bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sustainability of Palliative Care in a Rural Hospital in Tanzania: A Longitudinal and Prospective 4-Year Study
Authors: Pöyhiä Reino Torsti Ilmari , Mwalumuli Emmanuel Owden , Mtega Aida Charles , Vegula Jackson John 
Published: January 2020

Background: Palliative care has been developed in recent years in many sub-Saharan countries in Africa due to activities of African Association for Palliative Care. Palliative care units have been established also in most hospitals in Tanzania. Yet very little is known about their functions. Long-term studies about the sustainability of palliative care have not been carried out. Methods: The attitudes of 101 members of hospital staff and persons in charge of palliative care services of Ilembula District Designated Hospital (IDDH), Tanzania, were assessed using a modified and prevalidated questionnaire annually in 2014 to 2017. The inquiries were executed on randomly allocated days. Also, the patient and economy registries were analyzed. Additional qualitative data were obtained in personal interviews and during observational visits twice a year at the IDDH. Results: Ilembula District Designated Hospital has a true multiprofessional palliative care team, which provides services in the hospital, in the villages, and at homes. The activities are based on careful 5-year planning and budgeting. Up to 17 villages have been included in the services. Ninety-five percent of the patients were HIV infected. Short-acting morphine oral solution was the only available strong opioid. The hospital staff evaluated palliative care as good or excellent; 50% of the staff would need more support in the end-of-life care. Conclusions: A sustainable palliative care service can be built in a Tanzanian rural hospital if an advanced planning and budgeting are made. In Tanzania, the biggest group of palliative care patients are still HIV-infected individuals. There is a lack of opioids in the country.
Contribution of the Mesencephalon Indices to Differential Diagnosis of Parkinsonian Disorders
Authors: Oktay Cemil , Özkaynak S. Sibel , Eseroğlu Esma , Karaali Kamil 
Published: January 2020

Background and Purpose: This study aimed to assess the sensitivity and specificity of brain stem morphologic changes to differentiate the progressive supranuclear palsy (PSP) from Parkinson disease (PD) and multiple system atrophy (MSA), by single and combined magnetic resonance imaging (MRI) measurements. Materials and Methods: Peduncle angle (PA), pons area (P), mesencephalon area (M), middle cerebellar peduncles (MCPs), and superior cerebellar peduncles (SCPs) were measured in 14 PSP, 43 PD, 8 MSA patients, and 45 age-matched control participants on T1-weighted MRI. Neurologists clinically diagnosed all patients. Additionally, P/M ratio, MCPs/SCPs ratio, the previously defined Magnetic Resonance Parkinsonism Index, MRPI: (P/M) · (MCP/SCP), and also the Akdeniz Index (AKI) that we termed were calculated, AKI: (P/M) · (PA/180). Two blinded radiologists evaluated all MR images and inter-/intraobserver variations were measured. Results: Both M and SCPs were significantly lower and P/M, MCPs/SCPs, and PA were significantly higher in PSP patients than the other groups ( P < .001). This significance was related to patients with PSP and PD. But all single measurements showed some overlapping values. Therefore, previously defined MRPI was calculated and shown to distinguish patients (negative predictive values: 92%, sensitivity: 78%, specificity: 82%). In this study, interobserver correlation (0.68) was found low for MRPI. Therefore, we identified a more practical index: the Akdeniz Index, which has same diagnostic power with MRPI and higher interobserver correlation (0.91). Conclusion: The Akdeniz Index identified in our study is a practical index with high diagnostic power and can reinforce radiological distinguishing of PSP and PD, which are clinically difficult to distinguish.
Proenkephalin A Adds No Incremental Prognostic Value After Acute Ischemic Stroke
Authors: Gruber Philipp , Fluri Felix , Schweizer Juliane , Luft Andreas , Müller Beat , Christ-Crain Mirjam , Katan Mira 
Published: January 2020

Objective: The aim of this study was to confirm previous observations that proenkephalin A (PENK-A) may serve as prognostic marker in the setting of acute ischemic stroke in a large stroke cohort. Methods: The plasma concentration of PENK-A was measured within 72 hours of symptom onset in 320 consecutively enrolled patients with stroke. The primary outcome measures were unfavorable functional outcome (modified Rankin Scale score 0-2 vs 3-6) and mortality within 90 days. Logistic and cox proportional regression analyses were fitted to estimate odds ratios (ORs), hazard ratios (HRs) and 95% confidence intervals (CIs), respectively, for the association between PENK-A and the primary outcome measures. Results: After adjusting for demographic and vascular risk factors, PENK-A was neither independently associated with functional outcome (OR: 1.29, 95% CI: 0.16-10.35) nor mortality (HR: 1.02, 95% CI: 0.14-7.33). Conclusion: Among patients with acute stroke, PENK-A does not serve as an independent prognostic marker in this external validation cohort.
Considering the practices of the classification of societies – A step towards indigenization
Authors: Gamsakhurdia Vladimer Lado 
Published: January 2020

The reasonability of the construction of classificatory rankings of societies and related theoretical implications are considered in this paper. I argue that existing classificatory rankings are based on the essentialist views and represent societies as homogenous entities whereas they ignore intra-societal variety. Moreover, the quantitative methodology and methods which underlie those rankings are based on the etic approach and use concepts and indicators which are constructed in the west and don’t reflect indigenous socio-cultural dynamics. Besides, existing rankings simply equalize particular aspects to the whole societal development. For example, gross domestic product is equalized to the level of societal development; however, it actually can’t fully reflect even the situation in the economic field. Though it can be still reasonable to use such impersonal indicators as gross domestic product or longevity which are based entirely on impersonal data and are free from subjective interpretations, for the exploration of general tendencies in particular fields, however, we should restrain ourselves from invalid generalizations. Krys et al. proposed to elaborate culturally sensitive approach, however, still remained in frame of the etic approach, whereas I argue that the only way for the comprehensive and deeper assessment of the level of societal development is to construct a fully emic and indigenous approach that implies the usage of only locally constructed concepts during the definition of indicators. Those indigenous concepts most probably won’t be translatable to other languages that make the aim of the creation of a unified scale theoretically impossible; however, this is the only way for getting valid results at least concerning particular societies with current methodological apparatus. The solution to this issue requires further theoretical development and methodological innovations.
Update on the Surgical Treatment of Pancreatic Neuroendocrine Tumors
Authors: Jeune F. , Taibi A. , Gaujoux S. 
Published: January 2020

Background and Aims: Pancreatic neuroendocrine tumors (PNET) arise from uncontrolled proliferation of neuroendocrine cell and further genetic alterations that may induce hormone secretion such as glucagon/insulin/gastrin/VIP. Their incidence is rapidelly growing, especially because of the frequent incidental diagnosis of small asymptomatic non-functionnal neuroendocrine tumors with the widespread use of cross-sectional imaging. The vast majority of pancreatic neuroendocrine tumors are sporadic but up to 5%–10% of them arise from genetic syndromes, the main one being Multiple Endocrine Neopalsm type 1 (MEN1). Appropriate management of patients with PNET is a complex challenge for surgeons, and require extensive medical collaboration. This review aims to summarize major and recent updates regarding the medico-surgical management of PNETs. Material and Methods: Review of pertinent English language literature. Results: This article provides a concise summary of the clinical presentation, diagnosis, surgical management, alternative treatments and follow up of PNETs. Conclusion: PNET are a rare, heterogeneous group of neoplasms with a generally favorable prognosis at least compared to pancreatic adenocarcinoma. Surgical resection is the cornerstone of their management, particularly for localized disease, and should always be discussed in multidisciplinary tumor board.
Quantification of pleural effusions on thoracic ultrasound in acute heart failure
Authors: Lindner Moritz , Thomas Richard , Claggett Brian , Lewis Eldrin F , Groarke John , Merz Allison A , Silverman Montane B , Swamy Varsha , Rivero Jose , Hohenstein Christian , Solomon Scott D , McMurray John JV , Steigner Michael L , Platz Elke 
Published: January 2020

Background:
Although pleural effusions are common among patients with acute heart failure, the relevance of pleural effusion size assessed on thoracic ultrasound has not been investigated systematically.

Methods:
In this prospective observational study, we included patients hospitalised for acute heart failure and performed a thoracic ultrasound early after admission (thoracic ultrasound 1) and at discharge (thoracic ultrasound 2) independently of routine clinical management. A semiquantitative score was applied offline blinded to clinical findings to categorise and monitor pleural effusion size.

Results:
Among 188 patients (median age 72 years, 62% men, 78% white, median left ventricular ejection fraction 38%), pleural effusions on thoracic ultrasound 1 were present in 66% of patients and decreased in size during the hospitalisation in 75% based on the pleural effusion score (P&lt;0.0001). Higher values of the pleural effusion score were associated with higher pleural effusion volumes on computed tomography (P&lt;0.001), higher NT-pro brain natriuretic peptide values (P=0.001) and a greater number of B-lines on lung ultrasound (P=0.004). Nevertheless, 47% of patients were discharged with persistent pleural effusions, 19% with large effusions. However, higher values of the pleural effusion score on thoracic ultrasound 2 did not identify patients at increased risk of 90-day heart failure rehospitalisations or death (adjusted hazard ratio (HR) 1.05, 95% confidence interval (CI) 0.92–1.19; P=0.46) whereas seven or more B-lines on lung ultrasound at discharge were independently associated with adverse events (adjusted HR 2.43, 95% CI 1.11–5.37; P=0.027).

Conclusion:
Among patients with acute heart failure, pleural effusions are associated with other clinical, imaging and laboratory markers of congestion and improve with heart failure therapy. The prognostic relevance of persistent pleural effusions at discharge should be investigated in larger studies.
Guideline adherence and long-term clinical outcomes in patients with acute myocardial infarction: a Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) substudy
Authors: Wada Hideki , Ogita Manabu , Suwa Satoru , Nakao Koichi , Ozaki Yukio , Kimura Kazuo , Ako Junya , Noguchi Teruo , Yasuda Satoshi , Fujimoto Kazuteru , Nakama Yasuharu , Morita Takashi , Shimizu Wataru , Saito Yoshihiko , Hirohata Atsushi , Morita Yasuhiro , Inoue Teruo , Okamura Atsunori , Mano Toshiaki , Hirata Kazuhito , Tanabe Kengo , Shibata Yoshisato , Owa Mafumi , Tsujita Kenichi , Funayama Hiroshi , Kokubu Nobuaki , Kozuma Ken , Uemura Shiro , Toubaru Tetsuya , Saku Keijiro , Oshima Shigeru , Nishimura Kunihiro , Miyamoto Yoshihiro , Ogawa Hisao , Ishihara Masaharu , Sato Tadaya , Kyono Hiroyuki , Tobaru Tetsuya , Sone Takahito , Sone Yasuhiro , Fujino Masashi , Nishimura Kunihiko , Kotani Junichi , Okura Hiroyuki , Uematsu Masaaki , Uemura Shirou , Hokimoto Seiji 
Published: January 2020

Background:
The association between guideline adherence and long-term outcomes in patients with acute myocardial infarction in real-world clinical practice remains unclear.

Methods:
We investigated 3283 consecutive patients with acute myocardial infarction who were selected from a prospective, nation-wide, multicentre registry (J-MINUET) database covering 28 institutions in Japan between July 2012 and March 2014. Among the 2757 eligible patients, we evaluated the use of seven guideline-recommended therapies, including urgent revascularisation, door-to-balloon time of 90 minutes or less, and five discharge medications (P2Y12 inhibitors on aspirin, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, lipid-lowering drugs). The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, cardiac failure and urgent revascularisation for unstable angina up to 3 years.

Results:
The overall median composite guideline adherence was 85.7%. Patients were divided into the following three groups: complete (100%) adherence group (n=862); moderate adherence (75% to &lt;100%) group (n=911); and low adherence (0–75%) group (n=984). The rate of adverse cardiovascular events was significantly lower in the complete adherence group than in the low and moderate adherence groups (log rank P&lt;0.0001). Multivariate Cox regression analysis showed complete guideline adherence was also significantly associated with lower adverse cardiovascular events compared with low guideline adherence (hazard ratio 0.66; 95% confidence interval 0.52–0.85; P=0.001).

Conclusion:
The use of guideline-based therapies for patients with acute myocardial infarction in contemporary clinical practice was associated with significant decreases in adverse long-term clinical outcomes.

Trial registration:
UMIN Unique trial Number: UMIN000010037
Correlation between fat signal ratio on T1-weighted MRI in the lower vertebral bodies and age, comparing 1.5-T and 3-T scanners
Authors: Sieron Dominik , Drakopoulos Dionysios , Loebelenz Laura I , Schroeder Christophe , Ebner Lukas , Obmann Verena C , Huber Adrian T , Christe Andreas 
Published: January 2020

Background The hypothesis was that the fat-dependent T1 signal intensity in vertebral bodies increases with age due to red-yellow marrow conversion. Purpose To analyze the increasing fatty conversion of red bone marrow with age. Material and Methods A continuous sample of 524 patients (age range 2–96 years) with normal lumbar spine MRIs (T11–L5) was retrospectively selected in order to get a representative sample from our 1.5-T and 3-T MRI units (Siemens, Erlangen, Germany). Four radiologists read the images independently. Absolute T1 signal intensities were measured in the lower vertebral bodies and standardized by dividing their value by the signal of the subcutaneous fat on lumbar and sacral level. Results The standardized T1 signal correlated significantly with patients’ age at the 1.5-T unit, with the best correlation demonstrated by thoracic vertebra T11, followed by lumbar vertebra L1, with correlation coefficients (R) of 0.64 (95% CI 0.53–0.72, P < 0.0001) and 0.49 (95% CI 0.38–0.59, P < 0.0001), respectively. For women and men, the R values were similar in thoracic vertebra T11 at 0.62 (95% CI 0.49–0.72) and 0.64 (95% CI 0.44–0.77), respectively. The vertebral signal correlated significantly better with age in the 1.5-T compared to the 3-T unit on all vertebral levels: the best R value of the 3-T unit was only 0.20 (95% CI 0.09–0.30, P < 0.0001). Our study showed an average increase of the relative T1 signal in T11 of 10% per decade. Conclusion T1 fat signal ratio increases with age in the vertebral bodies, which could help estimating the age of a person. Best age correlation was found when measuring T1 signal in T11, standardized by the sacral subcutaneous fat signal and using a 1.5-T MRI.
Radiofrequency Microdebridement as an Adjunct to Arthroscopic Surgical Treatment for Recalcitrant Gluteal Tendinopathy: A Double-Blind, Randomized Controlled Trial
Authors: Blakey Caroline M. , O’Donnell John , Klaber Ianiv , Singh Parminder , Arora Manit , Takla Amir , Fitzpatrick Jane 
Published: January 2020

Background: Recalcitrant greater trochanteric pain is increasingly recognized as an indication for surgical intervention. The arthroscopic approach has become rapidly more common than the open alternative. Hypothesis: Patients undergoing radiofrequency microdebridement (RFMD) as an adjunct to arthroscopic gluteal bursectomy (AGB) and iliotibial band release (ITBR) will experience better functional improvement than AGB and ITBR alone at 1 year. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 33 patients with failed nonoperative treatment of gluteal tendinopathy were randomly allocated to undergo AGB/ITBR or AGB/ITBR + RFMD. Full-thickness tears were excluded. The primary outcome measure was the modified Harris Hip Score (mHHS) at 52 weeks. Secondary outcome measures included the mHHS, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and 12-item Short Form Health Survey (SF-12), which were evaluated at 0, 6, 12, 24, and 52 weeks. Statistical significance was defined as P < .05. Results: A total of 33 participants (33 hips; 30 female and 3 male; mean age, 58 years) were randomized; 16 patients underwent AGB/ITBR + RFMD, and 17 underwent AGB/ITBR. Participants’ functionality improved in both groups at all time intervals. The mean mHHS score improved from 57.49 ± 10.61 to 77.76 ± 18.40 ( P = .004) and from 58.98 ± 12.33 to 79.96 ± 18.86 ( P = .001) at 52 weeks in the AGB/ITBR and AGB/ITBR + RFMD groups, respectively, although there was no statistically significant difference between groups. There were no device-related adverse events. Conclusion: AGB/ITBR led to significant improvements in patients with recalcitrant gluteal tendinopathy. In this small RCT, the addition of RFMD showed no additional benefit to AGB/ITBR but provided a safe adjunct for the surgical management of recalcitrant gluteal tendinopathy. Registration: NCT01562366 ( ClinicalTrials.gov identifier).
Glenoid Cartilage Lesions Compromise Outcomes of Surgical Treatment for Posterior Shoulder Instability
Authors: Nourissat Geoffroy , Hardy Marie Beatrice , Garret Jerome , Mansat Pierre , Godenèche Arnaud ,   Société Francophone d’Arthroscopie
Published: January 2020

Background: Posterior shoulder instability is associated with nonspecific symptoms, including pain, subluxation, and functional impairment, which complicate its diagnosis and management. Owing to the rarity of the condition, there are no present decision tools for its diagnosis and treatment. Purpose: To investigate demographic, lesional, and surgical factors that influence functional outcomes in patients treated for posterior shoulder instability. Study Design: Case-control study; Level of evidence, 3. Methods: We analyzed the clinical and radiographic records of 150 patients treated surgically for isolated posterior shoulder instability at 10 centers between 2000 and 2015, of which 144 were eligible for inclusion: 114 men (79%) and 30 women (21%) (mean ± SD age, 28.7 ± 9.6 years). The mean time between onset of symptoms and surgery was 66 ± 75 months. Shoulder instability was of traumatic origin in 115 patients (80%). The primary treatment was bone-block procedures for 65 patients (45%), posterior Bankart repair for 67 (47%), and capsular plication for 12 (8%). Patients were assessed with the Constant and Walch-Duplay scores at a mean follow-up of 51 ± 32 months (range, 12-159 months). Uni- and multivariable regression analyses were performed to determine associations between clinical scores and sex, age, traumatic origin, type of lesion, type of procedure, and follow-up. Results: At final follow-up, subluxations or dislocations recurred in 24 patients (17%). The overall Constant score was 86.2 ± 14.5, with a pain component of 12.6 ± 3.5. The Walch-Duplay score was 79.8 ± 24.2. Multivariable regressions revealed that the presence of a glenoid cartilage lesion was the only factor associated with worse Constant score (beta = –10; P = .013) and Walch-Duplay score (beta = –16.7; P = .024) across all subcomponents. Conclusion: The only factor that jeopardized functional outcomes of posterior instability surgery was the presence of glenoid cartilage lesions. Knowing that shoulders with glenoid cartilage lesions are at greater risk of residual pain or instability could help manage patient expectation and justify faster intervention before lesions deteriorate.
Treatment with isoniazid or rifampin for latent tuberculosis infection: population-based study of hepatotoxicity, completion and costs
Authors: Ronald Lisa A. , FitzGerald J. Mark , Bartlett-Esquilant Gillian , Schwartzman Kevin , Benedetti Andrea , Boivin Jean-François , Menzies Dick 
Published: January 2020

Clinical trials suggest less hepatotoxicity and better adherence with 4 months rifampin (4R)versus9 months isoniazid (9H) for treating latent tuberculosis infection (LTBI). Our objectives were to compare frequencies of severe hepatic adverse events and treatment completion, and direct health system costs of LTBI regimens 4R and 9H, in the general population of the province of Quebec, Canada, using provincial health administrative data.Our retrospective cohort included all patients starting rifampin or isoniazid regimens between 2003 and 2007. We estimated hepatotoxicity from hospitalisation records, treatment completion from community pharmacy records and direct costs from billing records and fee schedules. We compared rifampin to isoniazid using logistic (hepatotoxicity), log-binomial (completion), and gamma (costs) regression, with adjustment for age, co-morbidities and other confounders.10 559 individuals started LTBI treatment (9684 isoniazid; 875 rifampin). Rifampin patients were older with more baseline co-morbidities. Severe hepatotoxicity risk was higher with isoniazid (n=15) than rifampin (n=1), adjusted OR=2.3 (95% CI: 0.3–16.1); there were two liver transplants and one death with isoniazid and none with rifampin. Overall, patients without co-morbidities had lower hepatotoxicity risk (0.1%versus1.0%). 4R completion (53.5%) was higher than 9H (36.9%), adjusted RR=1.5 (95% CI: 1.3–1.7). Mean costs per patient were lower for rifampin than isoniazid: adjusted cost ratio=0.7 (95% CI: 0.5–0.9).Risk of severe hepatotoxicity and direct costs were lower, and completion was higher, for 4R than 9H, after adjustment for age and co-morbidities. Severe hepatotoxicity resulted in death or liver transplant in three patients receiving 9H, compared with no patients receiving 4R.