bluuebunny/crossref_metadata_2025 huggingface dataset:
A Systematic Review and Meta-Analysis of Randomized Controlled Trials of Endovascular Thrombectomy Compared with Best Medical Treatment for Acute Ischemic Stroke
Authors: Balami Joyce S. , Sutherland Brad A. , Edmunds Laurel D. , Grunwald Iris Q. , Neuhaus Ain A. , Hadley Gina , Karbalai Hasneen , Metcalf Kneale A. , DeLuca Gabriele C. , Buchan Alastair M.
Published: August 2015

Background

Acute ischemic strokes involving occlusion of large vessels usually recanalize poorly following treatment with intravenous thrombolysis. Recent studies have shown higher recanalization and higher good outcome rates with endovascular therapy compared with best medical management alone. A systematic review and meta-analysis investigating the benefits of all randomized controlled trials of endovascular thrombectomy where at least 25% of patients were treated with a thrombectomy device for the treatment of acute ischemic stroke compared with best medical treatment have yet to be performed.

Aim

To perform a systematic review and a meta-analysis evaluating the effectiveness of endovascular thrombectomy compared with best medical care for treatment of acute ischemic stroke.

Summary of review

Our search identified 437 publications, from which eight studies (totaling 2423 patients) matched the inclusion criteria. Overall, endovascular thrombectomy was associated with improved functional outcomes (modified Rankin Scale 0–2) [odds ratio 1·56 (1·32–1·85), P < 0·00001]. There was a tendency toward decreased mortality [odds ratio 0·84 (0·67–1·05), P = 0·12], and symptomatic intracerebral hemorrhage was not increased [odds ratio 1·03 (0·71–1·49), P = 0·88] compared with best medical management alone. The odds ratio for a favorable functional outcome increased to 2·23 (1·77–2·81, P < 0·00001) when newer generation thrombectomy devices were used in greater than 50% of the cases in each trial.

Conclusions

There is clear evidence for improvement in functional independence with endovascular thrombectomy compared with standard medical care, suggesting that endovascular thrombectomy should be considered the standard effective treatment alongside thombolysis in eligible patients.
Cerebrovascular Correlates of Vitamin D Deficiency in Older Adults Living near the Equator: Results from the Atahualpa Project
Authors: Del Brutto Oscar H. , Mera Robertino M. , Macias Jorge , Morales Gabriela , Zambrano Mauricio
Published: August 2015

All studies attempting to find an association between vitamin D deficiency and cerebrovascular diseases have been conducted at latitudes far away from the Equator, where living conditions, cardiovascular risk factors, and sunshine exposure are different from tropical regions. We aimed to assess cerebrovascular correlates of vitamin D deficiency in community-dwelling older adults living in Atahualpa, a village located in rural coastal Ecuador. Out of 267 individuals enrolled in the neuroimaging substudy of the Atahualpa Project, 220 (82%) signed the informed consent. Mean age of participants was 70·9 ± 7·8 years, and 126 (57%) were women. Fifty-four (25%) persons have vitamin D levels <20 ng/ml, 47 (21%) had ischemic strokes, and 53 (24%) had moderate-to-severe white matter hyperintensities of presumed vascular origin. Exposure effect models constructed with vitamin D deficiency as the exposure, white matter hyperintensities and ischemic stroke as the outcomes, and confounders – age, gender, body mass index, physical activity, blood pressure, fasting glucose, total cholesterol, ionized calcium, phosphorus, intact parathormone, and serum creatinine – as independent variables revealed a significant association of vitamin D deficiency with white matter hyperintensities ( P = 0·006) but not with ischemic strokes ( P = 0·359). This study shows an association of vitamin D deficiency with diffuse subcortical brain damage in older adults living in a tropical region. Lack of awareness of the importance of vitamin D deficiency might be one of the factors influencing the high prevalence of white matter hyperintensities of presumed vascular origin in underserved Latin American populations.
Role of inflammation in benign prostatic hyperplasia development among Han Chinese: A population‐based and single‐institutional analysis
Authors: Hu Jimeng , Zhang Limin , Zou Lujia , Hu Mengbo , Fan Jie , Cai Yehua , Xu Gang , Fang Jie , Ding Qiang , Jiang Haowen
Published: August 2015

Objectives

To explore whether asymptomatic inflammatory prostatitis is associated with prostatic enlargement beyond that of benign prostatic hyperplasia patients without asymptomatic inflammatory prostatitis, and whether asymptomatic inflammatory prostatitis affects long‐term outcomes of transurethral resection of the prostate.

Methods

The present study involved 106 benign prostatic hyperplasia patients who underwent transurethral resection of the prostate. Clinical and pathological parameters were compared between those with benign prostatic hyperplasia associated with asymptomatic inflammatory prostatitis and those with benign prostatic hyperplasia alone.

Results

A total of 55 patients (52%) were found to have benign prostatic hyperplasia and asymptomatic inflammatory prostatitis, whereas 51 patients (48%) had benign prostatic hyperplasia alone. The prostate volume of the benign prostatic hyperplasia/asymptomatic inflammatory prostatitis group was significantly larger than the benign prostatic hyperplasia alone group: 68.1 cm3 (interquartile range 45.7–86.3) versus 44.1 cm3 (interquartile range 30.9–72.1), P = 0.036. In terms of histopathological analysis, benign prostatic hyperplasia/asymptomatic inflammatory prostatitis patients were more likely to show mild (53%), focal (67%) and stromal (40%) prostatic inflammation in our study. Furthermore, statistically significant differences of International Prostate Symptom Score were found 3 years after transurethral resection of the prostate, with benign prostatic hyperplasia/asymptomatic inflammatory prostatitis patients reporting higher (worse) scores than benign prostatic hyperplasia alone patients (P = 0.025).

Conclusions

Chronic prostatic inflammatory process might progressively conduce to benign prostatic hyperplasia development, which can also result in prostate enlargement and worsen long‐term postoperative International Prostate Symptom Scores. Multicenter studies with larger cohorts and longer follow‐up periods are required to confirm these findings.
Thymic stromal lymphopoietin‐induced interleukin‐17A is involved in the development of IgE‐mediated atopic dermatitis‐like skin lesions in mice
Authors: Mizutani Nobuaki , Sae‐Wong Chutha , Kangsanant Sureeporn , Nabe Takeshi , Yoshino Shin
Published: August 2015

Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with elevated levels of allergen‐specific IgE. Although thymic stromal lymphopoietin (TSLP) and interleukin‐17A (IL‐17A) have been considered as important factors in allergic diseases, their relationships in AD have not been fully defined. Here, we show the contribution of TSLP‐induced IL‐17A responses to IgE‐mediated AD‐like skin lesions. BALB/c mice passively sensitized by intraperitoneal injections of ovalbumin (OVA)‐specific IgE monoclonal antibody (mAb) were challenged with OVA applied to the skin six times. Treatment with anti‐TSLP mAb during the second to sixth challenges inhibited IgE‐mediated AD‐like skin lesions and IL‐17A production in lymph nodes. Furthermore, the increased number of IL‐17A‐producing CD4+ and γδ T cells in lymph nodes and neutrophilic inflammation in the skin were reduced by anti‐TSLP mAb. These findings prompted us to examine the roles of IL‐17A. Treatment with anti‐IL‐17A mAb suppressed the AD‐like skin lesions and neutrophilic inflammation; anti‐Gr‐1 mAb also inhibited them. Furthermore, treatment with CXCR2 antagonist reduced the AD‐like skin lesions and neutrophilic inflammation accompanied by the reduction of IL‐17A production; the increased CXCR2 expression in the epidermal cells was suppressed by anti‐TSLP mAb. Meanwhile, these treatments, except for anti‐Gr‐1 mAb, inhibited the increased mast cell accumulation in the skin. Collectively, the mechanism of IgE mediating IL‐17A‐producing CD4+ and γδ T cells through TSLP by repeated antigen challenges is involved in AD‐like skin lesions associated with skin inflammation, such as neutrophil and mast cell accumulation; TSLP may regulate CXCR2 signalling‐induced IL‐17A production.
Crystallization Behavior of Amorphous Si2BC3N Ceramic Monolith Subjected to High Pressure
Authors: Liang Bin , Yang Zhihua , Chen Qingqing , Wang Shengjin , Duan Xiaoming , Jia Dechang , Zhou Yu , Luo Kun , Yu Dongli , Tian Yongjun
Published: August 2015

The crystallization behavior of amorphous Si2BC3N monoliths by heating at 1000°C–1400°C and 5 GPa was investigated with the special attention to the nucleation mechanisms of β‐SiC and BN(C) phases. Nanoscale puckered structures arising in particle bridging areas were found and its evolution behavior well reflected the nucleation process of nanocrystallites. The temperature‐dependent crystallization of amorphous Si2BC3N monoliths at 5 GPa passes through four stages: The material remains amorphous below 1100°C. It undergoes partial phase segregation (1100°C–1200°C), followed by initiation of nucleation (1200°C–1250°C), and then nucleation and growth of β‐SiC and turbostratic BN(C) crystallites (>1250°C). The first principles calculation indicates the nucleation precedence of BN(C) phase over β‐SiC. BN(C) nucleates preferentially at bridges between ceramic particles causing SiC to concentrate in particle interiors thus forming capsule‐like structures.
A cost‐effectiveness analysis of two different repositioning strategies for the prevention of pressure ulcers
Authors: Marsden Grace , Jones Katie , Neilson Julie , Avital Liz , Collier Mark , Stansby Gerard
Published: August 2015

Aims

To assess the cost effectiveness of two repositioning strategies and inform the 2014 National Institute for Health and Care Excellence clinical guideline recommendations on pressure ulcer prevention.

Background

Pressure ulcers are distressing events, caused when skin and underlying tissues are placed under pressure sufficient to impair blood supply. They can have a substantial impact on quality of life and have significant resource implications. Repositioning is a key prevention strategy, but can be resource intensive, leading to variation in practice. This economic analysis was conducted to identify the most cost‐effective repositioning strategy for the prevention of pressure ulcers.

Design

The economic analysis took the form of a cost‐utility model.

Methods

The clinical inputs to the model were taken from a systematic review of clinical data. The population in the model was older people in a nursing home. The economic model was developed with members of the guideline development group and included costs borne by the UK National Health Service. Outcomes were expressed as costs and quality adjusted life years.

Conclusion

Despite being marginally more clinically effective, alternating 2 and 4 hourly repositioning is not a cost‐effective use of UK National Health Service resources (compared with 4 hourly repositioning) for this high risk group of patients at a cost‐effectiveness threshold of £20,000 per quality adjusted life years. These results were used to inform the clinical guideline recommendations for those who are at high risk of developing pressure ulcers.
Optimization of the Spray‐Drying Process for Developing Jabuticaba Waste Powder Employing Response Surface Methodology
Authors: Borges Leonardo L. , Martins Frederico S. , Conceição Edemilson C. , Silveira Dâmaris
Published: August 2015

The objective of this work was to obtain spray‐dried extract from seeds and peels jabuticaba (Myrciaria cauliflora) with optimized properties. To optimize the spray‐drying process, a 33 Box–Behnken design was used, in which the independent variables were the inlet drying air temperature (x1, 100–120C), feed flow rate (x2, 3–5 mL/min) and spray nozzle air flow rate (x3, 40–50 L/min). The dependent variables were ellagic acid content, total flavonoid content, total phenolic content, antioxidant activity, water activity and moisture content. Only flavonoid content and moisture content were influenced by none of the independent variables in the ranges studied. Using the desirability function, the optimum conditions for obtaining spray‐dried extracts for the responses (with significant effects) were inlet drying air temperature of 120C, feed flow rate of 3 mL/min and spray nozzle air flow rate of 50 L/min. Under these conditions, the results from the verification were 0.0844 ± 0.0013% for ellagic acid content, 16.27 ± 0.63 % for total phenolic content, 0.176 ± 0.02 for water activity and 54.45 ± 0.92% for antioxidant activity, which were in good agreement with the predicted values.

Practical Applications

This paper gives a report on the reuse of the vegetal wastes obtained from jabuticaba fruits – Myrciaria cauliflora (peels and seeds), which can be considered a raw material with several chemical compounds with biological activities. So, this work aims to arrive at the possible industrial application in the spray‐drying process to obtain an intermediary product from jabuticaba wastes. Furthermore, surface response methodology (SRM) was employed to determine the influence of the most important spray dryer parameters on the physicochemical properties of M. cauliflora spray‐dried extracts. Based on the results obtained from SRM and in biological activities known for this species, the spray‐dried extracts exhibited a great potential for use in pharmaceutical and nutraceutical fields.
Application of GAB Model for Water Desorption Isotherms and Thermodynamic Analysis of Sugar Beet Seeds
Authors: de Oliveira Gabriel Henrique Horta , Corrêa Paulo Cesar , de Oliveira Ana Paula Lelis Rodrigues , Reis Renata Cunha dos , Devilla Ivano Alessandro
Published: August 2015

The desorption isotherms and thermodynamic properties of sugar beet seeds of cv. “Chata do Egito” variety was determined at 10, 20, 30, 40 and 50C over a range of water activities (Aw) from 0.11 to 0.96. Equilibrium moisture content data were correlated by the Guggenheim–Anderson–de Boer model, which presented good fit to the data, according to statistical procedures. Equilibrium moisture content ranged from 1.50 to 20.0% d.b. (dry basis). Desorption isotherms of sugar beet seeds exhibited type II sigmoid shape. Thermodynamic properties were determined related to desorption process. Differential enthalpy values varied between 3,614.51 and 4,093.90 kJ/kg. Differential entropy and Gibbs free energy presented values between 3.67–4.08 kJ/kg.K and 0.75–508.11 kJ/kg, respectively. The enthalpy–entropy compensation theory is valid for the moisture desorption phenomena of sugar beet seeds, being enthalpy controlled.

Practical Applications

Almost 100% of the Brazilian sugar beet seeds are imported throughout the world and its commerce between different countries. Higher distances lead to physical, chemical and microbiological changes in sugar beet seeds. This trend could cause the deterioration of food products. Information on the sorption characteristics of sugar beet seeds could not be found in the literature, regardless of this culture importance. Sorption isotherms data are key information to predict optimum storage and trading conditions to ensure quality of sugar beet seeds for crop production. Finally, the lack of quality may affect employees, entrepreneurs and other professionals who work with sugar beet. This paper presents the desorption isotherms and thermodynamic properties of “Chata do Egito” sugar beet seed variety.
Methylation of tissue factor pathway inhibitor 2 as a prognostic biomarker for hepatocellular carcinoma after hepatectomy
Authors: Sun Feng‐Kai , Sun Qi , Fan Yu‐Chen , Gao Shuai , Zhao Jing , Li Feng , Jia Yi‐Bin , Liu Chuan , Wang Li‐Yuan , Li Xin‐You , Ji Xiang‐Fen , Wang Kai
Published: August 2015

Background and Aim

Methylation of tissue factor pathway inhibitor 2 (TFPI2) gene has been detected in hepatocellular carcinoma (HCC). However, the clinicopathologcial significance and prognostic value of TFPI2 methylation in HCC remains largely unknown. This study aimed to investigate the prognostic value of TFPI2 methylation in HCC after hepatectomy.

Methods

Methylation status of TFPI2 gene was examined in 178 surgical specimens of HCC and 20 normal liver samples using methylation‐specific polymerase chain reaction.

Results

Methylation of TFPI2 gene was detected in 44.9% (80 of 178) of primary HCC samples, 10.7% (19 of 178) of the corresponding non‐tumorous liver samples, and 5.0% (1/20) of the normal liver samples. The mRNA concentrations of TFPI2 in primary HCC tissues were significantly lower than those in corresponding non‐tumorous liver tissues and those in normal liver tissues. TFPI2 methylation was significantly associated with higher TNM stage. Patients with TFPI2 methylation demonstrated a significantly poorer prognosis than those without TFPI2 methylation for both overall survival and disease‐free survival (P < 0.001, respectively). Multivariate analyses confirmed that TFPI2 methylation was an independent prognostic factor for both overall survival (P = 0.002) and disease‐free survival (P = 0.000) in HCC after hepatectomy. Moreover, TFPI2 methylation was found to be the only independent predictor for early tumor recurrence of HCC after resection based on multivariate analysis (P = 0.002).

Conclusions

Methylation of TFPI2 predicts high risk of advanced tumor stage, early tumor recurrence, and poor prognosis, and it could be a potential prognostic biomarker in patients with HCC after hepatectomy.
Hepatitis B surface antigen quantification as a predictor of seroclearance during treatment in HIV‐hepatitis B virus coinfected patients from Sub‐Saharan Africa
Authors: Boyd Anders , Maylin Sarah , Moh Raoul , Mahjoub Nadia , Gabillard Delphine , Eholié Serge Paul , Danel Christine , Anglaret Xavier , Zoulim Fabien , Girard Pierre‐Marie , Delaugerre Constance
Published: August 2015

Background and Aim

In Sub‐Saharan Africa, seroclearance of hepatitis B surface antigen (HBsAg) and hepatitis B “e” antigen (HBeAg), including their quantifiable markers, have rarely been evaluated during long‐term antiviral treatment among patients coinfected with HIV and hepatitis B virus (HBV).

Methods

In this prospective cohort study from two randomized‐control trials in Côte d'Ivoire, 161 antiretroviral‐naïve HIV‐HBV coinfected patients starting lamivudine (n = 76) or tenofovir/emtricitabine (n = 85) containing antiretroviral therapy were included. HBV DNA was quantified using an in‐house assay (detection limit = 12 copies/mL) and HBsAg quantification (qHBsAg) using the Elecsys assay.

Results

Overall, 33 (20.5%) patients were HBeAg positive, 121 (75.2%) had detectable HBV DNA, and 92/93 (98.9%) harbored HBV genotype E. Median treatment duration was 35.5 months (interquartile range: 24.3–36.4). Among HBeAg‐positive patients, cumulative proportion with HBeAg seroclearance was 46.3% (n = 14). Overall, cumulative proportion of HBsAg seroclearance was 6.6% (n = 10). Lower baseline qHBsAg levels and strong 12‐month declines in qHBsAg were significantly associated with HBsAg seroclearance for both HBeAg‐negative and HBeAg‐positive patients. When taken at certain levels, these determinants provided moderate sensitivity (Se) and specificity (Sp) in predicting HBsAg seroclearance at month 36 (≤ 1000 IU/mL at baseline, Se = 0.80, Sp = 0.80; ≥ 1.0 log10 IU/mL drop at month 12, Se = 0.57, Sp = 1.00). Instead, qHBsAg levels ≤ 100 or ≤ 10 IU/mL at month 12 were optimal (both Se = 0.90 and Sp = 1.00). Detectable HBV‐DNA provided fairly high Se and Sp when evaluated at baseline (Se = 1.00, Sp = 0.80), but not at month 12 (Se = 0.80, Sp = 0.40).

Conclusions

HBsAg seroclearance rates are not common in patients from Sub‐Saharan Africa treated with anti‐HBV containing antiretroviral therapy. qHBsAg levels at 12 months of treatment may accurately predict HBsAg seroclearance.
Comparison of Pituitary Adenomas in Elderly and Younger Adults: Clinical Characteristics, Surgical Outcomes, and Prognosis
Authors: Liu Junfeng , Li Chaoxi , Xiao Qungen , Gan Chao , Chen Xi , Sun Wei , Li Xiaopeng , Xu Yu , Chen Juan , Shu Kai , Lei Ting
Published: August 2015

Objectives

To analyze and summarize the clinical characteristics, surgical outcomes, and prognosis of elderly adults with pituitary adenomas (PAs).

Design

Retrospective cohort study.

Setting

Tongji Hospital.

Participants

Individuals who underwent transsphenoidal surgery for PAs between 2009 and 2012 (N = 1,104).

Measurements

Participants were divided into two age groups (≥65 and <65), and their clinical characteristics, surgical complications, surgical outcomes, and follow‐up data were analyzed and compared.

Results

The older group had longer duration of symptoms. The most common symptom were mass effects (98.4%) in the older group and hormone‐secreting effects (55.2%) in the younger group. The incidence of pituitary apoplexy (P = .03), incidentaloma (P = .03) and misdiagnosis at first visit (P < .001) were higher in the older group. Nonfunctioning PAs (P < .001) and giant adenomas (P = .04) were more common in the elderly group than in the younger group. There were no significant differences in the incidence of postoperative diabetes insipidus, cerebrospinal fluid (CSF) leak, regrowth, visual outcome, or permanent hypopituitarism between the groups (P > .05). The incidence of severe systemic complications was greater in the older group (3/69 vs 3/1,035, relative risk = 15.00, 95% confidence interval = 3.08–72.94, P = .004), and all three cases in the older group occurred after emergency surgery. The incidence of hypopituitarism before surgery and 3 days after surgery was higher in the elderly group (P < .05). Older participants tended to have more difficulty recovering from preoperative hypopituitarism (P = .02).

Conclusion

Avoiding misdiagnosis and emergency surgery is critical for frail elderly adults with multiple comorbidities. With early active management, sufficient preoperative preparation, and multidisciplinary collaboration, the long‐term outcomes and prognosis of elderly adults with PAs are comparable with those of younger adults.
Associations Between Mild Cognitive Impairment and Hospitalization and Readmission
Authors: Callahan Kathryn E. , Lovato James F. , Miller Michael E. , Easterling Doug , Snitz Beth , Williamson Jeff D.
Published: August 2015

Objectives

To determine whether older adults with mild cognitive impairment (MCI), a condition not previously explored as a risk factor, have more hospitalizations and 30‐day readmissions than those with normal cognition.

Design

Post hoc analysis of prospectively gathered data on incident hospitalization and readmission from the Ginkgo Evaluation of Memory Study (GEMS), a randomized, double‐blind, placebo‐controlled trial designed to assess the effect of Ginkgo biloba on incidence of dementia.

Setting

GEMS was conducted in five academic medical centers in the United States.

Participants

Community‐dwelling adults aged 75 and older with normal cognition (n = 2,314) or MCI (n = 428) at baseline cognitive testing (N = 2,742).

Measurements

Index hospitalization and 30‐day hospital readmission, adjusted for age, sex, race, education, clinic site, trial assignment status, comorbidities, number of prescription medications, and living with an identified proxy.

Results

MCI was associated with a 17% greater risk of index hospitalization than normal cognition (adjusted hazard ratio (aHR) = 1.17, 95% confidence interval (CI)  = 1.02–1.34)). In participants who lived with a proxy, MCI was associated with a 39% greater risk of index hospitalization (aHR = 1.39, 95% CI = 1.17–1.66). Baseline MCI was not associated with greater odds of 30‐day hospital readmission (adjusted odds ratio = 0.90, 95% CI = 0.60–1.36).

Conclusion

MCI may represent a target condition for healthcare providers to coordinate support services in an effort to reduce hospitalization and subsequent disability.
One‐Year Change in the Japanese Version of the Montreal Cognitive Assessment Performance and Related Predictors in Community‐Dwelling Older Adults
Authors: Suzuki Hiroyuki , Kawai Hisashi , Hirano Hirohiko , Yoshida Hideyo , Ihara Kazushige , Kim Hunkyung , Chaves Paulo H. M. , Minami Ushio , Yasunaga Masashi , Obuchi Shuichi , Fujiwara Yoshinori
Published: August 2015

Objectives

To examine the distribution and associated predictors of 1‐year changes in the Japanese version of the Montreal Cognitive Assessment (MoCA‐J) in community‐dwelling older adults.

Design

Prospective cohort study.

Setting

Population‐based cohort study in Tokyo, Japan.

Participants

Individuals aged 65 to 84 (N = 496).

Measurements

Multinomial logistic regression analysis was performed to estimate the odds of experiencing subsequent improvement in MoCA‐J performance, as opposed to stable or deteriorating, while simultaneously adjusting for baseline MoCA‐J score and major confounders.

Results

Mean age was 74.0 ± 4.8; mean MoCA‐J score was 23.7 ± 3.6. Only 40% had stable MoCA‐J performance; 30% experienced deterioration and 30% improvement. Age increment, hospitalization in previous year, slower Timed Up and Go (TUG) score, and slower maximum walking speed were predictive of subsequent MoCA‐J performance deterioration.

Conclusion

Slower TUG and walking speed performances were independent predictors of short‐term MoCA‐J deterioration. Research aimed at assessing lower‐extremity performance‐based tests in MCI‐related decision‐making is warranted.
Drug‐Related‐Problem Outcomes and Program Satisfaction from a Comprehensive Brown Bag Medication Review
Authors: O'Connell Mary Beth , Chang Feng , Tocco Ashley , Mills Megan E. , Hwang Jamie M. , Garwood Candice L. , Khreizat Hanan S. , Gupta Nishi S.
Published: August 2015

Objectives

To classify and quantify drug‐related problems (DRPs), determine acceptance of DRP recommendations, and assess medication review satisfaction.

Design

Comprehensive brown bag medication reviews.

Setting

Six senior centers and three senior high‐rises.

Participants

Individuals aged 60 and older (mean age 75.9 ± 8.5) taking five or more medications (n = 85).

Measurements

Two investigators independently classified DRPs using modified Pharmaceutical Care Network Europe classification scheme and severity of medication error and value of service scales. Two other investigators adjudicated classification differences. Satisfaction surveys were administered immediately and 3 months after review. A DRP recommendation implementation survey was completed at least 3 months after the review.

Results

Participants had a mean of 4.3 ± 2.8 DRPs (range 0–10). DRPs were classified as adverse reactions (30%), treatment effectiveness (28%), treatment costs (13%), information need (8%), and other (21%). Causes included drug selection (40%), wrong dosage (23%), participant problems (e.g., adherence, lack of medication knowledge, 16%), drug use process problems (12%), drug formulation (0.5%), treatment duration (0.5%), and other (7%). Interventions required drug changes (44%), prescriber input (37%), individual counseling (18%), or other (1%). DRP severities were significant (59%) or minor (35%). Participants expressed satisfaction with the program because they were able to ask questions, trusted the answers, and knew more about their medications. After 3 months, they had implemented 63% of the DRP recommendations.

Conclusion

Older adults found the medication review helpful and implemented 63% of the DRP recommendations.
Peripherally Inserted Central Catheter Use in Skilled Nursing Facilities: A Pilot Study
Authors: Chopra Vineet , Montoya Ana , Joshi Darius , Becker Carol , Brant Amy , McGuirk Helen , Clark Jordyn , Harrod Molly , Kuhn Latoya , Mody Lona
Published: August 2015

Objectives

To describe patterns of use, care practices, and outcomes related to peripherally inserted central catheter (PICC) use in skilled nursing facilities (SNFs).

Design

Prospective cohort study.

Setting

Two community SNFs.

Participants

Adult SNF residents with PICCs (N = 56).

Measurements

Information on indication for PICC use, device characteristics (e.g., lumens, gauge), and participant data (comorbidities, medications) were obtained from medical records. Care practices (e.g., frequency of flushing, dressing care) and problems related to PICCs were recorded. Major (central line–associated bloodstream infection, venous thromboembolism, catheter dislodgement) and minor (migration, dressing disruption, lumen occlusion, exit site infection) complications and process measures (flushing of PICC, assessment of necessity) were recorded. Bivariate analyses with t‐tests, chi‐square tests, or Fischer exact tests were used for continuous and categorical data.

Results

Participants were enrolled from two SNFs. The most common indication for PICC use was intravenous antibiotic delivery. The average PICC dwell time was 43 days, and most devices were single‐lumen PICCs. Major and minor complications were common and occurred in 11 (20%) and 18 (32%) participants, respectively. Occlusion (23%, n = 13), accidental dislodgement (12%, n = 7), and dressing disruption (11%, n = 6) were the commonest complications observed. Documentation regarding catheter care practices occurred in 41% of cases.

Conclusion

Quality improvement efforts that seek to benchmark practice, identify gaps, and institute efforts to improve PICC care and practice in SNFs appear necessary.
Risk of Nonspine Fractures in Older Adults with Sarcopenia, Low Bone Mass, or Both
Authors: Chalhoub Didier , Cawthon Peggy M. , Ensrud Kristine E. , Stefanick Marcia L. , Kado Deborah M. , Boudreau Robert , Greenspan Susan , Newman Anne B. , Zmuda Joseph , Orwoll Eric S. , Cauley Jane A. ,   the Osteoporotic Fractures in Men Study Research Group
Published: August 2015

Objectives

To test the hypothesis that men and women with low bone mineral density (BMD) and sarcopenia have a higher risk of fracture than those with only one or neither conditions.

Design

The Osteoporotic Fractures in Men Study and the Study of Osteoporotic Fractures in women are prospective observational studies with a mean follow up of 9 (2000–2012) and 8 years (1997–2009), respectively.

Setting

U.S. clinical centers.

Participants

Men (n = 5,544; mean age 73.7) and women (n = 1,114; mean age 77.6) aged 65 and older, able to walk without assistance, and without bilateral hip replacement.

Measurements

Sarcopenia was defined as low appendicular lean mass plus slowness or weakness and low BMD according to the World Health Organization definition of a T‐score less than –1.0. Participants were classified as having normal BMD and no sarcopenia (3,367 men, 308 women), sarcopenia only (79 men, 48 women), low BMD only (1,986 men, 626 women), and low BMD and sarcopenia (112 men, 132 women).

Results

Men with low BMD and sarcopenia (hazard ratio (HR)=3.79, 95% confidence interval (CI)=2.65–5.41) and men with low BMD only (HR=1.67, 95% CI=1.45–1.93) but not men with sarcopenia only (HR=1.14, 95% CI=0.62–2.09) had greater risk of fracture than men with normal BMD and no sarcopenia. Women with low BMD and sarcopenia (HR=2.27, 95% CI=1.37–3.76) and women with low BMD alone (HR=2.62, 95% CI=1.74–3.95), but not women with only sarcopenia, had greater risk of fracture than women with normal BMD and no sarcopenia.

Conclusion

Men with low BMD and sarcopenia are at especially high risk of fracture. Sarcopenia alone did not increase fracture risk in either group.
Loss of Weight in Obese Older Adults: A Biomarker of Impending Expansion of Multimorbidity?
Authors: Fabbri Elisa , Tanaka Toshiko , An Yang , Zoli Marco , Bandinelli Stefania , Guralnik Jack M. , Simonsick Eleanor M. , Boyd Cynthia M. , Studenski Stephanie A. , Harris Tamara B. , Ferrucci Luigi
Published: August 2015

Objectives

To determine whether weight loss in older adults may be a marker of impending burden of multimorbidity regardless of initial weight, testing the hypotheses that obesity but not overweight in elderly adults is associated with greater number of diseases than normal weight and that obese older adults who lose weight over time have the greatest burden of multimorbidity.

Design

Longitudinal cohort study (Invecchiare in Chianti Study).

Setting

Community.

Participants

Individuals aged 60 and older at baseline followed for an average of 4 years (N = 1,025).

Measurements

Multimorbidity was measured as number of diagnosed diseases. Baseline body mass index (BMI) was categorized as normal weight (<25.0 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30.0 kg/m2). Loss of weight was defined as decrease over time in BMI of at least 0.15 kg/m2 per year. Age, sex, and education were covariates.

Results

Baseline obesity was cross‐sectionally associated with high multimorbidity and greater longitudinal increase of multimorbidity than normal weight (P = .005) and overweight (P < .001). Moreover, obese participants who lost weight over follow‐up had a significantly greater increase in multimorbidity than other participants, including obese participants who maintained or gained weight over time (P = .005). In nonobese participants, changes in weight had no effect on changes in multimorbidity over time. Sensitivity analyses confirmed that one specific disease did not drive the association and that competing mortality did not bias the association.

Conclusion

Loss of weight in obese older persons is a strong biomarker of impending expansion of multimorbidity. Older obese individuals who lose weight should receive thoughtful medical attention.
Multimorbidity and Risk of Mild Cognitive Impairment
Authors: Vassilaki Maria , Aakre Jeremiah A. , Cha Ruth H. , Kremers Walter K. , St. Sauver Jennifer L. , Mielke Michelle M. , Geda Yonas E. , Machulda Mary M. , Knopman David S. , Petersen Ronald C. , Roberts Rosebud O.
Published: August 2015

Objectives

To determine the association between multiple chronic conditions and risk of incident mild cognitive impairment (MCI) and dementia.

Design

Prospective cohort study.

Setting

Olmsted County, Minnesota.

Participants

Cognitively normal individuals (N = 2,176) enrolled in the Mayo Clinic Study of Aging (MCSA).

Measurements

Participants were randomly selected from the community, evaluated by a physician, and underwent neuropsychometric testing at baseline and at 15‐month intervals to assess diagnoses of MCI and dementia. Information on International Classification of Diseases, Ninth Revision codes for chronic conditions in the 5 years before enrollment was electronically captured using the Rochester Epidemiology Project medical records linkage system. Multimorbidity was defined as having two or more chronic conditions, and the association between multimorbidity and MCI and dementia was examined using Cox proportional hazards models.

Results

Of 2,176 cognitively normal participants (mean age ± standard deviation 78.5 ± 5.2; 50.6% male), 1,884 (86.6%) had multimorbidity. The risk of MCI or dementia was higher in persons with multimorbidity (hazard ratio (HR) = 1.38, 95% confidence interval (CI) = 1.05–1.82) than in those with one or no chronic condition. The HR was of greater magnitude in persons with four or more conditions (HR = 1.61, 95% CI = 1.21–2.13) than in those with two or three conditions (HR = 1.03, 95% CI = 0.76–1.39) and for men with multimorbidity(HR = 1.53, 95% CI = 1.01–2.31) than for women with multimorbidity (HR = 1.20, 95% CI = 0.83–1.74), compared to those with one or no chronic condition.

Conclusion

In older adults, having multiple chronic conditions is associated with greater risk of MCI and dementia. This is consistent with the hypothesis that multiple etiologies may contribute to MCI and late‐life dementia. Preventing chronic diseases may be beneficial in delaying or preventing MCI and dementia.
Effectiveness of ethinylestradiol/drospirenone for premenstrual symptoms in Japanese patients with dysmenorrhea: Open‐label pilot study
Authors: Takeda Takashi , Kondo Akiko , Koga Shoko , Hayakawa Jun , Hayakawa Kenichi , Hiramatsu Keizo , Yaegashi Nobuo
Published: August 2015

Aim

A combined oral contraceptive containing ethinylestradiol 20 µg plus drospirenone 3 mg (EE20 + DRSP) in a 24/4 regimen has been shown to alleviate the symptoms of premenstrual syndrome and premenstrual dysphoric disorder. This study was conducted to evaluate the efficacy of EE20 + DRSP in Japanese patients with premenstrual symptoms.

Material and Methods

A multicenter, prospective, open‐label, single‐arm, phase IV study was performed in Japanese women with dysmenorrhea and premenstrual symptoms. They were treated with EE20 + DRSP to alleviate the symptoms of dysmenorrhea for six treatment cycles. Premenstrual symptoms were evaluated using a Premenstrual Symptoms Questionnaire at baseline and after three and six cycles of EE20 + DRSP. The degree of dysmenorrhea was also evaluated using a visual analog scale at baseline and after one, three, and six cycles of EE20 + DRSP.

Results

Forty‐eight patients were treated with EE20 + DRSP. Most of the premenstrual symptoms were alleviated significantly by three and six cycles of EE20 + DRSP treatment. EE20 + DRSP treatment significantly improved the severity of premenstrual symptoms. We also confirmed the effectiveness of EE20 + DRSP for the treatment for dysmenorrhea.

Conclusion

This study showed that EE20 + DRSP could be a useful treatment strategy for premenstrual symptoms in Japanese women.
Incidence and risk factors for recurrent spontaneous preterm birth: A retrospective cohort study in Japan
Authors: Yamashita Michiko , Hayashi Shusaku , Endo Masayuki , Okuno Kentaro , Fukui On , Mimura Kazuya , Tachibana Yosuke , Ishii Keisuke , Mitsuda Nobuaki , Kimura Tadashi
Published: August 2015

Aim

The aim of this study was to assess the incidence and risk factors for recurrent spontaneous preterm birth (PTB) in Japan.

Material and Methods

A retrospective cohort study was conducted at five tertiary perinatal centers in Osaka, Japan from 2008 through 2012. Perinatal data were collected from medical records of women with a singleton gestation and a previous spontaneous PTB. Exclusion criteria were first‐trimester spontaneous abortion, first antenatal visit beyond 14 weeks of gestation, and previous PTB with medical indications, placenta previa, abruptio placenta, multiple pregnancy, fetal anomaly, and antepartum fetal demise. The associations between recurrent spontaneous PTB and perinatal factors were evaluated by logistic regression analysis.

Results

Of 547 women with a previous spontaneous PTB, 89 (16.3%) suffered a recurrent spontaneous PTB. The risk factors for recurrence included multiple previous spontaneous PTB (adjusted odds ratio [aOR]: 2.26; 95% confidence interval [CI]: 1.19–4.30; P = 0.013), no previous term birth (aOR: 2.08; 95%CI: 1.24–3.49; P = 0.005), and interpregnancy interval < 12 months (aOR: 2.13; 95%CI: 1.17–3.85; P = 0.013).

Conclusion

Approximately one in six women with a previous spontaneous PTB suffered a recurrent spontaneous PTB. Multiple previous spontaneous PTB, no previous term birth, and short interpregnancy interval were independent risk factors for recurrence.
Ratio of fetal anteroposterior to transverse cerebellar diameter for detection of the cerebellar hypoplasia in the second trimester and comparison with trisomy 18
Authors: Takano Mayumi , Hirata Hiroko , Kagawa Yukiko , Murata Susumu , Fujiwara Michihisa , Nakata Masahiko
Published: August 2015

Aim

Cerebellar hypoplasia, particularly, trisomy 18, represents a chromosomal abnormality. However, morphological assessment of the fetal cerebellum is yet to be established. The purpose of this study was to produce reference values for the fetal transverse cerebellar diameter (TCD), anteroposterior cerebellar diameter (APCD) and the ratio of APCD to TCD (APCD/TCD ratio) in normal fetuses, compared with cases of trisomy 18.

Methods

This retrospective study included 266 normal singleton pregnancies resulting in term delivery at our institution from 2012–2013. Patients had received ultrasound examinations in the second trimester. TCD and APCD measurements were performed and then APCD/TCD ratio was calculated. Consequently, three cases of trisomy 18 were compared with reference values.

Results

Gestational age correlated with TCD (rs = 0.766, P < 0.0001) and APCD (rs = 0.61, P < 0.0001), but not with APCD/TCD ratio (rs = 0.070, P = 0.252). The median APCD/TCD ratio was 0.52 and the standard deviation was 0.05. In cases of trisomy 18, all TCD measurements were located within normal ranges. In contrast, both the APCD and APCD/ TCD ratio displayed lower values than that of normal fetuses.

Conclusions

This study showed that not only TCD but also APCD correlated with gestational age, and APCD/TCD ratio indicated a fixed value (almost 0.5) in normal fetuses. Furthermore, APCD and APCD/TCD ratio were deemed useful indicators for cerebellar hypoplasia. In particular, the APCD/TCD ratio proved more convenient, without requiring individual evaluation of TCD and APCD.
Intrauterine adhesion after transvaginal ultrasound‐guided radiofrequency myolysis
Authors: Hai Ning , Ding Xiaoping
Published: August 2015

Transvaginal ultrasound‐guided radiofrequency myolysis offers an alternative to surgery for symptomatic uterine myomas, with encouraging efficacy and safety, suggesting low complication rates. This case study describes the first reported intrauterine adhesion after transvaginal ultrasound‐guided radiofrequency myolysis. Women who desire further pregnancy should be warned about the particular risk of intrauterine adhesion of radiofrequency myolysis.
Creation of a cerebellar diameter reference standard and its clinical application to the detection of cerebellar hypoplasia unique to trisomy 18
Authors: Hayata Kei , Hiramatsu Yuji , Masuyama Hisashi , Etou Eriko , Nobumoto Etsuko , Mitsui Takashi
Published: August 2015

Aim

We created a new reference standard focusing on the hemispheric anteroposterior cerebellar diameter (APCD) in addition to the transverse cerebellar diameter (TCD) and discussed whether or not the cerebellar measurement was useful for the detection of trisomy 18 (T18).

Material and Methods

In 150 normal fetuses between 14 and 36 weeks of gestational age (GA), the TCD and APCD were prospectively measured. In 26 cases with T18, the value was compared with the control.

Results

At <22 weeks of gestation, the TCD reference standard was calculated as follows: TCD = (1.027 × GA) – 0.674 (R2 = 0.97, P < 0.001). The reference standard of the APCD was calculated as follows: APCD = (0.682 × GA) – 3.925 (R2 = 0.73, P < 0.001). In eight cases with T18, the TCD was below the 5th percentile value in 7/8 (88%) cases and the APCD was below the 5th percentile value in 8/8 (100%) cases. At >22 weeks of gestation, the reference standard of the TCD was calculated as follows: TCD = (1.603 × GA) – 13.216 (R2 = 0.92, P < 0.001). The reference standard of the APCD was calculated as follows: APCD = (0.859 × GA) – 7.30 (R2 = 0.84, P < 0.001). In 18 cases with T18, the TCD was below the 5th percentile value in 14/18 (78%) cases and the APCD was below the 5th percentile value in 18/18 (100%) cases.

Conclusion

APCD reference standard, divided by the gestational age of more or less than 22 weeks, might be useful to diagnose T18.
Using nuclear gene data for plant phylogenetics: Progress and prospects II. Next‐gen approaches
Authors: Zimmer Elizabeth A. , Wen Jun
Published: August 2015

Single and low copy nuclear genes offer a larger number of, and more rapidly evolving, characters than the chloroplast and nuclear ribosomal gene sequences that have dominated plant phylogenetic studies to date. Until recently, only one or a few low copy nuclear gene markers were included in such studies. Now, the rapid adoption of “next generation sequencing” (NGS) techniques offers simpler and cheaper access to hundreds of, and not just tens of, coding and noncoding DNA regions. In this review, we describe the most commonly‐used NGS methods available for accessing nuclear genes and discuss many NGS case studies that have been published in the last two to three years. These approaches include whole genome sequencing to target microsatellites, transcriptome sequencing, Exon‐Primed Intron‐Crossing sequencing (EPIC), targeted enrichment (or sequence capture), RAD sequencing (RAD‐Seq, including genotyping‐by‐sequencing or GBS), and genome skimming. We also discuss some of the challenges to, and posed by, the NGS approaches.
The Arabidopsis immune regulator SRFR1 dampens defences against herbivory by Spodoptera exigua and parasitism by Heterodera schachtii
Authors: Nguyen Phuong Dung T. , Pike Sharon , Wang Jianying , Nepal Poudel Arati , Heinz Robert , Schultz Jack C. , Koo Abraham J. , Mitchum Melissa G. , Appel Heidi M. , Gassmann Walter
Published: August 2015

Plants have developed diverse mechanisms to fine tune defence responses to different types of enemy. Cross‐regulation between signalling pathways may allow the prioritization of one response over another. Previously, we identified SUPPRESSOR OF rps4‐RLD1 (SRFR1) as a negative regulator of ENHANCED DISEASE SUSCEPTIBILITY1 (EDS1)‐dependent effector‐triggered immunity against the bacterial pathogen Pseudomonas syringae pv. tomato strain DC3000 expressing avrRps4. The use of multiple stresses is a powerful tool to further define gene function. Here, we examined whether SRFR1 also impacts resistance to a herbivorous insect in leaves and to a cyst nematode in roots. Interestingly, srfr1‐1 plants showed increased resistance to herbivory by the beet army worm Spodoptera exigua and to parasitism by the cyst nematode Heterodera schachtii compared with the corresponding wild‐type Arabidopsis accession RLD. Using quantitative real‐time PCR (qRT‐PCR) to measure the transcript levels of salicylic acid (SA) and jasmonate/ethylene (JA/ET) pathway genes, we found that enhanced resistance of srfr1‐1 plants to S. exigua correlated with specific upregulation of the MYC2 branch of the JA pathway concurrent with suppression of the SA pathway. In contrast, the greater susceptibility of RLD was accompanied by simultaneously increased transcript levels of SA, JA and JA/ET signalling pathway genes. Surprisingly, mutation of either SRFR1 or EDS1 increased resistance to H. schachtii, indicating that the concurrent presence of both wild‐type genes promotes susceptibility. This finding suggests a novel form of resistance in Arabidopsis to the biotrophic pathogen H. schachtii or a root‐specific regulation of the SA pathway by EDS1, and places SRFR1 at an intersection between multiple defence pathways.
Gait velocity and walking distance to predict community walking after stroke
Authors: An SeungHeon , Lee YunBok , Shin HyeonHui , Lee GyuChang
Published: August 2015

Gait speed and walking distance were evaluated as predictors for levels of community walking after stroke. In this study, 103 stroke survivors were identified as limited (n = 67) or independent community walkers (n = 36). Ten meter and six min walk tests were used to measure gait speed and walking distance, respectively. The discriminative properties of gait speed and walking distance for community walking were investigated using receiver operating characteristic curves. Cut‐off values of 0.87 m/s for community walking gait speed for walking distance had positive predictive values of 65% and 55%, respectively. The negative predictive value ranged from 89% for gait speed to 79% for walking distance. Gait speed and walking distance showed significant differences between limited and independent community walking. Gait speed was more significantly related to community walking than walking distance. The results of this study suggest that gait speed is a better predictor for community walking than walking distance in moderately affected post‐stroke survivors.