bluuebunny/crossref_metadata_2025_split huggingface dataset:
Difficult-to-treat depression: A clinical and research roadmap for when remission is elusive
Authors: Rush Augustus John , Aaronson Scott T , Demyttenaere Koen 
Published: October 2018

Objectives: The report considers the pros and cons of the most commonly used conceptual model that forms the basis for most clinical practice guidelines for depression. This model promotes the attainment of sustained symptom remission as the treatment goal based on its well-established prognostic and functional importance. Sustained remission is very unlikely, however, after multiple treatment attempts. Our current model propels many clinicians to continue to change or add treatments despite little chance for remission or full functional restoration and despite the increasing risk of more adverse events from polypharmacy. An alternative ‘difficult-to-treat depression’ model is presented and considered. It accepts that the treatment aims for some depressed patients may shift to optimal symptom control rather than remission. When difficult-to-treat depression is suspected, the many treatable causes of persistent depression must be assessed and addressed (given the importance of remission when attainable) before difficult-to-treat depression can be ascribed. The clinical and research implications of the difficult-to-treat depression model are discussed. Conclusion: Suspected difficult-to-treat depression provides a practical basis for considering when to conduct a comprehensive evaluation. Once difficult-to-treat depression is confirmed, treatment may better focus on optimal disease management (symptom control and functional improvement).
Neoextractivism and Class Formation: Lessons from the Orinoco Mining Arc Project in Venezuela
Authors: Angosto-Ferrández Luis Fernando 
Published: October 2018

The Arco Minero del Orinoco (Orinoco Mining Arc—AMO) project, launched in 2016, demonstrates that Bolivarian governments have been unsuccessful in overcoming extractivism and rentier capitalism as structuring foundations of the Venezuelan state and its politics, but it simultaneously confirms that these governments remain supported by a bloc made up of heterogeneous class fractions primarily amalgamated around a demand for socioeconomic development. Mining extractivism is the focus of a rapid readjustment of regional and national class formation. The implementation of the Orinoco Mining Arc project could reactivate government-led redistribution in the short-to-medium term, reversing the deterioration of living conditions of the popular classes and potentially reactivating participation of some of their members in small and medium-sized economic ventures. However, given the political conditions under which the project was launched, the main immediate beneficiaries (to different degrees) are capital holders, corporatist groups within the state apparatus, and sectors of the indigenous population directly involved in extractivism. El proyecto Arco Minero del Orinoco (Orinoco Mining Arc—AMO), lanzado en 2016, demuestra que los gobiernos bolivarianos han fracasado en superar el extractivismo y el capitalismo rentista como fundamentos estructurales del Estado venezolano y su política, pero simultáneamente confirma que estos gobiernos permanecen apoyado por un bloque formado por fracciones de clase heterogéneas principalmente aglutinadas en torno a una demanda de desarrollo socioeconómico. El extractivismo minero es el foco de un rápido reajuste de la formación de clases regionales y nacionales. La implementación del proyecto Orinoco Mining Arc podría reactivar la redistribución liderada por el gobierno en el corto a mediano plazo, revirtiendo el deterioro de las condiciones de vida de las clases populares y potencialmente reactivando la participación de algunos de sus miembros en pequeñas y medianas empresas económicas. Sin embargo, dadas las condiciones políticas bajo las cuales se lanzó el proyecto, los principales beneficiarios inmediatos (en diferentes grados) son los titulares de capital, los grupos corporatistas dentro del aparato estatal y los sectores de la población indígena directamente involucrados en el extractivismo.
Chronicle of a Defeat Foretold: The PT Administrations from Compromise to the Coup
Authors: Antunes Ricardo , Santana Marco Aurelio , Praun Luci 
Published: October 2018

The period in which the Workers’ Party (Partido dos Trabalhadores—PT) was in power in Brazil was characterized by limits and contradictions with regard to policies on employment, unions, and the fight against poverty. An analysis of the factors that contributed to the end of the 14-year cycle of consecutive presidential terms highlights the combined impacts of the international economic crisis, a deepening political crisis with charges of corruption, the destabilization of the party’s political alliances, and mass discontent intensified by fiscal adjustment measures that further penalized the already stressed working class. The PT once in power did not motivate resistance, advances in social and union struggles, or social movements, and when it finally attempted to reach out to other social movements it was too late. With the coup represented by the impeachment of Dilma Rousseff in 2016, Brazil entered once again into what Florestan Fernandes has called “preventive counterrevolution.” O período durante o qual o PT (Partido dos Trabalhadores) esteve no poder no Brasil caracterizou-se pelos limites e contradições das políticas públicas referentes a emprego, sindicatos e à luta contra a pobreza. Uma análise dos fatores que contribuíram para o fim do ciclo de 14 anos de sucessivas presidências petistas assinala o impacto conjunto da crise econômica internacional, o aprofundamento da crise política com base em acusações de corrupção, a desestabilização das alianças políticas do partido e o descontentamento exa-cerbado pelo ajuste fiscal que penalizou ainda mais a já combalida classe trabalhadora. Uma vez no poder, o PT não encorajou a resistência, ou os avanços nas lutas sindical e social. Quando finalmente tentou ligar-se a outros movimentos sociais já era tarde demais. Com o golpe representado pelo impeachment de Dilma Rousseff em 2016, o Brasil novamente ingressou no que Florestan Fernandes denominou “contra-revolução preventiva.”
Age-related presentation of acute type A aortic dissection
Authors: Malvindi Pietro Giorgio , Votano Daniela , Ashoub Ahmed , Modi Amit , Miskolczi Szabolcs , Velissaris Theodore , Barlow Clifford , Ohri Sunil , Tsang Geoffrey , Livesey Steven , Göbölös Laszlo 
Published: October 2018

Background We evaluated the clinical and anatomic presentations of acute type A aortic dissection according to patient age. Methods We retrospectively reviewed 235 consecutive patients who underwent acute type A dissection repair between January 2000 and December 2014. The influence of age on anatomical and clinical presentation, surgical management in the entire cohort and also after exclusion of patients with known connective tissue disorders was assessed using logistic regression. Results Males presented with type A acute aortic dissection at a younger age than females. Acute onset with signs of myocardial ischemia, connective tissue disorders, or bicuspid aortic valve characterized the younger population. Extension to the coronary sinus(es) ( p = 0.0003), descending thoracic aorta ( p = 0.016), and abdominal aorta ( p = 0.029), and an intimal tear at the level of the aortic root ( p = 0.0017) correlated inversely with patient age. Similar findings were obtained after exclusion of patients with connective tissue disorders or a bicuspid aortic valve. Conclusions More frequent proximal and distal progression of the dissection flap occurs in younger patients with acute type A aortic dissection. Older age is associated with a lower probability of an intimal tear at the level of the sinus of Valsalva. These findings, associated with prognostic implications, account for the choice of more radical proximal procedures for repair of aortic dissection in younger patients.
Computer-assisted detection of acute pulmonary embolism at CT pulmonary angiography in children and young adults: a diagnostic performance analysis
Authors: Tang Chun Xiang , Zhou Chang Sheng , Schoepf Uwe Joseph , Mastrodicasa Domenico , Duguay Taylor , Cline Anna , Zhao Yan E , Lu Li , Li Xie , Tao Shu Min , Lu Meng Jie , Lu Guang Ming , Zhang Long Jiang 
Published: October 2018

Background To diagnose pulmonary embolism (PE) in children and adults since evaluating tiny pulmonary vasculature beyond segmental level is a challenging and demanding task with thousands of images. Purpose To evaluate the effect of computer-assisted detection (CAD) on acute PE on CTPA in children and young adults by readers with varying experience levels. Material and Methods Six radiologists were retrospectively divided into three groups according to experience levels and assessed the CTPA studies on a per-emboli basis. All readers identified independently the PE presence, and ranked diagnostic confidence on a 5-point scale with and without CAD. Reading time, sensitivities, specificities, accuracies, positive predictive values (PPVs), and negative predictive values (NPVs) were calculated for each reading. Results The sensitivities and NPVs differed significantly in most readers ( P = 0.004, 0.001, 0.010, 0.010, and 0.012 for sensitivities and P = 0.011, 0.003, 0.016, 0.017, and 0.019 for NPVs) except for reader 6 ( P = 0.148 and 0.165, respectively), and the accuracies of all readers differed significantly (all P < 0.05) in peripheral PE (beyond segmental level) detection readings with CAD versus without CAD between two reading methods. The overall time using CAD was longer than those without CAD (76.6 ± 54.4 s vs. 49.4 ± 17.7 s, P = 0.000) for all readers. Significant differences were found for confidence scores in inter-group measurements with CAD ( P = 0.045) and without CAD ( P < 0.001). Conclusion At the expense of longer reading time, the use of the CAD algorithms improves sensitivities, NPVs, and the accuracies of readers in peripheral PE detection, especially for readers with a poor level of interpretation experience.
Effect of aortic arch type on technical indicators in patients undergoing carotid artery stenting
Authors: Shen Songhe , Jiang Xiongjing , Dong Hui , Peng Meng , Wang Zhixue , Che Wuqiang , Zou Yubao , Yang Yuejin 
Published: October 2018

Objective This study was performed to explore the effect of the aortic arch type on technical indicators in patients undergoing carotid artery stenting (CAS). Methods The data of 224 consecutive patients who underwent unilateral CAS from January 2011 to December 2012 were retrospectively analyzed. The requirement for placement of the guiding catheter into the common carotid artery with assistance of an angiographic catheter, fluoroscopy time, contrast agent dose, and adverse events were recorded. Results The fluoroscopy time was significantly longer and the contrast agent dose was significantly higher in patients with Type III than Type I and II arches. Significantly more patients with Type III than Type I and II arches required placement of the guiding catheter with assistance of an angiographic catheter (46.2% vs. 15.0%, respectively). The procedural success rate was significantly lower in patients with Type III than Type I and II arches (96.2% vs. 100.0%, respectively). The incidence of death, myocardial infarction, and all types of stroke was significantly higher in patients with Type III than Type I and II arches (7.7% vs. 1.7%, respectively). Conclusions The aortic arch type is an important influential factor in CAS. Type III arches are associated with more difficulties and complications.
The Accuracy of Urinary TIMP-2 and IGFBP7 for the Diagnosis of Cardiac Surgery-Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis
Authors: Tai Qiang , Yi Huimin , Wei Xuxia , Xie Wenfeng , Zeng Ou , Zheng Donghua , Sun Jiaqi , Wang Ganping , Wang Siqi , Liu Genglong 
Published: October 2018

Background: Tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) are recent promising markers for identification of cardiac surgery-associated acute kidney injury (CSA-AKI). The aim of this study was systematically and quantitatively to evaluate the accuracy of urinary TIMP-2 and IGFBP7 for the diagnosis of CSA-AKI. Methods: Three databases including PubMed, ISI web of knowledge, and Embase were systematically searched from inception to March 2018. Two investigators conducted the processes of literature search study selection, data extraction, and quality evaluation independently. Meta-DiSc and STATA were used for all statistical analyses. Results: A total of 8 studies comprising 552 patients were included in this meta-analysis. Pooled sensitivity and specificity with corresponding 95% confidence intervals (CIs) were 0.79 (95% CI, 0.71-0.86, I 2 = 74.2%) and 0.76 (95% CI, 0.72-0.80, I 2 = 80.8%), respectively. Pooled positive likelihood ratio (LR), negative LR, and diagnostic odds ratio were 3.49 (95% CI, 2.44-5.00, I 2 = 61.5%), 0.31(95% CI, 0.19-0.51, I 2 = 51.8%), and 14.89 (95% CI, 7.31-30.32, I 2 = 27.9%), respectively. The area under curve estimated by summary receiver operating characteristic was 0.868 (standard error [SE] 0.032) with a Q* value of 0.799 (SE 0.032). Sensitivity analysis demonstrated that one study notably affected the stability of pooled results. One of the subgroups investigated—AKI threshold—could account for partial heterogeneity. Conclusion: Urinary TIMP-2 and IGFBP7 is a helpful biomarker for early diagnosis of CSA-AKI. And, the potential of this biomarker with a broader spectrum of clinical settings may be the focus of future studies.
A Technical Innovation in Midface Advancement With the External Frame Distraction Device
Authors: Hussain Syed Altaf , Vijayakumar Charanya 
Published: October 2018

Background: Maxillary advancement with a rigid external distractor (RED) II is a commonly performed procedure for correcting midface hypoplasia. While there are various methods of anchoring the osteotomized maxillary segment to the halo device, the looped transpyriform wire is the simplest and most cost-effective. However, a common complication with this is the cutting through of the stainless steel traction wire across the pyriform buttress during distraction. The patient with cleft undergoing midface distraction is particularly vulnerable since the force needed for distraction is higher due to scarring from previous operations. Innovation and Design: A single-hole titanium plate is introduced as an interface between the bone of the pyriform buttress and the looped stainless steel traction wire attached to the external frame device. Evaluation: Twenty-four patients with cleft who underwent midface advancement using the external frame distractor before the introduction of the innovation were compared with 26 patients who underwent the same procedure after its introduction. The former group had 12.5% complication in the form of cut through of the traction wire, while the latter group had only 3.8% complication rate. Conclusion: Introduction of the titanium eyelet as an interface between the traction wire and the bone is a simple technical addition for a more reliable distraction using the RED II device in patients with cleft even in the presence of extensive scarring.
Surgical Treatment for Stenosing Peroneal Tenosynovitis
Authors: Watson Geoffrey I. , Karnovsky Sydney C. , Levine David S. , Drakos Mark C. 
Published: October 2018

Background: Stenosing peroneal tenosynovitis (SPT) is an uncommon entity that is equally difficult to diagnose. We evaluated our outcomes with a local anesthetic diagnostic injection followed by surgical release of the sheath and calcaneal exostectomy. Methods: Eleven patients diagnosed with SPT underwent surgery between 2006 and 2014. Upon initial presentation, all patients reported a persistent history of pain along the ankle. Ultrasound-guided injections of anesthetics were administered into the peroneal tendon sheath to confirm the diagnosis. In patients with a confirmed diagnosis of SPT, we proceeded with surgical intervention with release of the peroneal tendon sheath and debridement of the calcaneal exostosis. Retrospective chart review was performed, and functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS). FAOS results were collected pre- and postoperatively and were successfully obtained at 1 year or greater. Results: Of these patients, all showed significant improvements ( P < .05) in 4 of 5 categories of the FAOS (pain, daily activities, sports activities, and quality of life). Conclusion: We present a case series in which the peroneal tendon sheath was diagnostically injected with anesthetic to confirm a diagnosis of SPT. In each of these cases, symptomatic improvement was obtained following the injection. With the fact that many of these patients had advanced imaging denoting no significant tears, we believe that this diagnostic injection is paramount for the success of surgical outcome. Level of Evidence: Level IV, retrospective case series.
MRI Tracking of the Effect of Bioabsorbable Pins on Bone Marrow Edema After Fixation of the Osteochondral Fragment in the Talus
Authors: Nakasa Tomoyuki , Ikuta Yasunari , Tsuyuguchi Yusuke , Ota Yuki , Kanemitsu Munekazu , Adachi Nobuo 
Published: October 2018

Background: Large osteochondral lesions of the talus (OLT) with good articular cartilage can be fixed by using bioabsorbable pins. These pins have various advantages but they can have adverse effects such as foreign body inflammation. This negative impact of pins on subchondral bone can be seen as bone marrow edema (BME) on magnetic resonance imaging (MRI). The purpose of this study was to investigate the course of change in BME on MRI, including osteolytic change around pins in OLT treated with pin fixation. Methods: This study comprised 13 ankles in 12 patients, who underwent surgeries to fix an OLT using poly-l-lactide acid pins. MRIs were taken at preoperative, 3, 6, and 12 months after surgery. The area of BME was measured at each time point, and osteolytic change around pins was evaluated. Moreover, pin insertion angle was measured. Results: BME significantly decreased from preoperative to 6 and 12 months. At 1 year, 28.1% of pins exhibited osteolytic change around them. Pin insertion angle was significantly lower in those with osteolytic change than those with no osteolytic change. At 3 and 6 months and 1 year postoperatively, BME with osteolytic change was significantly greater than those patients with no osteolytic change. The American Orthopaedic Foot & Ankle Society score significantly improved from preoperative (76.6±3.4 points) to 1 year after surgery (98.5±3.8 points). Conclusion: A shallow pin insertion angle was associated with osteolytic change around pins and persistence of BME on MRI, although excellent results were obtained at 1 year after surgery. Level of Evidence: Level III, retrospective comparative series.
Circulating Adrenomedullin Is Elevated in Gestational Diabetes and Its Role in Impaired Insulin Production by β-Cells
Authors: Dong Yuanlin , Banadakoppa Manu , Chauhan Madhu , Balakrishnan Meena , Belfort Michael , Yallampalli Chandra 
Published: October 2018

Abstract

Context
Defective pancreatic β-cell adaptation in pregnancy plays an important role in the pathophysiology of gestational diabetes mellitus (GDM), but the molecular basis remains unclear. Objectives of this study were to determine if circulating levels of adrenomedullin (ADM) in women with GDM are elevated and to assess the effects of ADM on insulin synthesis and secretion by human pancreatic β-cells.

Design
A stable gene product of ADM precursor, midregional pro-adrenomedullin (MR-proADM), was measured in plasma of pregnant women with normal glucose tolerance (NGT, n = 10) or GDM (n = 11). The β-Lox5 cell line, derived from human pancreatic β-cells, was transduced with homeodomain transcription factor pancreatic-duodenal homeobox (PDX) factor 1 (PDX1) encoding lentiviral vector and treated with different doses of ADM. mRNA for insulin, ADM, and its receptor components in β-Lox5 cells and insulin in media were measured.

Results
Plasma MR-proADM levels were significantly higher in GDM compared with patients with NGT. Pancreatic β-Lox5 cells express mRNA for insulin, ADM, and its receptor components. PDX1 transduction and cell-cell contact synergistically promote β-Lox5 cells insulin mRNA and secretion. Furthermore, ADM dose-dependently inhibited mRNA and secretion of insulin in β-Lox5 cell aggregates. These inhibitory effects were blocked by ADM antagonist ADM22-52, cAMP-dependent protein kinase A inhibitor KT5720, and Erk inhibitor PD98059, but not by PI-3K the inhibitor wortmannin.

Conclusions
Circulating ADM concentrations were elevated in pregnant women with GDM. ADM suppresses insulin synthesis and secretion by pancreatic β-cells in vitro. Thus, increased circulating ADM may contribute to the defective adaptation of β-cells in diabetic pregnancies, and blockade of ADM actions with its antagonists may improve β-cell functions.
Primary Adrenal Insufficiency During Lenvatinib or Vandetanib and Improvement of Fatigue After Cortisone Acetate Therapy
Authors: Colombo Carla , De Leo Simone , Di Stefano Marta , Vannucchi Guia , Persani Luca , Fugazzola Laura 
Published: October 2018

Abstract

Context
Two tyrosine kinase inhibitors (TKIs), lenvatinib and vandetanib, are often used to treat advanced radioiodine-refractory differentiated thyroid cancer (RAI-R DTC) and medullary thyroid cancer (MTC), respectively. Fatigue is a common adverse event during treatment with these and other TKIs and a common cause of drug discontinuation or dosage reduction.

Cases Description
We evaluated the basal and stimulated adrenal function in 12 patients with advanced RAI-R DTC and MTC treated with lenvatinib or vandetanib, respectively. Ten patients complaining of fatigue showed a progressive ACTH increase with normal cortisol levels. Moreover, six of 10 patients had a blunted cortisol response after ACTH stimulation, thus confirming the diagnosis of primary adrenal insufficiency (PAI). The causal relationship between TKIs and PAI onset was also demonstrated by the repeated testing of adrenal function before and during treatment. Patients with PAI received cortisone acetate replacement therapy, with a substantial and prompt improvement in the degree of fatigue, as assessed by the Common Terminology Criteria for Adverse Events version 4.03, thus supporting the major impact of impaired adrenal function in the genesis of this adverse event.

Conclusions
We show that the occurrence of PAI may be a common cause of fatigue during lenvatinib and vandetanib treatment, and we therefore recommend testing adrenal function for a prompt start of replacement therapy to avoid treatment discontinuation, dosage reduction, and potentially severe PAI complications.