bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Bisphosphonates on Bone Health in Adult Renal Transplant Patients: Beyond the First Year Posttransplant—A Systematic Review and Meta-Analysis
Authors: Lip Alyssa , Warias Ashley , Shamseddin M. Khaled , Thomson Benjamin , Wijeratne D. Thiwanka 
Published: June 2019

Background: Bone mineral density (BMD) decreases postrenal transplantation. Evidence demonstrating the effects of bisphosphonates on BMD and fracture risk beyond 1-year posttransplant is sparse in existing literature, but remains essential to enhance clinical outcomes in this population. Objective: Our study aimed to systematically review and meta-analyze the current literature on the use of any bisphosphonate in the adult renal transplant population beyond the first year of renal transplant to determine its effect on BMD and fracture incidence. Design: We conducted a systematic review and meta-analysis of primary research literature that included full-text, English-language, original randomized clinical trials (RCTs) and observational studies. Setting: Patient data were primarily captured in an outpatient setting across various studies. Patients: Our population of interest was patients older than 18 years who received deceased/living donor kidney transplantation and any bisphosphonate with a follow-up greater than 12 months posttransplantation. Measurements: The primary outcome was change in BMD from baseline. Secondary outcomes were the incidence of fractures and effects of other confounders on bone health. Methods: We included RCTs and observational studies that satisfied our inclusion criteria. Each study was analyzed for risk of bias and data were extrapolated to analyze for overall statistical significance accounting for heterogeneity of studies. Results: Sixteen studies (N = 1762) were analyzed. The follow-up ranged from 12 to 98 months. There was a nonsignificant improvement in BMD with bisphosphonate treatment persisting into the second and third years posttransplant at the lumbar spine. The calculated standardized mean BMD difference was −0.29 (−0.75 to 0.17), P = .22. Only 5 studies reported a total of 43 new fractures. Prednisone ( P < .01), low body weight ( P < .001), low body mass index ( P < .01), and male gender ( P < .05) correlated with reduced lumbar and femoral BMD. Limitations: Limitations of this review include the use of BMD as a surrogate outcome, the bias of the included studies, and the incomplete reporting data in numerous analyzed studies. Conclusions: We demonstrate no statistically significant benefit of bisphosphonate treatment on BMD beyond the first year postrenal transplantation. Despite heterogeneity of treatment, a differential nonsignificant improvement in lumbar spine BMD was consistent and may be clinically relevant. Trial Registration: PROSPERO CRD42019125593
No dynamic extrusion in medial meniscus root lesions - an ultrasound study
Authors: Karpinski Katrin , Petersen Wolf 
Published: June 2019

Aims and Objectives: Extrusion of the medial meniscus in MRI is an indirect radiological sign for a meniscus root tear. However, a recent study has shown that ultrasound-detectable dynamic extrusion is considered physiological in healthy volunteers. The aim of our study was to analyze the dynamic meniscal extrusion in patients with proven root injury in ultrasound. Our hypothesis was that dynamic extrusion is reduced in patients with root injury of the medial meniscus compared to healthy volunteers. Materials and Methods: Inclusion criteria for this prospective study were MRI signs for a root lesion of the medial meniscus (ghost sign, extrusion > 3 mm). An age matched group of healthy volunteers served as control. Exclusion criterion was osteoarthritis > II° of the medial compartment according to Kellgren & Lawrence. The extrusion of the medial meniscus (MME) of the affected knee was measured by ultrasound (US) in supine position and under full weight bearing. Results: 25 patients with a medial root lesion were included in the study. The evaluation of the ultrasound results revealed a significant decreased dynamic medial displacement of the meniscus in patients with root injury. In the supine position, the mean medial meniscus extrusion was 3.60 mm (± 1.00 mm). In the standing position, the mean medial meniscus extrusion increased to 3.72 mm (± 0.96 mm). The mean delta-extrusion was 0.11 mm (± 0.17 mm). This difference was statistically not significant. In 14 patients, no dynamic extrusion was detectable at all. All patients belonging to the medial root tear group had a significant varus deformity (mechanical axis hits the tibial joint line more than 15 mm medially form the center). In the control group, the mean medial meniscus extrusion was 1.34 mm (± 0.37 mm) in supine position and 2.20 mm (± 0.34 mm) under full weight bearing. The mean delta-extrusion was 0.85 mm (± 0.30 mm). The difference in mean delta-extrusion between the root tear and control group was statistically significant. Conclusion: Ultrasonography is a diagnostic tool to detect the dynamic extrusion of the medial meniscus. Lack of dynamic extrusion (“dead meniscus sign”) may serve as an indicator for medial root injury.
Clinical 2 years results after implantation of patient-specific mini-metal implants in middle-aged patients alfter previous frustrane cartilage surgery
Authors: Kösters Clemens , Glasbrenner Johannes , Raschke Michael J. 
Published: June 2019

Aims and Objectives: The treatment of focal (osteo-)chondral lesions of the knee in middle-aged patients with previous frustane cartilage regeneration is challenging. This prospective study presents clinical 2 years results after implantation of patient-specific mini-metal implants. Materials and Methods: Based on a three dimensional MRI planing 7 patient-specific mini-metal implants (Episealer, Episurf, Stockholm, Sweden) were produced for 4 patients (2 men, 2 women). In one patient a single implant was implanted to the trochlea, the other 3 patients received each a trochlea and a medial condyle implant. Corresponding cartilage lesions in the tibia plateau or retropatellar surface were excluded by a detailed specific MRI resulting in a so called “damage report”. MRI data was used to manufacture patient-specific implants and guide instruments, to fit the unique anatomy of each individual knee. Demographic, operative and clinical scores (VAS of pain and patient satisfaction, KOOS and Forgotten Joint Score) were collected preop and at 6 months, 1 and 2 years postoperatively. Results: Mean age was 51.5 (47-57) years. All patients had failed previous cartilage surgery. All mean KOOS domain scores were improved at 1 and 2 years. Mean preoperative aggregated KOOS (35) improved to 60 at 12 months and remained at 60 also at 24 months. Mean VAS score (pain) improved from 7.4 preoperatively to 2.1 at 24 months, mean VAS score (patient satisfaction) improved from 3.1 to 8.5 postoperatively at 24 months. The forgotten joint score reached a mean of 24 points. No revisions or complications were detected. Conclusion: Despite a very small patient number and leck of statistical power the new patient-spedific mini-metal implant seems to be a good options fort he treatment of middle-aged patients who already underwent frustane cartilage surgery. In these relatively rare caes early unicompartimental arthroplasty can be prevented. Further clinical studies with larger patient collectives have to prove the effectiveness of this new technique.
General, regional and combination anesthesia in knee arthroplasty: A multicenter cohort-study of 15326 cases analyzing patient satisfaction and perioperative pain management
Authors: Greimel Felix , Maderbach Günther , Baier Clemens , Keshmiri Armin , Schwarz Timo , Zeman Florian , Meissner Winfried , Grifka Joachim , Benditz Achim 
Published: June 2019

Aims and Objectives: In recent years, a steadily increasing number of total knee arthroplasty implants have been reported. After having ameliorated operation techniques and material, pain management and anesthetic methods have come into focus. Various anesthesia procedures for the surgical procedure itself as well as pain management programs have been developed. One of the main goals is to reduce postoperative pain and enable better and faster mobilization in the postoperative period. The present study aims to compare the use of general and regional anesthesia and their combination in terms of perioperative pain management and patient satisfaction. Materials and Methods: In the present cohort study, 15.326 patients were examined in 46 orthopedic departments after knee replacement surgery from 2009-2015. The parameters were analyzed on the first postoperative day as part of the project “QUIPS - Quality Improvement in Postoperative Pain Management”, an initiative to compare the outcome parameters in participating hospitals. Primary outcome values were pain levels (activity, minimum and maximum pain, and pain management satisfaction) on a NRS scale. Pain medication necessity was analyzed using the WHO pain ladder classification. Parameters were compared between the types of anesthesia used: general, regional and combination anesthesia. Results: Pain scores and pain management satisfaction were significantly better in the groups of either spinal or peripheral anesthesia combined with general anesthesia (p0.001, respectively). Patients who received the combination of general and spinal anesthesia were associated with the lowest need for opioids (p0.001). Conclusion: The use of a combined general and spinal anesthesia as well as using a combination of general and peripheral anesthesia in knee arthroplasty was associated with a highly significant advantage to other anesthetic techniques regarding perioperative pain management in daily clinical practice, but maybe below clinical relevance. Furthermore they were associated with positive tendency considering side effects and subjective well-being parameters.
The irreducible knee-luxation after low-velocity trauma
Authors: Fehske Kai , Jordan Martin , Meffert Rainer 
Published: June 2019

Aims and Objectives: Knee-luxations are severe and rare injuries. Within the last years there is an incline on low velocity trauma leading to a nee-luxation. The luxated knee should be reduced immediately to minimize collateral damage to soft-tissue structures, nerves, vessels, etc. Materials and Methods: We report about a 87-year old man who was brought to our emergency room after he fell out of his bed. He showed a to the lateral side luxated tibial-head, which could not be reduced in analog sedation. The foot pulses could be measured with the Doppler, the patient was under massive pain so we decided to perform an immediate operative intervention. Even under maximum relaxtion the knee stayed in medial luxation. Results: The open reposition showed the destruction of all medial structures including the subcutaneous fat. The medial condyle was completely uncovered. The sartorious fascia, the ruptured M. vastus medialis and fibres of the medial collateral ligament have been trapped in the medial tibial joint line. The reposition was made possible by incision of the sartorious fascia. The tibially ruptured acl was refixated in a modified canula technique, the medial structures were adapted with sutures and additionally stabilized with ligament bracing for the medial collateral ligament. Postoperatively, the knee was immobilized in an external fixation for two week. Afterward we started with functional rehabilitation. The postoperatively obtained CT-angiography showed now traumatic vascular damage. This case is completely foto-documented. Conclusion: The irreducible knee-luxations are rare complications. So far there are 4 cases published. In all cases there has been an interposition of the musculus vastus medialis an the surrounding structures. An immediate open intervenvtion to reposition the knee has to be performed to avoid severe damage to. Especially the elderly patient benefits from a single-staged procedure to reconstruct the ruptured ligaments. To realize the best outcome early functional rehabilitation under close supervision of the surgeon is necessary.
Cost Effectiveness of Multigene Panel Sequencing for Patients With Advanced Non–Small-Cell Lung Cancer
Authors: Steuten Lotte , Goulart Bernardo , Meropol Neal J. , Pritchard Daryl , Ramsey Scott D. 
Published: June 2019

PURPOSE Compared with single-marker genetic testing (SMGT), multigene panel sequencing (MGPS) has the potential to identify more patients with cancer who could benefit from targeted therapies, but the effects on outcome and total cost of care are uncertain. Our goal was to estimate the clinical and cost effectiveness of MGPS versus SMGT among patients with advanced non–small-cell lung cancer (aNSCLC). METHODS Patients with aNSCLC—stage IIIB or metastatic—who were diagnosed between 2011 and 2016 were identified from the Flatiron Health database. After stratifying patients into MGPS or SMGT cohorts, we analyzed the percentage of patients who received targeted treatment, survival, and total costs of care. SMGT included epidermal growth factor receptor ( EGFR) and anaplastic lymphoma kinase testing. MGPS also allowed for the detection of BRAF, RET, ROS1, HER2, and MET mutations. Cost data sources were the Centers for Medicare & Medicaid Services Fee Schedule and 2017 average sales price drug cost. We estimated the incremental cost-effectiveness ratio from a US payer perspective over a lifetime horizon using a decision model. RESULTS We identified 5,688 patients with aNSCLC who received MGPS (n = 875) or SMGT (n = 4,813), of which 22% tested positive for epidermal growth factor receptor (18.5% MGPS; 17.3% SMGT) or anaplastic lymphoma kinase (3.59% MGPS; 3.78% SMGT). Among MGPS-tested patients, an additional 8% were found to have BRAF, RET, ROS1, HER2, or MET mutations. Of MGPS-tested patients, 21% received treatments that were targeted to the specific mutations versus 19% with SMGT. Expected survival was 1.14 life years (LYs) in SMGT versus 1.20 LYs in MGPS. Lifetime total costs were $8,814 higher per patient for MGPS. The incremental cost-effectiveness ratio of MGPS versus SMGT was $148,478 per LY gained. CONCLUSION On the basis of data from a nationwide oncology patient database, MGPS is shown to have moderate cost effectiveness compared with SMGT in patients with aNSCLC.
Effect of Rifaximin Treatment on Endotoxemia and Insulin Sensitivity in Humans
Authors: Finlin Brian S , Zhu Beibei , Boyechko Tania , Westgate Philip M , Chia Chee W , Egan Josephine M , Kern Philip A 
Published: June 2019

Abstract

Context
The gut microbiome is a source of inflammatory factors such as lipopolysaccharide (LPS; endotoxin) that influence metabolic homeostasis. Rifaximin is a well-tolerated antibiotic that may reduce LPS.

Objective
We sought to develop a method to accurately assess postprandial endotoxemia and to determine whether rifaximin treatment improves metabolic homeostasis in obese humans with metabolic syndrome.

Design and Setting
Plasma LPS, adipose inflammation, glucose and lipid metabolism, and insulin sensitivity were evaluated in a clinical research setting.

Participants
Twelve obese human research participants with prediabetes or three features of metabolic syndrome participated.

Intervention
The research participants were randomized to placebo control or rifaximin soluble solid dispersion (80 mg/d) treatment groups and treated for 12 weeks.

Outcome Measures
We evaluated changes in insulin sensitivity with a euglycemic clamp; changes in lipid and glucose metabolism with oral lipid and glucose tolerance tests; changes in plasma LPS during the lipid tolerance test; and changes in adipose tissue and systemic inflammation by measuring inflammatory cytokines.

Results
Rifaximin treatment slightly worsened insulin sensitivity (P = 0.03), did not improve glucose or lipid homeostasis, and did not significantly improve adipose tissue inflammation. Our efforts to accurately assess plasma LPS using limulus amebocyte lysate assays revealed that the majority of LPS is masked from detection by limulus amebocyte lysate assays, but can be unmasked using a pretreatment step with protease. Unmasked LPS increases during the lipid tolerance test, but rifaximin treatment did not reduce this.

Conclusions
Rifaximin treatment did not lower plasma LPS or improve metabolic homeostasis in obese humans.
Evaluating mindfulness training for medical and PhD nursing students
Authors: Noble Helen , Reid Joanne , Walsh Ian K , Ellison Sharon E , McVeigh Clare 
Published: June 2019

Background: it is recognised that mindfulness training can positively impact holistic wellbeing and can improve mood, focus and resilience. Health service students often experience high levels of psychological morbidity. Engaging in mindfulness techniques may positively impact the psychological wellbeing of healthcare students. This is of vital importance to ensure optimum learning for healthcare practice with its associated challenges. Method: an evaluation was conducted with medical students (n=4) and PhD nursing students (n=6), who took part in a mindfulness-based workshop, followed by five weekly 30-minute sessions of mindfulness training, including a 15-minute meditation exercise. Data collection was carried out at baseline and post intervention, followed by a focus group discussion to elucidate qualitative experiences. Results: significant findings were identified with respect to cognitive mindfulness scores (P=0.02) and resilience (P=0.04). Discussion: data reflected three themes: the impact of mindfulness and maintaining practice, improvements in wellbeing, and improvements in academic endeavour. Conclusions: this evaluation found significant improvements in the ability to cope with stress and increased attention and resilience in all students. Although results are not generalisable in this small evaluation, students reported increased concentration levels and improved focus, both of which are likely to impact positively on any psychological symptoms, particularly those related to workload pressures.
Barriers to ideal palliative care in multiple care settings: the nurses' point of view
Authors: Uitdehaag Madeleen J , Stellato Rebecca K , Lugtig Peter , Olden Thirza , Teunissen Saskia 
Published: June 2019

Background: Nurses and certified nursing assistants (CNA) have a crucial role in 24/7 continuity of palliative care for many vulnerable patients and families, however, their perspective has been largely omitted in reported barriers to palliative care. Aim: To describe barriers to ideal palliative care that are specific to nurses and CNAs working in all care settings. Methods: A cross-sectional, online survey was distributed to members of the Dutch Nurses' Association. Findings: Almost 50% of the participating 2377 nurses and CNAs experienced more than five barriers to ideal palliative care in their work situation; nurses and CNAs employed in regional hospitals, mental healthcare and nursing home settings encountered more barriers than those working in other settings. Conclusion: The three most common barriers were: lack of proactive care planning, lack of internal consultation possibilities and lack of assessment of care recipients' preferences and needs for a seamless transition to another setting.
INDIVIDUALISMO E ALIENAÇÃO: CONDIÇÕES E CONTRADIÇÕES DO SER SOCIAL EM KARL MARX
Authors: Costa e Silva Patrícia 
Published: June 2019

Este artigo questiona as contradições da condição do ser social inerentes à nossasociedade capitalista que se produz por ocultação, a partir do recorte das determinações materiais de produção que constituíram o sujeito como classe, enquanto personificação de relações econômicas, sob a contradição entre capital e trabalho, o que relegou a antiga comunidade à sua dissolução na sociedade, bem como o sujeito a uma pulverização na forma de indivíduo. Sob uma condição de alienação, a valorização do indivíduo é estratégia que objetiva ocultá-lo enquanto pertencente a uma classe e, assim, aniquilá-lo enquanto sujeito, distanciando-o do desenvolvimento das suas potencialidades pessoais e sociais, enquanto sujeito de si e da história. Essa situação, no entanto, difere da condição primitivamente mais gregária dos homens e do ideal marxista de organização comunitária. Quanto mais se avança na história, mais individualizado, isolado e alienado o indivíduo se tornou, a fim de atender àsdemandas de domínio desta sociedade. Contudo, para Marx, a superação do atual estado das coisas será um movimento real e tendencial, como resultante das próprias premissas oferecidas por este sistema decadente.
MARX E A PROPRIEDADE
Authors: Moura Mauro Castelo Branco de 
Published: June 2019

A demonização do comunismo é um fenômeno que o acompanha desde sempre.Muito antes das fake news que se disseminam atualmente pelas redes sociais e, inclusive, pela grande imprensa, ou da política sistemática de repetição de calúnias contra alvos adredemente escolhidos fomentada por Goebbels, o mentor da propaganda nazista, e os comunistas já eram vítimas de campanhas de difamação cuidadosamente deliberadas. Em meio à Guerra Fria, porexemplo, parte da opinião pública foi persuadida de que os comunistas, estes seres satânicos, completamente avessos à democracia e ao “Mundo Livre” (e, por isso, legalmente proscritos no Brasil), dentre outras monstruosidades, dedicavam-se, dizia-se, a comer criancinhas... Nesta mesma direção, a relação dos comunistas com a propriedade privada sempre foi alvo, desde ostempos de Marx, das invectivas mais estapafúrdias de seus detratores, que trataram de disseminar a ideia, para anatematizar os incautos, de que os comunistas pretenderiam expropriar e coletivizar até os artigos de uso pessoal. No entanto, desde o Manifesto Comunista, Marx e Engels trataram de esclarecer que: “O que caracteriza o comunismo não é a abolição da propriedade em geral, mas a abolição da propriedade burguesa”. E, ao final do Livro I de suaobra maior, Marx retoma a temática concluindo que “o modo capitalista de produção e acumulação e, portanto, a propriedade privada capitalista exigem o aniquilamento da propriedade privada baseada no trabalho próprio, isto é, a expropriação do trabalhador”. Pretende-se, pois, modestamente, aqui, tão somente contribuir para o esclarecimento do que consiste esta “propriedade burguesa”.
NOTAS ESCLARECEDORAS SOBRE AS TESES DA PSICOLOGIA DE SCHOPENHAUER A PARTIR DA LEITURA DOS COMPLEMENTOS A O MUNDO COMO VONTADE E REPRESENTAÇÃO
Authors: Pedreira André Luiz Simões 
Published: June 2019

Nosso artigo pretendeu comentar as teses da psicologia de Schopenhauer, a saber, “a estrita distinção entre vontade e conhecimento e a primazia da primeira”, contidas nos Complementos ao Livro Quarto de O Mundo como Vontade e Representação, em seu capítulo 41, intitulado “Sobre a morte e sua relação com o caráter indestrutível de nosso ser em si.” O comentário visou apresentar algumas passagens dos Complementos que asseguram a distinção entre vontade e intelecto, no intuito de fornecer dados que evitem a confusão, a que muitos leitores de Schopenhauer são acometidos, ao confundirem a vontade com o seu fenômeno, asaber, a vontade humana.