bluuebunny/crossref_metadata_2025_split huggingface dataset:
Femoral malalignment after gamma nail insertion in the lateral decubitus position
Authors: Abubeih Hossam M.A. , Farouk Osama , Abdelnasser Mohammad Kamal , Eisa Amr Atef , Said Galal Zaki , El-adly Wael 
Published: July 2018

Introduction: Insertion of gamma nail with the patient in lateral decubitus position have the advantages of easier access to the entry point, easier fracture reduction and easier implant positioning. Our study described the incidence of femoral angular and rotational deformity following gamma nail insertion in lateral decubitus position.Methods: In a prospective clinical case series, 31 patients (26 males and 5 females; the average age of 42.6 years) with 31 proximal femoral shaft fractures that were treated with gamma IMN were included in our study. Postoperatively, computerized tomography scans of the pelvis and both knees (injured and uninjured sides) were examined to measure anteversion angles on both sides. A scout film of the pelvis and upper both femurs was taken to compare the neck shaft angles on both sides.Results: No angular malalignment was detected in our series; the mean angular malalignment angle was 1.6 ± 1.5°. There was a high incidence of true rotational malalignment of ≥10° in 16 out of 31 patients (51.6%); most of them were external rotational malalignment. Younger age group (≤40 years) had significantly more incidence of rotational malalignment (≥10°) than older age group (>40 years) (P-value 0.019).Discussion: Gamma nail fixation in lateral decubitus position without the fracture table gives an accurate and easier access to the entry point, good implant positioning with no or minimal angular malalignment (varus −valgus) but poses high incidence of true rotational malalignment. Great care and awareness of rotation should be exercised during fixing proximal femoral fractures in lateral decubitus position.
Diagnostik und Therapie der Immunthrombozytopenie
Authors: Matzdorff Axel , Wörmann Bernhard 
Published: July 2018

Was ist neu?
Ursachen Die Ursachen der Immunthrombozytopenie (ITP) sind sehr vielfältig. Eine ITP liegt gemäß der aktuellen Definition nur vor, wenn die Thrombozyten wiederholt unter 100 × 109/l liegen.
Klinisches Bild Die Blutungsneigung bei einer ITP ist geringer als bei Patienten mit einer vergleichbaren Thrombozytopenie anderer Ursache.
Diagnostik Die ITP ist eine Ausschlussdiagnose. Es gibt keinen Labortest und keine Untersuchung, die eine ITP „beweist“.
Stadieneinteilung und Therapieziele Die neue Einteilung der ITP in 3 Stadien hat die traditionelle Einteilung in „akut“ und „chronisch“ abgelöst.
Thrombozyten-Schwellenwert Die Indikationsstellung zur Therapie richtet sich nicht allein nach der Thrombozytenzahl, sondern berücksichtigt weitere individuelle Patientenfaktoren.
Therapie Arzneimittel der Wahl in der Erstlinientherapie sind Predniso(lo)n oder Dexamethason. Bei lebensbedrohlichen Blutungen ist die zusätzliche Gabe von Thrombozyten-Konzentraten indiziert. Die wirksamsten Zweitlinientherapien sind die Gabe von Thrombopoetin-Rezeptor-Agonisten oder die Splenektomie. In der Drittlinientherapie werden Präparate auch „off-label“ empfohlen.
Operationen und Zahneingriffe Vor invasiven Eingriffen sollte präoperativ eine Anhebung der Thrombozyten-Zahl erreicht werden. Eine Anhebung in den Normbereich ist nicht erforderlich.
Akute Nierenschädigung – Update 2018
Authors: Patschan Daniel , Müller Gerhard 
Published: July 2018

Was ist neu?
Prophylaxe der KM-induzierten akuten Nierenschädigung (AKI) (Kontrastmittelnephropathie, KMNP) Eine im November 2017 hochrangig publizierte Studie zeigt, dass die Anwendung von Natriumbikarbonat der Gabe von Natriumchlorid zur Prävention der Kontrastmittelnephropathie nicht überlegen ist.
SGLT-2-Antagonisten und AKI SGLT-2-Antagonisten entfalten mutmaßlich protektive Effekte hinsichtlich einer CKD (chronic kidney disease). Neuere Beobachtungen lassen vermuten, dass bei behandelten Patienten ein höheres Risiko für die akute Nierenschädigung besteht.
Zellbasierte Therapien der AKI Zellbasierte Therapieansätze der AKI sind in den letzten Jahren v. a. unter experimentellen Bedingungen evaluiert worden. Erste humane Studien mit mesenchymalen Stammzellen werden derzeit durchgeführt. Die Umsetzung zellbasierter Therapien bei humaner AKI ist allerdings noch mit zahlreichen Schwierigkeiten verbunden.
Pankreaskarzinom 2018 – reif für personalisierte Therapiekonzepte?
Authors: Simon Ole , Beyer Georg , Mahajan Ujjwal , Mayerle Julia 
Published: July 2018

Was ist neu?
Epidemiologie In Deutschland werden im Jahr 2018 schätzungsweise 19 000 Menschen an einem Pankreaskarzinom erkranken. Die 5-Jahres-Überlebensrate (5-JÜR) aller Pankreaskarzinompatienten liegt mit rund 6 % sehr niedrig und die potenziell kurative Operation ist nur bei 15 – 20 % der Erkrankten möglich. Durch häufigeren Einsatz und Kombination systemischer Chemotherapeutika konnte in den letzten Jahren eine verbesserte Lebenserwartung erreicht werden.
Resektables Stadium Nach vollständiger operativer Resektion eines Pankreaskarzinoms trägt eine adjuvante Chemotherapie zur Verlängerung des Gesamtüberlebens bei. Mittel der Wahl sind Gemcitabin oder 5-Fluorouracil (5-FU) und Folinsäure (FS). Kürzlich konnte für die Kombination aus Gemcitabin und Capecitabin (Gem-Cap) eine signifikante Verlängerung des Gesamtüberlebens im Vergleich zur Gemcitabin-Monotherapie gezeigt werden. Für den Einsatz einer adjuvanten Radiochemotherapie gibt es derzeit keine Empfehlung.
Borderline-resektables Stadium Eine neoadjuvante Therapie hat bei Pankreaskarzinomen außerhalb klinischer Studien keinen Stellenwert. Eine Ausnahme stellen borderline-resektable Pankreaskarzinome dar.
Fortgeschrittenes Stadium (M1) Patienten mit fortgeschrittenem oder metastasiertem Pankreaskarzinom profitieren von einer Chemotherapie. Für Patienten mit gutem ECOG-Status konnte kürzlich in 2 Phase-III-Studien eine signifikante Lebenszeitverlängerung durch die Kombination aus Gemcitabin plus nab-Paclitaxel (Gem-Nab) sowie durch das Kombinationsschema aus Folinsäure, 5-FU, Irinotecan und Oxaliplatin (FOLFIRINOX) gezeigt werden. In der Zweitlinie steht nanoliposomales Irinotecan oder Oxaliplatin kombiniert mit 5FU/FS (OFF) zur Verfügung.
Personalisierte Therapien Die molekulare Charakterisierung des Pankreaskarzinoms hat Fortschritte gemacht und bietet schon heute Ansätze zur personalisierten Medizin. Bei gutem ECOG-Status sollte vor Zweitlinientherapie eine MSI-H/dMMR-Analyse erfolgen, um den möglichen Einsatz einer Checkpoint-Inhibitor-Therapie zu evaluieren. Bei BRCA-Mutationen kann die Gabe von PARP-Inhibitoren vielversprechend sein.
Fibromyalgie-Syndrom: Aktuelle Empfehlungen zu Diagnostik und Therapie
Authors: Krasselt Marco , Baerwald Christoph 
Published: July 2018

Was ist neu?Die Therapie des Fibromyalgie-Syndroms (FMS) fußt auf einer Stärkung des Patienten hinsichtlich körperlicher Bewegung, physiotherapeutischen Maßnahmen und Krankheitsbewältigungsstrategien. Dieser Artikel thematisiert neben den aktuellen, leitliniengestützten Konzepten auch neue therapeutische Ansätze und pathophysiologische Überlegungen.
Pathophysiologische Aspekte Das biopsychosoziale Krankheitsmodell hat weiterhin Gültigkeit. Das FMS wird als „Endzustand“ infolge verschiedener ätiologischer Faktoren und pathophysiologischer Mechanismen verstanden. In den letzten Jahren wurde eine „small fiber“-Pathologie diskutiert, ebenso wie der potenziell negative Einfluss eines hohen Fruktose-Konsums auf den Serotoninstoffwechsel.
Diagnostik Die Diagnosekriterien wurden 2016 leicht modifiziert, die deutsche Leitlinie erfuhr ihr letztes Update 2017. Kernsymptome sind ein generalisierter Schmerz sowie Schlafstörungen und Fatigue. Das FMS kann begleitend zu anderen Erkrankungen vorkommen. Wichtig ist dennoch ein Ausschluss organischer Ursachen.
Therapie Im Vordergrund stehen körperliche Aktivierung und symptomorientierte Maßnahmen. Eine primäre medikamentöse Therapie wird nicht empfohlen, insbesondere NSAR oder Opiate sollten nicht zum Einsatz kommen. Bei schweren Verläufen sollte eine multimodale Behandlung erfolgen. Neue medikamentöse Therapien sind noch weit vom klinischen Einsatz entfernt.
The Enhanced Cytotoxic Effects of the p28-Apoptin Chimeric Protein As A Novel Anti-Cancer Agent on Breast Cancer Cell Lines
Authors: Noei Ahmad , Nili-Ahmadabadi Amir , Soleimani Meysam 
Published: July 2018

Abstract
Backgrounds Peptide-based drugs have shown promising results in overcoming the limitations of chemotherapeutic drugs by providing a targeted therapy approach to cancer. However, the response rate of targeted therapies is limited, in large part due to the intra- and inter-heterogeneity of tumors.
Methods In this study, we engineered a novel chimeric protein composed of the p28 peptide as a tumor-homing killer peptide and apoptin as a killer peptide. We evaluated its cytotoxicity against MCF7 and MDA-MB-231 breast cancer cells and HEK-293 normal cells by the MTT assay. Different linkers were evaluated when designing the chimeric protein. Three-dimensional structure predictions of chimeric proteins with different linkers were carried out by Modeller 9.19, and their validation and analysis were performed by RAMPAGE.
Results Results showed that a cleavable linker, including furin cleavage sites, is preferred over other linkers. The chimeric protein was then successfully expressed in E. coli and purified by affinity chromatography under native conditions, then confirmed by SDS-PAGE and Western blot analysis. Compared with apoptin alone, the chimeric protein showed significantly higher toxicity against breast cancer cell lines in a dose-dependent manner. The IC50 values of the chimeric protein for MCF7 and MDA-MB-231 cells were 38.55 µg/mL and 43.11 µg/mL, respectively. There was no significant cytotoxic effect on the normal HEK293 cell line.
Conclusion This study demonstrates that fusion of p28 peptide to a potent protein could provide an effective method for tumor targeting. Further, in vitro and in vivo studies of this novel chimeric protein are underway.
Pleiotropic Effects of Melatonin
Authors: Mahmood Danish 
Published: July 2018

AbstractMelatonin’s pleiotropic actions begin from controlling day/night cycle and hypothalamic/pituitary axes to, for example, vasomotor effects, immunomodulation, antilipid effects, modulation of endocrine functions, direct and indirect antiapoptotic effects, interference with nitric oxide signaling, other antiexcitatory actions through ion channels and neurotransmitter systems, and most prominently the antioxidant activities which include expression of genes relevant to redox metabolism, including modulation of mitochondrial electron flux. Because of ubiquitous nature of the melatonin receptor, melatonin serves as pleiotropic molecule and its multiplicity of action goes beyond the established antioxidant activities. Melatonin exhibits pleiotropic effects essentially through four different mechanisms: binding to membrane receptors; nuclear receptors; intracellular proteins, and a receptor-independent radical scavenging function. The present review highlights some of the important pleiotropic effects of melatonin in human body.
Treatment Options for Insomnia in Schizophrenia: A Systematic Review
Authors: Oliveira Pedro , Coroa Manuel , Madeira Nuno 
Published: July 2018

Abstract
Background Insomnia is a common feature of schizophrenia. Although several studies have been published about the influence of certain drugs on schizophrenia patients’ sleep, there are no well-grounded recommendations about insomnia treatment in this clinical setting. The present review aimed to identify relevant empirical evidence on available treatments of insomnia in patients with schizophrenia, assessing their safety and efficacy.
Methods This is a systematic review of clinical trials investigating the effect of treatments for insomnia in patients with a diagnosis of schizophrenia. Data were obtained from Medline/PubMed, Embase, PsycInfo, and the Cochrane Library. Risk of bias was assessed in individual studies for selection, performance, detection, attrition, and reporting bias.
Results Four studies met inclusion criteria; 2 using melatonin, 1 using paliperidone, and 1 with eszopiclone. All reported positive results: melatonin increased sleep efficiency and total duration of sleep; paliperidone decreased sleep latency onset and increased total sleep time and sleep efficiency; eszopiclone decreased insomnia severity index.
Conclusions Despite a very limited number of specific studies on this matter, all 4 studies have shown good benefit/risk ratios and reviewed options—melatonin, paliperidone, and eszopiclone—might represent valid options for residual insomnia in schizophrenia.
Tissue Factor Pathway Inhibitor Inhibits Aortic Smooth Muscle Cell Migration Induced by Tissue Factor/Factor VIIa Complex
Authors: Sato Yuichiro , Asada Yujiro , Marutsuka Kousuke , Hatakeyama Kinta , Kamikubo Yuichi , Sumiyoshi Akinobu 
Published: July 2018

SummaryTissue factor (TF), a transmembrane glycoprotein, forms a high affinity complex with factor Vll/VIIa (FVIIa) and thereby initiates blood coagulation. Tissue factor pathway inhibitor (TFPI) is an endogenous protease inhibitor of TF/FVIIa-initiated coagulation. We previously reported that TF was a strong chemotactic factor for cultured vascular smooth muscle cells (SMCs). In this study, we examined the contribution of FVIIa and the effect of TFPI to TF-induced cultured SMC migration. TF/FVIIa complex showed a strong migration ability, however, neither TF alone nor FVIIa induced SMC migration. TF/FVIIa treated by a serine protease inhibitor and the complex of TF and inactivated FVIIa (DEGR-FVIIa) did not stimulate SMC migration. Pretreatment with hirudin and the antibodies to a-thrombin and factor X had no effect on TF/FVIIa-induced SMC migration, although a-thrombin and factor Xa also induced SMC migration respectively. TFPI markedly inhibited TF/FVIIa-induced SMC migration in a concentration-dependent manner, but did not affect the SMC migration induced by platelet-derived growth factor (PDGF)-BB, basic fibro blast-growth factor (bFGF), or a-thrombin. These results indicate that the catalytic activity of TF/FVIIa complex is important on SMC migration, and TFPI can reduce SMC migration as well as thrombosis.
Co-inheritance of the 20210A Allele of the Prothrombin Gene Increases the Risk of Thrombosis in Subjects with Familial Thrombophilia
Authors: Makris M , Preston F E , Beauchamp N J , Cooper P C , Daly M E , Hampton K K , Bayliss P , Peake I R , Miller G J 
Published: July 2018

SummaryThe presence of the 20210A allele of the prothrombin (PT) gene has recently been shown to be a risk factor for venous thromboembolism. This is probably mediated through increased plasma prothrombin levels. The aim of this study was to compare the prevalence of the prothrombin 20210A allele in control subjects and in subjects with recognised thrombophilia and to establish whether the additional inheritance of the PT 20210A allele is associated with an increased risk of venous thromboembolism. 101 subjects with a history of venous thromboembolism and diagnosed as having either factor V Leiden (R506Q) or heritable deficiencies of protein C, protein S or antithrombin were studied. The prevalence of the PT 20210A allele in this group was compared with the results obtained for 150 control subjects. In addition, the relationships were examined between genetic status and the number of documented thromboembolic episodes, and between plasma prothrombin levels and possession of the PT 20210A allele. 8 (7.9%) of the 101 patients were also heterozygous for the PT 20210A allele. This compares with 0.7% in the control subjects (p = 0.005). After exclusion of patients on warfarin, the mean plasma prothrombin of 113 subjects without 20210A was 1.09 U/ml, as compared with 1.32 U/ml in 8 with the allele (p = 0.0002). Among the 101 patients with either factor V Leiden, protein S deficiency, protein C deficiency or antithrombin deficiency, the age adjusted mean (SD) number of venous thromboembolic episodes at diagnosis was 3.7 (1.5) in those with the PT 20210A allele, as compared with 1.9 (1.1) in those without (p = 0.0001). We have demonstrated that the prevalence of the PT 20210A allele is significantly greater in subjects with venous thrombosis and characterised heritable thrombophilia than in normal control subjects and that the additional inheritance of PT 20210A is associated with an increased risk of venous thromboembolism. We have also confirmed that plasma prothrombin levels are significantly greater in subjects possessing the PT 20210A compared with those who do not.
The Treatment of Bleeding in Acquired Haemophilia with Recombinant Factor VIIa: A Multicentre Study
Authors: Hay C R M , Negrier C , Ludlam C A 
Published: July 2018

SummaryRecombinant factor Vila was used to treat 38 patients with acquired haemophilia participating in the Novoseven compassionate-use program. 19 were male, median age 59, range 2-89 years. The median pre-treatment anti-human (H) and anti-porcine (P) inhibitor titre was H 43 BU/ml (range 1-4500) and P 4.5 BU/ml (range 0-1600). Recombinant factor VIIa was used as first-line therapy for 14 bleeding episodes and as salvage-therapy for 60 episodes which failed to respond to blood-product therapy given for a median of four days (range 1-21 days) prior to treatment with rVIIa. Pre-rVIIa treatment was not reported for four episodes. The indications for treatment were 7 haemarthroses, 40 muscle haematomas, 20 urinary or GI haemorrhages and 3 surgical interventions. The median starting dose of rVIIa was 90.4 ug/kg (range 45-181). A median of 28 doses (range 1-541) were given per episode, over a median 3.9 days (range 0-43).Efficacy was assessed clinically 8 and 24 h after the start of rVIIa and at the end of treatment. A good response was obtained in all 14 bleeds for which rVIIa was used as first-line therapy. The response after 24 h of rVIIa salvage-therapy for 60 bleeds was good in 75%, partial in 17% and poor in 8%. Efficacy was unreported in 4 cases. The median prothrombin time (PTT) shortened from 12 s (range 9.3-20) pre-treatment to 8.8 s (range 6-14) during treatment. The clinical response did not correlate with the dose of rVIIa used, the type of bleed or the degree of shortening of the PTT following rVIIa infusion.Three patients died from haemorrhagic complications of acquired haemophilia. This mortality of 7.9% is lower than previously reported for this condition. Although one patient developed DIC during treatment with rVIIa, this was probably attributable to hypovolaemic shock, massive transfusion and the use of PCCs. This study demonstrates that rVIIa is a safe, useful and effective treatment for bleeding in patients with acquired haemophilia.
Electronic Health Record Interactions through Voice: A Review
Authors: Kumah-Crystal Yaa , Pirtle Claude , Whyte Harrison , Goode Edward , Anders Shilo , Lehmann Christoph 
Published: July 2018

Background Usability problems in the electronic health record (EHR) lead to workflow inefficiencies when navigating charts and entering or retrieving data using standard keyboard and mouse interfaces. Voice input technology has been used to overcome some of the challenges associated with conventional interfaces and continues to evolve as a promising way to interact with the EHR.
Objective This article reviews the literature and evidence on voice input technology used to facilitate work in the EHR. It also reviews the benefits and challenges of implementation and use of voice technologies, and discusses emerging opportunities with voice assistant technology.
Methods We performed a systematic review of the literature to identify articles that discuss the use of voice technology to facilitate health care work. We searched MEDLINE and the Google search engine to identify relevant articles. We evaluated articles that discussed the strengths and limitations of voice technology to facilitate health care work. Consumer articles from leading technology publications addressing emerging use of voice assistants were reviewed to ascertain functionalities in existing consumer applications.
Results Using a MEDLINE search, we identified 683 articles that were reviewed for inclusion eligibility. The references of included articles were also reviewed. Sixty-one papers that discussed the use of voice tools in health care were included, of which 32 detailed the use of voice technologies in production environments. Articles were organized into three domains: Voice for (1) documentation, (2) commands, and (3) interactive response and navigation for patients. Of 31 articles that discussed usability attributes of consumer voice assistant technology, 12 were included in the review.
Conclusion We highlight the successes and challenges of voice input technologies in health care and discuss opportunities to incorporate emerging voice assistant technologies used in the consumer domain.
Spinopelvic Sagittal Alignment after Microendoscopic Laminotomy in Patients with Lumbar Degenerative Spondylolisthesis
Authors: Dohzono Sho , Hori Yusuke , Takahashi Shinji , Suzuki Akinobu , Terai Hidetomi , Nakamura Hiroaki , Toyoda Hiromitsu 
Published: July 2018

Background and Study Aims Spinopelvic sagittal balance is important in managing lumbar diseases. We evaluated the change in spinal sagittal alignment after microendoscopic laminotomy in patients with low-grade degenerative spondylolisthesis (DS).
Material and Methods We retrospectively reviewed the records of 87 patients who underwent microendoscopic laminotomy. We enrolled 35 patients with DS and 52 patients without DS. Spinopelvic parameters were evaluated, including the sagittal vertical axis (SVA), lumbar lordosis (LL), sacral slope, pelvic tilt, and pelvic incidence (PI). Primary outcome was a change in spinopelvic alignment between the baseline and latest follow-up values (DS group versus non-DS group). Secondary outcomes were the relationships between improved global sagittal alignment and preoperative spinopelvic parameters.
Results Both groups showed significantly alleviated low back pain (LBP), leg pain, and leg numbness. Preoperative SVA and PI were significantly higher in the DS group than in the non-DS group (p < 0.05). SVA significantly decreased and LL significantly increased in the DS group (p < 0.05), whereas those parameters did not differ significantly from before versus after surgery in the non-DS group. In both groups, SVA improvement correlated significantly with preoperative SVA (DS: r = 0.702; non-DS: r = 0.397). There was also a significant intergroup difference in the correlation coefficient (z = 1.98; r = 0.048).
Conclusions SVA and LL significantly improved after microscopic laminotomy in patients with low-grade DS and neurologic symptoms. SVA improvement in the DS group was correlated with preoperative spinopelvic sagittal imbalance. The strength of those correlations was greater in the DS group than in the non-DS group.