bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differential clinical characteristics, management and outcome of delirium among ward compared with intensive care unit patients
Authors: Canet Emmanuel , Amjad Sobia , Robbins Raymond , Lewis Jane , Matalanis Michelle , Jones Daryl , Bellomo Rinaldo 
Published: March 2019

AbstractBackgroundDelirium is common in hospitalised patients but its epidemiology remains poorly characterised.AimsTo test the hypothesis that patient demographics, clinical phenotype, management and outcomes of patient with delirium in hospital ward patients differ from intensive care unit (ICU) patients.MethodsRetrospective cohort of patients admitted to an Australian university‐affiliated hospital between March 2013 and April 2017 and coded for delirium at discharge using the International Classification of Diseases System, 10th revision, criteria.ResultsAmong 61 032 hospitalised patients, 2864 (4.7%) were coded for delirium. From these, we studied a random sample of 100 ward patients and 100 ICU patients. Ward patients were older (median age: 84 vs 65 years; P < 0.0001), more likely to have dementia (38% vs 2% for ICU patients; P < 0.0001) and less likely to have had surgery (24% vs 62%; P < 0.0001). Of ward patients, 74% had hypoactive delirium, while 64% of ICU patients had agitated delirium (P < 0.0001). Persistent delirium at hospital discharge was more common among ward patients (66% vs 17%, P < 0.0001). On multivariable analysis, age and dementia predicted persistent delirium, while surgery predicted recovery.ConclusionsDelirium in ward patients is profoundly different from delirium in ICU patients. It has a dominant hypoactive clinical phenotype, is preceded by dementia and is less likely to recover at hospital discharge. Therefore, delirium prevention, detection and goals of care should be adapted to the environment in which it occurs.
Discharge treatment with angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker after a heart failure hospitalisation is associated with a better prognosis irrespective of left ventricular ejection fraction
Authors: Vicent Lourdes , Cinca Juan , Vazquez‐García Rafael , Gonzalez‐Juanatey José R. , Rivera Miguel , Segovia Javier , Pascual‐Figal Domingo , Bover Ramón , Worner Fernando , Delgado‐Jiménez Juan , Fernández‐Avilés Francisco , Martínez‐Sellés Manuel 
Published: March 2019

AbstractBackgroundMedical therapy could improve the prognosis of real‐life patients discharged after a heart failure (HF) hospitalisation.AimTo determine the impact of discharge HF treatment on mortality and readmissions in different left ventricular ejection fraction (LVEF) groups.MethodsMulticentre prospective registry in 20 Spanish hospitals. Patients were enrolled after a HF hospitalisation.ResultsA total of 1831 patients was included (583 (31.8%) HF with reduced ejection fraction (HFrEF); 227 (12.4%) HF with midrange ejection fraction (HFmrEF); 610 (33.3%) HF with preserved ejection fraction (HFpEF), and 411 (22.4%) with unknown LVEF). Angiotensin‐converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB) at discharge were independently associated with a reduction in: (i) all‐cause mortality: hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.41–0.74, P < 0.001, with a similar effect in the four groups; (ii) mortality due to refractory HF HR 0.45, 95% CI 0.29–0.64, P < 0.001, with a similar effect in the three groups with known LVEF; (iii) mortality/HF admissions (HR 0.61; 95% CI: 0.50–0.74), more evident in HFrEF (HR 0.54; 95% CI: 0.38–0.78) compared with HRmEF (HR 0.64; 95% CI 0.40–1.02), or HFpEF (HR 0.70; 95% CI 0.53–0.92). In patients with HFrEF triple therapy (ACE inhibitor/ARB + beta blocker + mineralocorticoid receptor antagonist) was associated with the lowest mortality risk (HR 0.21; 95% CI: 0.08–0.57, P = 0.002) compared with patients that received none of these drugs.ConclusionsDischarge treatment with ACE inhibitor/ARB after a HF hospitalisation is associated with a reduction in all‐cause and refractory HF mortality, irrespective of LVEF.
Success rates of preformed metal crowns placed with the modified and standard hall technique in a paediatric dentistry setting
Authors: Midani Rama , Splieth Christian H. , Mustafa Ali Mahmoud , Schmoeckel Julian , Mourad Said M. , Santamaria Ruth M. 
Published: March 2019

BackgroundThe Hall Technique is a less invasive caries management technique for treating carious primary molars. It has become a routine treatment at specialists’ practices.AimTo retrospectively evaluate the clinical success and survival rates of preformed metal crowns placed on primary molars using the Hall Technique in a Paediatric Dentistry Setting.DesignPatient records of children receiving Hall crowns (with or without proximal slicing) between 2011 and 2017 were reviewed. Teeth with no clinical or radiographic evidence of pulp involvement at baseline and at least six months’ follow‐up were included. Kaplan‐Meier survival analyses and Mantel‐Cox statistics were carried out.ResultsIn total, 181 Hall crowns performed in 2‐ to 10‐year‐olds with a mean follow‐up period of 22 months were included for analysis. Mean d3mft/D3MFT was 6.55 ± 3.48/0.18 ± 0.66. The majority of crowns were successful (92.3%; n = 167), four presented at least one minor failure (2.2%; reversible pulpitis, crown lost, or secondary caries) and ten were major failures (5.5%; irreversible pulpitis or abscess). When comparing crowns performed with no tooth preparation to crowns performed with proximal slicing, no differences were observed (P = 0.70, CI = 0.68‐0.83).ConclusionThe survival rate and clinical efficacy of Hall crowns were high in a secondary care‐based setting. The HT is an effective and less invasive management option for asymptomatic carious primary molars.
FER1L4/miR‐372/E2F1 works as a ceRNA system to regulate the proliferation and cell cycle of glioma cells
Authors: Xia Liang , Nie Dekang , Wang Guangtao , Sun Caixing , Chen Gao 
Published: March 2019

AbstractLong non‐coding RNAs have recently become a key regulatory factor for cancers, whereas FER1L4, a newly discovered long non‐coding RNA, has been mostly studied in gastric carcinoma and colon cancer cases. The functions and molecular mechanism of FER1L4 have been rarely reported in glioma malignant phenotypes. In this study, it was found that the expression of LncRNA FER1L4 is upregulated in high‐grade gliomas than in low‐grade cases and that a high expression of LncRNA FER1L4 predicts poor prognosis of gliomas. Meanwhile, in vitro study suggests that expression of FER1L4 with SiRNA knockdown obviously suppresses cell cycle and proliferation. It is further demonstrated by experiments that the FER1L4 knockdown suppresses growth of in vivo glioma. Besides, it is found in our study that LncRNA FER1L4 expression is positively correlated with E2F1 mRNA expression. After knockdown of FER1L4 expression, E2F1 expression is significantly down‐regulated, whereas the expression of miR‐372 is significantly up‐regulated; the up‐regulation of miR‐372 leads to significant down‐regulation of FER1L4 and E2F1 expression. In addition, it is also found that FER1L4 can be used as competitive endogenous RNA to interact or bind with miR‐371 and thereby up‐regulate E2F1, thus promoting the cycle and proliferation of glioma cells. It may be one of the molecular mechanisms in which FER1L4 plays its oncogene‐like role in gliomas.
Egr1 mediates retinal vascular dysfunction in diabetes mellitus via promoting p53 transcription
Authors: Ao Haocheng , Liu Bingqian , Li Haichun , Lu Lin 
Published: March 2019

AbstractObjectivesThis study focused on investigating the expression and underlying molecular mechanism of early growth response 1 (Egr1) in diabetic retinopathy.MethodsA microarray assay was applied to examine differentially expressed genes in the retina tissues of normal rats, as well as in those of streptozotocin‐induced diabetic rats. Human retinal vascular endothelial cells (HRVECs) transfected with sh‐NC, sh‐Egr1 or sh‐Egr1+ pVax1‐p53 were cultured under high‐glucose conditions and then used to explore the role of Egr1 in vitro. The effect of Egr1 on retinal vascular dysfunction caused by diabetes was examined by sh‐Egr1 administration in vivoResultsEarly growth response 1 was found to be up‐regulated in the retinas of diabetic rats compared to those of normal rats. Down‐regulation of Egr1 in HRVECs under high‐glucose conditions inhibited the apoptosis, migration and tube formation in vitro. Moreover, sh‐Egr1 partially reduced the injurious effects of hyperglycaemia on retinal vascular function by decreasing apoptotic cells and microvascular formation in vivo. The reduction of Egr1 evidently down‐regulated the p53 expression. Overexpression of p53 rescued the inhibition of sh‐Egr1 in HRVECs under high‐glucose concentration on apoptosis, migration and tube formation in vitro.ConclusionDown‐regulation of Egr1 partially reduced the injurious effects of hyperglycaemia on retinal vascular function via inhibiting p53 expression.
Development and validation of a predictive model for periodontitis using NHANES 2011–2012 data
Authors: Montero Eduardo , Herrera David , Sanz Mariano , Dhir Sangeeta , Van Dyke Thomas , Sima Corneliu 
Published: March 2019

AbstractAimTo develop and validate a predictive model for moderate‐to‐severe periodontitis in the adult USA population, with data from the 2011–2012 National Health and Nutrition Examination Survey (NHANES) cycle.Material and MethodsA subset of 3017 subjects aged >30 years, with >14 teeth present and having received a periodontal examination in addition to data collected on cardio‐metabolic risk measures (smoking habit, body mass index [BMI], blood pressure, total cholesterol and glycated haemoglobin [HbA1c]) were used for model development by multivariable logistic regression.ResultsThe prevalence of moderate and severe periodontitis using CDC/AAP classification was 37.1% and 13.2%, respectively. A multivariable logistic regression model revealed that HbA1c ≥5.7% was significantly associated with moderate‐to‐severe periodontitis (odds ratio, OR = 1.29; p < 0.01). A predictive model including age, gender, ethnicity, HbA1c and smoking habit as variables had 70.0% sensitivity and 67.6% specificity in detecting moderate‐to‐severe periodontitis in US adults.ConclusionsPeriodontitis is a common disease in North American adults, and its prevalence is significantly higher in individuals with pre‐diabetes or diabetes. The present study demonstrates that a model including age, gender, ethnicity, HbA1c and smoking habit could be used as a reliable screening tool for periodontitis in primary medical care settings to facilitate referral of patients at risk for periodontal examination and diagnosis.
Skin diseases are more common than we think: screening results of an unreferred population at the Munich Oktoberfest
Authors: Tizek L. , Schielein M.C. , Seifert F. , Biedermann T. , Böhner A. , Zink A. 
Published: March 2019

AbstractBackgroundSkin diseases are ranked as the fourth most common cause of human illness, resulting in an enormous non‐fatal burden. Despite this, many affected people do not consult a physician. Accordingly, the actual skin disease burden might be even higher since reported prevalence rates are typically based on secondary data that exclude individuals who do not seek medical care.ObjectiveThe aim of the study was to investigate the prevalence of skin diseases in an unreferred population in a real‐life setting.MethodsA cross‐sectional study of 9 days duration was performed in 2016 at the ‘Bavarian Central Agricultural Festival’, which is part of the Munich Oktoberfest. As part of a public health check‐up, screening examinations were performed randomly on participating visitors. All participants were 18 years or older and provided written informed consent.ResultsA total of 2701 individuals (53.5% women, 46.2% men; mean age 51.9 ± 15.3 years) participated in the study. At least one skin abnormality was observed in 1662 of the participants (64.5%). The most common diagnoses were actinic keratosis (26.6%), rosacea (25.5%) and eczema (11.7%). Skin diseases increased with age and were more frequent in men (72.3%) than in women (58.0%). Clinical examinations showed that nearly two‐thirds of the affected participants were unaware of their abnormal skin findings.ConclusionSkin diseases might be more common than previously estimated based on the secondary data of some sub‐populations. Further information and awareness campaigns are needed to improve people's knowledge and reduce the global burden associated with skin diseases.
Evidence‐based medicine—Not a panacea for the problems of a complex adaptive world
Authors: Sturmberg Joachim P. 
Published: March 2019

AbstractThe recent sacking of Peter Gøtzsche from the Cochrane Collaboration Board raised strong responses and highlights the neglected issue about priorities—maintaining the reputation of the organization or vigorously debating the merits of scientific approaches to find answers to complex problems? The Cochrane approach hales the randomized trial (RCT) as the gold standard research approach and affirms that meta‐analysis provides the ultimate proof (or platinum standard) to settle contentious issues confronting the clinician. However, most published medical research is wrong, and critics coined the acronym GIGO (garbage in, garbage out) as a meme to highlight the risks of blind faith in the hyped‐up procedures of the EBM movement.This paper firstly explores the differences between the prevailing scientific method arising from the linear cause‐and‐effect assumption and the complex adaptive systems science methods arising from observations that most phenomena emerge from nonlinearity in networked systems. Most medical conditions are characterized by necessary features that by themselves are not sufficient to explain their nature and behaviour. Such nonlinear phenomena require modelling approaches rather than linear statistical and/or meta‐analysis approaches to be understood. These considerations also highlight that research is largely stuck at the data and information levels of understanding which fails clinicians who depend on knowledge—the synthesis of information—to apply in an adaptive way in the clinical encounter.Clinicians are constantly confronted with the linked challenges of doing things right and doing the right thing for their patients. EBM and Cochrane with their restrictive approaches are the antithesis to a practice of medicine that is responsive to constantly changing patient needs. As such, the EBM/Cochrane crisis opens a window of opportunity to re‐examine the nature of health, illness and disease, and the nature of health care and its systems for the benefits of its professionals and their patients. We are at the cusp of a paradigmatic shift towards an understanding a praxis of health care that takes account of its complexities.
Resistance of resin‐infiltrated enamel to surface changes in response to acidic challenge
Authors: Enan Enas T. , Aref Neven S. , Hammad Shaza M. 
Published: March 2019

AbstractObjectiveTo investigate the ability of resin infiltration to protect demineralized enamel against acidic challenge.Materials and methodsForty‐five extracted healthy premolars were selected for the study, each of which was sectioned vertically into 2 halves, giving 90 specimens. Specimens were then divided into three groups, where specimens of group A were not decalcified (control), while those of groups B and C were either subjected to decalcification only, or decalcification followed by Icon resin infiltration, respectively. Each group was further divided into three subgroups, according to the type of storage medium (water, Coca‐Cola, or Redbull). Evaluation parameters included color difference and surface roughness. Scanning electron microscope was used to evaluate enamel surface topography. Statistical analysis was performed by ANOVA followed by least significant difference test.ResultsAlthough Coca‐Cola caused the highest color change and surface roughness among the studied specimens, yet, the resin‐infiltrated enamel was more resistant to surface changes than the nonresin infiltrated enamel, even under acid attack.ConclusionResin infiltration has the ability to provide and maintain protection to the demineralized enamel against acidic attack.Clinical significanceResin infiltration may be considered as a promising solution to restore esthetic of demineralized enamel following orthodontic treatment and to protect it against acidic beverages.
Development of attenuated erythromycin‐resistant Streptococcus agalactiae vaccine for tilapia (Oreochromis niloticus) culture
Authors: Liu Ling , Lu Dan‐Qi , Xu Jun , Luo Heng‐Li , Li An‐Xing 
Published: March 2019

AbstractStreptococcus agalactiae is an important pathogen in fish, causing great losses of intensive tilapia farming. To develop a potential live attenuated vaccine, a re‐attenuated S. agalactiae (named TFJ‐ery) was developed from a natural low‐virulence S. agalactiae strain TFJ0901 through selection of resistance to erythromycin. The biological characteristics, virulence, stability and the immunization protective efficacy to tilapia of TFJ‐ery were determined. The results indicated that TFJ‐ery grew at a slower rate than TFJ0901. The capsule thickness of TFJ‐ery was significantly less (p < 0.05) than TFJ0901. When Nile tilapia were intraperitoneally (IP) injected with TFJ‐ery, the mortality of fish was decreased than that injected with TFJ0901. The RPS of fish immunized with TFJ‐ery at a dose of 5.0 × 107 CFU was 95.00%, 93.02% and 100.00% at 4, 8 and 16 weeks post‐vaccination, respectively. ELISA results showed that the vaccinated fish produced significantly higher (p < 0.05) antibody titres compared to those of control at 2 or 4 weeks post‐vaccination. Taken together, our results suggest that erythromycin could be used to attenuate S. agalactiae, and TFJ‐ery is a potent attenuated vaccine candidate to protect tilapia against S. agalactiae infections.
Noneffectiveness of electroacupuncture for comorbid generalized anxiety disorder and irritable bowel syndrome
Authors: Mak Arthur Dun‐Ping , Chung Vincent Chi Ho , Yuen Suet Ying , Tse Yee Kit , Wong Samuel Yeung Shan , Ju Yanli , Hung Sheung Sheung , Leung Ka Chun , You Joyce Hoi Sze , Lui Rashid , Wong Sunny Hei , Leung Owen Ngo Wang , Lam Linda Chiu Wa , Lee Sing , Wu Justin Che Yuen 
Published: March 2019

AbstractBackground and AimComorbid generalized anxiety disorder and irritable bowel syndrome are common and therapeutically challenging. We aimed to assess the effectiveness of electroacupuncture in relieving anxiety and bowel symptoms in Chinese adults with this form of comorbidity.MethodsIn a single‐blind randomized sham‐controlled trial, subjects with comorbid generalized anxiety disorder and irritable bowel syndrome were randomly assigned to receive 10 weekly sessions of electroacupuncture or sham electroacupuncture. Patients were assessed at baseline, immediately after intervention and at 6‐week follow‐up. Primary outcome was anxiety (7‐item Patient Health Questionnaire section for anxiety). Secondary outcomes included bowel symptoms (bowel symptoms questionnaire), depressive symptoms (9‐item Patient Health Questionnaire), somatic symptoms (15‐item Patient Health Questionnaire), and health‐related quality of life (EuroQol‐5 Dimensions).ResultsEighty subjects, 40 in each arm, were randomized. All but two in the sham group completed 10 weekly sessions. There was no significant difference in the proportion of patients experiencing significant (≥ 50%) reduction of anxiety symptoms between the two groups immediately after intervention (32.4% vs 21.6%, P = 0.06) and at 6‐week follow‐up (25.7% in electroacupuncture vs 27% in sham, P = 0.65). Anxiety, depressive symptom, and bowel symptom severity did not differ significantly between electroacupuncture and sham groups.ConclusionsFindings failed to support the effectiveness of electroacupuncture for comorbid generalized anxiety disorder and irritable bowel syndrome. Further studies are needed to identify effective acupuncture treatment protocols for such comorbidity.
Facilitators and barriers to a dietitian‐implemented blended care weight‐loss intervention (SMARTsize): a qualitative study
Authors: Heideman W. H. , Rongen F. C. , Bolleurs C. , Govers E. , Kroeze W. , Steenhuis I. H. M. 
Published: March 2019

AbstractBackgroundDietitians play an important role in the intervention and prevention of being overweight and obesity. More and more blended care interventions are being implemented. The present study aimed to evaluate the delivery by Dutch dietitians of a multicomponent, evidence‐based weight‐loss programme (SMARTsize), including counselling for relapse prevention. The aim of this qualitative study was to identify facilitators and barriers to the delivery of SMARTsize.MethodsNine semi‐structured interviews were conducted with 10 dietitians who participated in a larger implementation study. Each interview was recorded and transcribed verbatim. Determinants of theory of implementation, including characteristics of the user, the innovation, organisational context and setting, and innovation strategy guided interviews and analysis. Data were coded and analysed using the framework approach.ResultsAccording to dietitians, the SMARTsize intervention had a positive influence on patients. The main implementation facilitators were the availability of implementation materials, such as a manual, training in relapse prevention and social support from other dietitians. The main barriers to implementation were organisation and financial reimbursement of cooking classes, the belief that patients need more individual counselling in the starting phase, and the unsuitability for people with low levels of health literacy.ConclusionsMost dietitians considered that implementation of the SMARTsize intervention consisting of e‐health, written information and cooking classes and face‐to‐face counselling is challenging but feasible. Further development of the SMARTsize intervention and implementation tools is needed to lower experienced barriers. It is also recommended that a version of the intervention to be developed that is suitable for patients with lower levels of health literacy.
Clinical and neuropathological differences between Parkinson's disease, Parkinson's disease dementia and dementia with Lewy bodies – current issues and future directions
Authors: Walker Lauren , Stefanis Leonidas , Attems Johannes 
Published: March 2019

AbstractLewy body diseases share clinical, pathological, genetic and biochemical signatures, and are regarded as a highly heterogeneous group of neurodegenerative disorders. Inclusive of Parkinson's disease (PD), Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB), controversy still exists as to whether they should be considered as separate disease entities or as part of the same disease continuum. Here we discuss emerging knowledge relating to both clinical, and neuropathological differences and consider current biomarker strategies as we try to improve our diagnostic capabilities and design of disease modifying therapeutics for this group of debilitating neurodegenerative disorders.
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This article is part of the Special Issue “Synuclein”.