bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heparinbehandlung des akuten ischämischen zerebralen Insultes
Authors: Busse O. , Glahn J. 
Published: June 2018

ZusammenfassungDie Antikoagulation mit Heparin in der Akutphase des ischämischen Hirninfarkts ist keine kurative Maßnahme, sondern dient der Prophylaxe von Rezidivinsulten oder anderen thrombembolischen Komplikationen. Die subkutane Heparinbehandlung zur Prävention venöser thrombembolischer Komplikationen gilt im allgemeinen als gesichertes Therapieprinzip. Im Gegensatz hierzu ist die Wirksamkeit der intravenösen Heparinbehandlung mit PTT-wirksamen Dosen zur Rezidivprophylaxe nicht gesichert, wenn auch bei kardiogenen Embolien und Hochrisikopatienten mit atherothrombotischen Insulten sehr wahrscheinlich. Unverzichtbar vor der intravenösen Behandlung mit Heparin ist ein Computertomogramm zum Ausschluß einer Hirnblutung. Unter Berücksichtigung und Kenntnis potentieller Risikopatienten und Nebenwirkungen ist die Antikoagulation mit Heparin eine risikoarme Behandlung.
Myokardinfarkt und Thrombolyse
Authors: Priglinger Ute , Nikfardjam Mariani , Maurer G. , Huber K. 
Published: June 2018

ZusammenfassungDie Thrombolysetherapie stellt wegen ihrer ubiquitären Zugänglichkeit und einfachen Applikationsweise einen Meilenstein in der Behandlung des akuten Myokardinfarktes dar. Mit dem natürlichen Gewebeplasminogenaktivator (t-PA) und seinen biochemisch modifizierten Varianten, die zumindest theoretisch bessere Eigenschaften aufweisen als die Muttersubstanz, stehen uns heute äußerst potente Fibrinolytika zur Verfügung. Andere neue Präparate wie z.B. Staphylokinase, Pro-Urokinase, oder der Vampir-Fledermaus-Plasminogen-Aktivator DSPA-alpha-1 stehen an der Schwelle zur kommerziellen klinischen Nutzung. Im vorliegenden Artikel wird besonders auf weitere Verbesserungsmöglichkeiten der Thrombolysetherapie, wie z. B. die Verkürzung der Zeitdauer Infarktbeginn - Lysebeginn, die Verbesserung der TIMI-Grad-3-Flußrate und die Optimierung der antithrombotischen Begleittherapie, eingegangen.
Cases of pN1b and pM1 Papillary Microcarcinoma of the Thyroid
Authors: Takebayashi Shinji , Shinohara Shogo , Mizuno Keisuke , Saida Koji , Hayashi Kazuki , Yamamoto Ryosuke , Michida Tetsuhiko , Kikuchi Masahiro , Fujiwara Keizo , Naito Yasushi 
Published: June 2018

Introduction Papillary thyroid carcinoma has a relatively good prognosis among malignant tumors of the thyroid. Therefore, a “wait and see” strategy is often adopted for patients with micropapillary thyroid carcinoma. On the other hand, patients with papillary thyroid carcinoma with N1b or M1 disease are known to show a poor prognosis. Here, we investigated the differences in the characteristics between patients with papillary thyroid microcarcinoma with and without N1b metastatic nodes/distant metastases to identify the risk factors for metastasis.
Methods The retrospective study was performed in patients with thyroid microcarcinoma who were treated at the Kobe City Medical Center General Hospital from 2007 to 2017. The characteristics of the patients with thyroid microcarcinoma who were classified as having N1b or M1 disease (N1b/M1 group) were compared with those of patients with the same cancer classified as having N0, N1a, or M0 disease (N0/N1a group).
Results A total of 65 patients were enrolled in this study; 12 were classified into the N1b/M1 group and 53 were classified into the N0/N1a group. The proportion of males was significantly higher in the N1b/M1 group than in the N0/N1a group. There were no statistically significant differences in the distribution of the tumor sites, the ultrasonographic findings, or the frequency of the presence of multiple carcinomas. Although three patients died due to other causes, there were no patients who died due to papillary thyroid carcinoma.
Conclusion No significant predictors were identified for classifying patients with papillary thyroid microcarcinoma into the N1b/M1 group in this study. However, our findings suggested that male patients with papillary thyroid microcarcinoma require more careful follow-up in comparison to female patients with this cancer.
Disrupting LXRα phosphorylation promotes FoxM1 expression and modulates atherosclerosis by inducing macrophage proliferation
Authors: Gage M. C. , Bécares N. , Louie R. , Waddington K. E. , Zhang Y. , Tittanegro T. H. , Rodríguez-Lorenzo S. , Jathanna A. , Pourcet B. , Pello O. M. , De la Rosa J. V. , Castrillo A. , Pineda-Torra I. 
Published: June 2018

Significance
To date, the importance of liver X receptors (LXRs) in atherosclerosis development has been gleaned from their pharmacological or genetic manipulation. Here, we show that altering LXRα phosphorylation can shape proatherogenic responses to fat-rich diets, uncovering previously unrecognized mechanisms. Disrupting LXRα phosphorylation in myeloid cells triggers global changes in gene expression in macrophages, including the up-regulation of proliferation-promoting factors, consistent with increased proliferation of lesion-resident cells. This leads to an enhanced atherosclerotic plaque burden and plaques with altered phenotypic features. Notably, novel LXRα-regulated targets revealed by impaired LXRα phosphorylation are markedly distinct from those promoted by LXR ligand activation. Overall, this work reveals LXRα phosphorylation as an important determinant of atherosclerosis development. This could be exploited for the design of novel antiatherosclerotic strategies.
Children as visionary change agents in Danish school health promotion
Authors: Clausen Laura Tolnov , Schmidt Carina , Aagaard-Hansen Jens , Reinbach Helene Christine , Toft Ulla , Bloch Paul 
Published: June 2018

Summary
This paper describes children’s perceptions and visions for a healthier social and physical environment in the setting of a primary school on the Danish island of Bornholm. Guided by an everyday-life perspective and applying participatory action research methods including social imagination and visual techniques within the framework of future creating workshops, the study engaged 50 children aged 6–9 years in creative processes of identifying health-related problem areas and solutions in their school setting. The study observed that the children were very capable of articulating their thoughts, ideas and visions for a better and healthier school environment. Identified problem areas and solutions differed widely and represented a broad perspective of health including social, physical, environmental and emotional aspects. The paper discusses advantages and challenges of involving children in decision-making processes and concludes that children are visionary and creative agents of change in health promotion projects provided that applied participatory methods are appealing to the children.
Testing tidal theory for evolved stars by using red giant binaries observed by Kepler
Authors: Beck P G , Mathis S , Gallet F , Charbonnel C , Benbakoura M , García R A , do Nascimento J-D 
Published: June 2018

Abstract
Tidal interaction governs the redistribution of angular momentum in close binary stars and planetary systems and determines the systems evolution towards the possible equilibrium state. Turbulent friction acting on the equilibrium tide in the convective envelope of low-mass stars is known to have a strong impact on this exchange of angular momentum in binaries. Moreover, theoretical modelling in recent literature as well as presented in this paper suggests that the dissipation of the dynamical tide, constituted of tidal inertial waves propagating in the convective envelope, is weak compared to the dissipation of the equilibrium tide during the red giant phase. This prediction is confirmed when we apply the equilibrium-tide formalism developed by Zahn, Verbunt & Phinney, and Remus, Mathis & Zahn on to the sample of all known red giant binaries observed by the NASA Kepler mission. Moreover, the observations are adequately explained by only invoking the equilibrium tide dissipation. Such ensemble analysis also benefits from the seismic characterization of the oscillating components and surface rotation rates. Through asteroseismology, previous claims of the eccentricity as an evolutionary state diagnostic are discarded. This result is important for our understanding of the evolution of multiple star and planetary systems during advanced stages of stellar evolution.
Measuring masses in low mass X-ray binaries via X-ray spectroscopy: the case of MXB 1659-298
Authors: Ponti Gabriele , Bianchi Stefano , Muñoz-Darias Teo , Nandra Kirpal 
Published: June 2018

AbstractThe determination of fundamental parameters in low-mass X-ray binaries (LMXBs) typically relies on measuring the radial velocity curve of the companion star through optical or near-infrared spectroscopy. It was recently suggested that high resolution X-ray spectroscopy might enable a measurement of the radial velocity curve of the compact object by monitoring the Doppler shifts induced by the orbital motion of the disc wind or the disc atmosphere. We analysed a Chandra-HETG+NuSTAR soft state observation of MXB 1659-298, an eclipsing neutron star LMXB. We measured a radial velocity curve whose phase offset and semi-amplitude are consistent with the primary star. We derived the value for the semi-amplitude of the radial velocity for the compact object K1 = 89 ± 19 km s−1, constrained the mass of the secondary (0.3 M⊙ ≤ M2 ≤ 0.8 M⊙) and the orbital inclination of the binary system (73°≤ i≤77°). These values are consistent with previous estimates from independent methods. Via the same technique, the next generation of X-ray observatories equipped with high spectral resolution instruments (e.g. Athena) will have the potential to measure the radial velocity curve of the primary in high inclination X-ray binaries to an accuracy of a few per cent.
Pliny the Younger
Authors: Coleman Kathleen M. 
Published: June 2018

Pliny the Younger—to be distinguished from Pliny the Elder, his maternal uncle and the author of the encyclopedic Natural History—was born in Comum (modern Como) in Transpadane Italy c. 62 ce. His uncle adopted him, probably in his will. Pliny and his mother were living with him at Misenum when Vesuvius erupted in 79 ce. When his uncle went to investigate, Pliny stayed behind reading Livy, but his two eyewitness accounts of the event several decades later are among the most celebrated writings to have survived from Antiquity. As an adult, he led the busy life of a senator, landowner, and married man, dividing his time between the courts and Senate House in Rome and his estates in the country, which included villas at Comum, on the upper Tiber in Umbria, and on the coast of Latium south of Rome. He was highly educated and a dedicated member of intellectual circles in the city, attending recitations and writing risqué verse in his spare time. He advanced through the cursus honorum (series of public offices) to the consulship of 100. His effusive gratiarum actio (speech of thanks) to Trajan on his assumption of this office, which he polished up afterward in repeated drafts, has survived at the head of a collection of twelve Latin panegyrics and is known as the Panegyricus. Apart from the Apologia of Apuleius, which was probably delivered in 158/9 ce, it is the only Latin speech surviving intact between the last invective against Antony by Cicero—Pliny’s hero and model—in 43 bce and a panegyric celebrating the emperor Maximian’s birthday in 289 ce, and is therefore precious testimony to the development of Latin oratory under the empire. Yet it may not be representative of the many other speeches that Pliny composed and circulated, none of which has survived, and it may therefore skew our perceptions of his rhetorical skills. In the second decade of the 2nd century, Pliny’s career culminated in an appointment to govern the eastern province of Pontus-Bithynia as a special emissary of Trajan. A total of 107 letters exchanged between them while he was abroad constitute the tenth book of his Epistulae, prefaced by fourteen more addressed to Trajan earlier in Pliny’s career. Many of his vast circle of associates are visible elsewhere among the rich literary and epigraphic sources surviving for the Flavian and Trajanic periods, and in the nine books of private letters that he selected for publication, his skill as a raconteur and consummate stylist bring the kaleidoscope of contemporary society to life with unparalleled vividness of detail and elegance of expression. As a letter-writer and an orator, he has earned the posterity that—he frankly admits—he so ardently desired.
Effect of Thoracic Epidural Anesthesia in a Rat Model of Phrenic Motor Inhibition after Upper Abdominal Surgery
Authors: Chae Won-Seok , Choi Soron , Sugiyama Daisuke , Richerson George B. , Brennan Timothy J. , Kang Sinyoung 
Published: June 2018

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
One important example of impaired motor function after surgery is diaphragmatic dysfunction after upper abdominal surgery. In this study, the authors directly recorded efferent phrenic nerve activity and determined the effect of the upper abdominal incision. The authors hypothesized that phrenic motor output would be decreased after the upper abdominal incision; it was also hypothesized that blocking sensory input from the incision using thoracic epidural anesthesia would diminish this incision-induced change in phrenic motor activity.

Methods
Efferent phrenic activity was recorded 1 h to 10 days after upper abdominal incision in urethane-anesthetized rats. Ventilatory parameters were measured in unanesthetized rats using whole-body plethysmography at multiple time points after incision. The authors then determined the effect of thoracic epidural anesthesia on phrenic nerve activity and ventilatory parameters after incision.

Results
Phrenic motor output remained reduced by approximately 40% 1 h and 1 day after incision, but was not different from the sham group by postoperative day 10. One day after incision (n = 9), compared to sham-operated animals (n = 7), there was a significant decrease in spike frequency area-under-the-curve (median [interquartile range]: 54.0 [48.7 to 84.4] vs. 97.8 [88.7 to 130.3]; P = 0.0184), central respiratory rate (0.71 [0.63 to 0.79] vs. 0.86 [0.82 to 0.93]/s; P = 0.0460), and inspiratory-to-expiratory duration ratio (0.46 [0.44 to 0.55] vs. 0.78 [0.72 to 0.93]; P = 0.0023). Unlike humans, a decrease, not an increase, in breathing frequency has been observed after the abdominal incision in whole-body plethysmography. Thoracic epidural anesthesia attenuated the incision-induced changes in phrenic motor output and ventilatory parameters.

Conclusions
Upper abdominal incision decreased phrenic motor output and ventilatory parameters, and this incision-induced impairment was attenuated by thoracic epidural anesthesia. The authors’ results provide direct evidence that afferent inputs from the upper abdominal incision induce reflex inhibition of phrenic motor activity.
Flexor hallucis longus tendon transfer: a definitive procedure for Achilles tendon tear in Achilles tendinopathy. A 2-year prospective study
Authors: Hassan Ahmed , Aziz Ahmed M.K. 
Published: June 2018

Background:
Flexor hallucis longus (FHL) tendon transfer aims to relieve pain and restore function after Achilles tendon rupture in patients with Achilles tendinopathy. The choice of operative treatment for chronic Achilles tendon disease is based on the size of the tendon rupture. Our aim was to convey our experience in treating Achilles tendon rupture using FHL tendon transfer.

Methods:
This study included 22 patients (22 ankles) with Achilles tendon rupture after a history of Achilles tendinopathy in the form of ankle pain and edema for a mean period of 1 yr before trauma. Patients were followed for a mean period of 2 yr. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score was used for outcome measurement.

Results:
Twenty-two patients (22 ankles) had FHL tendon transfer (mean age 50.3 yr, follow-up period 2 yr). The AOFAS score improved from 68.9 to 88 (P<0.001), revealing significant improvement in ankle pain, function, and stability.

Conclusions:
This study supports the concept that FHL tendon transfer for Achilles tendon rupture in patients with Achilles tendinopathy is the procedure of choice and provides excellent clinical and functional results.

Level of Evidence:
Level IV, prospective cohort study.
Second Place: Dismounted complex blast injuries: patterns of remaining limb injuries in patients with single-limb lower extremity amputations
Authors: Dupaix John P. , Wilding CPT Steven R. , Tubb COL Creighton C. , Oh COL John S. , Ryan LTC Paul M. 
Published: June 2018

Background:
The conflict tactic of the Afghanistan theater of operations utilizes blast weapons while most patrols are on foot, leading to a pattern of injuries associated with lower extremity amputation termed “dismounted complex blast injury” (DCBI). The purpose of this study was to better define and describe the injuries occurring to the nonamputated extremities in patients injured as the result of DCBI.

Methods:
A retrospective review was conducted of data from the United States and United Kingdom Joint Theater Trauma Registries of injuries resulting from a dismounted improvised explosive device (IED) blast. CT and radiographs were used to characterize injuries. Fisher’s exact test was used to compare categorical data, and binomial logistic regression was used to compare proportions of types of injuries by traumatic amputation level observed.

Results:
Of the 295 patients with lower extremity injuries, 201 had traumatic lower extremity amputations (140 with bilateral lower extremity and 61 with single-leg amputations). All were male, with a mean age 23.38+/-3.77. Below-knee amputation was most common (55.7%), followed by through-knee (25%), and least frequently through-ankle amputation. Hindfoot-level amputation was associated with an 8.1% increase in the odds of the presence of a skeletal foot injury in the nonamputated lower extremity. An association of above-knee amputation with bilateral distal upper extremity injury was found. There was a 10.9% increase in odds for the ipsilateral hand/wrist fracture given an AKA.

Conclusions:
Proximal lower extremity amputation levels are significantly associated with distal upper extremity skeletal injury. Hindfoot-level amputation is significantly associated with contralateral foot fractures. Amputation levels proximal to the ankle often presented with associated genitourinary injuries.
The natural history of acromial stress fracture after reverse total shoulder arthroplasty
Authors: Merlin Gabriel , Louise Fowler Mary , Dashe Jesse , Smiley Paul , Lemos Mark 
Published: June 2018

Background:
The purpose of our study was to observe the natural history of acromial stress fracture after reverse total shoulder arthroplasty.

Methods:
In a two-surgeon, single academic institution, seven patients with acromial fractures after reverse total shoulder arthroplasty were identified and evaluated for pain and functional outcome based on a visual analog scale (VAS), Disability of the Arm, Shoulder, and Hand (DASH) score, and range of motion to compare with results after uncomplicated reverse total shoulder arthroplasty. Outcomes of the acromial stress fracture group were broken down by Levy classification.

Results:
There was no significant difference in VAS, DASH score, or range of motion between Levy 1 and 2 and uncomplicated reverse total shoulder arthroplasty. Levy 3 had significantly decreased forward flexion compared with Levy 1 and 2. Multivariate logistic regression did not show any association between fracture and smoking status, hand dominance, gender, or age. Levy 3 acromial fractures fared worse in this series than the other fracture types, eventually requiring open reduction internal fixation.

Conclusions:
The natural history of patients after reverse total shoulder arthroplasty with an acromial fracture is similar to patients without acromial fracture regarding pain and function on a DASH score. Nonoperative treatment should be attempted for Levy 1 and Levy 2 acromial fractures before offering the patient operative treatment after reverse total shoulder arthroplasty. Levy 3 fractures potentially need operative fixation. Multicenter, prospective studies should be carried out to increase the sample size of patients with acromial stress fracture after reverse total shoulder arthroplasty to assess long-term outcome.

Level of Evidence:
Level III, therapeutic study.
Minimally invasive percutaneous plating of complex metaphyseal-diaphyseal proximal humeral fractures
Authors: Singer Mohamed S. , Moussa Waleed Mohamed Fathy 
Published: June 2018

Background:
Many anatomic, cadaver studies have shown safe anterior and anterolateral percutaneous plating of the humerus; however, there is paucity of information on this in clinical case series. The aim of the current study was to assess outcome of minimally invasive plate osteosynthesis in complex metaphyseal-diaphyseal humeral fractures.

Methods:
Eighteen patients with acute, complex, proximal humeral fractures with diaphyseal extension were operated on using a long proximal humeral plate through a percutaneous minimally invasive technique.

Results:
Union was obtained in all patients with good alignment and good shoulder and elbow function. The average time to union was 15 wk (range, 9-21 wk). Two patients developed postoperative radial nerve palsy that recovered after 3 wk in the first and 9 wk in the second patient. There were no obvious neurovascular injuries or major complications.

Conclusions:
Mini-invasive percutaneous plating of complex metaphyseal-diaphyseal humeral fractures is feasible and safe and has good clinical outcomes.
Critical Friends: Health Professionals' Experiences of Collegial Feedback in a Clinical Setting
Authors: Carlson Elisabeth , Nygren Frida , Wennick Anne 
Published: June 2018

Introduction:
A critical friend is a trusted person who asks provocative questions, provides data to be examined through another lens, and offers critique of a person's work as part of collegial feedback. However, empirical evidence presenting the use of collegial feedback to develop health professionals' competence in clinical settings seems to be scarce. The aim of this study was to explore health professionals' experiences of observing each other as critical friends in a clinical setting, as part of a continuous professional development initiative.

Methods:
The study was designed as a qualitative inductive study. Reflective journals written by health professionals (n = 57) were analyzed using thematic networks. The health professionals represented registered nurses and registered nurses with different specialist education (eg, in pediatrics, mental health, intensive care, and anesthesiology), biomedical scientists, occupational therapists, physiotherapists, and dental hygienists.

Results:
Health professionals can successfully use collegial feedback and benefit from critical friendships in clinical settings as it offers ample opportunities for reflection before, during, and after the observation. A key finding was that to incorporate changes to professional practice, each individual needs to not only act as a critical friend but also experience being observed by a critical friend.

Discussion:
Based on the results of this study, it seems worthwhile to implement and further develop opportunities for health professionals to act as critical friends. We suggest that future research explore not only how professional competence develops over time but also how it impacts on health-related outcomes for patients.