bluuebunny/crossref_metadata_2025_split huggingface dataset:
Building toolkits for COPD exacerbations: lessons from the past and present
Authors: Sapey Elizabeth , Bafadhel Mona , Bolton Charlotte E , Wilkinson Thomas , Hurst John R , Quint Jennifer K 
Published: July 2019

In the nineteenth century, it was recognised that acute attacks of chronic bronchitis were harmful. 140 years later, it is clearer than ever that exacerbations of chronic obstructive pulmonary disease (ECOPD) are important events. They are associated with significant mortality, morbidity, a reduced quality of life and an increasing reliance on social care. ECOPD are common and are increasing in prevalence. Exacerbations beget exacerbations, with up to a quarter of in-patient episodes ending with readmission to hospital within 30 days. The healthcare costs are immense. Yet despite this, the tools available to diagnose and treat ECOPD are essentially unchanged, with the last new intervention (non-invasive ventilation) introduced over 25 years ago.An ECOPD is ‘an acute worsening of respiratory symptoms that results in additional therapy’. This symptom and healthcare utility-based definition does not describe pathology and is unable to differentiate from other causes of an acute deterioration in breathlessness with or without a cough and sputum. There is limited understanding of the host immune response during an acute event and no reliable and readily available means to identify aetiology or direct treatment at the point of care (POC). Corticosteroids, short acting bronchodilators with or without antibiotics have been the mainstay of treatment for over 30 years. This is in stark contrast to many other acute presentations of chronic illness, where specific biomarkers and mechanistic understanding has revolutionised care pathways. So why has progress been so slow in ECOPD? This review examines the history of diagnosing and treating ECOPD. It suggests that to move forward, there needs to be an acceptance that not all exacerbations are alike (just as not all COPD is alike) and that clinical presentation alone cannot identify aetiology or stratify treatment.
Poly (ADP) Ribose Glycohydrolase Can Be Effectively Targeted in Pancreatic Cancer
Authors: Jain Aditi , Agostini Lebaron C. , McCarthy Grace A. , Chand Saswati N. , Ramirez AnnJosette , Nevler Avinoam , Cozzitorto Joseph , Schultz Christopher W. , Lowder Cinthya Yabar , Smith Kate M. , Waddell Ian D. , Raitses-Gurevich Maria , Stossel Chani , Gorman Yulia Glick , Atias Dikla , Yeo Charles J. , Winter Jordan M. , Olive Kenneth P. , Golan Talia , Pishvaian Michael J. , Ogilvie Donald , James Dominic I. , Jordan Allan M. , Brody Jonathan R. 
Published: July 2019

Abstract

Patients with metastatic pancreatic ductal adenocarcinoma (PDAC) have an average survival of less than 1 year, underscoring the importance of evaluating novel targets with matched targeted agents. We recently identified that poly (ADP) ribose glycohydrolase (PARG) is a strong candidate target due to its dependence on the pro-oncogenic mRNA stability factor HuR (ELAVL1). Here, we evaluated PARG as a target in PDAC models using both genetic silencing of PARG and established small-molecule PARG inhibitors (PARGi), PDDX-01/04. Homologous repair–deficient cells compared with homologous repair–proficient cells were more sensitive to PARGi in vitro. In vivo, silencing of PARG significantly decreased tumor growth. PARGi synergized with DNA-damaging agents (i.e., oxaliplatin and 5-fluorouracil), but not with PARPi therapy. Mechanistically, combined PARGi and oxaliplatin treatment led to persistence of detrimental PARylation, increased expression of cleaved caspase-3, and increased γH2AX foci. In summary, these data validate PARG as a relevant target in PDAC and establish current therapies that synergize with PARGi.

Significance:
PARG is a potential target in pancreatic cancer as a single-agent anticancer therapy or in combination with current standard of care.
Para um conceito materialista de tempo musical. A teoria dos tipos nos fragmentos de Adorno sobre Beethoven
Authors: Socha Eduardo 
Published: July 2019

Pretende-se expor os elementos principais da teoria dos tipos, que encontramos nos Beethoven-Fragmente, de Theodor W. Adorno. Por meio desse modelo de pensamento, Adorno esclarece os critérios orientadores de seu conceito de tempo musical, que se particulariza criticamente nos escritos musicais posteriores, como as monografias sobre Wagner, Mahler e Berg, os ensaios sobre Stravinsky e as conferências sobre o serialismo pós-Webern. A teoria dos tipos envolveria as diferentes modalidades de “relação da música com o tempo em geral”. Além da exposição teórica, articulada à interpretação do tempo em Hegel, propõe-se a análise técnica de peças de Beethoven, sobretudo do 1º movimento da 3a Sinfonia, obra que fundamentaria in musicis o conceito adorniano de tempo musical.
Acerca da sensitividade tátil na teoria freudiana
Authors: Ibertis Carlota 
Published: July 2019

Como é sabido, o empirismo freudiano dá especial relevância para as sensações visuais e auditivas. Por outro lado, não fica claro, por falta de explicitação, se Freud valoriza as sensações táteis da mesma forma que essas, embora elas estejam presentes em vários momentos-chave da vida psíquica. Com base nisso, o presente artigo explora o significado das sensações táteis na teoria freudiana, examinando suas funções na figuração onírica, nas pulsões parciais da infância e na instauração do eu. A análise mostra uma estreita conexão entre as sensações táteis e o afeto, sugerindo que a consideração freudiana sobre estas sensações requer reavaliação.
A psicanálise nos primeiros tempos da Rússia Soviética
Authors: Maniakas Georgina Faneco 
Published: July 2019

O objetivo deste artigo é fazer uma breve exposição sobre a trajetória da psicanálise nos primeiros anos da Rússia soviética. Entre as práticas que tornaram a psicanálise acessível à classe trabalhadora, concentraremos nossa apresentação na experiência pioneira da “Casa das Crianças” (Detski Dom) de Moscou, primeira escola de educação infantil embasada em princípios psicanalíticos. Documentada por sua fundadora, Vera Schmidt, a escola funcionou entre 1921 e 1925, abrigando 30 crianças com idade entre 1 e 5 anos. Assim como a escola, nos anos que se seguiram à morte de Lênin e ao exílio de Trotsky as demais instituições psicanalíticas sucumbiram à censura ideológica. Em 1936, a repressão stalinista baniu oficialmente a psicanálise da União Soviética, interrompendo um processo que modificou a prática da psicanálise e ampliou o alcance cultural e social das ideias de Freud. Entretanto, o interesse pelo inconsciente se manteve, e no final dos anos 80 a psicanálise foi retomada na Rússia.
Community and caregiver perceptions of giving care to seniors
Authors: Waniger Anne , Gale Kathy , DeNomie Melissa , Nelson David 
Published: July 2019

Background Family caregivers of seniors and disabled adults frequently bear the responsibility of aiding in instrumental activities of daily living and locating resources, often while raising their own families. As the demand for care rises, caregivers may experience declining physical health and increased social and emotional stress compared to their noncaregiving counterparts. This study aims to better understand the journey of unpaid family caregivers and identify opportunities for improvement across organizations, policies, systems, and teams. Research design and methods: A purposive sample of 28 current and former unpaid caregivers of seniors or people with disabilities (26 females and 2 males) participated in four separate focus groups. Recordings were transcribed verbatim and analyzed using open coding. Results Six major themes surrounding the experience of caregiving emerged from the coding process: Ambivalence, “Boiling Point,” Coping, Acknowledgment and Acceptance, Family Dynamics, and Interaction with the System. Focus groups indicated an urgent need to identify and support unpaid caregivers earlier in their trajectory of caring for a senior and to provide consistent, right-time resources over the trajectory of the senior’s lifespan. Discussion and implications: The rational, emotional, and relational components of caregiving represent distinct but overlapping themes within the experience of giving care. Each theme influences another, creating an experience that is complex, fluid, and sensitive to change. The system surrounding caregivers must proactively identify caregivers as equal members of the care team for a senior or disabled adult early in the patient’s disease trajectory.
The witness of the patient's relatives increases the anxiety of the physician, but decreases the anxiety of the relatives of the patient
Authors: Celik Caner , Celik Gulden Sinem , Buyukcam Fatih 
Published: July 2019

Background:We generally keep relatives out of the area while a critical intervention so they cannot observe the management. Recent studies recommend witnessing of the resuscitation by arguing that it supports the patient's relatives’ beliefs that everything that could be done had been done.Objective:We investigated the influence of family witness on the anxiety of patients’ relatives and on the healthcare team.Methods:This study was planned as a prospective observational study. The critical patients who were managed in the resuscitation room with or without intubation were included in the study. The State‐Trait Anxiety Inventory survey form was given to patients’ relatives. Healthcare providers were given a survey, including a visual analog scale of anxiety.Results:The mean visual analog scale score of healthcare providers was 4.37 ± 2.5. The mean visual analog scale score of allied health personnel was similar to resident doctors but lower than consultant doctors. The anxiety of healthcare providers was higher during witnessed management. In the witnessed management group, the anxiety of healthcare providers was higher in patients who received cardiopulmonary resuscitation. The mean State‐Trait Anxiety Inventory anxiety score of patients’ relatives was 50.2 ± 10.3. In witnessed management, the mean anxiety score was 49.5 ± 11.3; in non‐witnessed management, the score was 51.0 ± 9.3. The anxiety of patients’ relatives was not higher, but rather slightly lower during witnessed management of patients.Conclusion:In our study, the anxiety of healthcare providers was higher in family‐witnessed management. It was argued that consultant physicians were more anxious because they have more responsibility about the patients. With witnessed management, the anxiety of patients’ relatives could be reduced, but it is more ominous for healthcare professionals.
Cardiovascular risk behaviour is an emerging health issue in developing countries: a cross-sectional study
Authors: Negesa Lemma B , Magarey Judy , Rasmussen Philippa , Hendriks Jeroen ML 
Published: July 2019

Background: Low and middle-income countries are facing a high burden of cardiovascular disease while there is limited availability of resources and evidence to educate and modify lifestyle behaviours in the population as well as to guide policy making. Aim: The goal of the present study was to quantify the prevalence of different cardiovascular risk behaviours among patients with known cardiovascular conditions in a developing country. Methods: A hospital-based cross-sectional survey was conducted in two referral hospitals in eastern Ethiopia. Outpatients who had a confirmed diagnosis of cardiovascular disease were recruited for the study. Data were collected through face-to-face interviews with patients using validated tools. Results: A total of 287 cardiovascular disease patients was recruited, of which 56.4% were women and 90.2% were urban residents. Most patients had inadequate consumption of fruit and vegetables, 51.6% were physically inactive, 20% were current khat chewers, 19% were current alcohol drinkers and only 1% were current smokers. Approximately one-third (30%) of the patients had one of these risk behaviours, more than half (51.9%) had two, 15% had three and 3.1% had four risk behaviours. The majority (70%) of the patients had multiple (more than two) risk behaviours. The prevalence of multiple risk behaviours did not significantly vary with sex, residence and educational level differences ( P>0.05). Conclusion: Cardiovascular disease patients continue to follow unhealthy lifestyles although they attend follow-up care with a specific focus on risk management. The findings of this study provide evidence for policy makers that health services reform is required to promote healthy lifestyle behaviours for the patients.
Current status of first- and second-line Helicobacter pylori eradication therapy in the metropolitan area: a multicenter study with a large number of patients
Authors: Mori Hideki , Suzuki Hidekazu , Omata Fumio , Masaoka Tatsuhiro , Asaoka Daisuke , Kawakami Kohei , Mizuno Shigeaki , Kurihara Naoto , Nagahara Akihito , Sakaki Nobuhiro , Ito Masayoshi , Kawamura Yo , Suzuki Masayuki , Shimada Yuji , Sasaki Hitoshi , Matsuhisa Takeshi , Torii Akira , Nishizawa Toshihiro , Mine Tetsuya , Ohkusa Toshifumi , Kawai Takashi , Tokunaga Kengo , Takahashi Shin’ichi 
Published: July 2019

Background: The environment surrounding Helicobacter pylori eradication treatment is dramatically changing. Recently, vonoprazan, a first-in-class potassium-competitive acid blocker (P-CAB), was introduced onto the market in 2015. The aging of Japan’s demographic structure is becoming pronounced. In this study, we examined the trend of the eradication rate of H. pylori in the metropolitan area and examined factors concerning successful eradication. Methods: We collected data from 20 hospitals in the Tokyo metropolitan area on patients who received first-line eradication therapy with a proton-pump inhibitor (PPI)/P-CAB, amoxicillin, and clarithromycin for 1 week and second-line eradication therapy with a PPI/P-CAB, amoxicillin, and metronidazole for 1 week from 2013 to 2018. The annual eradication rate and associated factors for successful eradication were analyzed. Results: We collected data of 4097 and 3572 patients in the first- and second-line eradication therapies, respectively. The eradication rate decreased from 2013 to 2014 and increased again from 2015 to 2018 with the first-line therapy [the eradication rates in 2013, 2014, 2015, 2016, 2017 and 2018 were 71.8%, 63.7%, 78.5%, 84.6%, 89.7 and 90.1%, respectively, in the per protocol (PP)]. The second-line eradication rates were 90.0%, 82.6%, 88.8%, 87.5%, 91.8% and 90.1% in 2013, 2014, 2015, 2016, 2017 and 2018, respectively, in PP. Vonoprazan was an independent factor for successful eradication in not only first-line, but also second-line eradication. Age over 75 years was an independent factor for eradication failure in both first- and second-line eradication therapies. Conclusion: The eradication rate improved from 2015 to 2018 with the first-line therapy because of the introduction of vonoprazan in the market. The eradication rates with first- and second-line regimens in elderly patients were lower than those in younger patients.
Predictors of permanent pacemaker requirement after cardiac surgery for infective endocarditis
Authors: Hill Terence E , Kiehl Erich L , Shrestha Nabin K , Gordon Steven M , Pettersson Gosta B , Mohan Chaitra , Hussein Ayman , Hussain Syed , Wazni Oussama , Wilkoff Bruce L , Menon Venu , Tarakji Khaldoun G 
Published: July 2019

Abstract

Background
Infectious endocarditis is often complicated by conduction abnormalities at the time of presentation. Cardiac surgery is the treatment of choice for many infectious endocarditis patients, but carries an additional risk of persistent postoperative conduction abnormality. We sought to define the incidence and clinical predictors of significant postoperative conduction abnormalities necessitating permanent pacemaker implantation after cardiac surgery for infectious endocarditis.

Methods
All consecutive patients with infectious endocarditis who were surgically treated at Cleveland Clinic from 2007 to 2013 were identified using the Cleveland Clinic Infective Endocarditis Registry and the Cardiovascular Information Registry. Patients with a pre-existing cardiac implantable electronic device were excluded. The primary outcome was the need for permanent pacemaker placement postoperatively for atrioventricular block. Regression analysis was performed to identify risk factors for permanent pacemaker requirement.

Results
Among 444 infectious endocarditis patients who underwent cardiac surgery for infectious endocarditis, 57 (13%) required postoperative permanent pacemaker for atrioventricular block. Multivariable analysis identified that prolongation in preoperative PR and QRS intervals, Staphylococcus aureus as the infectious endocarditis organism, the presence of intracardiac abscess, tricuspid valve involvement, and prior valvular surgery independently predicted postoperative permanent pacemaker placement. The developed model exhibited excellent predictive ability (c-statistic 0.88) and calibration.

Conclusion
Infectious endocarditis cardiac surgery patients often require a postoperative permanent pacemaker. Preoperative conduction abnormality, S. aureus infection, abscess, tricuspid valve involvement, and prior valvular surgery are strong predictors of postoperative permanent pacemaker placement.
Risk factors and treatment of relapses in autoimmune pancreatitis: Rituximab is safe and effective
Authors: Soliman Heithem , Vullierme Marie-Pierre , Maire Frédérique , Hentic Olivia , Ruszniewski Philippe , Lévy Philippe , Rebours Vinciane 
Published: July 2019

Background and aimsSteroid therapy is the first‐line treatment for autoimmune pancreatitis but relapses are frequent. The aims were to assess the efficacy and the safety of immunomodulator treatments for relapsing autoimmune pancreatitis and rituximab in particular and to identify relapsing risk factors.MethodsPatients followed for autoimmune pancreatitis from 2000 to 2016 were included. Data were retrospectively analysed regarding autoimmune pancreatitis treatment.ResultsIn total, 162 patients with autoimmune pancreatitis type 1 (n = 92) and type 2 (n = 70) were included (median follow‐up: 3 years (0.5–14). Relapse occurred in 46.5% of patients with autoimmune pancreatitis type 1 (vs 19.3% in autoimmune pancreatitis 2; p < 0.001). Risk factors of relapse were cholangitis, initial use of steroids, other organ involvement and chronic pancreatitis in autoimmune pancreatitis type 1 and initial use of steroids, tobacco consumption and chronic pancreatitis for autoimmune pancreatitis type 2. Overall, 21 patients were treated with immunomodulators (azathioprine, n = 19, or methotrexate, n = 2) for relapses. The efficiency rate was 67%. A total of 17 patients were treated with rituximab, with two perfusions at 15 days apart. The efficacy was 94% (16/17), significantly better than immunomodulator drugs (p = 0.03), with a median follow‐up of 20 months (11–44). Only two patients needed two supplementary perfusions.ConclusionIn relapsing autoimmune pancreatitis, rituximab is more efficient than immunomodulator drugs and shows better tolerance.
Hepatic vein variations in 500 patients: surgical and radiological significance
Authors: Sureka Binit , Sharma Neelmani , Khera Pushpinder Singh , Garg Pawan Kumar , Yadav Taruna 
Published: July 2019

Objectives:
The purpose of the study was to assess the incidence of hepatic vein variations on multidetector CT (MDCT) for abdominal examinations.

Methods:
A retrospective analysis of 534 MDCT scans was performed in patients sent for various abdominal pathologies between January 2017 and April 2019. After excluding 34 patients, finally total of 500 patients (N = 500) were included in the study. For simplification, we classified the hepatic vein variations as classified by Soyer et al, Fang et al and Cheng et al.

Results:
Single right hepatic vein was seen in 458 (91.6%) out of 500 patients in our study. Two right hepatic veins were seen in 36 patients out of which 27 had common trunk and nine had independent drainage into the inferior vena cava (IVC). Common trunk of middle hepatic vein (MHV) and left hepatic vein (LHV) was seen in 405 (81%) and independent drainage of MHV and LHV into the IVC was seen in 95 (19%) of patients in our study. Amongst the segmental hepatic vein variations, most common drainage of segment IV vein was into LHV (333,66.6%) followed by MHV (148,29.6%) and IVC (19,3.8%).

Conclusion:
Hepatic vein variations are commonly seen similar to variations in hepatic artery, portal vein and biliary anatomy. Knowledge of these variations is extremely important for transplant surgeons and intervention radiologists.

Advances in knowledge:
Awareness of the hepatic vein variations is essential for intervention radiologists and surgeons to reduce iatrogenic complications.
Group versus individual antenatal and first year postpartum care: Study protocol for a multi-country cluster randomized controlled trial in Kenya and Nigeria
Authors: Kabue Mark M. , Grenier Lindsay , Suhowatsky Stephanie , Oyetunji Jaiyeola , Ugwa Emmanuel , Onguti Brenda , Omanga Eunice , Gichangi Anthony , Wambua Jonesmus , Waka Charles , Enne Joseph , Don-Aki Jennyfer , Ali Mairo , Buba Maryam , Ang’aha Jenipher , Iya Daniel , Washika Elizabeth , Mohan Diwakar , Smith Jeffrey M. 
Published: July 2019

Background: Antenatal care (ANC) in many low- and middle-income countries is under-utilized and of sub-optimal quality. Group ANC (G-ANC) is an intervention designed to improve the experience and provision of ANC for groups of women (cohorts) at similar stages of pregnancy. Methods: A two-arm, two-phase, cluster randomized controlled trial (cRCT) (non-blinded) is being conducted in Kenya and Nigeria. Public health facilities were matched and randomized to either standard individual ANC (control) or G-ANC (intervention) prior to enrollment. Participants include pregnant women attending first ANC at gestational age <24 weeks, health care providers, and sub-national health managers. Enrollment ended in June 2017 for both countries. In the intervention arm, pregnant women are assigned to cohorts at first ANC visit and receive subsequent care together during five meetings facilitated by a health care provider (Phase 1). After birth, the same cohorts meet four times over 12 months with their babies (Phase 2). Data collection was performed through surveys, clinical data extraction, focus group discussions, and in-depth interviews. Phase 1 data collection ended in January 2018 and Phase 2 concludes in November 2018. Intention-to-treat analysis will be used to evaluate primary outcomes for Phases 1 and 2: health facility delivery and use of a modern method of family planning at 12 months postpartum, respectively. Data analysis and reporting of results will be consistent with norms for cRCTs. General estimating equation models that account for clustering will be employed for primary outcome analyzes. Results: Overall 1,075 and 1,013 pregnant women were enrolled in Nigeria and Kenya, respectively. Final study results will be available in February 2019. Conclusions: This is the first cRCT on G-ANC in Africa. It is among the first to examine the effects of continuing group care through the first year postpartum. Registration: Pan African Clinical Trials Registry PACTR201706002254227 May 02, 2017