bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethical and Welfare Implications of Genetically Altered Non-Human Primates for Biomedical Research
Authors: Prescott Mark J. 
Published: May 2020

Abstract
Breakthroughs in gene editing technologies have made it feasible to create genetically altered (GA) non-human primate (NHP) models of disease. This area of research is accelerating, particularly in China, Japan and the USA, and could lead to an increase in NHP use globally. The hope is that genetic models in animal species closely related to humans will significantly improve understanding of neurological diseases and validation of potential therapeutic interventions, for which there is a dire need. However, the creation and use of GA NHPs raises serious animal welfare and ethical issues, which are highlighted here. It represents a step change in how these highly sentient animals are used in biomedical research, because of the large numbers required, inherent wastage and the sum of the harms caused to the animals involved. There is little evidence of these important issues being addressed alongside the rapidly advancing science. We are still learning about how gene editing tools work in NHPs, and significant added scientific and medical benefit from GA NHP models has yet to be demonstrated. Together, this suggests that current regulatory and review frameworks, in some jurisdictions at least, are not adequately equipped to deal with this emerging, complex area of NHP use.
Clinical evaluation of a new dispersive aortic cannula
Authors: Goto Takeshi , Fukuda Ikuo , Konno Yukiya , Tabata Ai , Ohira Tomoyuki , Kato Ryutaro , Yamamoto Keigo , Ogasawara Junko , Daitoku Kazuyuki , Minakawa Masahito 
Published: May 2020

Introduction: Cerebral injury is a serious complication in open-heart surgery. Once it occurs, it causes significant disability and death. We developed a novel dispersive aortic cannula named the Stealth Flow cannula and used it as a standard aortic cannula in cardiopulmonary bypass. The aim of this study was to evaluate the efficiency of this aortic cannula. Methods: A total of 182 consecutive patients undergoing cardiac surgery using cardiopulmonary bypass were studied. The patients were divided into two groups: the Soft-Flow cannula group (n = 89) and the Stealth Flow cannula group (n = 93). Patients with a shaggy aortic arch were excluded from this study because the cannulae were inserted at the ascending aorta with a cannula tip directed toward the aortic root in these cases. Patients with multiple arterial perfusion sites were also excluded. Complications including early mortality, perioperative stroke, and intraoperative aortic injury were compared between the two groups. Results: Age, operative procedure, cardiopulmonary bypass time, and the Japan SCORE were not significantly different between the groups. In comparisons between the Stealth Flow and Soft-Flow groups, the incidences of early mortality, perioperative stroke, intraoperative aortic dissection, and all complications were 1.08% versus 1.12% (p = 0.98), 1.1% versus 2.2% (p = 0.53), 0% versus 1.1% (p = 0.33), and 1.1% versus 3.4% (p = 0.29), respectively. The incidence of major cardiovascular events, including early death, perioperative stroke, and aortic dissection, was not different. Conclusions: The Stealth Flow cannula, which was designed based on our previous experimental study, contributed to reducing cerebral and aortic events as much as the Soft-Flow cannula in the present clinical study.
The depiction of migraine visual aura on the internet
Authors: Viana Michele , Hougaard Anders , Do Thien Phu 
Published: May 2020

Introduction The most common and multifaceted migraine aura symptoms are visual disturbances. Health information is one of the most popular topics on the internet but the quality and reliability of publicized information is unknown. The aim of this study was to analyze images of migraine aura on Google to determine the frequency of correct presentations of visual aura and distribution of visual aura phenotypes. Methods Two authors screened the 100 highest indexed migraine aura related images on Google. The content of the images was categorized into elementary visual symptoms. Results Forty out of 100 images were accurate representations of visual migraine aura. Such images included 31 different visual aura phenotypes. The majority had more than one elementary visual symptom (median 2, IQR 1–3), most commonly “bean-like” forms (45%), zigzag lines (40%), and foggy/blurred vision (33%). Discussion Forty percent of images were accurate portrayals of visual migraine aura symptoms, but these presented limited phenotypes. The information derived from the internet photos may hinder the effective recognition of aura symptoms. Thus, there is a need to provide a more comprehensive representation of visual migraine aura symptoms on the internet.
Prevalence and Inpatient Hospital Outcomes of Malignancy-Related Ascites in the United States
Authors: Ramamoorthy Venkataraghavan , Rubens Muni , Saxena Anshul , Bhatt Chintan , Das Sankalp , Appunni Sandeep , Veledar Emir , McGranaghan Peter , Shehadeh Nancy , Viamonte-Ros Ana , Linhares Yuliya , Odia Yazmin , Kotecha Rupesh , Mehta Minesh P. 
Published: May 2020

Objective: Malignancy-related ascites (MRA) is the terminal stage of many advanced cancers, and the treatment is mainly palliative. This study looked for epidemiology and inpatient hospital outcomes of patients with MRA in the United States using a national database. Methods: The current study was a cross-sectional analysis of 2015 National Inpatient Sample data and consisted of patients ≥18 years with MRA. Descriptive statistics were used for understanding demographics, clinical characteristics, and MRA hospitalization costs. Multivariate regression models were used to identify predictors of length of hospital stay and in-hospital mortality. Results: There were 123 410 MRA hospitalizations in 2015. The median length of stay was 4.7 days (interquartile range [IQR]: 2.5-8.6 days), median cost of hospitalization was US$43 543 (IQR: US$23 485-US$82 248), and in-hospital mortality rate was 8.8% (n = 10 855). Multivariate analyses showed that male sex, black race, and admission to medium and large hospitals were associated with increased hospital length of stay. Factors associated with higher in-hospital mortality rates included male sex; Asian or Pacific Islander race; beneficiaries of private insurance, Medicaid, and self-pay; patients residing in large central and small metro counties; nonelective admission type; and rural and urban nonteaching hospitals. Conclusions: Our study showed that many demographic, socioeconomic, health care, and geographic factors were associated with hospital length of stay and in-hospital mortality and may suggest disparities in quality of care. These factors could be targeted for preventing unplanned hospitalization, decreasing hospital length of stay, and lowering in-hospital mortality for this population.
Do trabecular metal and cancellous titanium implants reduce the risk of late haematogenous infection? An experimental study in rabbits
Authors: Komnos George , Banios Konstantinos , Kolonia Konstantina , Poultsides Lazaros A , Petinaki Efthimia , Sarrou Styliani , Zintzaras Elias , Karachalios Theofilos 
Published: May 2020

Aim: This study evaluated the late resistance to haematogenous contamination by microbial pathogens of implants and bone-implant interface and the development of late clinical infection when cementless components with different surface or structural properties are implanted. Material and methods: 50 adult male New Zealand white rabbits were divided into 5 groups of 10 animals each. In Group A smooth titanium, in Group B grit blasted titanium, in Group C HA-coated titanium, in Group D trabecular metal and in group E cancellous titanium rods were implanted in the right proximal tibia. Four weeks later, 1 ml of inoculum of a standardised CA-MRSA strain (3 × 108 cfu/ml) was injected through a femoral artery catheter (groups B, C, D, E) while in group A, 1 ml of sterile saline was injected in a similar way (control group). Subjects were killed 8 weeks after the initial procedure and 3 samples of each tibial specimen were subjected to conventional cultures and PCR studies. Results: The number of the specimens (conventional cultures and PCR studies) contaminated by the standardized pathogen was as follows: Group A: 0/10, Group B: 7/10, Group C: 6/10, Group D; 5/10 and Group E: 5/10. Comparing the number of colony form units isolated from the implant samples, Group B (GB titanium) showed statistically significantly higher values (Mann-Whitney test) compared to Group C ( p = 0.044), Group D ( p = 0.040) and Group E ( p = 0.038). Local active infection was observed in 6 animals: 3 in Group B; 1 in Group C, 1 in Group D, and 1 in Group E. Conclusions: Modern cementless implants (trabecular metal and cancellous titanium) showed a lower risk of implant contamination and late clinical haematogenous infection.
Resting-state functional connectivity of anterior and posterior cerebellar lobes is altered in multiple sclerosis
Authors: Pasqua Gabriele , Tommasin Silvia , Bharti Komal , Ruggieri Serena , Petsas Nikolaos , Piervincenzi Claudia , Pozzilli Carlo , Pantano Patrizia 
Published: May 2020

Background: Damage to the cerebellar sensorimotor and cognitive domains may underlie physical and cognitive disability. Objective: To investigate resting-state functional connectivity (FC) of sensorimotor and cognitive cerebellum, and clinical correlates in multiple sclerosis (MS). Methods: A total of 119 patients with MS and 42 healthy subjects underwent multimodal 3T-magnetic resonance imaging (MRI). Patients were evaluated using the Expanded Disability Status Scale and Multiple Sclerosis Functional Composite Scale. After parcellation of sensorimotor (lobules I–V + VIII) and cognitive cerebellum (lobules VI, VII, IX, X), we calculated cerebellar resting-state FC using a seed-based approach. Results: In patients with MS, the sensorimotor cerebellum showed increased FC mainly with cerebellar, thalamic, and cortical (frontal, parietal, temporal) areas and decreased FC with insular areas; the cognitive cerebellum showed increased FC mainly with thalamic and cortical (temporal-occipital) areas, and decreased FC with frontal-insular areas. Both sensorimotor and cognitive cerebellar FC negatively correlated with disability, and positively with cognitive scores. Cerebellar structural damage only partially influenced results. Conclusion: The two neocerebellar circuits showed altered FC with subcortical and cortical areas. The association between increased sensorimotor and cognitive cerebellar FC and low levels of physical and cognitive disability suggests that altered FC might modulate the effects of cerebellar structural damage on clinical condition.
The educational impact of childhood-onset multiple sclerosis: Why assessing academic achievement is imperative
Authors: Vargas WS , Noble KG , Banwell B , De Jager P 
Published: May 2020

Background: Limited data suggest that adolescents with multiple sclerosis (MS) frequently discontinue school. While it is known that cognitive impairment occurs in 30% to 50% of children with MS, the functional impact of childhood MS on academic achievement is virtually unknown. Objective: To that end, this paper builds an evidence-based argument for evaluating educational outcomes in children with MS. Methods: This will be accomplished through (a) a review of pediatric MS and its cognitive consequences; (b) a selective review of the utility of neuropsychological batteries in assessing academic outcomes in pediatric populations in general; and (c) a brief overview of modifiable factors that have a potential benefit on school outcomes in children with MS. Conclusion: Scholastic achievement should be assessed as part of the routine cognitive screening of children and adolescents with MS.
Early and sustained symptom improvement with umeclidinium/vilanterol versus monotherapy in COPD: a post hoc analysis of the EMAX randomised controlled trial
Authors: Kerwin Edward M , Boucot Isabelle H , Vogelmeier Claus F , Maltais Francois , Naya Ian P , Tombs Lee , Jones Paul W , Lipson David A , Keeley Tom , Bjermer Leif 
Published: May 2020

Background: In chronic obstructive pulmonary disease (COPD), both the time needed for patients to gain symptom improvement with long-acting bronchodilator therapy and whether an early response is predictive of a sustained response is unknown. This study aimed to investigate how quickly meaningful symptom responses are seen in patients with COPD with bronchodilator therapy and whether these responses are sustained. Methods: Early MAXimisation of bronchodilation for improving COPD stability (EMAX) was a 24-week, double-blind, double-dummy, parallel-group trial that randomised patients to umeclidinium/vilanterol (UMEC/VI), umeclidinium or salmeterol. Daily Evaluating Respiratory Symptoms in COPD (E-RS:COPD) score and rescue salbutamol use were captured via an electronic diary and analysed initially in 4-weekly periods. Post hoc analyses assessed change from baseline in daily E-RS:COPD score and rescue medication use weekly (Weeks 1–8), and association between E-RS:COPD responder status at Weeks 1–4 and later time points. Results: In the intent-to-treat population ( n = 2425), reductions from baseline in E-RS:COPD scores and rescue medication use were apparent from Day 2 with all treatments. Treatment differences for UMEC/VI versus either monotherapy plateaued by Week 4–8 and were sustained at Weeks 21–24; improvements were consistently greater with UMEC/VI. For all treatments, most patients (60–85%) retained their Weeks 1–4 E-RS:COPD responder/non-responder status at Weeks 21−24. Among patients receiving UMEC/VI who were E-RS:COPD responders at Weeks 1–4, 70% were responders at Weeks 21–24. Conclusion: Patients with symptomatic COPD had greater potential for early symptom improvements with UMEC/VI versus either monotherapy. This benefit was generally maintained for 24 weeks. Early monitoring of treatment response can provide clinicians with an early indication of a patient’s likely longer-term response to prescribed bronchodilator treatment and will facilitate appropriate early adjustments in care. Clinical Trial Registration: NCT03034915, 2016-002513-22 (EudraCT Number). The reviews of this paper are available via the supplemental material section.
To What Extent Does Illicit Drug Use Predispose to Facial Injury? An Institutional Investigation for an Emergent Problem
Authors: Febbo Anthony , Hoffman Gary R. 
Published: May 2020

Study Design: There are potential substantive linkages between illicit drug use and the occurrence of injury. Objective: The purpose of our study was to determine the prevalence, class of illicit drugs abused, and demographics in relation to a cohort of patients who sustained facial injury. Methods: The authors undertook a retrospective observational study of a prospectively accessioned cohort of patients who had sustained a facial injury and presented to the John Hunter Hospital (Newcastle, NSW, Australia). The primary predictor variable was the presentation of a facial injury and the secondary outcome variables included illicit drug use, alcohol use, and socioeconomic factors. The study was carried out over a 12-month period. A descriptive analysis was undertaken on the assembled data. Results: Of the 465 patient medical records that were accessed for the study, 348 were male and 117 were female. Their average age was 42.6 years: 5.8% ( n = 27) were under the influence of illicit drugs at the time of their presentation and 13.1% ( n = 61) admitted to an intercurrent illicit drug habit. Those who were under the combined influence of alcohol and drugs comprised of 2.8% ( n = 13). Conclusions: Our study found that illicit drug use plays a small, but nonetheless, demonstrable role in the presentation of maxillofacial trauma patients to an urban level I trauma center. Illicit drug users are an emergent sociodemographic group of patients who can sustain facial trauma and their presentation needs to be appropriately considered, assessed, and managed collectively.
Obesity, cardiovascular risk and healthcare resource utilization in the UK
Authors: le Roux Carel W , Hartvig Niels V , Haase Christiane Lundegaard , Nordsborg Rikke Baastrup , Olsen Anne Helene , Satylganova Altynai 
Published: May 2020

Abstract

Aims
Obesity and cardiovascular diseases (CVDs) often co-occur, likely increasing the intensity of healthcare resource utilization (HCRU). This retrospective, observational database study examined the joint effect of obesity and cardiovascular risk status on HCRU and compared HCRU between body mass index (BMI) categories and CVD-risk categories in the UK.

Methods
Patient demographics and data on CVD and BMI were obtained from the UK Clinical Practice Research Datalink. Cardiovascular risk status, calculated using the Framingham Risk Equation, was used to categorize people into high-risk and low-risk groups, while a CVD diagnosis was used to define the established CVD group. Patients were split into BMI categories using the standard World Health Organization classifications. For each CVD and BMI category, mean number and costs of general practitioner contacts, hospital admissions and prescriptions were estimated.

Results
The final study population included 1,600,709 patients. Data on CVD status were available on just over one-quarter of the sample (28.6%) and BMI data for just less than half (43.2%). The number of general practitioner contacts and prescriptions increased with increasing BMI category for each of the three CVD-risk groups. The group with established CVD had the greatest utilization of all components of healthcare resource, followed by high CVD risk then low CVD-risk groups.

Conclusion
Increasing BMI category and CVD-risk status both affected several HCRU components. These findings highlight the importance of timely obesity management and treatment of CVD-risk factors as a means of preventing increasing HCRU.
Indirect Decompression Failure After Lateral Lumbar Interbody Fusion—Reported Failures and Predictive Factors: Systematic Review
Authors: Kirnaz Sertac , Navarro-Ramirez Rodrigo , Gu Jiaao , Wipplinger Christoph , Hussain Ibrahim , Adjei Joshua , Kim Eliana , Schmidt Franziska Anna , Wong Taylor , Hernandez Robert Nick , Härtl Roger 
Published: May 2020

Background: In patients with symptomatic lumbar stenosis undergoing lateral transpsoas approach for lumbar interbody fusion (LLIF) surgery, it is not always clear when indirect decompression is sufficient in order to achieve symptom resolution. Indirect decompression failure (IDF), defined as “postoperative persistent symptoms of nerve compression with or without a second direct decompression surgery to reach adequate symptom resolution,” is not widely reported. This information, however, is critical to better understand the indications, the potential, and the limitations of indirect decompression. Objective: The purpose of this study was to systematically review the current literature on IDF after LLIF. Methods: A literature search was performed on PubMed. We included randomized controlled trials and prospective, retrospective, case-control studies, and case reports. Information on sample size, demographics, procedure, number and location of involved levels, follow-up time, and complications were extracted. Results: After applying the exclusion criteria, we included 9 of the 268 screened articles that reported failure. A total of 632 patients were screened in these articles and detailed information was provided. Average follow-up time was 21 months. Overall reported incidence of IDF was 9%. Conclusion: Failures of decompression via LLIF are inconsistently reported and the incidence is approximately 9%. IDF failure in LLIF may be underreported or misinterpreted as a complication. We propose to include the term “IDF” as described in this article to differentiate them from complications for future studies. A better understanding of why IDF occurs will allow surgeons to better plan surgical intervention and will avoid revision surgery.
Architectural Models and Their Contexts in China’s 20th-Century Architectural Heritage: An Overview
Authors: Chang Qing 
Published: May 2020

AbstractThe article explores the morphological evolution of China’s 20th-century architecture chronologically. Chinese Neoclassicism has played a major role in forming the 20th-century heritage buildings surviving today. The phenomenon of Neoclassicism emerged because of the late arrival of China’s modernisation and industrialisation process compared with the West. In turn, in accepting and contesting Western culture, the Chinese elite have consciously relied upon architecture as a vehicle to uphold visible symbols of national Chinese identity and traditional Chinese culture. Meanwhile, in the foreign settlements of the treaty ports such as Shanghai, the Western Neoclassical style, along with other imported construction trends, also forms part of China’s 20th-century architectural heritage. Western Neoclassicism’s influence on China’s new architecture became even more evident in the mid-20th century, with the modern architectural heritage in Tiananmen Square as its exemplar. Nevertheless, the impact of Western modernist architecture on China’s architecture was minimal. It was not until the 1980s, as China reopened to the world, that various schools of thought from the post-industrial West flowed into China, which significantly enriched the types and sources of China’s 20th-century architectural heritage. Modern Classicism, late Modernism and Postmodernism all found their way into China’s contemporary architecture.
Vernacular Architecture: A Term Denoting and Transporting Diverse Content
Authors: Zwerger Klaus 
Published: May 2020

AbstractA selective review of the literature demonstrates the difficulty in defining ‘vernacular architecture’. Recent studies have presented an overly narrow, single-sided, or even unacceptable image of the topic in comparison with many earlier definitions and discussions. However, those earlier analyses also had various shortfalls. The interdependence of vernacular architecture, economic interests, and emerging awareness of buildings’ interaction with the environment demand a rethinking of vernacular architecture, which the present study understands as signifying housing offered for most of the world’s population.
Defining Local Heritages in Preserving Modern Shanghai Architecture
Authors: Lu Yongyi , Li Yanning 
Published: May 2020

AbstractThe notion that local heritage can be defined by the ‘collective memory’ of a city may be considered as being simplistic nowadays. Heritage is increasingly recognised as knowledge, a cultural product or even a political resource set within specific social circumstances. The local heritage underpins various ways of relating our past with our present and future, which are often much more complicated than we can imagine. The evolution of the conservation of Shanghai’s modern heritage architecture shows this complexity. By tracing more than 50 years’ progress in historic preservation, this paper shows how historical buildings from Shanghai’s early modern period were selected as urban heritage in the changing socio-political contexts of different time periods. Starting with how the first modern buildings were listed in a new Chinese narrative in the 1950s, this paper focuses on the great ideological changes and progress Shanghai achieved after China’s reform and opening policy since the 1980s. Emphasising the great significance of the establishment of local legislation for historic preservation as an extension of the national system, examples of the great enrichment of Shanghai’s local heritage are presented through multiple narratives and interpretations of Shanghai’s modern history. In a deeper observation of various practices and complicated contradictions, the historic preservation of Shanghai’s modern heritage architecture is shown to be a process of continuing to reconstruct the relationships between city and the State, the city and the world, as well as the city’s past, present and future in a pluralist society.