bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dynamic Changes of CHA2DS2-VASc Score and the Risk of Ischaemic Stroke in Asian Patients with Atrial Fibrillation: A Nationwide Cohort Study
Authors: Yoon Minjae , Yang Pil-Sung , Jang Eunsun , Yu Hee , Kim Tae-Hoon , Uhm Jae-Sun , Kim Jong-Youn , Pak Hui-Nam , Lee Moon-Hyoung , Lip Gregory , Joung Boyoung 
Published: May 2018

Background Stroke risk in atrial fibrillation (AF) is often assessed at initial presentation, and risk stratification performed as a ‘one off’. In validation studies of risk prediction, baseline values are often used to ‘predict’ events that occur many years later. Many clinical variables have ‘dynamic’ changes over time, as the patient is followed up. These dynamic changes in risk factors may increase the CHA2DS2-VASc score, stroke risk category and absolute ischaemic stroke rate.
Objective This article evaluates the ‘dynamic’ changes of CHA2DS2-VASc variables and its effect on prediction of stroke risk.
Patients and Methods From the Korea National Health Insurance Service database, a total of 167,262 oral anticoagulant-naive non-valvular AF patients aged ≥ 18 years old were enrolled between January 1, 2002, and December 31, 2005. These patients were followed up until December 31, 2015.
Results At baseline, the proportions of subjects categorized as ‘low’, ‘intermediate’ or ‘high risk’ by CHA2DS2-VASc score were 15.4, 10.6 and 74.0%, respectively. Mean CHA2DS2-VASc score increased annually by 0.14, particularly due to age and hypertension. During follow-up of 10 years, 46.6% of ‘low-risk’ patients and 72.0% of ‘intermediate risk’ patients were re-classified to higher stroke risk categories. Among the original ‘low-risk’ patients, annual ischaemic stroke rates were significantly higher in the re-classified ‘intermediate’ (1.17 per 100 person-years, p < 0.001) or re-classified ‘high-risk’ groups (1.44 per 100 person-years, p = 0.048) than consistently ‘low-risk’ group (0.29 per 100 person-years). The most recent CHA2DS2-VASc score and the score change with the longest follow-up had the best prediction for ischaemic stroke.
Conclusion In AF patients, stroke risk as assessed by the CHA2DS2-VASc score is dynamic and changes over time. Rates of ischaemic stroke increased when patients accumulated risk factors, and were re-classified into higher CHA2DS2-VASc score categories. Stroke risk assessment is needed at every patient contact, as accumulation of risk factors with increasing CHA2DS2-VASc score translates to greater stroke risks over time.
Das Lambert-Eaton-Myasthenie-Syndrom: ein Überblick
Authors: Kohler Siegfried , Meisel Andreas 
Published: May 2018

ZusammenfassungDas Lambert-Eaton-Myasthenie-Syndrom (LEMS) hat eine Prävalenz von etwa 5/1 000 000 und ist damit im Vergleich zur Myasthenia gravis (MG) ca. 10 – 20-mal seltener. Obwohl LEMS viele Ähnlichkeiten zur Myasthenia gravis aufweist, gibt es wichtige Unterschiede. Klinisch besteht eine vorwiegend proximal betonte belastungsabhängige Muskelschwäche, die bis hin zu einer respiratorischen Insuffizienz führen kann und häufig mit autonomen Störungen assoziiert ist. Ursächlich dafür sind Auto-Antikörper, welche gegen spannungsabhängige Kalziumkanäle (VGCC) vom P/Q-Typ an der Präsynapse gerichtet sind. Die Diagnosesicherung beruht vor allem auf der Detektion des pathologischen anti-VGCC Antikörpers sowie dem spezifischen Nachweis eines Inkrements von mindestens 60 % in der elektrophysiologischen Untersuchung eines betroffenen Muskels. Ein Inkrement ist dabei durch eine Steigerung des in Ruhe reduzierten Muskelsummenaktionspotenzials entweder nach maximaler Willkürinnervation oder hochfrequenter (≥ 20 Hz) Stimulation definiert. In einem Drittel der Patienten ist das LEMS paraneoplastischer Ätiologie, eine umfassende Tumorsuche nach Diagnosestellung ist daher notwendig. Klinisch gibt es einige Unterschiede zwischen dem paraneoplastischen (pLEMS) und dem rein autoimmunen (aiLEMS) Lambert-Eaton-Syndrom, die Hinweise geben können für die Ätiologie. Einen Anhalt dafür liefert der DELTA-P-Score und der SOX1-Antikörperstatus. Die häufigste zugrunde liegende Tumorerkrankung ist das kleinzellige Lungenkarzinom. Die Therapie basiert zunächst auf der Unterscheidung zwischen paraneoplastischer und autoimmuner Genese. pLEMS erfordert die Therapie der Tumorerkrankung. In der Regel profitieren aiLEMS- wie pLEMS-Patienten von einer symptomatischen Therapie mittels 3,4-Diaminopyridin (3,4-DAP), ggf. ergänzend Pyridostigmin sowie einer immunsuppressiven Langzeit-Therapie. Krisenhafte Verschlechterungen werden analog zur Myasthenia gravis mit Immunglobulinen, Plasmapherese oder Immunadsorption behandelt. Basierend auf positiven Erfahrungsberichten können auch moderne immunmodulatorische Ansätze, z. B. mit therapeutischen Antikörpern wie dem anti-CD20-Antikörper Rituximab, bei therapierefraktären Verläufen sinnvoll sein. Die Langzeitprognose des autoimmunen LEMS für eine klinische Stabilisierung mit weitgehender (pharmakologischer) Remission ist unserer Erfahrung nach gut, allerdings bestehen bei etwa 75 % deutliche Einschränkungen der Lebensqualität. Die Prognose der tumorassoziierten Form wird zu einem großen Teil von der Tumorerkrankung selbst und deren Therapie bestimmt. Kurative Verläufe der Tumorerkrankung und weitgehende Remission des pLEMS sind nicht selten.
Wie bewerten Nierenlebendspender die Spende und deren Folgen? Eine Befragung von 144 Betroffenen
Authors: Schieber Katharina , Gaag Sonja , Heller Katharina , Erim Yesim 
Published: May 2018

ZusammenfassungAufgrund des weltweiten Organmangels und der steigenden Anzahl an Patienten, die ein Organ benötigen, rückt die Lebendorganspende immer mehr in den Vordergrund. Um den Prozess der Lebendorganspende zu verbessern, wurde am Universitätsklinikum Erlangen eine Befragung zur Evaluation der Nierenlebendspende initiiert. Dabei sollten Erfahrungen und berichtete Folgen von Seiten der Lebendspender erfasst werden. Zwischen 2003–2014 wurden N=199 Lebendnierenspenden am Universitätsklinikum Erlangen durchgeführt. Von diesen willigten n=144 Lebendnierenspender (65,3% weiblich, Altersdurchschnitt 58,7 Jahre) ein, an der Studie teilzunehmen. Im Allgemeinen zeigte sich die große Mehrheit der Befragten mit der Lebendspende zufrieden. Nahezu alle Lebendnierenspender (98%) würden die Spende erneut durchführen, wenn sie könnten. Eine Belastung des körperlichen oder psychischen Befindens durch die Lebendspende wurde vom Großteil der Lebendspender verneint. Dennoch berichtete etwa ein Viertel der Befragten körperliche Einschränkungen, die nicht nur kurzfristige Operationsfolgen, wie Wundheilung oder Schmerzen beinhalten, sondern auch langfristige Beschwerden wie Bluthochdruck. Zudem wurden einzelne Problembereiche deutlich, wie z. B. mangelnde psychologische Versorgung oder ärztliche Nachsorge, die auf eine nötige Weiterentwicklung der Versorgungsstruktur hinweisen.
Fracture Toughness (KIC) of Lithography Based Manufactured Alumina Ceramic
Authors: Nindhia T. G. T. , Schlacher J. , Lube T. 
Published: May 2018

Abstract
Precision shaped ceramic components can be obtained by an emerging technique called Lithography based Ceramic Manufacturing (LCM). A green part is made from a slurry consisting of a ceramic powder in a photocurable binder with addition of dispersant and plasticizer. Components are built in a layer–by-layer way by exposing the desired cross- sections to light. The parts are subsequently sintered to their final density. It is a challenge to produce ceramic component with this method that yield the same mechanical properties in all direction. The fracture toughness (KIc) of of LCM-alumina (prepared at LITHOZ GmbH, Austria) was tested by using the Single-Edge-V-Notched Beam (SEVNB) method. Notches are made into prismatic bend-bars in all three direction X, Y and Z to recognize the value of fracture toughness of the material in all three directions. The microstructure was revealed with optical microscopy as well as Scanning Electron Microscopy (SEM). The results indicate that the fracture toughness in Y-direction has the highest value (3.10 MPam1/2) that is followed by the one in X-direction which is just a bit lower (2.90 MPam1/2). The Z-direction is found to have a similar fracture toughness (2.95 MPam1/2). This is supported by a homogeneous microstructure showing no hint of the layers used during production.
ProteomeVis: a web app for exploration of protein properties from structure to sequence evolution across organisms’ proteomes
Authors: Razban Rostam M , Gilson Amy I , Durfee Niamh , Strobelt Hendrik , Dinkla Kasper , Choi Jeong-Mo , Pfister Hanspeter , Shakhnovich Eugene I 
Published: May 2018

AbstractMotivationProtein evolution spans time scales and its effects span the length of an organism. A web app named ProteomeVis is developed to provide a comprehensive view of protein evolution in the Saccharomyces cerevisiae and Escherichia coli proteomes. ProteomeVis interactively creates protein chain graphs, where edges between nodes represent structure and sequence similarities within user-defined ranges, to study the long time scale effects of protein structure evolution. The short time scale effects of protein sequence evolution are studied by sequence evolutionary rate (ER) correlation analyses with protein properties that span from the molecular to the organismal level.ResultsWe demonstrate the utility and versatility of ProteomeVis by investigating the distribution of edges per node in organismal protein chain universe graphs (oPCUGs) and putative ER determinants. S.cerevisiae and E.coli oPCUGs are scale-free with scaling constants of 1.79 and 1.56, respectively. Both scaling constants can be explained by a previously reported theoretical model describing protein structure evolution. Protein abundance most strongly correlates with ER among properties in ProteomeVis, with Spearman correlations of –0.49 (P-value &lt; 10−10) and –0.46 (P-value &lt; 10−10) for S.cerevisiae and E.coli, respectively. This result is consistent with previous reports that found protein expression to be the most important ER determinant.Availability and implementationProteomeVis is freely accessible at http://proteomevis.chem.harvard.edu.Supplementary informationSupplementary data are available at Bioinformatics online.
Persistent Plasmodium falciparum Infection in Women With an Intent to Become Pregnant as a Risk Factor for Pregnancy-associated Malaria
Authors: Tuikue Ndam Nicaise , Tornyigah Bernard , Dossou Akpéyédjé Yannelle , Escriou Guillaume , Nielsen Morten A , Salanti Ali , Issifou Saadou , Massougbodji Achille , Chippaux Jean-Philippe , Deloron Philippe 
Published: May 2018

Abstract

Background
Pregnant women are more susceptible to Plasmodium falciparum than before pregnancy, and infection has consequences for both mother and offspring. The World Health Organization recommends that pregnant woman in areas of transmission receive intermittent preventive treatment (IPTp) starting in the second trimester. Consequently, women are not protected during the first trimester, although P. falciparum infections are both frequent and harmful.

Methods
A cohort of nulligravid women was followed up during subsequent pregnancy. Malaria was diagnosed by means of microscopy and polymerase chain reaction. Parasites were genotyped at polymorphic loci.

Results
Among 275 nulligravidae enrolled, 68 women became pregnant and were followed up during pregnancy. Before pregnancy, P. falciparum prevalence rates were 15% by microscopy and 66% by polymerase chain reaction. Microscopic infection rates increased to 29% until IPTp administration, and their density increased by 20-fold. Conversely, submicroscopic infection rates decreased. After IPTp administration, all types of infections decreased, but they increased again late in pregnancy. The risk of infection during pregnancy was higher in women with a microscopic (odds ratio, 6.5; P = .047) or submicroscopic (3.06; P = .05) infection before pregnancy and was not related to the season of occurrence. Most infections during pregnancy were persistent infections acquired before pregnancy.

Conclusions
Microscopic and submicroscopic malaria infections were frequent in nulligravid women from south Benin. During the first trimester of pregnancy, microscopic infections were more frequent, with a higher parasite density, and mainly derived from parasites infecting the woman before conception. Preventive strategies targeting nonpregnant women with a desire for conception need to be designed.
Effects of sucroferric oxyhydroxide and sevelamer carbonate on chronic kidney disease–mineral bone disorder parameters in dialysis patients
Authors: Ketteler Markus , Sprague Stuart M , Covic Adrian C , Rastogi Anjay , Spinowitz Bruce , Rakov Viatcheslav , Walpen Sebastian , Floege Jürgen 
Published: May 2018

Abstract

Background
Treatment of hyperphosphataemia is the primary goal of chronic kidney disease–mineral and bone disorder (CKD-MBD) management. This post hoc analysis of a randomized, Phase 3 study evaluated the effects of 1-year treatment with the phosphate binders sucroferric oxyhydroxide or sevelamer carbonate (‘sevelamer’) on CKD-MBD indices among dialysis patients with hyperphosphataemia.

Methods
After a 2- to 4-week washout from previous phosphate binders, 1059 patients were randomized 2:1 to sucroferric oxyhydroxide 1.0–3.0 g/day (n = 710) or sevelamer 2.4–14.4 g/day (n = 349) for up to 24 weeks. Eligible patients enrolled in a 28-week extension. This post hoc analysis was performed for patients who completed ≥1 year of continuous treatment (n = 549). As the treatment groups showed similar CKD-MBD outcomes, the data were pooled for this analysis.

Results
Phosphate-binder therapy was associated with significant and sustained 30% reductions in serum phosphorus (P < 0.001). Median intact fibroblast growth factor-23 (FGF-23) also significantly decreased (P < 0.001) by 64% over 1 year. Intact parathyroid hormone decreased significantly after 24 weeks (P < 0.001), but levels returned to near baseline values by Week 52; minimal changes in serum calcium were observed. Of the bone resorption markers evaluated, tartrate-resistant acid phosphatase 5b (TRAP5b) decreased significantly (P < 0.001), whereas CTx increased transiently but returned to baseline levels by Week 52. The bone formation markers bone-specific alkaline phosphatase and osteocalcin both increased over 1 year of treatment.

Conclusions
Overall, 1 year of sucroferric oxyhydroxide or sevelamer treatment significantly reduced serum FGF-23, which has been associated with clinical benefit in patients with CKD. The trend towards increased bone formation marker levels indicates a beneficial effect on bone metabolism.
Transportation of cull sows-a descriptive study of the clinical condition of cull sows before transportation to slaughter
Authors: Fogsgaard Katrine K , Herskin Mette S , Thodberg Karen 
Published: May 2018

AbstractEach year 500.000 sows, equal to 50% of Danish sows, are culled and transported to slaughter. However, the clinical condition, behavior, and welfare of cull sows have received almost no scientific attention. The aim of the current observational study was to describe the clinical condition of cull sows on the day of transportation to slaughter, including examination of possible differences between lactating and nonlactating sows. On the day of transportation, the participating farms were visited by trained technicians who conducted a thorough clinical examination of all sows selected by the farmer for slaughter. Four sows could not be transported because they were unfit according to the European Council Regulation regarding fitness for transportation, and they were not included in the present data. A total of 522 sows, with a median parity of 5 (range: 1–11), from 12 Danish farms were included in the study. Approximately, 10% showed signs of changed gait, and 0.8% were obvious lame. Wounds were observed in 54.6% of the sows, and 11% had decubital shoulder ulcers. Almost 40% of the cull sows were lactating. At culling, the lactating sows were of higher parity than the nonlactating sows, and lactating sows were at higher risk of having deviations from normal on clinical variables related to examination of the udder, such as udder swellings and inflammations. Nonlactating sows had 3.5 times more superficial skin lesions than lactating sows. Our findings warrant for further studies exploring different aspects of the life of cull sows in what is here defined as the The Cull Period, which is the interval from the culling decision is made until the sows are slaughtered
Characteristics and Prognostic Factors of Bone Metastasis in Patients With Colorectal Cancer
Authors: Kawamura Hidetaka , Yamaguchi Tatsuro , Yano Yuuta , Hozumi Takahiro , Takaki Yasunobu , Matsumoto Hiroshi , Nakano Daisuke , Takahashi Keiichi 
Published: May 2018

BACKGROUND:
Because bone metastasis from colorectal cancer is rare, there are little available data regarding such cases.

OBJECTIVE:
The study aim was to identify the prognostic factors and characteristics associated with survival in colorectal cancer patients with bone metastasis.

DESIGN:
This was a retrospective study from a prospectively collected database.

SETTINGS:
The study took place in a multidisciplinary, high-volume tertiary cancer center in Japan.

PATIENTS:
Examined were records from 104 consecutive patients treated between 2004 and 2015 for bone metastasis from colorectal cancer.

MAIN OUTCOME MEASURES:
The primary outcome measure was overall survival.

RESULTS:
The spine was the most common site of bone metastasis from colorectal cancer. Right colon cancer correlated significantly with long bone metastasis (p = 0.046), whereas left colon cancer correlated significantly with spinal bone metastasis (p = 0.034). Liver metastasis was also significantly correlated with spinal bone metastasis (p = 0.036). The median interval between the primary therapy for colorectal cancer and the metachronous diagnosis of bone metastasis was 20.0 months (quartile 1 to quartile 3, 9.0–46.5 mo). The median survival time from diagnosis of bone metastasis from colorectal cancer was 5.0 months (95% CI, 4.0–9.0 mo), and the 1-year survival rate was 30.0% (95% CI, 21.1%–39.4%). Multivariate analysis revealed that ≥2 extra-bone metastatic organs, hypercalcemia, and pathologic fractures were independent poor prognostic factors (p < 0.001, 0.001, and 0.033). The number of extra-bone metastatic organs correlated with prognosis.

LIMITATIONS:
This study was limited by its retrospective, nonrandomized design, as well as selection bias and performance at a single institute.

CONCLUSIONS:
The location of colorectal cancer correlates significantly with the site of bone metastasis; the prognosis of patients with bone metastasis from colorectal cancer is very poor, and the significant prognostic factors are number of extra-bone metastatic organs, hypercalcemia, and pathologic fractures. See Video Abstract at http://links.lww.com/DCR/A589.
An Optimal Orthotopic Mouse Model for Human Colorectal Cancer Primary Tumor Growth and Spontaneous Metastasis
Authors: Hite Nathan , Klinger Aaron , Hellmers Linh , Maresh Grace A. , Miller Peter E. , Zhang Xin , Li Li , Margolin David A. 
Published: May 2018

BACKGROUND:
Colorectal cancer is a leading cause of cancer-related death. Small animal models allow for the study of different metastatic patterns, but an optimal model for metastatic colorectal cancer has not been established.

OBJECTIVE:
The purpose of this study was to determine which orthotopic model most accurately emulates the patterns of primary tumor growth and spontaneous liver and lung metastases seen in patients with colorectal cancer.

DESIGN:
Using luciferase-tagged HT-29 cells coinoculated with lymph node stromal analog HK cells, 3 tumor cell delivery models were compared: intrarectal injection, intracecal injection, and acid enema followed by cancer cell instillation. Tumor growth was monitored weekly by bioluminescent imaging, and mice were sacrificed based on primary tumor size or signs of systemic decline. Liver and lungs were evaluated for metastases via bioluminescent imaging and histology.

SETTINGS:
The study was conducted at a single university center.

MAIN OUTCOME MEASURES:
Primary tumor and metastasis bioluminescent imaging were measured.

RESULTS:
Intrarectal injection had the lowest mortality at 4.0% (1/25) compared with the intracecal group at 17.4% (4/23) and the acid enema followed by cancer cell instillation group at 15.0% (3/20).The primary tumors in intrarectal mice had the highest average bioluminescence (3.78 × 1010 ± 4.94 × 1010 photons) compared with the mice in the intracecal (9.52 × 109 ± 1.92 × 1010 photons; p = 0.012) and acid enema followed by cancer cell instillation groups (6.23 × 108 ± 1.23 × 109 photons; p = 0.0016). A total of 100% of intrarectal and intracecal mice but only 35% of mice in the acid enema followed by cancer cell instillation group had positive bioluminescent imaging before necropsy. Sixty percent of intrarectal mice had liver metastases, and 56% had lung metastases. In the intracecal group, 39% of mice had liver metastases, and 35% had lung metastases. Only 2 acid enema followed by cancer cell instillation mice developed metastases.

LIMITATIONS:
Tumor injections were performed by multiple investigators. Distant metastases were confirmed, but local lymph node status was not evaluated.

CONCLUSIONS:
Intrarectal injection is the safest, most reproducible, and successful orthotopic mouse model for human colorectal cancer primary tumor growth and spontaneous metastasis.
Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges (SIRPIDs)
Authors: Johnson Emily L. , Kaplan Peter W. , Ritzl Eva K. 
Published: May 2018

Summary:
Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) are a relatively common phenomenon found on prolonged electroencephalogram (EEG) monitoring that captures state changes and stimulation of critically ill patients. Common causes include hypoxic injury, traumatic brain injury, and hemorrhage, as well as toxic-metabolic disturbances. Some studies have shown an association between SIRPIDs and the presence of spontaneous electrographic seizures. Although the degree to which SIRPIDs should be treated with antiepileptic medications is unknown, the rare cases of functional imaging obtained in patients with SIRPIDs have not shown an increase in cerebral blood flow to suggest an active ictal process. Stimulus-induced rhythmic, periodic, or ictal discharges may reflect dysregulation of thalamo-cortical projections into abnormal or hyperexcitable cortex.
Lateralized Periodic Discharges: A Literature Review
Authors: Lin Lu , Drislane Frank W. 
Published: May 2018

Summary:The purpose of this article is to provide a comprehensive review of the literature about a particular EEG pattern, lateralized periodic discharges (LPDs), or periodic lateralized epileptiform discharges (PLEDs). The review will discuss the history and terminology of LPDs and provide a detailed summary of the etiologies, pathophysiology, clinical symptoms, and imaging studies related to LPDs. Current controversies about the association of LPDs with seizures and their management will be reviewed. Finally, some unanswered questions and suggestions for future research on LPDs will be discussed.