bluuebunny/crossref_metadata_2025_split huggingface dataset:
Internal carotid artery occlusion may affect long-term quality of life in patients with high-flow carotid cavernous fistulas
Authors: Dai Rong-Qin , Bai Wei-Xing , Gao Bu-Lang , Li Tian-Xiao , Zhang Kun 
Published: July 2019

Purpose To investigate the mid- and long-term effects of parent artery occlusion on the carotid cavernous fistula and on the quality of life of patients. Materials and methods One hundred and twenty-six patients with high-flow direct carotid cavernous fistulas were enrolled. The modified Rankin scale scores, the headache impact test and the short form health survey scores were used to evaluate the patients' clinical status. Results Fifty-two patients had parent artery occlusion, while the rest of the 74 patients had embolization of carotid cavernous fistulas with parent artery preservation. No periprocedural complications occurred. Eighteen patients in the parent artery occlusion group had low perfusion symptoms within two weeks following embolization, and three patients had Horner's syndrome on the ipsilateral side. At two months' follow-up, the patients with parent artery occlusion had a significantly ( P < 0.05) greater proportion of headache than patients with parent artery preservation. At 12 months, no significant ( P > 0.05) difference existed in the headache impact test scores in both groups. At 36 months' follow-up, the patients with parent artery occlusion had decreased SF-30 scores in all the eight health domains compared with patients treated with parent artery preservation, with a significant ( P < 0.05) lower score in general health, vitality and bodily pain in the parent artery occlusion compared with the parent artery preservation group. No recurrence was shown in patients with parent artery occlusion, but nine (12.2%) patients were recurrent in patients with parent artery preservation. Conclusion Parent artery occlusion may affect the quality of life of patients with carotid cavernous fistulas despite being an effective treatment option for high-flow direct fistulas.
Evaluation of an unscheduled care model delivered by advanced nurse practitioners in a primary-care setting
Authors: Leask Calum F , Tennant Heather 
Published: July 2019

Background Considering new models of delivery may help reduce increasing pressures on primary care. One potentially viable solution is utilising Advanced Practitioners to deliver unscheduled afternoon visits otherwise undertaken by a General Practitioner (GP). Aims Evaluate the feasibility of utilising an Advanced Nurse Practitioner (ANP) to deliver unscheduled home visits on behalf of GPs in a primary care setting. Methods Following a telephone request from patients, ANPs conducted unscheduled home visits on behalf of GPs over a six-month period. Service-level data collected included patient-facing time and outcome of visits. Practice staff and ANPs participated in mind-mapping sessions to explore perceptions of the service. Results There were 239 accepted referrals (total visiting time 106.55 hours). The most common outcomes for visits were ‘medication and worsening statement given’ (107 cases) and ‘self-care advice’ (47 cases). GPs were very satisfied with the service (average score 90%), reporting reductions in stress and capacity improvements. Given the low referral rejection rate, ANPs discussed the potential to increase the number of practices able to access this model, in addition to the possibility of utilising other practitioners (such as paramedics or physiotherapists) to deliver the same service. Conclusions It appears delivering unscheduled care provision using an ANP is feasible and acceptable to GPs.
Using Interdisciplinary Dress Rehearsal Events to Ensure Staff Readiness When Opening a New Healthcare Facility
Authors: Aguilera Lynn S. , Dickey Erica K. , Guzman Kelly 
Published: July 2019

Objective: This nonresearch article describes best practices of using the simulation-based Dress Rehearsal method to prepare staff to move into a new hospital or a new space in an existing facility and to ensure the new facility is ready for use. The authors introduce a modified version of the interactive sociotechnical analysis (ISTA) model to serve as the academic foundation for the Dress Rehearsal concept. Background: Healthcare organizations that build new medical facilities must ensure the space is ready to use and that all staff, who will deliver and support patient care, are sufficiently trained. Currently, no standardized approach exists to prepare staff on an interdisciplinary level, to work in their new environment. There are multiple articles highlighting a single hospital or department using simulations before opening, but there is a lack of literature from an aggregate perspective. Method: The Dress Rehearsal method is examined by drawing from the author’s combined experience of conducting and evaluating hundreds of Dress Rehearsals across North America. Best practices to plan, prepare, and execute events will be reviewed. Results: Evaluations collected after each event present a positive impact related to staff feeling prepared to provide safe care in the new environment, with increased satisfaction after subsequent Dress Rehearsals. Conclusions: A standardized approach to ensure staff feel confident and safe to move into their new healthcare environment should be a top priority for healthcare leadership. The Dress Rehearsal method is a substantive strategy that supports building and staff readiness for opening day and beyond.
Early imaging predictors of longer term multiple sclerosis risk and severity in acute optic neuritis
Authors: Gajamange Sanuji , Stankovich Jim , Egan Gary , Kilpatrick Trevor , Butzkueven Helmut , Fielding Joanne , van der Walt Anneke , Kolbe Scott 
Published: July 2019

Background Biomarkers are urgently required for predicting the likely progression of multiple sclerosis (MS) at the earliest stages of the disease to aid in personalised therapy. Objective We aimed to examine early brain volumetric and microstructural changes and retinal nerve fibre layer thinning as predictors of longer term MS severity in patients with clinically isolated syndromes (CIS). Methods Lesion metrics, brain and regional atrophy, diffusion fractional anisotropy and retinal nerve fibre layer thickness were prospectively assessed in 36 patients with CIS over the first 12 months after presentation and compared with clinical outcomes at longer term follow-up [median (IQR) = 8.5 (7.8–8.9) years]. Results In total, 25 (69%) patients converted to MS and had greater baseline lesion volume ( p = 0.008) and number ( p = 0.03)than CIS patients. Over the initial 12 months, new lesions ( p = 0.0001), retinal nerve fibre layer thinning ( p = 0.04) and ventricular enlargement ( p = 0.03) were greater in MS than CIS patients. In MS patients, final Expanded Disability Status Scale score correlated with retinal nerve fibre layer thinning over the first 12 months (ρ = −0.67, p = 0.001). Conclusions Additional to lesion metrics, early measurements of fractional anisotropy and retinal nerve fibre layer thinning are informative about longer term clinical outcomes in CIS.
Evaluating the protective potency of Acacia hydaspica R. Parker on histological and biochemical changes induced by Cisplatin in the cardiac tissue of rats
Authors: Afsar Tayyaba , Razak Suhail , Almajwal Ali , Shabbir Maria , Khan Muhammad Rashid 
Published: July 2019

AbstractBackgroundIncrease oxidative trauma is the main cause behind Cisplatin (CP) induced cardiotoxicity which restricts its clinical application as anti-neoplastic prescription.Acacia hydaspicais a natural shrub with diverse bioactivities.Acacia hydaspicaethyl acetate extract (AHE) ameliorated drug-induced cardiotoxicity in animals with anti-oxidative mechanisms. Current study aimed to evaluate the protective potential ofA. hydaspicaagainst cisplatin-induced myocardial injury.MethodsRats were indiscriminately distributed into six groups (n = 6). Group 1: control; Groups 2: Injected with CP (7.5 mg/kg bw, i.p, single dose) on day 16; Group 3: Treated for 21 days with AHE (400 mg/kg b.w, oral); Group 4: Received CP injection on day 16 and treated with AHE for 5 days post injection; Group 5: Received AHE (400 mg/kg b.w/day, p.o.) for 21 days and CP (7.5 mg/kg b.w., i.p.) on day 16; Group 6: Treated with silymarin (100 mg/kg b.w., p.o.) after 1 day interval for 21 days and CP injection (7.5 mg/kg b.w., i.p.) on day 16. On 22nd day, the animals were sacrificed and their heart tissues were removed. Cisplatin induced cardiac toxicity and the influence of AHE were evaluated by examination of serum cardiac function markers, cardiac tissue antioxidant enzymes, oxidative stress markers and histology.ResultsCP inoculation considerably altered cardiac function biomarkers in serum and diminished the antioxidant enzymes levels, while increased oxidative stress biomarkers in cardiac tissues AHE treatment attenuated CP-induced deteriorations in creatine kinase (CK), Creatine kinase isoenzymes MB (CK-MB), cardiac Troponin I (cTNI) and lactate dehydrogenase (LDH) levels and ameliorated cardiac oxidative stress markers as evidenced by decreasing lipid peroxidation, H2O2and NO content along with augmentation in phase I and phase II antioxidant enzymes. Additionally, CP inoculation also induced morphological alterations which were ameliorated by AHE. In pretreatment group more significant protection was observed compared to post-treatment group indicating preventive potential of AHE. The protective potency of AHE was comparable to silymarin.ConclusionResults demonstrate that AHE attenuated CP induce cardiotoxicity. The polyphenolic metabolites and antioxidant properties of AHE might be responsible for its protective influence.
TACRM: trust access control and resource management mechanism in fog computing
Authors: Daoud Wided Ben , Obaidat Mohammad S. , Meddeb-Makhlouf Amel , Zarai Faouzi , Hsiao Kuei-Fang 
Published: July 2019

Abstract
Fog computing network is designed as an extension of the cloud due to the need for a supporting platform capable of ensuring the requirements of Internet of Thing (IoT). The growth of fog based fifth generation mobile communication (5G) system is challenged by the need for data sharing security. In fact, without properly securing access to Fog node resources in IoT network, services providers may not be able to achieve the desired performance. Indeed, fog computing obviously confront numerous security and privacy risks, due to its features, such as huge scale geolocation, heterogeneity and mobility. Thus, we propose a security model that is based on cooperation between IoT and fog. This model integrates an efficient access control process associated with a monitoring scheme to ensure secure cooperation between diverse resources and different operational parts. Indeed, a comprehensive scheduling process and resource allocation mechanism using our security model is proposed to improve the intended performance of the system. In fact, our main contribution is to introduce a distributed access control based on security resource management framework for fog-IoT networks, and proactive security scheme under ultra-trustworthiness and low-latency constraints. After evaluation based on iFogSim, we have proved that our scheme not only provides low latency with high security and privacy, but also reduces the complexity of administration and management of security and resources mechanisms.
Oligoanalgesia in Patients With an Initial Glasgow Coma Scale Score ≥8 in a Physician-Staffed Helicopter Emergency Medical Service: A Multicentric Secondary Data Analysis of >100,000 Out-of-Hospital Emergency Missions
Authors: Helm Matthias , Hossfeld Bjoern , Braun Benedikt , Werner Daniel , Peter Lena , Kulla Martin 
Published: July 2019

BACKGROUND:
Oligoanalgesia, as well as adverse events related to the initiated pain therapy, is prevalent in out-of-hospital emergency medicine, even when a physician is present. We sought to identify factors involved in insufficient pain therapy of patients presenting with an initial Glasgow Coma Scale (GCS) score of ≥8 in the out-of-hospital phase, when therapy is provided by a physician-staffed helicopter emergency medical service (p-HEMS).

METHODS:
This was a multicenter, secondary data analysis of conscious patients treated in primary p-HEMS missions between January 1, 2005, and December 31, 2017. Patients with a numeric rating scale (NRS) pain score ≥4, GCS score ≥8 on the scene, without cardiopulmonary resuscitation (CPR), and a National Advisory Committee for Aeronautics (NACA) score <VI were included. Multivariable logistic binary regression analyses were used to identify characteristics of oligoanalgesia (NRS ≥4 at handover or pain reduction <3). Linear regression analysis was used to identify changes in pain treatment within the study period.

RESULTS:
We analyzed data from 106,730 patients (3.6% missing data at variable level). Of these patients, 82.9% received some type of analgesic therapy on scene; 79.1% of all patients received analgesic drugs, and 38.6% received nonpharmacological interventions, while 37.4% received both types of intervention. Oligoanalgesia was identified in 18.4% (95% confidence interval [CI], 18.1–18.6) of patients. Factors associated with oligoanalgesia were a low NACA score and a low NRS score, as well as central nervous system or gynecological/obstetric complaints. The use of weak opioids (odds ratio [OR] = 1.05; 95% CI, 0.68–1.57) had no clinically relevant association with oligoanalgesia, in contrast to the use of strong or moderate opioids, nonopioid analgesics, or ketamine. We observed changes in the analgesic drugs used over the 12-year study period, particularly in the use of strong opioids (fentanyl or sufentanil), from 30.3% to 42.3% (P value <.001). Of all patients, 17.1% (95% CI, 16.9–17.3) did not receive any type of pain therapy.

CONCLUSIONS:
In the studied p-HEMS cohort, oligoanalgesia was present in 18.4% of all cases. Special presenting complaints, low NACA scores, and low pain scores were associated with the occurrence of oligoanalgesia. However, 17.1% of patients received no type of pain therapy, which suggests a scope for further improvement in prehospital pain therapy. Pharmacological and nonpharmaceutical pain relief should be initiated whenever indicated.
Zebrafish modeling of intestinal injury, bacterial exposures and medications defines epithelial in vivo responses relevant to human inflammatory bowel disease
Authors: Chuang Ling-shiang , Morrison Joshua , Hsu Nai-yun , Labrias Philippe Ronel , Nayar Shikha , Chen Ernie , Villaverde Nicole , Facey Jody Ann , Boschetti Gilles , Giri Mamta , Castillo-Martin Mireia , Thin Tin Htwe , Sharma Yashoda , Chu Jaime , Cho Judy H. 
Published: July 2019

ABSTRACT
Genome-wide association studies have identified over 200 genomic loci associated with inflammatory bowel disease (IBD). High-effect risk alleles define key roles for genes involved in bacterial response and innate defense. More high-throughput in vivo systems are required to rapidly evaluate therapeutic agents. We visualize, in zebrafish, the effects on epithelial barrier function and intestinal autophagy of one-course and repetitive injury. Repetitive injury induces increased mortality, impaired recovery of intestinal barrier function, failure to contain bacteria within the intestine and impaired autophagy. Prostaglandin E2 (PGE2) administration protected against injury by enhancing epithelial barrier function and limiting systemic infection. Effects of IBD therapeutic agents were defined: mesalamine showed protective features during injury, whereas 6-mercaptopurine displayed marked induction of autophagy during recovery. Given the highly conserved nature of innate defense in zebrafish, it represents an ideal model system with which to test established and new IBD therapies targeted to the epithelial barrier.
This article has an associated First Person interview with the first author of the paper.
In silico study of ginsenoside analogues as possible BACE1 inhibitors involved in Alzheimer's disease
Authors: Contreras-Puentes Neyder , Mercado-Camargo Jairo , Alvíz-Amador Antistio 
Published: July 2019

Background: Neurodegenerative disorders such as Alzheimer's disease show an alarming prevalence in the population, with around 50 million affected individuals worldwide, and is associated with the development of dementia, mainly affecting the elderly population. Currently, the treatments used are based on slowing the progression of the clinical symptoms of Alzheimer’s; however, no specific treatment has been found that induces reversion of the disease. Natural products may induce a wide range of palliative effects, such as ginseng (Panax ginseng), which produces secondary metabolites called ginsenosides, which have multiple therapeutic applications, including for neurodegenerative diseases such as Alzheimer’s. Methods: A virtual screening was carried out, using the CHEMBL database to find analogs of ginsenosides based on the ginsenoside Rg1 (CHEMBL501637). Next, the molecules were optimized and their format modified. The structure of BACE1 was downloaded from the Protein Data Bank database (ID: 1FKN) and prepared for the development of molecular docking using the PyRx software. A database of the ligands was created and molecular docking experiments were carried out, obtaining affinity energy values ​​in Kcal/mol. Results: Of the 27 analogues studied, it was found that the molecules CHEMBL451292, CHEMBL510371 and CHEMBL503302 showed considerable affinity with BACE1 when compared with the reference molecules (verubecestat and donepezil). These affinity energy values for CHEMBL451292, CHEMBL510371 and CHEMBL503302 ​​were -9.6, -8.1 and -7.6 Kcal/mol, respectively. Likewise, the binding site of the ligands to BACE1 were identified, with the main interactions being van der Waals and hydrogen bonding. Conclusions: Three ginsenoside analogues showed a similar binding energy with BACE1 compared to the reference drugs. The residues involved in the inhibitory activity of BACE1 and the type of predominant interactions were identified, which agreed with previous reports.
P024 Treatment patterns of biologic therapies used to treat ulcerative colitis: A retrospective database analysis in the United States
Authors: Erin Comerford , Marco DiBonaventura , Timothy Smith , Anthony Louder , David Gruben , Leonardo Salese , Daniel Quirk 
Published: July 2019

BACKGROUNDs:
Treatment goals for ulcerative colitis (UC) focus on inducing a response and maintaining long-term disease remission. The current study sought to document the real-world treatment patterns during the first year of biologic therapy in the United States.

METHODS:
This retrospective analysis used the PharMetrics Plus claims data from January 1, 2013 to October 1, 2017. Biologic-naïve patients aged ≥18 years with UC (ICD9:556.* or ICD10 K51.*) who newly initiated biologic therapy (adalimumab [ADA], infliximab [IFX], vedolizumab [VEDO], golimumab [GOL]) were included. Patients had to have 12 months of continuous enrollment prior to (pre-index) and after (post-index) their first biologic drug claim (index). Patients with Crohn's disease or a history of biologic therapy in the pre-index period were excluded. Treatment patterns were reported descriptively, including combination therapy (frequency of an IM with a biologic), persistence (frequency of patients using their index therapy at the end of the 12-month post-index period without a 60-day gap), and adherence (calculated based on the proportion of days covered).

RESULTS:
A total of N = 3,595 patients with UC were included (51.7% male; age = 42.4 years [SD = 13.6]; disease duration = 1.3 years [SD = 1.0]) with the following treatments at index: N = 2,055 on ADA, N = 1,218 on IFX, N = 152 on GOL, and N = 170 on VEDO. Use of a concomitant IM therapy at index occurred as follows: ADA = 30.75%, IFX = 32.10%, GOL = 29.61%, and VEDO = 25.29%. A total of 59.2% of patients who initiated a biologic therapy remained persistent (i.e., continued on therapy) throughout the 12-month post-index observation period. This varied by therapy: ADA = 56.2%, IFX = 64.9%, GOL = 44.1%, and VEDO = 69.4%. Non-persistent patients predominantly discontinued without switching to another medication or restarting their original medication (discontinuation rates ranged from 42.3% to 52.7% among ADA, GOL, and IFX patients). However, non-persistent VEDO patients predominantly restarted the same therapy after a ≥60 day discontinuation period (36.5%). Switching therapies immediately (i.e., less than 60 days) was also common across each treatment (ADA = 27.1%, IFX = 31.2%, GOL = 31.0%, VEDO = 28.9%). Adherence to biologic therapy, measured by the proportion of days covered, were as follows: ADA = 0.72, IFX = 0.81, GOL = 0.69, VEDO = 0.84.

CONCLUSION(S):
For UC patients initiating biologic therapy, at least 25% initiated concomitant IM therapy. A significant number (40%) of patients discontinued their biologic therapy within the first 12 months. These findings suggest a number of patients experience suboptimal levels of disease control within the first year of biologic therapy.
P039 Efficacy and safety of ustekinumab in patients with refractory Crohn's disease: data from a real world study in Brazil
Authors: Rogerio Parra , Julio Chebli , Liliana Chebli , Erika Bertges , Antonio José Alves Júnior , Orlando Ambrogini Junior , Tárcia Gomes , Marley Feitosa , Omar Féres , Joaquim Rocha José 
Published: July 2019

BACKGROUND:
Ustekinumab (UST) is a fully human monoclonal antibody against IL-12/23. UST induced a clinical response and maintained a higher rate of response than placebo in patients with Crohn's disease (CD). UST was approved in Brazil in November 2017. Real world data regarding efficacy and safety to UST in CD is lacking in our country. We report our experience of UST use in patients with CD refractory to anti-TNF therapy.

METHODS:
An open-label prospective not controlled study was performed including patients from 4 academic medical centers with severely active, refractory CD starting on UST (IV infusions followed by scheduled subcutaneous [SC] injections) between November 2017 and August 2018. We evaluated clinical response and remission (based on Harvey-Bradshaw index [HBI]), C-reactive protein (CRP) and faecal calproprotectin (FC) levels. Clinical response and clinical remission were defined by HBI decrease ≥3 and HBI ≤3, respectively. Patients were evaluated by HBI from baseline until week 32. CRP and FC were evaluated from baseline and at week 16.

RESULTS:
Thirty-seven patients were treated with UST during the study period. The mean age was 37.5 years (IQR: 22–68), disease duration 10.7 years (IQR: 1–29), 75.6% had previous surgeries, 54% had perianal disease, 68.5% had anaemia. Mean HBI at baseline was 10.5 (IQR: 5–19). At baseline mean CRP was 25.9 mg/L and mean FC was 1,134.6 mg/kg (IQR: 150–3,157). At week 8, 81.1% achieved clinical response and 40.5% achieved clinical remission. At second SC injection (week 16 or 20), 63.3% of individuals achieved clinical remission (19/30). After the third SC injection (week 24 or 32), 66.7% of patients presented clinical remission (14/21). CRP decreased to 15.9 mg/L at week 8 and to 10.8 mg/L at week 16. Mean FC at week 16 was 996.2 mg/Kg (IQR: 5–2,362), exhibiting a decrease of 138.4 mg/Kg from baseline. One patient stopped UST due to non-response. No new safety signals were observed.

CONCLUSION(S):
UST therapy was successful for inducing clinical remission and improving laboratory biomarkers of disease activity in patients with refractory CD. Both UST induction and maintenance regimens until week 32 were well tolerated. This result support a favorable safety profile.