bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypothalamic regulation of headache and migraine
Authors: May Arne , Burstein Rami 
Published: August 2019

Background The clinical picture, but also neuroimaging findings, suggested the brainstem and midbrain structures as possible driving or generating structures in migraine. Findings This has been intensely discussed in the last decades and the advent of modern imaging studies refined the involvement of rostral parts of the pons in acute migraine attacks, but more importantly suggested a predominant role of the hypothalamus and alterations in hypothalamic functional connectivity shortly before the beginning of migraine headaches. This was shown in the NO-triggered and also in the preictal stage of native human migraine attacks. Another headache type that is clinically even more suggestive of hypothalamic involvement is cluster headache, and indeed a structure in close proximity to the hypothalamus has been identified to play a crucial role in attack generation. Conclusion It is very likely that spontaneous oscillations of complex networks involving the hypothalamus, brainstem, and dopaminergic networks lead to changes in susceptibility thresholds that ultimately start but also terminate headache attacks. We will review clinical and neuroscience evidence that puts the hypothalamus in the center of scientific attention when attack generation is discussed.
Exposure to American Football and Neuropsychiatric Health in Former National Football League Players: Findings From the Football Players Health Study
Authors: Roberts Andrea L. , Pascual-Leone Alvaro , Speizer Frank E. , Zafonte Ross D. , Baggish Aaron L. , Taylor Herman , Nadler Lee M. , Courtney Theodore K. , Connor Ann , Grashow Rachel , Stillman Alexandra M. , Marengi Dean A. , Weisskopf Marc G. 
Published: August 2019

Background: Former American football players have a higher prevalence of cognitive impairment than that of the US general population. It remains unknown what aspects of playing football are associated with neuropsychiatric outcomes. Hypothesis: It was hypothesized that seasons of professional football, playing position, and experience of concussions were associated with cognition-related quality of life (QOL) and indicators of depression and anxiety. Study Design: Descriptive epidemiology study. Methods: The authors examined whether seasons of professional football, playing position, and experience of concussions, as measured by self-report of 10 symptoms, were associated with cognition-related QOL and indicators of depression and anxiety in a cross-sectional survey conducted 2015 to 2017. Cognition-related QOL was measured by the short form of the Quality of Life in Neurological Disorders: Applied Cognition–General Concerns. The Patient Health Questionnaire–4 measured depression and anxiety symptoms. Of 13,720 eligible men with apparently valid contact information, 3506 players returned a questionnaire at the time of this analysis (response rate = 25.6%). Results: Seasons of professional play (risk ratio [RR] per 5 seasons = 1.19, 95% CI = 1.06-1.34) and playing position were associated with cognition-related QOL. Each 5 seasons of play was associated with 9% increased risk of indicators of depression at borderline statistical significance ( P = .05). When compared with former kickers, punters, and quarterbacks, men who played any other position had a higher risk of poor cognition-related QOL, depression, and anxiety. Concussion symptoms were strongly associated with poor cognition-related QOL (highest concussion quartile, RR = 22.3, P < .001), depression (highest quartile, RR = 6.0, P < .0001), and anxiety (highest quartile, RR = 6.4, P < .0001), even 20 years after last professional play. Conclusion: The data suggest that seasons of play and playing position in the NFL are associated with lasting neuropsychiatric health deficits. Additionally, poor cognition-related QOL, depression, and anxiety appear to be associated with concussion in the long term.
Testis biopsy in absolute head teratospermia: Is it a logical option?
Authors: Shakhssalim Nasser , Sadeghi Mohamad Reza , Akhondi Mohammad Mehdi , Akhavizadegan Hamed 
Published: August 2019

Introduction: Absolute head teratospermia (100% abnormal head morphology) is associated with poor fertility and assisted reproductive techniques results. We aimed to find if it is possible to bypass this disorder using sperm retrieved by testis biopsy. Methods: Multiple testis biopsies were performed in patients with infertility and absolute head teratospermia who were not able to provide semen on the injection day from 2006 to 2018. Then, the found sperms were evaluated based on being proper or not proper for intracytoplasmic sperm injection. Results: Only 2 patients, of a total of 22 (9%), had relatively proper sperms for microinjection. Discussion: There is no benefit to performing testis biopsy in non-azoospermic patients with absolute abnormal head morphology.
Predicting Outcome After Out-of-Hospital Cardiac Arrest: Lactate, Need for Vasopressors, and Cytochrome c
Authors: Cocchi Michael N. , Salciccioli Justin , Yankama Tuyen , Chase Maureen , Patel Parth V. , Liu Xiaowen , Mader Timothy J. , Donnino Michael W. 
Published: August 2019

Background: Outcome prediction after out-of-hospital cardiac arrest (OHCA) is difficult. We hypothesized that lactate and need for vasopressors would predict outcome, and that addition of a mitochondrial biomarker would enhance performance of the tool. Methods: Prospective observational study of OHCA patients presenting to an academic medical center September 2008 to April 2016. We conducted univariate and multivariate logistic regressions. Results: Patients were divided based on 2 variables: vasopressor status and initial lactate (<5 mmol/L, 5-10, ≥10). Three hundred fifty-two patients were evaluated; 249 had a lactate within 3 hours and were included. Patients on vasopressors had higher mortality (74% vs 40%; P < .001). A stepwise increase in mortality is associated with increasing lactate (45% lactate <5, 66% 5-10, and 83% ≥10; P < 001). Multivariable models with lactate group and vasopressors as predictors demonstrated excellent discrimination (area under the receiver operating curve [AUC]: 0.73 [95% confidence interval, CI: 0.66-0.79]; adjusted for additional covariates: AUC: 0.81 [95% CI: 0.75-0.86]). Thirty-six patients had cytochrome c levels available; among these 36, when comparing models with and without cytochrome c, there was no difference (AUC: 0.88 [95% CI: 0.76-1.00] vs AUC: 0.85 [95% CI: 0.73-0.98], respectively; P = .30). Conclusion: In this prospective validation, the combination of lactate and vasopressors in the immediate postarrest period is predictive of mortality. Cytochrome c offered minimal additional predictive power.
Risks of Cardiovascular Disease and Beyond in Prescription of Nonsteroidal Anti-Inflammatory Drugs
Authors: Rane Manas A. , Gitin Alexander , Fiedler Benjamin , Fiedler Lawrence , Hennekens Charles H. 
Published: August 2019

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin, naproxen, diclofenac, and ibuprofen, as well as selective cyclooxygenase 2 inhibitors such as celecoxib. Their use is common, as well as their side effects which cause 100 000 hospitalizations and 17 000 deaths annually. Recently, the US Food and Drug Administration strengthened its warning about the risks of cardiovascular disease (CVD) attributed to nonaspirin NSAIDs. Methods: When the sample size is large, randomization provides control of confounding not possible to achieve with any observational study. Further, observational studies and, especially, claims data have inherent confounding by indication larger than the small to moderate effects being sought. Results: While trials are necessary, they must be of sufficient size and duration and achieve high compliance and follow-up. Until then, clinicians should remain uncertain about benefits and risks of these drugs. Conclusions: Since the totality of evidence remains incomplete, health-care providers should consider all these aforementioned benefits and risks, both CVD and beyond, in deciding whether and, if so, which, NSAID to prescribe. The factors in the decision of whether and, if so, which NSAID to prescribe for relief of pain from inflammatory arthritis should not be limited to risks of CVD or gastrointestinal side effects but should also include potential benefits including improvements in overall quality of life resulting from decreases in pain or impairment from musculoskeletal pain syndromes. The judicious individual clinical decision-making about the prescription of NSAIDs to relieve pain based on all these considerations has the potential to do much more good than harm.
Pars plana vitrectomy combined with irido-zonulo-hyaloidectomy for aqueous misdirection
Authors: Patel Shriji 
Published: August 2019

Introduction: To review the indications and necessary steps for successful irido-zonulo-hyaloidectomy in persistent aqueous misdirection. Study design/materials and methods: A 60-year-old woman was referred for persistent aqueous misdirection despite aggressive medical management. Her intraocular pressure would elevate with discontinuation of cycloplegics and her lens shifted anteriorly. She underwent standard 25g pars plana vitrectomy with irido-zonulo-hyaloidectomy. Results: The aqueous misdirection resolved with successful creation of the irido-zonulo-hyaloidectomy with noticeable deepening of the anterior chamber immediately. Vision improved to 20/30 and intraocular pressure was controlled without cycloplegics or ocular hypotensives. Conclusion: In persistent cases of aqueous misdirection unresponsive to medical management, irido-zonulo-hyaloidectomy is a useful adjunct to pars plana vitrectomy in ensuring resolution of the misdirection.
Early visual field changes in patients with type 1 diabetes mellitus
Authors: Ozates Serdar , Simsek Mert , Elgin Ufuk , Keskin Melikşah , Aycan Zehra 
Published: August 2019

Purpose: To assess the visual field sensitivity changes and investigate the association between visual field sensitivity and retinal nerve fiber layer thickness in patients with type 1 diabetes mellitus. Materials and methods: In this cross-sectional and observational study, 46 patients (22 males, 24 females) with type 1 diabetes mellitus and no diabetic retinopathy formed the diabetes mellitus group and 50 age-matched healthy subjects (32 males, 18 females) formed the control group. Retinal nerve fiber layer thickness, full-threshold standard automated perimetry, and short-wavelength automated perimetry were performed. Main outcomes were retinal nerve fiber layer thickness, mean deviation, pattern standard deviation, and short fluctuation. Results: Average retinal nerve fiber layer thickness was significantly thinner in the diabetes mellitus group (p < 0.001). The mean values of mean deviation and pattern standard deviation of the full-threshold standard automated perimetry did not differ between the groups (p = 0.179, p = 0.139, respectively). Mean short fluctuation was significantly greater in the diabetes mellitus group (p < 0.001). Both mean deviation and pattern standard deviation of the short-wavelength automated perimetry were significantly greater in the diabetes mellitus group (p < 0.001, p < 0.001, respectively). Pattern standard deviation of short-wavelength automated perimetry equal or higher than 1.57 dB had 91% sensitivity and 90% specificity (area under the curve = 0.969, p < 0.001) and short fluctuations of full-threshold standard automated perimetry equal or higher than 0.80 dB had 80% sensitivity and 76% specificity over detecting early retinal nerve fiber layer loss in patients with type 1 diabetes mellitus (area under the curve = 0.855, p < 0.001). Conclusion: This study showed that thinner retinal nerve fiber layer in patients with type 1 diabetes mellitus may be associated with abnormal retinal sensitivity to short-wavelength stimulations in short-wavelength automated perimetry; however, retinal sensitivity to white stimulus was similar to that in healthy subjects in full-threshold standard automated perimetry.
Soluble human Suppression of Tumorigenicity 2 is associated with endoscopic activity in patients with moderate-to-severe ulcerative colitis treated with golimumab
Authors: Magro Fernando , Lopes Susana , Silva Marco , Coelho Rosa , Portela Francisco , Branquinho Diogo , Correia Luís , Fernandes Samuel , Cravo Marília , Caldeira Paulo , Tavares de Sousa Helena , Patita Marta , Lago Paula , Ramos Jaime , Afonso Joana , Redondo Isabel , Machado Patrícia , Philip George , Lopes Joanne , Carneiro Fátima 
Published: August 2019

Background: Suppressor of Tumorigenicity 2 (ST2) is an IL33 receptor detected in the mucosa and serum of ulcerative colitis (UC) patients. We evaluated soluble ST2 (sST2) as a surrogate biomarker of disease outcome and therapeutic response, in moderate-to-severe UC patients treated with golimumab. Methods: We conducted an open-label single-arm multicentre prospective study. At screening/baseline, week 6 (W6) and week 16 (W16), clinical and endoscopic activity (total Mayo score), histologic activity (Geboes index) and biomarkers were evaluated. Results: From 38 patients, 34 (89.5%) completed W6 and 29 (76.3%) completed W16. Mean age (±SD) was 34.6 ± 12.6 years; 55.9% were female. At W16, 62.1% achieved clinical response. Patients with endoscopic activity at W6 ( n = 20) had higher baseline sST2 (median, 24.5 versus 18.7 ng/ml, p = 0.026) and no decrease from baseline (median change, 0.8 versus −2.7, p = 0.029). At W6, sST2 levels correlated with endoscopic activity ( rs = 0.45, p = 0.007) but not with histological activity ( rs = 0.25, p = 0.151). The best cut-offs for endoscopic activity were sST2 = 16.9 ng/ml (sensitivity = 85%; specificity = 71%) and faecal calprotectin (FC) = 353 μg/g (sensitivity = 90%, specificity = 67%). Patients with histological activity at W6 ( n = 27) had higher baseline ST2 levels (median, 23.0 versus 13.7 ng/ml, p = 0.035). sST2 did not correlate with FC or serum C-reactive protein. FC levels correlated with histological activity and baseline FC were higher when Geboes ⩾3.1 at W6. Conclusions: sST2 may be a surrogate biomarker of UC activity and therapeutic response as it correlates with endoscopic and clinical activity at W6 of golimumab treatment, and subjects with endoscopic and histological activity at W6 had higher baseline ST2 levels.
Does Overexertion Correlate With Increased Injury? The Relationship Between Player Workload and Soft Tissue Injury in Professional American Football Players Using Wearable Technology
Authors: Li Ryan T. , Salata Michael J. , Rambhia Sagar , Sheehan Joe , Voos James E. 
Published: August 2019

Background: The relationship of training load to injury using wearable technology has not been investigated in professional American football players. The primary objective of this study was to determine the correlation between player workload and soft tissue injury over the course of a football season utilizing wearable global positioning system (GPS) technology. Hypothesis: Increased training load is associated with a higher incidence of soft tissue injuries. Study Design: Case-control study. Level of Evidence: Level 3. Methods: Player workloads were assessed during preseason and regular-season practice sessions using GPS tracking and triaxial accelerometry from 2014 to 2016. Soft tissue injuries were recorded during each season. Player workload during the week of injury (acute) and average weekly workload during the 4 weeks (chronic) prior to injury were determined for each injury and in uninjured position-matched controls during the same week. A matched-pairs t test was used to determine differences in player workload. Subgroup analysis was also conducted to determine whether observed effects were confounded by training period and type of injury. Results: In total, 136 lower extremity injuries were recorded. Of the recorded injuries, 101 injuries with complete GPS and clinical data were included in the analysis. Injuries were associated with greater increases in workload during the week of injury over the prior month when compared with uninjured controls. Injured players saw a 111% (95% CI, 66%-156%) increase in workload whereas uninjured players saw a 73% (95% CI, 34%-112%) increase in workload during the week of injury ( P = 0.032). Individuals who had an acute to chronic workload ratio higher than 1.6 were 1.5 times more likely to sustain an injury relative to time- and position-matched controls (64.6% vs 43.1%; P = 0.004). Conclusion: Soft tissue injuries in professional football players were associated with sudden increases in training load over the course of a month. This effect seems to be especially pronounced during the preseason when player workloads are generally higher. These results suggest that a gradual increase of training intensity is a potential method to reduce the risk of soft tissue injury. Clinical Relevance: Preseason versus regular-season specific training programs monitored with wearable technology may assist team athletic training and medical staff in developing programs to optimize player performance.
Identification of novel diagnostic and prognostic biomarkers for abdominal aortic aneurysm
Authors: Memon Ashfaque A , Zarrouk Moncef , Ågren-Witteschus Sophia , Sundquist Jan , Gottsäter Anders , Sundquist Kristina 
Published: August 2019

AimsAbdominal aortic aneurysm is a life-threatening condition due to the risk of aneurysm growth and rupture. There are no approved diagnostic or prognostic biomarkers for abdominal aortic aneurysm. We aimed to identify diagnostic and prognostic biomarkers for abdominal aortic aneurysm and to investigate their relationship with abdominal aortic aneurysm diameter and growth.MethodsIn this case-control study, patients were included from an abdominal aortic aneurysm screening study on men aged ≥65 years. Of 24,589 examined men, 415 had abdominal aortic aneurysm, out of whom 134 consented to participate in the present study. One hundred and thirty-six screened men with aortic diameter <30 mm, matched for comorbidities and time of sampling were included as non-abdominal aortic aneurysm patients. Ninety-one cardiovascular specific proteins in plasma samples were measured by the Proseek Multiplex CVD III96x96panel.ResultsAfter Bonferroni correction, plasma levels of 21 proteins associated with proteolysis, oxidative-stress, lipid metabolism, and inflammation were significantly increased, whereas levels of paraoxonase 3, associated with high-density lipoprotein metabolism, were decreased in abdominal aortic aneurysm patients. Combination of growth/differentiation factor 15 and cystatin B had the best ability to discriminate abdominal aortic aneurysm from non-abdominal aortic aneurysm (area under the curve, 0.76; sensitivity, 80% and specificity, 52%). Myeloperoxidase showed the best prognostic value (area under the curve, 0.71; sensitivity, 80% and specificity, 59%) and higher baseline levels of myeloperoxidase were significantly associated with faster abdominal aortic aneurysm growth compared with lower levels, independent of baseline diameter.ConclusionsWe have identified multiple proteins associated with abdominal aortic aneurysm diameter and growth with a potential to become novel diagnostic and prognostic biomarkers for abdominal aortic aneurysm.
The pattern of substance abuse in Thai elderly: Ramathibodi Poison Center
Authors: Ruangritchankul Sirasa , Srisuma Sahaphume 
Published: August 2019

Objective: To describe substances, clinical manifestations, treatment, and medical outcomes of substance abuse exposures among older adults in Thailand. Method: This is a retrospective study of individuals aged 60 years or older with intentional abuse exposures reported to the Ramathibodi Poison Center from 1 January 2010 to 31 December 2017. Results: Forty-four cases were reported. The most common manifestation was somnolence (20, 45.5%). The most common substance used was kratom. There were 12 severe and fatal cases. Only one died due to methadone abuse. The most frequent manifestation among severe cases was respiratory failure (8 of 12 cases, 66.7%). Two cases had severe metabolic acidosis and were treated with hemodialysis. Three cases received norepinephrine. Conclusion: Substance abuse in the elderly is a serious problem that is often overlooked. Health personnel should promptly recognize and address this issue in order to reduce morbidity and mortality in the elderly population.
Prostatic malakoplakia associated with severe chronic active prostatitis
Authors: Mukendi Alain Mwamba , Dlamini Khayalethu , Padayachee Rushen Siva , Ngomane Nhlanhla 
Published: August 2019

A 70-year-old black male presented with a 2-month history of obstructive lower urinary tract symptoms. He had no current or previous proven history of urinary tract infections and was not on any antibiotics, steroids or immunosuppressive drugs. A tender, firm and non-nodular prostate was noted on digital rectal examination and his prostate-specific antigen level was 32.4 ug/L. Histopathological analysis following transrectal ultrasound-guided prostate biopsy showed an unusual finding, malakoplakia associated with severe chronic active prostatitis. Only a limited number of cases of prostatic malakoplakia have ever been reported in the literature. We present the first ever case of malakoplakia without any evidence of urinary tract infection associated with severe chronic active prostatitis in a black African male. Level of evidence: Level 5.
Capacity of Kidney Care in Canada: Identifying Barriers and Opportunities
Authors: Lunney Meaghan , Samimi Arian , Osman Mohamad A. , Jindal Kailash , Wiebe Natasha , Ye Feng , Johnson David W. , Levin Adeera , Bello Aminu K. 
Published: August 2019

Background: Chronic kidney disease (CKD) is a significant health problem in Canada. Understanding the capacity of the Canadian health-care system to deliver kidney care is important to provide optimal care. Objective: To compare Canada’s position in relation to countries of similar economic standing. Design: Cross-sectional electronic survey. Setting: Member countries of the Organisation for Economic Co-operation and Development (OECD) that participated in the survey. Participants: Nephrologists, other physicians, policymakers, and other professionals with relevant expertise in kidney care. Measurements: Not applicable. Methods: A survey administered by the International Society of Nephrology assessed the global capacity of kidney care delivery. Data from participating OECD countries were analyzed using descriptive statistics to compare Canada’s position. Results: Of the participating countries, most funded kidney care services (non-medication) by government (transplantation: 85%, dialysis: 81%, acute kidney injury (AKI): 77%). Most countries covered medication. Canada reported a public funding model for kidney services and a mix of public and private sources for medication. Nephrologists and nephrology trainee densities were lower in Canada compared to the median (15.33 vs. 25.82 and 1.74 vs. 3.94, respectively). CKD was recognized as a health priority in five countries, but not in Canada. Registries for CKD did not exist in most (24/26) countries. Canada followed a national strategy for noncommunicable diseases, but this was not specific to CKD care, dialysis, or transplantation. Limitations: Risks of recall bias or social desirability bias are present. Differences in a number of factors could influence discrepancies among countries and were not explored. Responses reflected the existence of practices, policies, and strategies, and may not necessarily describe action or impact. Capacity of care is not equal across all regions and provinces within Canada; however, the findings are reported on a national level and therefore may not appropriately address variability. Conclusions: This study describes the capacity for kidney care at a national level within the context of the Canadian health system. The Canadian health-care system is well funded by the government; however, there are areas that could be improved to increase the optimization of kidney care provided.