bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regression of a metastatic lung mass after receiving whole brain irradiation: Can the abscopal effect cross the blood–brain barrier?
Authors: Chuang Cheng‐Hao , Hsu Jui‐Feng , Shen Yu‐Ting , Yang Chih‐Jen 
Published: July 2018

AbstractAn abscopal effect refers to distant tumor regression after localized irradiation. The mechanism is thought to be via local radiotherapy triggering the immune system which then attacks distant tumor sites. Only several cases of solid tumors with an abscopal effect have been reported in the past few decades, and whether an abscopal effect can cross the blood–brain barrier is still unknown.Herein, we present a female patient who was admitted due to unsteady gait and dyspnea. Chest X‐ray (CXR) and chest CT showed a huge lung mass with left lung collapse and multiple liver masses. Brain MRI also showed multiple brain metastases. A bronchoscopic biopsy proved metastatic adenocarcinoma from colorectal cancer based on immunohistochemical staining. She therefore received 30 Gy (10 fractions) for the brain metastases; however, she refused to receive any systemic therapy for her lung mass and asked for hospice care. She was therefore transferred to a nursing home and was lost to follow‐up. She returned 2 months later due to right pneumonia with fever and productive cough. Surprisingly, her left lung mass had markedly regressed even though she had not received any additional systemic anticancer therapy. This may be the first case of an abscopal effect after receiving whole brain irradiation for brain metastases.
Gestational diabetes mellitus is associated with increased CD163 expression and iron storage in the placenta
Authors: Barke Theresa L. , Goldstein Jeffery A. , Sundermann Alexandra C. , Reddy Arun P. , Linder Jodell E. , Correa Hernan , Velez‐Edwards Digna R. , Aronoff David M. 
Published: July 2018

ProblemGDM has been associated with disturbances in iron homeostasis and exaggerated immune activation. We sought to investigate the extent to which placental iron storage and macrophage accumulations were altered in GDM.Method of StudyWe conducted a retrospective, case‐control study of archived placental tissues obtained from 22 pregnancies complicated by GDM and 22 unaffected controls. Controls were matched to cases based on maternal age, gestational age at birth, and method of delivery. Placental tissues were assessed for altered histology and CD68 and CD163 staining. Tissue iron was assessed using Prussian blue staining.ResultsMaternal hematocrit levels were higher in GDM participants compared to controls (P = 0.02). The presence of meconium‐laden macrophages was significantly greater within the amnion of GDM cases (adjusted odds ratio (OR) 12.51). Although the total abundance of CD68‐expressing macrophages was not significantly different between groups, we detected a significantly greater abundance of CD163 expression within the chorion and decidua of cases. The total area staining positive for iron was 24% (95% confidence intervals of 2%‐46%) greater in GDM placentae versus controls.ConclusionGDM is associated with altered placental histology and increases in meconium‐laden macrophages. Greater iron stores within the placentae of women with GDM is consistent with reports that iron excess is associated with an increased risk for GDM. The higher level of expression of CD163 on macrophage‐like cells of the chorion and decidua in GDM suggests an increase in M2‐like macrophages. Overall, our results add to growing evidence that GDM has direct effects on placental structure.
Laparoscopic transabdominal cerclage in pregnancy: A single centre experience
Authors: Ades Alex , Aref‐Adib Mehrnoosh , Parghi Sneha , Hong Phoebe 
Published: July 2018

BackgroundTransabdominal cerclage can reduce the risk of preterm birth in women with cervical insufficiency.AimsThis study evaluated outcomes following insertion of a laparoscopic transabdominal cerclage in pregnant women.Materials and methodsA retrospective observational study. Patients: pregnant women who underwent laparoscopic transabdominal cerclage from 2011 to 2017. Eligible women had cervical insufficiency and were not suitable for a transvaginal cerclage. Intervention: the insertion of a laparoscopic transabdominal cerclage in the pregnancy. Measurements: neonatal survival, delivery of an infant at ≥34 weeks gestation and surgical morbidity were evaluated.ResultsOf 19 women who underwent laparoscopic transabdominal cerclage in pregnancy, at 6–11 weeks gestation, the perinatal survival rate was 100%. There were no complications. The average gestational age at delivery was 37.1 weeks. Sixteen women delivered after 34 weeks.ConclusionsLaparoscopic transabdominal cerclage is a safe and effective procedure in women with poor obstetric histories. It requires the correct skill, expertise and patient selection.
A‐kinase anchor protein 4 precursor (pro‐AKAP4) in human spermatozoa
Authors: Jumeau F. , Sigala J. , Dossou‐Gbete F. , Frimat K. , Barbotin A. L. , Buée L. , Béhal H. , Sergeant N. , Mitchell V. 
Published: July 2018

AbstractBackgroundA‐kinase anchor protein 4 (AKAP4) and its precursor pro‐AKAP4 are two major proteins in spermatozoa of rodents and mammals. Although researchers have characterized the AKAP4 expression in various species, the protein's expression in humans has not been described in detail.ObjectivesThe objective of this study was to characterize human pro‐AKAP4 more precisely (notably the definition of its localization and expression levels in human spermatozoa and testes).Materials and Methodspro‐AKAP4 protein expression levels were assessed by Western blotting. The pro‐AKAP4's localization in spermatozoa and testes was determined using immunofluorescence staining and immunogold electron microscopy. Furthermore, pro‐AKAP4 protein expression levels were assessed in a series of 77 human semen samples, and associations with semen parameters were evaluated.ResultsWestern blotting revealed a 100‐kDa band in human sperm protein extracts. The pro‐AKAP4 was immunolocalized in the fibrous sheath of the flagellum of ejaculated spermatozoa and in elongated spermatids in human testes. A Western blot analysis of 77 normozoospermic semen samples evidenced striking differences in pro‐AKAP4 levels from one to another sample (median [interquartile range] integrated optical density = 305 [49–1038]). No correlations were found for pro‐AKAP4 levels on one hand and semen volume, sperm concentration, sperm count, sperm motility, or sperm morphology on the other (p > 0.05 for all). However, pro‐AKAP4 levels were positively correlated with motility after density gradient centrifugation of the semen (r = 0.224, p = 0.049).DiscussionAKAP4 protein might be activated as an alternative pathway to rescue sperm motility. In human spermatozoa, pro‐AKAP4 might therefore be a ‘reservoir’ of mature AKAP4.ConclusionThis study generated new knowledge about pro‐AKAP4 in human semen, which may be of interest in the management of male infertility.
“Lambda‐wave” ST‐elevation is associated with severe prognosis in stress (takotsubo) cardiomyopathy
Authors: Tarantino Nicola , Santoro Francesco , Guastafierro Francesca , Di Martino Luigi F. M. , Scarcia Maria , Ieva Riccardo , Ruggiero Antonio , Cuculo Andrea , Mariano Enrica , Di Biase Matteo , Brunetti Natale Daniele 
Published: July 2018

AbstractBackgroundPersistent ST‐segment elevation in acute coronary syndrome is associated with both short and long‐term complications. By contrast, there is limited information about ST‐elevation and its evolution during takotsubo (stress) cardiomyopathy (TTC).AimTo evaluate whether persistent downsloping ST‐elevation in the early stages of TTC might correlate with short and long‐term clinical events.MethodsOne‐hundred fifty‐eight consecutive subjects with TTC were prospectively enrolled and assessed by electrocardiogram. Patients were classified in two groups according to the presence of downsloping ST‐elevation ≥5 mm lasting at least 24 hr (“lambda‐wave” ST‐elevation group vs. without downsloping ST‐elevation) in at least one/two contiguous leads.ResultsFive (3.2%) patients, all female with a mean left ventricular ejection fraction 32 ± 5%, were included in the lambda‐wave ST‐elevation group. These patients were characterized by a higher prevalence of physical stressor (100% vs. 49%, p = 0.04) and higher admission and peak levels of troponin‐I levels during hospitalization. Peak of ST‐elevation in the lambda‐wave ST‐elevation group was reached 6 hr after admission and gradually decreased after 24 hr. In‐hospital complications were observed in all the patients presenting lambda ST‐elevation (100% vs. 23%, p = 0.03, OR: 29.1, p = 0.04); one patient presented endoventricular thrombosis and two died of cardiogenic shock. At long‐term follow‐up (mean 443 days), adverse events were observed in 80% of patients with lambda‐wave ST‐elevation (RR of adverse events at follow‐up 32, p < 0.01).ConclusionPersistent downsloping lambda‐wave ST‐elevation during the acute phase of stress cardiomyopathy may be associated with a higher risk of adverse events at short and long‐term follow‐up.
Peristomal pyoderma gangrenosum: 12‐year experience in a single tertiary referral centre
Authors: Toh James W. T. , Young Christopher J. , Rickard Matthew J. F. X. , Keshava Anil , Stewart Peter , Whiteley Ian 
Published: July 2018

BackgroundPeristomal pyoderma gangrenosum (PPG) is an unusual but potentially devastating condition that is difficult to diagnose and manage.MethodsThis was a single centre, retrospective review of a prospectively collected database. Included were consecutive patients referred to a stoma therapy clinic at a single institution between 2005 and 2016. Main outcomes of interest were management strategies and outcome of patients with PPG including time to healing and recurrence.ResultsOf 1295 consecutive patients who underwent stoma formation, 12 patients with PPG were identified. The mean age at the time of diagnosis of PPG was 43.5 years (range 19–72 years). Five cases (41.7%) were associated with Crohn's disease and five cases (41.7%) with ulcerative colitis. The median duration of days between stoma formation and PPG diagnosis was 101.5 days (mean duration was 670 days (range 14–2641 days)). Nearly all patients (91.7%) were referred to a dermatologist. Majority (66.7%) were managed in an outpatient setting. For those requiring inpatient management, the mean length of stay was 13.5 days (range 3–31 days). Five patients had a biopsy and seven patients were diagnosed with PPG by dermatologist without biopsy. A range of oral and topical steroids, steroid injections, dressings, anti‐inflammatories, antibiotics, tacrolimus and analgesia was used in the management of PPG. All patients achieved complete healing of PPG, with only one patient developing a recurrence of PPG. The mean duration of time to achieve complete healing of PPG was 282 days (range 28–1751 days).DiscussionMedical management of PPG was effective with complete healing and low recurrence. The average duration to complete healing of PPG was approximately 9 months.
Systematic review with meta‐analysis: anxiety and depression in children and adolescents with inflammatory bowel disease
Authors: Stapersma L. , van den Brink G. , Szigethy E. M. , Escher J. C. , Utens E. M. W. J. 
Published: July 2018

SummaryBackgroundThe co‐existence of psychological problems and paediatric inflammatory bowel disease (IBD) is receiving increasing attention. Most studies investigated anxiety and depression, with prevalence rates varying from 0% to 50%. A systematic review is necessary to provide clear insight into the prevalence of anxiety and depression in paediatric IBD.AimTo systematically evaluate available data on the prevalence of anxiety and depressive symptoms and disorders in paediatric IBD (aged 6‐18 years).MethodsComprehensive searches were performed in Embase, Medline Ovid, Web of Science, Cochrane, PubMed, PsychInfo Ovid, and Google scholar for studies published from 1994 to 2017. Pooled prevalence rates were calculated using inverse variance heterogeneity models. Meta‐regression was used to study if disease type, disease activity and gender influence prevalence.ResultsTwenty‐eight studies (N = 8107, mean age: 14.3) were identified. Pooled prevalence estimates were 16.4% (95% confidence interval [CI] 6.8%‐27.3%) for anxiety symptoms and 4.2% (95% CI 3.6%‐4.8%) for anxiety disorders. Pooled prevalence estimates were 15.0% (95% CI 6.4%‐24.8%) for depressive symptoms and 3.4% (95% CI 0%‐9.3%) for depressive disorders. Meta‐regression showed no influence of disease type or gender on these prevalence rates, but studies with a higher percentage of active disease had a higher rate of depressive symptoms.ConclusionsThe described pooled prevalence of anxiety and depressive symptoms is lower than in adult IBD. However, due to varying instruments/cut‐offs for measuring symptoms and few studies investigating disorders, the results should be interpreted with caution. Cross‐cultural use of the same instruments is needed to gain better insight into prevalence rates.
Systematic review with meta‐analysis: the prevalence of coeliac disease in patients with osteoporosis
Authors: Laszkowska M. , Mahadev S. , Sundström J. , Lebwohl B. , Green P. H. R. , Michaelsson K. , Ludvigsson J. F. 
Published: July 2018

SummaryBackgroundEarlier studies have produced highly varying risk estimates for the prevalence of coeliac disease (CD) in osteoporosis.AimsTo investigate the prevalence of CD among individuals with osteoporosis.MethodsWe conducted a systematic review of articles published in PubMed, Medline or EMBASE through May 2017 to identify studies looking at prevalence of CD in patients with osteoporosis. Search terms included “coeliac disease” combined with “fractures”, “bone disease”, “bone density”, “densitometry”, “osteoporos*”, “osteomal*”, “osteodys” or “dexa” or “dxa” or “skelet”. Non‐English papers with English‐language abstracts were included. We used fixed‐effects inverse variance‐weighted models, and tested heterogeneity through subgroup analysis as well as through meta‐regression.ResultsWe identified eight relevant studies, comprising data from 3188 individuals with osteoporosis. Of these, 59 individuals (1.9%) had CD. A weighted pooled analysis demonstrated biopsy‐confirmed CD in 1.6% (95% CI = 1.1%‐2.0%) of individuals with osteoporosis. The heterogeneity was moderate (I2 = 40.1%), and influenced by the underlying CD prevalence in the general population. After adding four studies (n = 814) with CD defined as positive tissue transglutaminase or endomysial antibodies, the pooled prevalence was comparable (1.6%; 95% CI = 1.2%‐2.0%).ConclusionsAbout 1 in 62 individuals with osteoporosis, or 1.6%, have biopsy‐verified CD. This prevalence is comparable to that in the general population. These findings argue against routinely screening patients with osteoporosis for CD, which is contrary to current guideline recommendations. Additional studies are needed to determine the true utility of such screening programs.
Worthy? Crowdfunding the Canadian Health Care and Education Sectors
Authors: Lukk Martin , Schneiderhan Erik , Soares Joanne 
Published: July 2018

AbstractCrowdfunding, the practice of asking for money from others using the Internet, is a major private means through which Canadians are funding their health care and education. Crowdfunding has proliferated in Canada during the 2010s and continues to grow, approaching the revenues of Canada's major traditional charities. Proponents describe it as an empowering practice from which anyone can benefit. If its gains are inequitably distributed, however, increasing reliance on this private funding mechanism, especially in core areas of welfare state provision, can further exacerbate inequalities of opportunity and income. This study asks why Canadians turn to health care and education crowdfunding and how equitably funds are raised using this novel method. Based on a mixed methods analysis of 319 campaigns conducted on two prominent crowdfunding platforms between 2012 and 2014, we find that crowdfunding users’ needs frequently correspond to known gaps in the contemporary social safety net, including in the area of cancer care, and that campaigns for older and visible minority Canadians face a disadvantage. We argue that health care and education crowdfunding is a response to the shortcomings of Canadian welfare state provision, but one that reproduces offline inequalities with potentially perilous consequences for democratic life and individual suffering.
Severe rebound relapse of multiple sclerosis after switching from fingolimod to dimethyl fumarate
Authors: Asano Shiori , Takeuchi Hideyuki , Morihara Keisuke , Takahashi Keita , Tanaka Kenichi , Higashiyama Yuichi , Doi Hiroshi , Koyano Shigeru , Tanaka Fumiaki 
Published: July 2018

AbstractBackgroundDimethyl fumarate (DMF) was the second oral disease‐modifying drug to be approved for multiple sclerosis (MS) in Japan, after fingolimod. Switching from fingolimod to DMF treatment is becoming increasingly common, because DMF has shown a better risk–benefit profile and an equivalent efficacy to fingolimod.Case presentationWe report a 35‐year‐old woman who was positive for anti‐John Cunningham virus antibody and who developed severe rebound relapse of MS after switching from fingolimod to DMF. Five months after starting DMF treatment, she had a severe relapse attack with disseminated lesions in the cerebrum and cervical spinal cord. Furthermore, subsequent relapse attacks occurred with new lesions in the thoracic spinal cord, even during repeated steroid pulse therapies and plasma exchanges. The disease activity finally ceased after natalizumab administration.ConclusionsSwitching from fingolimod to DMF carries the risk of MS reactivation and rebound. Natalizumab treatment for a limited period might be recommended to treat MS rebound in anti‐John Cunningham virus antibody‐positive patients.
Curating the Idea of Magna Carta
Authors: Smith Matthew 
Published: July 2018

AbstractOn 15th June 2015 Egham, the town adjacent to historic Runnymede in the United Kingdom, celebrated the 800th anniversary of the sealing of Magna Carta. In this article the Curator of Egham Museum at the time of the anniversary reflects on the challenges of curating an exhibition exploring the significance and legacy of Magna Carta without the star attraction: a copy of the Charter itself. The article explores the challenges facing small museums in telling stories without objects, the importance of objects to the definition of a museum and its functions and offers examples of other attempts to create museum exhibitions and heritage experiences without objects. Through review and reflection on Egham Museum's Public History orientated approach to the lack of objects at its disposal: the paper discusses facilitation with communities to help celebrate their own heritage and create their own collection of objects that revealed what a valued ephemeral concept might mean to them.
Managing ethical challenges around misattributed parentage within the clinical context: Insights from an African moral theory
Authors: Ewuoso Cornelius 
Published: July 2018

AbstractThis study argues the thesis that a set of guidelines ‐ firmly rooted in a particular interpretation of African moral theory, specifically, Ubuntu – will do a better job than current medical ethics frameworks, in addressing ethical challenges around misattributed parentage within the clinical context.Incidental information such as information with significant personal/health implications raises unique challenges for medical professionals. For example, withholding information of misattributed paternity accidentally discovered in clinical interactions may be seen by a patient as a violation of his/her right‐to‐know. Contrarily, disclosure where a patient has not requested information – or where establishing paternity is not the purpose of clinical visit/interaction – may be taken by the patient as a violation of his/her right ‘not‐to‐know’. Resolving these challenges remain a herculean task.African moral theory contains an under‐emphasized value for addressing such ethical challenges around misattributed parentage in the field of transplant. I seek to contribute this knowledge; and enhance clinician‐patient relationship.This study builds off three completed systematic reviews, which aimed to answer the following questions: “what are the ethical challenges regarding information health professionals face within the clinical contest?” and “what core aspects (or common themes) of Ubuntu can be identified in existing literature describing the same?” In this present study, I applied the definition of Ubuntu which captures the core aspects of the theory in ethical literature on the same, to address ethical issues around unsought information of misattributed parentage in the field of transplant.
Interpretation of HbA1c in primary care and potential influence of anaemia and chronic kidney disease: an analysis from the Copenhagen Primary Care Laboratory (CopLab) Database
Authors: Borg R. , Persson F. , Siersma V. , Lind B. , de Fine Olivarius N. , Andersen C. L. 
Published: July 2018

AbstractAimsTo investigate, in a large population in primary care, the relationship between fasting plasma glucose and HbA1c measurements, as well as the clinical implications of anaemia or chronic kidney disease for the interpretation of HbA1c values.MethodsFrom a primary care resource, we examined HbA1c and fasting plasma glucose as well as haemoglobin and estimated GFR. We stratified observations by chronic kidney disease stage and anaemia level. The estimation of the mean fasting plasma glucose level from HbA1c alone, and from HbA1c, haemoglobin and estimated GFR, respectively, was evaluated.ResultsIn 198 346 individuals, the fasting plasma glucose–HbA1c relationship mimicked the regression described in the A1c‐Derived Average Glucose (ADAG) study, which was based on average capillary and interstitial glucose. The fasting plasma glucose–HbA1c relationship was unaffected in mild to moderate chronic kidney disease and in mild to moderate anaemia. The correlation changed only in severe hyperglycaemia and concurrent severe anaemia or when estimated GFR was <45 ml/min/1.73m², so that glucose concentration was underestimated by HbA1c in anaemia and overestimated in chronic kidney disease. The prevalence of estimated GFR <30 ml/min/1.73m² was 0.82%, while the prevalence of haemoglobin <81 g/l (5.0 mmol/l) was 0.11%.ConclusionsThe relationship between fasting plasma glucose and HbA1c mimics that of the people with diabetes included in the ADAG study. Mild to moderate anaemia and CKD do not have a significant impact on the interpretation of HbA1c as a marker of retrograde glycaemia. Hence, it seems justified to use HbA1c without adjustment in primary care.
The evolution of post‐communist systems
Authors: Roland Gerard 
Published: July 2018

AbstractI propose in this article a new interpretation of the evolution of post‐communist systems by comparing the evolutions in Central and Eastern Europe and in China. Transition is reinterpreted as the result of a collapse of communist state structures in Central and Eastern Europe and, in China, in contrast, as the result of the will to prevent such an outcome. This reconceptualization helps us to better understand the emergence of bad institutions and corruption in Eastern Europe under the market economy as well as the absence of political liberalization in China and the strengthening of the power of the Communist Party in recent years.