bluuebunny/crossref_metadata_2025_split huggingface dataset:
Behavioral awareness in the feline consultation: Understanding physical and emotional health
Authors: Horwitz Debra F , Rodan Ilona 
Published: April 2018

Practical relevance: Awareness of the strong connection between observed behavior and physical and emotional health is essential for patient welfare. It is often a change in the individual’s normal behavior that informs owners and veterinarians of the possibility of illness, pain and stress/distress. There is ample evidence in the feline literature that medical and behavioral health go hand in hand. In most feline cases, medical and behavioral conditions contribute concurrently to clinical signs. Clinical challenges: Our domestic cats do not express change in physiological and emotional states in a way that is easily recognized. Therefore, it can be difficult to diagnose medical and behavioral illnesses and ascertain contributions from each one to the final diagnosis. When various levels of stress are present, especially distress, this compromises behavioral and physical health, and influences treatment outcomes. Aims: This review is intended to help veterinarians recognize physical and behavioral changes associated with acute stress through to chronic distress, including stress-associated diseases. An emphasis on thorough history-taking will allow the clinician to ascertain which signs are behavioral and which are medical, with the understanding that they are not mutually exclusive. Equally important is the contribution of pain, chronic disease and poor environmental situations to behavioral changes and the expression of medical disorders. Evidence base: There is an increasing amount of evidence that stress and distress have profound effects on feline health, behavior and welfare. The authors have drawn on a substantial body of published veterinary research in producing this review.
Mortality in Advanced Chronic Obstructive Pulmonary Disease and Heart Failure Following Cardiopulmonary Rehabilitation
Authors: Kang Youjeong , Steele Bonnie G. , Burr Robert L. , Dougherty Cynthia M. 
Published: April 2018

Cardiopulmonary rehabilitation (CR) improves physical function and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) and heart failure (HF), but it is unknown if CR improves outcomes in very severe disease. This study’s purpose was to describe functional capacity (6-min walk distance [6MWD], steps/day), symptoms (dyspnea, depression), QoL (Short-Form Health Survey–Veterans [SF-36 V]) and cardiopulmonary function ( N-terminal pro-brain natriuretic peptide [NT-proBNP], forced expiratory volume in 1 s [FEV1]), and derive predictors of mortality among patients with severe COPD and HF who participated in CR. Methods and Results: In this secondary analysis of a randomized controlled trial comparing two CR methods in severe COPD and HF, 90 (COPD = 63, HF = 27) male veterans, mean age 66 ± 9.24 years, 79% Caucasian, and body mass index 31 kg/m2, were followed for 12 months after CR. The COPD group had greater functional decline than the HF group (6MWD, p = .006). Dyspnea was lower ( p = .001) and QoL higher ( p = .006) in the HF group. Mean NT-proBNP was higher in the HF group at all time points. FEV1 improved over 12 months in both groups ( p = .01). Mortality was 8.9%, 16.7%, and 37.8% at 12, 24, and 60 months, respectively. One-year predictors of mortality were baseline total steps (<3,000/day), 6MWD (<229 meters), and NT-proBNP level (>2,000 mg/pg). Conclusions: In very severe COPD and HF, risks of mortality over 12 months can predict patients unlikely to benefit from CR and should be considered at initial referral.
The influence of early radiolucent lines appearing on femoral head penetration into HXLPE cemented sockets
Authors: Morita Daigo , Seki Taisuke , Higuchi Yoshitoshi , Takegami Yasuhiko , Amano Takafumi , Ishiguro Naoki 
Published: April 2018

Introduction: This study investigates differences in femoral head penetration between highly cross-linked polyethylene (HXLPE) cemented sockets both with and without radiolucent lines (RLLs) in the early postoperative phase and at 5 years follow-up. Methods: There were 35 patients (37 hips), mean age of 66.8 years, who underwent total hip arthroplasty (THA) using highly HXLPE cemented sockets. They were divided into 2 groups based on postoperative the early appearance of RLLs. Femoral head penetrations on both anteroposterior- and Lauenstein-view radiographs were evaluated, and the mean polyethylene (PE) wear rate was calculated based on femoral head penetrations between 2 and 5 years. Results: Femoral head penetrations in the proximal direction were 0.075 mm and 0.150 mm in the RLL and non-RLL groups at 1 year postoperatively ( p = 0.019). At 5 years measured penetration was 0.107 mm and 0.125 mm in the RLL and non-RLL groups, respectively ( p = 0.320). The mean PE wear rates in anteroposterior-view were 0.008 mm/year and 0.003 mm/year in the RLL and non-RLL groups ( p = 0.390) and those in Lauenstein-view were 0.010 mm/year and 0.005 mm/year, respectively ( p = 0.239). Conclusions: In the RLL group, the PE bedding-in was less compared with those in the non-RLL group. Additionally, the mean PE wear rate in the RLL group tended to be higher than that in the non-RLL group. The distribution of stress loading through the cement may differ according to whether early RLLs appear.
Fulminant rebound of relapsing–remitting multiple sclerosis after discontinuation of dimethyl fumarate: A case report
Authors: Harmel Peter , Schlunk Frieder , Harms Lutz 
Published: April 2018

Background: Rebound phenomena after discontinuation of different treatments for relapsing–remitting multiple sclerosis (RRMS) have previously been described. Systematic database research in PubMed did not show any report with relapse directly associated with dimethyl fumarate (DMF) cessation. Case presentation: Here, we report on a 38-year-old Caucasian male patient suffering from a relatively mild course of RRMS who developed a fulminant clinical rebound 2 months after discontinuation of DMF therapy. Radiological alterations presented impressively with primarily spinal involvement. The patient received intensive care and multiple immunomodulating therapies. Conclusion: We report on this case to raise neurologist’s awareness of complications of basic therapy discontinuation in RRMS.
A Qualitative Analysis of South African Health Professionals’ Discussion on Distrust and Unwillingness to Refer Organ Donors
Authors: Etheredge Harriet Rosanne , Penn Claire , Watermeyer Jennifer 
Published: April 2018

Introduction: South Africa is faced with very low deceased organ donor numbers. Often, sociocultural practices, which are thought to be fundamentally opposed to deceased organ donation, are hailed as the cause. However, other factors such as context, social perceptions, and clinical environment may play a role. Aim: The aim of this article is to present research that explored communication in organ transplant and identified barriers to organ donation decisions in a province of South Africa. Methods: Qualitative methods were used. Thirty semistructured interviews with transplant professionals and 2 focus groups with transplant coordinators took place across 6 health institutions in Gauteng Province. Results: Barriers that may prevent transplant professionals from referring potential donors were identified: The wider public and transplant professionals may be suspicious of biomedicine and have a perception that people could be killed for their organs. Organ donation was sometimes framed as “murder,” “killing,” or a “bunch of vultures.” Doctors may be unwilling to refer brain-dead patients, as this was seen as failing in one’s professional duty to cure the patient. The role of sociocultural practices was inconclusive, with the sample divided based on the extent of their influence. Conclusion: Low donor numbers may be a manifestation of barriers to referral in the clinical setting. These barriers interplay in a context of suspicion and are framed by a clinical transplant discourse that is sometimes loaded with negative connotation. Sociocultural practices are influential, but they may not be the overriding cause of low donor numbers.
Studies on sporadic non-syndromic thoracic aortic aneurysms: II. Alterations of extra-cellular matrix components and focal adhesion proteins
Authors: Chiarini Anna , Onorati Francesco , Marconi Maddalena , Pasquali Alessandra , Patuzzo Cristina , Malashicheva Anna , Irtyega Olga , Faggian Giuseppe , Pignatti Pier F , Trabetti Elisabetta , Armato Ubaldo , Dal Pra Ilaria 
Published: April 2018

BackgroundSporadic non-syndromic thoracic aortic aneurysms (SNSTAAs) are less well understood than familial non-syndromic or syndromic ones. Here, we focused on morphologic and molecular changes of the extracellular matrix of the tunica media of SNSTAAs.DesignSingle centre design.MethodsSurgical media samples from seven SNSTAAs and seven controls underwent quantitative polymerase chain reaction, proteomics-bioinformatics, immunoblotting, histology and immunohistochemistry analysis.ResultsA down-regulation of Decorin mRNA with unchanged protein levels associated with a remarkable increase of collagen fibres. A reduced and distorted network of elastic fibres partnered with an attenuated expression of microfibril-associated glycoprotein1 despite the rise of MFAP2 gene-encoded mRNA levels. An increasingly proteolysed paxillin (55 kDa PXN), a focal adhesion protein, combined with an upregulated 62 kDa PXN holoprotein, without changes in amount and phosphorylation of focal adhesion kinase (pp125FAK). The upregulation of SPOCK2-encoded Testican2 proteoglycan and of ectodysplasin (EDA) protein was coupled with a down-regulation of EDA2 receptor (EDA2R).ConclusionsSeveral tunica media extracellular matrix-related changes favour SNSTAA development. A steady level of decorin and a microfibril-associated glycoprotein1 protein shortage cause the assembly of structurally defective collagen and elastic fibres. Up-regulation of PXN holoproteins perturbs PXN/pp125FAKinteraction and focal adhesion functioning. Testican2 up-regulation suppresses the membrane-type matrix metalloproteinase inhibiting activities of other SPOCK family members thus enhancing extracellular matrix proteolysis. Finally, the altered EDA•EDA2R signalling would impact on the remodelling of SNSTAA tunica media. Altogether, our results pave the way to a deeper molecular understanding of SNSTAAs necessary to identify their early diagnostic biochemical markers.
Aortic centres should represent the standard of care for acute aortic syndrome
Authors: Mariscalco Giovanni , Maselli Daniele , Zanobini Marco , Ahmed Aamer , Bruno Vito D , Benedetto Umberto , Gherli Riccardo , Gherli Tiziano , Nicolini Francesco 
Published: April 2018

Background Existing evidence suggests that patients affected by acute aortic syndromes (AAS) may benefit from treatment at dedicated specialized aortic centres. The purpose of the present study was to perform a meta-analysis to evaluate the impact aortic service configuration has in clinical outcomes in AAS patients. Methods The design was a quantitative and qualitative review of observational studies. We searched PubMed/ MEDLINE, EMBASE, and Cochrane Library from inception to the end of December 2017 to identify eligible articles. Areas of interest included hospital and surgeon volume activity, presence of a multidisciplinary thoracic aortic surgery program, and a dedicated on-call aortic team. Participants were patients undergoing repair for AAS, and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were adopted for synthesizing hospital/30-day mortality. Results A total of 79,131 adult patients from a total of 30 studies were obtained. No randomized studies were identified. Pooled unadjusted ORs showed that patients treated in high-volume centres or by high-volume surgeons were associated with lower mortality rates (OR 0.51; 95% CI 0.46–0.56, and OR 0.41, 95% CI 0.25–0.66, respectively). Pooled adjusted estimates for both high-volume centres and surgeons confirmed these survival benefits (adjusted OR, 0.56; 95% CI 0.45–0.70, respectively). Patients treated in centres that introduced a specific multidisciplinary aortic program and a dedicated on-call aortic team also showed a significant reduction in mortality (OR 0.31; 95% CI 0.19–0.5, and OR 0.37; 95% CI 0.15–0.87, respectively). Conclusions We found that specialist aortic care improves outcomes and decreases mortality in patients affected by AAS.
PRECIOUS: PREvention of Complications to Improve OUtcome in elderly patients with acute Stroke. Rationale and design of a randomised, open, phase III, clinical trial with blinded outcome assessment
Authors: Reinink Hendrik , de Jonge Jeroen C , Bath Philip M , van de Beek Diederik , Berge Eivind , Borregaard Saskia , Ciccone Alfonso , Csiba Laszlo , Demotes Jacques , Dippel Diederik W , Kõrv Janika , Kurkowska-Jastrzebska Iwona , Lees Kennedy R , Macleod Malcolm R , Ntaios George , Randall Gary , Thomalla Götz , van der Worp H Bart 
Published: April 2018

Background Elderly patients are at high risk of complications after stroke, such as infections and fever. The occurrence of these complications has been associated with an increased risk of death or dependency. Hypothesis: Prevention of aspiration, infections, or fever with metoclopramide, ceftriaxone, paracetamol, or any combination of these in the first four days after stroke onset will improve functional outcome at 90 days in elderly patients with acute stroke. Design International, 3 × 2-factorial, randomised-controlled, open-label clinical trial with blinded outcome assessment (PROBE) in 3800 patients aged 66 years or older with acute ischaemic stroke or intracerebral haemorrhage and an NIHSS score ≥ 6. Patients will be randomly allocated to any combination of oral, rectal, or intravenous metoclopramide (10 mg thrice daily); intravenous ceftriaxone (2000 mg once daily); oral, rectal, or intravenous paracetamol (1000 mg four times daily); or usual care, started within 24 h after symptom onset and continued for four days or until complete recovery or discharge from hospital, if earlier. Outcome: The primary outcome measure is the score on the modified Rankin Scale at 90 days (± 14 days), as analysed with multiple regression. Summary: This trial will provide evidence for a simple, safe and generally available treatment strategy that may reduce the burden of death or disability in patients with stroke at very low costs. Planning: First patient included in May 2016; final follow-up of the last patient by April 2020. Registration: ISRCTN, ISRCTN82217627, https://doi.org/10.1186/ISRCTN82217627
Relapse Rate and Duration of Therapeutic Effect of Oral Psoralen plus Ultraviolet a (PUVA) in the Treatment of Plaque-type Psoriasis: Original Data Utilizing Standardized Measures of Effect Duration
Authors: Hong Judith , Priya Sivanesan S. , Chavez-Frazier Arianne , Bandow Grace D. , Malick Farah , Kricorian Greg , Letsinger Julie 
Published: April 2018

Background Treatments with long duration of therapeutic effects are ideal for the long-term treatment of psoriasis. This study evaluates psoralen plus ultraviolet light A (PUVA) therapy using standardized definitions of relapse and durability of therapeutic effect. Objectives The purpose of this study was to evaluate the relapse rate and duration of therapeutic effect for PUVA patients who achieved at least 75% reduction in the Psoriasis Area and Severity Index (PASI 75) score after 12 weeks of treatment. Methods This study involved 40 patients with psoriasis; 30 received PUVA and 10 received UVA with placebo for 12 weeks during the double-blind treatment phase. During the post-treatment follow-up, patients who achieved PASI 75 after 12 weeks of PUVA were followed for 48 weeks without treatment to evaluate for relapse (time when subjects return to ≤50% reduction in baseline PASI) and durability of therapeutic effect (time from stopping treatment until 50% of improvement in PASI from the treatment is lost). Results Using per-protocol analysis, 18 out of the 21 patients (86%) who completed the double-blind treatment phase achieved PASI 75 after 12 weeks of PUVA. None of the placebo-treated patients achieved PASI 75. Of the patients who reached PASI 75 after 12 weeks, 89% (16/18) did not relapse after 12 weeks, 69% (11/16) did not relapse after 24 weeks, and 36% (5/14) did not relapse after 48 weeks follow-up. Of the patients who relapsed during the 48-week follow-up, the median time to relapse was 32 weeks. The durability of therapeutic effect was at least 12 weeks, 24 weeks, and 48 weeks respectively in 100% (18/18), 75% (12/16) and 42% (6/14) of the patients. Limitations The study was relatively small with only 14 patients completing the total follow-up period and per-protocol analysis was used. In addition, the patients were generally younger and less severe than those evaluated in biologic studies. There was no direct head-to-head comparison with other treatment modalities to evaluate relative relapse rates. Conclusions The study results support previous reports in the literature and the general clinical impression that PUVA provides prolonged duration of response in patients with plaque-type psoriasis.
Poor Patient Satisfaction and Medication Adherence among Patients with Psoriasis: Results from a Large National Survey
Authors: Wu Ying , Mills Douglas , Barrett James , Bala Mohan 
Published: April 2018

Psoriasis is a chronic immune-mediated disease that is difficult to treat. Psoriasis treatment adherence and patients' satisfaction with their psoriasis treatment are important components to positive clinical outcomes. Data collected during the July 2005 U.S. National Health and Wellness Survey were analyzed. As part of this survey, patients with psoriasis self-assessed their adherence to and satisfaction with their psoriasis therapy. The Morisky-Green Test (MGT) was used to assess medication adherence, and a 5-point scale ranging from 1(not at all satisfied) to 5 (extremely satisfied), was used to assess psoriasis therapy satisfaction. Of 41,184 respondents included in the survey, 1,240 reported a diagnosis of psoriasis. Overall, patients were not satisfied with their treatment and their adherence was less than optimal. In this study, patients receiving biologics appeared to be the most satisfied and adherent. More than half of the patients were satisfied with biologics (72.1%), phototherapy (60.7%) and corticosteroid topical agents (50.4%), but levels of satisfaction were lower with noncorticosteroid topical therapies (42.6), oral immunosuppressants (41.2), vitamin-derived topical agents (37.2), other prescription treatments (37.0) and tars (32.6). Further research should focus more on patient education and improving physician-patient interactions to improve patient adherence to achieve optimal therapy outcome.
Treatment Satisfaction and Health-related Quality of Life among Individuals with Psoriasis: National Psoriasis Foundation Survey Findings
Authors: Horn Elizabeth J. , Fox Kathleen M. , Patel Vaishali , Kimball Alexa B. , Gordon Kenneth B. , Lebwohl Mark G. 
Published: April 2018

Objective To evaluate health-related quality of life (HRQoL) and treatment satisfaction among individuals with psoriasis. Methods Survey data from the National Psoriasis Foundation (2003–2006) were evaluated for >3,000 adult respondents. Psoriasis Quality of Life questionnaire (PQOL-12, lower scores = better HRQoL) assessed HRQoL. Respondents indicated satisfaction with psoriasis treatment on a scale of 1 (very unsatisfied) to 10 (very satisfied). Mean scores were compared by psoriasis severity using ANOVA. Multivariate linear regression evaluated the association of PQOL-12 scores and treatment satisfaction with demographic, clinical and treatment factors. Results Respondents with severe psoriasis had significantly higher PQOL-12 scores (mean= 7.0) than respondents with moderate (5.7) and mild (4.0) psoriasis, p<0.05. PQOL-12 scores were significantly associated with age, age at diagnosis, gender and psoriasis severity. Respondents with severe or moderate psoriasis reported lower (4.6 and 4.8, respectively) treatment satisfaction than respondents with mild psoriasis (6.1), p<0.0001. Psoriasis severity, psoriatic arthritis, therapy type, dermatologist and number of doctors seen were significantly associated with treatment satisfaction. Conclusion HRQoL and treatment satisfaction were significantly lower among respondents with severe and moderate psoriasis.
Mechanism behind Pruritus in Psoriasis
Authors: Hayashi Genki , Pang Mei-Lin 
Published: April 2018

Background A majority of psoriatic patients suffer from pruritus, but little is known about its mediator. Pruritus of psoriasis was thought to have been predominantly mediated by histamine, but the recent data suggest non-histamine mediators play the major role. Objective This paper reviews current published research on the mediators of pruritus in psoriatic patients. Methods English articles between 1980 and 2008, using the key words pruritus, psoriasis, itching, mechanism, and mediators, searched on MEDLINE and PubMed, were reviewed. Results Histamines appear to play little role in mediating pruritus in psoriatic patients, while other factors such as substance P (SP), nerve growth factor (NGF) and calcitonin gene-related peptide (CGRP) were shown to be more convincingly associated in mediating psoriatic pruritus. Conclusion The results indicate the possibility that there exist multiple mediators of pruritus with major involvement of the central nervous system (CNS).
Statin Use and Psoriasis Severity
Authors: Perry Adam , Kamalpour Loebat , Veledar Emir , Chen Suephy C. 
Published: April 2018

Background Inflammation plays a key role in psoriasis. Statins reduce inflammatory markers. However, data in the literature are limited regarding the effect of statins in psoriasis patients. Objective To examine the role of statin therapy in psoriasis. Methods We performed a retrospective chart review of 232 psoriasis patients. Psoriasis severity was measured by the percentage of body surface area covered by psoriatic lesions. It was recorded at two time points: (1) the last visit during which a new psoriasis medication was started and (2) the patient's most recent clinic visit. Subjects were divided according to statin use status. Results Although the statin users had a greater reduction in psoriasis severity, the difference did not reach statistical significance. Conclusions Our data suggest that future work regarding the impact of statin use on psoriasis severity is warranted.
A Review of the Efficacy and Safety of Combined Methotrexate and Ultraviolet B Phototherapy versus Ultraviolet B Phototherapy Alone in the Treatment of Psoriasis
Authors: Mudigonda Tejaswi , Levender Michelle M. , Feldman Steven R. 
Published: April 2018

Background Methotrexate (MTX) and ultraviolet light B (UVB) phototherapy are effective as single agents for psoriasis. By combining the two agents, it is proposed that the use of UVB-MTX can yield greater therapeutic efficacy than using MTX or UVB alone and limit the cumulative exposure of both UVB and MTX to the patient. Objective To review evidence on the clinical efficacy and safety of using combined UVB-MTX compared with using UVB alone. Methods We performed a PubMed search for studies involving the combination of UV therapy with MTX. The reported studies evaluate the clinical efficacy and safety of UVB-MTX therapy compared with UVB alone. Results Based on the studies we reviewed, combined UVB-MTX therapy is more effective than UVB alone in treating psoriasis. The mean cumulative MTX doses ranged from 112 to 196 mg, and no cases of MTX-related liver toxicity symptoms were reported in the three studies. Discussion Combination phototherapy involving UVB-MTX is more clinically effective than UVB alone for patients with plaque-type psoriasis. The current review is limited by the absence of studies comparing the efficacy of combined UVB-MTX therapy with MTX monotherapy. Combination UVB-MTX therapy appears to be safe and well tolerated.