bluuebunny/crossref_metadata_2025 huggingface dataset:
Defining Clinically Important Difference in the Atrial Fibrillation Effect on Quality-of-Life Score
Authors: Holmes DaJuanicia N. , Piccini Jonathan P. , Allen Larry A. , Fonarow Gregg C. , Gersh Bernard J. , Kowey Peter R. , O’Brien Emily C. , Reiffel James A. , Naccarelli Gerald V. , Ezekowitz Michael D. , Chan Paul S. , Singer Daniel E. , Spertus John A. , Peterson Eric D. , Thomas Laine ,   on behalf of the ORBIT-AF Investigators and Patients
Published: May 2019

Background:

The Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire has recently been validated to measure the impact of atrial fibrillation on quality of life, but a clinically important difference in AFEQT score has not been well defined.

Methods and Results:

To determine the clinically important difference in overall AFEQT (score range= 0 [worst] to 100 [best]) and selected subscales, we analyzed data in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry, a United States-based outpatient atrial fibrillation registry. AFEQT was assessed at baseline and 1 year in a subset of 1347 ORBIT-AF patients from 80 US sites participating in ORBIT-AF from June 2010 to August 2011. The mean change method was used to relate changes in 1-year AFEQT scores to clinically important changes in the physician assessment of European Heart Rhythm Association functional status (1 class improvement and separately 1 class deterioration). Clinically important differences and 95% CI corresponding to either a 1 European Heart Rhythm Association class improvement or deterioration were 5.4 (3.6–7.2) and −4.2 (−6.9 to −1.5) AFEQT points, respectively. Similarly, clinically important difference values were seen for a 1 European Heart Rhythm Association class improvement for the AFEQT subscales Activities of Daily Living and Symptoms: 5.1 (2.5–7.6) and 7.1 (5.3–9.0) AFEQT points, respectively.

Conclusions:

Based on the anchor of 1 European Heart Rhythm Association class change, changes in AFEQT score of + or −5 points are clinically important changes in patients’ health.

Clinical Trial Registration:

URL:
https://clinicaltrials.gov
. Unique identifier: NCT01165710.
Thirty-Day Hospital Readmission After Acute Myocardial Infarction in China
Authors: Li Jing , Dharmarajan Kumar , Bai Xueke , Masoudi Frederick A. , Spertus John A. , Li Xi , Zheng Xin , Zhang Haibo , Yan Xiaofang , Dreyer Rachel P. , Krumholz Harlan M. ,   for the China PEACE Collaborative Group
Published: May 2019

Background:

Readmission after acute myocardial infarction in low- and middle-income countries like China is not well characterized.

Methods and Results:

We approached consecutive patients with acute myocardial infarction hospitalized within 24 hours of symptom onset and discharged alive from 53 geographically diverse hospitals in China. We described rates of unplanned 30-day readmission, their timing and admitting diagnoses, and fit Cox proportional hazards models to identify factors associated with readmission. Among 3387 patients, median (interquartile range) age was 61 (52–69) years, and 76.9% were men. The index median length of stay was 11 (8–14) days. Unplanned 30-day readmission occurred in 6.3% of the cohort; most readmissions (77.7%) were for cardiovascular diagnoses. Nearly half (41.9% of all-cause readmissions; 44.3% of cardiovascular readmissions) occurred within 5 days of discharge. Mini-Global Registry of Acute Coronary Events scores at admission (hazard ratio [HR], 1.15 for every 10-point increase; 95% CI, 1.05–1.25), longer length of stay (HR, 1.03; 95% CI, 1.00–1.06 for each extra day), and in-hospital recurrent angina (HR, 1.40; 95% CI, 1.04–1.89) were associated with higher unplanned all-cause readmission. Revascularization during the index hospitalization (70.2% of the cohort) was associated with lower risks of all-cause readmission (HR, 0.27; 95% CI, 0.18–0.42). In addition, left ventricular ejection fraction <0.4 (HR, 1.79; 95% CI, 1.05–3.07) and in-hospital complication (HR, 1.20; 95% CI, 1.03–1.39) were associated with higher risk of unplanned cardiovascular readmission, and ST-segment–elevation myocardial infarction (HR, 0.60; 95% CI, 0.36–0.98) was associated with lower risk of unplanned cardiovascular readmission. Sex, family income, depression, stress level, lower social support, disease-specific health status, and medications were not associated with readmission.

Conclusions:

In China, most readmissions are for cardiovascular events, and almost half occur within 5 days of discharge. Clinical factors identify patients at higher and lower unplanned readmissions.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01624909.
Intracranial Cerebrospinal Fluid Volume as a Predictor of Malignant Middle Cerebral Artery Infarction
Authors: Kauw Frans , Bennink Edwin , de Jong Hugo W.A.M. , Kappelle L. Jaap , Horsch Alexander D. , Velthuis Birgitta K. , Dankbaar Jan W. ,   on behalf of the DUST Investigators, Majoie C.B. , Roos Y.B. , Duijm L.E. , Keizer K. , van der Lugt A. , Dippel D.W. , Droogh-de Greve K.E. , Bienfait H.P. , van Walderveen M.A. , Wermer M.J. , Lycklama à Nijeholt G.J. , Boiten J. , Gasthuis Onze Lieve Vrouwe , Duyndam D. , Kwa V.I. , Meijer F.J. , van Dijk E.J. , Kesselring F.O. , Hofmeijer J. , Vos J.A. , Schonewille W.J. , van Rooij W.J. , de Kort P.L. , Pleiter C.C. , Bakker S.L. , Bot J. , Visser M.C. , van der Schaaf I.C. , Mali W.P. , van Seeters T. , Niesten J.M. , Biessels G.J. , Luitse M.J. , van der Graaf Y.
Published: May 2019

Background and Purpose—

Predicting malignant middle cerebral artery (MCA) infarction can help to identify patients who may benefit from preventive decompressive surgery. We aimed to investigate the association between the ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) and malignant MCA infarction.

Methods—

Patients with an occlusion proximal to the M3 segment of the MCA were selected from the DUST (Dutch Acute Stroke Study). Admission imaging included noncontrast computed tomography (CT), CT perfusion, and CT angiography. Patient characteristics and CT findings were collected. The ratio of intracranial CSF volume to ICV (CSF/ICV) was quantified on admission thin-slice noncontrast CT. Malignant MCA infarction was defined as a midline shift of >5 mm on follow-up noncontrast CT, which was performed 3 days after the stroke or in case of clinical deterioration. To test the association between CSF/ICV and malignant MCA infarction, odds ratios and 95% CIs were calculated for 3 multivariable models by using binary logistic regression. Model performances were compared by using the likelihood ratio test.

Results—

Of the 286 included patients, 35 (12%) developed malignant MCA infarction. CSF/ICV was independently associated with malignant MCA infarction in 3 multivariable models: (1) with age and admission National Institutes of Health Stroke Scale (odds ratio, 3.3; 95% CI, 1.1–11.1), (2) with admission National Institutes of Health Stroke Scale and poor collateral score (odds ratio, 7.0; 95% CI, 2.6–21.3), and (3) with terminal internal carotid artery or proximal M1 occlusion and poor collateral score (odds ratio, 7.7; 95% CI, 2.8–23.9). The performance of model 1 (areas under the receiver operating characteristic curves, 0.795 versus 0.824;
P
=0.033), model 2 (areas under the receiver operating characteristic curves, 0.813 versus 0.850;
P
<0.001), and model 3 (areas under the receiver operating characteristic curves, 0.811 versus 0.856;
P
<0.001) improved significantly after adding CSF/ICV.

Conclusions—

The CSF/ICV ratio is associated with malignant MCA infarction and has added value to clinical and imaging prediction models in limited numbers of patients.
Detrimental Effect of Chronic Hypertension on Leptomeningeal Collateral Flow in Acute Ischemic Stroke
Authors: Fujita Kyohei , Tanaka Kanta , Yamagami Hiroshi , Ide Toshihiro , Ishiyama Hiroyuki , Sonoda Kazutaka , Satow Tetsu , Takahashi Jun C. , Ihara Masafumi , Koga Masatoshi , Yokota Takanori , Toyoda Kazunori
Published: May 2019

Background and Purpose—

We aimed to evaluate the effect of chronic hypertension on acute leptomeningeal collateral flow in patients with large-vessel ischemic stroke using digital subtraction angiography, which is the gold standard for the assessment of collateral circulation.

Methods—

Of the consecutive ischemic stroke patients from October 2011 to December 2017 seen in our institution, patients with acute occlusion of the M1 segment of the middle cerebral artery confirmed on initial digital subtraction angiography were enrolled. Chronic hypertension was defined as its documentation before the index stroke or as the administration of antihypertensive medications before onset. Angiographic leptomeningeal collateral flow was evaluated according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Flow Grading System and dichotomized the findings into excellent (grade 3–4) or poor (grade 0–2) collateral status for analysis.

Results—

Of the 3759 consecutive ischemic stroke patients, 100 patients were analyzed. Thirty-nine patients (39%) had poor collateral status. Patients with poor collateral status were older, more frequently male, and had chronic hypertension more frequently, shorter time from onset to angiography, and higher admission systolic blood pressure than those with excellent collateral status. Multivariable logistic analysis with prespecified covariates showed a significantly positive association between chronic hypertension and poor collateral status (odds ratio, 2.80; 95% CI, 1.08–7.70;
P
=0.034). This association was independent of admission systolic blood pressure. The proportion of patients with poor collateral status increased in a stepwise manner in patients without chronic hypertension, hypertensive patients with premorbid antihypertensive medications, and hypertensive patients without antihypertensive medications (
P
for trend <0.001).

Conclusions—

Our data suggest that chronic hypertension has a detrimental effect on acute leptomeningeal collateral flow in patients with cerebral large-vessel occlusion.

Clinical Trial Registration—

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02251665.
The Philocalia of Origen: A Crude or Creative Composition?
Authors: Blaski Andrew
Published: May 2019

This article seeks to demonstrate the underlying theological and structural sophistication of the fourth-century Philocalia of Origen, despite its apparent lack of thematic and editorial coherence. In the past, chapter fifteen has been singled out as a particular example of disorder, as it consists of two seemingly unrelated topics: the language of scripture and the flesh of Christ. In response, this article carefully examines chapter fifteen, arguing that the editors of the Philocalia intentionally and carefully placed these topics beside one another in order to reveal that they are both manifestations of one and the same subject: the Word of God.
Origen the Sophist: Anti-Sophistic Polemic in Porphyry’s Contra Christianos
Authors: Becker Matthias
Published: May 2019

Making use of Beatrice Wyss’ “pattern of the disparagement of sophists” for heuristic purposes, this paper argues that the depictions of Christian exegetes and scholars in a fragment of Porphyry’s lost work Contra Christianos (fr. 39 Harnack/fr. 6F. Becker) contain literary elements of ad hominem attacks which were used in Greek anti-sophistic polemic. Porphyry’s allusive language allows for the conclusion that he aimed specifically at casting Origen in the role of a sophist. This hitherto unnoticed component of Porphyry’s polemic against the Christians sheds light on how Platonists in the third century viewed Christian intellectuals through a Platonic lens in order to secure their identity against a stereotypical opponent which had ultimately been created by Plato himself. Thus, in Porphyry’s view, Christians are, as it were, new foes with old familiar faces.
Dinobryon taiyuanensis (Chrysophyta, Dinobryaceae), a new freshwater species described from Shanxi province, China
Authors: JIANG XIAO-DIE , NAN FANG-RU , LV JUN-PING , LIU QI , XIE SHU-LIAN , KOCIOLEK JOHN PATRICK , FENG JIA
Published: May 2019

A new freshwater species of Chrysophyceae, Dinobryon taiyuanensis, is described from Linde Lake in Shanxi province, China. This new species is similar to D. sertularia, the type species of the genus, in the shape of the lorica and organization of the colony. The cells have two heterokont flagella surrounded by a lorica and occurred both as free-living, solitary cells or in branched colonies. The lorica of our new species like a bent or S-shaped cone, and shorter than the lorica in D. sertularia. In addition to describing the morphological features of D. taiyuanensis, a phylogenetic analysis based on sequences of the nuclear small subunit ribosomal DNA (SSU rDNA) and internal transcribed spacer (including internal transcribed spacer 1, 5.8S rDNA and internal transcribed spacer 2) placed this alga in single clade with a considerable sequence distance from the other Dinobryon species. Thus, results of both morphological comparisons and phylogenetic analysis based on molecular data suggest this alga as a new species, increasing the total number of recognized freshwater Chrysophyta species in China.
A new species of the genus Leucheria (Asteraceae, Nassauvieae) from Argentina
Authors: JARA-ARANCIO PAOLA , RATTO FRANCISCO , BARTOLI ADRIANA , ARANCIO GINA , CARMONA-ORTIZ MARTÍN R.
Published: May 2019

Leucheria arancioi Jara-Arancio, Ratto & Adr. Bartoli (Asteraceae, Nassauvieae) is recognized as a new species. It was previously known as L. diemii var. purpurea Ratto, Bello & Adr. Bartoli. This is a perennial herb that inhabits the western part of the province of Santa Cruz, Department Río Chico, in the Patagonian phytogeographic province. Evaluation of morphological and molecular differences between the varieties of L. diemii showed that there are discriminating characters that warrant recognition of L. arancioi as a new species.
Scaphopoda (Mollusca) from the Brazilian continental shelf and upper slope (13º to 21ºS) with descriptions of two new species of the genus Cadulus Philippi, 1844
Authors: CAETANO CARLOS HENRIQUE SOARES , SCARABINO VICTOR , ABSALÃO RICARDO SILVA
Published: May 2019

Twenty six species of Scaphopoda, included in 12 genera and five families were identified. Within these, Fustiaria stenoschiza (Pilsbry & Sharp, 1897), Gadila pocula n.comb. (Dall, 1889); G. simpsoni n.comb. (Henderson, 1920) and G. pandionis (Verril & Smith in Verril, 1880) are recorded for the first time for Brazil and two new species of the genus Cadulus are here described. Besides that, six species previously recorded from north and northeast Brazil have their geographical range expanded southward: Antalis circumcincta (Watson, 1879), Episiphon didymum (Watson, 1879), Ep. sowerbyi (Guilding, 1834), Entalina platamodes (Watson, 1879), Gadila dominguensis (Orbigny, 1853) and Compressidens pressum (Pilsbry & Sharp, 1897). In the other hand, Paradentalium infractum n.comb. (Odhner, 1931) has its geographical distribution extended northward to the state of Maranhão (02ºS). Gadila acus (Dall, 1889) is proposed as junior synonym of G. dominguensis (Orbigny, 1853).
Neopsittaconirmus vendulae, a new species of louse (Phthiraptera: Philopteridae) from the Cockatiel Nymphicus hollandicus (Psittaciformes: Cacatuidae)
Authors: SYCHRA OLDÃICH
Published: May 2019

A new species of Neopsittaconirmus Conci is described from lice collected from captive cockatiels Nymphicus hollandicus, in Australia, Czech Republic, and Germany. This is the first record of lice from this host. These captive birds probably originated from limited populations which were randomly selected from wild populations and then bred and transported by cage-bird breeders. Keys are provided for identification of the 27 species of Neopsittaconirmus.
A study on genus Chlamydatus Curtis, 1833 from China (Heteroptera: Miridae: Phylinae)
Authors: LI XIAO-MING , LIU GUO-QING
Published: May 2019

Five species of Chlamydatus Curtis from China are presented of which two, Chlamydatus laminatus and Chlamydatus sichuanensis, are described as new. A key for discrimination of the Chinese species is given. Photographs of the dorsal habitus, scanning electron micrographs of the metathorax scent-gland, and illustrations of the male genitalia and legs are provided. All type specimens are deposited in the Institute of Entomology, Nankai University, Tianjin, China.
A revaluation of the Eurycopinae (Crustacea, Isopoda, Munnopsidae) with a description of Dubinectes gen. nov. from the southern Atlantic deep sea
Authors: MALYUTINA MARINA , BRANDT ANGELIKA
Published: May 2019

A new genus of Eurycopinae (Munnopsidae), Dubinectes gen. nov., is described for Eurycope acutitelson Menzies, 1962, E. nodosa Menzies, 1962 and two new species, collected from the Weddell Sea, Southern Ocean. The new genus is distinguished by the distinctive shape of the pleotelson posterior margin and the uropod protopod angled at midlength, along with the robust, long rostrum of a large head, overhanging frons, reduced distomedial lobe of article 1 of antenna 1, the produced male pleopod 1 distolateral lobes and the distinct shape of the male pleopod 2. Descriptions of the new genus, two new species and redescriptions of two previously described species are presented, as well as a new diagnosis of the subfamily Eurycopinae, the genus Eurycope and a key to the genera of Eurycopinae.
Euglossa samperi n. sp., a new species of orchid bee from the Ecuadorian Andes (Hymenoptera: Apidae)
Authors: RAMÍREZ SANTIAGO
Published: May 2019

A new species of orchid bee in the genus Euglossa is here described. Euglossa samperi n. sp. Ramírez occurs on the Pacific foothills of the Ecuadorian Andes. Based on morphological characters, this new taxon is assigned to the subgenus Glossurella, one of the most species-rich, yet poorly known groups of orchid bees.
Remarkable sexual dimorphism in the Afrotropical species Nycterimyia capensis Bezzi, 1924 (Diptera: Nemestrinidae), and its taxonomic implications
Authors: BARRACLOUGH DAVID A.
Published: May 2019

Nycterimyia is a genus of poorly understood and rarely collected Nemestrinidae from scattered localities in the Afrotropical (two species), Oriental (four species) and Australasian (four species) Regions. The Afrotropical species N. capensis is a variable taxon currently recorded from South Africa, Kenya and Madagascar. This paper records a pair of N. capensis collected at the same date and locality (Ranomofana) in Madagascar. The female is the first known from the Afrotropics. There is marked sexual dimorphism in N. capensis; important characters separating the sexes include shape and length of the antennal style, length and distribution of pile on the thorax and abdomen, wing shape, and most importantly distinctive wing patterning. The taxonomic implications of not recognizing sexual dimorphism in the genus are discussed.
Helobdella nahuelhuapensis sp. nov. (Hirudinea, Glossiphoniidae), from Bariloche, Argentina
Authors: GULLO BETTINA SANDRA
Published: May 2019

The new freshwater leech species Helobdella nahuelhuapensis is described based on the examination of 17 specimens collected near Nahuel Huapi Lake, Bariloche, Argentina with following diagnostic characters. Body thin and lanceolate. Chitinoid scute absent. Unpigmented region (nuchal gland) at somite VIII. Annuli subdivided dorsally. Dorsum surface lacking both papillae and tubercles. One pair of eyes on somite III; mouth pore in the anterior margin of the oral sucker; proboscis base at XII/XIII, diffuse parenchymal salivary tissue; oesophagus simple; crop with gastric chambers; postcaeca or diverticula extending posteriorly; intestine with four caeca. Six pairs of spherical testisacs; sperm ducts reach to somite XV/XVI. Atrium pyriform without preatrial loops. Ovisacs simple, reaching XIV.
Copepods of the family Dirivultidae (Siphonostomatoida) from deep-sea hydrothermal vent fields on the Mid-Atlantic Ridge at 14ºN and 5ºS
Authors: IVANENKO VIATCHESLAV N. , ARBIZU PEDRO MARTÍNEZ , STECHER JENS
Published: May 2019

Five species of three genera of Dirivultidae Humes and Dojiri, 1980 were found at deep-sea hydrothermal vent fields on the Mid-Atlantic Ridge, at the Logachev-1 field at 14ºN and at two new sites (Turtle Pits and Red Lion) explored at 5ºS. The copepods were collected with a Remotely Operated Vehicle (ROV Quest 4000) and Video Controlled Grab, operated from the R/V Meteor during two cruises (M60/3 and M64/1) conducted in 2004 and 2005 at depths 2992–3048 m. The male of Stygiopontius lomonosovi n. sp. from the Logachev field shares a medioventrally prolonged syncoxa of the maxilliped with S. mirus Humes, 1996 and S. latulus Humes, 1996 from the Snake Pit at 23ºN of the Mid-Atlantic Ridge, but differs from them in having two, instead of three, outer spines on the distal exopodal segment of leg 4. Aphotopontius atlanteus Humes, 1996 previously known from the Lucky Strike and the Menez Gwen sites at 37°N and Rimipontius mediospinifer Humes, 1996 known from three sites (Logachev, Snake Pit, and Broken Spur at 29°N) are recorded from the Logachev field. Stygiopontius pectinatus Humes, 1987 previously recorded from the Mid-Atlantic Ridge hydrothermal vent fields TAG (26°N), Snake Pit, Broken Spur (29°N), and from the Mariana Back-Arc Basin of the Pacific Ocean and Stygiopontius cladarus Humes, 1996 previously known only from Snake Pit and Broken Spur, were found associated with alvinocaridid shrimps (Rimicaris sp.) from the hydrothermal vent field at 5ºS. The discovery of dirivultids at 5ºS represents the first record of copepods from a deep-sea hydrothermal vent southward of the Logachev field in the Atlantic Ocean.
A revision of Colletes Latreille (Hymenoptera: Colletidae: Colletinae)
from Brazil, Paraguay and Uruguay
Authors: FERRARI RAFAEL R.
Published: May 2019

The species of Colletes Latreille from Brazil, Paraguay and/or Uruguay are revised through an integrative approach to taxonomy combining morphological and molecular data to delineate species. Herein, the following 19 species are recognized and illustrated, eight of them described as new: C. altimontanus Ferrari & Silveira, C. argentinus Friese, C. chicoi n. sp., C. cyaneus Holmberg, C. ferenudus n. sp., C. flagellaris n. sp., C. furfuraceus Holmberg, C. hawkingi n. sp., C. imbricatus n. sp., C. kerri Moure, C. meridionalis Schrottky, C. michenerianus Moure, C. ornatus Schrottky, C. pampeanus n. sp., C. petropolitanus Dalla Torre, C. rufipes Smith, C. rugicollis Friese, C. sertanicola n. sp., and C. sexangulus n. sp. To facilitate their recognition, diagnoses, detailed descriptions and redescriptions, and a fully-illustrated key for all species are provided.
On the Covariability of Cloud and Rain Water as a Function of Length Scale
Authors: Witte Mikael K. , Morrison Hugh , Jensen Jørgen B. , Bansemer Aaron , Gettelman Andrew
Published: May 2019

Microphysics parameterizations in large-scale models often account for subgrid variability in the calculation of process rates by integrating over assumed subgrid distributions of the input variables. The variances and covariances that define distribution width may be specified or diagnosed. The correlation ρ of cloud and rain mass mixing ratio/liquid water content (LWC) is a key input for accurate prediction of the accretion rate and a constant value is typically assumed. In this study, high-frequency aircraft measurements with a spatial resolution of ≈22 cm are used to evaluate the scaling behavior of cloud and rain LWC (qc and qr, respectively) and to demonstrate how and why covariability varies with length scale ℓ. It is shown that power spectral densities of both qc and qr exhibit scale invariance across a wide range of scales (2.04–142 m for qc; 33–1.45 × 104 m for qr). Because the cloud–rain cospectrum is also scale invariant, ρ is therefore expected to vary with ℓ. Direct calculation of ρ shows that it generally increases with ℓ, but there is significant variability in the ρ–ℓ relationship that primarily depends on cloud drop number concentration N and cloud cellular organization, suggesting that ρ may also vary with cloud regime. A parameterization of ρ as a function of ℓ and N is developed from aircraft observations and implications for diagnosis of ρ from limited-area model output are also discussed.
Molecular classification of colorectal cancer using the gene expression profile of tumor samples
Authors: Rashid Mamoon , Vishwakarma Ramesh K , Deeb Ahmad M , Hussein Mohamed A , Aziz Mohammad A
Published: May 2019

Molecular classifications of colorectal cancer are benefitting cancer research by providing insights into subtype-specific disease prognosis and improved therapeutic interventions. Different conventional DNA markers, such as microsatellite instability, CpG island methylator phenotype, chromosomal instability, and BRAF and KRAS mutations, have been used to classify colorectal cancer patients but have not yet shown promising prognostic values. Here, for the first time, to the best of our knowledge, we show a classification of colorectal cancer tumors from Saudi Arabian patients based on the gene expression profile. An existing method of colorectal cancer subtyping has been applied to the gene expression profile of tumors from Saudi colorectal cancer patients. A survival analysis was done on the predicted colorectal cancer subtypes. In silico functional analyses were conducted on the gene signature used for the subtype prediction. The predicted subtypes showed a distinct but statistically insignificant overall survival distribution (log-rank test, P = 0.069). A comparison of the predicted subtypes in Saudi colorectal cancer patients with that of French patients showed significant dissimilarity in the two populations (Chi-square test, P = 0.0091). Functional analyses of the gene signatures used for subtyping suggest their association with “cancer” and “gastrointestinal diseases.” Most of the signature genes were found differentially expressed in colorectal cancer tumors compared to adjacent normal tissues. This classification framework might facilitate the treatment of colorectal cancer patients.

Impact statement

Colorectal cancer is a heterogeneous disease and subtyping could be useful in implementing precision medicine approach. In this report, we identified molecular subtypes in relatively less studied CRC patients from Saudi Arabia using the prediction model developed on the French population. The predicted subtypes showed distinct overall survival among the six subtypes. Chi-square results exhibited the dissimilarity between French and Saudi colorectal cancer patient population in terms of subtype distribution ( P value = 0.0091). Gene signature (57 genes) used for subtyping was found to be functionally relevant as evident from the pathway analyses. These genes were found to be associated with gastrointestinal disease and cancer. Genes used for subtyping were found to be differentially expressed in Saudi colorectal cancer patient samples when compared with their own normal tissue. Taken together, this study supports a classification method for CRC patients by using patient samples from a different geographical region.
Setting the scene for the Second Stroke Recovery and Rehabilitation Roundtable
Authors: Bernhardt Julie , Borschmann Karen N , Kwakkel Gert , Burridge Jane H , Eng Janice J , Walker Marion F , Bird Marie-Louise , Cramer Steven C , Hayward Kathryn S , O’Sullivan Michael J , Clarkson Andrew N , Corbett Dale ,   for the SRRR2 Collaboration
Published: May 2019

The Stroke Recovery and Rehabilitation Roundtable (SRRR) meetings bring together an international group of preclinical and clinical researchers along with statisticians, methodologists, funders and consumers, working to accelerate the development of effective treatments for stroke recovery and to support best-evidence uptake in rehabilitation practice. The first meeting (2016) focused on four recommendation areas: translation of preclinical evidence into human discovery trials; recovery biomarkers to provide knowledge of therapeutic targets and prognosis in human stroke; intervention development, monitoring, and reporting standards; and standardized measurement in motor recovery trials. The impact of SRRR is growing, with uptake of recommendations emerging, and funders exploring ways to incorporate research targets and recommendations. At our second meeting (SRRR2, 2018), we worked on new priority areas: (1) cognitive impairment, (2) standardizing metrics for measuring quality of movement, (3) improving development of recovery trials, and (4) moving evidence-based treatments into practice. To accelerate progress towards breakthrough treatments, formation of an International Stroke Recovery and Rehabilitation Alliance is our next step, where working groups will take recommendations and build partnerships needed to achieve our goals.
Multiresolution neural networks for tracking seismic horizons from few training images
Authors: Peters Bas , Granek Justin , Haber Eldad
Published: May 2019

Detecting a specific horizon in seismic images is a valuable tool for geologic interpretation. Because hand picking the locations of the horizon is a time-consuming process, automated computational methods were developed starting three decades ago. Until now, most networks have been trained on data that were created by cutting larger seismic images into many small patches. This limits the networks ability to learn from large-scale geologic structures. Moreover, currently available networks and training strategies require label patches that have full and continuous horizon picks (annotations), which are also time-consuming to generate. We have developed a projected loss function that enables training on labels with just a few annotated pixels and has no issue with the other unknown label pixels. We use this loss function for training convolutional networks with a multiresolution structure, including variants of the U-net. Our networks learn from a small number of large seismic images without creating patches. Training uses all seismic data without reserving some for validation. Only the labels are split into training/testing. We validate the accuracy of the trained network using the horizon picks that were never shown to the network. Contrary to other work on horizon tracking, we train the network to perform nonlinear regression, not classification. As such, we generate labels as the convolution of a Gaussian kernel and the known horizon locations that communicate uncertainty in the labels. The network output is the probability of the horizon location. We examine the new method on two different data sets, one for horizon extrapolation and another data set for interpolation. We found that the predictions of our methodology are accurate even in areas far from known horizon locations because our learning strategy exploits all data in large seismic images.
Functional non-epileptic attacks: essential information for psychiatrists
Authors: Sheldon Rollo J.G. , Agrawal Niruj
Published: May 2019

Functional non-epileptic attacks (FNEA) are seizure-like events occurring in the absence of epilepsy. Having had many different names over the years including dissociative convulsions and pseudo-seizures, they now fall in the borderland between neurology and psychiatry, often not accepted by either specialty. However, there is evidence that there is a high rate of psychiatric comorbidity in these patients and therefore it is likely that psychiatrists will come across patients with FNEA and they should know the broad principles of assessment and management.

We have provided a clinically based overview of the evidence regarding epidemiology, risk factors, clinical features, differentiation from epilepsy, prognosis, assessment and treatment.

By the end of this article, readers should be able to understand the difference between epileptic seizures and FNEA, know how to manage acute FNEA, and understand the principles of neuropsychiatric assessment and management of these patients, based on knowledge of the evidence base.

Consent statement

Informed consent was obtained from the patient for publication of Box 1.

Declaration of interest

None.
Implications of Adoption Studies on Schizophrenia
Authors: Tienari Pekka
Published: May 2019

It is accepted that schizophrenia runs in families, but whether this relates to genetic or psychosocial transmission is an unanswered question. Kendler (1988) has articulated four testable hypotheses: (a) a general liability to any psychiatric illness (b) a liability to schizotypal functioning — oddness, suspiciousness etc. (c) a liability to broadly defined schizophrenic psychosis, or any functional, non-affective psychosis and (d) a specific liability to narrowly defined schizophrenia, e.g. using DSM-III-R criteria (American Psychiatric Association, 1987). Kendler suggests that neither hypothesis (a) nor (d) is correct, and that the familial predisposition is neither completely non-specific nor highly specific; available results strongly support the second hypothesis and also provide some support in favour of the third.
Paths to Relapse: Possible Transactional Processes Connecting Patient Illness Onset, Expressed Emotion, and Psychotic Relapse
Authors: Nuechterlein Keith H. , Snyder Karen S. , Mintz Jim
Published: May 2019

A vulnerability/stress framework for schizophrenia is one means by which the strong evidence for genetic and other biological factors in schizophrenia can be combined in a useful way with persistent evidence that stressful environments may play a role in precipitating psychotic episodes (Gottesman & Shields, 1972; Zubin & Spring, 1977; Nuechterlein & Dawson, 1984; Nuechterlein, 1987; Ciompi, 1989). Within a large longitudinal study of the early course of schizophrenia, we have been attempting to examine several possible ways in which both psychobiological vulnerability factors in the patient (Dawson & Nuechterlein, 1987; Nuechterlein et al, 1991) and external environmental stressors (Ventura et al, 1989) individually and jointly influence the course of schizophrenia. At the Second International Symposium on Schizophrenia in Bern, we focused on two promising mediating factors in schizophrenia — those involving persistent information-processing abnormalities and stress-triggered autonomic arousal (Nuechterlein et al, 1989). We focus here on recent analyses that relate to current controversies in the literature on interpersonal attitudes that are typically called expressed emotion (EE) — socio-environmental attributes that have been statistically associated with psychotic relapse in schizophrenia.
Assessment of Coping with Schizophrenia
Authors: Wiedl Karl-Heinz
Published: May 2019

The analysis of schizophrenic persons' attempts at coping with their disease has developed into a fertile research area over the last few years. Results are expected that may lead to a better understanding of specific psychopathological phenomena, and hopes are raised for improvements in specific therapeutic programmes (cf. Böker & Brenner, 1983; Wiedl & Schöttner, 1989a). Previous studies have shown that schizophrenics use many different strategies to cope with their disease. Sometimes conflicting results deal with the frequency of specific ways of coping, their orientation to specific symptoms or strains, their relationship to the course of the disease and the nosological classification of the patients, and finally, with their suitability or usefulness (cf. Wiedl & Schöttner, 1989b). Altogether, these investigations have contributed to correcting the image of the schizophrenic as a person who is passive and helpless against his/her illness, and have expanded the scope of knowledge in psychiatry and clinical psychology (cf. Strauss, 1989a,b).
Chronicity in Schizophrenia: Revisited
Authors: Harding Courtenay M. , Zubin Joseph , Strauss John S.
Published: May 2019

Derived simply from the Greek workchronos, meaning time, the label ‘chronic’ denotes an illness of long duration or one of frequent recurrence. However, when chronic is paired with schizophrenia, as in ‘this person is a chronic schizophrenic’, the connotation becomes an expectation of deterioration, defect, or deficit states (Cutting, 1983). These perceptions about schizophrenia have pervaded and guided clinical judgements (Feighneret al, 1972; American Psychiatric Association, 1980, 1987), treatment programming (Bachrach, 1979; Lamb, 1981; Strauss & Glazer, 1982), policy formulation (Greenblatt, 1978; Talbott, 1979), and decisions about priority for funding (Kraft, 1981). These perceptions have also stripped hopes of recovery from patients and their families (Chamberlin, 1979; Lovejoy, 1984). Further, the use of phrases such as ‘deinstitutionalisation of chronic mental patients’ glosses over the large heterogeneity of patient types, courses of illness and recovery, and the actual shifts in composition and migrations of groups of patients within society (Lamb, 1979; Leighton, 1982; Harding & Ashikaga, 1982).
Overall Survival of Patients With ALK-Positive Metastatic Non–Small-Cell Lung Cancer in the Russian Federation: Nationwide Cohort Study
Authors: Tsimafeyeu Ilya , Moiseenko Fedor , Orlov Sergei , Filippova Elena , Belonogov Alexander , Nebesnykh Aleksey , Khalimov Amir , Karabina Elena , Shikina Valentina , Abdelgafur Ahmed , Statsenko Galina , Titova Irina , Isaichikov Dmitry , Makarnyaeva Galina , Mordovskiy Aleksey , Barkovskaya Oksana , Smirnov Aleksey , Gikalo Marina , Savelov Nikita , Kosov Dmitry , Imyanitov Evgeny , Demidova Irina , Tjulandin Sergei
Published: May 2019

PURPOSE

The overall survival (OS) results in patients with ALK-positive metastatic non–small-cell lung cancer (NSCLC) have rarely been reported. The aim of this prospective-retrospective cohort study was to obtain real-world data on the use of crizotinib or chemotherapy in patients with ALK-positive metastatic NSCLC in Russia.

PATIENTS AND METHODS

Patients with epidermal growth factor receptor–negative metastatic NSCLC were screened in 23 cancer centers. To be eligible, patients were required to have confirmation of ALK rearrangement. Patients were treated with crizotinib (250 mg twice daily; n = 96) or the investigator’s choice of platinum-based chemotherapy (n = 53). The primary end point was OS.

RESULTS

A total of 149 ALK-positive patients were included. Mean age was 53 years in both groups. Patients were predominately women (59%) and never-smokers (74%), and most patients had adenocarcinoma histology (95%). At a median follow-up time of 15 months, 79 of the 149 patients included in the analysis had died. Median OS from the start of treatment was 31 months (95% CI, 28.5 to 33.5 months) in the crizotinib group and 15.0 months (95% CI, 9.0 to 21.0 months) in the chemotherapy group ( P < .001). The objective response rate was 34% in the crizotinib group. Among patients with brain metastasis, one complete response (6%) and five partial responses (31%) were achieved. Grade 3 adverse events were observed in three patients (3%) in the crizotinib group.

CONCLUSION

The improved OS observed in crizotinib clinical trials in ALK-positive NSCLC was also observed in the less selective patient populations treated in daily practice in Russia. The use of standard chemotherapy in these patients remains common but seems inappropriate as a result of the effectiveness of newer treatments, such as crizotinib.
Benefits of Physical Activity during Pregnancy and Postpartum: An Umbrella Review
Authors: DIPIETRO LORETTA , EVENSON KELLY R. , BLOODGOOD BONNY , SPROW KYLE , TROIANO RICHARD P. , PIERCY KATRINA L. , VAUX-BJERKE ALISON , POWELL KENNETH E.
Published: May 2019

Purpose

This study aimed to summarize the evidence from the2018 Physical Activity Guidelines Advisory Committee Scientific Report, including new evidence from an updated search of the effects of physical activity on maternal health during pregnancy and postpartum.

Methods

An initial search was undertaken to identify systematic reviews and meta-analyses published between 2006 and 2016. An updated search then identified additional systematic reviews and meta-analyses published between January 2017 and February 2018. The searches were conducted in PubMed®, CINAHL, and Cochrane Library and supplemented through hand searches of reference lists of included articles and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results

The original and updated searches yielded a total of 76 systematic reviews and meta-analyses. Strong evidence demonstrated that moderate-intensity physical activity reduced the risk of excessive gestational weight gain, gestational diabetes, and symptoms of postpartum depression. Limited evidence suggested an inverse relationship between physical activity and risk of preeclampsia, gestational hypertension, and antenatal anxiety and depressive symptomology. Insufficient evidence was available to determine the effect of physical activity on postpartum weight loss, postpartum anxiety, and affect during both pregnancy and postpartum. For all health outcomes, there was insufficient evidence to determine whether the relationships varied by age, race/ethnicity, socioeconomic status, or prepregnancy weight status.

Conclusions

The gestational period is an opportunity to promote positive health behaviors that can have both short- and long-term benefits for the mother. Given the low prevalence of physical activity in young women in general, and the high prevalence of obesity and cardiometabolic diseases among the U.S. population, the public health importance of increasing physical activity in women of childbearing age before, during, and after pregnancy is substantial.
Physical Activity to Prevent and Treat Hypertension: A Systematic Review
Authors: PESCATELLO LINDA S. , BUCHNER DAVID M. , JAKICIC JOHN M. , POWELL KENNETH E. , KRAUS WILLIAM E. , BLOODGOOD BONNY , CAMPBELL WAYNE W. , DIETZ SONDRA , DIPIETRO LORETTA , GEORGE STEPHANIE M. , MACKO RICHARD F. , MCTIERNAN ANNE , PATE RUSSELL R. , PIERCY KATRINA L.
Published: May 2019

Purpose

This systematic umbrella review examines and updates the evidence on the relationship between physical activity (PA) and blood pressure (BP) presented in the 2008 Physical Activity Guidelines Advisory Committee Scientific Report.

Methods

We performed a systematic review to identify systematic reviews and meta-analyses involving adults with normal BP, prehypertension, and hypertension published from 2006 to February 2018.

Results

In total, 17 meta-analyses and one systematic review with 594,129 adults ≥18 yr qualified. Strong evidence demonstrates: 1) an inverse dose–response relationship between PA and incident hypertension among adults with normal BP; 2) PA reduces the risk of cardiovascular disease (CVD) progression among adults with hypertension; 3) PA reduces BP among adults with normal BP, prehypertension, and hypertension; and 4) the magnitude of the BP response to PA varies by resting BP, with greater benefits among adults with prehypertension than normal BP. Moderate evidence indicates the relationship between resting BP and the magnitude of benefit does not vary by PA type among adults with normal BP, prehypertension, and hypertension. Limited evidence suggests the magnitude of the BP response to PA varies by resting BP among adults with hypertension. Insufficient evidence is available to determine if factors such as sex, age, race/ethnicity, socioeconomic status, and weight status or the frequency, intensity, time, and duration of PA influence the associations between PA and BP.

Conclusions

Future research is needed that adheres to standard BP measurement protocols and classification schemes to better understand the influence of PA on the risk of comorbid conditions, health-related quality of life, and CVD progression and mortality; the interactive effects between PA and antihypertensive medication use; and the immediate BP-lowering benefits of PA.
Association of seeking ophthalmic assessment in children with parental history of refractive errors
Authors: Latif Muhammad Zahid , Khan Muhammad Athar , Afzal Saira , Gilani Syed Amir
Published: May 2019

Objective: To find out the association of seeking ophthalmic assessment in children with parental history of refractive errors.

Methods: After the approval of ethical review board, an analytical cross-sectional study was conducted in eight high schools of public and private sector at Lahore during the period of seven months from August 2017 to March 2018. Multistage random sampling technique was opted and 2000 study subjects were recruited including 50% boys and 50% girls. Informed consent was obtained and data was collected on a structured questionnaire. The data was organized, entered in version 23 of IBM SPSS and analyzed by the use of statistical tools.

Results: Age of the respondents ranged between nine to 18 years with a mean of 13.40±1.82 SD. Parental history of wearing spectacles was present in 21.3% of the fathers and 28.6% of the mothers. Moreover, 72.4% of the participants never visited eye care professional. Among private schools, an association was found between the visit of boys to eye care professional and maternal positive history of wearing spectacles (p-value 0.019). A significant association was found between the positive paternal history of wearing spectacles and visit of the female strudy subjects to an eye care professional (p-value 0.001). In public schools, there was an association between visit of children to eye care services and positive history of mothers about the use of spectacles (p-value 0.018).

Conclusions: This study concludes that positive maternal history of wearing spectacles is associated with the ophthalmic examination of children in both public and private school.

doi: https://doi.org/10.12669/pjms.35.3.1010

How to cite this:Latif MZ, Khan MA, Afzal S, Gilani SA. Association of seeking ophthalmic assessment in children with parental history of refractive errors. Pak J Med Sci. 2019;35(3):743-748. doi: https://doi.org/10.12669/pjms.35.3.1010

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Case Report: Hepatopulmonary syndrome as the first clinical manifestation of cirrhosis in a patient with underlying chronic lung disease
Authors: Murphy Charles , Arad Danit
Published: May 2019

An 86 year old woman with multiple chronic lung diseases (including chronic obstructive pulmonary disease, bronchiectasis, and untreated mycobacterium avium-intracellulare) presented with two weeks of increased shortness of breath, notably worse when seated as compared to when lying down. After treatments focused on her known conditions did not resolve her dyspnea, the differential diagnosis was broadened and she was found to have evidence of cirrhosis on imaging. As a result of this new diagnosis, transthoracic echocardiography and arterial blood gas analysis were performed and together yielded the diagnosis of hepatopulmonary syndrome. We describe a rare presentation of hepatopulmonary syndrome manifesting as a patient’s first clinical evidence of suspected cirrhosis, a diagnosis made difficult by this patient’s numerous other lung diseases which muddied the picture.