bluuebunny/crossref_metadata_2025_split huggingface dataset:
A copula-based consistency analysis of education indicators
Authors: Cunha César , Fernández Mariela , García Jesús E. , González-López Verónica Andrea , Romano Nícolas 
Published: June 2019

In this paper we investigate the consistency of quality indicators of the Brazilian public educational system. According to the newspaper Estado de São Paulo – Brazil, of January 18, 2017, only 7.3% of students in the third year of high school have an adequate level of mathematics, this shows the relevance of the evaluation and assessment of the Brazilian educational system. In this paper we explore the dependence between two indicators: (i) mean value between the proportions (in two subjects: Portuguese and Mathematics) of students under the basic level (SARESP classification) and (ii) rate of fails, during the years 2013, 2014 and 2015. (i) and (ii) are bases to define the educational quality of public schools for the population of young people, between 14 and 17 years old. This inspection is carried out through the Bayesian estimation of the parameters of the Asymmetric Cubic Sections (ACS) copula. We show that the dependence profile, year after year, behaves in a very unstable way, although during those years there were no substantial changes which justify such instability. Through the copula we compute conditional probabilities of tail events. We verify that an inversion occurred in the concordance/discordance between (i) and (ii). We compute the probability of (i) assuming high values, conditioned to a threshold in (ii). In 2013, as the threshold in (ii) increases the probability increases (concordance), in 2014 the threshold in (ii) is almost irrelevant to the probability and in 2015, as the threshold in (ii) increases the probability decreases (discordance). The inspection of the tail dependence allows to expose some kind of manipulation, in view of for instance, the maintenance of a global index índice de desenvolvimento da educação de São Paulo (IDESP) used to classify the educational institutions.
Endoscopy-related musculoskeletal injuries in gastroenterology fellows
Authors: Villa Edward , Attar Bashar , Trick William , Kotwal Vikram 
Published: June 2019

Abstract
Background and study aims Gastroenterologists are at high risk for work-related musculoskeletal injuries. Studies have shown that 37 % to 89 % of endoscopists have work-related musculoskeletal injuries. While all surveys until now have focused on practicing endoscopists, there have been no publications assessing the prevalence of musculoskeletal injuries among gastrointerology fellows, which we sought to investigate.
Methods A 22-question survey about ergonomics and work-related musculoskeletal injuries was sent to 114 gastroenterology fellows in different programs across the United States in June 2016, and an additional 103 surveys were distributed at Digestive Disease Week in May 2017. Responses were collected, and data were analyzed.
Results A total of 156 surveys were collected. Of these, 74 fellows (47 %) reported a new musculoskeletal injury related to endoscopy. Injuries occurred mostly in the first year of fellowship (85 %, P < 0.001). The most common sites of injury were the right wrist (53 %), left thumb (42 %), back (27 %), and neck (22 %). Only 26 % those who had endoscopy-related musculoskeletal injuries had received training in ergonomics compared to 45 % of those who did not have injury (P = 0.012), and ergonomics training was highly desirable among respondents, particularly among those with previous injuries (P = 0.0030)
Conclusion Musculoskeletal injuries related to endoscopy are very common among gastroenterology fellows, particularly during the first year of fellowship. While the overall percentage of fellows who received training in ergonomics was low, those who did receive training were less like to report a musculoskeletal injury. There is an urgent need for ergonomics training among Gastroenterology fellows.
Inverted “upside-down” esophageal fully-covered self-expanding metal stent is effective for temporary treatment of colorectal strictures: a pilot case series
Authors: Testoni Pier Alberto , Fanti Lorella , Antonucci Enrico , Dabizzi Emanuele 
Published: June 2019

Abstract
Background and study aims Placement of a fully-covered self-expanding metal stent (FC-SEMS) is a valid alternative for benign and malignant colorectal strictures treatment. Despite the reportedly high technical success rate, stenting is still challenging, due to high rates of adverse events. Migration still represents the main issue, although several anti-migration systems have been proposed.
Patients and methods Before insertion, esophageal Beta Niti-S FC-SEMSs were inverted and reloaded on the deployment device to invert the proximal and distal parts of the stent, with the largest end placed above the stricture to contrast peristaltic activity. The inverted “upside-down” Beta Niti-S FC-SEMS was placed in five consecutive patients: four pts with benign anastomotic stricture unresponsive to repeated balloon dilation and persisting for at least 10 weeks, and one with malignant rectal neoplasia. In five patients, six inverted FC-SEMSs were placed.
Results The modified FC-SEMS did not migrate in 5/6 cases (83 %). Stent migration occurred in the neoplastic case, induced by neoadjuvant chemotherapy. The “upside-down” esophageal Beta Niti-S FC-SEMS stayed in place for an average of 6 weeks, achieving resolution of stricture in all patients but one, who required an additional stent placement, due to incomplete stricture resolution after 6 weeks.
Conclusion The inverted esophageal Beta Niti-S FC-SEMSs proved to be effective in treating colorectal stricture in all cases, with no spontaneous migration or significant side effects, and achieved resolution of strictures where a traditional approach, recommended by guidelines, failed.
Validation of a Photoplethysmographic Heart Rate Monitor: Polar OH1
Authors: Hermand Eric , Cassirame Johan , Ennequin Gaël , Hue Olivier 
Published: June 2019

AbstractThis study assessed the validity of a photoplethysmographic heart rate (HR) monitor, the Polar OH1 in various sports performed in ecological conditions: running, cycling, soccer, kayaking, walking, tennis and fitness. Seventy trained athletes (56 males, 14 females) wore the Polar OH1 armband and the H7 chest belt during training. A total of 390 h and 38 min of recording were compared using a 20-bpm window to assess data quality, and Bland-Altman agreements and ICC analyses were used to test accuracy. Linear regression analyses evaluated the HR accuracy and correlation with skin tone. Training loads (TRIMPs) were compared for each session. Reliability was high for endurance sports (>99%) and lower for sports involving arm movements (92~95%). Biases were slightly negative for all sports, whereas widths of limits of agreement varied from 7–20bpm. Bland-Altman agreements were all under 5% except tennis, kayak and fitness. HR accuracy was positively correlated to skin tone (p<0.05). Finally, TRIMPs from the OH1 device were inferior to criterion’s (except walking and soccer), within a 3% range from reference. Hence, OH1 represents a valid tool to monitor instantaneous HR and training load, especially for endurance sports.
Aktuelles zur Charcot-Marie-Tooth-Erkrankung
Authors: Stassart Ruth M. , Fledrich Robert , Sereda Michael W. , Bartl Michael 
Published: June 2019

ZUSAMMENFASSUNGDie Charcot-Marie-Tooth-Erkrankung (CMT) ist die häufigste hereditäre Neuropathie (Prävalenz 1:2500) mit über 90 assoziierten Genen. Der häufigste Subtyp (CMT1A), assoziiert mit einer Duplikation des peripheren Myelinprotein-22-Gens (PMP22) ist Ursache für 40–50 % aller Fälle. Klinische Zeichen sind distal symmetrische Paresen, Atrophien, Sensibilitätsstörungen, Fußdeformitäten und Areflexie. Validierte Skalen zur Evaluation der Beeinträchtigung (CMTNS2, ONLS, 9-hole-pegtest, Gehtestungen) sind verfügbar und molekulare Biomarker aus Blut und Hautbiopsien wurden validiert. Therapieoptionen im Entwicklungsstadium sind das Gen-Silencing (Minderung der Überexpression von PMP22), Sekretasen zur Regulierung der Neuregulinaktivität mit Einfluss auf Meylindicke und Funktion sowie Inhibitoren des Kalziuminfluxes in Schwannzellen. PXT3003 (Sorbitol, Naltrexon, Baclofen) wurde im Tiermodell erfolgreich getestet. Ein möglicher Therapieansatz mittels Substitution des Fettmoleküls Lecithin konnte in CMT1A-Ratten die Muskelkraft und die Anzahl myelinisierter Axone erhöhen.
Relationship of Activity Patterns to Acute Mountain Sickness in South Pole Workers
Authors: Pathangey Girish , Wheatley-Guy Courtney M. , Stewart Glenn , Anderson Paul J. , Richert Maile L. Ceridon , Miller Andrew D. , Johnson Jacob B. , Johnson Bruce 
Published: June 2019

AbstractThis study aimed to evaluate the influence of physical activity on incidence of acute mountain sickness (AMS) by continuous activity monitoring in a free-living sample of South Pole workers over the initial 72 h at altitude exposure of 2,840 m (9,318 ft). Body Media activity monitors were worn by 47 healthy participants. AMS was defined by the Lake Louise symptom questionnaire. Venous blood samples were taken at sea level and approximately 48 h after high altitude exposure. AMS incidence was 34% (n=16/47) over the first 48 h and 40% (n=19/47) over 72 h. On day 2 at high altitude, individuals with AMS demonstrated a significantly greater increase in the percent change in physical activity metrics from baseline: total energy expenditure 19±13 vs. 5±7%, total steps 65±51 vs. 10±18%, metabolic equivalent of tasks 21±13 vs. 7±13%, and time spent performing moderate to vigorous physical activity 114±79 vs. 26±27% for individuals with AMS vs. no AMS, respectively, p<0.05. In addition, erythropoietin and vascular endothelial growth factor were 1.69 and 1.75 times higher, respectively, in those with AMS. In conclusion, workers who engaged in increased physical activity and activity intensity during initial exposure to the South Pole were more susceptible to developing AMS.
Aktuelle Aspekte bei mitochondrialen Erkrankungen
Authors: Klopstock Thomas , Freisinger Peter 
Published: June 2019

ZUSAMMENFASSUNGDie Fortschritte in der Molekularbiologie haben in den letzten Jahren zu großen Fortschritten im molekularen Verständnis, in der Diagnostik und in der Therapie mitochondrialer Erkrankungen geführt. Insbesondere durch die Methode des Next-Generation-Sequencing sind Defekte in mehr als 350 Genen identifiziert worden, die mitochondriale Erkrankungen verursachen können. Eine exakte molekulare Diagnostik ist dabei Voraussetzung für die individuelle genetische Beratung der betroffenen Familien, auch hinsichtlich neuer reproduktiver Optionen. Das verbesserte Verständnis der molekularen Pathogenese hat darüber hinaus zu pathophysiologisch begründeten Therapieansätzen geführt: Die therapeutische Ära der mitochondrialen Medizin hat begonnen.In diesem Übersichtsartikel werden ausgewählte aktuelle Aspekte der mitochondrialen Medizin aus dem Bereich der Grundlagenforschung, der Prävention, der Diagnostik und der Therapie vorgestellt.
Nusinersen bei spinaler Muskelatrophie
Authors: Abu-Fares Omar , Götz Friederich , Petri Susanne , Schreiber-Katz Olivia , Osmanovic Alma 
Published: June 2019

ZUSAMMENFASSUNGFür die 5q-assoziierte spinale Muskelatrophie (SMA) ist mit dem Antisense-Oligonukleotid Nusinersen seit Juni 2017 in Europa die erste kausale Therapie verfügbar. Die Zulassung beruht auf Phase-III-Studien bei Kindern und umfasst altersunabhängig alle genetisch gesicherten Subtypen der SMA. Erfahrungen in der Anwendung von Nusinersen bei Erwachsenen werden dringend benötigt. Erwachsene SMA-Typ-II-Patienten stellen durch die fortgeschrittene Erkrankung mit Kontrakturen, Skoliosen und Metallimplantaten eine besondere Herausforderung für die regelmäßigen intrathekalen Gaben dar. Ein Drittel der in unserem Zentrum mit Nusinersen behandelten erwachsenen Patienten leiden an einer SMA Typ II. Die Behandlung erfolgt ausschließlich stationär in Begleitung einer pflegenden Person. Die CT-gestützte Lumbalpunktion hat sich als geeignete Methode zur sicheren Applikation erwiesen. Punktionsassoziierte Nebenwirkungen wurden berichtet, schwere Nebenwirkungen traten nicht auf. Mögliche Therapieeffekte bei diesen schwer betroffenen Patienten sind über motorische Funktionen hinaus durch geeignete Parameter wie patient-reported outcomes (PRO) langfristig zu bewerten. Unsere Erfahrung mit SMA-Typ II-Patienten zeigt die Machbarkeit und gute Verträglichkeit der Nusinersen-Anwendung, jedoch den Bedarf eines erfahrenen, interdisziplinären Behandlungssettings.
Hautveränderungen bei Störungen im Funktionskreis Leber
Authors: Huemer Gabriela 
Published: June 2019

ZusammenfassungAuch wenn die Haut in der chinesischen Medizin dem Funktionskreis Lunge zugeordnet ist, entstehen weitaus mehr Hauterkrankungen aufgrund von Störungen anderer Funktionskreise. Eine individuelle Syndrom-Diagnostik ist erforderlich.Der Beitrag gibt einen Überblick zu den wichtigsten Störungsmustern, die sich auch auf der Haut manifestieren. Herzstück der Behandlung sind Diätetik, Akupunktur und die chinesische Arzneipflanzentherapie. Ein Fall aus der Praxis zeigt das Vorgehen und die möglichen Erfolge.
Evidenz der Wirksamkeit von Methylsulfonylmethan
Authors: Vlachojannis Julia , Chrubasik-Hausmann Sigrun 
Published: June 2019

ZusammenfassungDas in der Nahrung enthaltende Methylsulfonylmethan (MSM) ist ein Schwefelspender. In-vitro-Untersuchungen weisen auf eine antientzündliche, antioxidative, antikanzerogene sowie eine den Knochenstoffwechsel stimulierende Wirkung hin. Lokal aufgetragen, erhöhte MSM die Penetration von EDTA durch die Cornea.Tierversuche zeigen Besserung bei altersbedingter Arthrose, experimentell erzeugter Arthrose/Arthritis und Ohrentzündungen. Auch auf eine krebsprogressions- und metastasenhemmende sowie auf eine blutzucker- und blutfettsenkende Wirkung von MSM weisen Tiermodelle hin. Nicht alle human-pharmakologischen Untersuchungen zeigen, dass MSM eine positive Wirkung bei hoher sportlicher Belastung besitzt. MSM wurde bei muskuloskelettalen Beschwerden als Monotherapie oder in Kombination mit anderen Antiarthrose-Präparaten eingesetzt. Die Kombinationstherapien waren der MSM-Monotherapie überlegen. Der Beweis für die Wirksamkeit, insbesondere auch für andere Indikationen, steht allerdings noch aus.
Colorectal endoscopic submucosal dissection can be efficiently performed by a trainee with use of a simple traction device and expert supervision
Authors: Ide Daisuke , Saito Shoichi , Ohya Tomohiko Richard , Nishikawa Yuske , Horie Yoshimasa , Yasue Chihiro , Chino Akiko , Igarashi Masahiro , Saruta Masayuki , Fujisaki Junko 
Published: June 2019

Abstract
Background and study aims Colorectal endoscopic submucosal dissection (ESD) is technically challenging owing to submucosal fibrosis and difficult endoscope manipulation. Therefore, various traction methods have been reported. We often use a simple looped nylon thread attached to a clip to assist with dissection. We assessed the feasibility of mentor-guided colorectal ESD using this traction device (TD).
Patients and methods From December 2017 to March 2018, we retrospectively reviewed outcomes of 101 colorectal ESDs performed by two groups of endoscopists (A, 5 endoscopists with colorectal ESD experience of < 50 cases; B, 5 endoscopists with experience of > 300 cases). Group A was further divided into two subgroups that performed ESD with or without TD.
Results No significant difference was observed in ESD completion rates (86.1 % [62/72] vs. 96.6 % [28/29]; odds ratio [OR], 0.22; 95 % conﬁdence interval [CI], 0.005 – 1.71; P = 0.17) or procedure times (52.0 min vs. 40.0 min; P = 0.27) and adverse event rates between groups A and B. The rate of TD use was significantly higher in group A than in group B (44.4 % [32/72] vs. 20.7 % [6/29]; OR, 3.03; CI, 1.04 – 10.23; P = 0.03). The completion rate was not different between the two subgroups of group A (with vs. without TD) (81.2 % [26/32] vs. 90.0 % [36/40]; OR, 0.49; CI, 0.09 – 2.29; P = 0.32); however, the proportion of fibrosis cases was significantly higher in the TD-use group (46.8 % [15/32] vs. 22.5 % [9/40]; OR, 2.99; CI, 0.98 – 9.59; P = 0.03).
Conclusion Mentor-guided colorectal ESD using TD was performed efficiently, safely, and in a manner comparable to that of experts.
Lower endoscopic ultrasound in preoperative evaluation of rectosigmoid endometriosis
Authors: James Theodore W. , Fan Y. Claire , Schiff Lauren D. , Gangarosa Lisa M. 
Published: June 2019

Abstract
Background and study aims Endometriosis affects a significant proportion of reproductive-aged women and involves the bowel in up to one-third of patients with the condition. Lower endoscopic ultrasound (LEUS) in assessment of endometriosis of the rectosigmoid colon was first described 20 years ago in European populations. The current study aimed to describe the diagnostic characteristics of this imaging modality at a tertiary US referral center in a large cohort and its impact on surgical planning.
Patients and methods This was a retrospective cohort study of adult women evaluated for rectosigmoid endometriosis by LEUS at an American tertiary referral center between January 2003 through June 2017. The reference standard for rectosigmoid endometriosis was surgical evaluation regardless of whether tissue was obtained for histologic evaluation. Two separate analyses were run; one comparing EUS to laparoscopic findings and another comparing EUS to histologic findings.
Results LEUS demonstrated a positive predictive value (PPV) of 93.8 % (CI:68.1,99.1) and negative predictive value (NPV) of 96.4 % (CI:87.8,99.0) in the diagnosis of rectosigmoid endometriosis. Test sensitivity was 88.2 % (CI:63.6,98.5) and specificity was 98.2 % (CI:90.1,99.9). Overall diagnostic accuracy of the test was 95.8 % (CI:88.1,99.1).
Conclusions In this large cohort of women at an American tertiary referral center undergoing evaluation for rectosigmoid endometriosis, LEUS demonstrated high PPV and NPV as well as excellent diagnostic accuracy. In addition, the LEUS findings provided important information to the referring gynecologic surgeon. This minimally-invasive imaging modality should be utilized in preoperative evaluation of women undergoing surgery for suspected or known endometriosis.
Eigenblutbehandlung bei Urtikaria
Authors: Maurer Marcus , Buttgereit Thomas , Stange Rainer 
Published: June 2019

ZusammenfassungDie meisten Leitlinien zu chronischer Urtikaria empfehlen derzeit eine Prophylaxe bzw. Therapie mit nicht sedierenden Antihistaminika. Es spricht jedoch nur etwa die Hälfte der Patienten darauf an. Die Therapie der Urtikaria mit autologem Vollblut oder Serum wird in den Leitlinien als „alternative Behandlungsoption“ gelistet. Sie eignet sich in erster Linie zur Therapie der chronischen spontanen Urtikaria, Studien deuten darauf hin, dass Patienten mit autoimmuner Komponente am ehesten profitieren.Die aktuelle Datenlage zeigt, dass die Eigenbluttherapie bei Urtikaria nach wie vor ihren Stellenwert hat. Unklar ist aktuell aber, wie sich die verschiedenen angewendeten Protokolle bezüglich Wirksamkeit und der Wirkmechanismen unterscheiden.
Are We Clinicians Away from Ethics?
Authors: Choudhury Minati , Kapoor Poonam Malhotra 
Published: June 2019

AbstractMedicine has always stood at the intersection between science and society. From antiquity to the present, everyone has faced health challenges that prompted the formation of groups of healers and the development of codes of ethics to govern the treatments that they offered. Medical codes of ethics blend the moral precepts, normative behavior, and social duties of the population in which they are used, and they change as new medical therapies and social issues arise. The written codes of ethics are based on modern terms for many of the issues raised in Charak Samhita. They also represent an effort to codify the essence of “the clinical encounter between physician and patient” and the role of society while emphasizing the importance of compassion, beneficence, nonmaleficence, respect for persons, and accountability. Medical ethics have been an integral part of Charak Samhita and its complete incorporation in present-day medical teaching and clinical practice will yield great results to this noble profession. Is it true that we clinicians are away from practice of ethics in medicine? Are we not following a structural approach to identify, analyze, and resolve ethical issue in clinical practice? We as clinicians should have some working knowledge about informed consent, confidentiality, patient's rights, and end-of-life care. At times, clinicians and patients disagree about the choices that may challenge their lives. It is then that ethical problem rises. While dealing with a patient, ethical problem can be avoided when the case is analyzed in four important areas: medical/surgical indications, preference by patient, quality of life with or without treatment, and other circumstantial features, for example socioeconomic, legal, or administrative aspects of the case.
Fat Grafting for Facial Contouring
Authors: Lam Samuel M. 
Published: June 2019

AbstractFat grafting is a safe, effective method for facial rejuvenation if used to restore lost facial volume, but it is not as a method to correct cutaneous deformities and rhytids, or to counteract gravitational effects. The most significant postoperative complication is weight gain that can make a face look overinflated. Accordingly, it is important to select a safe and appropriate candidate. This article outlines who is a suitable prospect for fat grafting and juxtaposes the two methods of facial volume restoration: fat grafting versus injectable fillers. Then a detailed exposition of the operative technique is outlined, including anesthesia, harvesting, processing, and injection. Finally, this article concludes with a description of the postoperative course and the management of potential complications.
Nonsurgical Treatment of Keloids and Hypertrophic Scars
Authors: Saddawi-Konefka Robert , Watson Deborah 
Published: June 2019

AbstractDespite the ubiquitous nature of scar tissue, there is not a single, reliable strategy to prevent or treat excessive scarring. The difficulty in arriving at a universally accepted form of management is multifaceted: there is an incomplete understanding of the complex pathophysiology of scar formation; a lack of common metrics hampers the accurate description of scar quality and characteristics; model systems do not exist for proper investigation in the controlled environment of a laboratory; and there is only limited data from prospective, randomized controlled clinical trials. Accordingly, the management of cutaneous scars is typically based upon the experience from practitioners rather than from evidence-based data. This article will review the pathophysiology of excessive scar formation, define the most common scars—hypertrophic scars and keloids—and discuss the evidence to support the current nonsurgical therapies in use to both prevent and treat excessive scars.