bluuebunny/crossref_metadata_2025_split huggingface dataset:
The stromal cell-derived factor-1 α (SDF-1α)/cysteine-X-cysteine chemokine receptor 4 (CXCR4) axis: a possible prognostic indicator of acute ischemic stroke
Authors: Huang Xianjun , Wan Mei , Yang Qian , Ding Xianhui , Zhou Zhiming 
Published: February 2019

Objective The stromal cell-derived factor-1α/cysteine-X-cysteine chemokine receptor 4 (SDF-1α/CXCR4) axis promotes neuroprotection and angiogenesis in animal studies. Few studies have investigated the potential clinical implications of the SDF-1α/CXCR4 axis in patients with acute ischemic stroke (AIS). We evaluated the prognostic values of the SDF-1α/CXCR4 axis in patients with proximal middle cerebral artery occlusion. Methods Fifty-five patients and 18 age- and sex-matched volunteers were enrolled. Baseline clinical characteristics and risk factors of stroke were recorded. Peripheral whole blood cells were double stained with anti-CD34 and anti-CXCR4 (CD184). CD34+CXCR4+ cells were analyzed by flow cytometry. Plasma SDF-1α levels were measured by enzyme-linked immunosorbent assay. Results In the AIS group, plasma SDF-1α levels and the number of circulating CD34+CXCR4+ cells were significantly higher than those in controls. Day 1 SDF-1α levels were negatively correlated with infarct volume (r = −0.521) and the initial National Institutes of Health Stroke Scale score (r = −0.489). SDF-1α levels (day 1: r = −0.514; day 3: r = −0.275; day 7: r = −0.375) and circulating CD34+CXCR4+ cells (day 7: r = −0.282) were inversely associated with the 90-day modified Rankin Scale score. Conclusion The SDF-1α/CXCR4 axis has potential applications for predicting the clinical outcome of AIS.
Application of a Purified Protein From Natural Latex and the Influence of Suture Type on Achilles Tendon Repair in Rats
Authors: Cury Diego Pulzatto , Schäfer Bárbara Tavares , de Almeida Sonia Regina Yokomizo , Righetti Marta Maria da Silva , Watanabe Ii-sei 
Published: February 2019

Background: The prolonged tendon-healing process, the high costs associated with treatment, the increase in the number of injuries over the past decades, and the lack of consensus on the optimal treatment of tendon injuries are a global problem. Restoring the normal tendon anatomy and decreasing the healing time are key factors for treatment advancement. Hypothesis: Application of a purified protein from natural latex (PPNL) accelerates the healing process, increasing collagen synthesis and decreasing metalloproteinases. PPNL associated with a simpler suture technique should decrease the healing time. Study Design: Controlled laboratory study. Methods: Injury, surgery, and treatment with PPNL were conducted with male Sprague-Dawley rats. Two suture techniques were used: U-suture, a simpler and lesser traumatic technique, and Kessler-Tajima, to avoid strangulation of the microcirculation. Achilles tendons were completely sectioned, and 100 µL of 0.1% PPNL was applied on the tendon during surgery. Tendon morphology, distribution, and quantity of collagen types I and III, as well as expression of TIMP-1, TIMP-2, MMP-2, and MMP-9 and ultrastructural aspects of cells and collagen fibrils, were assessed after 2 and 4 weeks. Results: PPNL treatment improved collagen type I synthesis and reduced MMP-2 expression. All groups showed a 6.8-times increase in tendon weight as compared with the control group after 2 weeks and a 5.2-times increase after 4 weeks. All groups showed an increase in diameter after 4 weeks, except for the ones treated with PPNL, which showed a slight reduction in diameter. The peak of concentration of collagen fibrils with a 80-nm diameter was 27.79% in the control group; all other experimental groups presented fibrils between 50 and 60 nm. However, the best results were observed with Kessler-Tajima suture associated with PPNL. Conclusion/Clinical Relevance: There are no known medicines or substances capable of aiding the tendon healing process besides surgery. The discovery of a substance able to improve this process and decrease its duration represents an important advancement in orthopaedic medicine.
Off-label versus on-label prescribing of oral oncology agents on time to receipt of medication in patients with soft tissue sarcoma
Authors: Tran Victor , Latour Emile , Palumbo Alison 
Published: February 2019

Purpose Off-label prescribing of oral oncology agents has been explored in the treatment of soft tissue sarcoma. The time for a prior authorization approval or rejection for an off-label use can be lengthy. The purpose of this study is to capture this burden by comparing the time it takes for patients to receive off-label versus on-label treatment for their soft tissue sarcoma. Patients and methods In this retrospective chart review study, patients aged 18 and older who received a new prescription for an oral oncology agent for soft tissue sarcoma from one of three sarcoma providers at Oregon Health & Science University oncology clinics between March 2014 and February 2016 were included. Objectives included comparing the effect of off-label to on-label prescribing of oral oncology agents on time to receipt of medication and patient copays for a 30-day supply of oral chemotherapy agent(s). Results The time to receipt of medication (median (IQR)) for the off-label group (N = 26) was 12.5 (3.3 to 30.8) days compared to the on-label group (N = 29), which was 8.0 (4.0 to 15.0) days (p = 0.327). The patient cost was $0.00 ($0.00 to $20.00) for the off-label group (N = 18) compared to $3.00 ($0.00 to $68.80) for the on-label group (N = 18) (p = 0.467). Conclusions There were no differences in the time to receipt of medication or patient cost between off-label and on-label prescriptions in soft tissue sarcoma patients. Despite lack of statistical significance, these results are meaningful to patient care and require further study to investigate these findings.
Superior migration of the femoral head in patients with severe hip osteoarthritis influences the gait patterns of the coronal plane
Authors: Tazawa Masayuki , Kurosaki Minori , Inoue Tomotaka , Ibe Yoko , Kobayashi Hiroki , Kitagawa Takanori , Chikuda Hirotaka , Wada Naoki 
Published: February 2019

Introduction: Patients with hip osteoarthritis (OA) show abnormal movement patterns, including the leaning of the trunk toward the affected limb (Duchenne limp). Patients with severe OA, especially those with OA due to hip dysplasia, show a lateral pelvic drop (Trendelenburg sign). Aim: The aim of this preoperative study is to investigate the relationship between superior migration of the arthritic femoral head, pain, and hip abductor muscle strength, and to clarify the relationship between the coronal plane gait patterns with pain and hip abductor muscle strength. Methods: The subjects of this study were 18 patients with unilateral hip OA secondary to dysplasia. A radiographic analysis was performed on standardised anteroposterior pelvis films. The abductor muscle strength of the OA hip joint was measured with a handheld dynamometer. The tilt angle of the pelvis and trunk lean angle during gait were obtained using a 3-dimensional motion analysis system. Visual analogue scale (VAS) of pain was obtained after trial. Results: The 2 lateral pelvic angle patterns at the mid-stance of the affected limb during gait were detected. 1 is a pattern that was pelvic rise, and the other was a contralateral pelvic drop. Subjects with pelvic drop showed more superior femoral migration than that with pelvic rise (r = 0.69 p < 0.01). VAS of pain correlate significantly with coronal trunk angle on mid-stance of affected limb during gait (r = 0.761, p < 0.01). Conclusion: The pelvic drop Trendelenburg sign was influenced by superior migration of the femoral head, whereas the trunk lean Duchenne limp was found to be affected by pain.
Timely recognition of palliative care needs of patients with advanced chronic heart failure: a pilot study of a Dutch translation of the Needs Assessment Tool: Progressive Disease – Heart Failure (NAT:PD-HF)
Authors: Janssen Daisy JA , Boyne Josiane , Currow David C , Schols Jos MGA , Johnson Miriam J , La Rocca H-P Brunner- 
Published: February 2019

Background: The Needs Assessment Tool: Progressive Disease – Heart Failure (NAT:PD-HF) was developed to identify and triage palliative care needs in patients with chronic heart failure. A Dutch version is currently lacking. Aims: The aim of this study was to investigate the feasibility and acceptability of a Dutch NAT:PD-HF in chronic heart failure outpatients; and to gain preliminary data regarding the effect of the NAT:PD-HF on palliative care referral, symptoms, health status, care dependency, caregiver burden and advance directives. Methods: A mixed methods study including 23 outpatients with advanced chronic heart failure and 20 family caregivers was performed. Nurses conducted patient consultations using a Dutch translation of the NAT:PD-HF and rated acceptability. Before this visit and 4 months later, symptoms, health status, performance status, care dependency, caregiver burden and recorded advance directives were assessed. A focus group with participating nurses discussed barriers and facilitators towards palliative care needs assessment. Results: Acceptability was rated as 7 (interquartile range 6–7 points) on a 10-point scale. All patients had palliative care needs. In 48% actions were taken, including two patients referred to palliative care. Symptoms, performance status, care dependency, caregiver burden and advance directives were unchanged at 4 months, while health status deteriorated in patients completing follow-up ( n=17). Barriers towards palliative care needs assessment included feeling uncomfortable to initiate discussions and concerns about the ability to address palliative care needs. Conclusions: The NAT:PD-HF identified palliative care needs in all participants, and triggered action to address these in half. However, training in palliative care communication skills as well as palliative care interventions should accompany the introduction of a palliative care needs assessment tool. Netherlands National Trial Register (NTR): 5616. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5616
Management of oral anticoagulation after intracerebral hemorrhage
Authors: Kuramatsu Joji B , Huttner Hagen B 
Published: February 2019

Background The most recent years have significantly expanded knowledge regarding risks and benefits of resuming oral anticoagulation (OAC) after intracerebral hemorrhage (ICH). No randomized data is yet available, though several large observational studies and meta-analyses have investigated the impact of resuming OAC on thromboembolic versus hemorrhagic complications in these high-risk patients after ICH. Aims The present review will summarize the most important studies conducted over the last years and will focus on relevant factors help guiding on decision-making on whether to start OAC after ICH. Summary of review Several important factors (demographic, co-morbidities, clinical characteristics) need to be considered before individual decision-making for or against OAC is employed. Existing observational data suggest that patients after ICH with indication for long-term oral anticoagulation benefit from OAC given significant reductions of thromboembolic events without significantly increasing bleeding complications. Studies even suggest that thereby also clinical outcomes may be improved. Prospective trials currently recruiting patients will clarify whether OAC after ICH – or left atrial appendage closure as a meaningful alternative – is of clinical net-benefit. Conclusions Large sized and well-executed investigations (moderate quality of evidence) are showing that OAC resumption after ICH decreases thromboembolic complications and long-term mortality without significantly increasing bleeding complications. Further, data suggest that resumption may be safer in non-lobar ICH compared to lobar ICH, but overall, thoughtful selection, strict blood pressure control, and precise communication are paramount before starting a patient on OAC after ICH.
Effects of Antibiotics on α-Toxin Levels during Staphylococcus aureus Culture: Implications for the Protection of Chondrocytes in a Model of Septic Arthritis
Authors: Miller Robbie P. , Berlouis Marie E. , Hall Alan G. , Simpson A. Hamish R.W. , Smith Innes D. M. , Hall Andrew C. 
Published: February 2019

Objective Septic arthritis results from joint infection by Staphylococcus aureus, which produces potent α-toxin causing cell death, potentially leading to permanent cartilage damage. Treatment is by joint irrigation and antibiotics, although it is unclear if, following treatment with antibiotics which cause bacterial lysis, there is release of additional stored α-toxin. Design A rabbit erythrocyte hemolysis assay was optimised to assess biologically-active α-toxin from cultured S. aureus α-toxin strain DU5946. Hemoglobin release was measured spectrophotometrically following addition of a bacteriostatic antibiotic (linezolid) or a bacteriolytic antibiotic (penicillin). A bovine cartilage model of septic arthritis was used to test the protective effects of antibiotics against S. aureus infection. Results During S. aureus culture, α-toxin levels increased rapidly but the rate of rise was quickly (within 20 minutes) suppressed by linezolid (25 μg/mL). Penicillin also reduced the increase in α-toxin levels; however, the time course was relatively slow compared to linezolid even at high concentrations (50,000 U/mL). The efficacy of penicillin (250,000 U/mL) at reducing the rise in α-toxin was approximately 8% less than that of linezolid ( P < 0.05) suggesting the presence of additional toxin. This could be due to a delayed action of penicillin, and/or release of a small pool of stored α-toxin from dying bacteria. In a bovine cartilage model, however, there was no difference between the protection of in situ chondrocytes against S. aureus by penicillin or linezolid ( P > 0.05). Conclusion The results suggested that equally effective protection of chondrocytes against S. aureus septic arthritis may be obtained by the bacteriostatic or bacteriolytic antibiotics tested.
Estimated age based on exercise stress testing performance outperforms chronological age in predicting mortality
Authors: Harb Serge C , Cremer Paul C , Wu Yuping , Xu Bo , Cho Leslie , Menon Venu , Jaber Wael A 
Published: February 2019

Abstract

Aims
We sought to estimate patients' age based on their stress testing exercise performance (A-BEST), and evaluate whether A-BEST would be a better predictor of mortality when compared to chronological age.

Methods
We included 126,356 consecutive patients referred for exercise (electrocardiography, echocardiography or myocardial perfusion imaging) stress testing at our institution from January 1st, 1991 to February 27th, 2015. Estimated age was computed based on exercise capacity (number of peak estimated metabolic equivalents of task), chronotropic reserve index and heart rate recovery, taking into account patient's gender and medications that affect heart rate. Uni and multivariable Cox models were used to determine the association of A-BEST with mortality. Improvement in predicting mortality using A-BEST compared to chronological age was evaluated with the use of net reclassification improvement and C statistic.

Results
Mean age was 53.5 ± 12.6 years and 59% were men. At follow-up (mean duration was 8.7 years), 9929 (8%) died. After adjustment for clinical comorbidities, higher metabolic equivalents of task (adjusted hazard ratio (HR) for mortality 0.71, 95% confidence interval (CI) 0.70–0.72, P &lt; 0.001) and higher chronotropic reserve index (adjusted HR for mortality 0.97, 95% CI 0.96–0.99, P = 0.0135) were associated with improved survival, whereas abnormal heart rate recovery (adjusted HR for mortality 1.53, 95% CI 1.46–1.61, P &lt; 0.001) and higher A-BEST (adjusted HR for mortality 1.05, 95% CI 1.04–1.05, P &lt; 0.001) were associated with higher mortality. When comparing prediction models using A-BEST versus chronological age, a significant increase in the area under the curve was demonstrated if A-BEST was used (0.82 vs. 0.79, P &lt; 0.001). The overall net reclassification improvement was 0.30 (P &lt; 0.001).

Conclusion
Estimated age based on exercise stress testing performance is a better predictor of mortality when compared to chronological age.
Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation
Authors: Wurdeman Shane R , Stevens Phillip M , Campbell James H 
Published: February 2019

Introduction Diabetes and vascular disease represent the most common etiologies for lower limb amputations. In lower limb loss rehabilitation, the prosthetic ankle-foot mechanism is the most common major component needed to restore function. The purpose of this study was to examine the impact of five common prosthetic ankle-foot mechanisms on functional mobility in a large sample of individuals with amputation due to diabetes/dysvascular disease. Methods A retrospective analysis of the Prosthetic Limb Users' Survey of Mobility (PLUS-M®) captured in the patient care setting. A total of 738 individuals were included and subsequently subdivided into five groups based on the ankle-foot mechanism of their current prosthesis. Groups were compared using a general linear univariate model with age, body mass index, comorbid health status, time since amputation, and amputation level entered as covariates. Results The microprocessor ankle-foot group had the highest mobility (F4,728 = 3.845, p=0.004), which was followed by the vertical loading pylon type ankle-foot, the hydraulic ankle-foot, the flex-walk-type ankle-foot, and lastly the flex-foot-type ankle-foot. Conclusion These results demonstrate that the selection of different prosthetic ankle-foot technology directly impacts functional mobility for the patient with an amputation due to diabetes and/or vascular disease.
Visual analytics for collaborative human-machine confidence in human-centric active learning tasks
Authors: Legg Phil , Smith Jim , Downing Alexander 
Published: February 2019

AbstractActive machine learning is a human-centric paradigm that leverages a small labelled dataset to build an initial weak classifier, that can then be improved over time through human-machine collaboration. As new unlabelled samples are observed, the machine can either provide a prediction, or query a human ‘oracle’ when the machine is not confident in its prediction. Of course, just as the machine may lack confidence, the same can also be true of a human ‘oracle’: humans are not all-knowing, untiring oracles. A human’s ability to provide an accurate and confident response will often vary between queries, according to the duration of the current interaction, their level of engagement with the system, and the difficulty of the labelling task. This poses an important question of how uncertainty can be expressed and accounted for in a human-machine collaboration. In short, how can we facilitate a mutually-transparent collaboration between two uncertain actors—a person and a machine—that leads to an improved outcome? In this work, we demonstrate the benefit of human-machine collaboration within the process of active learning, where limited data samples are available or where labelling costs are high. To achieve this, we developed a visual analytics tool for active learning that promotes transparency, inspection, understanding and trust, of the learning process through human-machine collaboration. Fundamental to the notion of confidence, both parties can report their level of confidence during active learning tasks using the tool, such that this can be used to inform learning. Human confidence of labels can be accounted for by the machine, the machine can query for samples based on confidence measures, and the machine can report confidence of current predictions to the human, to further the trust and transparency between the collaborative parties. In particular, we find that this can improve the robustness of the classifier when incorrect sample labels are provided, due to unconfidence or fatigue. Reported confidences can also better inform human-machine sample selection in collaborative sampling. Our experimentation compares the impact of different selection strategies for acquiring samples: machine-driven, human-driven, and collaborative selection. We demonstrate how a collaborative approach can improve trust in the model robustness, achieving high accuracy and low user correction, with only limited data sample selections.
Engagement in HIV Care and Access to Cancer Treatment Among Patients With HIV-Associated Malignancies in Uganda
Authors: Low Daniel H. , Phipps Warren , Orem Jackson , Casper Corey , Bender Ignacio Rachel A 
Published: February 2019

PURPOSE Health system constraints limit access to HIV and cancer treatment programs in sub-Saharan Africa. Limited access and continuity of care affect morbidity and mortality of patients with cancer and HIV. We assessed barriers in the care cascade of comorbid HIV and cancer. PATIENTS AND METHODS Structured interviews were conducted with 100 adult patients with HIV infection and new diagnoses of cancer at the Uganda Cancer Institute. Participants completed follow-up questionnaires after 1 year to assess ongoing engagement with and barriers to care. RESULTS The median time from new-onset cancer symptoms to initiation of cancer care at the Uganda Cancer Institute was 209 days (interquartile range, 113 to 384 days). Persons previously established in HIV care waited less overall to initiate cancer care ( P = .04). Patients established in HIV care experienced shorter times from initial symptoms to seeking of cancer care ( P = .02) and from seeking of care to cancer diagnosis ( P = .048). Barriers to receiving care for HIV and cancer included difficulty traveling to multiple clinics/hospitals (46%), conflicts between HIV and cancer appointments (23%), prohibitive costs (21%), and difficulty adhering to medications (15%). Reporting of any barriers to care was associated with premature discontinuation of cancer treatment ( P = .003). CONCLUSION Patients with HIV-associated malignancies reported multiple barriers to receiving care for both conditions, although knowledge of HIV status and engagement in HIV care before presentation with malignancy reduced subsequent time to the start of cancer treatment. This study provides evidence to support creation and evaluation of integrated HIV and cancer care models.