bluuebunny/crossref_metadata_2025 huggingface dataset:
Separation criteria of nanoscale water droplets from a nozzle plate surface
Authors: Nguyen Van Quang , Phung Xuan Son , Lin Jau-Wen
Published: May 2018

This paper studies the water nanojet ejection process using molecular dynamics simulation. The results show that nanoscale water droplets cannot separate from the nozzle plate surface when the nozzle aperture has a diameter of 27.5 Å or smaller. The maximum height of the produced water nanojet is reduced after reaching to its highest position when the jet does not separate from the plate surface. Separation phenomenon between the water nanojet and the nozzle plate surface is the most obvious with the 27.5-Å-diameter nozzle aperture for this simulation setup. In addition, initial findings on the characteristics of nanoscale water droplets (width and contact angle) impinging onto a fixed plate surface are revealed in preparation for future investigation.
Molecular characterization, overexpression and comparison of esterases-encoding LipRT, Lip4 and Lip20 from moderately thermophilic and mesophilic bacteria
Authors: Chen Yu-Pei , Liang Shu-Shan , Hwang Ing-Er , Chien Mei-Chih , Wang Guey-Horng , Liaw Li-Ling
Published: May 2018

Thermostable enzymes have the potential as the biocatalyst for industrial applications. To compare the relationship of enzymatic thermostability, the moderately thermophilic and mesophilic bacteria were utilized to explore the properties of esterases. By using the shotgun libraries of mesophilic Thalassomonas agarivorans, and Aeromonas sp., and moderately thermophilic Ralstonia sp., esterases-encoding Lip20, Lip4 and LipRT for α/β-hydrolase fold were cloned, sequenced, and characterized. According to the recombinant proteins overexpressed by Escherichia coli, these results indicated that Lip20, Lip4 and LipRT preferred to hydrolyze short-length p-nitrophenyl (p-NP) esters. The optimal temperature required for the activity of Lip20, Lip4 and LipRT was 30, 40 and 60°C, respectively, corresponding to the trend of bacterial growth temperature. Even at low temperature, cold-adapted Lip4 from Aeromonas sp. revealed well enzymatic activity. In addition, after 60 min incubation between 40-60°C, over 92% residual activity can be retained by the thermostable analysis of LipRT from Ralstonia sp.. Inspecting the predicted structures and amino acid composition, we found that the high helix content was exhibited in LipRT. Also, high frequency residues of Val, Phe and Arg for increasing hydrophobic and salt-bridge interactions were observed. These factors could improve LipRT thermal stabilization and lead to become more rigid.
Study on the relationship between project management and organizational efficacy in nonprofit organizations
Authors: Kao I-Chan
Published: May 2018

This study treats the members in nonprofit organizations (NPOs) as subjects, and explores the origination, planning, control, and completion of project management in NPOs, as well as the general performance of organizational efficacy, such as environmental satisfaction, organizational atmosphere, operational performance, job engagement, and work quality. It also probes into the relationship and effect. By various research methods, such as literature review and questionnaire survey, this study attempts to determine if project management in NPOs can significantly enhance organizational efficacy. This study finds that different NPOs have significant differences in the general performance of project management and organizational efficacy. When the performance of project management in NPOs is more significant, organizational efficacy is higher. Project management in NPOs has a significant path relationship to organizational efficacy; therefore, reinforcement of vocational training in the project management of NPOs could improve performance, which would have significant effect on enhancing organizational efficacy.
Evaluating key factors affecting knowledge exchange in social media community
Authors: Chuang Li-Wen , Chiu Shu-Ping
Published: May 2018

Today, social media opens up multiple options to add a new channel to learn and obtain knowledge. In particular, social media allows users to learn formal and informal social settings. Users can find like-minded people or community and organize knowledge exchange for educational or other purposes. This paper takes the theory of social network and social capital as the core factors to explore social media community members how to use social media platform to exchange knowledge. The paper uses social network and social capital as predictors of knowledge exchange so that we can use social media as a way to advance knowledge exchange ceaselessly. Therefore, there were 263 members of well-known social media community of knowledge exchange filling out the questionnaires completely, and then evaluated with structural equation modeling, and confirmatory factor analysis was also applied, using SmartPLS 2.0, to test if the empirical data conform to the proposed model. However, results also imply that social capital and social network distinctly play the important part of affecting knowledge exchange and communication about social issues on social media community goes hand in hand with knowledge exchange. Finally, this article proposes implications for theory and practice on the current and future research.
Simulation and verification for seed-filling performance of cell wheel precision seed metering device based on discrete element method
Authors: Lai Qinghui , Hua Ziwu , Xing Jinlong , Ma Wenpeng
Published: May 2018

The cell wheel seed metering device was improved and a stirring seed-filling device was added to improve the seed-filling performance of cell wheel pseudo-ginseng precision seed metering devices. Using pseudo-ginseng seeds in Wenshan Prefecture, Yunnan Province as the objects for seed metering, the software application EDEM was adopted based on the discrete element method for the simulation calculation and analysis of the seed-filling performance of the seed metering device under 4 rotational speeds of the cell wheel and 6 rotational speeds of the stir wheel. The simulation results indicate that the filling ratio increases as the rotational speed of the stir wheel increases under a constant rotational speed of the cell wheel. Test verification of the simulation analysis results was conducted on the test bed of the seed metering device. The results indicate that increasing the rotational speed of the stir wheel can obtain a filling ratio of over 90%. The test results display a similar variation trend to that of the simulation analysis with an error of average filling ratio less than 5%. Therefore, it is feasible to analyze the seed-filling performance of the stirring and seed-filling device of the seed metering device with the discrete element method.
Research on two dimensional Wiener stochastic degradation model based on the wear model
Authors: Zhang Hui , Yao Jun , Zhao Yan-Lin
Published: May 2018

One dimensional Wiener degradation process is often used to describe the degradation of product performance. However one dimensional Wiener degradation process doesn’t sufficiently consider the relevance of multiple degradation factors and wear process, which lead to inaccurate results. To overcome these problems, a new two dimensional Wiener stochastic degradation model is proposed, which applys to the products on wear process and stochastic degradation process. Combining wear model and two dimensional Wiener stochastic degradation model, a new reliability analytical form is obtained by constructing the Fokker-Planck equation. Then using the relation among wear volume, degradation characteristic lifetime and drift parameter, parameters of two dimensional Wiener degradation model on the basic of wear model can be estimated. Compared with the existing approaches, the proposed method can effectively improve accuracy. Finally, a case study is illustrated the application and advantages of the proposed method.
Decoding network patterns for urban disaster prevention by comparing Neihu district of Taipei and Sumida district of Tokyo
Authors: Chang Hung-Wen , Lee Wei-I
Published: May 2018

In this study, we performed routes network transport and emergency shelters capacity rate analyses to determine the accessibility and efficacy of urban patterns, and established a quantitative method for supplying priorities for actions of "Sendai Framework for Disaster Risk Reduction 2015-2030". By comparing two case studies, we used Space Syntax to develop two important indicators, Rn and CR, to present geographic information and hazard risk in a physical environment. This research also found potential function of Rn and decoded some patterns for urban planners or decision makers as follows：The most efficient configuration of the road network was not in the old areas of these two case studies because the several turns decreased the connectivity of the networks. And the CR indicator shown other findings about the quality of public facilities and services as follows：The service capacity of the emergency shelters was surveyed to indicate a higher correlation of residents population and preparedness security for disaster management. Therefore, with finding some risks that had not been encountered before, we addressed this proposed method is feasible and reliable to enhance the disaster preparedness for action regarding the 4th priority of “Sendai Framework for Disaster Risk Reduction 2015-2030”.
Low socioeconomic status and visual health behaviors as factors in childhood myopia development
Authors: Lee Cheng-Jong , Hsiao Yu-Ting , Sced Philip M. M. , Lee Shi-Huang
Published: May 2018

Although many studies have discussed visual acuity (VA), the childhood myopia epidemic has not been alleviated and requires further investigation. This study, therefore, investigates the differences in children’s VA among various family structures and the effects of visual health attitudes (VHA) and visual health behaviors (VHB) on VA. The children in low socioeconomic status (SES) families in Changhua County, Taiwan are the main research subjects. Using purposive sampling, the study conducts a questionnaire survey and a VA examination on low SES children, undergoing counseling at two social welfare organizations in Taiwan. The VA examination was conducted at the two social welfare organizations by an ophthalmologist from Tzu Chi Hospital, Taichung, between October 2016 and December 2016. 265 questionnaires were returned. Significantly, over 60% of the samples of low SES children were not living with their parents. Of these children, the highest proportion (35.8%) lived with their mothers; the second-highest (31.3%), lived with their grandparents; and the third highest (29.4%), lived with their fathers. 86.4% of the low SES children had poor (below 1.0) VA. The study, therefore, concludes that schools should focus on low SES students, and should focus on improving the VHA of the youngest students.
Efficient sequential experimental design for surrogate modeling of nested codes
Authors: Marque-Pucheu Sophie , Perrin Guillaume , Garnier Josselin
Published: May 2018

In this paper we consider two nested computer codes, with the first code output as one of the second code inputs. A predictor of this nested code is obtained by coupling the Gaussian predictors of the two codes. This predictor is non Gaussian and computing its statistical moments can be cumbersome. Sequential designs aiming at improving the accuracy of the nested predictor are proposed. One of the criteria allows to choose which code to launch by taking into account the computational costs of the two codes. Finally, two adaptations of the non Gaussian predictor are proposed in order to compute the prediction mean and variance rapidly or exactly.
Carbon dioxide versus air insufflation enteroscopy: a systematic review and meta-analysis based on randomized controlled trials
Authors: Aquino Julio , Bernardo Wanderley , de Moura Diogo , Morita Flávio , Rocha Rodrigo , Minata Maurício , Coronel Martin , Rodela Gustavo , Ishida Robson , Kuga Rogério , de Moura Eduardo
Published: May 2018

Objectives To compare the insufflation of CO2 and ambient air in enteroscopy.

Search sources The investigators researched the electronic databases MedLine, Cochrane Library, Central, LILACS, BVS, Scopus and Cinahl. The grey search was conducted in the base of theses of the University of São Paulo, books of digestive endoscopy and references of selected articles and in previous systematic revisions.

Study eligibility criteria The evaluation of eligibility was performed independently, in a non-blind manner, by two reviewers, firstly by title and abstract, followed by complete text. Disagreements between the reviewers were resolved by consensus.

Data collection and analysis method Through the spreadsheet of data extraction, where one author extracted the data and a second author checked the extraction. Disagreements were resolved by debate between the two reviewers. The quality analysis of the studies was performed using the Jadad score. The software RevMan 5 version 5.3 was used for the meta-analysis.

Results Four randomized clinical trials were identified, totaling 473 patients submitted to enteroscopy and comparing insufflation of CO2 and ambient air. There was no statistical difference in the intubation depth between the two groups. When CO2 insufflation was reduced, there was a significant difference in pain levels 1 hour after the procedure (95 % IC, –2.49 [–4.72, –0.26], P: 0.03, I2: 20%) and 3 hours after the procedure (95% IC, –3.05 [–5.92, –0.18], P: 0.04, I2: 0 %). There was a usage of lower propofol dosage in the CO2 insufflation group, with significant difference (95 % IC, –67.68 [–115.53, –19.84], P: 0.006, I2: 0 %). There was no significant difference between the groups in relation to the use of pethidine and to the oxygen saturation.

Limitations Restricted number of randomized clinical trials and nonuniformity of data were limitations to the analysis of the outcomes.

Conclusion The use of CO2 as insufflation gas in enteroscopy reduces the pain levels 1 hour and 3 hours after the procedure, in addition to the reduction of the sedation (propofol) dosage used.
Endoscopic electrochemotherapy for esophageal cancer: a phase I clinical study
Authors: Egeland Charlotte , Baeksgaard Lene , Johannesen Helle , Löfgren Johan , Plaschke Christina , Svendsen Lars , Gehl Julie , Achiam Michael
Published: May 2018

Background and study aims Esophageal cancer is on the rise in the western world and the disease has a poor 5-year survival prognosis below 20 %. Electrochemotherapy is a treatment where a chemotherapeutic drug is combined with locally applied electrical pulses, in order to increase the drug’s cytotoxicity in malignant cells. This study presents the first results with electrochemotherapy treatment in esophageal cancer.

Patients and methods In this first-in-human trial, six patients with advanced esophageal cancer were treated with electrochemotherapy using intravenous bleomycin. All side effects and adverse events (AEs) were registered and the patients were later evaluated with gastroscopy and 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI).

Results Treatment were well tolerated, main AEs being nausea, vomiting, oral thrush, pneumonia, retrosternal pain, fever, and hoarseness. No serious complications were observed. Five patients had a visual tumor response confirmed by gastroscopy. In two cases, these findings were confirmed with 18F-FDG PET/MRI as it revealed a reduction of total tumor mass.

Conclusion Electrochemotherapy in patients with advanced esophageal cancer was conducted without major safety concerns. This study paves the way for larger studies, which may further elucidate response rates for and side effects of this new treatment.
Soziale Verlusterlebnisse und deren Zusammenhang mit Depressionen im hohen Alter – Ergebnisse der Leipziger Langzeitstudie in der Altenbevölkerung (LEILA 75+)
Authors: Stein Janine , Bär Jonathan , König Hans-Helmut , Angermeyer Matthias , Riedel-Heller Steffi
Published: May 2018

Ziel der Studie Verlusterlebnisse im Alter können mit einer Vielzahl negativer gesundheitlicher Folgen für Betroffene wie Depressionen einhergehen.

Methodik 706 Personen (75+ Jahre) wurden mit einem strukturierten klinischen Interview befragt.

Ergebnisse Es zeigte sich, dass soziale Verlusterlebnisse signifikant mit Depressionen assoziiert waren.

Schlussfolgerung Die vorliegende Arbeit legt erstmalig für Deutschland umfängliche Ergebnisse zu sozialen Verlusterlebnissen im hohen Alter vor und stellt einen wertvollen Ausgangspunkt für zukünftige Forschungsarbeiten dar.
Wie können psychiatrische Kliniken in Österreich vollständig offen geführt werden?
Authors: Steinert Tilman , Scharfetter Joachim
Published: May 2018

Anliegen Viele psychiatrische Kliniken in Österreich werden offen geführt. Ein Vergleich einer österreichischen und einer deutschen Klinik sollte die Versorgungsbedingungen untersuchen.

Methode Vergleichende Analyse von Versorgungsdaten.

Ergebnisse Die Personalbesetzung war in Österreich in der Pflege besser, bei Ärzten und Psychologen vergleichbar. Freiheitseinschränkende Zwangsmaßnahmen waren in Österreich in Bezug auf die Gesamtzahl der Aufnahmen häufiger, nicht jedoch bezogen auf die gerichtlich Untergebrachten. Bei polizeilichen Fahndungen ergaben sich keine Unterschiede.

Diskussion Die Ergebnisse liefern keine Belege, dass die Öffnung der Stationen in Österreich in wesentlichem Maß durch andere Zwangsmaßnahmen ermöglicht wird.
Safety and efficacy of self-expanding metal stents for biliary drainage in patients receiving neoadjuvant therapy for pancreatic cancer
Authors: Ballard Darren , Rahman Syed , Ginnebaugh Brian , Khan Abdul , Dua Kulwinder
Published: May 2018

Background and study aims Durable biliary drainage is essential during neoadjuvant therapy (NAT) in patients with pancreatic cancer who present with biliary obstruction. Plastic stents (PS) tend to occlude readily, resulting in delay/interruption of treatment. Our aim was to evaluate the safety and efficacy of self-expanding metal stents (SEMS) for biliary drainage in patients receiving NAT for pancreatic cancer.

Patients and methods From 2009 to 2014, all consecutive patients with resectable pancreatic cancer at one tertiary center had SEMS placed for biliary drainage before NAT was started. Data on biliary drainage efficacy, stent malfunction rates and procedural adverse events were collected.

Results One hundred forty-two consecutive patients with pancreatic cancer (mean age 66 ± 9 SD years; 81 male, 61 female; 67 resectable, 75 borderline resectable) were enrolled. Eight-seven patients (61 %) had prior PS exchanged to SEMS and 55 (39 %) had SEMS placed upfront. Median duration from SEMS placement to the end of NAT/surgery was 111 days (range 44 – 282). During NAT, SEMS malfunction requiring reintervention occurred in 16 patients (11.2 %): tissue ingrowth 11, stent occlusion from food 6, stent migration 3, incomplete expansion 1, “tissue cheese-cutter” effect 1, and cystic duct obstruction 1. On subgroup analysis, no correlation between SEMS malfunction and stage of disease, prior PS, or duration of NAT was found (r2 = 0.05, P = 0.34). Presence of SEMS in situ did not affect pancreaticoduodenectomy.

Conclusion SEMS provide safe, effective and durable biliary drainage during NAT for pancreas cancer. Previously placed PS can be exchanged for SEMS. SEMS do not require removal prior to surgery.

Meeting presentations: Digestive Disease Week 2015 and 2017
Einfluss der demografischen Alterung auf die Inanspruchnahme der medizinischen Rehabilitation in Deutschland bis 2040
Authors: Nowossadeck Enno
Published: May 2018

Hintergrund Der Beitrag untersucht, welchen Einfluss die demografische Alterung auf die künftige Entwicklung der Fallzahlen in der medizinischen Rehabilitation haben wird. Implikationen der Ergebnisse für die Deutsche Rentenversicherung (DRV) und die Gesetzliche Krankenversicherung (GKV) werden diskutiert.

Methodik Es werden 3 Datenbestände herangezogen, die jeweils bestimmte Teilpopulationen der Rehabilitation umfassen, die der DRV, der GKV und die Statistik der Vorsorge- und Rehabilitationseinrichtungen mit mehr als 100 Betten von Destatis. Für jeden dieser Datenbestände erfolgt auf der Basis der 13. koordinierten Bevölkerungsvorausberechnung von Destatis eine Vorausberechnung bis 2040.

Ergebnisse Aufgrund der demografischen Entwicklung werden die Fallzahlen im Bereich der DRV von 961 Tsd. (2015) auf 911 Tsd. im Jahr 2040 sinken (− 5,2%). Für die GKV ergibt sich ein Anstieg von 742 Tsd. (2015) auf 934 Tsd. 2040 (+25,9%). Demografisch bedingt wird die Zahl Älterer in der Rehabilitation (65 Jahre und älter) bis 2040 um ca. ein Drittel steigen.

Schlussfolgerungen Der zu erwartende Anstieg der Älteren in der Rehabilitation betrifft v. a. die GKV. Die damit verbundenen Probleme lauten: Anreizprobleme in der Finanzierung sowie wachsende Bedeutung der Multimorbidität und der geriatrischen Rehabilitation. Für die Rehabilitation im Erwerbsalter ergibt sich ein zunehmendes Auseinanderdriften der demografisch bedingten Entwicklung der Fallzahlen und der Demografie-Komponente des Reha-Budgets der DRV.
Behandlungsverläufe und Nachhaltigkeit der Ambulanten Geriatrischen Komplexbehandlung – eine Analyse von 128 geriatrischen Patienten
Authors: Kiel Simone , Gerhardt Susanne , Meinhold Sabine , Meinhold Andreas , Schmidt Carsten , Chenot Jean-François
Published: May 2018

Ziel der Studie Die Beobachtungsstudie untersucht den Verlauf klinischer Endpunkte von multimorbiden geriatrischen Patienten, die an einer 4-wöchigen Ambulanten Geriatrischen Komplexbehandlung (AGKB) teilgenommen haben.

Methodik Die Analysen basierten auf Daten von 128 Patienten. Tests des geriatrischen Basisassessments und die EQ5D-Skala wurden vor, unmittelbar nach sowie 6 und 12 Monate nach der AGKB eingesetzt. Analysen erfolgten mittels Multilevel Mixed-Effekt-Regressions Modellen.

Ergebnisse Die AGKB verbesserte die Selbstständigkeit, die Mobilität, das Gleichgewicht, das Sturzrisiko und den allgemeinen Gesundheitszustand. Die kognitive Leistung nahm geringfügig ab.

Schlussfolgerung Die patientenbezogenen klinischen Endpunkte geben Hinweise auf einen positiven Einfluss funktioneller Defizite.
Anti-Diabetic Potential of Murraya Koenigii (L.) and its Antioxidant Capacity in Nicotinamide-Streptozotocin Induced Diabetic Rats
Authors: Husna Fauzul , Suyatna Franciscus , Arozal Wawaimuli , Poerwaningsih Erni
Published: May 2018

Aim and Objective The present study aims to investigate whether the antihyperglycemic effect of Murraya koenigii is mediated by antioxidant properties and insulin mimetic effect.

Methods Thirty Spraque-Dawley rats were induced hyperglycemia by streptozotocin and nicotinamide (STZ-NA). The STZ-NA diabetic rats were treated with an ethanolic extract of Murraya koenigii 200 mg/kg b.w and 400 mg/kg b.w. One group was treated with glibenclamide (1 mg/kg b.w). After the administration of Murraya koenigii extract and glibenclamide for four weeks, the rats were sacrificed. Blood and organ samples were collected under a fasting condition. The body weight and blood glucose levels were measured. Hepatic enzymes were determined using a commercial kit, protein levels were estimated by Bradford’s method, and plasma insulin was assayed by an ELISA kit. Malondialdehyde (MDA) and reduced glutathione (GSH) levels were estimated by the TBA-Wills method and Ellman’s method, respectively.

Results Ethanolic extract of Murraya koenigii showed a significant reduction in blood glucose level at both doses, 200 and 400 mg/kg b.w. In addition, Murraya koenigii exhibited a profound antioxidant effect with decreased MDA level and increased GSH level, particularly at the 200 mg/kg b.w. and significantly decreased the HOMA-IR index.

Conclusions The present study reveals that Murraya koenigii possesses antidiabetic activity and antioxidant effects on STZ-NA induced diabetes mellitus.
Multiple Causes of Pediatric Early Onset Chorea—Clinical and Genetic Approach
Authors: Lerman-Sagie Tally , Westenberger Ana , Ben-Pazi Hilla , Zerem Ayelet , Yosovich Keren , Lev Dorit , Blumkin Lubov
Published: May 2018

Objective This article elucidates a clinical and genetic approach to pediatric early-onset chorea in patients with normal neuroimaging.

Methods We retrospectively studied patients with onset hyperkinetic movement disorders. Only children with onset of chorea in the first 3 years of life were included, those with an abnormal magnetic resonance imaging (MRI) or electroencephalogram (EEG) were excluded.

We studied the movement disorder phenotype by clinical examination and by interpretation of videos and compared our data to the literature.

Results Four patients, aged 2 to 13 years, were diagnosed. Abnormal involuntary movements appeared between the ages of 6 months to 3 years in association with developmental delay. One patient has a close relative with NKX2.1-related chorea. One patient is from Iraqi-Jewish origin. Facial twitches and nocturnal dyskinetic attacks were observed in one.

The unique clinical presentation and family history enabled genetic diagnosis by molecular analysis of a specific mutation in two (NKX2.1, OPA3) and Sanger sequencing of a target gene in one (ADCY5). One patient was diagnosed by whole-exome sequencing (WES) (GNAO1).

Conclusion By carefully recording the phenotype and genetic background, a single gene can be suspected in some cases. In the rest, we suggest multigene panels or WES study.
Giant Cell Tumor of the Lateral Skull Base: Diagnostic and Management Options
Authors: Gamboa Nicholas , Ronna Brenden , Gamboa Christina , Palmer Cheryl , Park Min , Gurgel Richard , Couldwell William , Kalani M.
Published: May 2018

Giant cell tumor of bone (GCTB) is a rare, benign, osteolytic neoplasm that most commonly occurs in early adulthood and often involves the long bones of the body. Although GCTB largely affects the epiphyses of long bones, several reports of GCTB involvement of the cranial and facial bones exist in the literature. In addition to reviewing other reported cases of GCTBs of the lateral skull base in the literature, the authors report here on the clinical presentation, radiographic findings, and neurosurgical management of a patient found to have a GCTB of the middle and infratemporal fossae, which was treated by aggressive en bloc resection of the lateral skull base.
Ophthalmology Residents' Internship Selection and Initial Trainee Confidence: An Observational Study
Authors: Logothetis Hercules , Pyatetsky Dmitry , Baqai Jeanine , Volpe Nicholas
Published: May 2018

Purpose In this study, we set out to better understand the factors that influenced current ophthalmology residents' internship selection. We then tested the hypothesis that certain clinical or research experiences in medical school and internship may influence residents' confidence upon entering ophthalmology residency. Furthermore, we investigated whether completing internship at the same program as one's residency is correlated with confidence at the start of residency.

Design Observational, cross-sectional, multicenter survey.

Participants U.S. ophthalmology residents (Post Graduate Year 2/3) belonging to the class of 2018. Eighty surveys were submitted of which 63 were analyzed based on established inclusion criteria.

Methods Residents responded to a 22-question online survey addressing how residents chose their internship, internship curriculum, exposure to ophthalmology in medical school and during internship, confidence level entering ophthalmology residency, confidence in managing various ocular pathologies, and factors that built confidence prior to ophthalmology residency. A Likert scale format was used for the majority of survey questions. Kruskal–Wallis testing and Fisher's exact testing were used to compare outcome variables among three groups defined by sense of confidence entering ophthalmology training.

Main Outcome Measures Level of confidence at the start of ophthalmology residency.

Results Quality of life and geographic location were found to be the most important factors in choosing internship programs, while obtaining ophthalmology skills was least. Although 32.3% of residents either agreed or strongly agreed that they felt confident at the start of ophthalmology residency, 42.9% disagreed or strongly disagreed. Residents who felt most confident for ophthalmology training spent more time on ophthalmology rotations in medical school (p = 0.05) or internship (p = 0.02) and worked up patients independently during their internship ophthalmology rotation (s) (0.01). Completing one's internship at the same institution as one's ophthalmology residency did not correlate with confidence entering residency.

Conclusions Residents chose internships based on quality-of-life factors rather than enhancing ophthalmology training. Residents who felt confident at the start of ophthalmology residency had more hands on clinical ophthalmology experience than residents who did not feel confident. No statistically significant correlation was found between completion of internship at the same institution as one's ophthalmology residency and confidence entering residency.
Variants in the ATP1A3 Gene Mutations within Severe Apnea Starting in Early Infancy: An Observational Study of Two Cases with a Possible Relation to Epileptic Activity
Authors: Holze Niklas , Baalen Andreas , Stephani Ulrich , Helbig Ingo , Muhle Hiltrud
Published: May 2018

Mutations in the ATP1A3 gene are known to cause alternating hemiplegia of childhood (AHC) and rapid-onset dystonia parkinsonism (RDP). Both conditions are childhood-onset neurological disorders with distinct symptoms and different times of onset. ATP1A3 has also been associated with CAPOS syndrome (cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural hearing loss). Within the various ATP1A3-related neurological syndromes, a specific genotype–phenotype correlation is starting to emerge. Several mutations such as the relatively common p.E815K pathogenic variant have been shown to strongly correlate with AHC, while others may cause both AHC and RDP. A significant subset of patients with AHC and RDP are reported to have epileptic seizures. Even though detailed clinical descriptions of seizures in childhood are rare, seizures involving apneic events seem to be frequent in ATP1A3-related neurological disorders. Here, we describe two children with unexplained severe apnea beginning around the first year of life and pathogenic variants in ATP1A3. We hypothesize that the symptoms are early-onset autonomic seizures related to the underlying pathogenic ATP1A3 variants.
Growth Hormone Deficiency in Congenital Toxoplasmosis
Authors: Natsheh Juma , Abu-Libdeh Bassam , Abu-Libdeh Abdulsalam
Published: May 2018

Congenital toxoplasmosis represents the second most commonly recognized congenital infection. Ocular and neurological abnormalities are considered the most frequent sequelae. Endocrinological manifestations are rare and have received little attention. We report a 3.5-month-old female infant who presented with failure to thrive and recurrent hypoglycemic attacks, diagnosed as growth hormone deficiency due to sequelae of congenital toxoplasmosis. Although endocrinological sequelae of congenital toxoplasmosis are uncommon, they represent potentially treatable conditions. Here, we stress on the importance of monitoring pituitary function and growth in children in particular, with congenital toxoplasmosis, keeping in mind other possible, potentially treatable, endocrinological manifestations.
Statin Induced Dysuria- A Case Report
Authors: Soanker Radhika , Jyothi Arun , ram Sita
Published: May 2018

Statins are a class of hypolipidemic drugs, that are primarily used for the treatment of dyslipidemia and the prevention of cardiovascular disease. ATP III guidelines, 2002, recommends that LDL cholesterol be the primary target of therapy, and lipid lowering therapy may be initiated based on evaluation of short term and long term cardiovascular risk(1). We are report a case of dysuria follow statin group of drugs, which is not enlisted in the side effect of these drugs. In the present case after re-challenge with similar group of drug patient again developed the symptoms. Underlying hyperlipidemia was effectively controlled with Fenofibrates.
Does Ratio of Width to Length of Left Atrial Appendage Determine the Occurrence of Cerebrovascular Stroke Event in Both Genders?
Authors: Harish Oruganti , Srinivas Mantha ,   Jabeen
Published: May 2018

Objective : To see the Left atrial appendage size (width and length) in ischemic cerebrovascular accident (CVA) patients.

Design and method: Transesophageal echocardiography (TEE) was done in ischemic CVA patients after initial stabilization. We compared width length ratio(WLR) calculated from the average of width and length of LAA observed in earlier study by John P et al as controls. We chose this autopsy study as controls, as it is not possible to have TEE data in normal subjects.

Results : Study group includes 143 patients (F:M::37:106) and control group was 400 subjects (F:M::200:200) from the previous study. The mean ± std of width and length of LAA in females and males in study group were 1.99±0.67, 2.397±0.58 and 2.19±0.73, 2.49±0.66 respectively. In females, WLR is more (0.83 ± 0.37) in study group than in control group (0.66±0.26) which is statistically significant (z=4.06, P < 0.000001). So also for males (study group: control group :: 0.88 ±0.39 : 0.71±0.28) which is also statistically significant (z=7.03, P < 0.000001). So, broad and short LAA could determine the formation and dislodgement of thrombus resulting in embolic stroke in both sexes.

In conclusion, higher the width length ratio of left atrial appendage greater chances of embolic stoke.
Gender Difference in Risk Factor Profiles in Patients Referred for Coronary Angiogram
Authors: Deepti Gali , Kiran Ravi , Bharathi Vanaparthi
Published: May 2018

Background & Objective

Coronary artery disease (CAD) is a leading cause of death of women and men worldwide. Expected burden of athero-thrombotic CAD in India will surpass other regions of the world by the year 2020. It is better to control the risk factors for CAD to prevent this crisis. So, we want to study the gender difference in risk factor profiles in patients referred for coronary angiogram (CAG).

Materials & Methods

We did is a prospective observational study for risk factors profile in patients referred for CAG over 24 months (2013 to 2015) to the Nizam's institute of medical sciences. We collected the demographic, clinical and lab parameters including CAG finding in these patients.

Results

We analyzed the data of 3232 patients who undergone CAG during the study period. F: M::1081: 2151. 706 (65.3%) of female patients and 1312 (60.9%) of males patients had hypertension (HTN). 496 (45.9%) of females and 950 (44.1%) of males had Diabetes mellitus (DM). More males were presented with ACS (Acute coronary syndrome) whereas more females were presented with CSA (chronic stable angina). 203 (18.8%) female patients and 673 (31.3%) had lv dysfunction. Serum creatinine and Hemoglobin was low in females than males which were statistically significant. Total cholesterol was significantly higher in female CAD patients than male CAD patients (p=0.03). Both atherogenic (LDL) and protective (HDL) cholesterol were more in females than males with normal coronaries, but this difference was seen in patients with CAD in both sexes.

543 females and 551 males had normal coronaries. Overall prevalence of normal coronaries is more in females (p=0.00). Prevalence of diabetes showed a tendency more in females with normal coronaries than with males (p=0.063). Overall prevalence of risk factors in patients with normal coronaries is more in females compared to males (p=0.03). 782 (48.87%) males and 301(55.94%) females with CAD had diabetes. Prevalence of HTN (p=0.00) and DM (p=0.005) is more in females with CAD than males (p=0.00). Both DM & HTN was present in 647 (40.43%) of males and 273 (50.74%) of females, which is also is statistically significant.

Conclusion

Overall prevalence of normal coronaries is significantly more in females than males (p=0.00). Incidence of ACS is significantly more in males whereas CSA incidence more in females. Even though statistically significant more prevalence HTN in females, there was no statistical significant difference in prevalence of DM & HTN in between both sexes in patients with normal coronaries. But there was significantly high prevalence of DM & HTN in females with CAD compared to males.
Role of Tissue Doppler Echocardiography in the Diagnosis of Early Left Ventricular Dysfunction in Rheumatoid Arthritis
Authors: Arigondam Ashok , Prasad Vara , Rajasekhar Liza
Published: May 2018

Objective: Rheumatoid arthritis (RA) is a systemic disease involving many organ systems and is frequently accompanied by cardiac alterations. The purpose of our study is the usefulness of Tissue Doppler echocardiography to detect the nature and extent of cardiac involvement in RA patients with no symptoms of cardiac disease, in comparison with a control sample.

Methods: We selected 21 patients affected by rheumatoid arthritis. No patient had any symptoms of cardiac disease. As a control group we studied 21 volunteers, randomly selected among a larger group of subjects who had come for routine check-up. All were in sinus rhythm and without any cardiac symptom. Standard two-dimensional, M-mode and Doppler echocardiographic examination was carried out on each subject.

Results: out of 21 RA patients, 16 females 5 males with an average age of 38±9 years. Both the study group and control were matched with respect to age and sex. In RA patients we found a higher prevalence of several tissue Doppler parameters abnormalities. Patients with RA showed significantly higher tricuspid annular plane systolic ejection (TAPSE) 2.49±0.19 vs. 2.36±0.22 (p= 0.04), isovolumetric contraction time (IVCT) 48.8±11.7 vs. 41.2±7.7 msec, (p=0.02), isovolumetric velocity (IVV) 12.26±2.23 vs. 15.71±1.89 m/sec ( p = 0.00) acceleration time (AT) 0.43±0.05 vs. 0.35+0.05 msec (p = 0.00) lower isovolumetric acceleration (IVA) 28.68±6.57 vs. 45.8±10.1 m/sec2 (p = 0.00) early diastolic velocity (E)′ 10.48±1.99 vs. 13.02±1.54 cm/sec (p = 0.00). No significant difference was noted with IVRT (isovolumetric relaxation time) and A′ (late diastolic velocity). Duration of RA did not affect the significance of these parameters.

Conclusion: There was subclinical LV systolic and diastolic dysfunction with normal EF, detected by tissue Doppler imaging in Rheumatoid arthritis patients.
Comparison of Derived Central Aortic Pressure vs Cuff Peripheral Pressure
Authors: Krishna K. , Kiran M. , Garre Indrani
Published: May 2018

Background: Emerging evidence favours Central aortic pressure as a better correlate of cardiovascular events than peripheral BP recorded with sphygmomanometer. Noninvasive devices to calculate the derived central aortic pressures are available now. We want to see the difference of BP between derived central BP vs manual recorded BP and to see whether these BP values are consistent among different sexes and age groups.

Materials and methods: In the present study 63 consecutive patients both male and female who attended the cardiology outpatient department were studied. In all these patients blood pressure was recorded both manually by sphygmomanometer and by Mobil-O-Graph® Pulse Wave Analyser (ARC Solver). The Mobil-O-Graph ® system works on the oscillometric recording of pulse waves at the brachial artery site. We recorded the BP in sitting posture. We compared the derived central, manual and device measured BP, cardiac output, and pulse wave velocity between both genders.

Results: Among the study population (63 patients) 20 were females and 43 were males with mean age of 58.92±10.9 yrs. The mean systolic and diastolic manually recorded peripheral BP was 127.25 ± 19.89 and 79.25 ± 8.58 mm of Hg respectively, whereas the mean peripheral SBP and DBP recorded by the device was 129.40 ± 21.21 and 81.56 ± 12.83 mm of Hg respectively (comparable p=0.6, 0.2). The mean central aortic SBP & DBP recorded by the device was 117.37 ± 19.17 and 81.67 ± 13.04 mm of Hg with the mean pulse wave velocity of 8.392 ± 1.741 m/sec. There was a statistically significant difference in the central aortic SBP and manual SBP (p=0.005), whereas the difference in DBP was not statistically significant (p=0.2). There is no statistically significant difference in the central and peripheral SBP and DBP recorded by the device among males and females. The device derived parameters including cardiac output, pulse wave velocity also did not show significant difference in both sexes.

Conclusion: Derived central aortic systolic pressure recorded by the device is lower than the manually recorded pressure whereas there was no difference in diastolic BP. There is no difference in these BP recordings between the genders.
Failure of Stent Delivery in Lima PCI
Authors: Janapati Rama , Sneha G , Garre Indrani
Published: May 2018

Back Ground: The internal mammary artery was the most effective conduit for coronary artery bypass surgery and it was associated with significantly better long term patency, survival, and reintervention rates compared to other bypass conduits. The internal mammary artery (IMA) is not immune to atherosclerosis. IMA interventions constitute low percentage out of all coronary interventions. In addition to the tortuous course, the long length of IMA than native coronaries adds procedural difficulties to IMA PCI.

Aim: To analyze the acute outcomes of Percutaneous intervention procedures to the internal mammary artery and to found any association with clinical and demographic parameters to the procedural success at a single tertiary care hospital from India

Materials And Methods: This study was a retrospective analysis of post CABG patient who required and undergone the IMA intervention. We collected the clinical, demographic and procedural details of the IMA intervention. We defined as failure of the procedure when the stent could not be delivered to the lesion site through IMA.

Results: Total 21 patients were included in this retrospective analysis. Mean age of the study population was 56.1± 9.98 years and 18 patients were male. Twelve (57.1%) patients presented with chronic stable angina and six (28.6%) had Left ventricular dysfunction (LVD) (mild LVD in 5 and one patient had severe LVD). Mean stent diameter was 2.75±0.442 mm and the mean stent length was 17.71 ±5.63 mm. Transient slow flow occurred in 5 patients, but the end result of PCI procedure was good in them. In 4 (19.1%) patients stent could not be delivered. No LIMA dissections were observed. On binary logistic regression, there was no significant difference between successful PCI to the failed PCI with respect to age (p=0.9, z=0.16, OR=0.99, 95%CI=0.83to1.17), male sex (p=0.7, Z=0.34, OR=1.68), type of presentation (p=0.7, Z=0.38, OR=1.60, 95%CI= 0.14 to 17.7), presence of Left ventricular dysfunction (p=0.7, z=0.38, OR=1.60, 95%CI= 0.14 to 16.97) and with pre-dilatation during PCI (p=0.9, z=-0.16, OR=0.99).

Conclusion: PCI to the internal mammary artery was associated with 80.95% of success. Not able to deliver the stent to the target lesion was the major problem with LIMA PCI, in addition, to slow or no flow. The success or failure of PCI were not dependent on the age, sex, type of presentation or LV dysfunction.
Difference in the Mortality Between Weekend and Non-Weekend Coronary Artery Disease Admissions
Authors: Sandeep M. , Satish K.
Published: May 2018

Background: Acute coronary syndrome requires urgent diagnostic and therapeutic procedures, which may not be uniformly available throughout the week. So, we sought to examine the effects of admission on clinical outcomes in patients with wide spectrum coronary artery diseases.

Methods: A retrospective analysis of ICCU Inpatient sample database of 17 months from 2015 to 2016 used to compare differences in in-hospital mortality between patients admitted on a non-weekday versus weekend for wide spectrum ACS which include STEMI, NSTEMI and unstable angina and patients with cardiogenic shock. Out of these 75% had higher TIMI risk score (5-7).

Results: Total 2700 patients with ACS were included in the present study with wide spectrum coronary artery diseases. Out of that 20 % (n=541) were admitted in weekends and 79.9% (n=2159) were admitted in non-weekends. Total 804 females admitted on non-weekend had a mean age of 61.05±12 years and 162 females admitted on weekend had mean age 58.5±13.3 years (p value=0.025). Out of 2159 admitted on non-weekend, 1355 were males with mean age of 57.65±15.55 years and 379 were males admitted on weekend out of 541 patients with mean age of 56.85±13.1 years (p value =0.314). In-hospital mortality rate of these patients admitted on non-weekends was 9.4% (n=204) and those admitted on weekends was 5.9% (n=32) with statistically significant difference (95% CI; p= 0.003). The mortality rate of ACS without STEMI in non-weekend group was 8.6% (n=170) which was statistically significant (p = 0.006) with mortality of weekend group 5.3% (n=26).

Conclusion: Our study shows that there is no added mortality in patients with coronary artery disease on weekend days compared with non-weekend days. As the patients admitted during non-weekend were elder and sicker than the weekend admissions (having the high risk score), the in-hospital mortality is higher on non-weekends. Efforts to improve health care system should ensure comparable outcomes for patients irrespective of time of hospital admission.
Discordance is the Key
Authors: Prasad K. , Kumar A.
Published: May 2018

Congenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart disease characterised by atrioventricular as well as ventriculoarterial discordance. It is usually associated with a variety of severe intracardiac defects. Few patients with this abnormality survive past 50 years. A 54 Yr old male patient referred to our hospital for the management of post MI VSD. At the presentation Patient had mild central cyanosis, clubbing grade 2 and the vitals are stable. Cardiac examination revealed a 2/6 long ESM in a left parasternal area with pulsations in left 2nd and 3rd ICS. There is a lot of discrepancy in both clinical examination and workup. After detailed evaluation patient is diagnosed as having cyanotic congenital heart disease – L TGA + VSD with PS. Survival up to this age is very rare with this combination of associated defects in LTG. The patient is misdiagnosed as coronary artery disease with mechanical complication in another hospital. Unless there is suspicion and having knowledge about the asymptomatic presentation of congenital heart diseases up to this age group, patients will be misdiagnosed and treatment will be delayed.