bluuebunny/crossref_metadata_2025_split huggingface dataset:
Backward walking observational training improves gait ability in patients with chronic stroke: randomised controlled pilot study
Authors: Moon Yiyeop , Bae Youngsook 
Published: April 2019

Backward walking has a positive effect on gait ability. Action observational training is an effective treatment method for stroke neurological disorders. This randomised comparator-controlled pilot study aimed to evaluate the feasibility of backward walking observational training on the gait ability of chronic stroke patients. Fourteen chronic stroke participants were randomly allocated to the experimental group (backward walking observation; n = 7) and control group (landscape observation; n = 7). Both groups performed conventional therapy 5 days/week; then the backward walking observation and landscape observation + backward walking training groups performed the observational training 3 days/week for 4 weeks. The primary outcome was measured dynamic gait index, 10-m walking test, and timed up and go test time. Both groups showed significant increases in dynamic gait index, 10-m walking test, and timed up and go test time. The experimental group showed more significant improvements in dynamic gait index (P= 0.04, η2= 0.336), 10-m walking test (P= 0.04, η2= 0.306), and timed up and go test time (P= 0.03, η2= 0.334) than the control group. This pilot study demonstrated that conventional therapy with backward walking observational training improves gait ability. Our findings suggest that observing an action may have a positive effect on chronic stroke patients.Trial Registration Clinical Trials:KCT0003098.
Recommendations for Fall-Related Injury Prevention
Authors: Soncrant Christina , Neily Julia , Bulat Tatjana , Mills Peter D. 
Published: April 2019

Background:
Injurious falls continue to challenge health care. Causes of serious falls from the largest health care system in the United States can direct future prevention efforts.

Purpose:
This article analyzes injurious falls in the Veterans Health Administration and provides generalizable recommended actions to prevent future events.

Methods:
We categorized root cause analysis (RCA) reports and coded injury type, fall type, location, and root causes. We describe interventions during the fall and provide resources for future prevention.

Results:
There were 154 reported fall RCAs during this time. Most (83%, n = 128) resulted in major injury: hip fractures (43%, n = 66), other fractures (25%, n = 38), and head injury (16%, n = 24). Most falls were unwitnessed (75%, n = 116).

Conclusions:
Patients who fell were not wearing hip or head protection. Most falls were unwitnessed, and none were on 1:1 observation. Such interventions may help prevent future injurious falls.
Effectiveness of Retrobulbar Hyaluronidase Injection in an Iatrogenic Blindness Rabbit Model Using Hyaluronic Acid Filler Injection
Authors: Lee Won , Oh Wook , Ko Hyung-Seok , Lee Sang-Young , Kim Ki Wook , Yang Eun-Jung 
Published: April 2019

Background:
Blindness caused by soft-tissue filler injection is the most tragic complication, with no standard treatments until recently. Retrobulbar hyaluronidase injection has been proposed as the treatment, but its effectiveness in visual compromise remains to be determined. The authors aimed to determine the effectiveness of retrobulbar hyaluronidase using soft-tissue filler in an iatrogenic blindness animal model.

Methods:
New Zealand White rabbits were used to simulate the hyaluronic acid–associated vascular occlusion model. A volume of 0.7 to 1.6 ml of hyaluronic acid filler was injected into the internal carotid artery to create a retinal artery occlusion. The rabbits were administered retrobulbar hyaluronidase (3000 IU) at different postobstruction time points (5 and 10 minutes). No intervention was given to the control group. Fundus photography was performed before and immediately after the filler injection and immediately after the administration of retrobulbar hyaluronidase. Electroretinography was performed after 60 minutes to confirm the retinal reperfusion and electrophysiologic function.

Results:
All of the experimental eyes recorded total occlusion after hyaluronic acid injection. Three eyes with a completely occluded retinal artery following retrobulbar hyaluronidase treatment showed improved retinal reperfusion by fundus photography and corresponding electroretinography. Despite administration of the retrobulbar hyaluronidase injection, one completely occluded eye showed no improvement in perfusion. All of the control eyes recorded complete occlusion 1 hour after hyaluronic acid filler injection.

Conclusions:
Retrobulbar hyaluronidase may be an effective evidence-based treatment option for humans. Hyaluronidase concentration and injection time are the important factors for faster recovery, but additional studies are still required.
Outcomes of Single versus Double Fascicular Nerve Transfers for Restoration of Elbow Flexion in Patients with Brachial Plexus Injuries: A Systematic Review and Meta-Analysis
Authors: Sneiders Dimitri , Bulstra Liselotte F. , Hundepool Caroline A. , Treling Willemijn J. , Hovius Steven E. R. , Shin Alexander Y. 
Published: April 2019

Background:
Elbow flexion after upper brachial plexus injury may be restored by a nerve transfer from the ulnar nerve to the biceps motor branch with an optional nerve transfer from the median nerve to the brachialis motor branch (single and double fascicular nerve transfer). This meta-analysis assesses the effectiveness of both techniques and the added value of additional reinnervation of the brachialis muscle.

Methods:
Comprehensive searches were performed identifying studies concerning restoration of elbow flexion through single and double fascicular nerve transfers. Only C5 to C6 lesion patients were included in quantitative analysis to prevent confounding by indication. Primary outcome was the proportion of patients reaching British Medical Research Council elbow flexion grade 3 or greater. Meta-analysis was performed with random effects models.

Results:
Thirty-five studies were included (n = 688). In quantitative analysis, 29 studies were included (n = 341). After single fascicular nerve transfer, 190 of 207 patients reached Medical Research Council grade 3 or higher (random effects model, 95.6 percent; 95 percent CI, 92.9 to 98.2 percent); and after double fascicular nerve transfer, 128 of 134 patients reached grade 3 or higher (random effects model, 97.5 percent; 95 percent CI, 95.0 to 100 percent; p = 0.301). Significantly more double nerve transfer patients reached grade 4 or greater if preoperative delay was 6 months or less (84 of 101 versus 49 of 51; p = 0.035).

Conclusions:
Additional reinnervation of the brachialis muscle did not result in significantly more patients reaching Medical Research Council grade 3 or higher for elbow flexion. Double fascicular nerve transfer may result in more patients reaching grade 4 or higher in patients with a preoperative delay less than 6 months. The median nerve may be preserved or used for another nerve transfer without substantially impairing elbow flexion restoration.
Physician’s Experience and Disease Activity Affect the Impact of Ultrasound on the Treatment Decision in Rheumatoid Arthritis
Authors: Sifuentes-Cantú Cesar , Contreras-Yáñez Irazú , Gutiérrez Marwin , Torres-Ruiz Jiram , Zamora-Medina Maria del Carmen , Romo-Tena Jorge , Castillo Jose Pablo , Ruiz-Medrano Emmanuel , Martín-Nares Eduardo , Quintanilla-González Lauro , Bermúdez-Bermejo Paola , Pérez-Rodríguez Rogelio , López-Morales Jorge , Whittall-García Laura , García-Galicia Jorge , Valdés-Corona Luis , Pascual-Ramos Virginia 
Published: April 2019

Background/Objective
The aim of this cross-sectional study was to explore which factors affect the impact of musculoskeletal ultrasound (MUS) on the treatment proposal among rheumatologists with different degree of experience.

Methods
Sixteen clinical vignettes summarized data from rheumatoid arthritis (RA) outpatients; vignettes included clinical evaluation and a blank section for a first treatment proposal; MUS information was then added, based on German Ultrasound score, followed by a blank section for treatment re-consideration, if applicable. During a 6 months period, each vignette was concomitantly presented to six trainees and six senior rheumatologists (SR); three SR had ≥15 years of experience. Participants were blinded to colleagues’ responses. Appropriated statistics were used.

Results
Vignettes included data from female patients, who had a mean ± SD age of 43.3 ± 9 years, 7.6 ± 3.5 years of disease duration and comorbidities (68.8%). MUS induced treatment modification in 24% of evaluations, with similar percentage among SR and trainees. Within SR, more experienced rheumatologists (≥15 years) never translated MUS findings in a different treatment proposal, compared to 34% of those with lesser experience, p ≤ 0.0001. There were 60 clinical scenarios each, with remission and moderate disease activity, and 36 clinical scenarios each, with low and high disease activity. MUS-induced treatment modifications were more frequent in scenarios with low and moderate disease activity, compared to remission and high disease activity, p = 0.008.

Conclusions
Physician’s experience and disease activity level affect the impact of MUS on the treatment decision in RA outpatients. RA patients with intermediate disease activity may benefit from MUS incorporation to standard assessments.
Selenium and Selenoprotein P Deficiency Correlates With Complications and Adverse Outcome After Major Trauma
Authors: Braunstein Mareen , Kusmenkov Thomas , Zuck Catrin , Angstwurm Matthias , Becker Niels-Peter , Böcker Wolfgang , Schomburg Lutz , Bogner-Flatz Viktoria 
Published: April 2019

ABSTRACT

Background:
A declining selenium (Se) status constitutes a characteristic of critical illness and may affect disease course and survival. The dynamics of trauma-induced changes in biomarkers of Se status are poorly characterized, and an association with multiple organ failure (MOF) and mortality can be hypothesized. It was the aim of this study to investigate Se and selenoprotein P (SELENOP) concentrations in major trauma patients during the early posttraumatic period.

Patients and Methods:
Twenty-four patients after major trauma (ISS ≥16) were included at our level one trauma center. Se supplementation ever during the 90-day observation period was defined as an exclusion criterion. Serum samples were drawn within less than 60 min after trauma, and after 6 h, 12 h, 24 h, 48 h, and 72 h. Serum Se was analyzed by X-ray fluorescence and SELENOP concentrations by ELISA. The data were correlated to clinical parameters, occurrence of MOF defined by MOF and APACHE II score, lung injury defined by Horowitz index and clinical outcome (90-days survival).

Results:
Serum Se and SELENOP concentrations of the trauma patients were significantly below the average of healthy European subjects (mean ±SD; Se, 41.2±8.1 vs. 84.7±23.3 μg/L, P < 0.001; SePP, 1.5±0.3 vs. 4.3±1.0 mg/L, P < 0.001). A strong deficit was present already at the first time point (Se; 33.6±10.5 μg/L, SELENOP: 1.4±0.5 mg/L). The clinical scores collectively showed an inverse relation between health status and Se biomarkers. Patients who did not survive the 90-day observation period exhibited significantly lower initial post-trauma Se status than the surviving patients (mean±SD; Se, 24.7±7.2 vs. 39.2±8.4 μg/L, P<0.05; SePP, 1.1±0.4 vs. 1.6±0.4 mg/L, P<0.05).

Conclusion:
Very low Se and SELENOP concentrations occur fast after major trauma and are associated with poor survival odds. These findings support the notion that early Se substitution may constitute a meaningful adjuvant treatment strategy in trauma patients.
Cholecystokinin Modulates the Mucosal Inflammatory Response and Prevents the Lipopolysaccharide-Induced Intestinal Epithelial Barrier Dysfunction
Authors: Saia Rafael Simone , Ribeiro Aline Barbosa , Giusti Humberto 
Published: April 2019

ABSTRACT
The intestinal mucosa plays a critical role in the organism, acting as an interface between the lamina propria and the harmful antigens in the lumen. Sepsis is associated with primary injury to the intestinal mucosa, which in turn induces bacterial translocation and hyperpermeability. Cholecystokinin (CCK) is a peptide synthesized by several cell types, whose immunomodulatory activity has been reported in experimental models of inflammation. We hypothesized that the CCK treatment could modulate the inflammatory response and protect the integrity of the intestinal barrier in endotoxemic rats. Ten minutes before the endotoxemia induction by lipopolysaccharide (LPS) administration, rats were pretreated with CCK at two doses (0.4 μg/kg or 40 μg/kg). Mucosal permeability, bacterial translocation, cytokines production, histology injury, and expression of tight junction (TJ) proteins were the parameters assessed. In the early phase of endotoxemia, rats exhibited impaired intestinal barrier function, increased mucosal permeability, bacterial translocation, and also hyperactivation of the inflammatory response. On the other hand, the pretreatment with CCK modulated the mucosal production of pro-inflammatory cytokines and increased the expression of seal-forming TJ proteins (occludin, claudin-1 and junctional adhesion molecule (JAM-A)) only in the colon and also, reduced the bacterial counts in the mesenteric lymph nodes. However, CCK has a site-specific mechanism of action in the colon via CCK-1R, which is upregulated by the CCK treatment. In synergy with previous findings from our research group, the present results demonstrated that CCK preserves the integrity of the intestinal mucosa and might be a promising hormonal adjuvant therapy for the treatment of sepsis.
Effect of Vasopressors on the Macro- and Microcirculation During Systemic Inflammation in Humans In Vivo
Authors: van Loon Lex M. , Stolk Roeland F. , van der Hoeven Johannes G. , Veltink Peter H. , Pickkers Peter , Lemson Joris , Kox Matthijs 
Published: April 2019

ABSTRACT

Aim:
Comparing the effects of different vasopressors in septic shock patients is hampered by high heterogeneity and the fact that current guidelines dictate the use of norepinephrine. Herein, we studied the effects of three vasopressor agents, norepinephrine, phenylephrine, and vasopressin, on the macro- and microcirculation during experimental human endotoxemia, a standardized, controlled model of systemic inflammation in humans in vivo.

Methods:
We performed a randomized controlled study in which 40 healthy male volunteers were assigned to a 5-h infusion of either 0.05 μg/kg/min norepinephrine (n = 10), 0.5 μg/kg/min phenylephrine (n = 10), 0.04 IU/min vasopressin (n = 10), or saline (n = 10), starting 1 h before intravenous administration of 2 ng/kg lipopolysaccharide (LPS). The macrocirculation was monitored using arterial catheter-derived parameters with additional blood pressure waveform contour analysis (PCA) until 4.5 h following LPS administration. Sublingual microcirculatory density and flow were assessed using a handheld video microscope until 6 h post-LPS.

Results:
LPS administration affected all macrocirculatory and microcirculatory parameters. The LPS-induced decrease in blood pressure and systemic vascular resistance (SVR) was refractory to low-dose norepinephrine and phenylephrine, and to a lesser extent, to vasopressin. Only vasopressin exerted effects on PCA parameters compared with placebo, by mitigating the LPS-induced decrease in diastolic blood pressure by stabilizing SVR and cardiac output. The endotoxemia-induced decreased indices of microvascular flow and density were not influenced by vasopressor therapy.

Conclusions:
In a highly controlled model of systemic inflammation in humans in vivo, a 5-h infusion of various vasopressors revealed distinctive effects on macrohemodynamic variables without affecting the sublingual microcirculation.
Conversion of Adjustable Gastric Banding to Stapling Bariatric Procedures
Authors: Spaniolas Konstantinos , Yang Jie , Zhu Chencan , Maria Altieri , Bates Andrew T. , Docimo Salvatore , Talamini Mark , Pryor Aurora D. 
Published: April 2019

Objective:
The aim of this study was to compare the safety of single- versus two-stage conversion of adjustable gastric band (AGB) to gastric bypass (RYGB) or sleeve gastrectomy (SG).

Summary Background Data:
AGB patients often present for conversion to RYGB or SG. The impact of single- or two-stage approach of such conversion remains unclear.

Methods:
A statewide database was used to identify all patients who underwent AGB removal and concurrent (single-stage) or interval (two-stage) RYGB or SG. Propensity score matching schemes were constructed to account for differences in baseline comorbidities and demographics, allowing for matched pairs available for comparisons.

Results:
A total of 4330 patients underwent AGB conversion. Complications, readmissions, and ED visits were noted in 394 (9.1%), 278 (6.42%), and 589 (13.6%) patients, respectively. Three hundred sixty-seven matched pairs underwent RYGB; single-stage patients experienced shorter length of stay (LOS) (median difference −1 d, P < 0.0001), less complications [risk difference (RD): −8.4%, 95% confidence interval (CI), −13.4% to −3.5%], readmissions (RD: −5.2%, 95% CI, −9.6% to −0.8%), and ED visits (RD: −5.7%, 95% CI, −11.3% to −0.2%). Eight hundred seventy-five matched pairs underwent SG; single-stage patients experienced improved outcomes in all measures examined. For single-stage procedures (809 pairs), RYGB was associated with longer LOS, and more complications (RD: 3.3%, 95% CI, 0.9%–5.8%), with similar readmissions, and ED visits.

Conclusions:
AGB conversion procedures have low morbidity. Single-stage conversion is associated with lower morbidity compared with the two-stage approach. Conversion to SG seems to be safer than RYGB.
Preformed Donor-specific Antibodies Against HLA Class II and Graft Outcomes in Deceased-donor Kidney Transplantation
Authors: Uffing Audrey , Hidalgo Luis G. , McMullan Ciaran , Perry Jacqueline , Milford Edgar L. , Murakami Naoka , Yeung Melissa Y. , Guleria Indira , Wood Isabelle G. , Akalin Enver , Azzi Jamil , Chandraker Anil K. , Riella Leonardo V. 
Published: April 2019

Background.
Many kidney transplant centers in the United States report both HLA class I and II antibodies detected by sensitive solid-phase assays (SPAs) to United Network for Organ Sharing as unacceptable antigens, significantly reducing the compatible donor organ pool and prolonging waiting time for highly sensitized patients. However, the clinical relevance of all detected donor-specific antibodies (DSAs) by SPA is not unequivocal, because fluorescence intensity does not always accurately reflect antibody pathogenicity. Our center does not exclude patients from transplantation based on DSA class II.

Methods.
We performed a retrospective analysis in 179 deceased-donor kidney transplant recipients with solely DSA class II before transplant and patients without DSA and compared graft survival, rejection, and clinical outcomes. Patient survival was also compared with matched controls on the waiting list.

Results.
Patients transplanted with DSA class II showed a clear survival benefit compared with matched patients who remained on dialysis or were waitlisted on dialysis/transplanted at 5 years (100%, 34%, and 73%, respectively). After a mean follow-up of 5.5 years, there was no significant difference in death-censored graft survival between transplanted patients without DSA and those with preformed DSA class II (adjusted HR 1.10; 95% confidence interval, 0.41–2.97), although the incidence of rejection was higher in recipients with DSA class II (adjusted HR 5.84; 95% confidence interval, 2.58–13.23; P < 0.001). Serum creatinine levels at 1, 3, and 5 years posttransplant did not differ between groups. No predictors of rejection were found, although patients who received basiliximab induction therapy had higher incidence of rejection (100%) compared with those who received antithymocyte globulin (52%).

Conclusions.
We conclude that for highly sensitized patients, deceased-donor kidney transplantation with DSA class II yields a survival benefit over prolonged waiting time on dialysis. Instead of listing DSA class II as unacceptable antigens, an individual approach with further immunologic risk assessment is recommended.
Cortical visual prosthesis: a detailed large-scale simulation study
Authors: Antolik Jan , Sabatier Quentin , Galle Charlie , Frègnac Yves , Benosman Ryad 
Published: April 2019

AbstractRecent advances in applying optogenetics in primates initiated the development of light based prosthetic implants for sensory restoration. Thanks to being the most well explored cortical area that is readily accessible at the surface of the brain, vision restoration via direct optogenetic activation of primary visual cortex is one of the most promising early targets for a optogenetics based prosthetic program. However, two fundamental elements of the cortical optogenetic prosthesis remain unclear. First, the exact mechanisms of neural dynamics under direct cortical stimulation, especially in the context of living, active and functionally specific intra-cortical neural circuitry, is poorly understood. Second, we lack protocols for transformation of arbitrary visual stimuli into light activation patterns that would induce perception of the said stimulus by the subject. In this study we address these issues using a large-scale spiking neural network modeling strategy of high biological fidelity. We examine the relationship between specific spatial configuration of light delivered to cortex and the resulting spatio-temporal pattern of activity evoked in the simulated cortical circuitry. Using such virtual experiments, we design a protocol for translation of a specific set of stimuli to activation pattern of a matrix of light emitting elements and provide a detailed assessment of the resulting cortical activations with respect to the natural vision control condition. In this study we restrict our focus to the grating stimulus class, which are an ideal starting point for exploration due to their thoroughly characterized representation in V1 and well-defined information content. However, we also provide an outline of a straight-forward road-map for transforming this grating centric stimulation protocol towards general strategy capable of transforming arbitrary spatio-temporal visual stimulus to a spatio-temporal pattern of light, thus enabling vision restoration via optogenetic V1 activation.
How Cognitive and Affective Empathy Relate to Emotion Regulation: Divergent Patterns from Trait and Task-Based Measures
Authors: Thompson Nicholas M. , Reekum Carien M. van , Chakrabarti Bhismadev 
Published: April 2019

AbstractEvidence suggests that empathy and emotion regulation may be related, but few studies have directly investigated this relationship. Here we report two experiments which examined: 1) how different components of empathy (cognitive & affective) relate to the habitual use of cognitive reappraisal to regulate emotions (N=220), and 2) how these components of empathy relate to implicit reappraisal in a context-framing task (N=92). In study 1, a positive correlation between cognitive empathy and reappraisal use was observed. Affective empathy showed no relationship with reappraisal use. In study 2, participants completed an implicit reappraisal task in which previously viewed negative images were paired with either a neutralising (intended to reduce negative emotionality) or descriptive (which simply described the image) framing sentence. Participants then reported how unpleasant/pleasant each image made them feel. In contrast to study 1, a positive correlation between affective empathy and the implicit reappraisal task metric (rating of neutralising–descriptive framing conditions) was observed. There was no relationship between cognitive empathy and implicit reappraisal. These findings suggest that both components of empathy are related to reappraisal, but in different ways: Cognitive empathy is related to more deliberate use of reappraisal, while affective empathy is associated with more implicit reappraisal processes.