bluuebunny/crossref_metadata_2025_split huggingface dataset:
The risk of graft loss 5 years after kidney transplantation is increased if cold ischemia time exceeds 14 hours
Authors: Hansson Josefin , Mjörnstedt Lars , Lindnér Per 
Published: August 2018

AbstractBackgroundThe state of the evidence is unclear regarding the impact of cold ischemia time (CIT) on the outcome of kidney transplantation. The aim of this study was to investigate the effect of CIT on the short‐ and long‐term function of kidneys transplanted at the Sahlgrenska University Hospital in 2007‐2009 from donors after brain death (DBDs).MethodsThis study was designed as a retrospective analysis of data from local and national transplantation registers. The study endpoints were as follows: delayed graft function (DGF), primary nonfunction (PNF), biopsy‐proven acute rejection (BPAR), serum creatinine (S‐creatinine) level at discharge, days of hospitalization after transplantation, and graft survival at 5 years post‐transplantation. Adjusted regression analyses were used to determine causal relationships with CIT. A further aim was to estimate a threshold for CIT by analyzing event rates and coordinates of the receiver‐operated characteristic (ROC) curve.ResultsThere was a causal relationship between CIT as a continuous variable and the following endpoints: graft survival at 5 years post‐transplantation, though this was not significant (hazard ratio (HR) 1.07, P = 0.057), DGF (odds ratio (OR) 1.09, P = 0.03) and S‐creatinine (P = 0.003). In our material, the risk for impaired outcome was higher with longer CIT. We were therefore able to estimate a threshold value for CIT, set to 14 hours for both graft survival at 5 years post‐transplantation and DGF. This was proved with significance by analyzing both event rates and the coordinates of the ROC curve. The risk of graft loss increased, with HR 2.3 (P = 0.023), when comparing a CIT cutoff of ≥14 hours with CIT < 14 hours. Delayed graft function increased, with an OR of 2.6 (P = 0.001).ConclusionOur study confirms that, in this patient material, longer CIT was associated with increased risk for both impaired graft survival and incidence of DGF. We estimated a threshold for CIT of 14 hours.
Reproductive life planning in women after kidney or liver transplantation
Authors: Szpotanska‐Sikorska Monika , Mazanowska Natalia , Madej Anna , Kociszewska‐Najman Bozena , Wielgos Miroslaw , Pietrzak Bronislawa 
Published: August 2018

AbstractIntroductionTo estimate reproductive life planning in post‐transplant women and to identify factors affecting their pregnancy intentions.Material and MethodsA survey study on reproductive life planning was conducted in 217 women of childbearing age who underwent kidney or liver transplantation. The results were compared with data obtained from 816 healthy women surveyed by the Polish Centre for Public Opinion Research. Data were summarized using descriptive statistics.ResultsPost‐transplant women express a similar desire to have a child as women in the general population (42% vs 40%, respectively; P = 0.638). A comparable majority of childless women would like to give birth (65% vs 77%, P = 0.350). More post‐transplant women who have one child give up on future procreation plans (80% vs 46%, P < 0.001). The main factors affecting post‐transplant reproductive life planning were age (OR:0.79; 95% CI: 0.73‐0.85), number of live births (OR:0.22; 95% CI: 0.11‐0.43), and use of drugs contraindicated in pregnancy (OR:0.27; 95% CI: 0.11‐0.63).ConclusionsWomen after kidney or liver transplantation, especially childless, have a similar willingness to become mothers as those in the general population. For post‐transplant women who have already given birth, it is worth considering contraceptive counseling because these women more often choose to not attempt another pregnancy.
Is insulin pump therapy effective in Type 1 diabetes?
Authors: Pickup J. C. 
Published: August 2018

AbstractThere continues to be uncertainty about the effectiveness in Type 1 diabetes of insulin pump therapy (continuous subcutaneous insulin infusion, CSII) vs. multiple daily insulin injections (MDI). This narrative review discusses the reasons for this uncertainty, summarizes the current evidence base for CSII and suggests some future research needs. There are difficulties in interpreting trials of CSII because effectiveness varies widely due to factors such as differing baseline control, suboptimal use of best CSII practices, and psychological factors, for example, high external locus of control, non‐adherence and lack of motivation. Many summary meta‐analyses are also misleading because of poor trial selection (e.g. short duration, obsolete pumps, low baseline rate of hypoglycaemia) and reliance on mean effect size for decision‐making. Both MDI and CSII can achieve strict glycaemic control without hypoglycaemia in some people with Type 1 diabetes, especially those who are motivated and have undergone structured diabetes education, and with high levels of ongoing input from healthcare professionals. CSII is particularly effective in those people with Type 1 diabetes who have not achieved target HbA1c levels without disabling hypoglycaemia using best attempts with MDI, and here there can be valuable and substantial improvement. Insulin pumps are safe, effective and accepted when used in newly diagnosed diabetes, particularly in children, where MDI may not be practicable. Future research needs include more studies on mortality associated with insulin pumps where registry data have suggested lower rates vs. MDI; and psychological strategies to improve non‐adherence and suboptimal glycaemic outcomes on CSII.
A qualitative study exploring women's health behaviours after a pregnancy with gestational diabetes to inform the development of a diabetes prevention strategy
Authors: Parsons J. , Sparrow K. , Ismail K. , Hunt K. , Rogers H. , Forbes A. 
Published: August 2018

AbstractAimTo inform targeted interventions for women with gestational diabetes mellitus (GDM) by exploring the factors that influence their health behaviours and their preferences for lifestyle support.MethodsParticipants were women with previous GDM taken from a diverse inner‐city UK population. Data collection involved focus groups (n = 35 women in six groups) and semi‐structured interviews (n = 15 women). The transcribed data were analysed using framework analysis.ResultsEight themes relating to factors influencing health behaviour were identified: psychological legacy of pregnancy, relationships with healthcare professionals, physical impacts of pregnancy, social support and cultural norms, life‐scheduling, understanding and risk perception, appetite regulation, and prioritization of the baby. The women's recommendations for intervention components included addressing the emotional stress of pregnancy; conveying personalized risk in a motivational way, adopting a family‐centered approach, focusing on women's health rather than just the infant's, and developing flexible interventions. These recommendations were used to construct a model integrating the behaviour‐regulating factors with a suggested framework for intervention.ConclusionsThis study identified some common drivers that may regulate the health behaviours of women following GDM, and recognized some ways to improve care to impact on this. Interventions for diabetes prevention in this population need to address factors at both the individual and systemic levels.
Carbohydrate quantity in the dietary management of type 2 diabetes: A systematic review and meta‐analysis
Authors: Korsmo‐Haugen Henny‐Kristine , Brurberg Kjetil G. , Mann Jim , Aas Anne‐Marie 
Published: August 2018

AimsThis systematic review and meta‐analysis (registration number: CRD42013005825) compares the effects of low carbohydrate diets (LCDs) on body weight, glycaemic control, lipid profile and blood pressure with the effects of higher carbohydrate diets (HCDs) in adults with type 2 diabetes.MethodsMEDLINE, EMBASE, CENTRAL, CINAHL, Food Science Source and SweMed+ databases were systematically searched to identify randomized controlled trials (duration ≥3 months) investigating the effects of an LCD compared to an HCD in the management of type 2 diabetes. Data were extracted and pooled using a random effects model and were expressed as mean differences and risk ratio. Subgroup analyses were undertaken to examine the effects of duration of intervention, extent of carbohydrate restriction and risk of bias. The certainty of evidence was assessed using GRADE.ResultsOf the 1589 studies identified, 23, including 2178 participants, met inclusion criteria. Reductions were slightly greater with LCDs than with HCDs for HbA1c (−1.0 mmol/mol; CI, −1.9, −0.1 [−0.09%; CI, −0.17, −0.01]) and for triglycerides (−0.13 mmol/L; CI, −0.24, −0.02). Changes in weight, HDL‐ and LDL‐cholesterol, total cholesterol and blood pressure did not differ significantly between groups. Subgroup analyses suggested that the difference in HbA1c was evident only in studies with a duration of ≤6 months and with a high risk of bias.ConclusionsThe proportion of daily energy provided by carbohydrate intake is not an important determinant of response to dietary management, especially when considering longer term trials. A range of dietary patterns, including those traditional in Mediterranean countries, seems suitable for translating nutritional recommendations for individuals with diabetes into practical advice.
Brain glucose uptake is associated with endogenous glucose production in obese patients before and after bariatric surgery and predicts metabolic outcome at follow‐up
Authors: Rebelos Eleni , Immonen Heidi , Bucci Marco , Hannukainen Jarna C. , Nummenmaa Lauri , Honka Miikka‐Juhani , Soinio Minna , Salminen Paulina , Ferrannini Ele , Iozzo Patricia , Nuutila Pirjo 
Published: August 2018

AimsTo investigate further the finding that insulin enhances brain glucose uptake (BGU) in obese but not in lean people by combining BGU with measures of endogenous glucose production (EGP), and to explore the associations between insulin‐stimulated BGU and peripheral markers, such as metabolites and inflammatory markers.Materials and methodsA total of 20 morbidly obese individuals and 12 lean controls were recruited from the larger randomized controlled SLEEVEPASS study. All participants were studied under fasting and euglycaemic hyperinsulinaemic conditions using fluorodeoxyglucose‐positron emission tomography. Obese participants were re‐evaluated 6 months after bariatric surgery and were followed‐up for ~3 years.ResultsIn obese participants, we found a positive association between BGU and EGP during insulin stimulation. Across all participants, insulin‐stimulated BGU was associated positively with systemic inflammatory markers and plasma levels of leucine and phenylalanine. Six months after bariatric surgery, the obese participants had achieved significant weight loss. Although insulin‐stimulated BGU was decreased postoperatively, the association between BGU and EGP during insulin stimulation persisted. Moreover, high insulin‐stimulated BGU at baseline predicted smaller improvement in fasting plasma glucose at 2 and 3 years of follow‐up.ConclusionsOur findings suggest the presence of a brain‐liver axis in morbidly obese individuals, which persists postoperatively. This axis might contribute to further deterioration of glucose homeostasis.
Dentists’ responses about the effectiveness of continuing education activities
Authors: Al‐Ansari Asim , Nazir Muhammad Ashraf 
Published: August 2018

AbstractObjectiveTo report the responses of dentists about the effectiveness of continuing education (CE) activities.MethodsThis cross‐sectional study involved the administration of a pilot‐tested questionnaire amongst dentists from different cities of the eastern province of Saudi Arabia. A calculated sample of dentists (n = 323) was approached in person to collect their responses about CE activities they attended during the last one year. Descriptive statistics and multivariate logistic regression analyses were performed.ResultsThe response rate was 79.5% as 257 dentists returned completed questionnaires. There were 54.9% male and 45.1% female participants (mean age 31.18 ± 12.4 years). The majority of participants reported an improvement in knowledge (79.8%), a motivation for learning (79.8%), and quality of dental care (73.9%) as a result of CE activities. More than two‐thirds recognised the importance of CE courses for maintaining licensure in dentistry, and 91.1% felt the need to increase CE activities. Logistic regression models showed that male participants were less likely (OR = 0.48, P = 0.05) than female counterparts to report an improvement in clinical skills. Having a private job (OR = 2.38 P = 0.005) and >10 years since graduation (OR = 1.84, P = 0.05) were associated with an improvement in clinical skills. Believing in the importance of CE activities for maintaining licensure was significantly associated with the effectiveness of CE activities in improving knowledge (OR = 2.76, P = 0.01), clinical skills (OR = 2.02, P = 0.04) and patient satisfaction (OR = 2.22, P = 0.01).ConclusionThe majority of dentists recognised that CE activities were effective in improving their knowledge, clinical practice, quality of patient care and motivation for learning.
Self‐perceived preparedness of final year dental students in a developing country—A multi‐institution study
Authors: Ali Kamran , Cockerill Josephine , Zahra Daniel , Qazi Haroon S , Raja Ulfat , Ataullah Khurram 
Published: August 2018

AbstractAimsTo evaluate the self‐perceived preparedness to practice of final year dental undergraduate students in three dental institutions.MethodsDental undergraduate students in their final year from three dental institutions in Pakistan were invited to participate in an online study to assess self‐perceived preparedness using a validated preparedness assessment scale.ResultsIn total, 134 students responded to the questionnaire yielding a response rate of 72%. Students felt adequately prepared to carry out several clinical procedures including clinical assessment, fillings, tooth extractions and communication skills. However, perceived preparedness was low in the students’ ability to undertake intraoral radiographs, treatment planning, crowns, multirooted endodontics, research skills, referral for suspected oral cancer and raising concerns regarding inappropriate behaviour of colleagues.ConclusionsThis is the first study which investigates the self‐perceived preparedness of final year undergraduate dental students in Pakistan. The results show that the self‐perceived preparedness of final year students was satisfactory for a range of clinical and affective skills. However, several areas of weaknesses were identified which underscore the need for additional training and consolidation.
Outcomes of decades long installation of nest boxes for arboreal mammals in southern Australia
Authors: Goldingay Ross L. , Thomas Karen J. , Shanty Devi 
Published: August 2018

SummaryNest boxes are commonly installed to support hollow‐using species where the abundance of hollow‐bearing trees is deficient. Recent studies have provided equivocal evidence about the effectiveness of nest box projects and have highlighted significant management costs associated with some projects. We document the functionality of 303 nest boxes installed across five different community‐led projects in southern Australia for periods of 10–25 years. As expected, we found that nest boxes lost functionality over time. However, 60% remained functional to support the Brush‐tailed Phascogale (Phascogale tapoatafa) and the Sugar Glider (Petaurus breviceps) after almost 20 years. Years installed, method of nest box attachment and tree species influenced whether boxes remained functional. Nest box construction material changed over time so could not be assessed specifically. When inspected in a single year, the Brush‐tailed Phascogale occupied 9% of functional boxes and another 48% contained their nests. The Sugar Glider occupied 15% of functional boxes and another 22% contained their nests. These values suggest the nest box installations were highly effective for these species, although more detailed study is needed to understand what contribution these installations have made to support the local populations. Maintenance of most nest boxes occurred twice a year in the first five years after installation, but many received no maintenance for periods of three years, and some 10–15 years, before our census. Our findings suggest that infrequent maintenance by community groups can sustain nest box projects over periods of several decades. Research into employing nest boxes as a management tool in Australia is still in its infancy. Further studies are needed to resolve factors that limit their effectiveness.
Prevalence and phenotype of the c.1529C>T SPG7 variant in adult‐onset cerebellar ataxia in Italy
Authors: Mancini C. , Giorgio E. , Rubegni A. , Pradotto L. , Bagnoli S. , Rubino E. , Prontera P. , Cavalieri S. , Di Gregorio E. , Ferrero M. , Pozzi E. , Riberi E. , Ferrero P. , Nigro P. , Mauro A. , Zibetti M. , Tessa A. , Barghigiani M. , Antenora A. , Sirchia F. , Piacentini S. , Silvestri G. , De Michele G. , Filla A. , Orsi L. , Santorelli F. M. , Brusco A. 
Published: August 2018

Background and purposeHereditary ataxias are heterogeneous groups of neurodegenerative disorders, characterized by cerebellar syndromes associated with dysarthria, oculomotor and corticospinal signs, neuropathy and cognitive impairment.Recent reports have suggested mutations in the SPG7 gene, causing the most common form of autosomal recessive spastic paraplegia (MIM#607259), as a main cause of ataxias. The majority of described patients were homozygotes or compound heterozygotes for the c.1529C>T (p.Ala510Val) change. We screened a cohort of 895 Italian patients with ataxia for p.Ala510Val in order to define the prevalence and genotype–phenotype correlation of this variant.MethodsWe set up a rapid assay for c.1529C>T using restriction enzyme analysis after polymerase chain reaction amplification. We confirmed the diagnosis with Sanger sequencing.ResultsWe identified eight homozygotes and 13 compound heterozygotes, including two novel variants affecting splicing.Mutated patients showed a pure cerebellar ataxia at onset, evolving in mild spastic ataxia (alternatively) associated with dysarthria (~80% of patients), urinary urgency (~30%) and pyramidal signs (~70%). Comparing homozygotes and compound heterozygotes, we noted a difference in age at onset and Scale for the Assessment and Rating of Ataxia score between the two groups, supporting an earlier and more severe phenotype in compound heterozygotes versus homozygotes.ConclusionsThe SPG7 c.1529C>T (p.Ala510Val) mutants accounted for 2.3% of cerebellar ataxia cases in Italy, suggesting that this variant should be considered as a priority test in the presence of late‐onset pure ataxia. Moreover, the heterozygous/homozygous genotype appeared to predict the onset of clinical manifestation and disease progression.
Deep learning applied to whole‐brain connectome to determine seizure control after epilepsy surgery
Authors: Gleichgerrcht Ezequiel , Munsell Brent , Bhatia Sonal , Vandergrift William A. , Rorden Chris , McDonald Carrie , Edwards Jonathan , Kuzniecky Ruben , Bonilha Leonardo 
Published: August 2018

SummaryObjectiveWe evaluated whether deep learning applied to whole‐brain presurgical structural connectomes could be used to predict postoperative seizure outcome more accurately than inference from clinical variables in patients with mesial temporal lobe epilepsy (TLE).MethodsFifty patients with unilateral TLE were classified either as having persistent disabling seizures (SZ) or becoming seizure‐free (SZF) at least 1 year after epilepsy surgery. Their presurgical structural connectomes were reconstructed from whole‐brain diffusion tensor imaging. A deep network was trained based on connectome data to classify seizure outcome using 5‐fold cross‐validation.ResultsClassification accuracy of our trained neural network showed positive predictive value (PPV; seizure freedom) of 88 ± 7% and mean negative predictive value (NPV; seizure refractoriness) of 79 ± 8%. Conversely, a classification model based on clinical variables alone yielded <50% accuracy. The specific features that contributed to high accuracy classification of the neural network were located not only in the ipsilateral temporal and extratemporal regions, but also in the contralateral hemisphere.SignificanceDeep learning demonstrated to be a powerful statistical approach capable of isolating abnormal individualized patterns from complex datasets to provide a highly accurate prediction of seizure outcomes after surgery. Features involved in this predictive model were both ipsilateral and contralateral to the clinical foci and spanned across limbic and extralimbic networks.
Everolimus in infants with tuberous sclerosis complex–related West syndrome: First results from a single‐center prospective observational study
Authors: Samueli Sharon , Dressler Anastasia , Gröppel Gudrun , Scholl Theresa , Feucht Martha 
Published: August 2018

SummaryTuberous sclerosis complex (TSC) is the most common cause of West syndrome (WS). Currently available treatment options are ineffective in the majority of affected infants and/or associated with potential serious side effects. Based on the assumption that mTOR overactivation results in increased neuroexcitability in TSC, mTOR inhibitors have been studied as antiseizure therapy. As a result, everolimus recently received approval for the adjunctive treatment of patients aged ≥2 years with refractory TSC‐associated focal and secondary generalized seizures. However, efficacy and safety data for infants with TSC‐associated WS are still lacking. Therefore, a prospective open‐label observational study was initiated at our center, to evaluate everolimus add‐on treatment in infants with TSC‐associated WS, previously refractory to standard treatment. For this preliminary report, data from four male infants with TSC2 and a median observation period of 13 (range = 8‐42) months after treatment initiation were analyzed. Two infants showed electroclinical remission until day 14 after everolimus treatment initiation. In one additional infant, hypsarrhythmia resolved. No relapse after initial response was documented. Developmental progress improved in three infants. Tolerability was similar to that described in older children. According to our preliminary results, everolimus appears to have the potential to treat successfully both spasms and hypsarrhythmia in infants with TSC‐associated WS, contributing to better developmental progress.
Return of individual results in epilepsy genomic research: A view from the field
Authors: Ottman Ruth , Freyer Catharine , Mefford Heather C. , Poduri Annapurna , Lowenstein Daniel H. ,   Epilepsy Return of Results Workshop Participants
Published: August 2018

SummaryGenomic findings are emerging rapidly in 2 large, closely related epilepsy research consortia: the Epilepsy Phenome/Genome Project and Epi4K. Disclosure of individual results to participants in genomic research is increasingly viewed as an ethical obligation, but strategies for return of results were not included in the design of these consortia, raising complexities in establishing criteria for which results to offer, determining participant preferences, managing the large number of sites involved, and covering associated costs. Here, we describe the challenges faced, alternative approaches considered, and progress to date. Experience from these 2 consortia illustrates the importance, for genomic research in epilepsy and other disorders, of including a specific plan for return of results in the study design, with financial support for obtaining clinical confirmation and providing ongoing support for participants. Participant preferences for return of results should be established at the time of enrollment, and methods for allowing future contacts with participants should be included. In addition, methods should be developed for summarizing meaningful, comprehensible information about findings in the aggregate that participants can access in an ongoing way.