bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nutrients Essential for Cognitive Function Are Typical Problem Nutrients in the Diets of Myanmar Primary School Children: Findings of a Linear Programming Analysis
Authors: Soe Le Thandar , Fahmida Umi , Seniati Ali Nina Liche , Firmansyah Agus 
Published: February 2020

Background: Good cognitive function is important for school-age children. Although essential fatty acids play a main role in cognitive functions, their intakes are assumed as inadequate among developing countries including Myanmar. However, there is still lack of evidence to show whether they are problem nutrients. Objective: This study aimed to determine the problem nutrients in the diets of Myanmar primary schoolchildren and to formulate food-based recommendations (FBR) to optimize the intake of these micronutrients. Methods: A cross-sectional study was conducted at 3 primary schools in Nyaungdon Township of Myanmar. A 1-week dietary intake assessment was done on 7- to 9-year-old (n = 100) primary schoolchildren. A linear programming approach using the World Health Organization Optifood software was used to assess the nutrient intake and develop FBRs. Results: The prevalence of stunted growth, wasting, and being underweight in the students were 28%, 18%, and 28%, respectively. The intake of calcium, vitamin B1, folate, iron, omega-3 fatty acids, eicosapentaenoic acid, and docosahexaenoic acid was insufficient. Locally available nutrient-dense foods that include water spinach, carp fish, duck egg, garden pea, and shrimp were selected to develop FBR to increase the intake of problem nutrients. Conclusion: The linear programming analysis showed that the primary schoolchildren have difficulty meeting nutrient recommendations given locally available foods, especially iron and essential fatty acids which are important for cognitive performance of schoolchildren.
Adult macrophage activation syndrome–haemophagocytic lymphohistiocytosis: ‘of plasma exchange and immunosuppressive escalation strategies’ – a single centre reflection
Authors: Lorenz G , Schul L , Schraml F , Riedhammer K M , Einwächter H , Verbeek M , Slotta-Huspenina J , Schmaderer C , Küchle C , Heemann U , Moog P 
Published: February 2020

Objective In the context of systemic autoimmunity, that is systemic lupus erythematosus (SLE) or adult-onset Still’s disease (AOSD), secondary haemophagocytic lymphohistiocytosis (HLH; also referred to as macrophage activation syndrome (MAS) or more recently MAS-HLH) is a rare and potentially life-threatening complication. Pathophysiological hallmarks are aberrant macrophage and T cell hyperactivation and a systemic cytokine flare, which generate a sepsis-like, tissue-damaging, cytopenic phenotype. Unfortunately, for adult MAS-HLH we lack standardized treatment protocols that go beyond high-dose corticosteroids. Consequently, outcome data are scarce on steroid refractory cases. Aside from protocols based on treatment with calcineurin inhibitors, etoposide, cyclophosphamide and anti-IL-1, favourable outcomes have been reported with the use of intravenous immunoglobulin (IvIG) and plasma exchange (PE). Methods Here we report a retrospective series of steroid refractory MAS-HLH, the associated therapeutic regimes and outcomes. Results In this single-centre experience, 6/8 steroid refractory patients survived (median follow-up: 54.4 (interquartile range: 23.3–113.3) weeks). All were initially treated with PE, which induced partial response in 5/8 patients. Yet, all patients required escalation of immunosuppressive therapies. One case of MAS-HLH in new-onset AOSD had to be escalated to etoposide, whereas most SLE-associated MAS-HLH patients responded well to cyclophosphamide. Relapses occurred in 2/8 cases. Conclusion Together, early use of PE is at most a supportive measure, not a promising monotherapy of adult MAS-HLH. In refractory cases, conventional cytoreductive therapies (i.e. cyclophosphamide and etoposide) constitute potent and reliable rescue approaches, whereas IvIG, anti-thymoglobulin, and biologic agents appear to be less effective.
Partial Suture Fusion in Nonsyndromic Single-Suture Craniosynostosis
Authors: Boyajian Michael K. , Al-Samkari Hanny , Nguyen Dennis C. , Naidoo Sybill , Woo Albert S. 
Published: February 2020

Introduction: Partial synostosis of cranial sutures has been shown to have clinical and diagnostic significance. However, there is limited published information about how suture fusion progresses over time. In this study, we evaluate patients with nonsyndromic single-suture synostosis. We aim to define the incidence of partial versus complete suture fusion and whether a correlation exists between the degree of suture fusion and age. Methods: Two hundred fifty-four patients with nonsyndromic single-suture synostosis were evaluated. Preoperative computed tomography (CT) scans were rendered in 3-dimensions, all sutures were visualized and assessed for patency or fusion, and length of fusion was measured. Findings were grouped according to suture type (sagittal, coronal, metopic, or lambdoid), the degree of fusion (full, >50%, or <50%), and patient age at time of CT scan (0-90, 91-180, 181-360, or >360 days). Data were analyzed to correlate patient age versus the degree of suture fusion. Results: For all patients, 72% had complete and 28% had partial synostosis. Ratios of full to partial fusion for each suture type were as follows: sagittal 97:36, coronal 35:22, metopic 46:4, and lambdoid 4:10. The sagittal, coronal, and metopic groups demonstrated greater probabilities of complete suture fusion as patient age increases ( P = .021, P < .001, P = .001, respectively). This trend was also noted when all sutures were considered together by age-group ( P < .001). Conclusion: We note a partial suture fusion rate of 28.3%. Our analysis shows a correlation between the extent of suture synostosis and patient age. Finally, we demonstrate that different sutures display different patterns of partial and complete fusion.
Improved Injection Technique of Ethanol for Morton’s Neuroma
Authors: Pabinger Christof , Malaj Isabella , Lothaller Harald , Samaila Elena , Magnan Bruno 
Published: February 2020

Background: Morton’s neuroma is a common cause of forefoot pain. Various conservative methods (injections of various pharmacologic agents) have been published with an outcome of 6%-75% success rate (free of pain in daily life) per injection. The aim of the present study was to assess the outcome of an improved localization technique, a higher dosage, and a higher percentage of ethanol. Methods: Using fluoroscopic and electroneurographic guidance, 2.5 mL of 70% ethanol were injected into 33 feet with a magnetic resonance imaging (MRI)–verified neuroma. We evaluated patients at up to 5-year follow-up. Results: A “success rate” of more than 82% per single injection (defined as free of pain in daily life) was achieved and no recurrence was seen over 5 years. All scores (visual analog scale; Short Form–36 subscales, American Orthopaedic Foot & Ankle Society ankle-hindfoot score) showed significant improvement ( P < .0001). Mean 1.2 injections were necessary. No significant side effects were seen. However, some mild pain persisted in some patients who participated in sports. Conclusion: The injection of 2.5 mL of 70% ethanol under fluoroscopic and electroneurographic guidance was a safe method for the treatment of MRI-verified Morton’s neuromas. Combining the effect of a higher percentage of alcohol and a higher dosage and an improved localization technique resulted in a high rate of patients without pain. Level of Evidence: Level IV, cases series, prospective.
Consequences of ‘conversations not had’: insights into failures in communication affecting delays in hospital discharge for older people living with frailty
Authors: Redwood Sabi , Simmonds Bethany , Fox Fiona , Shaw Alison , Neubauer Kyra , Purdy Sarah , Baxter Helen 
Published: February 2020

Objectives Older people living with frailty (OPLWF) are often unable to leave hospital even if they no longer need acute care. The aim of this study was to elicit the views of health care professionals in England on the barriers to effective discharge of OPLWF. Methods We conducted semi-structured interviews with hospital-based doctors and nurses with responsibility for discharging OPLWF from one large urban acute care hospital in England. The data were analysed using the constant comparative method. Results We conducted interviews with 17 doctors (12 senior doctors or consultants and 5 doctors in training) and six senior nurses. Some of our findings reflect well-known barriers to hospital discharge including service fragmentation, requiring skilled coordination that was often not available due to high volumes of work, and poor communication between staff from different organizations. Participants’ accounts also referred to less frequently documented factors that affect decision making and the organization of patient discharges. These raised uncomfortable emotions and tensions that were often ignored or avoided. One participant referred to ‘conversations not had’, or failures in communication, because difficult topics about resuscitation, escalation of treatment and end-of-life care for OPLWF were not addressed. Conclusions The consequences of not initiating important conversations about decisions relating to the end of life are potentially far reaching not only regarding reduced efficiency due to delayed discharges but also for patients’ quality of life and care. As the population of older people is rising, this becomes a key priority for all practitioners in health and social care. Evidence to support practitioners, OPLWF and their families is needed to ensure that these vital conversations take place so that care at the end of life is humane and compassionate.
What happens before, during and after crisis for someone with dementia living at home: A systematic review
Authors: Hopkinson Jane B , King Amanda , Mullins Jane , Young Lucy , Kumar Sugandha , Hydon Kate , Muthukrishnan Sabarigirivasan , Elliott Fiona , Hopkinson Martin 
Published: February 2020

Background People living with dementia often experience crisis. Home treatment of crisis is an alternative to hospital admission that can have better outcomes. This systematic review is about people with dementia living at home and in crisis. It identifies modifiable factors in the crisis process that may facilitate crisis resolution. Methods The protocol is registered on PROSPERO. A systematic search of MEDLINE, EMBASE, CINAHL, AHMED, PsycINFO, Cochrane Library and references of retrieved publications, identified empirical research in English language and date range January 2000 to February 2019. Two researchers independently screened abstracts, selected publications and extracted data using a framework based on published guidelines. This is a report of the analysis and narrative synthesis. Results The search identified 2755 titles and abstracts, 76 were selected for full-text examination and 13 agreed for inclusion. The included studies evidence that: for a person with dementia, crisis is a process that begins with a problem judged to put them or others at risk of harm. It leads to decision and action to treat this risk, thus resolve the crisis. Such crisis can be predicted or unpredicted and progress quickly or slowly. Medical treatment, community resources and psychosocial support of personal resources, decision making, relationships and social networks, are all modifiable factors that can treat the risk of harm during crisis. Carers’ and professionals’ knowledge and skills in dementia care are likely to play a key role in crisis resolution in the home. Conclusion There has been limited investigation of the process and management of crisis at home for people living with dementia. The results of this review provide a foundation for future research. There is no consensus on critical components of home treatment to facilitate crisis resolution. However, education in dementia care for carers and professionals is likely to prove essential to successful home treatment.
Trigeminal neuralgia causes neurodegeneration in rats associated with upregulation of the CD95/CD95L pathway
Authors: Wang Lu , Long Menghong , Wang Maohua , Peng Shuangchun , Chen Guangxiang , Zhou Jun , Ou Cehua 
Published: February 2020

Objectives To explore the effects of trigeminal neuralgia on neurodegeneration in rats and the underlining mechanism. Methods Sixty adult male Sprague Dawley rats were divided randomly into Chronic Constriction Injury of the Rat’s Infraorbital Nerve (ION-CCI) group and sham group ( n = 30). Right suborbital nerve was ligated in ION-CCI group to establish a trigeminal neuralgia model. In sham group, suborbital nerve was exposed without ligation. Pain thresholds were measured before surgery and 1, 7, 15, and 30 days after surgery ( n = 10). Morris water maze tests ( n = 10) were conducted at 1, 15, and 30 days after surgery to evaluate the changes in learning and memory ability of rats. At 5, 19, and 34 days after surgery, serum S100β protein concentration and hippocampal Aβ1-42 protein expression were detected by enzyme-linked immunosorbent assay; total tau protein expression was detected by Western blotting; changes of neurons in hippocampus were observed by Nissl staining; and the expression of ser404p-tau, cluster of differentiation (CD)95, CD95L, and cleaved caspase-3 proteins was detected by immunofluorescence and Western blotting. Results Hyperalgesia occurred in ION-CCI group, and mechanical pain threshold decreased significantly ( P < 0.05). On the 15th and 30th days after surgery, ION-CCI group showed lower learning and memory ability than sham group ( P < 0.05). Serum S100β protein concentration, hippocampal A β1-42, and ser404p-tau protein expression increased in the ION-CCI group 19 and 34 days after surgery ( P < 0.05), hippocampal CD95 expression increased in the ION-CCI group after surgery ( P < 0.05), hippocampal CD95L expression increased at 19 and 34 days after surgery ( P < 0.05), and cleaved caspase-3 expression increased at 5 and 19 days after surgery ( P < 0.05). Nissl bodies in ION-CCI group decreased significantly at 15 days after surgery. The expression of cleaved caspase-3 protein in ION-CCI group was positively correlated with the expression of CD95 and CD95L ( P < 0.05). Conclusions Trigeminal neuralgia may lead to neuronal inflammation and neuronal apoptosis associated with upregulation of CD95/CD95L expression, thus causing neurodegeneration.
Exploring the determinants of the cardiac changes after ultra-long duration exercise: The echocardiographic Spartathlon study
Authors: Christou Georgios A , Pagourelias Efstathios D , Anifanti Maria A , Sotiriou Panagiota G , Koutlianos Nikolaos A , Tsironi Maria P , Andriopoulos Panagiotis I , Christou Konstantinos A , Kouidi Evangelia J , Deligiannis Asterios P 
Published: February 2020

Aim The investigation of the pathophysiological determinants of cardiac changes following ultra-long duration exercise. Methods Twenty-seven runners who finished a 246 km running race were examined both before and after the finish of the race. Examinations included echocardiography and measurement of body weight and blood biochemical parameters. Results Exercise increased left ventricular end-diastolic interventricular septum thickness (LVIVSd) ( p < 0.001) and posterior wall thickness (LVPWTd) ( p = 0.001) and right ventricular end-diastolic area ( p = 0.005), while reduced tricuspid annular plane systolic excursion (TAPSE) ( p = 0.004). A minor decrease in the peak absolute values of both left ventricular (from −20.9 ± 2.3% to −18.8 ± 2.0%, p = 0.009) and right ventricular (from −22.9 ± 3.6% to −21.2 ± 3.0%, p = 0.040) global longitudinal strains occurred. There was decrease in body weight ( p < 0.001) and increase in both circulating high-sensitivity troponin I ( p = 0.028) and amino-terminal pro-B type natriuretic peptide (NT-proBNP) ( p = 0.018). The change in the sum of LVIVSd and LVPWTd correlated negatively with percentage change of body weight ( r = −0.416, p = 0.049). The only independent determinant of post-exercise NT-proBNP was pulmonary artery systolic pressure ( r = 0.797, p = 0.002). Post-exercise NT-proBNP correlated positively with percentage changes of basal (RVbas) ( r = 0.582, p = 0.037) and mid-cavity (RVmid) ( r = 0.618, p = 0.043) right ventricular diameters and negatively with percentage change of TAPSE ( r = −0.720, p = 0.008). Similar correlations with RVbas, RVmid and TAPSE were found for pulmonary artery systolic pressure. Post-exercise high-sensitivity troponin I correlated negatively with percentage change of body weight ( r = −0.601, p = 0.039), but was not associated with any cardiac parameter. Conclusion The main cardiac effects of ultra-long duration exercise were the decrease in left ventricular end-diastolic dimensions and increase in left ventricular wall thickness, as well as minimal dilatation and alteration in systolic function of right ventricle, possibly due to the altered exercise-related right ventricular afterload.
A survey of syphilis knowledge among medical providers and students in Rhode Island
Authors: Bonnewell John , Magaziner Sarah , Fava Joseph L , Montgomery Madeline C , Almonte Alexi , Carey Michael , Chan Philip A 
Published: February 2020

Background: In the United States, syphilis cases have increased dramatically over the last decade. Recognition and timely diagnosis by medical providers are essential to treating syphilis and preventing further transmission. Methods: From 2016 to 2017, a cross-sectional survey was performed among medical students, residents, fellows, and attending physicians in Rhode Island. Topics included demographics, level of medical training, experience diagnosing and treating syphilis, and familiarity with the reverse testing algorithm. Participants were asked 25 true/false questions to assess basic knowledge of syphilis, which covered five domains: epidemiology, transmission, clinical signs and symptoms, diagnosis, and treatment. Univariate and bivariate analyses were performed to determine knowledge levels across provider characteristics. Significance was defined as p < 0.05. Results: Of the 231 participants, 45% were medical students, 34% were residents or fellows, 11% were medicine attendings (non-infectious diseases), and 10% were infectious diseases attendings. The overall mean score was 9.79 (out of 25; range = 0–23, p ⩽ 0.001). Mean scores differed significantly ( p < 0.001) across groups, including 7.68 for students (range = 0–16), 10.61 for residents/fellows (range = 3–17), 10.41 for non-infectious diseases attendings (range = 4–18), and 16.38 for infectious diseases attendings (range = 6–23). Familiarity with the reverse sequence algorithm was low with only 22% having heard of it. Infectious diseases attendings were significantly more knowledgeable compared to other groups. Overall and across domains, infectious diseases attendings had significantly higher scores except when compared to non-infectious diseases attendings in the epidemiology domain and residents/fellows in the transmission domain. Conclusion: Overall syphilis knowledge among non-infectious diseases medical providers was low. Improved education and clinical training are needed to promote early diagnosis, treatment, and prevention efforts.
The Prevalence and Clinical Implications of Comorbid Back Pain in Shoulder Instability: A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Cohort Study
Authors: Cronin Kevin J. , Wolf Brian R. , Magnuson Justin A. , Jacobs Cale A. , Ortiz Shannon ,   MOON Shoulder Group, Bishop Julie Y. , Bollier Matthew J. , Baumgarten Keith M. , Bravman Jonathan T. , Brophy Robert H. , Cox Charles L. , Feeley Brian T. , Grant John A. , Jones Grant L. , Kuhn John E. , Benjamin Ma C. , Marx Robert G. , McCarty Eric C. , Miller Bruce S. , Seidl Adam J. , Smith Matthew V. , Wright Rick W. , Zhang Alan L. , Hettrich Carolyn M. 
Published: February 2020

Background: Understanding predictors of pain is critical, as recent literature shows that comorbid back pain is an independent risk factor for worse functional and patient-reported outcomes (PROs) as well as increased opioid dependence after total joint arthroplasty. Purpose/Hypothesis: The purpose of this study was to evaluate whether comorbid back pain would be predictive of pain or self-reported instability symptoms at the time of stabilization surgery. We hypothesized that comorbid back pain will correlate with increased pain at the time of surgery as well as with worse scores on shoulder-related PRO measures. Study Design: Cross-sectional study; Level of evidence, 3. Methods: As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, patients consented to participate in pre- and intraoperative data collection. Demographic characteristics, injury history, preoperative PRO scores, and radiologic and intraoperative findings were recorded for patients undergoing surgical shoulder stabilization. Patients were also asked, whether they had any back pain. Results: The study cohort consisted of 1001 patients (81% male; mean age, 24.1 years). Patients with comorbid back pain (158 patients; 15.8%) were significantly older (28.1 vs 23.4 years; P < .001) and were more likely to be female (25.3% vs 17.4%; P = .02) but did not differ in terms of either preoperative imaging or intraoperative findings. Patients with self-reported back pain had significantly worse preoperative pain and shoulder-related PRO scores (American Shoulder and Elbow Surgeons score, Western Ontario Shoulder Instability Index) ( P < .001), more frequent depression (22.2% vs 8.3%; P < .001), poorer mental health status (worse scores for the RAND 36-Item Health Survey Mental Component Score, Iowa Quick Screen, and Personality Assessment Screener) ( P < .01), and worse preoperative expectations ( P < .01). Conclusion: Despite having similar physical findings, patients with comorbid back pain had more severe preoperative pain and self-reported symptoms of instability as well as more frequent depression and lower mental health scores. The combination of disproportionate shoulder pain, comorbid back pain and mental health conditions, and inferior preoperative expectations may affect not only the patient’s preoperative state but also postoperative pain control and/or postoperative outcomes.
Exploring molecular evolution of Rubisco in C3 and CAM Orchidaceae and Bromeliaceae
Authors: Hermida-Carrera Carmen , Fares Mario A. , Font-Carrascosa Marcel , Kapralov Maxim V. , Koch Marcus A. , Mir Arnau , Molins Arántzazu , Ribas-Carbó Miquel , Rocha Jairo , Galmés Jeroni 
Published: February 2020

Abstract
Background
The CO2-concentrating mechanism associated to Crassulacean acid metabolism (CAM) alters the catalytic context for Rubisco by increasing CO2 availability and provides an advantage in particular ecological conditions. We hypothesized about the existence of molecular changes linked to these particular adaptations in CAM Rubisco. We investigated molecular evolution of the Rubisco large (L-) subunit in 78 orchids and 144 bromeliads with C3 and CAM photosynthetic pathways. The sequence analyses were complemented with measurements of Rubisco kinetics in some species with contrasting photosynthetic mechanism and differing in the L-subunit sequence.

Results
We identified potential positively selected sites and residues with signatures of co-adaptation. The implementation of a decision tree model related Rubisco specific variable sites to the leaf carbon isotopic composition of the species. Differences in the Rubisco catalytic traits found among C3 orchids and between strong CAM and C3 bromeliads suggested Rubisco had evolved in response to differing CO2 concentration.

Conclusions
The results revealed that the variability in the Rubisco L-subunit sequence in orchids and bromeliads is composed of coevolving sites under potential positive adaptive signal. The sequence variability was related to δ13C in orchids and bromeliads, however it could not be linked to the variability found in the kinetic properties of the studied species.