bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘The House of God’: reflections 40 years on, in conversation with author Samuel Shem
Authors: Ward Joel , Papanikitas Andrew N , Lee Regent , Warner Naomi , Mckenzie-Edwards Emma , Bergman Stephen , Handa Ashok Inderraj 
Published: September 2018

AbstractThe House of God is a seminal work of medical satire based on the gruelling internship experiences of Samuel Shem at the Beth Israel Hospital. Thirteen ‘Laws’ were offered to rationalise the seemingly chaotic patient management and flow. There have been large shifts in the healthcare landscape and practice since, so we consider whether these medical truisms are still applicable to contemporary National Health Service practice and propose updates where necessary:1. People are sometimes allowed to die.2. GOMERs (Get Out of My Emergency Room) still go to ground.3. Master yourself, join the multidisciplinary team.4. The patient is the one with the disease, but not the only one suffering.5. Placement (discharge planning) comes first.6. There is no body cavity that cannot be reached with a gentle arm and good interventional radiologists.7. Fit the rule to the patient rather than the patient to the rule.8. They can always pay you less.9. The only bad admission is a futile one.10. If you don’t take a temperature you can’t find a fever and if you are not going to act on it, don’t do the test.11. Show me a BMS (best medical student) who ONLY triples my work, and I’ll show you a future Foundation Year 1 doctor (FY1) who is an asset to the firm.12. Interpret radiology freely, but share your clinical findings with the radiologist and in a timely fashion.13. Doing nothing can be a viable option.These were developed in conversation with Samuel Shem, who also offers further insight on the creation of the original laws.
Innovations in counterfeiting tax stamps: a study of ultraviolet watermarks in a sample of discarded New York City packs
Authors: Kurti Marin , von Lampe Klaus , He Yi , Delnevo Cristine , Qin Da 
Published: September 2018

ObjectiveDocument the use of ultraviolet watermark in counterfeit joint New York City/New York State cigarette tax stamps to assess the scale at which distributors of illegal cigarettes adapt to measures protecting the integrity of the system of tobacco tax collection.MethodsIn 2016, we collected 2357 empty discarded cigarette packs along a stratified random sample of block groups in New York City (n=114) and analysed 449 joint New York City/New York State tax stamps using long wave ultraviolet irradiation, light microscopy and taggant testers developed by the tax stamp manufacturer, Meyercord Revenue, to determine whether the tax stamps were counterfeit and how they differed from their genuine equivalent.Findings23% (n=102) of the joint NYC/NYS tax stamps examined were counterfeit. Subsequent investigation revealed that almost two-thirds (n=58) of the counterfeit sample bore ultraviolet watermark that closely resembled genuine tax stamps in terms of fluorescence, watermark colour and wording. However, microscopic findings revealed that counterfeit tax stamps mismatched the genuine ultraviolet watermark in regards to font style and word orientation.ConclusionCounterfeiters are using ultraviolet watermarks which makes it difficult to differentiate counterfeit joint New York City/New York State tax stamps from their genuine equivalent when UV irradiation is used as the sole screening tool. Innovations in counterfeiting technology may be the result of fluorescent ink being available for purchase in the mainstream market. Independent monitoring of trends in the illicit market for tobacco products is advised to keep apace of counterfeiting methods.
Global Image Dehazing via Frequency Perception Filtering
Authors: Xu Linli , Han Jing , Wang Tian , Bai Lianfa 
Published: September 2018

In outdoor scenes, haze limits the visibility of images, and degrades people’s judgement of the objects. In this paper, based on an assumption of human visual perception in frequency domain, a novel image haze removal filtering is proposed. Combining this assumption with the theory of frequency domain filtering, we first estimate the cut-off frequency to divide the frequency domain of the hazy image into three components — low-frequency domain, intermediate-frequency domain and high-frequency domain. Then, by introducing the weighting factors, the three components are recombined together. After the theoretical deduction of frequency domain, the establishment of the actual model and adjusting the cut-off frequency and weighting factors, we finally acquire a global and adaptive filtering. This filtering can restore the details and the contours of the images, which have less noise, and improve the visibility of the objects in hazy images. Moreover, our method is simple in structure and strongly applicable, and rarely affected by parameters. Our algorithm is stable and performs well in heavy fog and the scene changes.
Dexmedetomidine Ameliorates Acute Stress‐Induced Kidney Injury by Attenuating Oxidative Stress and Apoptosis through Inhibition of the ROS/JNK Signaling Pathway
Authors: Chen Yongping , Feng Xiujing , Hu Xueyuan , Sha Jichen , Li Bei , Zhang Huayun , Fan Honggang 
Published: September 2018

Acute stress induces tissue damage through excessive oxidative stress. Dexmedetomidine (DEX) reportedly has an antioxidant effect. However, protective roles and related potential molecular mechanisms of DEX against kidney injury induced by acute stress are unknown. Herein, rats were forced to swim 15 min followed by restraint stress for 3 h with/without DEX (30 μg/kg). Successful model establishment was validated by an open‐field test. Assessment of renal function (creatinine, urea nitrogen), histopathology, oxidative stress (malondialdehyde, glutathione, and superoxide dismutase), and apoptosis (transferase‐mediated dUTP nick end labeling) was performed. Localization of apoptosis was determined by immunohistochemistry of cleaved caspase 3 protein. In addition, key proteins of the death receptor‐mediated pathway, mitochondrial pathway, endoplasmic reticulum stress (ERS) pathway, and ROS/JNK signaling pathway were measured by Western blot. We found that DEX significantly improved renal dysfunction, ameliorated kidney injury, reduced oxidative stress, and alleviated apoptosis. DEX also inhibited the release of norepinephrine (NE), decreased the production of reactive oxygen species (ROS), and inhibited JNK phosphorylation. Additionally, DEX downregulated the expression of Bax, cytochrome C, cleaved caspase 9, and cleaved caspase 3 proteins in mitochondria‐dependent pathways. In summary, DEX protects against acute stress‐induced kidney injury in rats by reducing oxidative stress and apoptosis via inhibition of the ROS/JNK pathway.
Association between Radiotherapy and Anatomic Severity of Coronary Artery Disease: A Propensity Score Matching Comparison Among Adult-Onset Thoracic Cancer Survivors
Authors: Hu Shunying , Gao Hai , Zhang Jianzhong , Han Xian , Yang Qian , Zhang Juan , Chen Yundai 
Published: September 2018

<b><i>Objective:</i></b> To investigate the association between radiotherapy and anatomic severity of coronary artery disease (CAD) using the SYNTAX scores (SXscores) of coronary angiograms in adult-onset thoracic cancer survivors. <b><i>Methods:</i></b> A total of 152 patients who previously had thoracic cancer and underwent coronary angiography between 2010 and 2016 were examined. Propensity score matching (PSM) was used to identify 27 well-matched pairs of patients. Characteristics and coronary angiograms were collected from each patient. Coronary artery abnormalities were assessed using SXscores of coronary angiograms. <b><i>Results:</i></b> Among the 152 patients, the SXscores and percentage of high SXscores were higher in the radiotherapy group than in the non-radiotherapy group; however, the latter was not significantly different (<i>p</i> = 0.0266 and <i>p</i> = 0.064, respectively). After PSM, the SXscores and percentage of high SXscores were significantly higher in the radiotherapy group than in the non-radiotherapy group (22 [interquartile range (IQR) 10.00–30.00] vs. 15.00 [IQR 4.00–26.00], <i>p</i> = 0.0459), (70.07 vs. 44.44%, <i>p</i> = 0.027), respectively. After adjusting for related risk factors and chemotherapy, the OR of radiotherapy for a high SXscore was 3.674 (95% CI 1.094–12.343) by logistic regression analysis. <b><i>Conclusion:</i></b> Thoracic cancer survivors who underwent radiotherapy have higher SXscores and are at a higher risk of developing anatomically severe CAD, independent of chemotherapy.
Class Strategies in Chavista Venezuela: Pragmatic and Populist Policies in a Broader Context
Authors: Ellner Steve 
Published: September 2018

The governments of Hugo Chávez and Nicolás Maduro responded to the opposition’s attempts at regime change by implementing pragmatic policies favoring businesspeople who refused to participate in destabilization actions, as well as populist social measures benefiting the nonprivileged. Both sets of policies have to be placed in political context. The characterization of allegedly pro-government businesspeople as a new ruling elite referred to as the boliburguesía fails to take into account the sharp tensions between them and the Chavista leadership. The primary importance of social programs in the Chavista political triumphs over an extended period of time and of the periodic initiatives that sparked life into individual programs implicitly rules out claims regarding the government’s failure to alleviate poverty or achieve other social objectives. The Chavista governments failed to take full advantage of favorable periods and junctures when the opposition was demoralized following defeats in order to correct the negative side effects of pragmatic and populist class policies, such as bureaucratization and crony capitalism. Los gobiernos de Hugo Chávez y Nicolás Maduro respondieron a los intentos de la oposición por el cambio de régimen implementando políticas pragmáticas que favorecían a los empresarios que se negaban a participar en acciones de desestabilización, así como medidas sociales populistas que beneficiaban a los no privilegiados. Ambos conjuntos de políticas deben situarse en un contexto político. La caracterización de empresarios supuestamente progubernamentales como una nueva elite gobernante conocida como la boliburguesía no toma en cuenta las fuertes tensiones entre ellos y la dirigencia chavista. La importancia primordial de los programas sociales en los triunfos políticos chavistas a lo largo de un período prolongado y de las iniciativas periódicas que avivaron los programas individuales contrarresta la afirmación sobre la incapacidad del gobierno para aliviar la pobreza o alcanzar otros objetivos sociales. Los gobiernos chavistas no aprovecharon al máximo los períodos y coyunturas favorables cuando la oposición se desmoralizó tras las derrotas con el fin de corregir los efectos negativos de las políticas pragmáticas y populistas, como la burocratización y el capitalismo amiguista.
Comparative study of psychometric properties of three assessment tools for degenerative rotator cuff disease
Authors: James-Belin Etienne , Roy Anne Laure , Lasbleiz Sandra , Ostertag Agnès , Yelnik Alain , Orcel Philippe , Beaudreuil Johann 
Published: September 2018

Objective: To compare psychometric properties of Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Shoulder Pain and Disability Index (SPADI) and Constant–Murley scale, in patients with degenerative rotator cuff disease (DRCD). Design: Longitudinal cohort. Setting: One French university hospital. Methods: The scales were applied twice at one-week interval before physiotherapy and once after physiotherapy two months later. The perceived improvement after treatment was self-assessed on a numerical scale (0–4). The test–retest reliability of the DASH, SPADI and Constant–Murley scales was assessed before treatment by the intraclass correlation coefficient (ICC). The responsiveness was assessed by the paired t-test ( P < 0.05) and standardized mean difference (SMD). The correlation between the percentage of variation in scale scores and the self-assessed improvement score after treatment was measured by the Spearman coefficient. Results: Fifty-three patients were included. Twenty-six only were available for reliability. The test–retest reliability was very good for the DASH (ICC = 0.97), SPADI (0.95) and Constant–Murley (0.92). The scale score was improved after treatment for each scale ( P < 0.05). The SMD was moderate for the DASH (0.56) and SPADI (0.56) scales, and small for the Constant–Murley (0.44). The correlation between the percentage of variation in scores and self-assessed improvement score after treatment was high, moderate and not significant for the SPADI (0.59, P < 0.0001), DASH (0.42, P < 0.01) and Constant–Murley scales, respectively. Conclusion: The test–retest reliability of the DASH, SPADI and Constant–Murley scales is very good for patients with DRCD. The highest responsiveness was achieved with the SPADI.
Another important time target in ST-elevation myocardial infarction management—door-in door-out time: Do we meet door-in door-out time targets?
Authors: Doğan Ismahan , Çorbacıoğlu Şeref Kerem , Emektar Emine , Aytar Halit , Çevik Yunsur 
Published: September 2018

Background: In non-PCI capable hospitals, another important time to be noticed in patients who have been referred for PCI-capable centers; is the time of doo-in door-out (DIDO), defined as the duration of time from patient discharge from the transferrring hospital. In our country, there is no clear information about the duration of DIDO time and transfer time. Consequently, very little is known about how frequently these targets can be met nationally. Objectives: This study aimed to measure door-in door-out time for ST-elevation myocardial infarction diagnosed patients who admitted to emergency department of a hospital capable of non-percutaneous coronary intervention and to measure whether door-in door-out time meets the guidelines. Methods: This single-center, prospective study was conducted in emergency department (non-percutaneous coronary intervention capable) between 1 August 2015 and 1 August 2016 with patients who presented to the emergency department and were diagnosed with ST-segment elevation myocardial infarction. All the times including door-in time, door to electrocardiogram time, door to emergency medical services activation time, door to defined percutaneous coronary intervention hospital, and finally door-in door-out time were measured and recorded. Results: During the study period, 135 of patients met the inclusion criteria and diagnosed with ST-elevation myocardial infarction and referred to another hospital for percutaneous coronary intervention. When the median values (interquartile range of 25%–75%) of the time periods are examined, it is found door-in door-out time was 55 (43–74) min. It was found that the number of patients meeting the recommended duration of door-in door-out (30 min or less) was 12 (8.9%). Of the remaining 123 patients (91.1%), door-in door-out times were found to be over 30 min. Conclusion: In conclusion, our study showed that compliance with door-in door-out time is very poor and is far behind to met the criteria which is recommended by current guidelines.
Significant hyperopic shift in a patient with extreme myopia following severe hypotonia caused by glaucoma filtering surgery
Authors: Costa João C , Alió Jorge 
Published: September 2018

Introduction: To report the case of a high hyperopic refractive shift associated with significant shortening of the ocular axial length following glaucoma filtering surgery. Methods: Case report. Patient’s records were consulted retrospectively. Results: A 57-year-old woman, highly myopic, with a history of bilateral intraocular refractive surgery in 1998 (phakic lens ZB5M) and bilensectomy in 2011 (phakic intraocular lens extraction plus cataract surgery with pseudophakic intraocular lens implantation), presented with consistently high intraocular pressure. Despite the treatment with different topical antiglaucomatous medications and good compliance, her intraocular pressure values remained consistently above 20 mmHg. In 2016, the patient was submitted for glaucoma filtering surgery and the mini shunt Ex-Press was implanted in both the eyes (3 months between surgeries). On the first postoperative day, the eyes were hypotonic (intraocular pressure of 5 mmHg) and bilateral macular edema was observed. Three days later, the intraocular pressure in both the eyes reached values higher than 6 mmHg (between 6 and 14 mmHg). Five months after the surgery the macular edema resolved and a significant shortening of the axial length and an important hyperopic refractive shift was observed. When comparing the preoperative and postoperative (18 months) measurements, the variation of the axial length was 2.49 mm in the right eye and 2.19 mm in the left eye; the patient refraction (spherical equivalent) shifted 2.50 diopters in the right eye and 1.75 diopters in the left eye. Conclusion: To the best of our knowledge, we report herein the first documented case of an axial length change of this magnitude after glaucoma filtering surgery.
Radical cystectomy in frail octogenarians in thoracic continuous spinal anesthesia and analgesia: a pilot study
Authors: Castellani Daniele , Starnari Roberto , Faloia Lucia , Stronati Massimo , Venezia Alfredo , Gasparri Luca , Claudini Redi , Branchi Alessandro , Giampieri Marina , Dellabella Marco 
Published: September 2018

Background: Radical cystectomy (RC) is the gold standard therapy in nonmetastatic muscle-invasive bladder cancer and is usually performed under general anesthesia (GA). GA is high risk in most older patients due to comorbidities. Continuous spinal anesthesia (CSA) may be an alternative solution to reduce postoperative morbidity in elderly. The aim of this study was to assess the feasibility, morbidity, and mortality of RC performed under CSA in octogenarian patients. Methods: We retrospectively reviewed data of five frail patients aged ⩾80 who underwent RC in CSA. CSA was achieved starting with 2.5 mg hyperbaric bupivacaine plus 25 µg fentanyl. Postoperative analgesia was achieved through the intrathecal catheter, using continuous delivery of levo-bupivacaine 60 mg plus fentanyl 75 µg in 72 hours. Results: Surgery was completed in all cases in CSA. No patients required postoperative intensive care unit admission. Complications were Clavien I for four in three patients, Clavien II for seven in five patients, and Clavien IIIb for one patient. Postoperative consumption of painkillers was negligible. Oral feeding resumed within 3 days in all cases. The mean postoperative stay was 9.6 days. All patients were alive at 3 months of follow up. Conclusions: Management of muscle-invasive bladder cancer (MIBC) in older patients is becoming an important issue due to the continuous aging of the population. Age should not preclude RC, but careful management is mandatory because perioperative morbidity and mortality are increased in the elderly. Our preliminary results show that CSA and analgesia is a feasible option as an additional way to reduce morbidity and mortality in frail octogenarians who require RC.
A Microarray Study of Articular Cartilage in Relation to Obesity and Severity of Knee Osteoarthritis
Authors: Rai Muhammad Farooq , Sandell Linda J. , Barrack Toby N. , Cai Lei , Tycksen Eric D. , Tang Simon Y. , Silva Matthew J. , Barrack Robert L. 
Published: September 2018

Objective To query the transcript-level changes in the medial and lateral tibial plateau cartilage in tandem with obesity in patients with end-stage osteoarthritis (OA). Design Cartilage was obtained from 23 patients (20 obese [body mass index > 30 kg/m2], 3 overweight [body mass index < 30 kg/m2]) at the time of total knee replacement. Cartilage integrity was assessed using Outerbridge scale, while radiographic changes were scored on preoperative X-rays using Kellgren-Lawrence (K-L) classification. RNA was probed for differentially expressed transcripts between medial and lateral compartments using Affymetrix Gene 2.0 ST Array and validated via real-time polymerase chain reaction. Gene ontology and pathway analyses were also queried. Results Scoring of cartilage integrity by the Outerbridge scale indicated that the medial and lateral compartments were similar, while scoring by the K-L classification indicated that the medial compartment was more severely damaged than the lateral compartment. We observed a distinct transcript profile with >50% of transcripts unique between medial and lateral compartments. MMP13 and COL2A1 were more highly expressed in medial versus lateral compartment. Polymerase chain reaction confirmed expression of 4 differentially expressed transcripts. Numerous transcripts, biological processes, and pathways were significantly different between overweight and obese patients with a differential response of obesity on medial and lateral compartments. Conclusions Our findings support molecular differences between medial and lateral compartments reflective of the greater severity of OA in the medial compartment. The K-L system better reflected the molecular results than did the Outerbridge. Moreover, the molecular effect of obesity was different between the medial and lateral compartments of the same knee plausibly reflecting the molecular effects of differential biomechanical loading.
Bipolar Osteochondral Allograft Transplantation of the Patella and Trochlea
Authors: Mirzayan Raffy , Charles Michael D. , Batech Michael , Suh Brian D. , DeWitt David 
Published: September 2018

Objective To evaluate clinical, functional, and radiographic outcomes of patients who underwent bipolar osteochondral allograft transplantation (OCAT) of the patellofemoral joint (PFJ). Design Prospectively collected data on 18 knees who underwent fresh osteochondral allograft transplantation of the patella and trochlea by a single surgeon were reviewed. Inclusion criteria were: high-grade chondral lesions of PFJ (5 knees), or recurrent patella dislocations with trochlear dysplasia and chondral injury to the patella and/or trochlea (13 knees). Functional scores were obtained preoperatively and at follow-up appointments included Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), Oxford, Cincinnati, Tenger-Lysholm, visual analogue scale (VAS)–pain, and Single Assessment Numeric Evaluation (SANE). Grafts were also evaluated using Osteochondral Allograft MRI Scoring System (OCAMRISS). Results Three patients were lost to follow-up, leaving 4 knees in group 1, and 11 knees in group 2. Average age was 28.9 years (range 16-52 years). The average follow-up was 33.2 months (range 12-64 months). There was significant improvement of KOOS (from 38.7 to 83.1), IKDC (from 28.2 to 76.6), Tegner-Lysholm (from 38.3 to 88.3), Oxford (from 22.7 to 42.9), Cincinnati (from 35.1 to 83.6), VAS (from 71 to 17.9.), and SANE (from 43.3 to 83) ( P < 0.0001). The OCAMRISS score for patella was 2.23 and for trochlea 4.69. There were no revisions or conversions to arthroplasty Conclusion Bipolar OCAT of the patella and trochlea provide significant improvement in functional outcomes, relief from pain, activity level, and prevent recurrent instability.