk stratification including the role of coronary imaging.

Recent findings

Several factors have shown to be independent predictors of ASCVD in familial hypercholesterolemia. These include clinical scores with cardiovascular risk factors, coronary imaging and novel protein biomarkers. However, the recent introduction of the SAFEHEART risk-equation (SAFEHEART-RE) could allow a more accurate ASCVD risk prediction in familial hypercholesterolemia.

This article highlights the SAFEHEART-RE as a model to predict incident ASCVD in familial hypercholesterolemia. This equation is a simple and widely applicable tool for use in every clinical setting. Furthermore, coronary atherosclerosis assessed by coronary computed-tomographic angiography (coronary-CTA) is independently associated to the cardiovascular risk estimated according to the SAFEHEART-RE. This equation, as well as coronary-CTA and new biomarkers, could increase individual ASCVD risk stratification and could improve the efficiency and the use of new lipid-lowering therapies in familial hypercholesterolemia.
The prediction of therapy-benefit for individual cardiovascular disease prevention: rationale, implications, and implementation
Authors: Jaspers Nicole E.M. , Ridker Paul M. , Dorresteijn Jannick A.N. , Visseren Frank L.J.
Published: October 2018

Purpose of review

We aim to outline the importance and the clinical implications of using predicted individual therapy-benefit in making patient-centered treatment decisions in cardiovascular disease (CVD) prevention. Therapy-benefit concepts will be illustrated with examples of patients undergoing lipid management.

Recent findings

In both primary and secondary CVD prevention, the degree of variation in individual therapy-benefit is large. An individual's therapy-benefit can be estimated by combining prediction algorithms and clinical trial data. Measures of therapy-benefit can be easily integrated into clinical practice via a variety of online calculators. Lifetime estimates (e.g., gain in healthy life expectancy) look at therapy-benefit over the course of an individual's life, and are less influenced by age than short-term estimates (e.g., 10-year absolute risk reduction). Lifetime estimates can thus identify people who could substantially benefit from early initiation of CVD prevention. Compared with current guidelines, treatment based on predicted therapy-benefit would increase eligibility for therapy among young people with a moderate risk-factor burden and individuals with a high residual risk.

The estimation of individual therapy-benefit is an important part of individualized medicine. Implementation tools allow for clinicians to readily estimate both short-term and lifetime therapy-benefit.
Airway Clearance for the Preterm Newborn
Authors: Harbin Brandi R. , Adams Ellise D. , O'Neal Pamela V.
Published: October 2018

Purpose:

The purpose of this study was to explore airway clearance practices for the preterm newborn in the neonatal intensive care unit (NICU).

Study Design and Methods:

This descriptive, retrospective medical record review analyzed airway clearance practices in a level III regional NICU from 2016 to 2017 in preterm newborns ranging from 32 weeks to 36 weeks and 6 days. There were 87 preterm newborns and 384 suctioning events reviewed during the entire length of stay. Practices reviewed include device used, frequency, color, consistency, and tolerance of airway clearance. Method of nursing documentation for these practices was also reviewed.

Results:

Babies born via cesarean required more suctioning (65.5%). Males (60.9%) required more airway clearance events than females (39.1%). After suction events, nurses reported no distress (74%), equal bilateral breath sounds (30%), desaturation (6%), and collectively color change, apnea, or bradycardia (<1%). The most common discharge diagnosis was respiratory distress syndrome (90%). Preterm newborns were suctioned with the blue bulb syringe (15.6%), oral/nasal-pharyngeal suction device (42.7%), and endotracheal suction devices (41.7%).

Clinical Implications:

Electronic medical records promote less detailed, narrative documentation and more point and click documentation. If electronic medical record systems are not designed to gather airway clearance indications, specifics about the procedure and the preterm newborn response to the procedure, evidence-based practice cannot be measured. More studies are needed to evaluate suction practices applied in the NICU setting.
Nasal Airway Clearance for Bronchiolitis
Authors: Norris Casey L. , O'Neal Pamela V. , Adams Ellise D. , Wyatt Tami H.
Published: October 2018

Bronchiolitis is a leading cause of emergency department visits and hospitalization in the first year of life with estimated costs to the healthcare system in the United States of $1.73 billion annually. The highest rates of admission occur in the first 3 to 6 months of life. Traditional therapies such as bronchodilators and antibiotics have repeatedly been shown to be ineffective. Thickened nasal secretions cause decreased oxygenation, difficulty sleeping, poor feeding, and respiratory distress symptoms. Bronchiolitis guidelines recommend supportive care such as noninvasive nasal airway clearance with saline to clear obstructed airways, improve oxygenation, and promote optimal infant eating and sleeping. Evidence on the safety and efficacy of use of noninvasive nasal airway clearance as supportive care for infants with bronchiolitis in the acute care setting is presented.
Nestin Expression in Spitzoid Lesions: An Immunohistochemical Characterization With Clinical and Dermoscopic Correlations
Authors: Guanziroli Elena , Del Gobbo Alessandro , Coggi Antonella , Venegoni Luigia , Fanoni Daniele , Ercoli Giulia , Boggio Francesca , Veraldi Stefano , Cavicchini Stefano , Berti Emilio , Ferrero Stefano , Gianotti Raffaele
Published: October 2018

Spindle or epithelioid melanocytic (Spitz) nevi usually affect children or adolescents and growth in the face or the lower extremities. Histologically, they may show cytoarchitectural atypia and mitotic figures that could represent diagnostic pitfalls with malignant melanoma. Atypical spitzoid tumors (AST) indicate lesions that microscopically show intermediate characteristics between benign nevi and malignant melanoma. Nestin expression has been evaluated in benign nevi and malignant melanoma, but no studies on its role in Spitz lesion have been elaborated so far. Our results indicate that Nestin could allow to discriminate between AST and malignant spiztoid melanoma; the typical dermoscopic pattern is also associated with benign nevi in contrast to the atypical pattern that accumunates AST and malignant spitzoid melanoma.
Radiotherapy for Hodgkin Lymphoma
Authors: Specht Lena
Published: October 2018

Radiation therapy (RT) for Hodgkin lymphoma has changed dramatically over the past couple of decades, from the very large extended-field RT with prophylactic treatment of all the major lymph node regions to the very limited involved-site RT with treatment only of the initially macroscopically involved lymphoma volume in the combined modality setting. Technological developments in imaging, treatment planning, and treatment machines have enabled very significant reductions in radiation doses to normal organs without jeopardizing the coverage of the lymphoma. Hence, the risks of long-term adverse effects have become much smaller than those in the past. Radiation therapy for Hodgkin lymphoma is now a highly individualized treatment, tailored to each patient. The risks of this limited RT should be weighed against the risks of long-term toxicity of possible additional systemic treatment up-front and at relapse in order to select the optimal treatment combination for each individual patient.
Advanced-Stage Hodgkin Lymphoma
Authors: Connors Joseph M.
Published: October 2018

Depending on a variety of prognostic factors including age, stage, laboratory abnormalities, and initial response to treatment, from 70% to 90% of patients with advanced-stage Hodgkin lymphoma can be cured with modern multiagent chemotherapy. Two effective strategies offer the promise to improve on those results. Early intensification of treatment, typically by increasing the doses and frequency of administration of standard chemotherapy agents, induces higher initial response rates but has the major drawback of causing unacceptably severe acute toxicity, increased numbers of secondary neoplasms, and infertility due to oligospermia in men and premature menopause in women. Alternatively, integration of novel therapeutic agents into primary treatment is attractive, especially when the introduction not only improves the frequency and durability of disease response but also does not unacceptably increase acute or long-term toxicity. Finally, widespread availability of functional imaging with positron emission tomography now enables response-adapted therapy, a separate innovation in the treatment of Hodgkin lymphoma that can be incorporated with either intensified chemotherapy or addition of novel agents. This article discusses these exciting new developments in the treatment of advanced-stage Hodgkin lymphoma.