bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time-dependence of NIHSS in predicting functional outcome of patients with acute ischemic stroke treated with intravenous thrombolysis
Authors: Wu Zimu , Zeng Minyan , Li Chao , Qiu Hongyan , Feng Haixia , Xu Xiaonan , Zhang Haoyang , Wu Jun 
Published: April 2019

AbstractObjectivesThe National Institute of Health Stroke Scale (NIHSS) is a predictor for the prognosis of acute ischaemic stroke (AIS) and its prediction is time-dependent. We examined the performance of NIHSS at different timepoints in predicting functional outcome of patients with thrombolysed AIS.MethodsThis prospective study included 269 patients with AIS treated with recombinant tissue plasminogen activator (rt-PA). Unfavourable functional outcome was defined as modified Rankin Scale score 4–6 at 3 months after rt-PA treatment. Receiver operating characteristic curves were used to examine the predictive power of NIHSS score at admission and 2 hours/24 hours/7 days/10 days after rt-PA treatment. Youden’s index was used to select the threshold of NIHSS score. Logistic regression was used to estimate the ORs of unfavourable functional outcome for patients with NIHSS score higher than the selected thresholds.ResultsThe threshold of NIHSS score at admission was 12 (sensitivity: 0.51, specificity: 0.84) with an acceptable predictive power (area under curve [AUC] 0.74) for unfavourable functional outcome. The threshold changed to 5 at 24 hours after rt-PA treatment (sensitivity: 0.83, specificity: 0.65) and remained unchanged afterwards. The predictive power and sensitivity sequentially increased over time and peaked at 10 days after rt-PA treatment (AUC 0.92, sensitivity: 0.85, specificity: 0.80). NIHSS scores higher than the thresholds were associated with elevated risk of unfavourable functional outcome at all timepoints (all p&lt;0.001).ConclusionsNIHSS is time-dependent in predicting AIS prognosis with increasing predictive power over time. Since patients whose NIHSS score ≥ 12 are likely to have unfavourable functional outcome with rt-PA treatment only, mechanical thrombectomy should be largely taken into consideration for these patients.
Early complementopathy predicts the outcomes of patients with trauma
Authors: Li Yansong , Zhao Qingwei , Liu Bin , Dixon Alexander , Cancio Leopoldo , Dubick Michael , Dalle Lucca Jurandir 
Published: April 2019

BackgroundComplementopathy (rapid complement activation and consumption after trauma) has been reported in trauma patients, but the underlying mechanism of these phenomena and their clinical significance remain unclear. This study aimed to determine the complement/complement pathway activation and identify the association of complement activation with clinical outcomes in trauma patients.MethodsWe studied 33 trauma patients with mean Injury Severity Score of 25, and 25 healthy volunteers. Sera were collected on patients’ arrival at the emergency department, as well as 1, 2, 3, 5, and 7 days after trauma, to measure the levels of terminal complement activation product soluble C5b-9 (sC5b-9) by ELISA. In addition, the functional complement activation pathway was evaluated using a commercial complement system screening kit.ResultsSerum concentrations of sC5b-9 (complement terminal pathway activity) were significantly increased in trauma patients throughout the entire observation period except on day 1. Complement terminal activities were significantly higher in 27 of 33 patients with systemic inflammatory response syndrome (SIRS) than non-SIRS patients on day 2, day 5, and day 7. Increased serum levels of sC5b-9 positively correlated with SIRS. Functional complement analysis revealed that the classical pathway was the predominant pathway responsible for complement activation. Burn patients tended to have a greater and prolonged classical pathway activation than non-burn patients, and burn injury and blunt injury were associated with higher blood levels of sC5b-9 than penetrating injury.DiscussionEarly complement activation through the classical pathway after trauma is observed and positively correlated with the development of SIRS. Thus, monitoring of the complement system might be beneficial in the care of critically injured patients.Level of evidenceIII.Study typePrognostic.
Amputation to treat osteomyelitis of the metatarsus in two partially domesticated springboks (Antidorcas marsupialis)
Authors: Poore Luke Alexander , Koeppel Katja , Steenkamp Gerhard 
Published: April 2019

Two springboks were diagnosed with chronic osteomyelitis of the metatarsus of the left hindlimb. The springboks had both suffered open fractures of the metatarsus of the left hindlimb 12 weeks and one week prior to presentation. External coaptation had initially been used to give stability and encourage fracture healing. This had proved unsuccessful in both cases and an infection and osteomyelitis had developed at the fracture sites. Two amputations had been subsequently performed in case 1 but had failed to resolve infection of the skin and subcutaneous tissues. An osteomyelitis of the underlying metatarsus had developed. No treatment apart from external coaptation had been performed before referral in case 2. Surgical amputation of the metatarsus and tarsus was performed as salvage procedures in both cases. The springboks adjusted to the loss of the left tarsus and metatarsus with no orthopaedic disorders at re‐examinations 12 months after surgery.
Spontaneous pneumomediastinum in three adult horses
Authors: Smith Sarah , Marr Celia M 
Published: April 2019

The report describes the diagnosis and management of spontaneous pneumomediastinum in three horses which were presented with acute‐onset increased respiratory effort. Pneumomediastinum was evident radiographically without evidence of internal or external trauma. Two horses had no obvious inciting cause and one horse had chronic interstitial pneumonia. All horses developed echocardiographic changes consistent with right heart dysfunction. Radiographic evidence of pneumomediastinum resolved in 14–21 days along with all other clinical abnormalities. Despite the severity of the initial clinical signs, all cases reported made a rapid and complete recovery, suggesting that, as in human beings, spontaneous pneumomediastinum in horses is a benign condition with a good prognosis.
Extracorporeal Blood Purification Therapies for Sepsis
Authors: Monard Céline , Rimmelé Thomas , Ronco Claudio 
Published: April 2019

Extracorporeal blood purification is proposed as an adjuvant therapy for sepsis, aiming at controlling the associated dysregulation of the immune system, which is known to induce organ dysfunctions. Different therapies have been developed to address certain steps of the immune dysregulation. Most of the available blood purification devices focus on a single target, such as the endotoxin that triggers the immune cascade, or the cytokine storm that causes organ damages. However, the highly adsorptive membrane named oXiris® is a unique 4-in-1 device that combines cytokine and endotoxin removal properties, renal replacement function, and antithrombogenic properties. More recently, promising treatments that focus on the pathogen itself or the immune cells have been developed and are currently under investigation. In this review, we aim to summarize, according to their target, the different extracorporeal blood purification techniques that are already available for use. We will also briefly introduce the most recent techniques that are still under development. Because of its unique ability to remove both endotoxins and cytokines, we will particularly discuss the highly adsorptive preheparinized oXiris® membrane. We will present its properties, advantages, pitfalls, as well as therapeutic perspectives based on experimental and clinical data. Video Journal Club “Cappuccino with Claudio Ronco” at https://www.karger.com/Journal/ArticleNews/223997?sponsor=52
Pulse Pressure is a Stronger Predictor Than Systolic Blood Pressure for Severe Eye Diseases in Diabetes Mellitus
Authors: Yamamoto Masahiko , Fujihara Kazuya , Ishizawa Masahiro , Osawa Taeko , Kaneko Masanori , Ishiguro Hajime , Matsubayashi Yasuhiro , Seida Hiroyasu , Yamanaka Nauta , Tanaka Shiro , Kodama Satoru , Hasebe Hiruma , Sone Hirohito 
Published: April 2019

Background

Evidence of the role of systolic blood pressure (
SBP
) in development of severe diabetic retinopathy is not strong, although the adverse effect of low diastolic blood pressure has been a partial explanation. We assessed the predictive ability of incident severe diabetic retinopathy between pulse pressure (
PP
) which considers both
SBP
and diastolic blood pressure, compared with
SBP
.

Methods and Results

Eligible patients (12 242, 83% men) aged 19 to 72 years from a nationwide claims database were analyzed for a median observational 4.8‐year period. Severe diabetic retinopathy was defined as vision‐threatening treatment‐required diabetic eye diseases. Multivariate Cox regression analysis revealed that hazard ratios (95%
CI
) of treatment‐required diabetic eye diseases for 1 increment of standard deviation and the top tertile compared with the bottom tertile were 1.39 (1.21–1.60) and 1.72 (1.17–2.51), respectively, for
PP
and 1.22 (1.05–1.41) and 1.43 (0.97–2.11), respectively, for
SBP
adjusted for age, sex, body mass index, hemoglobin A1c, fasting plasma glucose, lipids, and smoking status. In a model with
SBP
and
PP
simultaneously as covariates, the hazard ratios of only
PP
(hazard ratios [95%
CI
], 1.57 [1.26–1.96]) but not
SBP
(0.85 [0.68–1.07]) were statistically significant. Delong test revealed a significant difference in the area under the receiver operating characteristic curve between
PP
and
SBP
(area under the receiver operating characteristic curve [95%
CI
], 0.58 [0.54–0.63] versus 0.54 [0.50–0.59];
P
=0.03). The strongest predictor remained as hemoglobin A1c (area under the receiver operating characteristic curve [95%
CI
], 0.80 [0.77–0.84]).

Conclusions

After excluding the significant impact of glycemic control,
PP
in comparison with
SBP
is a better predictor of severe diabetic retinopathy, suggesting a role of diastolic blood pressure and arterial stiffness in pathology.
Blood-Brain Barrier Leakage
Authors: Serlin Yonatan , Ofer Jonathan , Ben-Arie Gal , Veksler Ronel , Ifergane Gal , Shelef Ilan , Minuk Jeffrey , Horev Anat , Friedman Alon 
Published: April 2019

Background and Purpose—
The diagnosis of transient ischemic attack is challenging. Evidence of acute ischemia on MRI diffusion-weighted imaging is highly variable and confirmed in only about one-third of patients. This study investigated the significance of blood-brain barrier dysfunction (BBBD) mapping in patients with transient neurological deficits, as a diagnostic and prognostic biomarker required for risk stratification and stroke prevention.

Methods—
We used dynamic contrast-enhanced MRI to quantitatively map BBBD in a prospective cohort study of 57 patients diagnosed with transient ischemic attack/minor stroke and 50 healthy controls.

Results—

Brain volume with BBBD was significantly higher in patients compared with controls (
P
=0.002). BBBD localization corresponded with the clinical presentation in 41 patients (72%) and was more extensive in patients with acute infarct on diffusion-weighted imaging (
P
=0.05). Patients who developed new stroke during follow-up had a significantly greater BBBD at the initial presentation (
P
=0.03) with a risk ratio of 5.35 for recurrent stroke.

Conclusions—
This is the first description of the extent and localization of BBBD in patients with transient ischemic attack/minor stroke. We propose BBBD mapping as a valuable tool for detection of subtle brain ischemia and a promising predictive biomarker required for risk stratification and stroke prevention.
Functional iron deficiency markers are absent during pregnancy despite evidence of low iron stores
Authors: Demmers Martijn WHJ , Niens Marijke , van der Haar Gerrie , van der Zaag-Loonen Hester J , Hoffmann Johannes JML , Adriaansen Henk J 
Published: April 2019

Introduction Functional iron deficiency parameters predict iron-restricted erythropoiesis more precisely than ferritin. Ferritin and erythropoiesis can be affected by inflammation and hormonal alterations. We hypothesize that the association between low ferritin concentrations and iron-restricted erythropoiesis is not comparable between pregnant and non-pregnant women. Materials and methods Pregnant women ( n = 926) were included at week 12 of gestation. Ferritin concentrations, %hypochromic erythrocytes (%HYPO), %microcytic erythrocytes (%MICRO), reticulocyte haemoglobin content (MCHr), mean cell volume (MCV) and mean cell haemoglobin (MCH) were analysed. Data were compared with non-pregnant women ( n = 1302). Results Functional iron deficiency parameters (%HYPO, %MICRO, MCHr) were present in, respectively, 3.9%, 14.3% and 2.3% off all pregnant women. Univariate analysis of low ferritin (<20 μg/L) showed significant differences between non-pregnant versus pregnant women; %HYPO (10.92% vs. 0.92%), increased %MICRO (4.33% vs. 1.00%) and decreased MCHr (24.9 pg vs. 29.5 pg), respectively. In the logistic regression analysis, MCHr, %MICRO and MCV were independently associated with low ferritin concentrations in pregnant women, while %HYPO and %MICRO were independently associated variables in non-pregnant women with low ferritin concentrations. Discussion Functional iron deficiency is significantly less frequent in pregnant women compared with iron-deficient non-pregnant women. During pregnancy, iron metabolism might be differentially regulated for optimal fetal growth and development despite low maternal iron stores.
The simultaneous quantification of candidate serum biomarker peptides for hypertensive disorders of pregnancy
Authors: Yanagida Mitsuaki , Hamamura Kensuke , Takamori Kenji , Araki Yoshihiko 
Published: April 2019

BackgroundHypertensive disorders of pregnancy are defined as syndromes characterized by high blood pressure that develop after 20 weeks of pregnancy. The pathogenesis of hypertensive disorders of pregnancy has not been fully elucidated, and the most effective treatment is the termination of pregnancy. Therefore, methods for an early predictive diagnosis should be developed to rescue both the mother and the child.MethodsPreviously, we explored the serum peptides whose concentration varied specifically between patients with hypertensive disorders of pregnancy and normal pregnant women using peptidomics analysis and identified seven candidate marker peptides. To quantify the marker peptides more reliably, we attempted to quantify these peptides simultaneously by multiple reaction monitoring using liquid chromatography/tandem mass spectrometry (LC-MRM/MS). Non-labelled and stable isotope-labelled forms of the seven peptides were synthesized as standards, and the multiple reaction monitoring transitions for their quantification were determined.ResultsAs the retention of the peptides by the reversed-phase column was dependent on their hydrophobicity, two solvent compositions were required for the retention of all peptides. Under these conditions, we detected the peptides by LC-MRM/MS using a column-switching method. Further, we succeeded in quantifying the peptides in the serum of pregnant women using stable isotope dilution.ConclusionOur new peptidomics method has great value for peptides, particularly those that have no specific antibody as a detection tool. Using this system, the serum peptides in patients with hypertensive disorders of pregnancy can be validated as diagnostic markers of hypertensive disorders of pregnancy. Further, this method can potentially be applied to the general quantification of other serum peptides.
Reimagining digital health education: Reflections on the possibilities of the storyboarding method
Authors: Lupton Deborah , Leahy Deana 
Published: April 2019

Objectives: To use the design method of storyboarding to challenge pre-service health education teachers to work together to think creatively and differently about digital health, to introduce pre-service teachers to the method as a pedagogical technique for use in their own classrooms, to experiment with our methods as a design sociology research project and to analyse the materials generated by the participants. Design: Storyboarding, a design research method for engagement and research that invites participants to generate a narrative using images and words, was used. Setting: We conducted a 3-hour workshop using storyboarding as part of an Australian university programme for pre-service health education teachers. Method: Following an introduction to the sociology of digital health and the possibilities of design methods, the pre-service teachers were formed into groups. Each group was provided with guidelines for imagining a new digital health device. They worked in their groups to generate a narrative in a storyboard format that described how this device would be used as part of everyday life. The groups then presented their storyboard to the class. The storyboards provided the research materials for analysing the sociotechnical imaginaries concerning digital health they presented. Results: We found that the storyboarding method worked well as an engaging and creative exercise for the participants and to generate insights for us as researchers on the ways in which they conceptualised and imagined the role of digital health technologies. However, despite attempts to educate the pre-service teachers in critical thinking in the lead-up to the workshop that emphasised the sociocultural and political contexts of health behaviours, their storyboards largely presented visions of digital health technologies that relied on individualistic behaviour change. Conclusion: After reflecting on the process, our conclusions provide some ideas for the way forward in using storyboarding as a transformative pedagogical and research tool.
‘Keeping politicians at arm’s length’: how managers in a collaborative organization deal with the administration–politics interface
Authors: Brorström Sara , Norbäck Maria 
Published: April 2019

This study examines the relationship between politicians and managers in a Swedish city. The context is a collaborative organization responsible for drafting and implementing the vision and strategies for a city organization, and for future development of the downtown river area. The article examines the efforts of city managers to manage the relationship with city politicians. We illustrate how the managers strive to manage an appropriate ‘arm’s-length’ relationship with the politicians by navigating in and out of the ‘purple zone’ of the politics–management interface, and how the context of collaborative organizations seems to increase the amount of time public managers spend in this zone. Points for practitioners This article illustrates the relation between managers and politicians in a city organization. We use the concept of the ‘purple zone’ to show how managers’ and politicians’ work is blurred in a collaborative organization, and how this context seems to increase the amount of time public managers spend in this zone. This implies that managers often take on a responsibility for solving complex issues.
Administrative openness and diversity in Swiss municipalities: how does local autonomy influence transparency practices?
Authors: Keuffer Nicolas , Mabillard Vincent 
Published: April 2019

The increasing demand for transparency has recently fostered greater openness within public administrations. Considered as an essential tool of good governance, transparency helps reinforce the perceived legitimacy of authorities. At the same time, local autonomy has been increasingly embraced in recent decades and recommended by many international institutions. This article combines these two concepts and seeks to highlight the causal relationship that binds them. Given its diversity, Switzerland offers fertile ground for assessing the influence of local autonomy on information-dissemination practices through a comparative perspective. To do so, this article has adopted a mixed approach, based on the creation of a transparency index for two Swiss cantons and on interviews conducted with elected officials from 16 municipalities. The results show, on the one hand, that transparency practices diverge sharply between Swiss municipalities and, on the other hand, that autonomy does have an influence on the degree of transparency at the local level. They encourage further reflection on local government practices and methods to measure what they mean for relations between authorities and citizens. Points for practitioners In this article, the development of a transparency index provides an insight into the very diverse online information-dissemination practices of Swiss municipalities. It reveals that municipal autonomy has a positive impact on the degree of transparency at the local level. The interviews conducted also show that proximity to citizens makes it possible to circumvent the lack of resources available to smaller municipalities through more direct information channels. These results encourage proactive communication by elected municipal officials.
Challenges following a personalised diet adhering to dietary guidelines in a sample of Australian university students
Authors: Irwin Christopher , Desbrow Ben , Khalesi Saman , McCartney Danielle 
Published: April 2019

Background: Food-based dietary guidelines are designed to support populations to adopt a healthy diet. University students studying nutrition related courses are typically en-route to professional roles that involve advocating a healthy diet. Aim: The present study compared the dietary intake of university students enrolled in a foundation nutrition course against the Australian Dietary Guidelines (ADGs) and Nutrient Reference Values (NRVs), and explored students’ experiences of following a 3-day self-determined diet plan adhering to the ADGs/NRVs. Methods: Students ( n = 115) initially collected, and subsequently analysed a 3-day prospective diet record to determine food group/nutrient intake. Individuals then modified their diet to comply with recommendations (ADGs/NRVs) and attempted to implement the diet plan. Challenges associated with meeting the ADGs/NRVs were described in an online survey form. Results: Baseline food group and nutrient intakes deviated from the guidelines, with ‘lean meats & alternatives’ the only group consumed in recommended quantities. Students demonstrated the capacity to plan a modified personal diet adhering to the ADGs food group recommendations. However, when following this, several key challenges to dietary adherence were identified. Challenges were categorised as personal/behavioural factors (e.g. the quantity/type of food) and societal factors (e.g. time, cost, social factors). Conclusion: Overall, this study highlights challenges influencing adherence to dietary guidelines in a sample of undergraduate university students. Understanding these factors may help tailor advice to facilitate improved dietary patterns in this population group.