bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Association Between Hyperchloremia and Acute Kidney Injury in Patients With Acute Ischemic Stroke
Authors: Haller J. Tyler , Smetana Keaton , Erdman Michael J. , Miano Todd A. , Riha Heidi M. , Rinaldi Alyssa , Goyal Nitin , Jones G. Morgan 
Published: March 2020

Background and Purpose: While an association between hyperchloremia and worse outcomes, such as acute kidney injury and increased mortality, has been demonstrated in hemorrhagic stroke, it is unclear whether the same relationship exists after acute ischemic stroke. This study aims to determine the relationship between moderate hyperchloremia (serum chloride ≥115 mmol/L) and acute kidney injury in patients with ischemic stroke. Methods: This is a multicenter, retrospective, propensity-matched cohort study of adults admitted for acute ischemic stroke. The primary objective was to determine the relationship between moderate hyperchloremia and acute kidney injury, as defined by the Acute Kidney Injury Network criteria. Secondary objectives included mortality and hospital length of stay. Results: A total of 407 patients were included in the unmatched cohort (332 nonhyperchloremia and 75 hyperchloremia) and 114 patients (57 in each group) were matched based upon propensity scores. In the matched cohort, hyperchloremia was associated with an increased risk of acute kidney injury (relative risk 1.91 [95% confidence interval 1.01-3.59]) and a longer hospital length of stay (16 vs 12 days; P = .03). Mortality was higher in the hyperchloremia group (19.3% vs 10.5%, P = .19), but this did not reach statistical significance. Conclusions: In this study, hyperchloremia after ischemic stroke was associated with increased rates of acute kidney injury and longer hospital length of stay. Further research is needed to determine which interventions may increase chloride levels in patients with acute ischemic stroke and the association between hyperchloremia and clinical outcomes.
Symptom Control of Patients With Chronic Rhinosinusitis With Nasal Polyps Under Maintenance Therapy With Daily Acetylsalicylic Acid
Authors: Hahn Janina , Appel Heike , Scheithauer Marc O. , Petereit Florian , Greve Jens , Lindemann Jörg , Hoffmann Thomas K. , Veit Johannes A. , Sommer Fabian 
Published: March 2020

Introduction Nonsteroidal anti-inflammatory drugs (NSAID)-exacerbated respiratory disease (NERD) is defined by intolerance to cyclooxygenase 1 inhibitors, chronic rhinosinusitis with recurrent nasal polyps, and/or intrinsic bronchial asthma. Long-term administration of acetylsalicylic acid (ASA) after desensitization has been used to mitigate these sequelae, but the optimal dose and balancing symptom relief and side effects remain unsettled. Methods Retrospective data analysis of 85 patients with NERD receiving maintenance therapy of 300 mg ASA was followed by questionnaires (our own, not validated and the Sino-Nasal Outcome Test-20). We received responses from 55 patients and examined 30 of them clinically. Results Patients with no ASA-associated side effects were 56.4% (56 of 85 patients) of the cohort. In this study, 60% (33 of 55 patients) continued prophylaxis of 300 mg ASA daily for an average of 34.7 months. Elective surgery was the most frequent cause of discontinuation of ASA (21.8%; 12 of 55 patients). Rhinomanometry values were significantly improved with ASA ( P < .05; Wilcoxon), but there was no significant reduction in nasal polyposis or improvement in olfaction at the time of follow-up examination. Conclusions Minor clinical improvements were identified. Side effects were well tolerated by most patients, and no serious sequelae occurred. The indications for long-term ASA therapy in NERD patients remain unsettled.
Left ventricular hypertrophy in athletes: How to differentiate between hypertensive heart disease and athlete’s heart
Authors: D’Ascenzi Flavio , Fiorentini Caterina , Anselmi Francesca , Mondillo Sergio 
Published: March 2020

Abstract
Athlete’s heart is typically accompanied by a remodelling of the cardiac chambers induced by exercise. However, although competitive athletes are commonly considered healthy, they can be affected by cardiac disorders characterised by an increase in left ventricular mass and wall thickness, such as hypertension. Unfortunately, training-induced increase in left ventricular mass, wall thickness, and atrial and ventricular dilatation observed in competitive athletes may mimic the pathological remodelling of pathological hypertrophy. As a consequence, distinguishing between athlete’s heart and hypertension can sometimes be challenging. The present review aimed to focus on the differential diagnosis between hypertensive heart disease and athlete’s heart, providing clinical information useful to distinguish between physiological and pathological remodelling.
A systematic review of the behaviour change techniques and digital features in technology-driven type 2 diabetes prevention interventions
Authors: Van Rhoon Luke , Byrne Molly , Morrissey Eimear , Murphy Jane , McSharry Jenny 
Published: March 2020

Objectives Our aim was to conduct a systematic review to determine which technology-driven diabetes prevention interventions were effective in producing clinically significant weight loss, and to identify the behaviour change techniques and digital features frequently used in effective interventions. Methods We searched five databases (CINAHL, EMBASE, MEDLINE, PsychINFO, and Pubmed) from inception to September 2018 and reviewed 19 experimental and non-experimental studies of 21 technology-driven diet plus physical activity interventions for adults (≥18 years) at risk of developing type 2 diabetes. Behaviour change techniques were coded using the BCT taxonomy v1, and digital features were identified via thematic analysis of intervention descriptions. Results Sixty-three per cent of interventions were effective in the short term (achieving ≥3% weight loss at ≤6 months), using an average of 5.6 more behaviour change techniques than non-effective interventions, and 33% were effective in the long term (achieving ≥5% weight loss at ≥12 months), using 3.7 more behaviour change techniques than non-effective interventions. The techniques of social support (unspecified), goal setting (outcome/behaviour), feedback on behaviour, and self-monitoring of outcome(s) of behaviour were identified in over 90% of effective interventions. Interventions containing digital features that facilitated health and lifestyle education, behaviour/outcome tracking, and/or online health coaching were most effective. Conclusion The integration of specific behaviour change techniques and digital features may optimise digital diabetes prevention interventions to achieve clinically significant weight loss. Additional research is needed to identify the mechanisms in which behaviour change techniques and digital features directly influence physical activity, dietary behaviours, and intervention engagement.
Catering for Learner Diversity in Hong Kong Secondary Schools: Insights from the Relationships Between Students’ Learning Styles and Approaches
Authors: Yin Hongbiao , Lee John Chi-Kin , Zhang Zhonghua 
Published: March 2020

Purpose: Catering for learner diversity is a key issue in the recent educational reforms in Hong Kong. The present study addresses this issue through an investigation of the relationships between students’ learning styles and approaches to learning in Hong Kong secondary schools. Design/Approach/Methods: A total of 6,054 junior secondary students in Hong Kong responded to a questionnaire consisting of two instruments. A series of confirmatory factor analysis, two-way analysis of variance, and structural equation modeling analysis were conducted. Findings: The results identified three types of learning style among the students which are characterized by a cognitive orientation, a social orientation, and a methodological orientation. Some significant gender- and achievement-level differences were revealed. Compared with the socially oriented learning style, the cognitively and methodologically oriented learning styles were more extensively and strongly related to students’ approaches to learning, even though these students showed a greater preference for the socially oriented learning style. Originality/Value: It is unwise to blindly cater for students’ learning styles in classroom teaching and curriculum design. Teachers should adopt a comprehensive and balanced approach toward the design of curriculum and teaching which not only highlights the congruence between students’ learning styles and teacher’s pedagogy but also integrates the constructive frictions between them into classroom teaching.
Age and Tightness of Repair Are Predictors of Heel-Rise Height After Achilles Tendon Rupture
Authors: Carmont Michael R. , Zellers Jennifer A. , Brorsson Annelie , Nilsson-Helander Katarina , Karlsson Jón , Grävare Silbernagel Karin 
Published: March 2020

Background: Achilles tendon rupture leads to weakness of ankle plantarflexion. Treatment of Achilles tendon rupture should aim to restore function while minimizing weakness and complications of management. Purpose: To determine the influence of factors (age, sex, body mass index [BMI], weight, time from injury to operative repair, and tightness of repair) in the initial surgical management of patients after an acute Achilles tendon rupture on 12-month functional outcome assessment after percutaneous and minimally invasive repair. Study Design: Cohort study; Level of evidence, 3. Methods: From May 2012 to January 2018, patients sustaining an Achilles tendon rupture receiving operative repair were prospectively evaluated. Tightness of repair was quantified using the intraoperative Achilles tendon resting angle (ATRA). Heel-rise height index (HRHI) was used as the primary 12-month outcome variable. Secondary outcome measures included Achilles tendon total rupture score (ATRS) and Tegner score. Stepwise multiple regression was used to create a model to predict 12-month HRHI. Results: A total of 122 patients met the inclusion criteria for data analysis (mean ± SD age, 44.1 ± 10.8 years; 78% male; mean ± SD BMI, 28.1 ± 4.3 kg/m2). The elapsed time to surgery was 6.5 ± 4.0 days. At 12-month follow-up, patients had an HRHI of 82% ± 16% and performed 82% ± 17% of repetitions compared with the noninjured side. Participants had a mean ATRS of 87 ± 15 and a median Tegner score of 5 (range, 1-9), with a reduction in Tegner score of 2 from preinjury levels. The relative ATRA at 12 months was –4.8° ± 3.9°. Multiple regression identified younger age (B = ±0.006; P < .001) and greater intraoperative ATRA (B = 0.005; P = .053) as predictors of more symmetrical 12-month HRHI ( R 2 = 0.19; P < .001; n = 120). Conclusion: Age was found to be the strongest predictor of outcome after Achilles tendon rupture. The most important modifiable risk factor was the tightness of repair. It is recommended that repair be performed as tight as possible to optimize heel-rise height 1 year after Achilles tendon rupture and possibly to reduce tendon elongation.
Expressive language abilities of boys with idiopathic autism spectrum disorder and boys with fragile X syndrome + autism spectrum disorder: Cross-context comparisons
Authors: Hilvert Elizabeth , Sterling Audra , Haebig Eileen , Friedman Laura 
Published: March 2020

Background and aims Understanding the unique expressive language profiles of children with phenotypically similar, but distinct neurodevelopmental disorders, such as idiopathic autism spectrum disorder and fragile X syndrome with a co-diagnosis of autism spectrum disorder (fragile X syndrome + autism spectrum disorder), has both clinical and theoretical implications. However, comparative studies of these two clinical groups have been limited, and results have been inconsistent, partially as a result of different assessment methods being utilized. Thus, the current study compared the expressive language profiles of boys with idiopathic autism spectrum disorder and boys with fragile X syndrome + autism spectrum disorder and examined whether a similar linguistic profile emerged across different language sampling contexts: a semi-structured conversation and the Autism Diagnostic Observation Schedule. Methods Eighteen boys with autism spectrum disorder ( Mage = 13.25 years) and 19 boys with fragile X syndrome + autism spectrum disorder ( Mage = 12.19 years), matched on autism spectrum disorder symptom severity and similar in terms of chronological age and mean length of utterance, participated in this study. Boys produced two language samples: one semi-structured conversation and one taken from the Autism Diagnostic Observation Schedule. Language samples were coded for talkativeness, lexical diversity, mean length of utterance, intelligibility, and repetitive or perseverative language. Results Analyses revealed that boys with autism spectrum disorder produced language samples that were more lexically diverse and intelligible, and that included less topic perseveration compared to boys with fragile X syndrome + autism spectrum disorder. With regards to sampling context, boys in both groups were more talkative and produced longer and more intelligible utterances in their conversation sample compared to their Autism Diagnostic Observation Schedule sample. However, boys with autism spectrum disorder and fragile X syndrome + autism spectrum disorder used a higher proportion of topic perseveration during the conversation sample. Conclusions Overall, we found similarities as well as distinctions in the expressive language profiles of boys with fragile X syndrome + autism spectrum disorder and boys with idiopathic autism spectrum disorder. Moreover, the Autism Diagnostic Observation Schedule sample elicited a relatively different language profile than the conversation sample for boys in both groups. Implications These findings help to further elucidate the unique language phenotypes of boys with idiopathic autism spectrum disorder and boys with fragile X syndrome + autism spectrum disorder. Moreover, our findings indicate that multiple language samples may be needed to obtain a comprehensive account of a child’s expressive language ability.
SUGAMMADEX versus neostigmine after ROCURONIUM continuous infusion in patients undergoing liver transplantation
Authors: Deana Cristian , Barbariol Federico , D’Incà Stefano , Pompei Livia , Rocca Giorgio Della 
Published: March 2020

Abstract
Background
Rapid neuromuscular block reversal at the end of major abdominal surgery is recommended to avoid any postoperative residual block. To date, no study has evaluated sugammadex performance after rocuronium administration in patients undergoing liver transplantation.
This is a randomized controlled trial with the primary objective of assessing the neuromuscular transmission recovery time obtained with sugammadex versus neostigmine after rocuronium induced neuromuscular blockade in patients undergoing orthotopic liver transplantation.

Methods
The TOF-Watch SX®, calibrated and linked to a portable computer equipped with TOF-Watch SX Monitor Software®, was used to monitor and record intraoperative neuromuscular block maintained with a continuous infusion of rocuronium. Anaesthetic management was standardized as per our institution’s internal protocol. At the end of surgery, neuromuscular moderate block reversal was obtained by administration of 2 mg/kg of sugammadex or 50 mcg/kg of neostigmine (plus 10 mcg/kg of atropine).

Results
Data from 41 patients undergoing liver transplantation were analysed. In this population, recovery from neuromuscular block was faster following sugammadex administration than neostigmine administration, with mean times±SD of 9.4 ± 4.6 min and 34.6 ± 24.9 min, respectively (p < 0.0001).

Conclusion
Sugammadex is able to reverse neuromuscular block maintained by rocuronium continuous infusion in patients undergoing liver transplantation. The mean reversal time obtained with sugammadex was significantly faster than that for neostigmine. It is important to note that the sugammadex recovery time in this population was found to be considerably longer than in other surgical settings, and should be considered in clinical practice.

Trial registration
ClinicalTrials.govNCT02697929 (registered 3rd March 2016).
The omitted symptoms challenge the diagnosis of right atrial myxoma: a case report
Authors: Ma Shulun , Xu Qian , Shi Ruizheng , Zhang Xin , Chen Xuliang 
Published: March 2020

Abstract
Background
Cardiac myxoma (CM) is the most common type of primary cardiac tumors. The prevalence of primary cardiac tumors is 0.0017–0.28% in various autopsy studies. The clinical symptoms of CM which includes embolism, intracardiac obstruction, general or constitutional manifestations and infected myxoma are largely depended on the size, growing speed, location and pedicle length of the tumor. The following case reported a missed diagnostic case of a right atrial myxoma firstly presented digestive, systemic symptoms and immunologic disorder, leading to emergent tricuspid valves obstruction situation.

Case presentation
We reported a critical case of a 51-year-old female with CM was firstly admitted to the gastroenterology clinical department because of poor appetite, marked fatigability and weight loss for 2 months. The physician diagnosed her as chronic gastritis and treated her with some symptomatic treatment such as ilaprazole and magnesium aluminum carbonate. After months without definitive diagnosis, this right atrial myxoma grew into right ventricle and obstructed the tricuspid valves, causing her dyspnea, sweating, dizziness, feeling of impending death when she was sleeping. Transthoracic echocardiogram revealed a 6.1 × 4.2 × 3.7 cm2 mass adjacent to tricuspid valves. The patient underwent surgical excision and pathology revealed a primary cardiac myxoma.

Conclusion
This case reported a critical result of missed diagnosis of right atrial myxoma and showed its systematic symptoms and immunologic disorder, highlighting the importance of systematic examinations on patients. Furthermore, it appeals early diagnosis of CM and consideration of drug targets to suppress CM development.
Management in primary care at the time of a suicide attempt and its impact on care post-suicide attempt: an observational study in the French GP sentinel surveillance system
Authors: Younes Nadia , Rivière Mathieu , Urbain Frédéric , Pons Romain , Hanslik Thomas , Rossignol Louise , Chan Chee Christine , Blanchon Thierry 
Published: March 2020

Abstract
Background
We aimed to describe primary care management at the time of a suicide attempt (SA) and after the SA.

Methods
An observational (cross-sectional) study was conducted among 166 sentinel GPs within France (a non-gatekeeping country) between 2013 and 2017 for all GP’s patients who attempted suicide. Measurements: frequency of patients 1) managed by the GP at the time of the SA, 2) addressed to an emergency department (ED), 3) without care at the time of the SA, and 4) managed by the GP after the SA and factors associated with GP management at the time of and after the SA.

Results
Three hundred twenty-one SAs were reported, of which N = 95 (29.6%) were managed by the GP at the time of the SA, N = (70.5%) were referred to an ED, and N = (27.4%) remained at home. Forty-eight (14.9%) patients did not receive any care at the time of the SA and 178 (55.4%) were managed directly by an ED. GPs were more likely to be involved in management of the patient at the time of the SA if they were younger (39.2% for patients < 34 years old; 22.9% for those 35 to 54 years old, and 30.3% for those more than 55 years old p = 0.02) or the SA involved a firearm or self-cutting (51.9%) versus those involving drugs (23.7%); p = 0.006). After the SA, GPs managed 174 patients (54.2%), more often (60%) when they provided care at home at the time of the SA, p = 0.04; 1.87 [1.07; 3.35]. No other factor was associated with management by GPs after the SA.

Conclusions
The study faced limitations: data were not available for patients managed solely by specialists during their SA and results may not be generalisable to countries with a stronger gatekeeping system. We concluded that GPs are involved in the management of patients at the time of a SA for a third of patients. EDs are the major provider of care at that time. Half patients consulted GPs after the SA and connections between GPs and ED upon discharge should be improved.
Gingival phenotypes and their relation to age, gender and other risk factors
Authors: Alhajj Wadhah Abdulnasser 
Published: March 2020

AbstractBackgroundCareful consideration and assessment of the type of phenotype has gained a fundamental importance in the treatment planning for any patient. We evaluated the prevalence of gingival phenotypes in a sample of Yemeni population and to explore its relationships to gender, age and other risk factors.MethodsThis cross-sectional study was performed among 456 patients. All maxillary anterior teeth were included for all parameters and 1st molars were included for gingival thickness measurements. All patients included in this study were systemically healthy and presented no dental crowding. Four clinical parameters were systematically recorded: Gingival thickness (GT), Width of keratinized gingiva (WKG), Crown width/ crown length (CW/CL) ratio and Papilla height (PH). Scores obtained from different parameters measurements were recorded and analyzed using non-parametric tests whereP-value < 0.05 was considered significant. One examiner performed all measurements.ResultsThe mean age was 29.9 ± 8.26 years. Of 456 recruited subjects, 83 (18.2%) subjects had thin, 69 (15.1%) had thick GT and 304 (66.7%) were placed in non-categorized (1.5–2 mm) GT. Square crown shape was found in 210 (44.1%) patients and 245 patients (55.9%) showed rectangular shape. Regarding WKG, 114 (25%) patients had width < 4 mm, 319 (70%) had width 4.1–8 mm and 23 (5%) patients had width >  8 mm. There was no significant difference between males and females for GT measurements. Regarding WKG, results showed that the prevalence of WKG 4.1–8 mm was more among females while males had more prevalence of ≤4 mm with significance difference. PH showed no significant differences between males and females. Regarding age, there was no significant differences between patients ≤25 years and >  25 years for all gingival parameters measurements. The relationship of smoking with different gingival parameters also showed no significant differences between smokers and non-smokers. Similarly, relationship of khat chewing with different gingival parameters showed no significant difference. Regarding inter-relationship between parameters, thin GT was associated with rectangular tooth form while square and quadrate forms are more associated with “1.5–2 mm” GT. WKG of ≤4 mm was associated with rectangular tooth form while WKG >  8 was more associated with square and quadrate forms with no significant difference. Results showed significant association between thin GT with 4.1–8 mm WKG.ConclusionYemeni population had more prevalence of “1.5–2 mm” GT, rectangular crown shape and WKG from 4.1–8 mm. Regarding interrelationship between gingival parameters, GT showed obvious relationship with WKG, CW/CL ratio and PH. WKG with CW/CL also showed significant relationship while no relationship was shown between other gingival phenotype parameters.