bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Urinary Kallidinogenase on NIHSS score, mRS score, and fasting glucose levels in acute ischemic stroke patients with abnormal glucose metabolism
Authors: Chen Lei , Geng Lianxia , Chen Junmin , Yan Yan , Yang Lan , Zhao Jing , Sun Qian , He Junna , Bai Lin , Wang Xiaopeng 
Published: August 2019

Abstract
Urinary kallidinogenase may assist recovery acute ischemic stroke. This study evaluated the effect of urinary kallidinogenase on National Institute of Health Stroke Scale (NIHSS) score, modified Rankin scale (mRS) score, and fasting glucose levels in patients with acute ischemic stroke (AIS) combined with diabetes mellitus and impaired fasting glucose.
Patients with AIS and abnormal glucose metabolism were enrolled in this prospective cohort study and divided into 2 groups. The human urinary kallidinogenase (HUK) group were treated with urinary kallidinogenase and standard treatment; the control group received standard treatment. NIHSS scores, mRS scores, and fasting blood glucose were evaluated and compared.
A total of 113 patients were included: 58 in the HUK group and 55 in the control group. NIHSS scores decreased with treatment in both groups (time effect P < .05), but were lower in the HUK group (main effect P = .026). The mRS score decreased in both groups from 10 until 90 days after treatment (time effect P < .05); the 2 groups were similar (main effect, P = .130). Blood glucose levels decreased in both groups 10 days after treatment (time effect, P < .05), but there was no significant treatment effect (main effect, P = .635). Multivariate analysis showed blood uric acid >420 μmol/L (odds ratio [OR]: 0.053, 95% confidence interval [CI]: 0.008–0.350; P = .002) and application of HUK (OR: 0.217, 95% CI: 0.049–0.954; P = .043) were associated with 90% NIHSS recovery. Baseline NIHSS score was independently associated with poor curative effect.
Urinary kallidinogenase with conventional therapy significantly improved NIHSS scores in patients with AIS. Urinary kallidinogenase also showed a trend toward lower fasting blood glucose levels, although the level did not reach significance.
Coeliac disease: older patients have the most extensive small bowel involvement on capsule endoscopy
Authors: Chetcuti Zammit Stefania , Sanders David S. , Sidhu Reena 
Published: August 2019

Objective
The relation between symptomatology, serology and findings on small bowel capsule endoscopy (SBCE) in patients with coeliac disease (CD) remains unclear. Clarifying such associations will help to determine whether symptoms and serology can predict severity and extent of disease on SBCE.

Methods
Patients with newly diagnosed CD were recruited. Information on SBCE was recorded. Signs and symptoms at presentation, serological markers and histological classification of the disease in the duodenum were noted.

Results
Sixty patients with newly diagnosed CD (mean age: 44.9 years, SD: ±17.4, 17–76) were included in this study. Older patients (P = 0.025) and patients presenting with iron deficiency anaemia had more extensive small bowel (SB) involvement (25.7% vs. 13.5%; P = 0.026). Those with weight loss were more likely to have SB involvement beyond the duodenum (37.5% vs. 5.8%; P = 0.027). Patients presenting with iron deficiency anaemia (53.5 vs. 42.4 years; P = 0.038) and weight loss (60.5 vs. 42.4 years; P = 0.009) were significantly older at diagnosis. Serum albumin was lower in those patients diagnosed later on in life (Pearson correlation −0.0361; P = 0.007). There was no significant association between anti-tissue transglutaminase antibody (P = 0.396) and extent of affected SB mucosa. Patients with more severe Marsh scores on histology from the duodenal bulb had more extensive SB involvement (P = 0.017).

Conclusions
This is the largest study on the use of SBCE in newly diagnosed CD. Older patients are likely to have more extensive disease on SBCE at diagnosis. Symptoms and serology had no impact on the findings on SBCE apart from weight loss and iron deficiency anaemia.
Neurodevelopmental–behavioural paediatrics
Authors: McDowell Michael , Lesslie Jane 
Published: August 2019

Purpose of reviewNeurodevelopmental–behavioural paediatrics (NBP) is a field of medical practice that has arisen in response to recent changes in child health epidemiology. This review considers how the profession of NBP is addressing clinical need, and discusses possibilities for future development of the field.Recent findingsResearch publications relevant to NBP clinical practice focus primarily on cause (e.g. biology, imaging, neuropsychology), early detection, diagnostic methodologies and initial treatment strategies, with emphasis on psychotropic medication. Translation of this research implies that NBP clinical services should be undertaken using algorithmic methodologies, and evaluated against treatment attributable outcomes. These strategies and outcomes potentially define the central purpose of the profession; however, they may not be sufficient to best help the children seen.SummaryTwo sets of information inform and extend consideration of NBP purpose and strategy. Firstly, longitudinal and adult studies indicate that even with treatment, problems persist in adult life for a significant proportion of children with neurodevelopmental–behavioural disorders. Secondly, NBP clinical practice deals with significant, irreducible complexity and uncertainty, arising from both child-diagnostic and contextual factors. Complexity limits the extent to which evidence-based clinical algorithms are able to inform care. Suggestions for how to address both challenges are offered.
The Effects of Logotherapy on Distress, Depression, and Demoralization in Breast Cancer and Gynecological Cancer Patients
Authors: Sun Fan-Ko , Hung Chao-Ming , Yao YuChun , Fu Chi-Feng , Tsai Pei-Jung , Chiang Chun-Ying 
Published: August 2019

Background
Globally, cancer is the second leading cause of death. Breast cancer and gynecological cancer can damage patients’ body image and lead to psychological distress, depression, and demoralization syndrome. No studies have explored the effect of logotherapy in gynecological cancer patients’ psychological distress, depression, and demoralization.

Objective
To evaluate the effects of logotherapy on distress, depression, and demoralization in breast cancer and gynecological cancer patients.

Methods
A quasi-experimental design was used in this study, involving 61 breast cancer and gynecological cancer patients: 31 in the experimental group and 30 in the control group. Participants in the experimental group received logotherapy 4 to 6 times during the 12 weeks of intervention. Outcomes were measured by the (1) Distress Thermometer, (2) Patient Health Questionnaire, and (3) Demoralization Scale Mandarin Version (DS-MV).

Results
Distress Thermometer did not differ between groups, but significant differences in favor of the intervention group were noted in the Patient Health Questionnaire (U = 674.500, P = .002); the DS-MV subcategories of loss of meaning (U = 706.500, P = .000), dysphoria (U = 673.000, P = .002), disheartenment (U = 670.000, P = .003), helplessness (U = 621.000, P = .022), and sense of failure (U = 629.500, P = .016); and the total score of the DS-MV (U = 728.500, P = .000).

Conclusion
Logotherapy was effective in the reduction of breast cancer and gynecological cancer patients’ depression and demoralization.

Implications for Practice
Clinical professionals could add logotherapy to the treatment for breast cancer and gynecological cancer patients to reduce their depression and demoralization.
Adaptation of Quality of Life Measure for Limb Lymphedema–Arm in Turkish Women With Breast Cancer–Related Lymphedema
Authors: Karayurt Özgül , Deveci Zeynep , Eyigör Sibel , Özgür İnbat Menekse 
Published: August 2019

Background
Quality-of-life measures are needed for clinicians and researchers to identify quality of women’s life with breast cancer–related lymphedema (BCRL).

Objective
To adapt Quality of Life Measure for Limb Lymphedema–Arm into Turkish (TR) and to test its validity and reliability.

Methods
This is a methodological and cross-sectional study and was conducted in the lymphedema outpatient clinic of a university hospital. The study included 109 women with BCRL. After linguistic validity of the scale was achieved, confirmatory factor analyses and known group validity were used to test its construct validity. Reliability of the scale was tested with Cronbach’s α, item-total correlations, and Spearman-Brown coefficient.

Results
After linguistic validity was achieved, opinions requested from 5 experts specializing in lymphedema showed that item and content validity indexes of the scale were 1. Fit indexes of confirmatory factor analysis were as follows: χ
2/df = 1.86, root mean square error of approximation = 0.089, standardized root mean square residual = 0.09, and comparative fit index = 0.81. Known group validity analysis showed a significant difference in the mean scores for the subscales of Quality of Life Measure for Limb Lymphedema–Arm-TR, symptom, function, and body image/appearance in terms of lymphedema stages (P < .05). The internal reliability coefficients for the subscales ranged from 0.78 and 0.86. The item-total correlation coefficients ranged between 0.36 and 0.73.

Conclusion
Quality of Life Measure for Limb Lymphedema–Arm-TR was found to be valid and reliable in the TR population. It could be used in research to evaluate the quality of life in patients with BCRL.

Implications for Practice
The scale can be used to evaluate effectiveness of nursing interventions directed toward patients developing breast cancer–related lymphedema in clinical settings and studies.
Public Perceptions of Moral Insanity in the 19th Century
Authors: Hanganu-Bresch Cristina 
Published: August 2019

Abstract
The diagnosis of moral insanity was primarily used through the best part of the 19th century to define and justify the psychiatric treatment of a particular type of conduct in which the patient seemed otherwise rational but displayed certain inexplicable and undesirable behaviors deemed socially perverse or “unfit.” This article traces the history of this highly contested concept, which mirrors a historical arc in which psychiatry emerges as a discipline and stakes territorial claims on defining and regulating moral behavior. As illustration, I focus on the Hinchman Conspiracy Trial of 1849 as a less known case of wrongful confinement that hinged on proving the diagnosis of moral insanity in court. Moral insanity is a case study of the efforts to medicalize human ethical conduct, an effort starkly resisted by both the courts and the public. Some of the legacies of the term are the contemporary use of insanity as a legal defense, and the ability of patients to dispute psychiatric ward confinement orders in court.
Using an eLearning Module to Facilitate Sepsis Knowledge Acquisition Across Multiple Institutions and Learner Disciplines
Authors: Woods Jason M. , Scott Halden F. , Mullan Paul C. , Badolato Gia , Sestokas Jeff , Sarnacki Rachel , Wolff Margaret , Lane Roni , Dawson Emily , Kaplan Ron , Zaveri Pavan 
Published: August 2019

Objective
Guidelines exist for care of pediatric sepsis, but no study has assessed the benefit of electronic learning (eLearning) in this topic area. The objective of this multicenter study was to assess knowledge acquisition and retention for pediatric sepsis across multiple health care provider roles, using an adaptive and interactive eLearning module.

Methods
The study used pretest, posttest, and 90-day delayed test scores to evaluate provider knowledge after an adaptive and interactive eLearning module intervention. The eLearning module contained conditional logic-based assessments that allowed real-time adjustments of the displayed content according to each participant's demonstrated knowledge. Physicians, nurses, and advanced practice providers, primarily emergency department based, at 9 pediatric institutions were included. Changes in test scores were stratified by provider role.

Results
A total of 574 participants completed the posttest, and 296 (51.6%) of those completed the delayed test. Across all providers, there was an increase in test scores of 15.7% between the pretest and posttest (P < 0.001) with a large effect size as measured by Cramer's V. Across all providers, there was an overall test score increase of 5.2% (P < 0.001) between the pretest and delayed test, with a small effect size.

Conclusions
An eLearning module improved immediate and delayed pediatric sepsis knowledge in pediatric health care providers across multiple institutions and provider roles. Immediate knowledge gain was meaningful as indicated by effect sizes, although by the time of the delayed test, the effect was smaller. This module fills an important gap in currently available pediatric sepsis education.
Complications Associated With Electromyography
Authors: Cushman Daniel M. , Strenn Quinn , Elmer Andrew , Yang Aaron J. , Onofrei Ligia 
Published: August 2019

Objectives
The aims of the study were to systematically review the available literature concerning complications due to electromyography and to review those associated with nerve conduction studies.

Design
A systematic review was undertaken of Medline and Cochrane Central Register of Controlled Trials. Any complication related to clinical electromyography written in English was included, and all bibliographies were scanned for missed articles.

Results
A total of 27 articles fit the inclusion criteria, with two observational studies, and the rest case series or case studies; 42 patients were reported. Of these, 28 patients required hospitalization and 22 required surgery or a procedure, with zero deaths reported. Needle-related complications were the most prevalent (18 patients reported), with 17 related to pneumothoraces. Disorders of hemostasis were identified in 13 patients (many were asymptomatic) and cutaneous disorders were identified in 11 patients. Only one complication was identified in the narrative review related to nerve conduction studies.

Conclusions
This systematic review identified a variety of complications related to electromyography. Although the incidence of these occurrences cannot be elucidated from the case series and case study–predominant literature, adverse events seem to be rare but can cause significant morbidity. Electromyographers should be aware of all reported complications; this review outlines all reported occurrences that fit the inclusion criteria.
Topography of the Central Retinal Artery Relevant to Retrobulbar Reperfusion in Filler Complications
Authors: Lee Shin-Hyo , Ha Tae-Jun , Lee Je-Sung , Koh Ki-Seok , Song Wu-Chul 
Published: August 2019

Background:
Vision loss caused by retrograde occlusion of the central retinal artery is a serious complication of cosmetic filler injections. Salvage methods that involve applying hyaluronidases in the retrobulbar space to degrade filler materials have been proposed recently for rescuing the retinal circulation in an ophthalmic emergency.

Methods:
Sixty-six eyeballs and orbital contents were extracted from formalin-embalmed cadavers and dissected carefully to examine the topographic relationship of the central retinal artery and optic nerve. To observe the three-dimensional course of a central retinal artery that invaginates into the optic nerve, serial sections reconstructed at 100-μm intervals using software were visualized in 11 specimens.

Results:
The central retinal artery ramified from the ophthalmic artery and entered the optic nerve inferiorly at 8.7 ± 1.7 mm (mean ± SD) from the posterior margin of the eyeball. The intraneural course of a central retinal artery changed acutely between the periorbital environment of the fibrous optic nerve sheath, intermediate subarachnoid spaces, and center of the optic nerve stroma.

Conclusion:
When applying a retrobulbar approach for central retinal artery reperfusion with hyaluronidases, the reliable access route is suggested to be at a depth of 3.0 to 3.5 cm from the border of the inferolateral orbital rim, based on consideration of the entry point of the central retinal artery into the optic nerve.
Quantification of Head Shape from Three-Dimensional Photography for Presurgical and Postsurgical Evaluation of Craniosynostosis
Authors: Porras Antonio R. , Tu Liyun , Tsering Deki , Mantilla Esperanza , Oh Albert , Enquobahrie Andinet , Keating Robert , Rogers Gary F. , Linguraru Marius George 
Published: August 2019

Background:
Evaluation of surgical treatment for craniosynostosis is typically based on subjective visual assessment or simple clinical metrics of cranial shape that are prone to interobserver variability. Three-dimensional photography provides cheap and noninvasive information to assess surgical outcomes, but there are no clinical tools to analyze it. The authors aim to objectively and automatically quantify head shape from three-dimensional photography.

Methods:
The authors present an automatic method to quantify intuitive metrics of local head shape from three-dimensional photography using a normative statistical head shape model built from 201 subjects. The authors use these metrics together with a machine learning classifier to distinguish between patients with (n = 266) and without (n = 201) craniosynostosis (aged 0 to 6 years). The authors also use their algorithms to quantify objectively local surgical head shape improvements on 18 patients with presurgical and postsurgical three-dimensional photographs.

Results:
The authors’ methods detected craniosynostosis automatically with 94.74 percent sensitivity and 96.02 percent specificity. Within the data set of patients with craniosynostosis, the authors identified correctly the fused sutures with 99.51 percent sensitivity and 99.13 percent specificity. When the authors compared quantitatively the presurgical and postsurgical head shapes of patients with craniosynostosis, they obtained a significant reduction of head shape abnormalities (p < 0.05), in agreement with the treatment approach and the clinical observations.

Conclusions:
Quantitative head shape analysis and three-dimensional photography provide an accurate and objective tool to screen for head shape abnormalities at low cost and avoiding imaging with radiation and/or sedation. The authors’ automatic quantitative framework allows for the evaluation of surgical outcomes and has the potential to detect relapses.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, I.
Involvement of PDGF-BB and IGF-1 in Activation of Human Schwann Cells by Platelet-Rich Plasma
Authors: Sowa Yoshihiro , Kishida Tsunao , Tomita Koichi , Adachi Tetsuya , Numajiri Toshiaki , Mazda Osam 
Published: August 2019

Background:
Platelet-rich plasma contains high concentrations of growth factors that stimulate proliferation and migration of various cell types. Earlier experiments demonstrated that local platelet-rich plasma administration activates Schwann cells to improve axonal regeneration at a transected peripheral nerve lesion. However, the optimal concentration of human platelet-rich plasma for activation of human Schwann cells has not been determined, and mechanisms by which platelet-rich plasma activates Schwann cells remain to be clarified.

Methods:
Human Schwann cells were cultured with various concentrations of platelet-rich plasma in 5% fetal bovine serum/Dulbecco’s Modified Eagle Medium. Cell viability, microchemotaxis, flow cytometry, and quantitative real-time polymerase chain reaction assays were performed to assess proliferation, migration, cell cycle, and neurotrophic factor expression of the human Schwann cells, respectively. Human Schwann cells were co-cultured with neuronal cells to assess their capacity to induce neurite extension. Neutralizing antibodies for platelet-derived growth factor-BB (PDGF-BB) and insulin-like growth factor-1 (IGF-1) were added to the culture to estimate contribution of these cytokines to human Schwann cell stimulation by platelet-rich plasma.

Results:
An addition of platelet-rich plasma at 5% strongly elevated proliferation, migration, and neurotrophic factor production of human Schwann cells. Both PDGF-BB and IGF-1 may be involved in mitogenic effect of platelet-rich plasma on human Schwann cells, and PDGF-BB may also play an important role in the migration-inducing effect of platelet-rich plasma. Neutralization of both PDGF-BB and IGF-1 cancelled the promoting effect of platelet-rich plasma on neurite-inducing activity of human Schwann cells.

Conclusion:
This study may suggest the optimal concentration of platelet-rich plasma for human Schwann cell stimulation and potential mechanisms underlying the activation of human Schwann cells by platelet-rich plasma, which may be quite useful for platelet-rich plasma therapy for peripheral nerve regeneration.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Mechanical Signals Induce Dedifferentiation of Mature Adipocytes and Increase the Retention Rate of Fat Grafts
Authors: Ma Jingjing , Xia, M.D. Jing , Gao Jianhua , Lu Feng , Liao Yunjun 
Published: August 2019

Background:
Mature adipocytes dedifferentiate in vivo on application of a soft-tissue expander. Dedifferentiated adipocytes can proliferate and redifferentiate. This study used tissue expanders to pretreat adipose flaps, to increase the retention rate after fat graft.

Methods:
A soft-tissue expander and silicone sheet were implanted beneath the left and right inguinal fat pads of rats, respectively. After 7 days of expansion, the adipose tissue derived from the pads was transplanted beneath dorsal skin. Samples were harvested at various time points, and histologic, immunohistochemical, and gene expression analyses were conducted. Mature adipocytes were cultured in vitro under a pressure of 520 Pa. Changes in cell morphology, the cytoskeleton, and expression of mechanical signal–related proteins were investigated.

Results:
Pressure in adipose flaps increased to 25 kPa on expansion. Mature adipocytes dedifferentiated following expansion. At 1 week after transplantation, the expression of vascular endothelial growth factor (p < 0.05) was higher in the expanded group. The retention rate at 12 weeks after transplantation was higher in the expanded group (56 ± 3 percent) than in the control group (32 ± 3 percent) (p < 0.05), and the surviving/regenerating zones (p < 0.01) were wider. The lipid content of mature adipocytes gradually decreased on culture under increased pressure, and these cells regained a proliferative capacity. This was accompanied by increased expression of mechanical signal--related proteins (p < 0.05).

Conclusions:
Mechanical signals may induce dedifferentiation of mature adipocytes. Dedifferentiated adipocytes increase the retention rate of fat grafts by acting as seed cells.