bluuebunny/crossref_metadata_2025_split huggingface dataset:
18F-Flutemetamol PET post-stroke - a seven year follow-up study
Authors: Hagberg Guri , Ihle-Hansen Hege , Fure Brynjar , Thommessen Bente , Ihle-Hansen Håkon , Øksengård Anne Rita , Beyer Mona K. , Wyller  , Müller Ebba Gløersen , Pendlebury Sarah T. , Selnes Per 
Published: December 2019

Abstract
Background: Cognitive impairment (CI) with mixed vascular and neurodegenerative pathologies after stroke is common. The role of amyloid pathology in post-stroke CI is unclear. We hypothesize that amyloid deposition, measured with Flutemetamol (18F-Flut) positron emission tomography (PET), is common in 7-year stroke survivors diagnosed with CI and, further, that quantitatively assessed 18F-Flut-PET uptake after seven years correlates with amyloid-β peptide (Aβ₄₂) levels in cerebrospinal fluid (CSF) at one year, and with measures of neurodegeneration and cognition at seven years post-stroke. Methods: 208 patients with first-ever stroke or TIA without pre-existing CI were included during 2007 and 2008. At one- and seven-years post-stroke, cognitive status was assessed, and categorized into dementia, mild cognitive impairment or none. Etiologic sub-classification was based on magnetic resonance imaging (MRI) findings, CSF biomarkers and clinical cognitive profile. At seven years, patients were offered 18F-Flut-PET, and amyloid-positivity was assessed visually and semi-quantitatively. The associations between 18F-Flut-PET standardized uptake value ratios (SUVr) and measures of neurodegeneration (medial temporal lobe atrophy (MTLA), global cortical atrophy (GCA)) and cognition (Mini-Mental State Exam (MMSE), Trail-making test A (TMT-A)) and CSF Aβ₄₂ levels were assessed using linear regression. Results: In all, 111 patients completed 7-year follow-up, and 26 patients agreed to PET imaging, of whom 13 had CSF biomarkers from one year. Thirteen out of 26 patients were diagnosed with CI seven years post-stroke, but only one had visually assessed amyloid positivity. CSF Aβ₄₂ levels at one year, MTA grade, GCA scale, MMSE score or TMT-A at seven years did not correlate with 18F-Flut-PET SUVr in this cohort.Conclusions: Amyloid binding were not common in 7-year stroke survivors diagnosed with CI. Quantitatively assessed amyloid did not correlate with other measures related to neurodegeneration and cognition. Therefore amyloid pathology may not be a key mediator of neurodegeneration seven years post-stroke.
Environmental factors and spatiotemporal distribution of Japanese encephalitis after vaccination campaign in Guizhou Province, China (2004–2016)
Authors: zhao suye , Wang Huanyu , Tian Huaiyu 
Published: December 2019

Abstract
BackgroundAlthough a vaccination campaign has been conducted since 2004, Japanese encephalitis (JE) is still a public health problem in Guizhou, one of the provinces with the highest incidence of JE in China. The aim of this study was to understand the spatiotemporal distribution of JE and its relationship with environmental factors in Guizhou Province in the post-vaccination era, 2004–2016.Methods/Principal FindingsWe collected data on human JE cases in Guizhou Province from 2004 to 2016 from the national infectious disease reporting system. A Poisson regression model was used to analyze the relationship between JE occurrence and environmental factors amongst counties. Our results showed that the incidence and mortality of JE decreased after the initiation of vaccination. JE cases were mainly concentrated in preschool and school-age children and the number of cases in children over age 15 years was significantly decreased compared with the previous 10 years; the seasonality of JE before and after the use of vaccines was unchanged. JE incidence was positively associated with cultivated land and negatively associated with gross domestic product (GDP), vegetation coverage, and developed land. In areas with cultivated land coverage <25%, vegetation coverage >55%, and urban area coverage >25%, the JE risk was lower. The highest JE incidence was among mid-level GDP areas and in moderately urbanized areas.Conclusions /SignificanceThis study assessed the relationship between incidence of JE and environmental factors in Guizhou Province. Our results highlight that the highest risk of JE transmission in the post-vaccination era is in mid-level developed areas. Keywords: Japanese encephalitis; spatial analysis; spatial epidemiology;mosquito;vaccine
Health-related quality of life among 13–14 year old adolescents with overweight - a mixed methods approach
Authors: Sundar Turid Kristin Bigum , Riiser Kirsti , Småstuen Milada , Opheim Randi , Løndal Knut , Glavin Kari , Helseth Sølvi 
Published: December 2019

Abstract
BackgroundOverweight and obesity are public concerns with risk of adverse health outcomes. Health-related quality of life (HRQoL) is lower in adolescents than children in general. An increase in body mass index (BMI) is associated with a decrease in HRQoL. The purpose of this study was to measure and explore the HRQoL among adolescents with overweight or obesity who had participated in an intervention study with the aim of increasing PA, reducing BMI and promoting HRQoL.Methods Mixed methods, with a convergent design, were used to investigate how different methodological approaches could expand our understanding of the adolescents’ HRQoL. Quantitative post-intervention data on HRQoL were collected among the 84 intervention participants, aged 13–14 years, using the KIDSCREEN 52 questionnaire. The data were compared with a Norwegian reference population of 244 individuals, and analysed using a non-parametric Mann-Whitney test. Qualitative semi-structured interviews were conducted with 21 adolescents from the intervention. A directed approach to content analysis was adopted, using the ten sub-scales from KIDSCREEN 52.ResultsHRQoL in the intervention sample was significantly reduced on the sub-scale of physical well-being compared to the reference population. The reference population scored significantly lower than the intervention sample on the sub-scale of parent relation and home life. No significant differences were found on the other sub-scales. The qualitative data supported the quantitative findings on the sub-scale of physical well-being, but showed that perceptions of fitness, energy level or health could vary. Regarding parent relations, the interviewees extended this to include relationships to other family members as equally important. Most of the interviewees expressed a negative view of their bodies, but not their clothing or accessories. This may explain why no statistically significant differences were found on these aspects in the results from the KIDSCREEN questionnaire. ConclusionThe use of the KIDSCREEN 52 instrument gave important indications about the adolescents’ HRQoL. Combining methods enabled a comprehensive approach to research on HRQoL, indicating better ways of providing help. More research using the benefits of mixed methods approaches is needed to further elucidate these findings.
Recurrent disc herniation following percutaneous endoscopic lumbar discectomy preferentially occurs when Modic changes are present
Authors: Hao Lu , Li Shengwen , Liu Junhui , Shan Zhi , Fan Shunwu , Zhao Fengdong 
Published: December 2019

Abstract
Objective: To investigate the effect of Modic changes (MCs) and the herniated disc component on recurrent lumbar disc herniation (rLDH) following percutaneous endoscopic lumbar discectomy (PELD).Methods: We included 102 (65 males,37 females, aged 20–66 yr) inpatients who underwent PELD from August 2013 to August 2016. All patients underwent CT and MRI preoperative. The presence and type of Modic changes were assessed. During surgery the herniated disc component of each patient was classified into two groups: Nucleus pulposus group, Hyaline cartilage group. The association of herniated disc component with Modic changes was investigated. The incidence of recurrent disc herniation was assessed on more than 2-year follow-up.Results: In total, 11 patients were lost to follow up; the other 91 were followed up for 24–60 months. Of the 91 patients, 99 discs underwent PELD; 28/99 (28.3%) had MCs. Type I and II MCs were seen in 9 (9.1%) and 19 (19.2%), respectively; no type III MCs were found. Among 28 endplates with MCs, according to the herniated disc component, 18/28 (64.3%) showed evidence of hyaline cartilage in the intraoperative specimens, including 6/9 and 12/19 endplates with type I and II MCs, respectively. Among 71 endplates without MCs, 14/71 (19.7%) showed evidence of hyaline cartilage in the intraoperative specimens. Hyaline cartilage was more common in patients with MCs (P<0.05). We found 2 cases of rLDH in the non-MC group (n=71); 6 cases rLDH were found in the MC group (n=28), including 2 and 4 cases for types I and II, respectively. There was no significant difference between types I and II (P>0.05). rLDH was more common in patients with MCs (P<0.05). We found 5 rLDH cases in the hyaline cartilage group (n=32); 3 rLDH cases were found in the nucleus pulposus group (n=67). rLDH was more common in the hyaline cartilage group (P<0.05). Conclusions: MCs were associated with the herniated cartilage disc component. rLDH following PELD preferentially occurs when MCs or the herniated cartilage are present.
Does zero-profile anchored cage accompanied by a higher postoperative subsidence compared with cage-plate construct? A meta-analysis
Authors: Lu Yingjie , Fang Yuepeng , Shen Xu , Lu Dongdong , Zhou Liyu , Gan Minfeng , Zhu Xuesong 
Published: December 2019

Abstract
Background Zero-profile anchored cage (ZP) has been widely used for its lower occurrence of dysphagia. However, it is still controversial whether it has the same stability as the cage-plate construct (CP) and increases the incidence of postoperative subsidence. We compared the rate of subsidence after anterior cervical discectomy and fusion (ACDF) with ZP and CP to determine whether the zero-profile device had a higher subsidence rate?Methods We performed a meta-analysis of studies which compared the subsidence rate of ZP and CP. An extensive and systematical search covered Medline, Embase and Web of Science databases according to PRISMA guidelines and identified ten articles that satisfied our inclusion criteria. Relevant clinical and radiological data were extracted and analysed by RevMan 5.3 software.Results Ten trials involving 626 patients were included in this meta-analysis. The incidence of postoperative subsidence in ZP group was significantly higher than with CP group [15.1% (89/588) vs. 8.8% (51/581), OR = 1.97 (1.34, 2.89), P = 0.0005]. In subgroup analysis, we found that the definition of subsidence did not affect the higher subsidence rate in the ZP group. Considering the quantity of operative segments, there was no significant difference in the incidence of subsidence between the two groups after single-level fusion (OR 1.43, 95% CI 0.61-3.37, P = 0.41). However, the subsidence rate of the ZP group was significantly higher than the CP group (OR 2.61, 95% CI 1.55-4.40, P = 0.0003) after multi-level surgery. There were no significant differences in intraoperative blood loss, JOA score, NDI score, fusion rate and cervical aligment in the final followup between the two groups. In addition, the CP group had a longer operation time and a higher incidence of dysphagia at each follow-up time than the ZP group.Conclusion ZP had a higher risk of postoperative subsidence than CP. Although there was a high occurrence of swallowing discomfort, we are more agreed that the anterior plate should be used in multi-level surgery as far as possible to reduce the subsidence and adverse clinical symptoms in the long term.
Out-of-hours workload among Norwegian general practitioners – an observational study
Authors: Rebnord Ingrid Keilegavlen , Morken Tone , Maartmann-Moe Kjell , Hunskaar Steinar 
Published: December 2019

Abstract
Background Repeated studies of working hours among Norwegian regular general practitioners (RGPs) have shown that the average total weekly working hours have remained unchanged since 1994 until 2014. For both male and female RGPs the mean total weekly working hours were almost 50 hours in 2014. In recent years there has been an outcry of dissatisfaction among Norwegian RGPs. They experience significantly increased workload without compensation, such as more doctors or better payments. A study from the Norwegian Directorate of Health in 2018 (the RGP study) showed that Norwegian RGPs worked 55.6 hours weekly (median 52.5). 25% of the respondents worked more than 62.2 hours weekly. Based on data from the RGP-study we investigated Norwegian RGPs work out-of-hours (OOH), how the working time was distributed, and to which extent the OOH work affected the regular working hours.Methods In early 2018, an electronic survey was sent to all 4716 RGPs in Norway. Each RGP reported prospectively how many minutes per day they used on various tasks during one week. Working time also included additional tasks in the municipality, other professional medical work and OOH primary health care. Differences were analyzed by independent t-tests, and regression analyses.Results 1876 RGPs (39.8%) responded, 640 (34.1%) had registered OOH work. Male RGPs worked in average 1.5 hours more with regular work than females (p=0.001) and in average 2.3 hours more OOH work than females (p=0.079). RGPs with no OOH work registered a mean of 1.0 hours more clinical work than RGPs working OOH (p=0.043). There was a large variation in OOH working hours. A linear regression analysis showed that male RGPs and RGPs in rural areas had the highest OOH workload.Conclusions Every third of Norwegian RGPs participated in OOH work during the registration week in the RGP study. OOH work was done in addition to a high regular workload as RGP. We found small gender differences. OOH work did not lead to reduced regular RGP work.
Drug resistance occurred in a newly characterized preclinical model of lung cancer brain metastasis.
Authors: Shah Neal , Liu Zhongwei , Tallman Rachel M. , Mohammad Afroz , Sprowls Samuel A , Saralkar Pushkar A. , Vickers Schuyler D. , Pinti Mark V. , Gao Weimin , Lockman Paul R 
Published: December 2019

Abstract
Background Cancer metastasis and drug resistance have traditionally been studied separately, though these two lethal pathological phenomena almost always occur concurrently. Brain metastasis occurs in a large proportion of lung cancer patients (~30%). Once diagnosed, patients have a poor prognosis surviving typically less than 1 year due to lack of treatment efficacy. Methods Human metastatic lung cancer cells (PC-9-Br) were injected into the left cardiac ventricle of female athymic nude mice. Brain lesions were allowed to grow for 21 days, animals were then randomized into treatment groups and treated until presentation of neurological symptoms or when moribund. Prior to tissue collection mice were injected with Oregon Green and 14C-Aminoisobutyric acid followed by an indocyanine green vascular washout. Tracer accumulation was determined by quantitative fluorescent microscopy and quantitative autoradiography. Survival was tracked and tumor burden was monitored via bioluminescent imaging. Extent of mutation differences and acquired resistance was measured in-vitro through half-maximal inhibitory assays and qRT-PCR analysis. Results A PC-9 brain seeking line (PC-9-Br) was established. Mice inoculated with PC-9-Br resulted in a significantly decreased survival time compared with mice inoculated with parental PC-9. Non-targeted chemotherapy with cisplatin and etoposide (51.5 days) significantly prolonged survival of PC-9-Br brain metastases in mice compared to vehicle control (42 days) or cisplatin and pemetrexed (45 days). Further in-vivo imaging showed greater tumor vasculature in mice treated with cisplatin and etoposide compared to non-tumor regions, which was not observed in mice treated with vehicle or cisplatin and pemetrexed. More importantly, PC-9-Br showed significant resistance to gefitinib by in-vitro MTT assays (IC50>2.5 µM at 48hrs and 0.1 µM at 72hrs) compared with parental PC-9 (IC50: 0.75 µM at 48hrs and 0.027 µM at 72hrs). Further studies on the molecular mechanisms of gefitinib resistance revealed that EGFR and phospho-EGFR were significantly decreased in PC-9-Br compared with PC-9. Expression of E-cadherin and vimentin did not show EMT in PC-9-Br compared with parental PC-9, and PC-9-Br had neither T790 mutation nor amplifications of MET and HER2 compared with parental PC-9. Conclusion Our study demonstrated that brain metastases of lung cancer cells may independently prompt drug resistance without drug treatment.
Is menopause still evolving? Evidence from a longitudinal study of multiethnic populations and its relevance to women's health
Authors: Singh Rama Shankar , Chan Shirley , Gomes Alyssa 
Published: December 2019

Abstract
To reflect on the impact of changing patterns of delayed marriage and reproduction and to seek evidence as to whether menopause is still evolving, characteristics of the menopause transition were investigated within and between ethnic populations in this study. A cross-sectional analysis was conducted using data on 747 middle-aged women obtained from the Study of Women’s Health Across the Nation (SWAN) from 1996 to 2008. The ethnic groups included: Afro-American, Chinese, Japanese, Caucasian, and Hispanic. Perimenopause age and duration, menopause age, and hormonal indicators of menopause were examined across five ethnicities. We found a similar window of menopause age within populations, but no significant difference in perimenopause and menopause age between populations. The rate of increase of follicle-stimulating hormone and testosterone differed significantly in Hispanics and African-Americans during the menopause transition period. The broad window of variation in age at menopause within the population (45-60 years) and the absence of significant differences between populations, in combination with population variation in menopause symptoms, suggest that menopause is a relatively recently evolved and still evolving trait. Under the mate choice theory of menopause, menopause is the result of the accumulation of infertility mutations in older women due to men’s preference for younger mates. We propose a shifting mate choice-shifting menopause model which posits that, as the age of mate choice/marriage shifts to older age, so will the age at menopause, and that menopause is a transient phase of female fertility; it can de-evolve, be delayed and even disappear, in theory.
Usual physical activity and subsequent hospital usage over 20 years in a general population: the EPIC-Norfolk cohort
Authors: Luben Robert N , Hayat Shabina , Wareham Nicholas , Pharoah Paul , Khaw Kay-Tee 
Published: December 2019

Abstract
Background While physical activity interventions have been reported to reduce hospital stays, it is not clear if, in the general population, usual physical activity patterns may be associated with subsequent hospital use independently of other lifestyle factors. We examined the relationship between reported usual physical activity and subsequent admissions to hospital and time spent in hospital for 11,228 men and 13,786 women aged 40–79 years in the general population. MethodsParticipants from a British prospective population-based study were followed for 20 years (1999–2019) using record linkage to document hospital usage. Total physical activity was estimated by combining workplace and leisure time activity reported in a baseline lifestyle questionnaire and repeated in a subset at a second time point approximately 12 years later. Results Compared to those reporting no physical activity, participants who were the most active had a lower likelihood of spending more than 20 days in hospital odds ratio (OR) 0.88 (95% confidence interval (CI) 0.81–0.96) over the next 20 years after multivariable adjustment for age, sex, smoking status, education, social class and body mass index. Participants reporting any activity had a mean of 0.42 fewer hospital days per year between 1999 and 2009 compared to inactive participants, an estimated saving to the National Health Service (NHS) of £247 per person per year, or approximately 7% of UK health expenditure. Participants who remained physically active or became active 12 years later had lower risk of subsequent hospital usage than those who remained inactive or became inactive, p-trend < 0.001. Conclusions Usual physical activity in this middle-aged and older population predicts lower future hospitalisations - time spent in hospital and number of admissions independently of behavioural and sociodemographic factors. Small feasible differences in usual physical activity in the general population may potentially have a substantial impact on hospital usage and costs.
Incidence and risk factors of post operative delirium in elderly patients who underwent spinal anesthesia in Orotta, Halibet and Sembel Hospitals: A Cross sectional analytic study in ERITREA
Authors: Mengistu Michael Beraki , Andemeskel Yonatan Mehari , Emehatsion Ariam Tsegay , Wrieta Habtom Tareke , Gebreyessus Natsnet Yacob 
Published: December 2019

Abstract
BackgroundDelirium is a common but often underdiagnosed set of transient symptomin the elderly patients following surgeries under spinal anesthesia. Delirium can be improved with early recognition and diagnosis based on the established standard criteria. The identification of the possible contributing factors and magnitude of the burden will help in the management of the fragile elderly patients. Managing delirium with environmental, supportive and pharmacological interventions will possibly reduce the incidence, and complication associated with postoperative delirium. The aim of this study is to determine the incidence of postoperative delirium and associated risk factors in elderly patients who did surgery under spinal anesthesia. MethodThis cross sectional study was conducted in the National Referral Hospitals in Eritrea (Orotta and Halibet), including Sembel hospital from February to May, 2019. The study participants were elderly patients (age ≥65 years) having no mental disorder, no history of acute cerebrovascular disease, no known history of delirium and/or dementia. Basic background and clinical characteristics of the patients was collected. To assess the status of cognitive impairment level, the Mini Mental State Examination and Confusion Assessment Method tools were used. Data was collected through an interview method. After the data was entered into SPSS version 22 software, it was conducted with frequency, percentage, bivariate and multivariate logistic regression analysis method as appropriate. P value at<0.05 was considered as statistically significant. ConclusionPostoperative delirium occurred in 14 out of 129 case (10.9%). The multivariate analysis showed that only age was significantly associated with postoperative delirium. The other variables did not significantly influence the occurrence of POD. Therefore, t he incidence of postoperative delirium after spinal anesthesia was relatively high (10.9%). Similarly, old age was found as the risk factor for the development of delirium in those elderly patients who underwent spinal anesthesia. This findings might help to develop preventive strategies to decrease POD through targeted factors.