bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Reference Levels for Diagnostic and Interventional X-Ray Procedures in Germany: Update and Handling
Authors: Schegerer Alexander , Loose Reinhard , Heuser Lothar J. , Brix Gunnar 
Published: January 2019

Purpose Recent developments in medical technology have broadened the spectrum of X-ray procedures and changed exposure practice in X-ray facilities. For this reason, diagnostic reference levels (DRLs) for diagnostic and interventional X-ray procedures were updated in 2016 and 2018, respectively. It is the aim of this paper to present the procedure for the update of the DRLs and to give advice on their practical application.
Materials and Methods For the determination of DRLs, data from different independent sources that collect dose-relevant data from different facilities in Germany were considered. Seven different weight intervals were specified for classifying pediatric X-ray procedures. For each X-ray procedure considered, the 25th, 50th, and 75th percentile of the respective national distribution of the dose-relevant parameters were determined. Additionally, effective doses that correspond to the DRLs were estimated.
Results In procedures with already existing DRLs before 2016, the values were lowered by circa 20 % on average. Numerous DRLs were established for the first time (9 for interventional procedures, 10 for CT examinations).
Conclusion For dose optimizations even below the new national DRLs, the BfS recommends establishing local reference levels, using dose management software (particularly in CT and interventional radiology), adapting dose-relevant parameters of X-ray protocols to the individual patient size, and establishing internal radiation protection teams responsible for optimizing X-ray procedures in clinical practice. When applying good medical practice and using modern equipment, the median dose values of the nationwide dose distributions can not only be easily achieved but can even be undercut.
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Evaluation of Anti-Diarrheal Activity of Methanol Root Bark Extract of Milicia Excelsa (Welw) C. C Berg (Moraceae) in Rats
Authors: Adebayo Muritala Ayofe , Adedokun Oluwasegun Adekanmi , Akinpelu Lateef Abiola , Okafor Paul Okwudili 
Published: January 2019

Abstract
Milicia excelsa (Moraceae) plant is used as an antidiarrheal agent in ethnomedicine but there is no scientific rationale for its claim. Hence, this study examined the acute toxicity (LD50) and anti-diarrheal effect of methanol root bark extract of Milicia excelsa per oral in rats as well as the probable phytoconstituents responsible for this effect. The LD50 was>5000 mg/kg, suggesting its safety. The extract significantly (p<0.05) reduced the total number of feces and wet feces in castor oil-induced diarrhea with percentage inhibitions of 41.36 and 50.88% at 200 and 400 mg/kg respectively; it also significantly (p<0.05) reduced the distance travelled by charcoal in a dose dependent manner with percentage inhibitions of 33.85, 43.07 and 50.76% at 100, 200 and 400 mg/kg respectively in gastrointestinal motility test indicating anti-diarrheal potentials. The extract significantly (p<0.05) reduced the intestinal fluid accumulation with percentage inhibitions of 33.28 and 45.61% at 200 and 400 mg/kg respectively, suggesting antisecretory effect. Furthermore, the extract significantly (p<0.05) inhibited the intestinal propulsion of the charcoal meal through the gastrointestinal tract in castor oil-induced gastrointestinal transit suggesting antimotility effect. Total flavonoids and tannins are the most abundant phytoconstituents therein. This study therefore concluded that the anti-diarrhea action of the extract may at least in part be mediated via antisecretory and antimotility mechanisms, which could be due to the additive, synergy or counter interaction of the phytoconstituents therein, thus supporting its ethnomedicinal claim.
Gedächtnisambulanzstrukturen in Deutschland – Ergebnisse einer Klinikbefragung
Authors: Meiberth Dix , Rapp Michael , Jessen Frank 
Published: January 2019

Zusammenfassung
Ziel der Studie Erfassung der Strukturen zur Frühdiagnostik von Demenzen an Krankenhäusern in Deutschland.
Methodik Fragebogenerhebung.
Ergebnisse 14 % von 1758 kontaktierten Einrichtungen antworteten. 52 % berichteten über ein entsprechendes Angebot, zum großen Teil mit leitlinienorientierten Verfahren, wie Liquordiagnostik. Das Diagnosespektrum umfasste zu 46 % Demenzen und zu 41 % Diagnosen der leichten oder subjektiven kognitiven Störung.
Schlussfolgerung Leitlinienbasierte Diagnostik und Früherkennungskonzepte sind in Gedächtnisambulanzen weitgehend etabliert.
A Prospective Study of Efficacy of Small Fenestra Stapedotomy at a South Asian Center
Authors: Sriraam Laya , Shukla Sunita , Ramalingam Ravi , Ramalingam K. 
Published: January 2019

Abstract
Introduction The best surgical treatment for otosclerosis is stapedotomy. Various methods are used for creating fenestra, including manual pick, laser, and Skeeter drill. In India, despite several studies on the hearing outcomes of otosclerosis surgery, there exist few studies on small fenestra stapedotomy performed using a microdrill. Hence, we designed this study with the objectives of examining the demographic profile, hearing improvement after surgery, anatomical variations encountered at surgery, effect of microdrill use on bone conduction (BC), and postoperative complications of small fenestra stapedotomy.
Methods A prospective study was conducted for 63 patients of otosclerosis. Stapedotomy was performed by the same surgeon on all patients by a transcanal approach under local anesthesia. Small fenestra stapedotomy was performed using Skeeter microdrill. The study proforma included sociodemographic profile, clinical history, examination, audiometry, surgical details, and postoperative findings. Descriptive statistics was used to analyze the data.
Results Our study demonstrated a male preponderance (58.7%) over females (41.3%). Of the study population, 31.7% reported a family history of otosclerosis, whereas nine (14.28%) individuals had a history of measles. All four different types of footplates were identified. Most of them were either type 1 (52.4%) or 2 (34.9%). In most cases, the diameter was 0.4 mm (96.8%), a majority of the cases having either 4.25 (22.2%) or 4.5 mm (63.5%) long piston. After stapes surgery, the mean ABG reduced from 39.48 (±9.17) to 13.89 (±7.99) dB. The mean worsening in postoperative BC was only 3.035 dB. Use of microdrill caused only a slight and statistically insignificant decline in BC. Anatomical variation of a narrow oval window niche may require drilling of the bone. In practice, this drilling does not adversely affect the BC of the patient. Some facial nerve variation (partially overhanging facial nerve and exposed facial nerve) may be encountered, but it does not affect the facial nerve function or hearing improvement. On rare occasions, facial paresis may occur on the fifth to sixth postoperative day, even without facial nerve handling. This can be managed conservatively with oral steroids with favorable results. Taste alterations are seen even when the chorda handling is minimal. Complaints are most common in the first few weeks after surgery. Over a 6-month period, only 5% of the patients who underwent surgery were found to have altered taste sensation.
Conclusion Microdrill-assisted small fenestra stapedotomy, performed under local anesthesia, with placement of a 0.4-mm Teflon piston for patients with otosclerosis produces excellent results. The complication rates are low, and the surgery has a positive impact on the patient's hearing.
40 Years of Hydrogen–Deuterium Exchange Adjacent to Heteroatoms: A Survey
Authors: Roche Maxime , Michelotti Alessia 
Published: January 2019

Deuteration of bioactive molecules is gaining more and more attention, especially after the approval of the first deuterated drug (Austedo™) by the US Food and Drug Administration (FDA). Not only is deuteration important for drug development, the amount of deuterium in a molecule is critical for the production of standards in mass spectrometry and the selectivity of the deuteration is mandatory for NMR applications. Very frequently, the molecules involved in these applications contain several heteroatoms. It has been demonstrated that oxygen-, nitrogen-, and more recently, sulfur-containing molecules can be easily deuterated at the α position leading to high deuterium incorporation. In this review we will focus our attention on the historical background and the recent progress made on heteroatom-directed deuteration, with particular attention on the catalysts and the mechanisms that drive such transformations.1	Introduction2	Oxygen-Directed Deuteration3	Nitrogen-Directed Deuteration4	Sulfur-Directed Deuteration5	Conclusion
Synthesis of Bullvalenes: Classical Approaches and Recent Developments
Authors: Ferrer Sofia , Echavarren Antonio 
Published: January 2019

The goal of this short review is to provide an overview of the different synthetic methodologies applied along the years for the synthesis of bullvalenes, prototypical fluxional molecules that were key in the understanding of valence tautomerism phenomena. Some interesting applications of these unique shapeshifting compounds are also presented.1	Introduction2	Classical Syntheses of Bullvalenes3	Recent Developments in the Synthesis of Bullvalenes4	Applications of Bullvalenes5	Conclusion
Stereocontrol in the Synthesis of β-Lactams Arising from the Interlocked Structure of Benzylfumaramide-Based Hydrogen-Bonded [2]Rotaxanes
Authors: Martinez-Cuezva Alberto , Lopez-Leonardo Carmen , Alajarin Mateo , Berna Jose 
Published: January 2019

β-Lactams are highly valuable compounds due to their antibiotic activity. Among the number of well-established methodologies for building this privileged scaffold, our research group has settled on a novel synthetic approach for their preparation. This Account focuses on our latest progress in the synthesis of these compounds through a novel base-promoted intramolecular cyclization of benzylfumaramide-based rotaxanes. The mechanical bond plays a significant role in the process by activating the cyclization inside the macrocycle void, avoiding the formation of byproducts and fully controlling the diastereoselectivity. Further investigations on this transformation led to the formation of ­enantioenriched 2-azetidinones. The cyclization of enantiopure interlocked α-methylbenzylfumaramides allows the formation of two new stereogenic centers in the lactamic four-membered ring, one of them a quaternary carbon, keeping the initial configuration of the chiral group of the starting material.1	Introduction1.1	Mechanically Interlocked Molecules and Applications1.2	Chemical Stabilization of the Mechanical Bond2	Literature Methods for 4-exo-trig Ring Closures of Fumaramides for the Synthesis of β-Lactams3	Our First Encounter with Interlocked β-Lactams3.1	An Unexpected Result in Our Laboratory3.2	Finding the Optimal Reaction Conditions3.3	Elucidating the Effects of the Mechanical Bond4	Diastereoselective Synthesis of Interlocked and Non-Interlocked β-Lactams5	Asymmetric Cyclization of Enantiopure Interlocked Fumaramides6	Conclusions
Use of the Rochester Epidemiology Project for Clinical Research in Colon and Rectal Surgery
Authors: Cima Robert , Lightner Amy 
Published: January 2019

AbstractThe Rochester Epidemiology Project (REP), a longitudinal population-based database, is the largest epidemiologic database in the world. Originally established at Mayo Clinic in Rochester, Minnesota, the REP has been instrumental in defining the natural history of disease states and the impact of treatment in a well-defined population. In the United States, the REP has made important contributions to the colon and rectal literature, largely because healthcare is fragmented with no unique identifier to longitudinally follow-up with a patient throughout the system over his or her lifespan. Investigation with the REP has provided insight to the economic burden associated with inflammatory bowel disease, the benefit of screening for colorectal cancer, and the natural history of Mekel's and diverticular disease. In addition to practice changing research, the REP can be used as a model for future linkage systems in the United States.
Clinical Research Using the National Inpatient Sample: A Brief Review of Colorectal Studies Utilizing the NIS Database
Authors: Kelley Katherine , Tsikitis V. 
Published: January 2019

AbstractThe National Inpatient Sample (NIS) is the largest collection of longitudinal hospital care data in the United States and is sponsored by the Agency for Healthcare Research and Quality. The data are collected from state organizations, hospital associations, private organizations, and the federal government. This database has been used in more than 400 disease-focused studies to examine health care utilization, access, charges, quality, and outcomes of care. The database has been maintained since 1988, making it one of the oldest on hospital data. The focus of this review is to explore and discuss the use of NIS database in colorectal surgery research and to formulate a simplified guide of the data captured for future researchers.
Safety and Efficacy of Perampanel as Adjunctive Therapy in Patients with Refractory Focal Epilepsy Over 12 Months: Clinical Experience in a Real-World Setting
Authors: Rinaldi Fabrizio , De Maria Giovanni 
Published: January 2019

Abstract
Background The main purpose of this study is to assess efficacy and tolerability of perampanel (PER), a noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor antagonist, as an add-on treatment in adult patients with refractory focal-onset seizures.
Patients and Methods A prospective, open label, observational study was conducted in patients with refractory focal-onset seizures treated with PER at our Epilepsy Unit, from May 2015 to February 2016. Patients were followed up for 1 year. Frequency of seizure and tolerability was assessed every 3 months. Patients were under a polytherapy, and the mean number of concomitant antiepileptic drugs (AEDs) at PER initiation was 2.9.
Results We consecutively enrolled 52 patients (M/F = 18/34). Three were lost on follow-up. Mean age was 38.7 years, with a mean duration of disease of 28.1 years. After 1 year of treatment, 57.14% reported a 50% or greater reduction in seizure frequency; five (10.21%) were seizure free. Six (12.25%) patients reported a reduction lower than 50%. Mean dosage of PER was 7.57 mg. Thirty-one patients were taking enzyme-inducing AEDs (carbamazepine, oxcarbazepine, phenytoin). In this subgroup, the responder rate was 45.2%. Twenty-one patients reported side-effects, most frequently somnolence (11), vertigo/ataxia (6), and aggressiveness (5). Eleven (22.4%) patients reduced or discontinued at least one concomitant AED, while the electroencephalography improved in four (8.16%). Sixteen (32.65%) patients withdrew PER, after a mean duration of 163 days, the mean dosage being 6.4 mg (range 4–12).
Conclusions Adjunctive PER can achieve clinically meaningful improvement, or even seizure freedom, in almost two-thirds of patients suffering from refractory focal-onset epilepsies. It seems similarly safe and well-tolerated. Enzyme-inducing AEDs may limit the efficacy of PER.
Smart Medication
™, an Electronic Diary for Surveillance of Haemophilia Home Care and Optimization of Resource Distribution
Authors: Mondorf Wolfgang , Eichler Hermann , Fischer Ronald , Holstein Katharina , Klamroth Robert , Nimtz-Talaska Antje , Wermes Cornelia , Richter Heinrich , Severin Kai 
Published: January 2019

ZusammenfassungIm Folgenden wird das elektronische Substitutionstagebuch smart medication
™ vorgestellt, sowie eine Analyse der damit erhobenen Echtzeitdaten. Seit 2012 wurde smart medication
™ von 663 Patienten in 30 Deutschen Hämophilie Zentren (HZ) genutzt. Daten aus 9 HZ wurden für die nachfolgende Analyse zusammengeführt. Entsprechend der Mittelwerte des jährlichen Faktorenverbrauchs und der Anzahl von Gelenkblutungen wurden vier Gruppen gebildet. Die größte Gruppe (A, 42%) war die mit unterdurchschnittlichem Faktorenverbrauch und weniger als 2,25 Gelenkblutungen pro Jahr. Die zweitgrößte Gruppe (B, 32%) zeigte ähnlich niedrige Blutungsraten bei überdurchschnittlichem Faktorenverbrauch. Eine Reduktion des Faktorenverbrauchs bei einigen dieser Patienten wäre ggf. möglich. Hingegen könnten andere Patienten mit häufigen Gelenkblutungen bei gleichzeitig niedrigem Faktorenverbrauch (D, 13%), von einer Erhöhung der Dosis profitieren. Patienten mit häufigen Gelenkblutungen trotz überdurchschnittlichem Faktorenverbrauch (C, 13%) benötigen eine intensivierte Behandlung jenseits einer Dosisanpassung, wie pharmakokinetisch adaptierte Dosisanpassungen oder orthopädische Maßnahmen. Mit Hilfe von smart medication
™ können Patienten, die eine Änderung ihrer laufenden Behandlung benötigen, lange vor der nächsten Vorstellung im HZ identifiziert werden. Der ständig wachsende Datenpool erlaubt zudem eine kontinuierliche Analyse von Echtzeitdaten und damit eine Optimierung der zur Verfügung stehenden Ressourcen.
The Neuroanatomy of Reproduction: Seeing Is Believing
Authors: Vlasak Alexander L. , Schaub Amelia , Barry Margaret E. Robin , Rhoton-Vlasak Alice S. 
Published: January 2019

AbstractThe brain is the central controller of reproduction and the menstrual cycle. Reproductive endocrinologists spend their days treating patients with perturbations in reproduction as a result of pituitary diseases and manipulate pituitary hormones to enhance fertility and quality of life. Microscopic neuroanatomical images will allow a better understanding of how a tumor in the pituitary might affect vision, or a mass in the brain might cause amenorrhea. Clinical correlations that are taught every day become much clearer once the anatomical relationships are explored. The objective of this pictorial tour is to elucidate anatomical and clinical relationships while showcasing the neuroanatomy of reproduction.
Outcomes Measures in Hip Arthroscopy
Authors: Trofa David , Westermann Robert , Hagen Mia , Rosneck James , Lynch T. , Sonnenfeld Julian 
Published: January 2019

AbstractAs techniques in hip arthroscopy are rapidly advancing, patient-reported outcome (PRO) measures are becoming an integral part of measuring treatment effectiveness. The movement toward developing valid and reproducible outcome measurement tools has shifted from the traditional physician-derived data to patient-centered scores. As a result, the current standard for measuring the effectiveness of any surgical treatment is to use an outcome that reflects the patient's perspective. This review highlights the quality of the questionnaire properties and their application to the patient undergoing hip arthroscopy. Although the Modified Harris Hip Score (mHHS) has historically been used as the traditional outcome measure for hip surgery, new PRO tools in the field have been developed. The Nonarthritic Hip Score (NAHS) was intended for the younger, active patient to assess hip pain and function without radiographic findings. The Copenhagen Hip and Groing Outcome Score (HAGOS) and Hip Disability and Osteoarthritis Outcome Score (HOOS) both incorporated hip related quality of life measures. The Hip Outcome Score (HOS) was developed to assess the treatment outcomes of hip arthroscopy in young-to-middle-aged individuals. Finally, the International Hip Outcome Tool-33 (iHOT-33) addresses the outcomes of treatment in young active patients with hip disorders, in conjuction with the multicenter arthroscopy of the hip outcomes research network. Among the available literature comparing PROs in this patient population, the iHOT-33, HOS, and HOOS remain reliable, valid, and consistent available PRO tools for hip arthroscopy surgery.
Concussions: Activity Avoidance and Rest Recommendation
Authors: Salvatore Anthony , Banks Russell 
Published: January 2019

AbstractResearch surrounding rest recommendations for the concussed population is discussed. Rest is compared with activity avoidance, which is common in several chronic disease and traumatic injury types. The case is made for rest recommendations tailored to each head-injured individual. Research is presented which suggests that activity in the initial stages of concussion recovery may be beneficial in reducing postconcussion symptom duration and severity. Furthermore, a gradual increase in activity may potentially aid in returning to normal daily activity sooner than those who avoid both physical and cognitive activity during the acute stage of a traumatic brain injury. Finally, the current state of rest recommendations is reviewed and anticipated future directions are discussed.
Malignant Pleural Effusions: Management Options
Authors: Porcel Jose , Rahman Najib , McCracken David 
Published: January 2019

AbstractMalignant pleural effusion (MPE) represents advanced metastatic malignancy and is associated with poor median survival. Incidence remains high and continues to rise, in part due to changing population demographics. This therefore represents a significant health care burden. Management is predominantly palliative in nature and multiple interventions are available within conventional treatment paradigms, all of which are proven to result in statistically significant patient benefit. This article further explores the methods available in the management of MPE along with the pitfalls, complications, and alternatives. Recent advances within the field are discussed with an exploration of likely future directions, including the role of ultrasound as a prospective predictor and the role of intrapleural fibrinolytic therapy.
Sticky Platelet Syndrome: 35 Years of Growing Evidence
Authors: Holly Pavol , Stasko Jan , Kubisz Peter 
Published: January 2019

AbstractSince the identification of antithrombin deficiency by Egeberg in 1956, ongoing research in prothrombotic defects continues to progress. Interestingly, past research has predominantly focused on coagulation factors and not on other components of the hemostatic system. The possible role of platelet function defects in the development of thrombotic events was suggested for the first time in the late 1970s, when an increased platelet adhesiveness and aggregation after epinephrine (EPI) and adenosine diphosphate (ADP) was found in a group of patients with unexplained transient ischemic attack. Clinical evidence for other types of thrombotic events (e. g. myocardial infarction, ischemic stroke, optic neuropathy, and pregnancy-related complications) with similar laboratory findings was provided by several authors in the 1980s and 1990s, with Drs. Mammen and Bick undertaking key research. The familial occurrence was noted as well, and the term sticky platelet syndrome was introduced by Holliday in 1983 to describe the defect. The term in our present understanding describes a thrombophilic qualitative platelet disorder characterized by increased in vitro platelet aggregation after the addition of very low concentrations of ADP and/or EPI and an increased risk of thromboembolic (predominantly arterial) events. Although now recognized for 35 years, significant issues, namely its etiology, inheritance, epidemiology, and diagnostics, remain a matter of vigorous debate. The aim of this review is to summarize the history, key works, and present understanding of the syndrome and to outline present-day diagnostic and clinical problems and controversies.
Management of Asymptomatic Popliteal Artery Aneurysms
Authors: Kim Tanner , Sumpio Bauer 
Published: January 2019

AbstractPopliteal artery aneurysms (PAAs) are the most common peripheral artery aneurysms. They are frequently symptomatic and are associated with high rates of morbidity and limb loss. PAA can be treated by open or endovascular means, although there are no specified recommendations guiding treatment choice. This article delineates many of the differences between open and endovascular repair of asymptomatic PAA, and highlights several key articles comparing open and endovascular repair to guide decision making. Proper diagnosis and choice of repair can lead to good outcomes in the treatment of asymptomatic PAA.