bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bupropion With Clozapine: Case Reports of Seizure After Coadministration
Authors: Schmitz Allison , Botner Brandon , Hund Morris 
Published: February 2020

Background: Clozapine is more effective than other atypical antipsychotics for treatment resistant schizophrenia, but has serious side effects. Clozapine has an estimated cumulative seizure risk of 10% in patients treated for 3.8 years. Bupropion can also induce seizures and its estimated risk is 0.4% at recommended doses. While some risk factors for seizures are known, much remains unknown about predicting seizure risk. Cases: We present 2 cases of seizures in patients treated with clozapine and bupropion without a seizure history. In the first case, a patient with schizoaffective disorder treated with dual antipsychotic therapy had a witnessed generalized tonic–clonic seizure. With the exception of bupropion/naltrexone which was started 2.5 months prior for weight loss, she had not had any recent medication changes. In the second case, a patient with schizoaffective disorder was treated with clozapine and was prescribed bupropion SR for smoking cessation for an extended duration. He had cut back on cigarette use in the 2 months prior to reporting “spells.” The neurologist’s assessment was probable epileptic seizures which resolved after the bupropion was stopped and divalproex was started for seizure prophylaxis. Conclusion: Clozapine and bupropion are known to lower the seizure threshold, but little information is available regarding the risk when used in combination. It is unclear whether these agents, when used in combination, have additive seizure risk or possible synergistic effects. Bupropion should be used cautiously in patients treated with clozapine. Safer agents that do not lower the seizure threshold should be utilized whenever possible.
Concurrent thoracic pathology identified with radiology in hyperthyroid cats referred for radioiodine therapy
Authors: Kormpou Foteini , Gil-Morales Claudia , Warren-Smith Chris , Hibbert Angie 
Published: February 2020

Objectives Radioiodine (RAI) treatment for hyperthyroidism is becoming increasingly available in the UK. Pretreatment assessment is commonly performed, as patient handling is limited once RAI has been administered. The aims of this study were to determine the prevalence of thoracic pathology using thoracic radiography in hyperthyroid cats referred for RAI treatment and to determine the value of this technique pretreatment. Methods The hospital databases were searched for hyperthyroid cats referred for RAI treatment at the Feline Centre, Langford Vets, between January 2012 and July 2016. Radiographs were reviewed by Diplomates of the European College of Veterinary Diagnostic Imaging at the time of treatment and each set of radiographs was subsequently reviewed by one radiologist for the study. Cardiorespiratory signs were recorded, if present, and any change in treatment plan or suitability for RAI treatment was documented. Results Two hundred and fifty-two cats were included in the study. Thoracic pathology was identified in 77% (n = 194/252) of the cats, of which 59% (n = 115/194) had pulmonary abnormalities with bronchial and bronchointerstitial patterns most frequently; 57% (n = 111/194) had skeletal abnormalities and 43% (n = 84/194) had cardiac abnormalities, with mild-to-moderate cardiomegaly most prevalent. Other abnormalities included sternal lymphadenomegaly (7%; n = 13/194), mediastinal pathology (3%; n = 5/194), oesophageal pathology (2%; n = 4/194) and pleural space disease (0.5%; n = 1/194).Twelve cases (6%) had a change in their treatment plan as a result of thoracic radiographic abnormalities, of which five subsequently underwent RAI treatment. Conclusions and relevance A low prevalence of significant thoracic pathology was identified on radiographs in hyperthyroid cats referred for RAI treatment. Incidental thoracic abnormalities were found much more commonly; hence, results of thoracic radiology need to be combined with the clinical picture, to decide whether further investigations or alterations to the treatment plan are required pre-RAI.
Contraceptive implants used by cat breeders in France: a study of 140 purebred cats
Authors: Furthner Etienne , Roos Juliette , Niewiadomska Zuzanna , Maenhoudt Cindy , Fontbonne Alain 
Published: February 2020

Objectives Deslorelin 4.7 mg and melatonin 18 mg subcutaneous implants were studied in purebred male and female cats, via questionnaires sent to French cat breeders, to assess breed, age, duration of the contraceptive effect, fertility after use, changes in behaviour and side effects. Methods Reproductive data were collected in 57 tom cats and 41 queens implanted with deslorelin 4.7 mg, and 42 queens implanted with melatonin 18 mg, for a total of 140 purebred cats, from 38 different catteries, representing 18 breeds. Results Using deslorelin (Suprelorin 4.7 mg; Virbac), sexual behaviour in males was inhibited for a mean ± SD of 13.4 ± 3.2 (range 8–21) months in 37/57 cats. Of these, 24/37 mated successfully and produced litters at a mean of 15.5 ± 3.6 (range 9–20) months. Inhibition lasted 11 ± 1.1 (range 9–12; n = 6), 13.2 ± 2.4 (range 12–18; n = 6) and 15 ± 3.5 (range 9–18; n = 6) months in Norwegian Forest Cat, Singapura and Ragdoll males, respectively. In 26/41 females implanted with deslorelin 4.7 mg, oestrus was inhibited for a mean of 16.0 ± 5.7 (8–38) months; 12/26 went on to produce a litter. Of the side effects specific to females: two presented persistent oestrus, leading to the removal of the implant; two developed lactation; one had fibroadenomatosis; and one was sterilised owing to cystic endometrial hyperplasia. Using melatonin (Melovine 18 mg; Ceva), 33/42 females had oestrus inhibited for a mean of 86 ± 50 (range 21–277) days after implantation with a peak return to oestrus in March, and 12/33 had a subsequent litter. No side effects were reported. Conclusions and relevance This study is the first to collect a large amount of field data, in 140 purebred male and female cats where a deslorelin 4.7 mg or a melatonin 18 mg implant was used. These field results may allow for more accurate clinical advice and open up new avenues of research.
Second-Generation Women Entrepreneurs in Chinese Family-Owned Businesses: Motivations, Challenges, and Opportunities
Authors: Li Jessica , Sun Judy Yi , Wang Lianjuan , Ke Jie 
Published: February 2020

The ProblemFamily-owned businesses provide a large portion of the job opportunities in the Chinese economy. Many successful family-owned businesses in China were established during the initial years of economic reform in the late 1970s and 1980s. Today, as the founders of these companies approach retirement, leadership transition is becoming a pressing issue. Among the various factors involved in family business succession are gender-specific obstacles faced by women who seek to achieve leadership positions. Women entrepreneurs in China are gradually increasing in number, but those who desire to take the helm of family-owned companies face important social and structural challenges in China’s male-dominated business culture.The SolutionIn this study, we used a qualitative interview approach to learn about the experiences of second-generation women entrepreneurs in Chinese family-owned businesses and to better understand their motivations along with the challenges and opportunities that they face. The findings revealed that the motivations of these women entrepreneurs were centered more on internal “pull” factors (e.g., self-actualization) rather than external “push” factors (e.g., economic pressures). The major challenges that were reported included tense relationships with parents, gender-role conflicts, and alignment issues in relation to their family businesses’ established culture. Understanding these factors can help in identifying opportunities for effective human resource development and promoting women’s entrepreneurship in the Chinese context.The StakeholdersSecond-generation women entrepreneurs, family businesses in China, women leaders, and human resource development professionals.
Exploring the Risky Terrain of Entrepreneurship With Support From Developmental Relationships: Narratives From Indian Women Entrepreneurs
Authors: Chaudhuri Sanghamitra , Ghosh Rajashi , Abichandani Yogita 
Published: February 2020

The Problem There has been a burgeoning interest in studies on women entrepreneurs in the past decade, but in most studies conducted thus far, the scope has remained narrow with the focus mostly on strategic perspective and not so much on the individual-level understanding of the entrepreneurs. Furthermore, the limited number of studies that have looked into novice women entrepreneurs are restricted to western hemisphere, and to our knowledge, no study has looked into narratives on how women entrepreneurs in India benefit from various developmental relationships over the course of their entrepreneurial journey. The Solution Using narrative inquiry, we explore the stories of six urban women entrepreneurs in India illustrating how and why they started their careers in entrepreneurship, the challenges they experienced along the way, and how the varied developmental relationships they nurtured over time supported them to cope with those challenges. The Stakeholders The article aimed at venture capitalists that extend support to women entrepreneurs and to women who are considering to pursue entrepreneurship. The findings can guide them to anticipate the challenges and opportunities commonly experienced by women entrepreneurs and appreciate the value of developmental relationships that help to sustain motivation to be entrepreneurs.
Acute kidney injury is associated with increased healthcare utilization, complications, and mortality after primary total knee arthroplasty
Authors: Singh Jasvinder A. , Cleveland John D. 
Published: February 2020

Background: The objective of this study was to assess healthcare utilization and complications associated with acute kidney injury (AKI) in patients undergoing primary total knee arthroplasty (TKA). Methods: We used the 1998–2014 US National Inpatient Sample to assess whether AKI is associated with healthcare utilization or in-hospital postoperative complications post-TKA using multivariable-adjusted logistic regression analyses. We calculated odds ratios (ORs) and a 95% confidence intervals (CIs). Sensitivity analyses additionally adjusted for hospital characteristics (location/teaching status, bed size, and region). Results: Of the 8,127,282 people who underwent primary TKA from 1998 to 2014, 104,366 (1.3%) had a diagnosis of AKI. People with AKI had longer unadjusted mean hospital stay, 6.1 versus 3.5 days, higher mean hospital charges, US$71,385 versus US$42,067, and higher rates of all in-hospital postoperative complications, including mortality. Adjusted for age, sex, race, underlying diagnosis, medical comorbidity, income, and insurance payer, AKI was associated with a significantly higher OR (95% CI) of total hospital charges above the median, 2.76 (2.68, 2.85); length of hospital stay > 3 days, 2.21 (2.14, 2.28); and discharge to a rehabilitation facility, 4.68 (4.54, 4.83). AKI was associated with significantly higher OR (95% CI) of in-hospital complications, including infection, 2.60 (1.97, 3.43); transfusion, 2.94 (2.85, 3.03); revision, 2.13 (1.72, 2.64); and mortality, 19.75 (17.39, 22.42). Sensitivity analyses replicated the main study findings, without any attenuation of ORs. Conclusions: AKI is associated with a significantly higher risk of increased healthcare utilization, complications, and mortality after primary TKA. Future studies should assess significant factors associated and interventions that can prevent AKI.
A Pilot Study of Flat and Circadian Insulin Infusion Rates in Continuous Subcutaneous Insulin Infusion (CSII) in Adults with Type 1 Diabetes (FIRST1D)
Authors: Rilstone Siân , Reddy Monika , Oliver Nick 
Published: February 2020

Background: Initiation of continuous subcutaneous insulin therapy (CSII) in type 1 diabetes requires conversion of a basal insulin dose into a continuous infusion regimen. There are limited data to guide the optimal insulin profile to rapidly achieve target glucose and minimize healthcare professional input. The aim of this pilot study was to compare circadian and flat insulin infusion rates in CSII naïve adults with type 1 diabetes. Methods: Adults with type 1 diabetes commencing CSII were recruited. Participants were randomized to circadian or flat basal profile calculated from the total daily dose. Basal rate testing was undertaken on days 7, 14 and 28 and basal rates were adjusted. The primary outcome was the between-group difference in absolute change in insulin basal rate over 24 hours following three rounds of basal testing. Secondary outcomes included the number of basal rate changes and the time blocks. Results: Seventeen participants (mean age 33.3 (SD 8.6) years) were recruited. There was no significant difference in absolute change in insulin basal rates between groups ( P = .85). The circadian group experienced significant variation in the number of changes made with the most changes in the morning and evening ( P = .005). The circadian group received a greater reduction in total insulin (−14.1 (interquartile range (IQR) −22.5-12.95) units) than the flat group (−7.48 (IQR −11.90-1.23) units) ( P = .021). Conclusion: The initial insulin profile does not impact on the magnitude of basal rate changes during optimization. The circadian profile requires changes at specific time points. Further development of the circadian profile may be the optimal strategy.
The relationship between obstructive sleep apnoea and quality of life in women with polycystic ovary syndrome: a cross-sectional study
Authors: Kahal Hassan , Tahrani Abd A. , Kyrou Ioannis , Dimitriadis Georgios K. , Kimani Peter K. , Barber Thomas M. , Nicholls Matthew , Ali Asad , Weickert Martin O. , Randeva Harpal S. 
Published: February 2020

Background: Obstructive sleep apnoea (OSA) and polycystic ovary syndrome (PCOS) are associated with significant comorbidities and commonly coexist. The primary aim of this study was to examine the relationship between OSA and quality of life (QoL) in women with PCOS. Methods: We conducted an observational cross-sectional study. PCOS was diagnosed according to the Rotterdam criteria. Women with increased risk of OSA, based on the Berlin questionnaire or the Epworth Sleepiness Scale (ESS), had home-based polysomnography performed (ALICE PDx). Participants were divided into two groups: (a) PCOS only: women with normal ESS and low-risk Berlin questionnaire (no sleep studies performed), or women with normal sleep studies [oxygen desaturation index (ODI) < 5 events/hour]; and (b) PCOS+OSA: women with PCOS and OSA ODI ⩾ 5. QoL was assessed using the World Health Organization QoL questionnaire (WHOQOL-BREF) and the PCOS health-related quality of life questionnaire (PCOSQ). Results: A total of 39 women were included; age (mean ± SD) was 32.2 ± 8.9 years, weight 92.5 ± 23.7 kg and body mass index (BMI) 34.1 ± 7.9 kg/m2; 38.5% ( n = 15) had OSA. Compared with women with PCOS only, women with PCOS+OSA had higher BMI, HbA1c, C-reactive protein and low-density lipoprotein. ODI was independently associated with impaired QoL. Excessive daytime sleepiness (EDS) was independently associated with anxiety, depression and impaired QoL. Conclusions: OSA is highly prevalent and is associated with impaired QoL and worse metabolic profile in women with PCOS. Interventional studies are needed to examine the impact of OSA in women with PCOS. ClinicalTrials.gov Identifier: NCT03065322
Use of the Living Kidney Donor Profile Index in the Canadian Kidney Transplant Recipient Population: A Validation Study
Authors: Shantier Mohamed , Li Yanhong , Ashwin Monika , Famure Olsegun , Singh Sunita K. 
Published: February 2020

Background: The Living Kidney Donor Profile Index (LKDPI) was derived in a cohort of kidney transplant recipients (KTR) from the United States to predict the risk of total graft failure. There are important differences in patient demographics, listing practices, access to transplantation, delivery of care, and posttransplant mortality in Canada as compared with the United States, and the generalizability of the LKDPI in the Canadian context is unknown. Objective: The purpose of this study was to externally validate the LKDPI in a large contemporary cohort of Canadian KTR. Design: Retrospective cohort validation study. Setting: Toronto General Hospital, University Health Network, Toronto, Ontario, Canada Patients: A total of 645 adult (≥18 years old) living donor KTR between January 1, 2006 and December 31, 2016 with follow-up until December 31, 2017 were included in the study. Measurements: The predictive performance of the LKDPI was evaluated. The outcome of interest was total graft failure, defined as the need for chronic dialysis, retransplantation, or death with graft function. Methods: The Cox proportional hazards model was used to examine the relation between the LKDPI and total graft failure. The Cox proportional hazards model was also used for external validation and performance assessment of the model. Discrimination and calibration were used to assess model performance. Discrimination was assessed using Harrell’s C statistic and calibration was assessed graphically, comparing observed versus predicted probabilities of total graft failure. Results: A total of 645 living donor KTR were included in the study. The median LKDPI score was 13 (interquartile range [IQR] = 1.1, 29.9). Higher LKDPI scores were associated with an increased risk of total graft failure (hazard ratio = 1.01; 95% confidence interval [CI] = 1.0-1.02; P = .02). Discrimination was poor (C statistic = 0.55; 95% CI = 0.48-0.61). Calibration was as good at 1-year posttransplant but suboptimal at 3- and 5-years posttransplant. Limitations: Limitations include a relatively small sample size, predicted probabilities for assessment of calibration only available for scores of 0 to 100, and some missing data handled by imputation. Conclusions: In this external validation study, the predictive ability of the LKDPI was modest in a cohort of Canadian KTR. Validation of prediction models is an important step to assess performance in external populations. Potential recalibration of the LKDPI may be useful prior to clinical use in external cohorts.
A molecular survey, whole genome sequencing and phylogenetic analysis of astroviruses from roe deer
Authors: Jamnikar-Ciglenecki Urska , Civnik Vita , Kirbis Andrej , Kuhar Urska 
Published: February 2020

Abstract
Background
Although astroviruses (AstV) have been detected in a variety of host species, there are only limited records of their occurrence in deer. One of the most important game species in Europe, due to its meat and antlers, is roe deer. Infected game animals can pose a threat to the health of other animals and of humans, so more attention needs to be focused on understanding the diversity of viruses in wildlife. The complete genome and organization of the roe deer AstV genome have not so far been described.

Results
In our study, 111 game animals were screened for the presence of AstV. While no AstVs were detected in red deer, wild boar, chamois and mouflon, AstV RNA was present in three samples of roe deer. They were further subjected to whole genome sequencing with next generation sequencing. In this study, two AstV genomes were assembled; one in sample D5–14 and one in sample D12–14, while, in sample D45–14, no AstV sequences were identified. The complete coding sequences of the AstV SLO/D5–14 strain genome and of the almost complete genome of the AstV SLO/D12–14 strain were determined. They showed a typical Mamastrovirus organization. Phylogenetic analyses and amino acid pairwise distance analysis revealed that Slovenian roe deer AstV strains are closely related to each other and, also, related to other deer, bovine, water buffalo, yak, Sichuan takin, dromedary, porcine and porcupine AstV strains - thus forming a highly supported group of currently unassigned sequences.

Conclusions
Our findings suggest the existence of a new Mamastrovirus genogroup might be constituted while this aforementioned group is distantly related to Mamastrovirus genogroups I and II. In this study, additional data supporting a novel taxonomic classification are presented.
Syndesmotic malreduction may decrease fixation stability: a biomechanical study
Authors: Bai Lu , Zhang Wentao , Guan Siyao , Liu Jianxin , Chen Peng 
Published: February 2020

Abstract
Background
This study aims to investigate the malreduction of syndesmosis and its effects on stability.

Methods
The biomechanical tests, including the three-dimensional (3D) displacement of the syndesmotic incisura, fibular rotation angle, and torque resistance, were performed on six cadaver legs. These specimens were first tested intact (intact group), then cut all the syndesmotic ligaments and fixed in anatomical position (anatomical model group) and test again. After that, syndesmosis was fixed in 1 cm malreduction (anterior and posterior displacement group) to do the same test.

Results
In internal or external load, there were significant differences in torque resistance and fibular rotation angle (internal t = 2.412, P = 0.036; external t = 2.412, P = 0.039) between the intact and post-malreduction groups. In internal rotation load, there were significant differences in sagittal displacement between the intact and post-malreduction groups (P = 0.011), and between the anatomical and post-malreduction groups (P = 0.020). In external rotation load, significant differences existed between the intact and ant-malreduction group (P = 0.034) in sagittal (anterior-posterior) displacement. Significant differences also existed between the intact and post-malreduction groups (P = 0.013), and between the anatomical and post-malreduction groups (P = 0.038) in coronal (medial-lateral) displacement.

Conclusions
Malreduction in different conditions does affect the stability of the syndesmotic fixation. The result of the study may reveal the biomechanical mechanism of poor clinical outcome in syndesmosis malreduction patients and pathological displacement patterns of the ankle under syndesmotic malreduction conditions.

Level of evidence
III
Sick leave, disability, and mortality in acute hepatic porphyria: a nationwide cohort study
Authors: Baravelli Carl Michael , Aarsand Aasne Karine , Sandberg Sverre , Tollånes Mette Christophersen 
Published: February 2020

Abstract
Background
Acute hepatic porphyria (AHP) consists of three rare metabolic disorders. We investigated the risk of long-term sick leave, disability pension, and premature death in individuals with AHP compared to the general population.

Methods
In a nationwide cohort study from 1992 to 2017, records of 333 persons (total person-years = 6728) with a confirmed AHP diagnosis were linked to several national compulsory registries (reference population = 5,819,937). We conducted survival analyses to assess additional risk.

Results
Persons with AHP had higher risks of accessing long-term sick leave (adjusted hazard ratio (aHR): 1.5, 95% confidence interval (CI): 1.3, 1.7) and disability pension (aHR: 1.9, CI: 1.5, 2.4). The risk was highest in persons who had been hospitalised for acute attacks, while no additional risk was observed in asymptomatic AHP gene mutation carriers. The median age when accessing disability pension was 45 years, 21 years younger than the general population. AHP was associated with increased risk of mortality due to hepatocellular carcinoma (adjusted mortality rate ratio (aMRR): 84.4, CI: 37.8, 188.2), but no overall increased risk of premature death was observed.

Conclusions
Persons with symptomatic AHP were at increased risk of accessing long-term sick leave and disability pension but not of premature death.